Hello there,
Just started using the Tandem insulin pump 2 weeks ago. My sugars are still crazy as I figure out the right settings/insulin doses. One important thing I hear is to get the Basal settings close to correct. They say start with the overnight basal. Started out with one setting and it seemed to be too much as bs went down 70 points in 1.5hrs and they say it’s not supposed to go down even that much all night? Cut basal in half and still went down a lot but now doesn’t barely go down at all overnight, and some nights it goes up while other nights goes down then up again. …How long did it take you to get your basal settings ok (overnight and during day)? I know blood sugars always change with different factors, especially for me…It’s like hitting moving targets :/…And what’s your secret for good sugars after eating carbs without taking too much insulin that it goes low?
Hi. I’ve been using the t:slim since mid-January & love it so far though my bg are worse. My endo adjusted at the last visit & i see her again next month so we’ll see. That brings me to the obvious question of are you working with a doctor? When i got my pump, the CDE needed orders & settings from the endo before we could get started. So i’m worried if you’re doing this yourself.
Some of the veteran pumpers have posted on another thread how to calculate your basal rates & how to adjust. I hope you will find those threads. And as for the secret to good bg after eating carbs, the pump should be programmed with your insulin to carb ratio, which is how your pump delivers the right amount of insulin based on your carbs. I keep my pump set to carbs so that it calculates based on what i eat. Others keep the pump set on insulin units which means you have to do the math yourself (like you did with injections).
You’ll be glad you found TuD and i hope you will take a stroll through the topics & threads. I’ve learned a bunch of great info to help me get a handle on my bg.
Don’t know how helpful this was 
It takes time to get everything right. And then it changes. The book “Pumping Insulin” by John Walsh is full of good advice. If you make your changes based on a week or two of data, you can get a better idea of your averages.
Getting the pump basal rates close to what your body actually needs is a worthwhile effort. I’ve used Gary Scheiner’s basal testing protocol successfully. Working your way through this method is not fast; I think it took me two weeks to get my basal rates close.
I say “close” because that’s likely the best you’ll be able to accomplish. As you wrote above, dealing with diabetes is “like hitting moving targets.” If you study insulin dosing and pump therapy much, you’ll find several useful formulas including: insulin to carb ratio (I:C), insulin sensitivity factor (ISF) or how much one unit of insulin will lower your blood glucose, and duration of insulin action (DIA).
All these formulas may lead you to believe that your job is to find the perfect set of formulas for you and life with diabetes will be perfect. I’ve discovered, as have many others, that the formulas can only get you close to what you need and sometimes they don’t even do that.
But getting close to what you need insulin-wise is a great goal. Because once you’re close then you can close that gap with some real-time micro-moves that can nudge your blood glucose into a nice blood sugar range, within your target with low variability. T1D and endocrinologist, Stephen Ponder, wrote a book about this very topic, called Sugar Surfing. Once you start to master basic pump tactics, I’d highly recommend reading this book.
If you follow the link I posted above to Gary Scheiner’s Integrated Diabetes website, take a look around. Gary has written several books about diabetes and lives with diabetes himself.
An insulin pump is a great tool but, in the end, it’s only a fancy syringe. What matters most is what you know and how you use that knowledge for your benefit. Unfortunately, diabetes is forever, so you have time to learn how to deal with it. Learn something new every day and you’ll be surprised at the knowledge you’ll gain over time.
Good luck and please give us an update from time to time.
