Hi Scott: For me, Pumping Insulin was the book that helped me most. Then, although I have not read it cover to cover, Ginger Vieira's book Your Diabetes Science Experiment seems to address the things you are talking about, and Gary Scheiner wrote a promotional blurb for the book. Finally, Sheri Colberg has written a book on the diabetic athlete that might be useful.
Thanks for showing your data Holger. As for control, I still want to watch other pilots landing their planes. That way I can get a good idea of what to expect. I'm currently going with the approach I started with, and before doing things differently, I'd like to get some idea of what kind of numbers others are getting. I've been taking a low carb approach (or at least trying) and with slow onset LADA type 1, it was the best way to go for me; however, now that I'm done crashing and my numbers are stabilized, I might move away from that approach. Then with a mixture approaches using old insulins, I'm mainly just curious about how effectively it can be done.
As I mentioned I'm at an advantage with low (NOT Dr B low) carb because my lipids have always been very low and with good ratios. Eating eggs daily for breakfast isn't a problem for me, and is probably healthy from that standpoint.
To me BG management is a bit of a game. I'm trying to see how tight I can get my numbers, and mostly enjoying it at this point (especially with getting a correct diagnosis, not having doctors pushing T2 meds on me, and not feeling physically ill much of the time).
I just want to take a day or two off occasionally, but it typically doesn't go well.
Thanks Melitta! I'll check those out. I hadn't heard about Vieira's book, and you are right that it sounds like what I'm looking for.
I read somewhere, not sure if it was at tu or not, that it is "ok" to take a day or two off.. I guess it depends on your stress levels when you see higher bg? Mine would prolly not allow it, but I definitely would like that too :)
OK Scott - I've been traveling for the last several weeks and don't have all my data uploaded but here are three days of data from June consolidated onto a Diasend report. I must admit that during my travel time, the numbers have degraded somewhat. I'm getting back in the groove now.
The fingerstick data is hard (or impossible) to read because I was double-sticking most of my BG readings and the chart superimposes the numbers. At least you can see where the dot is located on the chart. Exercise and carb corrections are not tracked. The only carbs that appear are from the carb-dosing function of the pump.
Hello Terry, the current link does only allow access from the computer that has originally been used for the login to Diasend. Maybe there is another way of sharing available on the Diasend page?
I think I know what you mean, you want more of a "workbook with examples" type approach. For those who used them in college, like a "Schaum's Outline", where they start with the equations, then go to step by step examples, and then practice questions. The pump companies and CDE's have such things often as handouts. I'm not sure there's a published book like that. Others are mentioning Walsh and Schneiner but really they don't quite go into that level.
There used to be a "insulin treatment simulator" online that let you vary food quantities and types and insulin doses and types and see the result on a graph over a whole day. That was cool. Still not the level of detail you need but a start. The one I'm remembering was old enough that it predated the insulin analogues (i.e. I think it had R, N, and Lente).
I'm not sure this will be useful, but here are my results from yesterday. I've had T1 for 38 years. No pump or CGM. A fairly typical good day including exercise (I exercise 3 or 4 times a week). Good day is one where food and BG track more or less as expected.
8:30 140 19uL 1uH Wake up later than usual (may explain high BG). Correct for 140.
9:00 Arrive work. Eat breakfast ~0g carb
11:30 114
12:30 90 Eat lunch ~50g carb
1:15 5uH Inject after lunch (typical)
2:00 138 Don't correct since lunch bolus not yet started
2:30 97
2:45 70 Eat some fruit (raisins) ~20g carb
3:30 104
5:30 136 2uH BG rises in late afternoon (typical)
7:00 119
8:00 90 Eat dinner ~80g carb
8:40 6uH Inject after dinner (typical)
9:40 81
10:00 64 19uL Eat some fruit (peach, dates) ~20g carb
11:00 103 Run 5K (typically exercise before dinner but not tonight)
11:45 146 2uH Correct exercise or dinner rise before sleep
Insulin L:Levemir; H:Humalog. I/C ratios vary depending on time of day
Mean BG: 106.7
Standard Deviation: 26.6
Breakfast: one hardboiled egg with mustard
Lunch: 3 slices bread - sandwiches with chicken, cheese, and peanut butter
Dinner: Indian masala chicken with rice; stewed cabbage with tomatoes; corn on cob; piece chocolate
I've found I need to inject right after eating, not before. If I inject before eating a mixed meal with carb, protein, and fat, I will go low.
