Never say "impossible"

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1

This is yesterday. I don't know if I can do it again - but I didn't think I could ever have a 24-hour period as good as this. So who knows?! I'll definitely be trying for a repeat today!

This is with eating three meals yesterday (breakfast, lunch, dinner - a total of 100 carbs), no exercise (but I did exercise the few days previously), pre-bolusing for everything by 30-45 minutes, no high GI foods (although I did eat half a cup of quinoa pasta, not sure of the GI on that), and having previously basal tested from overnight until noon. Before bed I ate half a glucose tablet, and at 4am I ate half a glucose tablet, but that's all the "low" corrections I needed.

I was sitting around all day yesterday doing noting, so this may be more challenging on a normal day, but since in the back of my mind I didn't really think I'd ever do it, the fact that I've done it is incredible. And, I am during the period when hormones are wrecking havoc and making me high, which makes this even more amazing!

My alerts are set to 4.5 (80 mg/dl) for low and 8.0 (145 mg/dl) for highs. The high alert was set to 10.0 (180 mg/dl), but I lowered it yesterday because I was doing so well.

Yesterday the highest I hit was 6.9 (124 mg/dl) and the lowest was 4.6 (83 mg/dl). This has to be the most stable my blood sugar has been since before I was diagnosed over 23 years ago! I questioned whether the Dexcom was accurate so tested throughout the day. According to my meter, the highest I tested at was 7.6 (137 mg/dl) and the lowest was 4.8 (86 mg/dl).

And now, to see if I can make something similar happen again.

A 24 hours of staying between the lines

2

Wow! This is a great line. Doing this once means it's within your reach. I'm such a fan of CGM use. It provides critical feedback to educate the wearer how her body responds to real world inputs like insulin, food, and exercise. Seeing the results allows us to make adjustments that make sense for our individual needs.

Jen, with all the struggles you've experienced, this has to feel great for you! Every day won't be as good as this but you've now proven to yourself that it can be done. Powerful.

3

I went without the Dexcom for a week between the trial unit and my own, and my blood sugar was insane (like hitting 17-25 every day!). I think the Dexcom is life-changing. I don't feel high or low unless I'm pretty far out of rnage, and I think that's part of my problem when I don't have the Dexcom. As well as getting the feedback you mentioned, which is amazing. You're right, before I always sort of counted you and AR and others in "another league" compared to me because I felt like I'd never be able to do it. Well, now I've done it once, I just have to figure out how to do it a majority of the time!

4

That's awesome, Jen! I am so happy for you. I am feeling sooo much better, as well. Keep us updated. I'm getting stability like I have never seen before after splitting my Lantus. Is this after you moved to a single Lantus dose after getting off the pump, or are you doing two shots, like me, or are u still pumping? The data looks soooo good!

5

Still pumping. I would never give up my pump! However, it might be interesting for me to do a pump vacation and see how Lantus is for me. My pump has six basal rates that range from 1.0 to 1.5 units an hour, and part of how I've moved towards this is by using temporary basal rates when I exercise, so not sure how well Lantus would work.

(Ironically, just now my low alert went off. I posted that picture just in time!!)

6

I'm happy for you. This may be a turning point for you that you'll look back on and refer to things as before and after your CGM adoption. I look forward to seeing more of your flatlines, Jen.

7

That graph is a thing of beauty, Jan.

Do you attribute this achievement to having a CGM? Is that what made it possible?

It is certainly the most important tool in my arsenal, after insulin itself, of course.

EDIT: Never mind, just read your reply to Terry (I suppose I should read the whole discussion before popping off :-))

One of the biggest "adds" the CGM gives me is the ability to do something about a high before it gets to be a bad high. With just a glucometer, you only know your BG is getting out of control when you either feel like crap (by then it's too late), or you happen to "spot check" at the right time and get lucky.

With the CGM, you see it as it's evolving, and can take action.

The other big difference the CGM did for me was giving me valuable information to make earlier pre-bolusing less risky. My pre-bolus advance varies between 30-45 minutes, based on some juju with my body that only a certified witch doctor understands, and they're not sharing their secrets.

So, some times 45 minutes ahead is just fine, others I'm start to fall by the 45 mark. If I was doing this blindly, I'd have a lot more true lows, or worse control (backing off on pre-bolusing to avoid the hypos).

CGM allows me to "pre-correct", and keep things about 65. When I do this, I just pump another drop or two of insulin to make sure I've accounted for those carbs.

CGMs take pre-bolusing from a game of chicken to a process with workable stimulus/response.

There's that engineering control loop we're talking about in that other discussion :-)

8

Yes. There is no way I'd have accomplished this without the Dexcom for the past 4-6 weeks. It's 100% worth the money I'm paying for it!

