hypo aggressive behaviour

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In summary, he feels that the pump users he saw weren't doing that well, and he suspects it's because of scarring/lipohypertrophy.
Personally I believe the majority of problems with pumps is the user. Many appear to think it's plug and play and do b*gger all regarding basal testing or even using their cgm data to make adjustments.
In the last year we have had least 4 people to my knowledge who have never basal tested or made an adjustment of their settings. This included one person who had been pumping for 3 years or more.
Lack of common sense, training and or will power seems to be the reason people don't see any improvements whilst pumping.

The ones that do put the effort in have fantastic results as it should be. Thankfully there are more good pumpers than not so good these days 🙂
 
The ones that do put the effort in have fantastic results as it should be.
Could be. I think England is low compared to the US (something like 12% vs 60% of adult Type 1 people, with England having ~50% of children on pumps), so possibly the relatively low proportion in England tend to be people who care more than some in the US. (I don't know what the rates were in 2013 but I'm guessing they were still higher than in England now.)
 
So any suggestion that for me 4.3 is a sensible place to be is coming from someone with no understanding that one size does not fit all. If Dr B is truly saying that (as opposed to others repeating that out of context or just wrongly) then Dr B can have no credibility in my eyes. My Consultant has consistently encouraged me to raise my level to high 6s into 7s if I want to stay safe and bypo free.
Yes it's a good point.
 
In the last year we have had least 4 people to my knowledge who have never basal tested or made an adjustment of their settings.
Here's the fifth🙄
Although to keep the context I am not using a pump. But I know that basal testing is an important piece now.
I take only my tresiba, no ingesting foods and observe my sugar levels over a period of time. There's more information to be found on the forums I am certain.
 
It also left a huge impression on me that he believes 4.3 to be the sugar levels of a healthy non-diabetic.

Lots have already questioned this as dangerously low, but important to recognise that it is also not what CGM studies have shown. This large 2019 study puts it more mid-high 5s (depending on age)


So aiming to return to mid-6s (or slightly higher) seems a pretty good benchmark to me?

FWIW, with the benefit of hybrid closed loop, my 90-day sensor average is 6.6mmol/L, and my last A1c was in the 5s
 
Maybe it can be true that a non-D’s blood sugar sits around 4.3 a lot of the time. When my mum first got a blood tester sometime in the 80s she tested all of us a few times, and I always came out at the low end (even got a 3.6 once!). Although I think my dad and brother were higher. However, trying to achieve this when you don’t have a correctly functioning pancreas is pretty much impossible, as we’ve all found out. Therefore we have to aim higher for safety, and there’s absolutely nothing wrong with being in the 5s or 6s which are right in the middle of the normal range. And that’s the important point. Makes you realise how clever your body is when it works properly!
 
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I have seen stuff online regarding non diabetics using CGMs for sport “refuelling.”
There have been blogs including a cyclist. They stay within range, but the peaks & troughs? (Not clinical hypos.) Some struggle to understand it. From what I’ve seen, they don’t sit in the fours all day. Even with a functioning pancreas.
 
Here's the fifth🙄
Although to keep the context I am not using a pump. But I know that basal testing is an important piece now.
I take only my tresiba, no ingesting foods and observe my sugar levels over a period of time. There's more information to be found on the forums I am certain.

We all live and learn @bujanin 🙂 That’s the good thing about this forum - lots of experience and great support.

For basal testing, you don’t have to starve yourself for 24 hours. You break the day down into shorter periods and do the testing over a number of days. There’s a link explaining below.

Basal testing:

https://www.mysugr.com/en/blog/basal-rate-testing/

.
 
