Nicely done @2hobbit1... Coming back to this group has made a difference in my lines as well.
hobbit - I just went through discovering how to post my lines here from the Dex Studio software. I use a Mac computer to post to the website but use a netbook PC running Vista to upload from my Dex receiver.
I can give you detailed directions for this setup but am not much help with other operating systems. You basically want to create a jpeg file of a portion of your Word file.
I go from Word to pdf, then take a "screen shot" of the part I want to save and then "export" it. After the export, it opens in another window that permits saving as a jpeg. A bit of a tortuous path but at least it works.
I figured it out by googling "create a jpeg from a Word file." Let me know if I can offer additional help.
ok lets see if a pdf will load, if not ill be trying Terry's word to jpg suggestion.
If this works will be my last 14 day composite
Yes!!!
hobbit - You have great control! With 92% in a 70-130 target range and only 1% low, that's quite an accomplishment. Have you had diabetes very long?
Terry,
I'm fairly new to D compared to some - T1D was my surprise 60th birthday present. Have been using the G4 for 10 months and the tslim for 9 months. Think I have some residual pancreas function still since I do not tend to go below 60 unless I really goof up on my dosing. I'm ICA positive but not GAD, and have a low but not absent c-peptide. Endo codes me as LADA, treated as T1, but I was in DKA, with 480 BG at dx and had totally normal numbers at workplace health screenings just 6months prior. Work with kids so lots of fun viral exposures over the years.
At this point if I splurge on flash carbs(party time/night out), or do not get the timing or carb count right I will be up over 250-300 in a flash, if I do not stay on top of my G4 trends.
The micro delivery from the tslim seems to work very well for me. I don't need a huge amount of.insulin, had to get my team on board for the U-50 novolog and the slower trickle absorbs well for me. I found that the change from MDI to tslim required a 50% drop in insulin when using a slant set, not the 25% I was initially set up for. The first day was an adventure to say the least. Straight set don't work as well for me- need about a third more that I'm currently using with my comfort shorts.
While diabetes was a rude discovery at age 60, you have been saved the long-term effects of elevated blood glucose. Your low-dose diluted insulin regimen with attendant great control will go a long way to extending your remaining pancreatic function. In short - bad news but it could have been worse. Your aggressive and vigilant response will make your life better in the long run. Good luck! I look forward to many good reports from you on this site.
Thanks Terry, While my planning for retirement has changed fairly abruptly due to my bday present, I am thankful that I have not needed to deal with it/complications over the long term. I am blessed to work for a pediatric healthcare provider who recognises the importance of preventive medicine, and treating chronic conditions aggressively up front rather than paying out long term for complications. Will probably need to delay my retirement since Medicare does not cover D stuff as well as my employer does especially since Medicare is not currently covering CGMs.
Will need to be stocking the shelves, and do not plan on retiring until I can get a dual channel pump. Want to retire in with my third pump.
My current focus is on how to work in the hard core exercise piece of the puzzle. One of the reasons I went to the U-50 was that when I go hiking/backpacking now I have crash and burn lows that I have trouble keeping on top of, on what was a easy hike in the past. If I suspend basal to help then I get a big time liver dump...still need a trickle of basal. I have been using the climbing effect to help control post meal numbers, but when I'm on the trail will not be as easy.
Will be heading to the Franconia Notch are of NH for this summer's vacation, and have a AT and Pacific Crest through hike on my bucket list - even if I have to do it in pieces.
hobbit - I was lucky enough to retire with full insurance benefits until Medicare age. I, too, am worried about paying for CGM sensors out of pocket once I reach age 65.
You will benefit for taking aggressive action now with your BGs. More than once I've seen reference to the long-term protective effects of post-diagnosis BG control period, even in cases when a subsequent period exhibits worse control.
With regard to your backpacking lows, have you tried turning the pump basal down to 0.025 units/hour? It's the smallest amount that current pump technology can deliver.
Good luck with your planned summer hikes. Exercise is so important to maintaing good BGs. By the way, I hiked a 150 mile stretch of the Pacific Crest Trail when I was 19. Not sure I could do that again at this age, with a 60 pound pack!
Terry,
Envy your PC trail experience. Have done several sections on the AT over the years, a lot of weekend segments, and 1-2 week sections, some solo with pup for company. All at that point was done BC - before child - have done lots of day hikes/weekend trips AC with multiple summer's in the White Mountains. Now starting to revisit the old haunts with grown kids. Lots of fun memories revisited for all involved. Now trying to work in the now D with pump piece.
