How do you deal with the basal insulin? If you’re pumping, I understand. If someone is on MDI, does one skip the basal injection for fasting? or it doesn’t matter?
@lh378 – I understand that basal insulin is intended to counteract the liver glucose release only. Basal is for the liver and bolus is for meals. So, when fasting, basal insulin is still needed. In fact, fasting will reveal if your basal program is doing its job. It’s very easy for basal insulin cover some for meals and bolus insulin to cover some basal needs. Troubleshooting and analysis is much easier, however, when there is no basal/bolus overlap.
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I wouldn’t say “fail”, I’d suspect you have some excellent data that might suggest a different approach to whatever happened next time!!
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Probably has something to do with some Dogfish Head.
I always take basal. When I skip a meal, I don’t take fast acting.
No lines here, they’ve been ok lately except a slightly nighmarish 290something CGM on the way to the Grateful Dead, we stopped in at a greasy hot dog joint for Chicago Dawgs, which came with fries so I guessed conservatively carbwise and it kept floating up then a guy I was with ordered the beer. I was thinking “light, or maybe a low carb cocktail…” but got a Lagunitas Ale, or about 1/2 a Big Mac worth of beer and kept going up, it sort of stayed up despite corrections for a while, maybe pregame adrenaline. Then, of course, crashed at showtime. Fortunately, we had club seats with a bar so I could score a quick margarita to balance it out and everything fell into place! LOL.
Anyway, enough of that, I was writing to report a 4.9 A1C! I flattened out my basal to c. .8 with a slight bump in the AM and had time to turn it below where it worked so I’m very confident I need it and it’s worked ok. The late afternoon seems like it might be a shade hot and could stand to be turned down but, other than that, I’m very pleased to be there, no hypo crises or anything! 
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Congrats on breaking into the 4% range! That is truly an exclusive zone for PWDs.
Your more casual way of rolling really works for you. That’s what probably amazes me the most about your style. Good for you!
I’ve found my A1c’s are disconnected from my CGM and fingerstick data. I’ve never been lower than 5.9% yet my meter and CGM shows a 90-100 average. I’ve checked my meter against the blood draw and it’s pretty close. My working hypothesis is that my red blood cells live longer than the standard assumption of the A1c test. In my case, I downplay the A1c because I don’t think it’s accurate for me. Instead I focus on % time in range, % time low, and standard deviation.
Congrats again, AR; you’re doing an amazing job.
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Well do my Acid!!! Woot Woot! 
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Acidrock23 STAR! 
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Fast descent and stuck the landing
I woke up this morning with my BG at 248. Ugh! Some poor eating choices yesterday led to this, but that’s another story. For my correction I inhaled 4 units of Afrezza combined with a 3 unit intramuscular shot.
I figured that the Afrezza would knock 50 points off and so I calculated (248-50) = 198. Next I targeted 83 so the difference between 198 and 83 = 115. I used a more aggressive ISF of 40 instead of 50 since the starting BG is so high. I then took the 115 and divided by 40 = 2.875. I rounded up to 3 and give the IM.
What followed was the steepest and fastest correction where I didn’t over-correct, at least not by much. I made it into my 120 or less target zone in two hours, light speed compared to my past corrections.
Not a flatline, I know, but instructive just the same. Green stripe = 65-120 mg/dl.
I took my breakfast dose at 10:15 a.m. and ate at 11:15 a.m. If I had started eating at 11:00 a.m. it would have been perfect. As it was, I only spent about 15 minutes below 65 mg/dl with the bottom at 59 mg/dl.
Not the way I’d like to start the day but it did have a silver lining. Tomorrow’s another opportunity – hopefully with a little less drama.
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Two days ago, a better day
Had some lows at 5:30 a.m., just before 10:00 a.m. and in the afternoon just after 4:00. Nothing less than 55. Other than that, a pretty good day.
The numbers
Time in range = 78%
Time low = 12%
Standard Deviation = 21 mg/dl
Average = 87 mg/dl
Made 2/4 goals and very close to 3/4.