Hi there,
I am working with a Dr. and nurse educator. She set my basals and settings and the first several nights the overnight basal was way too much, as it brought bs down almost 100pts in less than two hrs. They said it shouldn’t budge + or - 50 pts all night…so thought that was too much. So cut basal overnight in half which still proved too much for a few nights and covered some food…Now it’s proving not enough as my sugar rises towards the AM so am slowly increasing it closer to original dose. My other settings like correction factor work sometimes not all the time like it is set. And the food ratio works sometimes too when tested separately. When put all together, the doses don’t really work. It is so frustrating and causes high stress b/c if I add any other factor like exercise (haven’t been exercising b/c would cause sugars to crash, then would take less and it would be too high later), even a little exercise makes me much more insulin sensitive…And I’ve had such bad reactions with Lantus AND humalog after eating, where bs would crash up to 30 pts a minute!! So scary, it made me afraid to eat and/or take insulin. So am trying to take baby steps to adjust each insulin setting but I think I might need much more time to work with the current settings of all the doses so that I don’t get even MORE stressed…My diabetes has caused me to have to leave jobs and school Has it ever caused that for anyone else? ALso work places didn’t really let me take care of my sugars like I should…and gave me trouble about eating :/…
It’s been 10 years and I’m still trying to get my basal and carb ratios right, as is probably everyone on this forum! The pump can’t replace the ability of the body to adjust to different insulin requirements that happen on a second by second basis… yet. Maybe the closed-loop models coming out are closer to this goal! In the meantime just keep trying to make adjustments and know that just because you have it right one day doesn’t mean you will have it right the next. The two biggest variables I find are the stress you are encountering in your life at the moment (which causes the liver to dump glucose at different rates, messing up your control) and the placement of your infusion site - some sites just work better than others and you have to adjust sometimes after changing it. Also remember if you’ve eaten within a few hours of going to bed there may be active insulin from your bolus bringing you low, and it may not be your basal. As for your carb ratios try to eat foods that you’re familiar with and make adjustments through trial and error. Remember depending on the type of carbs you can expect that your blood sugar will rise 1-2 hours after eating and then should be brought back down to what it was before you ate within 3-4 hours. Good luck!
As for your question about leaving work or school, it hasn’t been a problem for me but I can certainly understand it. I was a few days away from writing university finals when I was diagnosed and didn’t postpone them because I figured that would make things even more annoying, but I’m in a unique situation where my dad was diagnosed as type 1 in the 1970s and I had watched him deal with it my whole life without ever letting it stop him from doing anything. I find the key is to realize most people don’t give a crap about your diabetes, even when they feign interest for a few minutes and then tune you out when you start explaining it to them. Most people don’t understand it at all, don’t understand why you don’t just take a shot and you’re fine all day, and don’t understand all the thinking and planning you have to do just to eat or do normal activities without going low or high. It’s a self-managed disease and one you have to constantly be prepared for even by doing small things such as keeping glucose tablets close by at all times, and monitoring your blood sugars and adjusting before every situation. There’s a good interview with Brett Michaels where he says he was told when he was young no one is going to be sympathetic to him once he becomes an adult, so he has to do his best to manage his diabetes himself, etc., or something like that. It’s not always easy though and it makes life and being around other people extra annoying sometimes, that’s for sure!
Hi there, thanks for response. It’s been about a month since going on pump but been diabetic for 20 yrs and haven’t been doing good. Been trying to get my insulin right for that long too w/not much luck! If I eat something one day and take insulin and the results are just ‘ok’, then eat and take the same exact thing another time, with my sugars being about the same at the start of meal, the results are TOTALLY different much of the time…Sometimes it’ll go up a lot by next meal, sometimes down a little but not as much as calculated and sometimes it’ll stay the same…but when I test the correction factor with no food, it can bring it down as calculated , sometimes less and sometimes MORE…but when used in combo with food insulin, never works right…and if I get any exercise, it can work almost twice as hard…but then just when you think it’ll go down when exercising, it goes up, and then next time you say ‘oh last time I exercised it went up prob from the liver secreting sugar during the exercise so I better not take less insulin’ then it bs shoots down and I have to stop exercising. I’m trying to get my sugars better before meals but as a diabetic friend said to me who had same trouble, you can never tell what the insulin is GOING to do or HOW it’ll work so it’s SOO hard to know what adjustments to make beforehand, before you do anything! Eating, exercising, sleeping, stresses in life etc and the more I try it seems the more nothing works…I’m getting to the point where I don’t even want to try anything anymore :(…my diabetic friend said same, that she gave up trying to figure out what do do with food and exercise…but then that’s no good either I’m just nervous taht when I see my Dr. in 2 wks that they’ll make increases all around to my insulin when I haven’t even had much time to work with what I’m doing now…and then I’ll be even MORE stressed out when eating and exercising b./c increased insulin with me leads to sometimes much bigger swings with sugars which is why I wanted the pump in the first place, to avoid the BIG DROPS and risings…Don’t think Dr’s REALLY get that your body isn’t a computer where the same dose and food wiill do the same thing and your sugars will alwyas just be good…otherwise we wouldn’t be diabetic!! Want to get bs’s better but not have it drop another 70pts spontaneously while I’m just walking, (w/no extra correction) if it’s shortly after bolus…I think dr’ s with someone like me who has had so much trouble with insulin/crashing should say consider changing other things than the insulin, like add regular exercise, or avoiding certain TYPES of carbs (do you find different types raise more therefore need a diff ratio?) rather than just saying you need a lot more insulin when that may not always be the case. …Sorry for the novel here! I’m just at my wits end and am only 28 
Thank you for your time!!
