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Reflections on inflections

Sugar Surfers reflect on inflections. What does that mean? It means that keeping an eye on changes in the direction of your blood sugar trend line. Whenever the trend line changes direction (inflects), it's wise to think about what might be causing this shift to occur. The only person who will best know this is you. This ability to reflect and respond is vital to learning how to control the line's direction of flow. When a glycemic trend changes direction and it is NOT because of a proactive action you took (i.e., an insulin, exercise or carb pivot), this change will carry significance to you, the Sugar Surfer.

When viewing a glycemic inflection you should reflect on WHY the trend line is changing direction. That demands your situational awareness. As Sugar Surfing is "management in the moment", that means you should recall your most recent diabetes self care events. This should be fairly easy to do.

For example, is this an upward inflection occurring after a meal time insulin dose taken a few hours earlier? If so, this might be the result of the prior meal time insulin dose wearing off. The meal carbohydrates are still converting to blood sugar and might now be winning the glycemic 'tug of war', sending your BG trend line trending upward.

If this inflection tends to occur at a fairly predictable time after the previous meal time dose, you might be witnessing the effective 'duration of insulin action' or DIA. It's also called the 'insulin on board'. It's a measure of how long your meal time insulin works, measured from the time you took the dose. If you are a purist, then the exact time would be from the first downward "bend" until the first significant upward bend. DIA is not an exact value since a larger meal time dose will tend to last longer than a smaller one. Furthermore, if there is a large imbalance between carbs and insulin (insulin dose too low for what was eaten), then there will be an upward trend after the meal which continues to rise.

After dosing for a meal, a classic Sugar Surfing move called "waiting for the bend" describes the first infection of the glycemic trend line which might be a helpful cue in deciding when to eat. But of course it's important to have a good appreciation for the blood sugar raising effect of the meal about to be eaten. Fast carbs? Slow carbs? Something in-between? That's your task to figure out.

As Sugar Surfers, our goal is to balance the duration of insulin action and the duration of our meal's blood sugar raising action. It's common for food to outlast an insulin dose and for peaking insulin to often overwhelm the maximum sugar raising power of the food. This is the reason we use combination or dual wave boluses with pumps, or "I-chains" with injected insulin (Sugar Surfing term). Rarely will a "one and done" approach to food and insulin result in a proper blood sugar response curve. Follow up actions are often necessary.

Inflections tell us a lot, if we know what to look for. Don't ignore them. Learn from them. Mastering the inflections is essential to becoming a true "Surf Ninja".

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