Breakfast is small and no carb. After diagnosis I spent 30 years eating no breakfast at all and am not really hungry in the morning; but was finally persuaded it was good to eat some breakfast and have noticed benefit that I'm not starving if lunch is delayed.
It looks like I should eat fruit with my meals, instead of delaying it until afterwards. I don't because I have found that I have relatively insulin sensitive days (like today) and insulin insensitive days. If I always eat fruit with my meals I will sometimes get high BG and need correction.
Rise in late afternoon seems to be either Levemir curve or protein/fat from lunch. I've found I almost always need to bolus for it, but still test to be sure.
(Sorry its hard to read - the crappy editor they have on this site strips out spaces, even when input as plaintext).
Thank you Terry and thank you Jag1- very interesting for me. I'm just beginning to get "some" better results and seeing your actual DAYS helps to get the overall picture. Interesting that you bolus after meals, Jag1. And I was wondering Terry how long the "dual wave" or extended bolus should last.
Thanks Jag. I like the holding back on fruit approach and it seems to work pretty well.
Re the original question, about a book showing everything on a day. I'd second Melitta's recommendation of Ginger Vieira's book "Your Diabetes Science Experiment" quite a bit because it's simple and makes the process into an interesting exercise. She includes "Ginger's day" examples and sort of walks you through doing experiments on yourself to make adjustments and figure out how to make things run more smoothly. And includes a blank version of the sheet so you can do your own experiments if you're inclined to use her methodology. I read it once but, just flipping through it now, I can see that it's pretty useful and I liked the style, very playful, "Die Fröliche Wißenschaft!" indeed! I read it a few years ago and didn't take notes but it's pretty readable and about as much fun as you can have with diabetes. I recall one part where she adopted something that struck me as being sort of in opposition to the "YDMMV" approach and I am personally inclined to agree with that. Insulin has always seemed like a pretty linear thing to me, if you take more, your BG will go lower and if you take less, it will run up. It's hard to think of "more" and "less" in terms of the ratios but when I started paying attention to that, with the quality of data and fine tuning possible with a pump, I was able to get pretty good results while maintaining my wild, middle-aged dad who likes to run and then party lifestyle. Then I got a CGM, more data and have done a bit better with that.
"Think Like a Pancreas" struck me the same way as Ginger's book and it was really useful for me. I haven't read it for a while either. I keep thinking I need to go back and read these books I am recommending but well, I haven't gotten around to it. I love Dr. Bernstein's interesting story but don't like (and won't do...) his approach. I can make my BG work without it. I mostly restrict certain things (e.g. potato chips, french fries...) because I used to weigh more but will still eat 100-150G of carbs/ day.
Here are some of my numbers/meals etc. in case this may help you Scott:
I'm starting from lunch yesterday since I haven't eaten my dinner yet.. I usually eat two meals per day and sometimes a snack.. and I'm nocturnal so I have weird hours...
12;59 pm Pre lunch: fbg=100 4 units novolog, wait 20 minutes to eat 9g 2 eggs fried in butter, 1/4-1/2 green pepper, monterey jack cheese, salt, green tea, heavy cream, stevia, 10 blueberries, water, supplements, losartan
5:08 pm post lunch bg= 115... higher than usual for me it was prolly the blueberries I added in but I usually spike around this time and often do a 1 unit anyway: correction 1 unit and water
6pm 8 units basal levemir
7:30pm:bg= 92 various activities such as shopping
9:54pm bg = 57 6 grams candy & some nuts and cheese
10:32pm predinnerbg=59 more nuts and some candy 4.5 units novolog wait 20 minutes
25g chicken, green pepper, olives, cucumber, mayo, salt, fage 2% yogurt, blueberries, strawberries, red gooseberries, cognac, cacoa nibs, vanilla stevia, almonds/pecans, water, red wine
2:20 am post dinner bg =92
meds: arnica montana, lansoprazil melatonin
5:18 am bg = 88 3 units levemir
8:45am bg = 61 4g candy
pre lunch: 2:30 pm bg= 91 4 units levemir wait 20 minutes 9g food same as before
post lunch: 5:03 pm bg=94
I usually test two hours after each meal but sometimes forget if I don't set my alarm and then regret it if I spike.
my total carbs is usually 50g per day not including correction carbs for lows/exercise etc. I don't calculate anything else that much anymore... I eat very similar meals all the time unless I eat out.
I also drink a lot filtered water throughout the day.
Dr B, takes the low carb to extremes, but I think a lower carb diet is a good starting point at least while one gets used to doing the ratios. Also having a pump and CGM probably make it easier to correct for more carbs. With me, I was initially diagnosed T2 and had slow onset T1, and there really wasn't an alternative given that my body's production of insulin wasn't consistent. Still, I think his book is loaded with a lot of good information...as long as you don't take it as gospel.