Also, thank you I looked at the Brett Michaels interview and it was interesting…he seems to have it down pat and doing ok…It is almost harder mentally than physically…nope nvm, just the same either way…It is uplifting and also disconcerting to hear of other ppl doing so well b/c then I think well maybe it 's possible! But then get sad I’m not one of those ppl…Like you said being around people who don’t care about your disease and how it affects you and ppl that pretend to care but really don’t know a thing about it is hard…My whole family is like that, turned their heads and never said a word for 20 yrs…I just recently mentioned how I’m not doing well and am weary and my relative said ’ they’d have nothing to do with someone who can’t fix their own problems and to get over it and have a nice life"…That was a tad sad to me. So don’t really have much family or friends to speak of :/…Also going to holiday parties is hard with all the sweets/food!! Any tips ? 
Just beginning to read around different topics. Considering switching from MDI to a pump. Link to G. Scheiner’s Integrated Diabetes Website is very useful!
we have lots of interviews with Gary Scheiner in our video archive
I’m curious about your basal settings. Are you getting the same amount of basal every hour overnight? Have you discussed Dawn Phenomenon? Do you have a CGM?
FWIW - when I started pumping back in the last century 
- pre-CGM, my endo had me wake up @ 3AM to test. That was very helpful. I also agree with @Terry4 regarding Gary Scheiner’s basal testing protocol. Have you tried that yet?
Once you get your basals in place, you can start considering playing around with temporary basal rate settings to help out with exercise. In general, aerobic exercise, running, walking, swimming, treadmill, etc. will drop your BG. As you begin exercising, you may also find a significant basal reduction is needed overnight Anaerobic exercise, circuit training, some crossfit, etc. will raise your BG. A CGM is very helpful here as well.
While there are days where NOTHING seems to work like it did in the past, with experience, you will find that things work similarly. During my initial pumping start-up, I did focus on trying to eat the same foods at the same time each day to reduce the variables. Again, a CGM is an invaluable tool here, as you can see when your BG starts to rise after a meal, and when it starts to fall in response to your bolus.
I have never lost a job/left school due to my diabetes, though I do know that my ability to concentrate was sometimes lacking (mainly due to low BGs). However, I communicated with my professors/managers/team mates and found them to be accommodating in most every instance. I also keep glucose tabs available so I can discreetly raise my BG when trending low.
The truth about holiday parties is… I still have no idea! The food is all unpredictable, all sweeter than you think, and even if you do everything right you will probably still fail. I have yet to get it perfect and just kind of accept that my blood sugars aren’t going to be great during any holiday time, though this year I think I did a little bit better. My best advice is stick with small portions, try to eat things you are somewhat familiar with, avoid anything you know will send your blood sugars through the roof if you can, and probably just be prepared to test a lot and correct! The square/dual wave functions on your pump may be helpful if you’ve tried them, because the problem with eating a lot of food is you’re bound to get a spike later as it starts to digest, even if you had perfect blood sugars right after eating. I agree with you that every day is different and that taking the same amount of insulin for the same meal two different days will give you completely different results. Getting a Dexcom was the most important thing I’ve done since I was diagnosed and the only real way I’ve been able to achieve great control. Finger testing is not enough in my experience - there are so many times I will test before bed and have a number between 4 and 6 mmol/L, only for my blood sugar to start spiking an hour later. I have my ratios and basals as starting points now, but I know every meal and every minute of the day is going to be different, and I expect that and adjust accordingly based on what my CGM is telling me. If you’re able to get a CGM I highly recommend it, though I know they can be near unaffordable and definitely overwhelming at first. If you’re still really struggling you may want to try a very low-carb diet. Even with the unpredictability of stress hormones it’s far easier to control your blood sugars by avoiding almost all carbs. Life would be too boring for me that way though and I don’t think it’s necessary with the technology we have to, but it’s something to consider if you find you’re still struggling. Keep me posted and feel free to message me if you need any more advice, I’m always trying to find ways to eat (mostly) what I want and still have (mostly) great numbers!
