How do you get a "flatline"?

+1

See, that is what I mean … how do you not spike at all when eating?! Even eating 10-15g of carbs spikes me (not sure how high though since I don’t have a CGM).

I would try turning your carb ratio up one, maybe just at one meal, to see if it makes it spike less? Also, I would try it for 3 days in a row. When I change stuff, I get goofy results and I like to let it ride. I usually try to do one meal at a time as it’s easier.

Re the favorite picture, I can’t believe you guys missed the DF centerfold. That was a much better pic! :slight_smile:

My ratio could be off because I’ve hit some, ahem, hormone-related issues and have changed my ratio from 1:10 to 1:8 over the past two days, as well as put my basal rates up by 0.2 u/hr. I spiked to a ridiculous 23.1 (416 mgd/dl) this afternoon after lunch (I ate out, but I got a salad I’ve had before!!!) so it wouldn’t surprise me if it needs some more adjusting. Ugh. I think having to make these types of sudden, huge adjustments every 2-3 weeks is half my problem, honestly!

I’m starting a course that will run all day, every day for the next three months. This means my schedule will be almost perfectly consistent instead of being different every day like it has been for the past year. I’d like to use this chance to try and figure things out and get in really awesome control, which is why I’m asking you all for advice here!

That all makes sense, if it’s a hormonal thing, perhaps a basal thing might fix that. I suppose I have some hormones but don’t see the patterns fluctuating that much. I adjusted my basal 200% a few years ago when I had an RX for steroids and that worked ok, although it took a day to figure that out?

Jen , if I were to be physically inactive ( I mean sit and get stressed by a course ) it would possibly work for me to set a temp basal of x number of hours at 165 percent OR set the pump for the next 3 months with higher basals ??? …
I hope you enjoy the course !!

Katsz, Ive been a T1d for 25 years, since I was 9. I went through those teen years which are really tough. The discipline will come. You can do a few things that will help and annoy. Dont give up, ever. My folks stopped helping me with my blood work at around 11 or 12. I had become independent, but still really needed them to even just sit with me to know that some sort of authority was governing things. Granted this isnt 16, but I think the same thought translates. Secondly, the determination will come. I remember as a teen, getting sick a lot, aliments that would take ages to beat away. I didnt know it at the time, but I could stay all this with tighter control. I like to think that, that would have been a good driving force for me. Lastly, arm yourself with knowledge. if your teen sees you knowing more about their disease than they do it might have the effect of driving them to want to know more as well. And if not, at least you can supplement them with the knowledge to control things. Oh and to add try to find a management style that fits them. Thats been the toughest challenge through this all for me. Luckily, I after some 23 years, I found one.

AR, you are exactly right. Although I wasn’t sure it was going to work until it miraculously did. I really think correcting early makes a huge difference. When I ate my grease bomb last Friday, I did about 4 or 5 small corrections as the evening went on, and it worked. I think the biggest help for success is having a CGM and being comfortable with its trends. Which takes learning about its idiosyncrasies, and then adjusting in accordance with that. And paying attention – you can’t just test 2 hours after eating and then forget about it until the next meal, particularly if you’ve had protein and fat. I DON’T feel like a robot, I actually feel more secure doing that. I think it’s a philosophy – a way of thinking that allows you to take the 2 seconds to peek at the CGM and make decisions as you go.

The other thing I did was change my basals DOWN, because the CGM told me I was consistently drifting down, especially at night. And I’m pretty good at matching insulin to my favorite foods, and eyeballing the rest, and correcting as needed if I don’t quite get it right. I tend to underestimate my food, so that if I’m high after 2 hours, I can take a small correction and not go low. This is an extension of Bernstein’s law of small numbers, and it really does make a lot of sense.

And I agree – the more people we can get working on this, the more we get to celebrate! :slight_smile:

Hi Danny, thanks for letting us know this. I don’t use a CGM but would find it really motivating to join your group!

With those daily high fives also comes a sense of comradery with the other flatliners. Thats something I personally value very much. Its been said before, but hearing aobut it is one thing. Seeing the trend is something completely different.

I’m working on it!



I was thinking about it before but it wasn’t until the recent events that I’ve actually started to make attempts to get there.



I think it will take a while - it’s more difficult on injections and without a CGM, but I’m already doing better than I’ve done in a longer time.



What I’ve figured is that the correct basal rate is important, so I’m working that out first.

