Morning
@Teapot99. I've been distracted by very early starts and very late finishes since Monday, so only now been able to read this post.
I think your opening question about insulin stacking was great - in that it's allowed various aspects of insulin dependency to be explored and clarified.
My BG levels have been between 8-10 twice today, something that I would have panicked about previously, but I was so happy about today!
Slowly getting there
Those 2 remarks are very refreshing to read.
I like the analogy between driving a car and being insulin dependent. Those first lessons for driving had "their moments" when it all seemed a bit overwhelming, but at least the driving instructor was sitting right beside you and had a keen self-interest in their health (and the car's bodywork) to get you through unscathed! Then that very first solo drive. My daughter's first solo was a 5mile round trip to get some petrol and came back with a fresh dent in our faithful (long suffering) family car! Then follows a nervous period of solo journeys, going further afield, longer trips on routes not previously encountered and having to navigate the way as well as worry about driving safely! But in time experience takes over and we slip into the driving seat, start the car and move off without any thought about the precise route, the time of day traffic conditions, or any of the other extraneous but important raod factors. In fact we just drive somewhere as a routine event - in truth far more complacently than we should be! And so it is with our insulin dependency.
We learn how to manage both driving and our diabetes - such that with time most of what we do is instinctive. Then something untoward pops up: the car misbehaves when a long way from home or our BG triggers an unexpected CGM alert. We have to deal with each situation as a new and potentially anxious circumstance and there is potential risk.
But knowledge helps dispel fear. By staying calm, as much as possible, by taking that instinctive course of action; eg treating a hypo with 15 gms of fast carbs and waiting (calmly) for a recovery; repeat 15 or 20 mins later if needed.
Today, after this post reminding you that
- Snacks [all meals] = bolus
- High = corrections
and
It definitely is a marathon, not a sprint - I used to be petrified if my BG was in the 4's but now I trust the way I feel and the doses I've taken (But it has taken a long time!) - you will get there though - well done so far 🙂
It so
definitely is a marathon.
I regularly get things a bit wrong. Sometimes I overreact and sometimes am too complacent. When this happens I'll look back a little bit and see if there is a lesson to learn. But for me that anxiety is best managed by accepting the event and moving on. I can't go back in time, I can learn something if appropriate for the future.
Returning to "stacking". I found on my DAFNE course in late 2022 that the lead DSN was too dogmatic about not stacking; her mindset was too influenced by the era before CGM. That was good for the one (of 10) students who was only 3 months into her new T1 diagnosis - very much intended on keeping that lady very safe.
But unhelpful for those 7 or 8 of us with CGM and who were seeing the cause and effect of eating and dosing - whenever we looked (or heard an alarm/alert). CGM was not in DAFNE's syllabus so the DSN blatantly guillotined questions and discussion about CGM. Consequently no time was spent on explaining or understanding that CGM with readings from interstitial fluid lags actual BG from fps. No discussion about when abnormal CGM readings could or should be a suitable panic moment and when to pause to confirm the display. Hence no discussion about when that 6.0 and a double vertical arrow might be real or just misleading the user. [Indeed in my case, no discussion about my inevitable brittle diabetes and my potential to seriously crash.] [6.0 and a double vertical arrow wouldn't even trigger a low alert with Libre, with its upper low limit of 5.6 - but that couldn't be discussed anyway!! How stupid and frustrating.]
As with everything to do with Diabetes there aren't easy, fixed rules that will always apply. For my infrequent hypos I start with just 10 gms of fast carbs and wait 20 mins. So it is with stacking bolus. Guidelines, but not rules. There are various things at play day by day, hour by hour: not just iob; nor food digesting past, present and future; nor just activity levels and exercising; nor stress from work or home; weather, hormones, other medications, and so on. It's a judgement business - an art as much as a science. You have to go through your trial and learning moments.
BUT with good CGM, that you can reasonably trust, the odd time when you stack inappropriately can be wholly successfully managed with a suitable hypo response, if you have overstacked. This requires an appropriate CGM Alarm setting. It's no use having a low alarm set at 4.0. An Alert at 5.6 gives time to check, establish the trend and maybe confirm with a fp, then respond accordingly. I periodically read people saying there is too much stress from CGM alarms interfering with their daily living. They are alive because they know how to walk across a main road safely; they pay attention because they need to. And so it ought to be when using CGM; just another routine, sensible, safety matter that we need to take in our stride.
Enough from me. Good luck with all of this. It was a great post.