I have seen stuff online regarding non diabetics using CGMs for sport “refuelling.”
There have been blogs including a cyclist. They stay within range, but the peaks & troughs? (Not clinical hypos.) Some struggle to understand it. From what I’ve seen, they don’t sit in the fours all day. Even with a functioning pancreas.
I am not convinced sports people's Libre graphs are great examples for the general public.
As you mentioned, they may use Libre to time fuelling. If they don't fuel in time, they can "bonk" which is, basically, going into what those of us on insulin consider a hypo.
My partner is fit but not an elite athlete. He has not used a Libre but we occasionally check his BG for "fun". It has become almost a joke that it always reads 5.2.
That was until he didn't fuel on a long cycle ride. He had to stop because he felt so bad. He sat around recovering for 15 minutes or so and then pricked his finger : 2.9.
Most people don't do intensive exercise for over two hours so I would not expect them to see such figures.
 
Here's the fifth🙄
Although to keep the context I am not using a pump. But I know that basal testing is an important piece now.
I take only my tresiba, no ingesting foods and observe my sugar levels over a period of time. There's more information to be found on the forums I am certain.
Lol no your not the 5th, I was referring to pump users. Unfortunately some people do not get the concept that a pump is not plug and play but involves a lot of hard work.

You will get there my favourite saying is Rome wasn't built in a day 🙂
Small positive steps is the way to go (which is what you are now doing)
No1 is sort out your basal.
No2 is then to check your carb ratio. Do you know that not everyone has the same carb ratio for each meal?
 
@bujanin, about sorting out one's basal: our bodies basal requirement is different at different times of the day and basal testing is generally done so that people can find the best dose of basal for different times of day. This is appropriate and necessary, particularly when dealing with split basals, eg levermir, where each split dose only lasts part of the 24 hrs. But Tresiba is different and needs a different mindset.

Because it is simply not possible to have a daily Tresiba dose that provides varying basal cover across 24 hrs one has to optimise the steady Tresiba release for best effect over a part day and most people make that for the late evening into and through the night. One major part of basal testing is to assess how the basal is doing in the absence of bolus or food and for many of us that coincides with that period from late evening and through the night. So it is possible and indeed relatively easy to assess how one's Tresiba is doing from 10 or 11pm through to 6 or 7 am (or longer 'fasting' hrs) simply by definitely making that a bolus and food free period for that one period of basal test - in conjunction with the CGM graph for that period. I would suggest also with a confirmatory finger prick at start and finish; this fp is just to confirm that CGM and actual are broadly in unison over that period and thus the test period is broadly valid. It really doesn't matter if there is a bit of variation between CGM and actual. But one is looking for a horizontal graph, ie level trend over the test period.

So far so good: if the test period shows a horizontal trend then, even if higher or lower than wanted, the actual Tresiba is fine during that period and adjustment might be needed to get a better start point, then arrive at a better finish point. If trend is down, then the basal is dominating that test period and needs reducing. If the trend is going up then Tresiba needs increasing. Tresiba changes should be done in modest steps, using trial and learning to arrive at the optimum (horizontal/level) graph. You won't necessarily get a perfect flat graph (on this forum people sometimes refer to an overnight 'flatfish'); perfection is not realistic. Just start and finish at about the same point and not too much waviness in between.

But here is where Tresiba is different and needs that different mindset.
Firstly, as far as I'm concerned no point in splitting Tresiba; in my opinion doing so is a waste of time and attracting the risk of forgetting one of the split doses from time to time.​
Secondly, by day you have to manage your BG using bolus, exercise/activity and eating. The Tresiba basal will be doing its stuff throughout the day, but just not necessarily providing exactly what is needed to precisely cover glucose releases from one's liver, etc. In effect one either 'sugar surfs' or 'chases the insulin' - depending on what one's BG is doing on any day. In practice this is normal BG management that we all try and do, with all the everyday complications of carb counting, bolus ratio assessing and then dosing, along with the adjustments we try and gauge for different levels of activity and exercise on different days (and for weekends vs weekdays). Plus the adjustments we need to for those other things that somehow seem to come from the ether and have affected our BG!​
Thirdly no change to Tresiba doses until it becomes apparent that the basal needs adjusting because of long term changes from, perhaps, weather seasonal variations or maybe a definite change in exercise regimes; long term illness, perhaps. But fundamentally when after several days it is clear that the Tresiba dose is no longer right. I seem to only need to adjust my Tresiba no more than 4 times in 12 months.​
Fourthly, just because one has optimised Tresiba for the ideal night, it doesn't mean you can't ever change the 24 hr routine. I sometimes have a late evening snack and bolus for that, or change my evening exercise regime, or drink alcohol close to bedtime (alcohol and insulin aren't great companions for me, so I need to make allowance for my liver behaving differently in how it metabolises my evening meal or late snack). BUT I just need to keep in mind that I may have varied the evening and night time parameters and so may need to adjust my bolus and eating thinking for that period. I also need to gracefully and accept that my overnight CGM graph was altered by my chosen regime changes.​
Fifthly: because you are not trying to optimise Tresiba for daytime, just accepting that it is doing whatever it does, then "basal testing" has become very simple. Just do the test for evening and night, with due exclusion of bolus and food in that window, with no need (or point) to test across other time periods.​
Tresiba may not be ideal for everyone, it's just one of the tools available to us for keeping us alive and managing our BG. But with understanding of what Tresiba is intended to achieve it can be a really good basal and just needs awareness of how to get the best out of it. Just depend on Tresiba for its consistency for part of the 24 hrs and then use bolus, exercise and carbs for the rest (easy written - far from easy to do sometimes).