Right now, it might be too high since I have to eat at one or the other point to get me out of the “low zone”. On the other hand, my bg goes up at other times of the day but I can’t do much about that with injections since my basal is always there and I can’t vary it for different hours.
When it starts looking more flat, I’ll post a picture. Fortunately, my new Contour USB shows trends, so I won’t have to enter any numbers manually.



The other thing that makes it difficult is that my correction ration varies!

I usually get more or less results with a 1:40 ration (1 unit for 40 mg/dl), but if I’m too high up, I need more insulin - also, if I haven’t eaten carbs for a while and am not going to eat ayntime soon, it can change to the opposite: just yesterday, I had the case that 1/2 unit brought me down 60 points.



I also noticed that my bg spikes ~ 3 ours after lunch, just when my bolus is not doing much anymore.

That’s one thing I don’t have a solution for, yet. But that’s something to think about when everything else is figured out. It’s even possible that this problem will solve itself on its own.



What does that tell us?

Well, it tells us that there are different challenges to face while working on a “flatline” and that it is likely to not always work out.

My advice to everyone (including myself) would be not to get frustrated if the trend line is not as flat as you want it to be. And that it is important to find ratios (in general - basal, bolus, corrections) that fit you, at least most of the time.

Flatlining is…



Finding the management style that works best for you. I was an out of control PWD with A1Cs 7-10s for the last 24 years. Its always sucked. I never quite understood why my management wasnt working, but it wasnt. So,I asked how other do it. The responses led me to low carb. The management style fits me extremely well and I have been able to become the diabetic I always wanted to be. That is only because the management style fits who I am and my habits.



Flatlining lends itself to all kinds of management styles. Moderate carbs with exercise, Symlin with regular carb and exercise, Bernstein low carb, regular carb with diatary repetition etc. I think whats shocked me the most - how many different ways a flatline can be achieved. I do think we have some things in common such as a touch of OCD, we all fallow trends closely (be those CGM or fingerstick), we all make changes to find what works and run with it (like symlin or low carb).



Personally, I found low carb to be the best method for my management system for me. I try to minimize variables in my calculations and low carb really has been fantastic for that. Carbs (and a lack of fat) would bounce me around. I would think ok, if I eat this Ill cover it with a bolus and be good in 2 hours. Then 6 hours later at bed time, Id be wondering what the heck happened to my BGs.



Do I eat like a robot? No. I have a 50/50 diet of new to repetitious foods. In fact, I really enjoy what I eat and although I do a bit more cooking, tend to think I eat like a king. Repetition helps to make things easier for dosing sometimes, but so does eating a carbless meal (think ribs and SF sauce or none at all). I pick up low carb pitas, lavash, and tortillas at around 6 carbs each and mix those into my diet. With low carb, I found that the unknowns seem to go away. The randomized BG happens far less than it did and I can usually tell why things are going south, if they do. Is it luck? Sure. I was dang lucky to ask the question that lead to the advise, that lead to the Dick Bernstein book (with Gerri and FHS’s help) that lead to the management style that fit my life. If I stopped looking at the Dexcom every so often, watching my infusions sites, and eating low carb would the luck run out? You bet your bottom dollar it would.



ok, last to add. flatlining for me is not eating the things that will spike me, paying some attention to the CGMS, knowing the way my body will react to certain things (exercise, food, etc.) , and having my basals set correctly. The rest we can work out, but those are the key for me.

Great reply Anne. I really hope you get the basals and what not straightened out. Great to hear that the Contour USB will make things a bit easier.

So, for lunch is this with all meals? Is there any consistency? Those sound like the tendency of a higher protein meal. Have you tried dosing an hour post meal? Or Doing a combo bolus, maybe one for carbs, then another 1 hour latery for protein (i.e., TAGing)?

Jen, please do. The support and comradery mixed with inspiration is second to none. =^)

Seeing a trend line helps me. It motivates and makes it easier to find flaws.
If you want one without a CGM, you’ll have to draw it by hand, and I’m lazy. I can do that for 2 weeks but will stop eventually. The great thing about your meter doing it is: it doesn’t forget single numbers that may be important (“How on earth did I get from A to B?!”).

I’m not sure with what kinds of meals it happens. There are cases it does not, but it often does.
I’ve never heard of the connection between late bg spikes and proteins. Maybe I should start paying attention to that and see if it is the reason.
Bolusing at 125 1,5h post meal is a dangerous thing to do if I don’t know for sure I’ll be at 190 later. Before randomly trying that, I better pay closer attention to any patterns.
Thanks for the link!

