A criticism this thread sometimes gets is that there are too many flat lines and people who post here must have the “easy kind of diabetes”. I think there can also be a frustration from people who cannot achieve this level of control. I wanted to give my perspective to remind people that there is value in this thread for some people.
I found Tudiabetes about a year ago after an eye doctor visit. After 29 years of hearing the eye doctor say “Your eyes are perfect - not a sign of diabetes.” to “hmmm… there is a tiny bleed in a blood vessel in one of your eyes - you need to come in once a year so we can monitor it. You should improve your blood sugar control so it doesn’t progress.” I had not idea how to improve my blood sugar control. My doctor said I was doing well and I pretty well followed the “rules”. I even had gone back to the diabetes clinic about 2 years earlier to try to pick-up some new tricks but there were not a lot of new tricks to pick-up (I did find a few though ). I had never thought to look online for a diabetes community (I have no idea why) and TuD had a lot of good info and people willing to share.
Then found this thread and it inspired me two ways - First it showed me that it was possible for some people to have flat lines. Knowing a flat line was possible was a huge motivation for me to put the effort in to see if I could improve my control. Second many of the people who posted their flat lines also were happy to share what techniques they used to get a flat line. Many of those techniques are pretty obvious when you think about it, but they are not always taught by the medical establishment and I obviously didn’t think them up myself.
After I found this thread, I quickly called the Dexcom rep and ordered a Dexcom G4 one over the phone (no prescription needed for this in Canada). I was surprised to find out after that my health insurance covered the CGM which was great - at that point I was willing to pay out of pocket. At the time I was on MDI with Humalog/Levemir and only took Levemir once a day in the evening. My first week with a CGM in September 2016 looked like this…
Then I started to try some of the techniques other people on this site were using:
- I used a CGM (Dexcom)
- Split the Levemir into morning/evening doses (My doctor had not suggested that).
- Using the CGM - I safely increased my Humalog pre-bolus time to reduce after-meal spikes
- I started to reduce consumption of foods that caused huge spikes and replaced with equally good food (or even better food ) .
- Began to cut back on carbs eaten at one sitting a little bit.
- Made exercise a more regular thing. (I did previously get exercise but I made it more regular).
By December, things looked like this. A huge change you can see is the reduction of the evening highs by splitting the levemir dose into morning/evening. Also time in range is much improved.
I kept this up for another few months and started to think how I could improve this more. I noticed some predictable lows/highs with the levemir that I realized the only way I could fix was three levemir shots a day (not going to happen as I could easily forget a shot) or getting a pump. I didn’t really want a pump,but I thought maybe the effort would pay off.
So over this year I:
- Got a pump (Omnipod) to get a controllable basal rate
- Switched insulin from Humalog to Fiasp (not a huge change, but definitely reduces pre-bolus time which makes bolusing for meals more convenient and also makes corrections faster).
- Because of some late rises from the Fiasp, I started extended bolusing for protein and sometimes fat (I bolus for 50% of the protien grams and 10% of the fat grams and extend the bolus to deliver about 1.5U/hr)
- Lowered by carb consumption a little bit more - (Target no more than about 20 to 30g of fast acting carbs per sitting).
This was my last week -
I think I am now in a reasonable happy place. The improvements I could make would be to go full-Bernstein (low carb and eliminate the so called no-no foods), but I am not sure that I want to do that. Definitely may give it a try.
Also - I would love to give the loop or Open APS a try, but not sure where to start with getting a pump that is capable of looping.
My diabetes Zen is continuing. I am on my 4th day without a CGM alarm (i.e. in range). I could have used the loop last night as my BG crept up just before midnight while I was sleeping and then again around 5am, but otherwise I can’t complain. (Yes I did eat breakfast this morning… it is possible to eat carbs at breakfast and not get a BG rise).