How do you get a "flatline"?

For those of you who are Type 1 and have “flatline” type blood sugars, how do you do it? I look at some of the CGM graphs out there and don’t understand how people can be so steady even while eating.

I can’t seem to do it no matter what I try. Today I was 4.8 (86 mg/dl) prior to eating a 15g snack, which was hours after eating my last meal so I had no food or insulin on board. I pre-bolused by about 20 minutes (I use Apidra), and I was STILL 9.9 (178 mg/dl) an hour and a half later.

Now this is pretty awesome (for me) and I am not complaining, I’m just seriously wondering how those of you who stay under 7.8 (140 mg/dl) for days at a time do it.

I am really boring foodwise. Some of this is b/c about 6 or 7 years ago, I was like 275 lbs and realized I needed to lose weight. I also did a bunch of other stuff but by eating pretty much the same thing (toast eggs breakfast, 1/2 sandwich for lunch), it is easy to see if my ratios/ rates are correct or if they need adjustment. If I hit 178 after eating 3x days in a row (and was confident in the carb counts, didn’t get into it with the 12 year old or any one of the other things that might push it up…), I’d try to lower my ratio from 9G/U to 8G/ U and see what happened. If that made it work, and it worked for 3 days, I’d consider it fixed.

That’s just how I approach the numbers and adjust them to put them where I want them. The flatness sort of happens doing that all the time. I don’t make a lot of big changes.

Sometimes, depending on the data, telemetry, what the “delta” is, if I hit 120 and it’s going up fast, I’ll figure I screwed up a carb count and bolus for the 10G of carbs I missed. Or, if it’s 95, and I have a bunch of IOB, I’ll eat the 10 carbs I missed. That seems to help avoid some of the crazy excursions too.

Thats a good question, while am not one of them, am a roller coaster! I believe I can aid in answering your concern.

I believe if you want to be “flatline” it is easy to do, all you need is to become a robot. Do the same thing everyday nothing more or less! Eat daily the same amount of carbs, drink, and move the same thing everyday. Afterword all you need to do is to adjust your insulin amount to reach the flatline. AND no cheating, even if it was your birthday!

That will be the ultimate diabetic person that you Endo want you to become!

And… this comes w/ determination… that I fear my 16 year old does not have yet…and maybe never will.

Not sure either… for my son the after meal highs can be in the 200s… I think it is his choice of food…but that won’t change…not until he gets older I am afraid.

Since 16 year olds are run on peer influence, Katsz, perhaps your son could be exposed to other Type 1 teens, either on here, in diabetes camp or a local support group so that he gets the motivation to work on his own diabetes. Having regular highs in the 200s with all those years to build up complications is a bit scary. Maybe he can come to think of it as “cool” to better manage his own diabetes!

The answer is that you do not flatline for very long. You can have some very good hours, but eventually D comes back to bite you.
I have done weeks where I eat the same thing for every meal–no viariation-- and BGs change dramtically. D is often a crapshoot!!

Hey katsz

FYI, I was diagnosed at age 2. When I reached 16 I was in no way going to test my sugars and make myself feel even more different than other people my age (sole diabetic in my class). Of course back then we tested urine so it took a bit longer than the meters do. Anyhoo, I reached my early 20s before I wanted to be in control, and even though retinopathy had set in, I have been in good control for the last 30 years without complications (retinopathy has not changed). Yes, it would be ideal if your son had great control, but I think the teens, early 20s are hard enough on “normal” people, let alone being diabetic. And today? Well, hormones seem to be kicking in and screwing things up for me again. But I AM on top of things. I just do a lot of corrections.

Katsz, I wrote this to give you the diabetic’s insight . Things may be different today but I felt I was a pariah when I was growing up.

Best wishes to both you and your son!


In order to flatline, I probably need to get a different CGMS. I am at the end of my rope with the Minimed system, but unfortunately I don’t think that I can convince my insurance to buy a Dexcom for me.

I had a typical start for a sensor today. Inserted the sensor last night and calibrated this morning at 96. It tracked fairly closely this morning. It asked for the 6- hour calibration. I entered 135. A half hour later I bolused for lunch and ate. Within the hour the CGMS is alerting me to a high BG. The CGMS reads 274 and my meter reads 146. I let it go a while, but the CGMS never goes below 230 while my meter reads 102. As far as I know, the only thing to do is restart the sensor.

This scenario has happened on almost every sensor lately. I actually went 6 weeks without using it because of these crap results. However, had a terrible low that “I needed help from someone” on Tuesday, so thought that for safety’s sake, I should start using the CGM again.

Because of my good A1c, insurance won’t buy me a new system. However, they still keep buying replacement sensors. Am in a quandary as to what to do.

If I knew that they would buy the sensors, I would pay for the Dexcom out of pocket. But I have no way of knowing that and I’m afraid if I ask, they may stop paying for the Minimed sensors.

Back to the original post. Sometimes I do flatline even though my sensor results are peaks and valleys. And then there are times when the sensor reads absolutely flat, but my BG’s are all over the map.

For this gal …far too many variables from moment to moment ; in other words as Ahmad said : I am not a robot and I have stopped comparing myself . I have not stopped " researching " here and elsewhere !

I think this is a really important question. I don’t know that I have an answer. I’ve posed similar questions over at the flatliner club. In the end, I think that it all has to with variability. And everyone is differnent, but some of us have to deal with high levels of variability. I think we can improve our variability with certain things, lowering our carbs, exercising and attention to detail. But in the end, some are “luckier” than others.