Same thing happened to me this morning… I think it was a rebound from low blood sugar right before bedtime. I noticed it at 5:45 AM when I got up to take thyroid meds. Took 3 units Humalog, and bg was down to 123 by 8:30AM.
Evening is a tricky time for me, in general. I eat my largest meal for dinner (helps keep adrenal rhythms where I want them) and–because of gastro paresis–food is slow to reach blood chemistry. This is an extreme though, doesn’t happen this way very often, and I wonder: Is it possible that, as I increase my exercise activity and metabolism finds a new set point, that I should consider less insulin at dinner? And, if so, how can I assess that pattern accurately? Any ideas?
Thanks for your help.
Ahnalira - Do you use a pump? (The old TuD site revealed that kind of info by clicking on the member name.) If so, you could experiment with an extended bolus. If you do MDI, then you could try using Regular insulin for dinner to see if that might better match your slower digestion. Personal trial and error has helped me to adjust these things. I hope you can find a method that will work for you.
Maybe you need to “exercise your carb skills @Terry4? I’ve had some turbulence occasionally, I had a really hairy time at work as I had one of those “30U should be enough in the tank days…” ran high and had an unexpected enormous lunch through work and then yanked my site out. “argh, I’ll have to go for a spare” but it was 32” tubing and priming it killed most of the juice in my tank. I had 6U IOB leftover from lunch but also the food and rode up and up and finally took some drastic measures, which just had me breaking even on the way home about 180, corrected more, the gizmo said “------.–” but I wasn’t sure when it ran out and kept correcting so I got home, primed and it still had juice to pump which was good but fussing around getting new site together, etc. and by the time I checked again was 39! Eek!!
I like to carry my current insulin vial with me in a Frio pouch. But I’ve been caught running out of insulin in my pump. No matter how well one usually prepares, it just happens sometimes. It’s been many years since I’ve done this and it’s definitely not preferred but here’s what I’ve done when I’m left with no other options; it’s either do this or go without insulin for several hours. Basically what I do is use the insulin stranded in the set. My set contains about 20 units in the tubing.
I disconnect at the site and then disconnect the set from the cartridge. Do a complete pump rewind. Then I draw the plunger in the cartridge back with a spare plunger handle that I keep in my kit. What I’m doing is using air in the cartridge to push insulin in the set tubing. Reconnect and prime the pump with the set disconnected at the site. When the prime is finished and you’ve seen at least one drop of insulin exit the set, reconnect the set to the site.
It’s not pretty and can be dangerous but I’ve successfully done this several times. Closely monitoring BGs is a must. I know any doctors, nurses, or CDEs would hate this but sometimes you need to take care of business!
Glad you caught that 39 when you did. It’s amazing that a 39 can sometimes feel a lot like an 83!
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I inject, @Terry4… Lantus twice per day and Humalog when I eat. I thought about what you wrote and decided to reconfigure the dosage–increasing lantus by .5 units each time and decreasing Humalog at dinner…and it worked! Just that small adjustment and my BG was between 70 and 80 from 8PM to 8AM (Dinner was a huge salad and a small piece of gluten free pizza)
My husband, who studied physics during his undergraduate years calls this “dynamic systems adjustment” 
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Checking in 
Here’s my last 24 hours
For the most part, I’m finding the low carb/low grain protocol sustainable. Over the weekend, though, I got an undeniable craving for cookies. So, I made peanut butter and chocolate chip (sweetened with stevia) cookies. I doubled the eggs and replaced 2/3 of the gluten free flour with unsweetened shredded coconut. Sweetened with stevia and applesauce… My math brought It to 3 grams of carb per cookie. Coconut made for a very soft, chewy texture. Not very sweet, but very satisfying and settled my “need” quite nicely 
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Nice line, @Ahnalira. Congrats on finding an acceptable treat to satisfy you. Your range of blood sugar is non-diabetic. Impressive!