This morning I made an insulin dosing decision that I make on many mornings. I will present this information in the five minute increments that the Dexcom G6 uses to update. This particular instance turned out well for me; every decision I make does not always work this well. I’m right, however, a lot more often than I’m wrong.
The primary driver of glucose elevations at this time of day for me is the combination of the circadian rise known as dawn phenomenon and what many of us refer to as “feet on the floor” or FOTF phenomenon. This is a rise in glucose that is not so much connected to the clock but related to arising from bed and changing your body orientation from horizontal to vertical.
5:08 am. – 93 mg/dL
I woke up about 30 minutes earlier at 82 mg/dL. My wake-up goal is < 100.
5:13 — 93
5:18 — 93 +0
5:23 — 93 +0
This steady BG in my goal range requires no action from me.
5:28 — 100 +7
This +7 jump catches my attention but I will wait for more data to confirm a trend.
5:33 — 103 +3
5:38 — 109 +6
5:43 — 114 +5
I see a valid trend and decide to inhale one 4-unit cartridge of Afrezza, a dose I find equivalent to 2 units of liquid insulin. I took this dose at 5:44.
5:48 — 119 +5
This continuing steep rise of about 1 mg/dL/minute causes me to take another 4-unit dose of Afrezza at 5:51.
5:53 — 122 +3
First 4-unit Afrezza dose starts to make its effect felt. Now I’m wondering if I reacted too quickly with the second Afrezza dose.
5:58 — 122 +0
6:03 — 121 -1
6:08 — 120 -1
6:13 — 118 -2
6:18 — 112 -6
6:23 — 109 -3
6:28 — 104 -5
At this point I continue to wonder if I overdid the Afrezza this morning. My BG is dropping about 1 mg/dL/min for the last 15 minutes. I certainly don’t want to go hypo but I decide to just keep a close eye on events.
6:33 — 99 -5
6:28 — 94 -5
6:43 — 89 -5
6:48 — 85 -4
This is the end of the steep and a little worrying drop.
6:53 — 83 -2
6:58 — 80 -3
7:03 — 78 -2
The BG drop moderates and it looks like I made an aggressive but accurate correction.
7:08 — 78 +0
7:13 — 77 -1
7:18 — 77 +0
7:23 — 77 +0
It looks like the effect of the two 4-unit doses of Afrezza has worn out. I usually find that a single 4-unit Afrezza dose finishes at about 1:20 after inhaling. As you see, there is still a little more drop to come. 7:18 am is 1:27 after the second dose.
7:28 — 76 -2
7:33 — 74 -2
7:38 — 72 -2
7:43 — 71 -1
Here’s the bottom of the BG-lowering caused by the two Afrezza doses. It’s 1:52 after the second dose.
7:48 — 70 -1
7:53 — 70 +0
7:58 — 71 +1
I landed safely!
Here’s the Nightscout graph of the event:
The blue top portion of the graph is the basal insulin profile controlled by Loop. As you can see, Loop decides to halt any basal insulin once it comprehends the two doses of Afrezza that I delivered. Since my experience with Afrezza observes that a 4-unit cartridge of Afrezza is equivalent to 2 units of liquid insulin, I log it as two 2-unit doses.
The dashed blue line across the basal profile is the background basal rate that’s programmed into the pump and Loop. It is the basal rate that would have occurred if my BG had stayed closer to target of 83 mg/dL.
You can see the “Pre-Meal” notes on this graph. This is when I shift my Loop target from 83 to 65 to make it more aggressive. It’s the equivalent to “stepping on the gas” when driving a car. When it’s set, it will automatically time-out at 60 minutes unless you terminate it and reset it again for another 60 minutes.
The green dot glucose reports in Nightscout represent glucose from 65-120 mg/dL. The yellow dots are those above 120 mg/dL
Loop also provides a way to set the target BG higher for situation like exercise when you want to pre-empt a hypo.
This account may be more detail that some people find useful. They may not like to operate at this level a minutia; I understand that. I like getting into the nitty-gritty of these kind of things since I believe in the end that it is less complicated and demanding when I can keep my glucose levels in range.
It’s alway easier to prevent hyperglycemia than it is to rein it in when it’s already gone too high.
Loop takes the every five-minute burden out of managing my blood sugar and permits me to take a higher level view of things. I should be able to program in a basal rate and insulin sensitivity to programmatically take care of this but that effort is still a work in progress.
I realize that this type of post is not of universal interest and I appreciate the chance to give others a view of how I manage my insulin. This exercise helps cement and reinforce my experience.
If you’ve read this far, I thank you for your attention. I’m happy to answer any questions.