9

I've been off the site for a while, I thought you were considering changing because of infusion set probs or concern over scar tissue or something. I do remember your six basal rates. Glad to hear its all worked out. Just in case you ever do have some need or interest in going on lantus, I found two injections of lantus was the only thing that worked, so maybe that would give some additional flexibility. I never knew you could split lantus. My dosages are the same as I started with. So strange! After all that effort, I only changed from a 35 unit PM injection to two 17 u injections.

Yea, I don't know how you work exercise with lantus, unless your like me..and barley anyone's like me with the exercise highs.

10

Yep, when I was on Lantus I started with one injection but then moved to two, and it made a huge difference overall. You're right, I was considering taking a pump vacation a year or two ago, but I've switched to metal sets and am finding that changing them once a day is working out quite well for me.

The past few days have not been nearly as good as the above - yesterday I ranged from 17.9 to LOW - but I'm hoping to get back there again soon.

11

Way to go, Jen! I know you keep a good attitude despite working very hard and getting frustrating results a lot of the time, and you deserve this "reward!"
I'm a big proponent of the idea of "the luck of the draw" being a part of why some nearly effortlessly get flatline results and some always struggle. (because I think it is important not to compare and get frustrated). But I do think it is easy to slip over the line into thinking we are never going to get any better. There is a line that they read in 12-step meetings about "some of us being constitutionally incapable..." I always cringe at that line as I feel all will think "that's me, I'm damaged" and precludes human striving to do better.

You may not stay there on a daily basis, but now you know you have something to strive for and achieve again!

12

Thanks, Zoe! The Dexcom is teaching me so much about what works and what doesn't in terms of my blood sugars. And having days like the above make days like the below easier to handle, knowing that they will only be temporary until I get things sorted out again!! It is still a bit frustrating when I know I didn't rage bolus for highs or overtreat lows and still get results like this, but it'll pass eventually!

I had three days where my blood sugar stayed between the lines constnatly and was beginning to joke that I'd been cured, so maybe I just needed a reminder that I still have diabetes. :)

Dexcom with rollercoaster of highs and lows over 24 hours

13

I think if I had more than the very occasional day like the one above I would feel differently about getting a CGM. Sounds like it has been a major key for you and well worth it for peace of mind.

14

No matter how well one controls BGs, diabetes humbles!

15

Congratulations Jen on your "no hitter" which we all know is difficult to accomplish and very rare (just like in baseball).

16

that is awesome! im so glad youve been able to get your little hands on a dexcom! i hope you can repeat it more days than not-great news and great job!

17

I had to pay for the Dexcom myself - expensive, but totally worth the money if I can make more days like this happen!

18

Congratulations, Jen. I have learned alot from your posts and soooooooo enjoy reading them. I love your positive attitude. I have only been dealing with T1 since July'13, but was 57 at dx.

19

Wow! That's incredible.... What did you eat? The prebolusing by 30 to 45 minutes, risky, but with cgms, you are covered. Quinoa pasta is incredible. We used to use the Ancient Harvest brand and she would have two cups of it and bolus for 50 grams as she needed less coverage for it. Don't know why, it's the way it digested for her. So for 80 grams we only had to bolus 50. No spike later on. Not sure if that is true for everyone. You can eat a decent amount of food for 100 grams depending on what you eat. Don't know if you can continue to do this, but it is an eye opener for those who can adhere to a lower carb diet.

20

I actually didn't find I dropped much prebolusing by 30-45 minutes, I just stayed pretty level until I ate, which surprised me. Quinoa pasta is pretty low GI as it's a seed rather than a grain (I'm avoiding wheat due to allergies, so the only grain I really eat is rice). Since I pretty much never eat out due to a lot of food allergies, I weigh or measure pretty much everything I eat, so my carb counting is very accurate and not estimation.

For breakfast I had toast (brown rice bread), dairy-free margarine, and eggs, which I pre-bolused for by 45 minutes. For lunch I had veggies and dip and a turkey sandwich on the same bread as for breakfast. This is partly why I'm so surprised at my tight control - this is not eating what I would consider a restrictive low carb diet, although it's definitely not eating 80 grams of carbs at a meal, either (all meals were under 40 grams).

After the last few days, where I've tried pushing meals to 50-60 grams of carbs, I really think the 30-40 gram limit is vital for me. You can see from my other graph posted earlier in this thread that yesterday really did not work out for me trying to do that, even with pre-bolusing! Today I also spiked at breakfast (which was 50 grams - I was eating a higher carb type of bread, and even though it was quinoa I still spiked), basically skipped lunch because I was so high (I did eat some celery and dip), and ate a 30 gram, lower GI dinner with a 30 minute pre-bolus and have been between the lines since then until I went low. I've been low for the past hour despite eating four glucose tablets, so I think my basal is a bit too high...