I can't remember if you have previously done a DAFNE course. But if you are intending to ask for a course in the near future, I found rhe DSN leading the course I did kept emphasising the need to adjust bolus ratios or basal doses; I had to politely remind her that did not apply to me withbTresiba as my basal and by the end of the 5 days she was including the comment "but not with Tresiba". I didn't need to be told, but good to hear it openly said. Good luck.
 
I am not convinced sports people's Libre graphs are great examples for the general public.
As you mentioned, they may use Libre to time fuelling. If they don't fuel in time, they can "bonk" which is, basically, going into what those of us on insulin consider a hypo.
My partner is fit but not an elite athlete. He has not used a Libre but we occasionally check his BG for "fun". It has become almost a joke that it always reads 5.2.
That was until he didn't fuel on a long cycle ride. He had to stop because he felt so bad. He sat around recovering for 15 minutes or so and then pricked his finger : 2.9.
Most people don't do intensive exercise for over two hours so I would not expect them to see such figures.
From what I have noticed from the average non diabetic “bio hacker.” using a CGM. (These people are not “pro.” Just testing sensors.) they can’t understand the body’s reaction to the general diet they use to maintain fitness.
Some of us can successfully use our insulin & change the “landscape” on trends? (With exogenous insulin.)

Please focus on supporting this guy. Instead of trying to undermine others positive reassurances on progression and resolving an issue. To which has been bravely reached out for?
I’ve randomly tested my wife too. It not fun to do when her eyes widen with concern on the meter result after the same meal.
She isn’t diabetic. & I just happened to cunningly bolus for what we had that evening.
Lesson learned, never do this again. She does go for regular “well woman” check ups.
 
So aiming to return to mid-6s (or slightly higher) seems a pretty good benchmark to me?
Yes I think so. I walked four hours today in the moors staying around 6/7. Previously when the alarm would go off at 4.3 ish I would carry on for a while. Today the alarm went off at 5.5 and I reached for something straight away.
I will acknowledge that I do feel more settled mentally at the higher numbers.
 
@bujanin, about sorting out one's basal: our bodies basal requirement is different at different times of the day and basal testing is generally done so that people can find the best dose of basal for different times of day. This is appropriate and necessary, particularly when dealing with split basals, eg levermir, where each split dose only lasts part of the 24 hrs. But Tresiba is different and needs a different mindset.

Because it is simply not possible to have a daily Tresiba dose that provides varying basal cover across 24 hrs one has to optimise the steady Tresiba release for best effect over a part day and most people make that for the late evening into and through the night. One major part of basal testing is to assess how the basal is doing in the absence of bolus or food and for many of us that coincides with that period from late evening and through the night. So it is possible and indeed relatively easy to assess how one's Tresiba is doing from 10 or 11pm through to 6 or 7 am (or longer 'fasting' hrs) simply by definitely making that a bolus and food free period for that one period of basal test - in conjunction with the CGM graph for that period. I would suggest also with a confirmatory finger prick at start and finish; this fp is just to confirm that CGM and actual are broadly in unison over that period and thus the test period is broadly valid. It really doesn't matter if there is a bit of variation between CGM and actual. But one is looking for a horizontal graph, ie level trend over the test period.

