Well, I'm T2 but insofar as insulin production goes, just about T1 :-)
Like you, if I have a Hershey's bar and take no insulin, my BG will zoom way up, probably we into the 300s, and stay there. Main difference is I have a smidgen of insulin production, so I won't go DKA (although at my worst before my "come to Jesus moment" I was borderline DKA), and my BG will very very gradually come down in to high hundreds over 24-48 hours, stay there, and not come down any more.
My treatment behavoir doing this super-intensive control with pump and CGM looks no different from AcidRock, Terry, and other T1's here, save the dosing, which is about 3-4x due to IR.
I love how there are degrees of unicorn-ness on this forum. I've been treated as a unicorn for much of my life--5.8ish A1cs on a moderate carb diet aren't what my doctors and nurses usually see, I think--and then I come here and there are people running 5.0 A1cs, while eating carbs, and grappling with other issues.
I'll posit that we really haven't seen the impact of these tools yet, given that they're relatively new juxtaposed against a lifespan. My grandfather had diabetes, all sorts of complications, and was not a very willing patient, yet he still lived into his 80s.
Home glucometers are what -- 25-30 years available? The accuracy we have today probably only 20 years.
Insulin analogs: HUGE advance in diabetes care. 20 years on the market, some less.
And CGMs! Oh, CGMs!
I expect that after another decade we'll be getting tons of real data on what impact all these technologies yield, for those that use them diligently and control their BG with discipline.
there's no way any of these folks would be flatlining, or for that matter avoiding rollercoasters, if they were consuming very large quantities of sugar, or any other carb
True dat!
I shoot for <100g/day, and average more like 150. Not low enough to trigger switchover to a ketotic metabolism, but low/modest carb by "normal" nutritional guidelines -- even ADA guidelines :-)
This idea "there's no way any of these folks would be flatlining, or for that matter avoiding rollercoasters, if they were consuming very large quantities of sugar, or any other carb" is not true dat, Dave. I eat plenty of carbs and have followed the ADA guideline that I was given 35 years ago with some adjustments and revisions as I grow up and different foods are available and my tastes and activities change. For my carbs I prefer natural foods including fruits and veggies, and the dangerous and ever hated whole grains. In addition I limit the fat in my diet as recommended for issues beyond my diabetes. If I ate pancakes all day, then I would certainly need a lot more insulin (12 units would be an overdose even if I ate a whole Denny's stack - so WOW) but I am not that hungry and one pancake seems like a waste of effort and ingredients.
I maintain normal blood glucose for the most part because I know how to match my insulin bolus and know how to manage my basal to fit into my life and diet. I don't ride roller coasters except for fun. Lows and Highs happen now and again and must be dealt with when they do. Were they to happen every single day I would figure out why and fix that.
Writing everything down; tracking patterns; knowing what, when, and why is key to be able to make necessary changes and eliminate the roller coaster rides. As Terry suggested earlier - there are some excellent books to help diabetics.
Basal testing is so very important and I am learning that this is something folks simply do not do. Why is this?? I suppose it is easier to to chase and guess and use more insulin than necessary and fix the problem later.
As said a time or two and even in this thread - Normal bg management can be done, and IS being done by some of us. And even enjoying some carbohydrate in the diet one can experience flat lining, and avoid roller coasters.
Mostly black beans. High fiber. I was targeting a carb with no highly refined sugar and a bunch of protein. I'm not gonna cry myself to sleep if my bean diet is a flop. But, I try to eat consistently when I'm making baseline insulin adjustments so I know, for certain, that I'm eliminating 'bad meal bolus' as a variable. Like, I might eat only sandwiches. Goal: eliminate variability in the system - eliminate 'noise.' I don't let events overlap. If there is, for instance, an active correction AND a meal bolus, then I throw the data out and call it 'noisy.' I don't use it as evidence in my trial against either a bolus meal dose OR a correction dose. Both doses get off, Scot-free, in that instance. Does that make sense? Do you do that?
I would agree with that evaluation. That is what I find most striking about other peoples data - that they are able to stay in one range for so long. I have heard your guy's arguments for increasing both fat and protein. I was increasing fats for about a month. That was fun. Sadly, I have moved on into an exploration of increasing protein, which is less fun. But, maybe it will do away with my new nickname - Beefcakes. LOL.
I don't mean to pry, Karen, but I don't think there are as many women posting as men. Are you using muliple basal rates? If so, how many? I'm only using one, so everybody's starting to convince me that more is better. What do you think?
That seems like it could work....something to strive towards. Its complicated. I think I could work my way up to figuring that out, step by step, maybe. I have to change the way I think about the problem.
Before I had a sensor, I assumed my data was a lot more flatline than it actually is. So, that was a big change in perspective for me. When I saw how dynamic the data was, I didn't know what to make of it, and still don't. I heard an elderly Doc say that 'insulin pumps were driving diabetics to try and make their numbers too stable' and that there were some concerns about the effect of this. I blew it off as crazy because it seemed so contradictory to what we are taught - that stable data is the best data ever. I still believe that stable data is better data. But, trying to wrap my brain around how unstable my system is, I read this small paperback called 'Complexity for Clinicians.' They mention, in the blood sugar chapter, that stable blood sugar data can be an indication of declining health in type II. They make an argument that dynamic data might represent a characteristic of a healthy system. Its so backwards that it stuck in the back of my mind. We are all so allover the map in terms of how dynamic or stable our systems are. I no longer have any frame of reference to judge how our systems are 'supposed to behave.' Special thanks to all the unicorns, who let me poke at 'em with sticks and ask them too many questions.
Do you test 2 hours after eating a high carb load (anything over 50-75 carbs) and see what your BG is regularly?
Count me as extremely skeptical that you truly keep a near normal blood sugar profile after eating a large carb load. The slow action of exogenous insulin -- relative to endogenous -- just doesn't make this possible. It simple is not possible for the insulin to enter your bloodstream as fast as the glucose. It's the "tail" phenom.
Yes, I have 4 basal rates, I need very little insulin during sleep and then more for DP and then the day and evening basal rates. Also the insulin to carb ratios need to be measured, I have 3 settings. More is better in my opinion and experience. I expect it is a challenge without a pump though.
How did you determine the one basal? Have you done any basal testing mohe?? I think you should. If you are steady with the one basal then you can work on your I:C. That 12 units for dinner blew my mind!
Karen, I find your situation inspiring and I had a couple questions. How far in advance do you bolus and does it vary based upon time of day? I'm realizing that not bolusing far enough in advance is one thing causing me to roller-coaster and I was curious as to how you handle it.
No CGM...just the old fashioned testing. I test 1, 2, 3, 4 hours after a meal as well as before. I test a lot (and when I tried a CGM I tested even more!). 50-75 carbs is more food than I could physically stomach unless it's a dinner party or a night out for a show. I simply don't eat that much usually, but yes if I did I could match it without much trouble. I would have to tack on a couple extra miles the next day to undo the damage of that pie ;)
That "tail" phenom you describe is not the result of high carb for me, mine comes from protein. I don't enjoy big slabs of meat so my sources of protein are fairly small. If and when I need a correction, it is 4 to 6 hours after I devoured the ball park frank at the baseball game.
You can be skeptical all you want. I have learned that folks who do manage to keep near normal bg numbers are not all that interesting or believed in the DOC. Success is boring I suppose!
