Thanksgiving Dinner-- Read 'Em n Weep

Well put!

Hey pancreas. Here's a link to the TuD page where I posted several of my seasonal recipes:

https://forum.tudiabetes.org/topics/thanksgiving-yummies?xg_source=msg_com_forum&id=583967%3ATopic%3A3563558&page=1#comments

You can see that the stuffing recipe is loose and infinitely adaptable. You can use more or less butter and chicken broth depending on how moist you like it. Two refinements we figured out yesterday: one of those "pounder thingeys" you use to tenderize meat did a great job of breaking up the Wasas 2 or 3 at a time---much more efficient---and since I first developed the recipe, we have acquired a large All-Clad stock pot----you can do it all in that, from sautéing stuff to mixing in the Wasas. Saves on dishes and mess!...Blessings!

Also have to take into account that there are variables involved in how fast any one of us will utilize any exogenous insulin and the graphs are just representative of what the manufacturer considers 'typical'

'typical' is a fairly worthless concept when it comes to human physiology though. IE-- a 'typical' person lives 74 years. A 'typical' person can run mile in 10 minutes, though many can't run at all and some can do it under 4, etc...

we all WAG sometimes that's the name of the game really, but we have a lot of practice at it and our WAGS are typically well educated WAGs or at least WAGs with a lot of experience

I wish I had luck but I went hypo on thanksgiving for the 2nd time in my life lol. My first hypo was on thanksgiving and my meter greeted me with a 58 mg/dL last night. Granted, last time I had a somewhat traditional thanksgiving meal for a vegetarian (Green bean casserole, mashed cauliflower , I think I had some bread and a very tiny amount of corn as well? then a slice of pumpkin pie) estimated up everything, and felt like crap with a 66 mg/dL last time. This time it was weird and I didn't eat a traditional thanksgiving meal, ate something I eat almost every day, and went hypo? Probably because I had an 8 hour shift at work and it was active and I need to adjust my pre-meal insulin or my lantus not sure which.

I'm actually very happy with my results for Thanksgiving.

Started the day at 86 followed by 104,133,105,108,114,113,114,116

And woke up to a 96 Friday AM.

Ate the same stuff the gulco-normals did, even had some Mac & cheese and mashed potatoes!

AND I even had a piece of my legendary (in our family at least) spice cake with peanut butter/vanilla frosting!

I guess I'll consider this as the final exam for my seven month learning curve for diabetes management using an insulin pump: All of my boluses were a complete SWAG! - I PASSED!

This thread must be either motivational or discouraging for most folks who just aspire to A1cs below 7 or, if they're ambitious, below 6.5, and a number of you guys are trumpeting numbers that equate to A1cs in the high-4s or low-5s, while eating meals that aren't exactly carb-restricted. Impressive!

I've got to pat myself on the back when I can. No one else will do it for me. :-)

If you knew my history you would fully understand why I'm so happy. Up until this year I have been unable to get my A1c below 8 for nearly 25 years! I had some other serious health problems crop up in January and shortly afterwards started suffering from frequent, serious, debilitating Hypos. That all helped 'motivate' me.

My last 2 A1c's were 6.01 and 6.1 with pump data showing an average BG of 116. Last 60 day average BG = 112.8, SG = 110.2.

My doctor (and wife) now describe my management technique as almost maniacal, though I prefer the term elaborate: Maniacal would be turkey tofu and a glass of water. I had Turkey, Ham, Salad, Lima beans, Mac & cheese, Mashed potatoes and CAKE...there is a difference.

I found a system that works for me...I guess I'm one of the lucky ones, it only took my 25 years to get here. The amazing level of control offered by a pump combined with a CGM was key for me.

I can say without equivocation, that my Medtronic pump and CGM have saved my life, or at least have allowed me to actually live it.

Congrats on your Thanksgiving meal BG numbers. Now I'm curious about your "system." If you'd like to share, I want to know.

Oh, I'm patting you on the back, too, and all the more so now that you mentioned your history!

I've been incredibly lucky to have lived a 12-year honeymoon since I was diagnosed, and still make just a little endogenous insulin today, and that plus an active and healthy-eating lifestyle (I was lucky to eat pretty much the same as I do now pre-diagnosis, though I do miss some things like orange juice!) have kept me with A1cs mostly in the high-5s, occasionally very low-6s. Doctors always praise me for that but I know it's more luck than my own efforts, though those aren't totally irrelevant. I suppose with a super stringent Bernstein-style diet I could be in the low-5s, but at least so far I'm not sold on the necessity/desirability of that.

