Okay you guys, I could use your help. I've been using Dexcom G4 since Feb 27th of this year. I'm very happy with this step and it has helped me wake up from unnoticed lows. It has helped me dose my mealtime bolus 30 - 45 min prior to a meal, so my numbers do not skyrocket any more.
Now my question is: how can I prevent lows without having extra carbs? The numerous lows make me crazy and the weight comes on just like that. I hate that extra weight! Changing my basal pattern on my insulin pump is a no-no for the lows are not consistent.
Are lows occurring after meals? At same times of day? Are lows preceded by activity? After taking medication or vitamins? Now that I am on pump, the main cause of lows for me are trying a new meal, high activity, or (rarely) a need to adjust my basal rates. Hope you figure it out. The Dexcom is perfect for that.
Have you tried to treat your lows more conservatively? Often we are told to use the rule of 15/15. Take 15 grams of carbs and then test in 15 minutes. But for many of us, 15 grams of carbs might raise our blood sugar 50-100 mg/dl. For lows that occur hours after a meal and are slow moving, I think you can treat much more conservatively with just a gram or two of carbs. I like to use smarties or sweet tarts which come on little tabs that are less than a gram each.
why would lows cause weight gain...? i just use glucose tabs or jelly beans, which have no calories - or very, very few..a juice box has very little calories too. if you're continually going low, fasting, etc...then yes, you'll have to adjust your basal rates (thus, the beauty of an insulin pump). if you're going low after meals, you'll have to adjust your I:CR accordingly. We all have lows, unfortunately, but I just use glucose tabs.
If you're going low after meals, the obvious thing to do would be to bolus less. I'm working on preventing lows too. It is difficult because when I reduce insulin I often spike, there seems to be no happy medium for me.
For me it is impossible to find a proper bolus amount. If I bolus enough to avoid an after-meal high then I go low 90 minutes after the meal.
I decided to split all my meals into half. The second half I eat about 90 minutes after the first half. With this strategy I don't gain weight and manage to keep the after-meal peak below 120.
I agree with Brian about the amount of carbs required to treat a low. I read recently 1 gram of carbs raises blood sugar 4 points. This is where the 15/15 rule comes from. The ADA likes PWD to have their blood sugars routinely at 120-130. So if you're "ADA low" or 70 mgs/dl or less then the 15 grams of carbs will bring up your blood sugar by 60 points. So a single glucose tablet 4 grams of carbs will bring you from 60 to 76 or 70 to 86. It has 15 calories no fat and doesn't taste good enough to actually indulge in more than the bare minimum necessary. Do some basal rate checks, see when the lows happen and try your best not to over treat them.
I agree, treating lows makes you gain weight--carbs are stored as fat. I use Sprite (any soft drink) but only the exact amount I need to get back up to MY normal (which is 85--no idea what the ADA has in mind but sometimes they lack insight...). So for me that would mean if I am at 50, I need about 4 oz. of soft drink to come back up to 90. This seems to work well. I find that Total Available Glucose (blousing 100% for carbs, 50% for protein, and 10% for fat--and extending the protein and fat bolus) is a lot easier to work with, which means my basal rate can be much lower. Many fewer lows result for me.
I don't think that it's just the low treatment that can crank up your weight but, if you're running low all the time, you're sort of running your insulin, maybe basal, maybe bolus, a bit 'hot', a smidgen more than you need, which will push you to eat more than you "need." The balancing can be very tight and even a small amount of more insulin than you need, maybe try to push your ratios/ rates a bit lower, sometimes a very small bit and see what happens. If you can get by without snacks, try and see what happens. If it works, keep at it and see what you can do!
that sounds like a plan. Isn't it too much of a hassle to split your meals? Do you find the time to do it? How about the mealtime bolus (I do mine 30 - 45 min before my meals).
Thank you. Last night, I lowered my basal pattern just a teeny bit. Let's see what today does. Included, there's the graph of my work day yesterday. The red plus signs are, when I temporarily put my pump on 0% delivery for half an hour. Most of the times, that does not cut the deal. The bread symbol shows my meals and the snacks because of lows. You can see I bolus half an hour before my meals. Thank you all for thinking with me.
You are dropping almost every hour or two and it looks like you would run continously low for hours if you didn't eat. Sure seems like you should decrease your basal rates and as Acidrock says, a small amount can make a big difference.
Actually, my theory is that "overtreating" lows can make you gain weight. Extra glucose is converted to triglycerides which become bodyfat. A conservative treatment of a low will raise your blood sugar only to a normal range, you won't have extra glucose and you should not gain weight. Well, that is my theory.
And I agree with you, I bolus for protein as well (although not fat). Others such as Bernstein also suggest that you bolus for protein. It makes a big difference when eating a low carb meal.
I looked at your graph. It seems that your basal overnight is keeping you right on target, is that right? If that is correct, while you might have some daytime basal adjustments that are needed, the real problem is that your mealtime insulin is probably too high.
Look at the pattern. Breakfast, start with a normal number, you bolus a tad late, so you go a tad high, but at two hours you are low. And then lunch, you bolus and then by one hour you are low and have to suspend. I don't see dinner, but I suspect it is the same problem. It really looks like you are taking too much insulin for the meals that you are eating.
I would really recommend that you review your ratios for meals, check the duration of action that is in your pump and then do some specific tests to calibrate your ratios. The book "Pumping Insulin" by Walsh might be very helpful.
For breakfast I bolus for a whole bagel but eat only half. 90 minutes later I eat an apple or a banana. Not much of a burden. In fact, I am looking forward to the snacks. How long I have to bolus before meals depends on the time of day and glycemic index of the food. For breakfast I bolus about 20 minutes ahead. When I eat a slice of Costco pizza for lunch I bolus after the last bite.
actually, isn't it too many highs cause weight gain...theory being, you're taking insulin, not the right amount, obviously, and thus causing insulin resistance, thus weight gain. i've never heard that extra glucose is converted into body fat. just take glucose tabs, if you're low. we need glucose and to eat when we're low.
I found when I was taking too much insulin and having a lot of hypos my weight ballooned. Since I got off the f&%&ing sliding scale of insulin, and started counting carbs and tailoring the amount of insulin to what I was eating, I have managed to lose almost 40 pounds. If there is too much insulin, you constantly have to feed the insulin. I never became insulin resistant but I was always overdosing and causing lows. It may work the same way on the hyper side as well. Although I would think if you take too little insulin and go hyper you're more likely to get into the DKA range and start peeing away the weight. I think this is the kind of thing diabulemics do to lose weight.
yeah...i think it's trying to find that 'correct' amount of insulin, too much or too little I think can cause weight gain - or for me it's more like water retention, that's what I'm seeing. too little and, if you're high, but not high enough to cause ketones - dka, then you're just taking insulin and it's not moving into the cells (or whatever it's supposed to do) and moving excess glucose out of the body (often causing insulin resistance), too much and you've got all this extra insulin floating around, where does it go? how's the POD? I start mine again tomorrow...waking up to another 200 this morning..ugh! Can't wait! hope you're well, clare.
I think this advice from Brian is right on. I would begin with adjusting the meal bolus and ratios. That is assuming that basal testing has been done. If the overnight it fine, then maybe the day time could be tested.
thank you! I will look into that. Keep you informed on the results. Today, I used the Temporary Speed reduction on my insulin pump several times... that says it all I guess.. and I was still running low.