One of the reasons I've gone to the U-50, and may try U-10 on hiking trips, is my low insulin requirements and the tslim quirk of needing a minimal 0.1 basal rate. It can do .005 increments but needs the 0.1 minimal rate. That tidbit did not register when I was making pump choices since my basal on MDI was not that low. I played with stutter pumping, as in on/off rates to get lower averages, but had just started pumping one week before heading off to the Whites for vacation last year, so not a lot of hiking experience on pump. My agreement with pump team at the time was to cover exercise with carbs since I was so new, but it was very hard to do at the start of trip. Was a little better by the end but was using standard U100 at that point. Had a lot of fun with white knuckle driving through the NYC area driving my BG through the roof on trip up and back.
I can see with my day to day on U50 that i will drop/control a post meal spike by climbing the stairs from cafeteria to 5th floor. When hiking I did the equivalent of 100 floors in a 4 hour walk, so will still be a learning curve. If I go to U10 on hiking days will be able to run much lower temp rates that might work for mountain hiking.
For those who are interested/need diluted insulin novonordisk makes a diluent for novolog that you can get your endo to order. It is shipped to endo office only, then you need suplies to make the dilution. I get my endo to write for 5cc syringes and needles so I can make the diluted insulin. U-50, and U-10 are easy to make and fairly standard in the pediatric population. I was fortunate to work with that population so had resources to connect to with questions about what to get my docs to order to get correct diagnosis, and then how to work with my low daily TDD/very kid similar doseing requirements, especially as i tried to get back to my normal exercise/strength training routines. Not something that most adult endos are experienced with.
From what I have seen in the year if been using the tslim I do not regret my pump choice, have been able to adapt to U-50 pump programs, have my U-10 programmed already set up for summertime hiking vacations. With the tslim micro delivery have had no fears of accidental overdoses due to pump malfunctions. In fact the microdelivey has helped me stay on top of my Dex G4 trends - I get better control by running higher temp rates matched with extra bolus insulin when I splurge/go off track as life happens.
I had an interesting day yesterday. I have the Tour de Cure in 2 weeks so I had to do a long ride this weekend and, since it was a beautiful day yesterday, I figured I’d get it done! Unfortunately I woke up at 250 and was like $%#& but decided to do a couple of U IV to fix it rather than wait 4 hours for a CB to work. My pump calculated 4.5U to correct that mess so I shot like 2.25-5ish U and made coffee pumped tires and was down in the 90s c. 45 minutes later, had some breakfast and was all set.
More getting ready, some downdrift to around 70 so I had some more snacks, apple and milk, nothing too heavy, and set off. I had 2x bottles, one w/ 30G of Gatorade and one with 40, figuring if I blew through the 30, I’d want to be sure I had enough carbs. I also had 2 bags of Smartie Beans and a spare bag of some leftover Skittles from when I’d run out. I brought lunch, a peanut butter sandwich on Ezekiel bread, about 30G too.
The ride was fun, no BG adventures, a few navigation adventures. I wanted to ride out 37.5 miles and then back to get 75. about 32 miles, I popped out of the woods and saw the town my friend’s bike store is in, the friend whose team I’m riding the TdC with, so I figured "well, it’s just over there, I’ll just mozy over, but some navigation adventures followed. After I found my way there, I ran into her, her husband and the race director, who was getting her new bike for the ride today, “Bike the Drive” in Chicago so I was glad I found my way there. Then, like the hobbit, I was back again. The return trip was up and down, some cramps in my thighs so maybe need to hydrate more next time. I kept to 13-14 mph average which was where I wanted to but then, perhaps as I brought my HR monitor along, my Garmin ran out of juice at 64 miles, still with a ways to go! I think I ran my BG down as I was concerned (for no reason…) about running out of carbs…) and I was 40 by the time I got home, no wonder that last hill was rough.
Last night, we rode over to our friends’ house for a grown-up game night, with Cards Against Humanity and boozed it up, wine, beer and Wild Turkey and a fun bike ride home. I was glad to see the tasty BG this AM. I should probably try to do that every weekend?
@hobbit - I'm surprised that Tandem chose to place their lower basal limit at 0.1 units/hour. Animas and I believe Medtronic both use 0.025 units/hour as their minimum basal rate. You've developed a sophisticate work-around with your dilution system. Are you ever afraid of miscalculating/mismatching the pump and dilution combination?
Hard and sustained exercise is really a specialty when it comes to dosing insulin. It seems like you have a great understanding about what to do. Acidrock, as you can read below, also knows how to deal with long duration exercise.
Your staircase routine at work reminds me of when I did the same thing at work before I retired. Timing that kind of routine with peak insulin action is really effective.
I'm glad to read some good reports, like yours, on the t:slim. I was tempted to buy that pump in December of 2012 but they had a no trial/no money back policy that prevented me from taking that risk.
