Starting to piss me OFF

Starting to ■■■■ me OFF
I am writing today because i am starting to get really frustrated. I am on MDI Have 10 lantus in PM and 13 Lantus PM.
My ratios I;C
Breakfest: 1:8
Lunch: 1:10-12
Diner: 1:10-12

My ISF AM: 1: 2mmol ( 36mg/dl)

ISF NOON: 1:3mmol (54mg/dl)

ISF Diner: 1:3.5mmol (63mg/dl)

I count the carbs carfully. Mesure. Read labels. When i go see the diatitien he is always amazed. But really my Bg is were i am suppose to be LAst Ac1 8% HAve not had a AC1 below 7.3 since 5 years ago. Sometimes when i eat + add my correction my 2 hour bg is right on track but dont meet my correction target. Other times when my 2 hour is not on track i move a bit more and 2 hours later i am almost low. What the heck. Really i cant comprehend having a I:C of 1:10 but an ISF of 54 (or 3mmol). How is this possible. I am lean 6.2 feet 190 lbs. Watch what i eat. Really this is driving nuts.

i know i just sometimes get so frustrated. i add meal + correction and nothing its like the correction is not there the meal is just covered and sometimes i correct with no meal and bag i drop real fast

Better than getting pissed on!!

Many of us with Type 1 have explored low carb diets as a way to get rid of some of the spikes and valleys of blood glucose levels. I end up with lots of highs followed by lows if I try to eat a “normal” amount of carbs. My numbers aren’t perfect but they are much more consistent and predictable with fewer carbs. I try to stay at or below 80 grams per day.

No one ever said that Type 1 is easy to control so don’t be so hard on yourself. It sounds as though you are working really hard.

It's just not a exact science, I can eat the same food every day for a mounth and every day will give me different numbers, sometimes good and sometimes bad. I can always count on my BG to change, it never stays the same for long.

Just when you think you have it figured out...the Bete's will stick it's tongue out at you and show you who the real boss is.

There is no prefect solution for insulin dependence, If your looking for some gratification find a new hobby...there are things in this world worth smiling's just never going to be diabetes.

You got this just take it one day at a time. The trick is to know your body.

I have the same issues.Unexpected highs and lows and my sensitivity varies a lot. This am I went low unexpectedly and then kept waking up correcting more minor lows. No real reason why, I was a little more active than usual at that time so that may have been why. That is just type 1. I did skip my snack before sleeping though, but I guaranteed you if I had had the snack then this time I would have woken up at 190! Murphies law…lol. I eat around 50g per day at meals, not including corrections etc. It does keep me more stable but it doesn't eliminate fluctuations by any means.

Same ratios as me buddy, and height + weight! My doppelganger! Except my A1C is 6.5%. If you're very sensitive, fats + proteins play a larger role and you need to think about them (start by assuming an extra 5 grams). I've found this when we predict the blood sugars of Type 2s. See my profile.

Il be checking your profile. Thanks been watching vapire diaries haha

I think that it *is* an exact science in that if I get a little bit out of whack, I will see numbers go flying all over the place. I don't bother with ISF and just adjust the basal rates and ratios. That whole thing all boils down to more or less insulin and it doesn't really seem to matter if the more or less is because of a ratio or because of an ISF so I just let the ISF ride (currently 41...) and adjust the other stuff in line with the food. I count food pretty carefully and am always disappointed that doctors shunt me off to a dietitian to discuss food. Diabetes is about balancing insulin and food and docs should bring food into their discussions.

I haven't had an A1C> 5.8 since I got my pump and haven't been above 5.3 (only once, the others were 5.2 or 5.1...) in a couple of years. I'd say put the ISF lower and don't worry about the ratios, put them where they need to be. I'm 5' 10" and about 190 so a bit chunkier but am pretty active. Is there any consistency to your numbers that are off? I have a pump that has "pie charts" showing your % in range and low and high at different times of the day that are my favorite thing to use to adjust stuff. Do you have anything like that with your meter? Sometimes, I'll think "things are ok..." but look at the charts and see that post lunch is higher than it needs to be like 40% of the time. If I fix that, it gets rid of the lows before dinner and leads to less munching to fix the lows and less correcting and all that and can smooth out several "pie charts" in a row, often with a small change.

