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


#1149

I have a sales job, and I usually work 11 to 14 hour days. I don’t have anything considered consistent for a schedule. So I literally cannot prebolus during the weekdays. I have tried and had some big mistakes.

Still, I have never had a previous work this well on the chicken strips before!
I also think I am not dropping off as bad afterwards. And that is all about fiasp being a big improvement. The tail is still there, but it is a lot easier to manage for me, so far.


#1150

I thought I’d share my flatline of today (with NO glucose tablets needed) and a new strategy that I’ve started using that I’ve found surprisingly successful.

(For reference: Type 1 diabetes for 26 years since childhood, using pump and CGM, eating a low-carb diet, using extended-release metformin.)

I have a bunch of Lantus and other insulin sitting in the fridge that I’d like to use up. I tried the “untethered regimen” a year or two ago and didn’t notice much benefit. I’ve decided to try it again, but instead of dosing 50% of my basal as Lantus, I just injected five units of Lantus and adjusted my basal rates slightly. This is so little insulin that I didn’t think it would make much difference (by basal rates equal 25-50 units depending on hormones).

However, over the past few days my blood sugar has been near perfect. With using Fiasp I usually have not been able to disconnect from my pump for even half an hour without seeing a significant rise in my BG. I’ve been having issues with unstable blood sugar recently and I thought that maybe the fact that Fiasp is so fast-acting makes any small variation in insulin delivery, absorption, or interruption have more of an impact.

With this tiny dose of Lantus, it’s had no real impact on my boluses or basal profile, but I’ve been able to disconnect for showers without seeing a rise in BG. This afternoon I commuted home from work, something that I’ve been struggling with for literally years (I go low, but in trying not to go low I always go high). I suspended my pump for an hour and a half (something I can never do without feeling nauseous and developing high ketones and high BG later) and when I got home did a one unit bolus when my BG began to rise. I always have to bolus after suspending my pump, but the difference is that today’s bolus was relatively small AND the rise turned right around and came right back down. This is literally the firs ttime in ages I can think of where I haven’t gone high or low during this commute period. Also, with only five units of Lantus on board I’m still able to suspend my pump for half an hour and see a bit of a bump in my BG, but it’s a mere “bump” as opposed to a big spike (I often use this strategy if drifting slowly towards low). You can see me using this strategy around 11:00 AM where I was headed low and instead of eating glucose tablets I suspended my pump for half an hour.

If this better control isn’t just a fluke, then it seems to me that having a tiny bit of insulin in the bloodstream at all times versus no insulin makes a massive difference to blood sugar stability.


#1151

This is amazing. Who could have anticipated the outsized effect this small Lantus dose brings? I like the untethered regimen I tried just before I hooked up with Loop. Maybe you could label this regimen the “minimal untethered.”

I think it’s good to shake things with diabetes habits from time to time. It would be great if this trend can last. You have learned something important about how your body prefers its basal insulin.


#1152

Ha, I like that!

I like this small dose because it really doens’t seem to impact anything except take the edge off the disconnection spikes and seems to smooth things out overall while still allowing me to fully utilize my pump’s features (including suspend).

Maybe it is all a fluke, but I plan to continue taking Lantus for the foreseeable future to see if this trend continues.


#1153

I doubt that. Perhaps the intensity or steadiness of these initial effects may slack, I think you’re observing an important effect.

Nice line, by the way.


#1154

I’ve read that people who have even small amounts of residual insulin production have an easier time with control (more steady BG, less severe highs and lows, lower A1c, etc.). I’ve never had it tested, but I think I probably don’t produce any measureable insulin. I think maybe what I’m seeing is having some tiny amount of insulin in the bloodstream at all times (with the flexibility the pump provides, as I tried MDI back in January and had terrible control with a fixed basal) versus zero insulin. It would be interesting to test that theory out somehow.


#1155

Yes, and I’m probably an example of this - and I tend to experience that – my pancreas has likely not given up entirely on insulin production - so I avoid really high highs and have been resistant to the cascade that can end in DKA. When tested, however, my endogenous insulin levels are measurable, but very low. Turning off my pump for short times is very effective for correcting mild lows - BUT, I don’t skyrocket (by most folks’ standard) if I have an occlusion or accidentally disconnect overnight. There are obviously still challenges (like WHY have I been having “big” overnight spikes every night lately??), but that small amount of background insulin helps.

