I'm adding some new tools to my toolbox. I don't know exactly why, but I've never been able to recover the control I had prior to developing Graves' disease. So, since what I've been trying hasn't been working, I'm going to try some new strategies.
First, I'm on day 3 of trying a new medication called Forxiga that's meant for Type 2s but that works completely independently of insulin production or other hormones, so is also being tried in Type 1s. Below is the result of day 2.
Each spike is a meal of about 40 grams of carbs, pre-blouses by 30-60 minutes. I tried very low-carb <50 grams a day for several months, but I found it too restrictive on top of multiple food allergies. And, while it did help my blood sugar, it made diabetes harder rather than easier. So, in part because of that and in part because of the new medication, I'm going to try eating more carbs and pre-bolusing. I'll probably still eat "moderate" carbs at around 100 grams a day.
Finally, I've been experimenting with intramuscular injections of insulin and found they sometimes work amazingly well and sometimes not at all. I think I'm only hitting muscle half the time. So I ordered some 12 mm pen needles to use, which should be more effective.
The amazing thing about the below graph is that it's with my basal rates reduced by 1/3 and bolus ratios reduced slightly as well. I didn't have to do a single correction. I did have to eat glucose tablets numerous times overnight because my -30% basal I'd set for 24 hours ran out, and the Ping doesn't have any warning that a temp basal is ending. I'll do another temp basal today and then make the changes permanent. The two other amazing things about this graph (well, in addition to the fact that it was a high-carb day) are that I'm also sick and I spent the entire day lounging around watching Netflix.
But the medication isn't perfect; one potential side effect (among several) is DKA even with near-normal blood sugar. The day I started this medication I ran at 8-10 mmol/L all day despite numerous aggressive corrections with my pump and injections and running a double basal rate. I finally checked ketones and they were positive. Changed sites and began running low for hours. My endocrinologist has me checking ketones daily and anytime I feel unwell while taking this. And now I also know with a site failure I may only be 8 mmol/L rather than 18 mmol/L, so I'll check if I'm stuck at 8 mmol/L or above rather than 14 mmol/L or above.