I thought I’d report in on my control, since it continues to be better than I’ve ever had before (thanks to Fiasp, setting my Dexcom alerts tighter than my actual target range, and eating a very low-carb diet).
My average BG is 6.4 mmol/L (116 mg/dl).
My standard deviation is 1.6 mmol/L (28 mg/dl).
I have 83% of readings in range, 14% high (above 8 mmol/L), and 3% low (below 4 mmol/L).
One new strategy I’ve been trying (inspired by those using APS systems that use lots of little basal suspends) is to use a 30 minute 0% basal rate prior to walking anywhere. Usually I have to eat several glucose tablets just to walk to the store or do any sort of commute anywhere. The briefly reduced basal rate works well at preventing that, although frequently I still have to eat a glucose tablet (but better than eating four or six). My pump unfortunately does not allow me to do temporary rates in smaller intervals than 30 minutes, so in future I might try suspending my pump to get more precision (I might try 35 minutes). I have to be careful, because I know already that 45 or 60 minutes without insulin will make my blood sugar skyrocket. I find 30 minutes causes my blood sugar to fairly reliably rise by about 1.5 mmol/L (or stay flat, in the case of exercise that’s simultaneously dropping it by 1.5 mmol/L). I’ve also used the same strategy to give my blood sugar a small 1.5 mmol/L bump if I’m running a bit low (but still within range) before bed or during the night. One thing I really like about Fiasp is that these temporary rates seem to kick in within 45 to 60 minutes, rather than having to wait two hours.
I see my endocrinologist this week and am going to ask him about trying metformin. The most annoying (remaining) part of my diabetes control is that hormones still throw me off as they cause 30-50% jumps or dips in my insulin needs. I saw Dr. Bernstein mention that metformin can help smooth these changes out for some women. I also hope it would help me lose weight, since despite eating low-carb and taking less insulin, my weight is just holding steady. I hope that my endocrinologist is open to the idea. I asked him about metformin once before and he didn’t think it would have much of an impact, so I tried an SGLT-2 inhibitor instead (and had to stop because of side effects).