I've been asked how I came to develop Sugar Surfing. My answer is simple: I chose to reject the traditional "boilerplate" insulin dosing approach to type 1 diabetes I was taught (and taught to others) once I saw how blood sugar levels really behaved after using a continuous glucose monitoring device (CGM).
The conventional "static" approach to type 1 diabetes has come to be defined by terms like insulin sliding scales, insulin to carbohydrate ratios, correction factors and insulin on board. These are not inherently wrong, but they always left me wanting more. I sought to take full command of how my blood sugar levels behaved. Sugar Surfing opened that door.
Sugar Surfing began by conducting personal experiments with my diabetes under carefully scripted conditions. On one level that sounds scary, but I did it very carefully and with close attention to my CGM trend line. I used all sorts of safeguards to prevent a rapid drop or rise in my BG which might compromise me. I was prepared.
This "nudge" example illustrates my intent. I had long been taught that the "Rule of 15" was how to properly treat a low range blood sugar. Simply stated, the Rule of 15 says that a low blood sugar reading should be treated with 15 grams of fast acting carbs, then the BG should be re-checked in 15 minutes.
In the CGM universe, I found that 15 grams of fast acting carbohydrates would usually make my blood sugar skyrocket almost 100 mg/dl or greater (5-6 mmol/L), much higher than what I wanted.
So...I started to experiment. I discuss this in greater detail in the book Sugar Surfing. I asked myself a simple question: just how small a dose of fast carbs could I take and make a measureable and meaningful impact on my blood sugar level, when on a steady BG trend line .
This image exemplifies my work. But it takes some setting up first. I was not dropping when I did this. My BG was low-ish and I wanted to see just how much a small dose of fast carbs might raise it. Boy was I surprised at first.
The image shows that I'm trending in the mid-60 mg/dl range (~3.6 mmol/L). I was on a glycemic "shelf" as illustrated by the green box. That is, within a steady trend line.
I was also NOT engaged in strenuous physical activity nor was I unusually stressed. With those caveats, I ate 4 grams of glucose: a standard single dextrose tablet.
Then I waited. As you can see it took some time for my BG to slowly drift up to a higher range: about 20 mg/dl higher (~ 1 mmol/L) over half an hour. It remained there afterwards.
This experiment was repeated several times. The same general trend was seen. If my BG was trending upward or downward, the results would be impacted. For example, if I was drifting downward, it would require more fast carbs to slow the fall. If a dose of insulin had been taken recently, then greater "force" would be needed to raise the BG trend line. Sugar Surfers know this particular move as a "carb pivot". The above image is an example of a carb "nudge".
Sugar Surfers must master the art of glycemic finesse. It starts by careful experimenting combined with the traits of patience, consistency and resilience.