-----Flatliners Club-----


#1069

I seem to recall that @jen, @mayak, and I are all in the Pacific Northwest-ish area and we all have been having a “heat wave” + smoke from wildfires - That must be it - smoke from wildfires must improve control - if only I could bottle it and sell it :).

I use the AGP in Nightscout and in xDrip+. Clarity was not available in the Canadian market until recently so I have never used it. The Clarity AGP is a lot prettier than the Nighscout one so I have to see if I can upload from xdrip to Clarity now and get a better view.

Thanks for the link on the AGP - it is a good read.

@Terry4’s AGP makes me think that looping overnight really helps. I seem to have less BG varibaility during the day once I am awake and can pay attention to my BG. Terry - I also have a dinner time challenge.


#1070

I’m pretty sure @Terry4 is in the Pacific Northwest as well, so he’s likely also being affected by the smoke. Here’s hoping it (and the horrible fires!) go away soon—even if it is a magic ingredient to good diabetes control!


#1071

About a week or more ago, I definitely noticed a haze over Portland and thought it looked like smoke but it didn’t smell like smoke. Then I saw a news piece online about all the wildfires fires in British Columbia. It semi-cleared for a few days and now is hazy again.

@AE13 - your observation about the Loop’s overnight performance is right. I often wake up under 100 (5.6) and standard deviation overnight around 10. I’ve had periods not-too-long ago of better post-meal numbers and I’m just trying to restore that.


#1072

Your AGP, @MayaK, will be a skinny set of five lines crossing from left to right without mountains or even foothills! I thought my upper target range limit of 120 (6.7) was low until I saw your upper limit of 110 (6.1)!


#1073

@Terry4 7 @AE13 - Excellent performance!! (and to the others, too…) Wish I could try the Loop some day… I’m sure it would help with those annoying morning surges I’ve been having, as well as the

My numbers over the last two weeks are good, but the occasional after dinner spikes have been a bit frustrating: Last two week’s average (as of Monday) was 110, with SD up to 25. I usually have my targets set to 70 and 125, but for this picture, I set it to 65/130 – Time in range: 85.2% :

No 100% in-range day this period, but did have a 99$ day (I think the CGM gave me a false low, but not sure):

Average that day was 101, SD 13 – I really want to get that average back below 100 or even below 90. Need to figure that one out, I suppose…


#1074

I just got my A1c back (of course it was the last test result to come in, so kept me in suspense!) and it was 6.0 with a lab range of 4.5-6.0 (my last A1c was 6.8). I am pretty happy with that! This is the second time in my life I’ve brushed the upper end of the non-diabetic range, so technically this is my best-ever A1c, even though I did achieve it once before (summer of 2015). Assuming no other health issues crop up this time around, I’m aiming to break into the 5s next, just to see if I can do it. :slight_smile:


#1075

My 2 week chart. Not flat, but pretty good. I need to work on my 10:00-2:00 numbers, but hard with working and not wanting to struggle with lows at work.


#1076

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 :slight_smile: ). 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:

  1. I used a CGM (Dexcom)
  2. Split the Levemir into morning/evening doses (My doctor had not suggested that).
  3. Using the CGM - I safely increased my Humalog pre-bolus time to reduce after-meal spikes
  4. I started to reduce consumption of foods that caused huge spikes and replaced with equally good food (or even better food :slight_smile:) .
  5. Began to cut back on carbs eaten at one sitting a little bit.
  6. 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:

  1. Got a pump (Omnipod) to get a controllable basal rate
  2. 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).
  3. 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)
  4. 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).

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#1077

Awesome work @Jen - I love it when the result turns off the “alarm” colour on the lab results page and says that you are in range. Good luck on getting to the 5’s next time.


#1078

Congrats on a great A1c! Your spirit and tenacity carried the day. :+1::+1:


#1079

I read your comment with interest and joy. Your progression from OK control to excellent control really shows in the graphs. I went through a similar experience back in 2012 when I started trying some ideas posted on TuD, including some on this thread.

I know some people criticize the idea of striving for a “flatline.” I’ve even heard the criticism that the only people with BG flatlines are dead! I fully understand that the flatlines we strive for are not really natural, even in the non-D world. And none of us can consistently do this day after day. Some people get better results than others but I think we’ve been fairly successful in keeping normal human competitiveness out of the discussion.

I sympathize with the occasional visitor who see some of our better work and are demoralized. We’ve all posted some of our worse days in an attempt to show that we all struggle and we are after all, simply human.

Having said that, I do think we need a place to celebrate once in a while. Diabetes is hard. We do need to connect when D beats us up and leaves us metabolically miserable and feeling defeated. But we also enjoy sharing when we kick @ss and take names with the sinister D!

I think the longevity of this thread is testament to the value it can bestow. Congrats on such an inspiring transformation, @AE13. Your comment is sure to help others who read it. Like you, when I saw incredible CGM traces some people were able to post here, just knowing it was humanly possible created credibility and real hope. If someone else with diabetes can do this then I probably can, too!