Carb reduction need not be extreme to enjoy blood glucose benefits. I found substantial blood sugar benefits when I lowered carbs to about 100 grams per day with more time in range, lower variability and a lower average. I’ve experimented with less than 30 grams/day and now eat in the 50-75 gram range.
Lowering carbs in the diet can be viewed as a temporary personal experiment and any commitment decided later. It’s another tool in the toolkit but one I’ve found to be particularly effective. I enjoy the food I eat and don’t feel deprived.
Hi there, thanks for response…I try to eat the same things all the time, like a stir fry, omelet, salad etc with like one serving carbs or up to 20g ish per meal…Like yesterday, I had a sandwich on lite bread and took a 10 min walk within 1hr after bolus and my sugar went down 100 pts in 1 hr, i got nervous that it was going down that much when usually this bread keeps bs up …could’ve been the small walk but I seem to be very exercise sensitive where any exercise just makes the insulin (food insulin and correction factor) work way harder and I never can tell what it WILL do…so I am almost paralyzed to do anything b/c I got afraid to eat, take insulin OR exercise because of the SEVERE crashing…Today I had the same bread only with a few diff things with it (sugar free jelly, but still had 5 g carbs, peanut butter and a small stir fry with cheese) and my bs ended up 100 pts higher at next meal! thats with a correction too …Soo frustrating!
This leads me to next question…I’m still a new pump user, been on it about 1 1/2 months…and about 7 or 8 times now (thats almost 24 days) I’ve had pump malfunction where the SITE of insertion was not a good site…only I didn’t know it and the pump didn’t give an alarm…just once it gave an alarm…but just yesterday, my sugars had been high for the last 3 days, and I couldn’t figure why so I gave correction doses like around the clock, and sometimes it’d go down and other times it’d stay exactly the same…this got me thinking ‘ok maybe the site is ok since it is going down sometimes, not as much as it potentially could’…but when I changed the site yesterday, as I took it out of skin, sry for graphic-ness! As I took it out, there was a BIG like blob/puddle/bubbles of insulin that came out along with blood…It looked like a lot of insulin…I got nervous and called the company…they said that means it could’ve been a bad site underneath and the insulin pooled under skin for 3 days…and that’s why my sugars were high…HAS THIS POOLING EVER HAPPENED TO ANYONE?? I was soo nervous that all this insulin now would get RE-ABSORBED (like um 80 units worth??) and my sugar would go extremely low…COULD THAT HAPPEN? …NOW, EVERY TIME I insert a new pump site…I’ll never know if it is a bad site (cannula bent in skin etc) or not, b/c apparently even if it is a semi-bad site like yesterday, some insulin can still be absorbed like the last few days and so I might think my sugars being high are due to other things, food, etc…So how can you tell if its a good site??
I find that I try to give now a correction dose with no food to see that bs is coming down at all, then I know at least it’s not completely bent…But the pooling of insulin has me real nervous…So then if correction brings it down somewhat, it could still be a semi bad site and not give enough for the food, so I end up eating no carbs a lot, not eating to a meal at all to see if correction works or eating very little carbs which really stinks cuz then you’re hungry!! I am NOT liking this pump so far and it’s given me only trouble since I started…DOes it get better after a while? I see my dr in a few days and they’ll just think I’ll need wayy more insulin for my high sugars but the company said they can’t do that b/c half the times it was a bad site and when it wasn’t i’m still getting used to the tight settings I"m on and could’ve been other factors affecting my high sugars…Also if I add any exercise it changes the whole game (I’ve been avoiding exercise cuz of the extreme swings)
Also, do you cover foods like sugar free jelly, peanut butter, bbq sauce, salad dressings, chocolate (b/c of fat) in small amts, nuts etc? All of which I see raises my bs so I think I’d need to 'cover ’ them even tho dr says don’t , but just use a diff ratio to give less insulin for those foods? Also how do you cover things like fruits (which doesn’t raise bs for as long as like say bread?), mixed carbs at a meal, and sweets (which might need a tighter ratio?) whew! Thanks! I have more q’s for another day lol! I’m just having such trouble with no one to really talk to and the Dr’s don’t help sometimes
With regard to your occlusion–I have the Tandem X2 pump. You will find a lot of threads on Tandem occlusions here and everyone seems to have their own home-grown solution. For me two things have helped. One is a hint I found on TU–keep the pigtail (the part between the pump and the luer lock)fairly straight. Do not bunch it up in your pocket. The other hint is to try different infusion sets. Different ones work for different folks. I tried them all and I have the best luck with the contact detach. You need to try different ones to see what works for you. Your trainer can send you some samples of other sets.
The other thing with Tandem, talk to your trainer. Mine has been so helpful at working through the occlusion problems with me and answering millions of random pump-related questions. So use him/her. I would talk about youe frustrations with that person. He/she is there to help you learn how to use the pump and they expect it to take months to get the real hang of it.
My trainer helped me figure out and set up different profiles for different types of exercise because, yes, exercise really impacts blood sugar. A lot of it is trial and error. You make your best guess and then adjust. But the pump allows for different profiles with numerous settings on each profile.
It also sounds like a certified diabetes educator would be beneficial to you. Is there one where you live?
As far as which carbs to count, I count them all and dose for them all.
I’ll try to address what seem to be your 3 main questions:
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Exercise
This one is really tricky and I still haven’t figured it out perfectly. My best advice is to stay away from exercise following a meal, even though that sounds counterintuitive, because you will have a large dose of active insulin in you that will be absorbed really quickly and bring you crashing down every time. Of course, I’ve been diabetic for over 10 years and I’m still not good at following this advice. Yesterday I ate a bagel and then biked 21km. I dropped to about 2.2, but had glucose tablets on me and lows have never been dangerous for me luckily. Before you do any exercise, take a look at how much active insulin/insulin on board is showing on your pump. If you have any at all I would wait till it clears out. Then lower your basal (try 50% at first and try something else next time if that is too much or too little) about half an hour to 45 min before activity and for about the duration of the activity. See if that helps with lows. Honestly I still need to down glucose tablets or gatorade every time I play sports/exercise and I’ve just gotten used to it. -
Bad sites
I still have problems with these now and then, and it’s definitely the most frustrating thing about pumping. What type of infusion set are you using? I was using a straight set for a while and was having way too many occlusion alarms where I would remove the site and see blood just like you are describing. I’ve found an angled infusion set to be better, are you using or have you tried an angled type? I think you will learn as you go which areas of your body work well and which don’t in terms of absorption consistency and occlusions. Try different places and experiment. -
Carb counting
I’ve never found doctors or dieticians to be very helpful with this, and had to figure most of it out myself through trial and error. Sweets and fruits are the hardest things to bolus for. I don’t low carb or eat any particular diet but I really don’t drink fruit juices or regular soft drinks because I just find it’s impossible to carb count for these things. I do eat fruit but it’s much easier if you have it with or at the end of a meal so that the other food slows down the digestion. For example banana and peanut butter on toast is way easier to eat than just a banana on its own, and you can bolus for everything. I bolus for almost everything but have found through experience there is no need to for a few things. I don’t bolus for the small amount of milk I put in coffee and typically I don’t find I need to for salad dressings or sauces with small amounts of sugar/carbs (they seem to be covered by the rest of my meal bolus). I think you just have to experiment and see what works for you. The hardest part typically is not the amount of the carbs, but learning how slow or fast you digest things and how to bolus for them.
Hi there, thanks for reply.
Yes exercise has always been an issue for me too, where sometimes it can bring bs down, sometimes up, sometimes not budge at all…this is with doing similar types/intensities of exercise for the same amount of time. It is very frustrating! Just like every part of this disease. I’ve read to try to exercise right after a meal to prevent too much of a bs spike after food (but I think this might be more for type 2? As they’re not on insulin and can have such a crashing effect). Sorry I don’t recognize your system of measuring bs? What is 2.2 after you biked? Where are you from? Am new to this site , don’t know if it’s just the US or international? …I agree with you saying wait til the insulin on board is done to exercise, but then I’ve read and experienced that if you have no insulin on board, bs can go up with exercise.?? It’s so hard to always predict predict predict WHEN and HOW MUCH or IF bs will go down …just when you think it’ll go down it goes up, then you think you need more insulin next time to cover that , then it crashes I haven’t had it go too low with exercise in a long while b/c I have to keep it so high because of the extreme crashing it has done (up to 30 points a minute!!) SOO scary, and it just makes you want to not exercise at all…This has been the way with eating and taking insulin too…The SAME foods and amounts of foods will have TOTALLY different one day than the next, like 100+pts difference
THis makes it look like you need much more insulin but might not be the case b/c it can react so fdifferent.
