Sugar Surfing Lesson #15: "Maxim"-izing your control

Sugar Surfing™ is a method of diabetes self-management based on categorizing groups of blood glucose (BG) information into sets of recognizable geometric patterns. Effective Sugar Surfing encourages learning to identify these patterns as they are forming or taking shape, then making decisions about them "in the moment".

The ability to recognize BG patterns combines with the Sugar Surfer’s “situational awareness” of the person’s recent, current and anticipated actions. This allows the Surfer to assign significance (or non-significance) to any given trending pattern or series of patterns. Through ongoing practice, experience, and experimentation the Sugar Surfer develops proficiency in acting or not acting while watching the glycemic trend line. The ultimate aim of Sugar Surfing is to “steer” the BG trendline by manipulation of activity, food and insulin.

Sugar Surfing defies simplification into mathematical formulas, carbohydrate counts, or standardized protocols. Real life variables (e.g., stress, the speed of digestion, inconsistent insulin action, etc.) do not convert well into equations. Sugar Surfing transcends formulaic and static methods of diabetes self-care. It is a 'next level' approach to diabetes self care.

The word “Meta” as defined by the Urban Dictionary means “about the thing itself. It's seeing the thing from a higher perspective instead of from within the thing, like being self-aware.” By this definition, Sugar Surfing is arguably a “meta-therapy” for persons with type 1 diabetes.

Maxims are rules for good or sensible behavior. The following are helpful maxims to consider and apply when viewing recognizable trend line patterns and structures. Specifically, these maxims are useful when deciding when or not to act on a BG trend line pattern “in the moment”.

This above image summarizes the shapes of the basic features from a blood sugar trendline as displayed on a continuous glucose monitor.

1. Watch a drop if well over your target BG.

If a BG trendline is falling for any reason and you are well above the upper target range, its best to wait and watch. If the blood sugar is trending downward and it is not near a level considered low or hypoglycemic, then it is usually wise to continue periodically following the trendline by glancing, not act with any additional insulin. There may be several reasons for a high drop, starting with a prior insulin dose which is now starting to kick in, a change in basal insulin delivery rate (if using an insulin pump), or increase in physical activity (exercise). Any or all of the above might combine to create a drop and should be considered. Sometimes there is no easily defined reason. Nevertheless, always go through your mental checklist first before attributing a BG change to chaos or chance.

Watch to see if the high drop inflects (bends) into a relatively level period of glucose trending (i.e., a shelf), or continues to drop past a glucose level you feel is worthy of treating with food or fast acting carbohydrates (see image below). If a high trending shelf occurs, then after a sufficient period of waiting and watching, it is worth considering an insulin dose (and/or added exercise) to reduce the blood sugar further. This is called “taking the drop” in the book (see image below).

Lag time is important to consider when acting to change a BG trend. Depending of what and how much carbohydrate is eaten, the trendline may take longer than you think to show the desired effect. This is partly due to the time it takes for the food to convert to sugar in the body, plus the time it takes for the sugar level to change in the interstitial fluid where the sensor detects it. Make a mental (or