Following your analogy, the plane's pilot had an instructor pilot (while learning to fly each type of aircraft).
I have found in TU (many from you) hints and tactics that have been very helpful while flying in stormy weather. I don't be follow your flight plan but do imitate your flying skills.
Examples might include topics like how, and how often, do people recheck their ISF? A single day's numbers probably do not contain enough information but some discussion of analyzing numbers to develop hypotheses about adequate basal dosing, gluconeogensis, etc. might be more helpful and provide insight into self management. Another example might be a discussion of finger sticks, Many HCP's blindly focus there because of the hysteresis from the differntial blood flow rates. I submit that if you are testing more than x times a day and are not in a hypo event that alternate site testing is equally viable and a lot less painful.
Curating this information to a single repository might be convenient.
For a change, I thought I might try to answer just the question asked. This was my day yesterday.
6:06 AM - Breakfast BG=115 - 22 units Lantus, 12 units Apidra
Breakfast was 1 egg and 2 bacon slices - 172 calories 0 carb, 13 fat, 12 protein
10:30 AM - mid morning BG check BG = 105
12:06 PM - lunch BG = 103 - 12 units Apidra
Lunch was salad with sliced steak, boiled egg, bacon, Marie's Blue Cheese dressing
426 calories 2 carb, 36 fat, 25 protein
3:16 PM mid-afternoon BG check BG = 115
6:06 PM Dinner BG = 115 - 22 units Lantus and 14 units Apidra
Dinner was seared scallops (4) and 6 oz of steamed shrimp with chipotle mayo
10:27PM Bedtime BG = 107
Lest you think that I am some sort of virtuous diabetic the evening hours included 1.5 bottles of red wine. May not help BG but does wonders for sanity. These kinds of numbers are new for me since April. I was never very accurate "chasing" highs so when I get in a groove like this it is easy to maintain and I feel good.
HTH
beachbeard - Your BG results from yesterday are incredibly stable. It appears to me that your low carb way of eating is a big contributor. Do you follow a fixed Apidra dosing for each meal (12 for breakfast and lunch and 14 for dinner) or is it a result of a calculation you do based on the nutritional content? Did you change something in April that lead to such great BG numbers?
I share your enjoyment of red wine. I find that I can't drink it more than two days per week or it totally bounces my numbers. My typical BG pattern after having a few glasses at dinner is a low that I need to treat between midnight and 2 a.m. followed by a rebound high from 3 a.m. through 7 a.m. I haven't experimented with a way to compensate my insulin dosing to adapt to this. I guess I could do a temp basal on my pump (minus 20%?) from 10 p.m. midnight. MDI would be harder.
Thanks for sharing your details.
I do vary my Apidra but the variance is reduced by using TAG with this diet of mostly proteins and fats. I use 60% of the protein mass and 10% of the fat mass to calculate the bolus but the math says that if I eat more fat I do not need that much more Apidra. For example of a variance, my wake-up shot of Apidra was going to be 14 this morning but for the first time in a very long tem the pen needle got plugged. As I was removing it I lost an unknown part of the dose. My strategy was to wait for 3.5 hours and test. At that point I took an incremental 7 units to make up for the loss. Was still high at lunch an hour later (163). Apidra takes about 4 hours to complete and since I knew I still had most of that 7 still on board I bolused 12 based on lunch content. At 4 PM am now down to 106.
I am sensitive to everyone's caution about everyone's diabetes being different. But I reached a good approach for myself from reading the shared experiences on TU (and paying attention to whatever Holger writes).
For some reason, the 12% alcohol in wine affects me differently. I sip it slowly over 4 hours while reading my Kindle. Maybe it is the reading or that fact that I am Irish?
Sounds like you have an effective understanding to how your BG metabolism works. I also use TAG to calculate my meal doses. I use 50% for protein and 10% for fat. I deliver that protein/fat bolus over time using the extended bolus on my pump.
I'm not a big fan of the "your diabetes may vary" philosophy. While I don't dispute its truth, I'm not very interested in how my diabetes varies from yours. I'm more interested in what we share.
I learned a lot on the TAG and flatline groups here. The TAG dosing, in particular, is one of the most useful BG control tools I use. If I didn't monitor what others were doing and place more belief in our shared characteristics rather than our differences, I'm not sure I would have ever discovered TAG on my own.
Your pen needle misfire is just another example of how many ways we can be knocked off balance. Nice recovery!