This is unusual system behavior

[mohe0001]

I don’t have to bolus for meals anymore.
I’ve been shoveling out after the most recent large snow fall.
Its a pretty herculean effort.

Sometimes a half hour of shoveling is OK, but an hour of shoveling is NEVER OK.
Yesterday I shoveled for 25 min and I had a plan. But by the time I got back into the house and started heating a huge bowl of cheese tortellini, my brain was starting to send me strange low bg thoughts.

I’m certain I ate 60g of tortellini, 4 kiwis, and 40g of unknown Mexican candy. I had Breaking Bad playing on Netflix in the background and for a while I thought the Mexican candy was laced with drugs and was causing me to hallucinate, for a spell. I ended up going high because the 40g of Mexican candy was super high sugar and not part of the original plan. I simply wasn’t thinking straight.

I have a week’s worth of detailed BG records. The data is problematic. I’m just in one of those ‘bad phases.’

Frequently, anaerobic exercise sends me high. That’s clearly not what is happening this season, but that’s why I run tests at the start of the season.

The basals are flatline, absent any eating or exercise events.

Strategy #1.) If I eat 2 pieces of toast, and dose and extraordinary amount of bolus, I hit 400 post meal, but then return to normal within 2 hours. So, eating is making me kinda sick.

I had intended to increase the basals to an untoward level in order to shake those postprandial peaks, and just deal with low blood sugar fallout by snacking throughout the day.

But, this unusual exercise pattern makes me nervous about implementing strategy #1. I’m worried that I won’t be able to do any amount of shoveling if I increase the basals. Plus, I’m starting a new job soon and don’t want to set myself up for failure. Lower risk is better.

I’m gonna run some pre-bolus tests and see if that helps. But it feels like if I do a really large pre-bolus, a lot of it is kicking in around 4 hours later. I might require a 4-hour prebolus. It’s acting like correction, which makes me think my basals need increase. But the basals appear flatline. If I needed to increase the basal, then I don’t think I would be getting these extreme low BG’s from shoveling…unless I’m just out of shape and this pattern will go away. I see these significant low BGs associated w/ exercise when I’m out of shape sometimes.

Here’s one that came out on the money:

As long as I combine some shoveling with the morning meal, and bolus heavy, it works. As long as I combine some shoveling with an evening meal, and don’t take a meal bolus, the data works.

There’s nothing practical about this strategy.

[Jag1]

There’s a lot to piece together from your post, so I have probably missed some things, but let me make a stab at it.

I own a house with long drive so about 30 feet to hand shovel. I used to own a snowblower, but maintenance on small engines is not my forte, so several years ago I decided to give up on the snowblower to do strictly hand shoveling. Like you, I figured shoveling was good exercise, so instead of using a rowing machine I’ll just shovel on the days we have snow.

The difference is that I treat my shoveling the same as my other exercise - namely I schedule it when I have no insulin on board. This means I won’t exercise/shovel within four hours after eating a meal i.e. taking insulin. This restricts the times I can shovel, but that isn’t so bad, since late morning before lunch, or early evening before dinner works great. If I do that, then I can do more than an hour of shoveling without experiencing major carb needs. I will come in to warm up every half hour or so, and may need to grab some carb, but it avoids the major lows or huge carb needs.

The other comment I wanted to make was about pre-bolus. I was reminded today of how important pre-bolus is for me when I ate out at lunch today with a friend and forgot to bolus until I was almost through eating. If I pre-bolus by fifteen minutes to a half hour (depending on whether my BG is trending down or up at the time) I can get a very flat BG line, compared to today when that 40 minute difference, injecting after eating, gave me a mountain peak. (If you’re curious I could post comparative dexcom traces). Luckily I almost never forget to pre-bolus.

I assume you are being facetious about a four hour pre-bolus (since that is clearly not a pre-bolus) but will just note that keeping your meals and exercise separate is far easier and works well. Sure we sometimes need to combine them, but that is when we need to pay particularly close attention to BG motion, and that is hard to do while performing a task like shoveling which requires being outside, bundled up, covered in snow, sweating hard, etc.

Happy shoveling.