I think our stories sometimes discourage others that are struggling. I often think about that when I want to post a success story and celebrate. But I think most of us here would never intend to discourage others. That's not why we participate.

When I read about other's numbers that exceed my ability, I remind myself that a certain percentage of people with diabetes, both T1 and T2, have some residual insulin production. This remaining function, I believe, can help a lot. And there may very well be other physiological factors at play that science has not yet observed.

I don't begrudge them that good fortune. I'm certain that I've also benefitted from some kindness of fate. We each are dealt our own unique metabolic hand. We must play the hand we're dealt. Playing it well and not giving up is the only common measure of success we share.

That being said, when I've observed some of the success of other members here, especially the flatliners' club and TAGgers United, it inspired me to attempt to reproduce their success. Lo and behold, it worked for me, too! I believed that if they could do it then so would I. I also believe that our self-imposed limits make up most of our actual limits.

The system is really nothing more than intensive observation and extremely detailed record keeping.

For the most part I limit my Carbs to a 'reasonable' level for me, which is currently 100g/day. That helps a lot.

I suffer from persistent hypoglycemia unawareness, and in the past was considered 'brittle' with wild swings in BG, often 80-90 points in a period of five minutes. Thankfully those days are very rare now since starting on the pump about six months ago.

I test about 10 times/day. A little less on 'good' days, much, much more on 'bad' days: Upwards of 25-30 times on sick days. Allowing me to micro-manage the pump settings - something completely impossible with MDI. I've had days where I've had to make 8 or 10 changes to my basal settings to keep things under control.

As for my 'system', EVERYTHING diabetes related goes into my 'logbook' and I mean everything!

I use a Google Form for input on my phone and it sends everything to a Google Spreadsheet. It's a fairly comprehensive form with some 'smart' navigation that streamlines the data entry process for me, because in addition to being forgetful and lazy, I'm also very impatient.

So I start off with a time stamp, then an 'event'. The event can be a BG reading, infusion set/sensor change, sensor events/alarms, battery, pump settings change, Meal info, etc. Then based on that, the form asks me related questions, like which finger, the value, etc. Or Sensor/set location, lot #, comments. Or Carbs and Bolus Wizard values, etc.

Did I mention that I'm forgetful? Well, I've set the form up to automatically prompt me with the next finger stick location. I use seven distinct locations on each finger and rotate those to reduce bruising and tenderness.

Typically the data entry now only takes about 30 seconds, so it is pretty convenient - much more so that other Apps or a manual paper logbook.

All of that goes into a group of spreadsheets automatically and with the help of a few hundred lines of JavaScript it slices and dices and serves it up in a format that I can use. For me this is much better than relying on CareLink (I still use it though, but more as a historical tool) as it gives me access to the data real-time.

And since it is all neatly organized into spreadsheets I can graph/analyze it in any way I choose.

With manual systems, I never had the patience to write it all down, and then was too lazy at the end of the day to transfer it all into an App for analysis. So I'd end up not having current data for days on end...not good when you have a lousy memory.

So it's really nothing more than a sophisticated data collection system that gives me instant feedback, plus access to all of my historical data. Either on my phone from anywhere or on my laptop (where I have greater ability to graph/analyze) - everything is stored in the Google Cloud.

I really don't spend too much time managing things anymore now that all of the data is always available and I have a really good handle on how my body responds to different situations.

I will admit to glancing at the CGM display a couple dozen times a day. Plus I've had some nights where I've not gone to sleep, at all, because of some weirdness with my BG's, or set my alarm every two hours just to check. But for me, that's what it takes to prevent unfortunate events from sneaking up on me. Been there, done that, have the hospitals bill to prove it.

I was intrigued to read that Medtronic is doing a beta test next month with smart phone integration - but they're doing it with iPhone only first :-(
I hope they expose the raw data so third party or custom Apps can grab the data real-time. I mean, the meter sends the BG to the pump and CareLink reads the pump data wirelessly, so it should be 'simple', right? Then I could skip even more of the data entry steps I perform now.

I've been considering learning Android application development and re-writing my whole setup. But as I've said, I'm lazy, so that won't happen until I run into some dead-ends that I can't overcome with my current setup.

Wow! That's an impressive set of details that you track. And it appears that it's had a positive effect on your BG control, a concrete bottom-line.

Many people with diabetes look at a regimen like yours and just see all the work keeping track. What they don't see is that after a while it becomes habit and life does get easier. With good BG control, life gets better, too!