So far so good: if the test period shows a horizontal trend then, even if higher or lower than wanted, the actual Tresiba is fine during that period and adjustment might be needed to get a better start point, then arrive at a better finish point. If trend is down, then the basal is dominating that test period and needs reducing. If the trend is going up then Tresiba needs increasing. Tresiba changes should be done in modest steps, using trial and learning to arrive at the optimum (horizontal/level) graph. You won't necessarily get a perfect flat graph (on this forum people sometimes refer to an overnight 'flatfish'); perfection is not realistic. Just start and finish at about the same point and not too much waviness in between.

But here is where Tresiba is different and needs that different mindset.
Firstly, as far as I'm concerned no point in splitting Tresiba; in my opinion doing so is a waste of time and attracting the risk of forgetting one of the split doses from time to time.​
Secondly, by day you have to manage your BG using bolus, exercise/activity and eating. The Tresiba basal will be doing its stuff throughout the day, but just not necessarily providing exactly what is needed to precisely cover glucose releases from one's liver, etc. In effect one either 'sugar surfs' or 'chases the insulin' - depending on what one's BG is doing on any day. In practice this is normal BG management that we all try and do, with all the everyday complications of carb counting, bolus ratio assessing and then dosing, along with the adjustments we try and gauge for different levels of activity and exercise on different days (and for weekends vs weekdays). Plus the adjustments we need to for those other things that somehow seem to come from the ether and have affected our BG!​
Thirdly no change to Tresiba doses until it becomes apparent that the basal needs adjusting because of long term changes from, perhaps, weather seasonal variations or maybe a definite change in exercise regimes; long term illness, perhaps. But fundamentally when after several days it is clear that the Tresiba dose is no longer right. I seem to only need to adjust my Tresiba no more than 4 times in 12 months.​
Fourthly, just because one has optimised Tresiba for the ideal night, it doesn't mean you can't ever change the 24 hr routine. I sometimes have a late evening snack and bolus for that, or change my evening exercise regime, or drink alcohol close to bedtime (alcohol and insulin aren't great companions for me, so I need to make allowance for my liver behaving differently in how it metabolises my evening meal or late snack). BUT I just need to keep in mind that I may have varied the evening and night time parameters and so may need to adjust my bolus and eating thinking for that period. I also need to gracefully and accept that my overnight CGM graph was altered by my chosen regime changes.​
Fifthly: because you are not trying to optimise Tresiba for daytime, just accepting that it is doing whatever it does, then "basal testing" has become very simple. Just do the test for evening and night, with due exclusion of bolus and food in that window, with no need (or point) to test across other time periods.​
Tresiba may not be ideal for everyone, it's just one of the tools available to us for keeping us alive and managing our BG. But with understanding of what Tresiba is intended to achieve it can be a really good basal and just needs awareness of how to get the best out of it. Just depend on Tresiba for its consistency for part of the 24 hrs and then use bolus, exercise and carbs for the rest (easy written - far from easy to do sometimes).

I can't remember if you have previously done a DAFNE course. But if you are intending to ask for a course in the near future, I found rhe DSN leading the course I did kept emphasising the need to adjust bolus ratios or basal doses; I had to politely remind her that did not apply to me withbTresiba as my basal and by the end of the 5 days she was including the comment "but not with Tresiba". I didn't need to be told, but good to hear it openly said. Good luck.
Very generous thank you. I've read through twice and can see what I need to do.

I haven't done a DAFNE course. Having moved to Devon from London the nearest course now is a long way away in Somerset but I will definitley keep it in mind.
 
I will acknowledge that I do feel more settled mentally at the higher numbers.

This is so great to hear! And levelling at 6-7ish while romping over the moors is perfect 🙂

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Long may it continue :D
 
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