[mohe0001]

Thanks Jag. I’m gonna need to implement all the tricks.
There’s something unusual in my physiology.
Everything I do has a super intense effect.
It’s all helter skelter. I never need to pre-bolus, but for some reason now I do.

Hit 45 overnight and woke up so disoriented that I was calling people for help. Someone told me to eat something, so I grabbed a box of cheerios I left next to my bed and it all worked out. But it was pretty disruptive.

Hoping this doesn’t last long.

My brother wants to go skiing. I don’t know if I can pull that off, honestly. I’m barley getting thru the day.

Something has gone super haywire in my body. DP is intense. Everything is having an intense effect.

[MBW]

I hear your frustration.

When that happens to me suddenly, it’s usually a pump / infusion set problem. It almost seems that insulin has no effect (like it’s being sequestered somehow) and then it’s suddenly unleaded all at once. Changing my infuser fixes it.

Well, usually.

.

There are other times where it’s more like my body is resetting itself. NOT fixing itself, mind you! So it’s back to square one.

I start back looking at what happens during the periods that I’m not eating. How is my basal insulin at keeping my line flat? Then carefully count carbs, dose for those, and determine if I’m over or underdosing. Figure out where I need to work on insulin to carbs ratio. I know it’s somewhere in the 1 unit to 10 carbs ballpark bit it is different at different times of the day. And next, what is my correction factor? Again I’m usually at one unit drops me about 3 mmol/L but that varies as well.

And what about exercise? I try to under-dose myself for carbs if I know I’ll be skiing or biking or whatever within a couple of hours after eating. And I always use “exercise” as an activity when I’m exerting myself for more than 20 minutes or so, unless I’m exercising to correct an unwanted upward trend! Exercise sets the target glucose for the pump at a higher number.

The other thing about exercise: I’ve set up additional personal profiles (in ”my pump”), one is “lazy” (if I’m going to be enforced sitting for a prolonged period, like a car or an airplane) and one I call “active” which dramatically lowers my basal rate and correction factors. Also if I’m planning a multi- hour activity I have at least 100 g of emergency carbs with me, including juice box, organic chews, granola bars, etc. Each of those is worth about 20 g.

But just when I think I’m rocking it, all is set up, it goes haywire again and I look to my first principles again. Sometimes only need to make small changes. Of course all of this requires a CGM and a pump! I don’t know how I managed all those years with a finger poke and a needle in the belly.

Well, I do know. Not very well.

[mohe0001]

The basals look solid. That’s all I can say so far.

This is a my body resetting itself. It does that - it drifts out of balance every 3 months. This is a bad reset.

A star means tests pass.

Pre-bolus tempers the postprandials, but might result in post meal lows. Food and exercise are still problematic.

[mohe0001]

I have one week to figure this out. Panic is setting in.

[MBW]

@mohe0001

Pre-bolus tempers the postprandials,

You could be getting post prandial lows from autocorrection a few hours later? For me, my pump will dose it it sees a sharp rise especially if I haven’t got much insulin on board. And that, in turn, can drop me like a rock, especially if it was really short acting carbs (high glycemic index) and if I’ve set too aggressive a CF.

[mohe0001]

Good guess. I’m running manual.

But, on that note, this is exactly the type of situation that makes it really hard to unravel automated functionality for me. The problem has always been that when I run auto, I loose my conscious knowledge/memory of how the system is behaving and how to fix it. Even in manual, this can get tricky.

[mohe0001]

OK. Given no alternative, I’m bumping up the basals to accomidate eating.

You can see pretty clearly where I eat. It’s where everything goes to ■■■■.

[MBW]

@mohe0001

I’m bumping up the basals to accomidate eating

Ok but what if you are late to eat, or miss a meal?

I think it’s important to have clear mealtime / basal needs separation, even if you’re only using one type of insulin.

I’d consider increasing your insulin to carb ratio. So instead of one unit for ten grams, try one unit for nine (or wherever you are).

Maybe a mit less aggressive correction while you’re at it?

Just a thought, if you are making changes.

[mohe0001]

@MBW

Ok but what if you are late to eat, or miss a meal?