I also recently tried an experiment with basal. .8U/ hour has always seemed "hot", to push things down but .775U didn't seem like quite enough, I'd park at like 110 and just drift up slowly until I'd correct it. Blech. I went through and programmed my pump in 1/2 hour increments (the smallest...) at .8 and .775U/hr, to "cook" a .7875U/hour fake basal and it's worked very well, making days very low impact. I don't snack much at all, unless I want to. I've kept working out and all of that too and think that this is a useful experiment in that it shows how a change that I'd have scoffed at a couple of years ago "meh, .0025/hour? Who cares? Party down!" seems to have actually made a difference. I would expect doctors to be aware of this but they seem to have a perspective problem that turns off their "science" button a bit. Maybe some fine tuning would help things for you!?

What do you consider being "on track" at 2 hours and what do you consider "almost low"? Perhaps part of your problem is that your targets are a bit too high...


We have come to believe that our ratio's, our ICR and ISF, are exactly related by a formula. If you follow the rules laid out by people like Walsh in "Using Insulin" (and others), the ICR and ISF should be connected by a ratio I would call the Carb Sensitivity Factor (CSF). Most people have a CSF of about 5 mg/dl/g, namely your blood sugar should rise 5 mg/dl for each gram of carbs. Thus your ISF = CSF * ICR. But life is not so simple, particularly if you low carb, react differently to various carbs (I have trouble with wheat) and have things like a wicked case of Darn Phenomenon. I find that when I eat protein heavy meals, I have to bolus for protein and in the morning, if I awake high (almost all the time), it takes an absurd amount of insulin to restore a normal blood sugar. And as others have said, our bodies totally defy any attempt at being repeatable, usually the best you could ever hope is to be right on average and not experience too many swings.

What do you use as basal (units lantus/levemir)

...a wicked case of Darn Phenomenon.

that's gotta be the typo of the day!

The reason there isn't a formulaic, tight relationship between ISF (CF in the states) and I:C is because a plethora of additional hormones are involved in digestion, and consequent signaling to the glucose metabolism, that are not present during fasting.

Because of this, the insulin-sensitive tissues (chiefly hepatic, adipose, and skeletal muscle) react differently when glucose is present due to digestion, vs. during fasting (>3h after eating).

It "makes sense" when you think about it in terms of available energy during the evolution of more primitive creatures that we are evolved from. When food energy is available, your body want to suck it up like a sponge and store it. Hormones produced by the stomach and the brain when digesting combine with insulin to increase uptake by fat cells and the liver; the former converting the glucose in to fatty acids, the latter into glycogen complexes.

During fasting, BG has to be maintained from the body's stores. In the absence of those other hormones, insulin doesn't seem to work as well in part because any glucose stored away is simply canceled by glycogen being broken down to supply glucose to the body (and much more slowly, fat).

In the morning, with Dawn Phenomena, this vicious circle rages, and insulin can seem completely impotent.

For these reasons, eating something when your BG is high can actually help bring it down. The digestion hormones kick the storage tissues into high gear, and also suppress gluconeogenesis in the liver (as there is another source of glucose -- digestion).

This works for some, not so well for others. I'm one of the lucky folk that, if I have a small, balanced meal in the morning, my DP is totally controllable. If I skip breakfast, I fight it until lunch.

When your having a tough time correcting, eat a small snack (10-15g carb with a little protein and fat -- a few cheese and crackers is a good fit), then bolus for both your food, and the correction.

Verry interesting but what I have remarked is this. Let’s say my bg is 10 mmol (180) pré lunch. If i skip lunch and correct then 2 units would bring me to 4mmol (72) but if i eat let’s say 50 carbs bolus 5 units + a correction on 2 units. My bg tends to get lowered less with the 2 extra units. I would reach 7 mmol (126)instead of 4 mmol (72)

There could be two different things going on here. First, many people are more insulin resistant when high so that you might do much better correcting the 180 first and then eating perhaps an hour later. Second, you may need more than 5 units to cover 50 carbs and your ratio is off. If you are 80-110 before lunch, will 5 units for 50 carbs take you to where you want to be?

Either way you have to take another 1/2 unit of insulin with lunch at 180 to get down to about 100