Lathump…On the side …I wear the MM sensor . Took a 3 week holiday due to being also very frustrated and spoke to a MM trainer here in my province. A couple of reminders she shared ( she is a pumper too ) : the first day numbers maybe questionable …presently in day 2 and 8 hours …she recommended turning vibrating warnings off ( I wear a Veo ). I do check around 3 am with a poke .The big thing for me was as far as it appears , that I inserted on the 45 degree, sensor when removed somewhat bend …this time I inserted on a less than 45 degree angle , standing up , skin taut …so far so good. All the while finger pokes and sensor readings ( allow for the 20 minutes deviance …( is this the correct word ? ) very comparable .

I was kind of like that when I was younger but my alterior motive was that I didn’t want diabetes getting in the way of my wild, rock and roll lifestyle. These days I have other stuff motivating me but I loathe the idea of saying I can’t do something.

I don’t think I’m exactly a robot. I am pretty robotic during the week at work since 1) we got a dog last August so my mornings are very regimented to take care of her. She’s low maintenence but I like her being happy and just toss food down. Eggs and toast doesn’t strike me as “slumming” and I have about 2/3 of a pot of coffee so I’m uh, quite lively. 2) I eat the same stuff at lunch again more b/c of the weight, when I went out to eat, I was about 90 lbs heavier, BP was 150/100, I don’t recall cholesterol but probably not brilliant. Work has become more stressful and bacon cheeseburgers or whatever would not really change that. Working through lunch and tossing 1/2 a sandwich down is plenty of food. I don’t even consider it cheating at night but I eat and drink pretty much whatever I want.

I eat different stuff every night, unless there are leftovers. I have beer, cocktails, wine, etc. I have dessert occasionally and count all that garbage which, sometimes gives me pause in that I’m like “yikes, 110G of carbs, urp” but I don’t see it boring. It is boring to me to go out and eat crap and ■■■■■ about work so I just get stuff done @ work for an hour. I haven’t gotten much, if any coaching from my endo either. I am totally dedicated to continuing to eat what I want as long as I can keep my BG in line and count the occasionally ridiculous carbs ok. Perhaps I cheat by running a lot but I like that too and it’s good to be 43 (years old, not BG, although I’ve done that too…) and out and about. It’s also handy to have the “robot” time because the data is pretty easy to see when stuff changes.

Last summer, I overdid a couple of races too close to each other and switched from running to cycling for a while and noted some changes in my patterns that were easy to fix. If I am seeing a 140 that I don’t want or can’t explain for 3 days in a row, it makes sense to try an adjustment and beat it up until it says “uncle” and goes back to 120. I don’t expect everyone to want to bother doing that but whatever your BG is, you are likely to think about it. It makes sense to me to try to think about it proactively.


That’s my favorite diabetes picture of all time! :slight_smile:

Talk to Danny and Acidrock and Onesaint and Courtney and Kate in the Flatliner’s club. They are DOING it. And not being robots, either.

For me, the solution has been low-carb eating, not eating too much at any one time, getting my insulin:carb ratio right, insulin sensitivity factor right, and paying close attention to the CGM. If my BG starts to go up, I correct – don’t wait for it to sail out of sight. Fortunately, the pump doesn’t let me overcorrect, so I don’t stack insulin and go too low. But, of course, this depends on having your ratios right. Acidrock made a comment about how he adjusts ratios, and he does have the right idea!

I have a Medtronic CGM, and it did have a learning curve. It took some experimentation with insertion technique and calibration times to get it right, but it’s pretty close most of the time now.

Here’s a picture of my last line – not so beautiful as Acidrock’s but still pretty acceptable:

Highest was around 155 and lowest was around 65. Certainly better than going above 200 all the time like I used to do before I started the low-carb and CGM!

This looks great Natalie …I will get into taking pix again …busy with advocating for PWD and a Federal election May 2( one more sleep !!) . …signed not a low carber , but a person who eats mindfully( most of the time !)

I have always been a boring eater and tend to eat the same foods every day. I don’t think that you need to be a robot, but you do need to try & eliminate the foods that you know are causing problems or find a way to work around it. If you know a food is going to send you to 180 three hours after you eat it, then take another bolus before you hit 180. I used to bolus for protein & fat, but I did not have a formula for doing it before joining TAG. I have the alarms on my Dex set for 120 so I get alerted sooner when my BS is starting to go up. I hate keeping logs, but they do come in handy for trying to figure stuff up. Once you know what a food is going to do to your BS, then it makes it easier try to figure out how to bolus for it. If that means taking several shots per meal with MDI or using the extended bolus with your pump, then do that.

Chocolate seems to be a popular food item if you read the posts in the Flatliners group, so I think chocolate might have a role in those flatlines!

Natalie, isn’t some of your recent success due to changing your goals and adjusting the targets you were shooting for, turning your “high” line down to clue you in to highs earlier on on the high cycle and using the different target approach to approach issues differently leading, in turn, to lines that we can all ooh and ahhh over?

Another thing that I would toss out is that little adjustments, like 1G/U +/- or .5U basal rate, seem to make a pretty significant shift in my numbers when I play around. If a number is always off, I don’t see that you have a lot to lose by trying an adjustment to fix it. If it doesn’t work, you shouldn’t look at a result as “bad” because the point in changing is to get data and there’s no such thing as bad data, as long as it’s not a catastrophic hypo. So stock up on jelly beans or whatever and try some incremental adjustments, maybe one number/ day and see if you can improve a number you are not satisfied with. It doesn’t have to be 85 all day, moving a number from 140 to 120 consistently will have some impact in A1C and, more importantly, should get you a buttload of high fives and congratulations if you tell us about it! Ooo Rah!