My system is less custom and detailed than yours as I use the Dexcom Studio software and the Diasend web-site to upload all my devices. I focus on four primary goals, in order of importance to me:

  1. Time in range >= 80% (65-140 mg/dl)
  2. Time hypo <= 5% (< 65 mg/dl)
  3. Standard deviation <= 30
  4. BG average <= 110 mg/dl

I don't have an A1c goal since I think it is a flawed measurement and can hide a lot of hypoglycemia. I place my BG average last for the same reason. If I succeed at the three superior goals then my BG average seems to drop in somewhere between 100-110 mg/dl.

These goals are "reach goals" for me and I often meet 2 or 3 of the 4 but the ones that miss are not too distant. I look at weekly, 14-day, monthly, and quarterly time periods.

I limit my daily carbs to no more than about 70 grams with many days around 40 grams. I walk almost every day, averaging 25-30 miles per week.

I dose for carbs, protein and fat. I use a spreadsheet for calculating the dose and I've stored many of my more common meals to make things easier. For every meal I use a combination bolus that includes and immediate bolus to cover carbs and an extended bolus of 1-5 hours t cover protein and fat.

I think it can be discouraging, I did not have a good few days and I'm not able to eat whatever I want ever without often paying the consequence, sometimes I'm not able to eat anything without going high truthfully, low carb or whatever- so I really don't want to hear how everyone can eat whatever they want and so on and end up in normal range- most of the time I would have to take a huge bolus/prebolus and risk during or after meal hypos etc.to do it.

Yesterday I barely ate anything early in the day, did my usual insulins with larger than needed dose for what I did eat and after getting myself down after one spike I still ended up spiking to 200 while I was out for no apparent reason, but I'm suspecting it was extended dp and the lack of eating my normal larger first meal & bolus. I can eat a low carb meal and do exercise and spike tremendously. I hope a pump is going to maybe make things easier for me but I'm not looking forward to all the extra work needed for it. This disease already takes up enough of my life and although I come from a scientific family I don't want to spend my days & nights looking at spread sheets and graphs etc. even though I do enjoy seeing them and what is potentially going on. I'm beginning to think it wouldn't even make any difference in my case if I did this.

meee - We all struggle. I missed a 90 minute 50-60 mg/dl hypo this morning while I was sleeping. I must have slept through the CGM alarm and my dog didn't catch it.

I treated the hypo with a tablespoon of maple syrup at 8:15 a.m. I skipped breakfast and went for a three mile walk. My BG topped out at 191 but stayed above 140 for six hours! Talk about insulin resistance. I even ran a 200% temp basal for two hours without much effect. I knew that throwing insulin at it wouldn't help, but I tried anyway.

I went out for a one mile walk about 5 hours into the hyper and it finally drifted below 140 after the walk.

This is a tough disease to treat well and a few days of success does not prevent later BG disasters.

Your getting a pump could help with getting your basal needs matched well. That, I think, is the key to making mealtime insulin work. It needs a firm stage from which to launch.

I wish you well with your pump adoption. It is a great tool but does have a learning curve. When I have tough BG patches, it always seems to get harder before it gets easier. The important thing is to stay on it and don't give up.

Hi meee. I can't bring myself to do a lot of time-consuming logging, and I'm on MDI so I get no help from a pump. My compromise is to write down every shot a take in little columns for bolus, corrections and basal, noting the time for each shot. Just that amount of recording seems to help me a lot, maybe because I know when I have insulin on board, maybe because I have time to double-check myself on whichever shot I'm taking. Whatever works; this method works for me.

Meee- sorry you feel that way, that certainly wasn’t the intention. We all see things differently, I get discouraged when I see stories like the one about Kimala the Ugandan Giant on here the other day, or other people suffering from complications, (which, remarkably-- there are a relatively minimal amount of such stories in this community) I get inspired when I hear someone else celebrating a success-- that was my intention.

My successes have only come after 25 years of battling this beast.

I prefer to focus on the positive things, otherwise I'd be posting about my severe cardiac problems (they tell me it's probably inoperable), or that I might lose a foot due to a persistent ulcer that I've been fighting since April. Or regale the members with stories of my, many, debilitating Hypos. (OK, I have posted a couple of those.)

So I hope folks won't begrudge me my little (or sometimes not so little) Wins.

For those that hate record keeping (I'm most definitely in that club too) my routine takes maybe 30 seconds per 'event' and unless there is a problem I only glance at the detail once a week or so. But it is a huge comfort to know it is all there - real time - In all it's excruciating detail, should I need it.

Here's a snapshot of my summary page: