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It took me almost half a century to work out how to remove hypos or low blood sugars with symptoms. To stop lows I had to remove VARIABILITY, and to do that I first stopped eating out of turn, and by that I mean I only eat at meals. I don’t have drinks full of milk with variable digestion from day to day (with gastroparesis). Eating fairly routine meals also put the last nail in the coffin for low blood sugars. Now I have straight flat even blood glucose day in day out. It wasn’t until I started to look at myself with a microscope that I realised much of my eating was done from boredom or anything but nutrition even though I didn’t have an eating disorder as such I realised almost everyone around me did the same. In any case if you want to remove roller coasters or what seems like random lows then I can attest to removing variability. I want variability in my life not in my diabetes control and almost 50 years of type one I’ve had a lifetime of that.
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I started my diabetes journey when finger sticks were just starting and multiple injections with regular and nph insulin was the best we had.I controlled my diet because I had to, when I didn’t I felt sick.when I started pumping, I was told now you can eat as much as you want whenever you want and I did that to an extent and it was liberating, but then I quickly realized that I shouldn’t be eating whatever I want and no one should diabetic or not. Pumping gives me flexibility where I can eat at different times and I can even skip a meal, but I’m pretty sure I wouldn’t just eat everything even if I wasn’t diabetic. I think most people are creatures of habit and if you are in the habit of eating poorly you will likely continue, but if you eat healthier, you are also likely to continue it.
It bothers me when I still see advertisements for different diabetic solutions that tout the “eat what ever you want” mentality
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Update:
I get more disconcerting hypo symptoms from a rapid drop within target range than I do from a gradual fall below range. I started with a CGM because of my concern over nocternal hypoglycemia. I started with an augmented pump so I didn’t need to worry so much about drifting low.
I haven’t been below range since I started with the T:slim pump in April 2022. I did have drops before meals that fell below my personal low range limit of 75mg/dL and concerned me until I saw that they were consistently leveling out and rising.
I changed my pre-meal bolus time from 15 minutes and made one other very important other change.
To flatten my curve, all my premeal boluses are now extended boluses.
I made this change after experimenting with extended boluses to figure out how to shape the delivery curve to match-the meal content and compensate for any correction needed.
My numbers below are based in hundreds of tests with my weighed and known content hime prepared meals. They are personal, and can’t be directly applied withiut adjusting for what anther person eats. But they can be used to indicate the direction of changes needed to accomodate changes in meal composition.
For me the rise of a single bolus of Novolog was too fast and the peak too soon to closely match anything but a correction or high carb/low fiber content meal. I was dropping quickly before any meal that I couldn’t start eatting exactly on time and running out of bolus for fat and protein “heavy” dinners. My dinners are normally low fat with 3 oz of protein. Adding 28 g of cheese or 55g of lean meat are enough to make that dinner high fat or protein for me.
If I’m pretty sure when the meal will be served, and the content isn’t high-carb, or fat- or protein-heavy, I use a 30 minute window with no initial bolus. This makes the Novolog action more closely match the curve of the Novolin I used for many years without premeal hypo.
If I need a +correction, I make that part of the initial bolus.
If a meal is fat- or protein- heavy, I use a 45-60 minute window.
If a meal has very easily digested carbs, I increase the inital percentage to include the correction plus 20% if the meal bolus and reduce the window to 20 minutes.
This would be too complex for someone who eats spontaneously to get great control, but, imo, it’s less likely to result in hypo than single boluses at guestimated lead times, and anything that can flatten the curve is an imporvement.
To get great control without micromanaging a pump or many corrections, you would need to know what you are eating, be very good at calculating portion sizes, or both. I and my wife are lousy estimators, so we read labels carefully and weigh/measure everything every time.
This is working well for me. My curve is much flatter, with SD <15% and my average lower, ~125 mg/dL. My first year target was an A1c of 6.0 with TIR >97%. Now that I’m meeting it consistently and safely, I can consider a lower target, like 5.8/120mg/dL.
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