I use Apidra in my pump and I've read here that many believe Apidra has a shorter time to peak and shorter duration. My experience, however, is that Apidra's peak time is similar to the other rapid-acting insulin analogs. I set my pump for 4.5 hours duration of action (DIA). I had many otherwise unexplained low incidents about 4 hours after dosing. 4.5 hours works better for me.
In general, I've found that there is a "sweet spot" (no pun intended) for insulin dosing where less is more. When I did systematic and extended basal testing last year, I noted more than once that cutting basal rates actually produced dropping BGs, up to a point. I've also experienced the opposite to be true; when adding more and more insulin, I reached a point point when it was no longer effective.
The best measure of insulin sensitivity is to monitor your total daily dose (TDD) on the pump. If you see it going down with your daily calories consumed is about the same and BG control is stable, then your insulin sensitivity has increased.
Sam - I also don't think of "lows" in the 60s as any big deal. I think of the 60s as my "buffer zone" where I need to take some action. I defend against going below 60 much more aggressively than I do going below 70.
I divide my lows into three categories: 60-69, 50-59, and <50. I call them Low, Very Low, and Dangerously Low. My goal is keep all lows < 5% of my BG data. I use CGM data but enough consistent fingersticks (maybe at least 8 per day) corresponds well with the larger CGM data set. I also want at least 2/3 of all my lows to fall into the Low (60-69) group. When I fail this goal then I need to take some kind of longer term action.
I learned from a study published this year that gluco-normal people experience over 5% of their time below 70, as measured by a CGM. This occurs in the early morning hours. I figure if non-diabetics drop into the 60 range on a regular basis then it's OK for me to do that also.
By claiming the 60s as my buffer or action zone, it allows me to lower my average BG provided my standard deviation doesn't elevate too much.
I agree, below 60 would be a true 'low'. during our recent health screening at work, most of my nondiabetic coworkers had fasting bgs in the upper 60s.
I have a1c's in the mid 5s usually and will have numerous readings in the 60s over the couse of a week, but not a lot below that. maybe a couple in the 50s, and very few below 50. I am very careful about treating when it gets that low, and do have a cgm so I know the dropping pattern that indicates I will be going low and can usually catch it early
I think it depends on when the low occurs. If I wake up at 3.7 (67) then I don't really consider that low, although considering I don't have a CGM it's too low for comfort for me overnight. So in that sense, it is low, even though it's not dangerous. But if I am 3.7 two or three hours after eating and still have IOB, then that's definitely a low even if I catch it before it gets any lower.
I think if I had a CGM I might see things differently. I see the upper 3s (approximately the 60s) as a sort of buffer zone, but since I don't even feel low when I'm at that level it doesn't really buffer anything unless I just happen to test at that time and have IOB (so that I know I'm heading downwards). Before a meal I usually won't treat a blood sugar at that level unless I'm feeling low (and hence think I'm dropping), but any other time of day I would treat it with something.
Jen - I agree, the context of any low is important. A 70 with a high IOB looks different than a 70 with zero IOB. The CGM does give an advantage to see a trend more easily.
The DCCT trail was PAINFULLY CLEAR.
The tighter our so called control, the more by definition we would require OUTSIDE HELP c. 30% more. Not brought up by those who push for tight (sic. strangle-hold) control. Only so low we can force ourselves, so low we can set our BG "cruise control" without severe risk of crash and burn routine.
Hey Jen,
"But with this new-found control has come a new problem in the form lows, lots and lots of them."
ME TOO!
Diabetes SUCKS.
I don't see 70 as a low. It's a problem if it is diving. For me, the mid 60s are low, and then I'd call the 50s serious. Then to confuse matters my Dexcom seems to run a bit low in that range. In the past month, I've been in the 50s 2-3 times, and mid 60s maybe 6-10 times.
Any chance of trying the Dexcom out again? Maybe you know someone who uses it, and you can have them check your hardware out (maybe a company rep can do it as well). I use upper thigh kind of where a coin would be in my pocket (if I was sitting it would be facing up). I've gotten almost a month out of the current sensor.
DCCT trial ended about 24 years ago. BG testing has improved quite a bit since then, especially with CGMs. Furthermore, my understanding is that DCCT didn't look at low carb dieting (50 or less) which can make control easier.
I've never tried the Dexcom—it's not yet available in Canada. A few years ago I went on the iPro (Minimed stand-alone CGM with no real-time readings) for about five days just to see what was going on with my blood sugars. I don't think the stand-alone Minimed CGM is available here, either. From the research I've done, it's only the CGM-integrated pump, which I don't have (I use Animas). When the Animas Vibe comes out I plan on getting that, even if I have to pay for it myself.
I do think a CGM might change my perceptions of what's considered low, and probably make my endocrinologist a bit more relaxed, too. Right now, it's impossible for me to know if a 70 is going up or going down, so I consider it low unless it's immediately prior to eating, in which case I won't treat it. I see lots here saying borderline low is only low if it's heading down, but for me that's not possible to know. There have been times I have tested at, say, 75 and left it, only to feel low 15 minutes later and test at 45.