Using temp rates like you do is one of the big advantages of a pump over MDI. I adjust my basal profile regularly to adapt to changing BG trends.
Happy hiking!
@AR - Great 24-hour line, especially with 75 miles of bicycling thrown into the mix. Your low @ 40 was the only negative. It's like you can do 99 things out of 100 well and the D will exploit that one thing you did wrong or missed! It's downright relentless and evil.
I don't know how your body can handle the alcohol. I find that I often get a crazy low at 3 in the morning if I drink, when the one-thing-at-a-time liver stops releasing glucose to metabolize the alcohol.
Your robust exercise combined with great BG control are much to your credit. You need to watch out, however, for those sneaky 40s ;-). In retrospect, I'm usually amazed at how competent I feel when I live through a low like that. It's part of why it fools me.
Good luck on the fund-raising tour. I expect to see a complete post here!
Terry, I'm hoping they with change it with the next version of the software. It can bolus to .005 so it is a programing issue not a hardware issue. Don't think they were thinking about the pediatric population at first roll out. I have been very happy with it otherwise. As for program confusion I have my programs ID'd by insulin strength. Don't even have a U100 program on the pump at this point. Don't know about other pumps but the tslim lets you use an alpha/numeric name for each program.
At this point I keep my U100 stock and diluent in a different spot in the fridge from my U50. I put a big yellow sticker on my U50 bottles with the date I made it as an additional safety check. I'm a lab geek so making dilutions is second nature for me. I had to lead my pump team with this, since as an adult practice they had not dealt with TDDs like mine, with heavy-duty exercise.
I have put a big U50 insulin sticker on the front and back of the pump just in case. The math is easy my IC ratios and CF are cut in half, the duration and target stay the same. If I go to U10 then the decimal gets moved over one place rather than dividing in half.
I don't mix and match, just using U50 for now, but have worked out a program for U10 if I can't get the U50 to work for vacation hiking. My TDD for u100 is around 10, to I pump 20units with U50and would pump 100 if I went to U10, the 300 unit cartridge lasts a long time. The more active I get the lower my basal will go.
Whoa, AR, that is impressive!
hobbit - Your math sounds one whole order of complexity harder than what I normally do. I guess you can get just as familiar with U50 insulin but switching to the U10 and make could really make it harder.
Maybe you could post a picture of your CGM line some time.
Terry, the math is not done on a daily basis - just the once to set up a program, after that the pump does it all. Although I still need to translate for my pump team when I go in for visits.
Making U50 is simple - one vial of U100, one vial of diluent, two 5cc syringes, use the 2 syringes to take 5cc from each vial, then swap syringes and return to vials. It makes 2 vials of U50, they will keep in fridge for about a month and a half before starting to deteriorate.
As for lines, I just posted a line in 12-24 as well as roller coasters. Like the rest of us I have my good and bad days. I find I have the best success at getting a <100 average if I use 85 as my target. For some reason if I use endo recommended 100 as my target I get a 110-120 average. At this point they are not arguing with success, since I can get there with out many lows.
Terry, the only daily math I do is carb counting/guesstimation. Since the pump program is set up with modified IC/CF s based on the strength of insulin I'm using I don't need to do anything different than the rest of the D world. If I eat bkfast sandwich with 30 carbs on the label I dose for 30 carbs, don't need to make any adjustments for the U50, if I go to U100 for hiking days the same will be true. Since I use a larger volume of diluted insulin to get the same activity it lets me work around the tslim limitation on basal rate to get a lower dose if I need to,
You're right about the pump taking care of the math with adjusted I:C and insulin sensitivity factors. Sometimes I deliver a "normal" bolus while doing the carb math in my head. That would cause me problems with diluted insulin. I don't think, however, that I'll ever use anything but U100 insulin. I'm on about 35 units TDD.
Does your t:slim permit all these various dilution programs to be stored at the same time?
Terry, I think I can have 6 different programs set on pump at any one time. Each program can have 16 time segments. Changing from one to the other is a simple menus selection and activation step. But it is on an different screen than the dosing screens.
When you upload the pump data it lists the active program as well as all programs on pump. The tslim connect program let you see all of your historical data, so I can retrieve all of my U100 programs if I need to.
If I need to do a correction, all I do is enter BG reading and will get correction dose, can add carb amount and correction if needed. On thing I like Is to bolus by carbs before meal and then top up. It has a rapid bolus feature you can set for either a set amount of insulin or a set amount of carbs. Have mine set for 10 carb increments for the rapid bolus. Don't need to see pump to do it as long as i can get to the nutrition. Has a beep and vibrate pattern to confirm the dose you requested.