The flatline is a balancing act of insulin activity, carbohydrate absorbtion and carbohydrate consumption. It is a high challenge and I think these points are important:

Amylin is missing: one unfair problem we T1's face is the fact that we have only little to no insulin production left (as if you would not know that ;-). But let me explain: When insulin is produced it is part of a bigger structure that also contains amylin. The hormone amylin is slowing the digestion down so the insulin can unfold its action before the carboydrates hit the blood stream. This mechanism is broken in T1 too. Unfortunately this makes our digestion very fast and the younger we are the faster it is. I assume that some (not all) of the flatliners have pre-stages of gastroparesis OR it is their age that causes the digestion to be slower. This gives the insulin the little extra time needed. Thinking the other way around it also means high spikes => healthy digestion. There is artificial amylin available called symlin. But this would be an additional shot per meal and the side effects can be unpleasant.

Insulin action differs: the genetical sequence of analog insulins is not the same. HumaLog, NovoLog and Apidra differ slightly in their sequence to prevent that the insulin molecules will fold to a more complex structure. In contrast normal insulin will often form a hexamere structure. After injection this structure has to unfold before the insulin can get active. These little variations and different preservatives also cause the analog insulins to act differently from individual to individual. Apidra might be the fastest analog for many but is it fast enough for you? I can say that I always had spikes with normal insulin even with pre-bolusing. It was the NovoLog that made the difference - it just eats up the spike (not always but often). Very likely a flatliner has found the best working insulin and timing. Most importantly he found the correct basal coverage too.

Slow carbing: obviously a limited amount of carbs is better to catch because the spike will be less dramatic. But the speed of the carbs is important too. It does not help to do low carbing if the carbs are fast like white bread. I think a flatliner made huge adjustments in his eating style or was always eating that way. He prefers slower food and eleminates food with negative outcome. For me it was the bread maker that made the biggest difference. With this reliability in carb counting I could find the right factor to catch bread without a huge spike.

Physical activity: if your pattern of physical activity is different from day to day it is much more challenging to achieve a flat line. I think or better I assume that flatliners have a more repetitive rhythm in their lifes. If your pattern is soo much different it would not be fair to compare yourself. Maybe you achieve brilliant results in perspective to your physical activity. For example a very sporty person will likely have a more "sensitive" liver. With sensitive I mean the liver will release glucose if it thinks it might be necessary. Likely this leads to dawn or stress reactions of the liver too - another cause of unwanted spikes. Currently I am experiencing this for myself. I started to work out for 1 hour every day and I have some trouble to adjust. Luckily I have no stress related liver reaction. But if this would be the case then I would try moderate the liver output with a small dosage of metformin (if my doctor would be willing to follow this approach and I could tolerate metformin).

Obviously it is the will to work on the small things that makes the difference.

FWIW, I am pretty active but I follow Jeff Galloway’s (non-diabetes oriented…) advice for 40+ year olds and run every other day most of the time, although this weekend I was unable to resist the run/bike combo to sneak an an extra workout, that’s probably the exception, rather than the rule for me.

You know, when you write that you spiked to 416 mg/dl, that just leaves my head spinning. I don’t understand it. When I eat carbs, I rise 2-3 mg/dl for every gram of carbs. Now, granted, I am a big guy, I admit it, I am “gasp” over 200 lbs. But for the most part, the amount that you rise from each gram of carbs is proportional to your bodyweight.

If I started at at your 86 mg/dl and ate a 15g snack, I would be 116-131 mg/dl. If you weigh half what I do, you should be between 146-176 mg/dl (with no insulin). You rose more than that. And to go to 416 mg/dl after a “salad.” What is that, maybe a generous 45g. That is a disproportionate rise.

I wonder if there are certain foods that really cause you problems. Do you think you might have some allergies or intolerances?

Hey Jen - I have recently started using a cgm and joined the Flatliners group here. I have been working on increasing my exercise, lowering the junky carbs that I don’t need and figuring out how to eat the carbs I want to achieve the best and most consistent blood sugar levels I can. I am not a robot nor am I perfect. But I am getting better than I was when I started and I am confident that I can make more improvements in the future.

It sounds like we are on the same ahem schedule. One of my favorite endos of all time once told me to give myself a break once a month when hormones flare up and mess everything up. At this time, it is pointless for me to try to figure out if my basal and boluses are okay when I cannot tell what is causing the issue (human error vs. hormone error). If I were in your shoes, I would hold tight this week and make a game plan for next week when my hormone levels were more normal. I would also eat chocolate ice cream…a lot :slight_smile:

I get those also. (Isn’t 67 a bit low?) My point is just that it is hard to maintain consistently. I mean, even the weather will affect my BGs! :slight_smile: