. . .folks who do manage to keep near normal bg numbers are not all that interesting or believed in the DOC.
+1 to that. Nor anywhere else. (Support groups, etc.)
Protein does matter, depending on context. Personally I tend to eat low carb/high protein meals, which is why I still use Regular to cover planned meals. Its longer action matches up to protein much better than the fast analogs do. For me, anyway.
(Of course, for a quick correction, nothing can touch my Apidra, delivered via IM.)
I'm not a pumper, but everything I have ever heard says that having multiple basal rates is one of the best things about a pump. I have a friend who experiences ferocious Darn Phenomenons and he uses 9 basal rates to cope.
Even black beans are mostly carbs, with moderate amounts of fiber and protein. Totally manageable as part of a mixed diet for all but the ultra-low carbers, but a pure black bean diet is very, very carb-heavy.
Personally, I do eat black beans when I allow myself the occasional Chipotle burrito bowl, but the 86g carb hit for one meal, mostly from brown rice and those beans, is higher than I eat with any regularity.
If you're testing, eliminating variability as you describe makes sense to me. But while it can be useful to see how your body reacts to one food, it's also useful to see how it reacts to a typical, balanced meal.
The Chipotle burrito calculator is pretty great (or horrifying, depending on your perspective): http://www.chipotle.com/en-us/menu/nutrition_calculator/nutrition_calculator.aspxEating moderate carbs as part of a balanced diet is very different than eating huge quantities of sugar/high-fructose corn syrup, in the context of almost pure-carb foods.
I think different forms of stable and dynamic are being conflated in this discussion. Obviously we want the dynamism of being able to surge insulin in response to carbs or to correct a high. The ultimate stable system is a lifeless body, after all. That said, the kind of "dynamic stability" that a healthy body exhibits is pretty plausibly the ultimate, and perhaps unobtainable for most, goal.
Awww, thanks :) I bolus at the start of any eats. Rapid insulin really is rapid in my body...and because I pump mine it there is always rapid insulin working. I remember when Velosulin was the pump insulin, you were supposed to bolus 30 minutes before eats. That was not good, I was often crashing before the meal was ready. If advance bolus works for you, then go for it.
By trolling, I meant being less-than-serious to try to get a rise out of folks. If you are in fact eating an almost pure carb diet (whether that's from sugar and high-fructose corn syrup, as mentioned earlier, or a pure bean diet, as mentioned more recently), then struggling with both high peaks (the 300s you report) and rollercoastering BGs doesn't seem very surprising. In fact, to stabilize your system, and break the carb craving cycle, you might want to try a very low-carb diet at least temporarily, for at least a week or maybe a few, before gradually reintroducing healthy carbs in the context of a balanced diet.
I do try and "eat normal" when I feel my results are getting hard to understand, but for me, that means things like scrambled eggs and toast, a sandwich, or a bit of protein (meat) with a salad for dinner.
I think this whole discussion has finally pushed me over the edge as far as the pump goes. I just had an endo appointment and we discussed how to proceed regarding getting one. Not entirely certain yet, but taking the next steps.
Karen, first of all everything I'm posting in response is delivered politely and with friendly intent. Scepticism is just that, nothing more. I'm certainly not calling you a liar -- you experience what you experience, and I don't challenge that.
I'm just trying to reconcile my understanding of the pharmacodynamics of injected insulin with that of digested carbs. For all practical purposes, 100% of the carbs in what you eat is fully digested in in the blood within 1-2 hours most of the time, unless one is eating low-carb and substituting fat and protien for the other needed calories.
So let's put this a bit differently. A non-diabetic can eat 100g of hard candy and not rise above 100 mg/dl AT ALL after eating it. On an empty stomach, all that will be in the blood within 90 minutes.
A diabetic, particularly a T1, will experience that same dynamics of digestion and glucose absorption. Yet, calculating the necessary insulin to cover those carbs, and injecting it, will result in the insulin acting from 4-6 hours, tapering off (the "tail"), finally bringing BG back to where it started at the end of that period.
Therefore, there simply is no logical scenario where BG stays flat for the diabetic with such a large, fast carb load. It can't be done. Sugar that will be cleared hours later is in the bloodstream, not yet cleared. BG goes up.