Scary Stressful Short Music Clip

That is the question.
I’m hoping to find some happy medium where I bump up the basals to something “tolerable” and find a “tolerable” meal bolus (something where I don’t hit 400 post meal)

[mohe0001]

@MBW

increasing your insulin to carb ratio

I’d have to increase my bolus to some “crazy,” if I don’t increase the basal.

If I require “crazy” bolus doses, I’m gonna see crazy events.

Its softer/easier to catch myself drifting into lows from having high basal than it is to deal with these brutal meal events.

[MBW]

@mohe0001

Its softer/easier to catch myself drifting into lows from having high basal than it is to deal with these brutal meal events.

So true! What else can a person do? Stop eating??

One problem I encounter is exercising when my basal rate is too high: it’s not drifting gentle lows; it’s plummeting, scary ones.

[MM1]

@mohe0001

If I require “crazy” bolus doses, I’m gonna see crazy events.

Do you bolus just carbs? Do most meals contain approx same number of carbs, fats, proteins?

Have you heard of T-A-G as way of calculating combo meals? (many are taught to only count carbs). Maybe something to try. I will try to link more info, or search T-A-G. Check this post.

Automode bolus high protein foods

I am using a 770 insulin pump and I am in automode in about 98% of the time. When I eat an eggsalad sandwich my sugar rises after most of the insulin is gone. My question is can I bolus for a carbohydrate to compensate for this rise? Automode isn’t aggressive enough to lower it.

[mohe0001]

Minor increase to the basal allows me to eat whatever I want.

Data seemed OK yesterday.

This might have something to do with me loosing a bunch of weight rapidly in Vegas because I was walking 10 miles a day. Then, I gained it all back. I expect to loose 10 lbs over the next few weeks from increased activity. There’s gonna be some chaos.

There’s a lingering problem with intense effects from exercise. The name of the game will be to watch that like a hawk and immediately suspend delivery if I start drifting low or am walking around. I’m gonna make sure I have an obnoxious alarm set at 70 and that I check before driving. It’s prudent to leave lots of time for travel so I can stop half way and check again. Road conditions have been terrible, so a 1 hour drive rapidly deteriorates into a 2 hour drive.

I’m entering a period of high risk and that’s just how it’s gonna be, I think. I need to take the time to be cautious.

[Jag1]

Not sure you heard me the first time, if you exercise when you have zero bolus insulin in your system, then you will see a dramatically reduced effect on your BG. Exercise right BEFORE a meal just works much better in my experience. That said, I wholeheartedly agree with using an obnoxious CGM alarm when you go below 70, and always carrying sugar in whatever form you choose, any time you are anywhere. I wouldn’t call that “cautious” as much as “prudent”.

BTW, getting CGM display on your watch means you don’t have to stop anything to check BG; it is always there on your wrist; driving or anything else. It was great for the cross country trip I made a few months ago.

[mohe0001]

@Jag1

exercise when you have zero bolus insulin

This isn’t gonna cut it.

I need to look over yesterday’s data.

We had a horrible ice storm that resulted in a 2 hour drive prior to a 4 hour dentist appointment. It took me 30 min to drive the initial 3 miles. One lady crashed before she even got out of her driveway.

Between 1:00 and 4:00, I was headed low. Suspending delivery did nothing to help. I’ll need to decrease basal and try to find a sweet spot. Bright spot was that I did a bunch of shoveling after 4:00 and had no difficulty.

Problematic period starts in this data on Tuesday and then leaks into Wed, when it caused a big problem. I’ll change that basal today.

Running out of time. Only have a few days left to straighten this out…

[mohe0001]

Meal bolus doses change every single day. It’s anybody’s guess.

[mohe0001]

I think it’s gonna be good enough. Just gotta watch the lows and keep an eye on things.

I’m super hypoglycemic aware. That’s great, except that I can’t very low before I kinda spiral. Gotta have snacks on hand all the time.

[Timothy]

If you try exercise mode you might like it, I never crash while using it. Even in 2 hour hikes or runs. I bring carb gel with me but lately I hardly ever need it .
I do intermittent fasting sometimes and I put in exercise mode. I will run a little higher but I never go low, I can easily fast 18-24 hours. And my sugar won’t ever g over 120 and not below 65. I kinda wish I could fast all the time but gotta eat at some point .