do you have to count protein as carbs ever? or are you one of the “fortunate” ones who only needs to bolus for straight up carbs like rice,potatoes and other starchy foods?
also, i cannot imagine myself waiting for this so-called bend to take place. if i waited an hour to eat after taking my novolog, i would end up in the ER w/ a glycogen needle in my leg.
RE protein, I usually simplify the calculation by figuring 5-10 extra G of carbs for a hunk of protein. Like eggs are 7G PRO each or 14G for two so half that is about 7G of carbs so that’s what I’d bolus for. A burger is more like 20 so that would be 10G extra. Stuff like a giant steak, 8 oz fish is probably a bit more but it’s really just eyeballing it.
RE the waiting, the key is to watch while you wait. Right when I got a pump, I didn’t have a CGM but was really busy between, work, dad activities and my other job of learning and teaching Tae Kwon Do, which was also physically challenging. I’d test 17x/ day as many times, I’d do two tests quickly to keep an eye on the “delta” or the apparent rate of change in BG readings.
I, too, often need to wait an hour before eating - especially if there are more than a handful of carbs involved. The CGM enlightened me to that situation as well - though now I also get headaches with the spikes, so I have even more incentive to take that bolus and wait to see that BG drop before starting to eat whenever possible. and yes, it’s not without risk - occasionally, I’ve waited too long - then I have to resist the urge to overeat for the low…
Hm, I dunno. I don’t bolus for protein as such, but it’s more a matter of only having the patience to go thus far and no farther into the weeds with this stuff. I mean, I kinda-sorta carb count, but mostly I’ve just developed a feel for it over lo these many years with the stuff I eat most regularly, and only really get down and scrutinize a Nutrition label of something when I’m going far off the rez into hi-Carb Land. Truly the disease requires us all to get in touch with our inner OCD, but some have to dig deeper to find it than others. 
i am one who needs to “dig deeper than others.” its a pain in the A**. i try and have a system, but it changes frequently, so management is imperative.
I have found that there seems to be some type of threshold when correcting a high for me. If the correction amount is relatively low, it doesn’t seem to be as reactive as a normal bolus would be. I find myself sometimes giving a larger correction than needed followed by a small amount of carbs to balance it out. Have you heard of this before?
When I’m over 200, I use a lower correction factor ( deliver more insulin per mg/dl change targeted). For corrections under 200 I use a 1:50 correction factor, but ramp it up to a 1:40 insulin correction is over 200.
I know what you mean about adding carbs to “correct the correction,” but I usually wait until my BG level asks for it.
Sometimes I would do such “bolus+carb” corrections to treat an annoying high, or a “carb+bolus” to deal with an anticipated more severe low. Here is an example of a “bolus+carb” correction, which I call “poor man’s Afrezza” because the idea is to correct a high quickly. This was all done with a pump:
Note that I decided to do this only after I had already made two mistakes, so this is not a surfing technique I would recommend or use often. Overall, for this performance I would give myself a C+. If I only treated the first anticipated low properly, I would have never seen anything above 120, and would have saved myself from couple of hours of bg above 140. This would have deserved an A. I could have also realized earlier that I had too much carbs, and could have done a small correction bolus around 3pm, the time of the first dip - this would have deserved a B. But, at least I did not end up roller-coasting through the rest of the day - so it’s a C. I give myself a “+” for keeping a positive, no-guilt attitude: learn from mistakes, will do better next time. Finally, a word of caution: double corrections (bolus+carb or carb+bolus) are more “advanced” surfing techniques - please do not attempt unless you feel very comfortable with sugar surfing.
You’ve given us a well-documented real world example. For me, in years past, this roller coaster could have gone on for days. You reeled it in in a matter of hours. Well done! I know you take responsibility for the error that started this whole thing in the first place, but you were able to clean up your own mess. I understand the mistake that caused it; we’re just humans. I admire your aggressive and successful tactics to pull yourself out of a metabolic roller coaster.
Wow! Thanks for the reply. Very insightful and helpful.
Zombie Thread - ARISE!
Sorry to pull up such an old thread, but the topic fits!
I’m T2 rather than T1, and not on an insulin pump. I did get my Dexcom yesterday. Is there enough information specific to CGMs in the Sugar Surfing book to recommend it to a T2, or is it really pretty much T1/Insulin Pump focused?
I’ve looked, and the San Antonio Library doesn’t have a single copy of this book in any branch, at least that I saw when I searched. They do have a few older copies of “Think Like a Pancreas” which I’ve also seen recommended, and I’ve picked that up, and may spring for a newer version after at least skimming the older version. If there’s enough of use to a T2 on a Dexcom, I’d be willing to spring for the Kindle version off of Amazon, but thought I’d check here first and see if this post pretty much sums it up first, though.
I see no reason why a T2 would not benefit from the whole sugar surfing idea. The CGM is a critical central element. It allows you to closely monitor your blood glucose patterns so that you can begin to recognize patterns, anticipate the trend, and take appropriate counter-measures, whether to cut off a peak or soft land a precipitous dive, it’s all surfing.
Your patterns will be influenced by your unique metabolic state but I think using a CGM in a T2D in the spirit of sugar surfing is a great idea. The big lesson of the book is that blood sugar management is a dynamic art; the target moves and you move with it.
Thanks, Terry. I’ll see about getting ahold of the Kindle version and loading Amazon’s reader app onto my laptop.
I am T2 and use the information from Sugar Surfing. Despite the fact that the book is written for T1, I found that it helped quantify what I’d been doing on my own before reading the book. I am on a pump, but a pump is not essential for using the methodology - the CGM, as @Terry4 said, is the more critical element.
There are times (like the last 24 hours for me!) when nothing seems to work, but the lessons in the book and the mindset of dynamic D management are excellent and, in my opinion, quite appropriate for a T2 on bolus/basal insulin, especially with a CGM. You won’t know how well it works for you without a lot of experimentation, of course, but it’s definitely a “good read.”
the different ratio for the correction factor is helpful - thank you
just finished the book sugar surfing and having some much better numbers now.
