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Sugar Surfing™ Lesson #12: Skipping stones

Skipping stones on the water is a pastime dating back to antiquity. Sugar Surfers can learn to skip their blood sugar trendlines like the path of a stone on the water. It takes patience and practice.

Here is an example (in mg/dL and mmol/L) of a 12-hour period of micro-dosing insulin and carbs. Through periodic glances at the trend line and seeing (glancing at) minor drifts up or down, a series of carbohydrate ‘nudges” kept the trend line hovering around 70 mg/dl (~4 mmol/L).

I show this to make a point about the power of manipulating the trend line. If it can be done at this level of blood sugar, it can be done at any level you choose. A closer inspection of the images will show that I ate first and injected afterwards for breakfast. There was no “waiting for the bend” needed here since I was already around 60 mg/dL (3.3 mmol/L) and trending level.

For the record, this CGM session was running a few points below my meter so I estimated I was probably 10 mg/dL (0.6 mmol/L) higher than what is displayed. Please take note of the actions used to avoid over steering the trend line in either direction. I know many of you reading this would not be as comfortable running this tightly with yourself or your child’s blood sugars at the levels shown here. I appreciate that 100%. Please focus on the teaching points.

In this example, my basal insulin is by injection: 12 Units of Insulin degludec (Tresiba) to be exact, taken at 9PM the night before.

I will list my key teaching points here.

· Small carb amounts (fast acting) can effectively shift the trendline when there is no active insulin on board.

· Meal time insulin can sometimes be taken AFTER eating when the premeal blood sugar level is low or trending downward and already in your target blood sugar range.

· The CGM user determines the significance of a shift (up or down) in the blood sugar trendline and then whether to act, and by how much to act.

· The art of subtlety is a powerful tool for an experienced Sugar Surfer.

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