Sugar Surfing™ is the art of 1) visual pattern recognition, 2) assigning significance to what is visualized, 3) choosing an action to take (or not take), then 4) following up carefully and at times frequently. Here is another basic lesson in Sugar Surfing I ask you to study carefully.
The image below highlights all the basic patterns seen on a blood glucose trendline. I’ve color-coded them to help each stand out. First, notice the light orange “drop” on the left. It’s a slowing falling BG trend which began at a steady BG trend around 160 mg/dl (8.9 mmol/L). It’s a slow drop of around 90 mg/dl (5 mmol/L) over a 3-hour period. Slow drops or rises often happens at work when I get busy moving about the office or stressed for whatever reason. In this instance, the drop was not fast enough to trigger a falling BG alert alarm. Yet I was aware of it since I glance every hour or two, more so as I approach a meal time. I also make a habit of glancing at the trend line between patient encounters in my clinic.
Since this BG trend was falling gradually, I chose to do a little experiment of sorts. Normally, I eat a small meal at lunch. In this case some Greek yogurt with a total of 8 grams carbs (20 grams protein). Since I wasn’t falling fast and was not going to do anything strenuous over noon, I just chose to break the BG drop with a small carb meal and see what happened. I will also add that this food is on my “top ten” list of foods I can eat. That means I have a good idea of how this meal will behave regarding blood sugar changes. This is another core Sugar Surfing principle: know how your favorite meals or foods affect your blood sugar. It’s not just the amount of carbs. Think holistically. The fat and protein, plus other factors, will contribute to the overall blood sugar effect of a given meal or food.
Next, you can see the lag time, which in this case I was already expecting to be longer compared to consuming 8 grams of pure carbs. I was fully prepared with fast carbs should I have dropped lower, but I only fell into the high 60 mg/dl (3.3 mmol/L) range before pivoting up. As a reminder, lags and pivots (a form of inflection of the trend line created by an intentional action like insulin or food) are core Sugar Surfing patterns we all demonstrate through the day. You learn how to identify them all by glances at the CGM screen.
The pivot occurred about a half hour after the meal. That marks the start of a slow delta wave, shown in red. This rise lasted about 1.5 hours until a new period of BG trending stability occurred, better known as a “shelf” in Sugar Surfing parlance. In this example the shelf hovered around 120 mg/dl (6.8 mmol/L).
So, in this specific example, I did not inject insulin for a small low carb meal. This was a choice. I allowed the “momentum” of a slow drop to substitute for a small insulin dose. Many of you reading this are frequent practitioners of low carb eating, so the information in this post should not be news to you. However, others who think insulin is always needed for meals might take notice that there are times when this is not necessarily the case. But each case must be judged by its own merits.
For the record, the basal insulin I receive is by injection. This example does not involve an insulin pump. I take 12 U Tresiba (insulin degludec) every evening. My daytime BG levels, like everyone else’s, ebb and flow. The next day, this pattern might be total different. A BG rise might occur, or simply a shelf. Each one gets my attention. It’s I who choose how to respond to each. My responses will vary based on the patterns I recognize “in the moment”. Sugar Surfing gives me the POWER to direct this line more than it directs ME.
Finally, in this single demonstration exists almost every key element of Sugar Surfing. Remember S.U.R.F.
See the patterns: drop, lag, pivot, delta wave, shelf. They are all there. I either watched them happen or created them myself.
Understand their significance: I was not falling fast, doing no ongoing strenuous activity, highly familiar with the food being eaten, and had a backup plan.
Respond appropriately: I withheld insulin and went about my daily noon time in office routine.
Followed up carefully: I glanced at the trend line more often after eating, waited to “feel” the BG rise, then less often watched as the delta wave occurred over the next couple of hours. I “felt” the shelf too and remained there for the next few hours.
While you might think this took a lot of mental energy, I would say that my work went unimpeded and these actions simply fit into the flow of my day. At first you will spend more time practicing this, but with time, experience and success your confidence grows. It’s at that point you begin developing fluency in the art of Sugar Surfing.
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