little things make us happy :)
I think most children with Type 1 have extremely changable basal rates; sometimes ICR and sensitivity is manipulated as well. Due to growth spurts, primarily. You just may not have noticed it or you are completely through with even the vestiges of your honeymoon. Our DD was pretty stable for a year and a half after the honeymoon was over. With LADA, progression is slower. Diabetes Mellitus, Uncontrollable was our DD's diagnosis. You can manage it, respond to changes but not control it. I would say that is an accurate description. I am convinced, in our case, most of her changes are basal, but you can more easily adjust ICR to deal with sporadic basal changes during the day (much as you are forced to do on MDI). Sensitivity stays the same for a much longer period; however exercise has an immediate 12 hour (at least) effect on sensitivity. With exercise we also must immediately give less insulin for meals. And to complicate matters, different foods require different amounts of insulin. By testing two hours after each meal, you can adjust with more insulin or Ex-Carbs if you know how high your blood sugar must be at the two-hour mark in order to reach target when the insulin finally has done its work. It's a very precarious roller coaster Type 1s are on but you will figure out what works best for you. I truly think the best device to aid in glucose control is the continuous monitor, if you don't object to wearing one of them. This will take the mystery out of your readings and you will be more able to correct sooner and when necessary, more aggressively. As well as see the true real time picture of what is going on.
Recently I went on a CGM and I've had to change Basals, IC Ratios,and ISF. I was constantly up and down with low & High BGs. The ISF seemed to create the most positive change, but still having some challenges.
I agree. I have to change stuff all the time. I didn't realize it clearly until I got a CGM, although I think I might have had signs of it w/ the pump and more accurate data collection? This is a big thing that people without diabetes and, apparently, most doctors, don't realize?
I went into my Endo's office last week. I had changed all my basal rates, and ISF. She looked everything over with the Dexcom and said, "You've done all that I would do. I think you've got it under control". WOW, that made me feel better. Chemistries all came back good and A1C of 5.7. You just have to know what's going on with your body and roll with the punches. After 37 years of this finally!
That's sort of the downside of "getting it" as it seems like there's not a lot to talk about with your doctor(s) at that point.
Yes, but there's always stones in the road. I had a roller coaster weekend of BGs, and nothing to explain it. Changed infusion set and it looked fine. Never called my Endo, I give it a couple of days before calling in the doc.
From my experience, basals are almost set in stone. I follow a regular pattern, and I have no documented cases of it changing in the short term. I have found that low carbing will adjust my profile down, usually in about 20% drops. I think this is due to the reset glycogen levels -- eat less sugar, you store less sugar (insulin).
You have to basal test. If you guess your basals, then you have unknown variances. Basal testing removes most of the question marks, so when you experience wonky results, you can pretty safely discount basal mis-matches. In my experince, we tend to offset our basal mismatches with opposite I:C ratios. If your morning basals are too low, then your morning I:C is likely too high. This will manifest by experiencing hypos after big meals and hypers after small meals.
Setting meal ratios is also very problematic. Besides insulin, we do not make amylin nor c-peptides. Amylin is an incretin hormone that will "control" glucagon release. Glucagon of course is responsible for gluconeogenesis. Without amylin, we can be runaway glucose making factories, and this phenomenon can vary depending on activity.
Glucagon is a hormone, and consider for a moment other hormonal behavior - sex. After a sexual encounter, how long before you are ready for another? If you abstain, does this affect your sexual response? I think it's safe to say our sexual responses vary, they are not linear. The same can be said about glucagon responses:
- skip a meal, your glucagon release will be higher next meal.
- if you eat a big meal, will your response be lower next meal?
- if you have a hypo, will that affect next meal's response?
- exercise, stress, snacking, meal size, meal frequency, sex, alcohol, ...
It's a wonder we can ever get anything right.
Wow, PowerPumper - well said.
Every day, every year, I learn more and more... I went on the pump 16 years ago and thought I learned a lot about fine-tuning my control, but even better was going on the Dexcom this past year... wow was it revealing! Can't recommend it enough. Are things perfect now? No. I don't know that they will ever be, but I'm closer than I've ever been before.
One tip to add to our quest for possible variables... Joslin Diabetes Center in Denver has studied 550 people who have lived with T1DM for 50 years. They found that 66% of these patients were still producing some insulin. Our bodies are constantly trying to regenerate beta cells, but we just keep attacking them, darn it! No wonder we have such a hard time explaining some of our swings!
Just a few things to consider outside of the typical food/insulin/exercise:
1. Hormone cycles
3. Euphoric Hypoyglycemic (I suffer from this big-time! Even have a special basal
setting on my pump for being around certain people who make me feel very
5. Dawns Phenomenon
6. Symogi Effect
7. Other Meds that can cause high/low bg's
8. They type of exercise you choose, affecting your bg for hours or days
9. Not just carbs, but what kinds of carbs (and other details... high fat meals
increase insulin resistance, causing you to need more insulin, etc.)
11. Patterns and frequency of lows
12. Morning insulin-to-carb ratio is usually requires more insulin in most folks.
13. The Brewed factor
and we could go on, and on, and on....
That's a good list!
thnx acidrock. Our bodies are so complex and interwoven. It really ticks me off to see diabetics treated like they 'should' have great control as if we are cookie-cutter people out of some textbook.
oh... and I forgot one more...
14. How long has it been since you last ate? (Liver can over-produce glucose during a fasting state.)
I think our liver plays a huge role in glucose management... just don't know all the details yet...
I'd love to hear anyone else's thoughts on other reasons for bg swings...