#1080

Way to roll, @Thas! Your lines have always impressed me. I also like to get my averages < 100 (5.6). I’ve been doing this long enough to realize that my control ebbs and flows, another rise and fall in my array of data. The goals are important to me; they keep me always reaching for better. Not perfect – better!


#1081

This is so important. I used to be someone in exactly that category. I had no idea years ago that I’d be aiming to hit an A1c in the 5% range or participating in this thread. Like you, I’ve followed this thread and others on TuD and gradually incorporated the strategies mentioned into my diabetes management.

I would not say that I have “easy” diabetes at all. Many days are a struggle to stay in range even with all the changes I’ve made. But the way I look at it is that I have a choice of putting in a lot of work up-front in preventing highs and lows, or I put in that same energy later on when having to deal with highs and lows and complications. I choose to put in the work up-front. I’ve found the mort important thing is to make diabetes one of my top priorities. If it’s not one of my top priorities, my control slips, even with all the latest technology. Maintaining control also takes constant work, all day every day.

All in all, I’ve gone from never thinking I’d be one of “those people” with a non-diabetic A1c level to feeling that my current setup and strategies are something I can maintain long-term, even though it does take a lot of daily work.


#1082

I think days like today are the biggest remaining challenge for me. I upped my basal rates by 50% and dropped my ratios by 30% a couple of days ago. Those changes seemed to work, but then last night I started spiking rapidly out of nowhere so gave a huge four-unit bolus before bed. That worked perfectly, but today I woke up to my Dexcom alarming and just have not been able to get into my target range. Site changes, basals increased again, and over 15 units of corrective insulin (which is more than double the amount I usually bolus for carbs in an entire day!), and not eating any carbohydrates hasn’t helped much. I have yet to find anyone in this thread who has such fluctuating insulin needs (I think because I seem to be the only woman, ha), but I am proof that even we can do it!


#1083

Not a bad day - you pretty much kept in under 10.

I can sympathize with the whole “fluctuating insulin needs thing” and hormones - I have a 1 year old with T1 and the whole hormone thing is a real battle. We just went through a brief period of having everything dialed in and now all of a sudden things change. Early morning is the worst - around 1am-3am and he can drop 5-10 mmol/l in an hour or so. He is on shots so not much you can do but even if he was on a pump it would be hard as it is not predictable. Last night he was 14 mmol/l at 3am and decision was made not to correct - sure enough this morning when he woke he was like 4.9. Had we corrected he would have been low.

You will notice he is not on this thread :slight_smile: (although his parents try hard.)


#1084

SLACKERS! :wink:


#1085

Yeah, I read about kids and hormones, and I feel like that’s what I go through for half of every month. Although I think with kids it’s a lot harder, their blood sugar is more unpredictable and I do things with myself that I would never do with a kid (like setting a +100% basal rate). Is your son eating a low-carb diet like you?

Last night I finally dropped down into range with a 0.1 unit/hour increase in basals and a +100% temp basal, had to eat a glucose tablet or two in order to not drop low. Then overnight dropped down to 2.9 mmol/L, treated with four glucose tablets and put my basal rates back down by 0.1 unit/hour, and woke up this morning at 4.3 mmol/L. Here’s hoping today is smoother!


#1086

Maybe we can have a Humpers Club? (Hmm, on second thought …) Getting a flat line isn’t my goal – I’d only be setting myself up for hourly failure – but turning mountain peaks into gently rolling hills and dales is a realistic goal. And if I do happen to flatline once in a while, well it’s a beautiful thing, and I’d be happy to be called unnatural.


#1087

No - my little guy is not low carb but generally we try to limit high GI foods - in my opinion low carb would be very difficult with a toddler, but I know there are those out there that successfully do that. The problem we have is that the insulin doses are so tiny that you end up having to give enough carbs to cover the insulin. Same thing goes with corrections, when we correct we sometimes have to give a couple of grams of carbs or he will go to low from the correction.

I am on my 5th day of diabetes zen - BG has stayed in the range between 4-8mmol (70-144mg/dl) for the last 5 days. This is a record for me. My BG started to creep up above 6 (108) last night so I corrected and put in a 10% temp basal in for the night. That was my first temp basal in 4 days.

All of a sudden everything has become very easy for me. By easy - I mean predictable not actually easy. Every issue I have is very small and can easily be corrected. I have no idea why things are going so well but will enjoy it while it lasts.

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#1088

Five days is a long run, at least it is for me. When I find myself in that zone I often see it degrade after three days.

I’ve observed a certain stickiness to some of my glucose trends, both good and bad. We’ve all fought with stubbornly high BGs that seem to take more than the usual punch to pull them down. I think you’ve found the flip side to that condition, an in-range BG stubbornly sticking to the status quo.

Enjoy!