I hope your strategy keeps on working for you!


#1156

Another fantastic day of control. At day five of this, I think this is a record for me (usually I can’t go more than two or three days with this control before something goes way off).

I am still putting in all my usual work to keep this line going, but for the first time in maybe forever I feel like the results are reflective of my efforts for more than a day or two. If this continues long-term, I will be ecstatic.

(Now I just literally polished off an entire tub of blueberries…that and cereal being the two high-carb foods I still crave like crazy… We’ll see how my BG responds to that!)


#1157

I think you have cracked your code. Things will still stray and vary from this new central tendancy, but I think mini-dose syringe basal is demonstrating effects in excess of its diminutive dose size. Enjoy!


#1159

So after my first week of doing Lantus, including travel for half this week that really messed up my schedule and blood sugar, my stats are as follows:

Average blood sugar of 6.0 mmol/L (108 mg/dl)
Readings in range of 74% (4-8 mmol/L or 70-140 mg/dl)
Standard deviation of 2.1 mmol/L (38 mg/dl)
Highest reading of 16.3 mmol/L (293 mg/dl)
Lowest reading of 2.7 mmol/L (48 mg/dl)

Not great compared to some here, but pretty good for me especially for an entire week and a week that was half travel and likely has hormones kicking in. These stats were significantly better the first half of the week (average of 5.4 mmol/L or 97 mg/dl; 86% of readings in range; standard deviation of 1.5 mmol/L or 27 mg/dl) but were dragged down significantly by the fact that my BG has been crazy the past three days or so and I’m finding it diffiuclt to get re-balanced.

I’ll keep up the small dose of Lantus and I have no planned travel for the next month, so hopefully my control will return to how good it was at the beginning of the week in the near future.


#1160

Really great numbers! Mine haven’t been that much different, lately :frowning_face: Gotta make some changes…

I hope it keeps working for you!


#1161

Yeah, my bubble burst unfortunately. Crazy high numbers for the past few days, lucky if I get 20% of readings in range type of days. Then last night I rage bolused and dropped to 2.2 mmol/L for an hour and a half. I was so enraged last night. So frustrated that I put so much effort into this and still have diabetes kick my butt so often. It didn’t help that I’ve been working hard to get a good sleep schedule and get enough sleep, to see if that helps with fatigue issues, and diabetes was keeping me up far later than I wanted.

Fitbit has just come out with a cycle tracking feature for women so I’ve started using that (two days ago, ha) and am hoping that maybe that will help me deal with these massive fluctuations. In the meantime, increasing my doses by 25-50% hasn’t helped much, so I’ll bump them up to a 75% increase and see if that helps.


#1162

Jen, don’t lose hope. Diabetes is just plain tough. Your persistence will make a difference in the long run. I’m sure you will be back on top, soon!


#1163

Yeah, I’ll get past it eventually once my hormones shift again in a week or so. And I’m sure it will pay off long-term. It’s just so utterly frustrating at times when I put in SO much effort way above and beyond and still get results where you’d think I’m totally slacking.

There has been some discussion of steroids recently, and I feel like I’m basically dealing with “steroids” about 50% of my diabetes control time, and extreme insulin sensitivity another 25% of my diabetes control time. And very fast (almost instant) transitions between those two periods. So that’s about 25% of the time where my body is not being affected, and that time is BLISS! That is the time I feel like everything is working, I’m in control, I could continue this forever, and is the time I can easily see how people would come to see diabetes control as a game, or a fun fine-tuning and tweaking project, or a challenge to see just how flat they can maintain that line. But I get that glimpse of what I think must be normal for many people who follow as strict a regimen as I do, and yet a majority of the time I’m struggling just to keep 50% of readings in range and avoid serious highs and lows and holding on for dear life as my insulin needs change every week, and I do not feel like I’m winning that challenge.

I’m hoping my tracking will provide some insights and maybe I can come up with some strategies and techniques over time. In the meantime, I’d be happy if I could just get my blood sugar out of the 11 mmol/L (200 mg/dl) range where I’ve been for the better part of a week.


#1164

When I see how much work and thought you put into diabetes, I realize that I play an easier game than you. I know your efforts will accrue many benefits, you just have to stick with it, even though it’s insanely unfair. Be kind to yourself, you are very competent treating your diabetes!