Of course the solution is in your reply -- you don't eat that many carbs. I too can stay pretty flat with proper pre-bolusing and if necessary a combined bolus with a long square-wave over 3-4 hours -- if I eat no more than 40 carbs or so. Double or triple that (two slices of pizza), and I'm going into the 160-180 range, no matter what I do. The insulin is not fast enough. The carbs are faster.
Your thoughts?
Thats what happened to me.
I find that I want to wait at least 20 minutes between bolus and food, and if I'm bold, I can push it to 45 minutes. If it hits an hour, I go low. Even at 45, what happens is that as I start to eat, I nudge the upper bound of low, and then bounce back up. But it does help to curb that quick spike from carbs. The other variable is what my pre-meal BG is, usually it's around 100, but if it's elevated to say 140, I'll wait longer for it to drop. Conversely, if I really need/want to eat sooner than 20 minutes, I often super bolus (which doesn't speed up insulin action but does increase peak insulin available to cover a spike).
My biggest challenge is that, once I've counted carbs & injected, my mind is on food and it's very difficult to wait! Getting better about it, but still a challenge.
My basal is correct. Overnight and DP are my two, really consistent, predictable patterns, so they are are in good shape. When I was on a pump, I started with one basal, but after fours years, I had concern for my safety and went back to MI (which caused a big fight with my Doc). You guys have convinced me that multiple basals is a better starting point, and with good testing, I think I could start that up and perhaps see better results than before. I have a better understanding of system behavior, after a few years on a sensor. I should have started on a pump WITH a sensor in the first place. I think that the sensor hardware has developed to a point where it is helpful to me, now.
Short Backstory: Doc threatened not to be my Doc anymore if I got off the pump. It took months for me to bring her around. She is a real 'how low can you go,' kinda Doc that likes A1cs as low as possible, so when I was reading low 6, high 5, she was happy and credited the pump. I had a natural inclination to drive it kinda low, as well, because I believed that high BS was causing seizures. She didn't believe that I was having seizures, or that seizures were occurring at high bs. We were in deadlock until I had a giant grand mal that hospitalized me for four days. Because I went down at work, the medics checked my BS and I obtained proof that I had a seizure at bg=100, which changed everything into an epilepsy diagnosis. My Doc thinks that lower A1c's may increase the likelihood of seizure and I believe she is correct, because I have had some real bad reactions while running too much basal on a pump. We now try to target high 6 or low 7 because that is where I am comfortable that the variability doesn't push me so low that it causes increased risk of seizure. Very few since returning to MI. Now that I have had some time to sit with both illnesses in a comfortable easy chair, for a few years, I think I understand the system better and might be able to manage a pump. Too many unknown variables were at play before.
Are you very petite, Karen? I like your low insulin requirements. But, I'm a big boned Swede - built for plowing fields. I think that my Danish half contributes a high production of adrenaline that requires more insulin when I'm exercising, or doing a lot of different things. I'm really high energy, so my high carb intake might be normal for me. I only suspect I have high carb intake, compared to the rest of you, because I'm vegetarian. Have been since I was 7. Its probably not good for me because it requires more insulin. A diet without meat, probably tends to substitute more carbs. But, thats here to stay. Am trying to introduce more protein, on your suggestions.
Wow, the seizure thing is a big additional complication, my sympathies for having to deal with that, and kudos for being so thoughtful about it.
More protein makes sense, also good fats--be liberal with the olive oil bottle! Assuming consistent with weight maintenance, of course.
Oh, don't feel bad. Its not bad compared to many people with epilepsy, thats why I wasn't diagnosed until very late in life. I have always been able to manage without meds. But, no more working in ambulances. That was a bummer.
In the interest of full disclosure, here in the Minnesota, there are a lot of Nordics and they can tell that I have a bunch of Danish heritage, even without me telling them. It might be a little wives-tale-ish, but I think they know something. They tell me sometimes that I've got viking berzerker genes - I make the Swedes real nervous sometimes. I think I have unusually high energy and adrenaline production and that has an effect on BS. It comes from being born of a fairly small gene pool.
Understood! However, pre-bolusing is the key to tight control.
Insulin in me is similar to niccolo -- I wait 20-40 minutes before eating depending on several factors. 60 minutes and I'm going to be hypo, no matter what I pour down my maw at that point.
It's a little science, art, and magic getting it all right. However, I simply can not control my BG reasonably if I bolus with or after eating.
Very nice!