Do you bolus/‘count’ carbs like sugar free jelly, peanut butter, carrots, tomato sauce (can be 15grams/serving), say like cocoa covered almonds, bbq sauce etc? My Dr. yesterday said don’t typically count those things, but if you have several of them at a meal it can add up to an extra 20g’s or so…And would you bolus for them with the SAME RATIO as say a piece of bread or pasta? I think I should bolus for these things but perhaps use a looser bolus ratio for them ?? I see a nurse educator too and she said don’t really count them but I see that they can impact my bs…
SHe also said don’t change insulin/change profile for exercise or take less?? SHe said just lower basal but that seems like it wouldn’t be enough??
I am just at my wits end, I barely eat anything and bs are all over the place…I don’t know why this is happening to me, when I was younger it didn’t do this AS much…I can’t take this disease anymore and the more I try the more it seems backfires with negative or ERRATIC results…One thing is that my nurse wants perfection and makes me nervous when wants to change insulin doses so much/often. Can I say not now???
Tandem didn’t give me a trainer, they said talk to my nurse educator, whom I saw yesterday and she said to call Tandem…I get the run around. I use the t-90 infusion sets and it’s given me trouble and now Tandem said even if its a partially bad site, bent a little, it wont give you an alarm and I might be getting some insulin , not all. Perhaps this caused the pooling/bubbling of insulin that came squirting out when changing site…That was scary b/c I wasn’t getting my full insulin only some so my bs’s were high and i thought it was waht I was eating and needed more insulin. The dr’s aren’t listening really to the problems I 've been having and need to give me a lot of time to work with this! Then if insulin does pool under skin/come out after taking out site, HOW MUCH did I not get and can it be reabsorbed??? Tandem said maybe and which is VERY dangerous b/c now you don’t know HOW MUCH or when it will go back in your system?!!
The pump so far has been even more stressful than the shots! Thanks for your time though everyone , appreciated!!!
Hey, I’m from Canada and we use a different measurement system up here (mmol/L instead of mg/dl). You can convert it by just multiplying by 18, so by 2.2 I meant about 40. I agree you shouldn’t exercise with no insulin in your body, but this is different from how much insulin on board the pump display since insulin on board only counts boluses and not your basal insulin. So basically don’t disconnect your pump if you are exercising since then you will have no insulin in your body and will definitely have big highs, but do exercise with your pump connected and receiving some basal insulin. You have to experiment with how much to lower your basal by and make sure you do it 45min to an hour before exercising, or maybe even longer, as it takes time for the basal insulin already in your system to clear out. Also, you may find that after intense exercise you will start going high within an hour after finishing, as your liver starts dumping glucose. I think you just have to experiment, see if this is the case for you, and counter it by increasing your basal the minute you are done. As for preventing spikes after meals, exercise can help with that but intense exercise will bring you crashing low. Just try taking a walk after eating, and bolus 20-30 minutes before eating which is more important for stopping those nasty spikes.
I try to count carbs for everything I eat, but carb counting isn’t an exact science. You have to learn how your body handles certain foods and the only way to do it is through trial and error. Pasta sauce will definitely require insulin, but the pasta will probably delay the digestion of it and if you bolus for it all up front it you will probably go crashing low (and then very high later). You need to take some of the insulin as a regular bolus and some of it spread out over a few hours (it should be called extended bolus or something like that on your pump). You may find this is the case with many foods, and how much you should take up front and how many hours you should extend it for you will only find out through trial and error (and it can be different every time I’m afraid). Things like pizza and pasta and foods with sauces are very difficult to eat and bolus properly for. You may want to try simpler foods until you get the hang of your pump, but then again experiment and go nuts!
The t-90 is a straight set, just like the one I was having trouble with on my pump. I recommend trying an angled set (I think it’s called the t-30). I don’t know what your body profile is, but I’m pretty lean and found 90-degree sets would give me all kinds of problems. I still have problems now and then with the angled sets, but they work far better for lean people I think.