Request D’Mine: Diabetes Mail Bag Redux

If it is not 1 thing with diabetes, it’s just another — out of trying to determine our dosing needs to cross-over along with different disorders to how we feel about sharing our D-issues with nearest and dearest and others in our lives. We in the ‘Mine are here to support you, particularly each Saturday using our weekly in-depth advice column, Ask D’Mine, hosted by veteran type 1, diabetes writer and instructor Wil Dubois.

This week, Wil’s addressing four intriguing “straggler” questions in the mail bag… which we thank you for keeping full of great inquiries!

Mary, type 1 in Kentucky, writes:I have had type 1 for 49 years and have been pumping insulin for about 20 years now, currently utilizing an Animas 2020. I have times once I have to set my temp basal rate up +30%. I usually place it as soon as I see exactly what my day is going to be like, and time it to stop at 9pm or 10pm. Bearing that in mind, I have been having lows through the nighttime, any time from 2am to 4am. My basal rate is only 0.3 from 12am to 3am; can I be reduced due to a residual in the temp basal speed?

Wil@Ask D’Mine answers:Maaaaaaaaybe the 2am low, but no way could the temp rates you are describing cause you trouble in 4am. Much like Elvis, the building has been left by the insulin by then. Even if you conducted a +3,000% temp rate–not that you can–the quantity of insulin is irrelevant. It’s the end period of the speed that decides how long the extra insulin functions, not how much you used.

The effective real-world length of action to get fast-acting insulin I see in many folks is at four hours. Now of course some experts can argue for three hours, others five hours ; and the tag will say six hours –but that is the tail of this action curve in a test tube, which is not sufficient to lower a person’s blood sugar out in the trenches.

If your temp rate ends at 9pm, I’d expect the incentive bolus to be gone by 1am. If you wrapped it up at 10pm, the last additional fall could still have an impact at 2am. That is why I said maybe. Even if the reduced had been at 2:30 in the morning, I guess a bit of upstream insulin could have set you up onto a downhill slide that didn’t go officially low until after the insulin’s run. But 4am? Nah. That is too late. It’s either the basal or the residual effects of exercise or booze–both of which are typical suspects when it has to do with lows many hours downstream.

So… are you highly active on the times that you use the temp rate? If so, I’d follow this up with a negative temp basal rate for a few hours during pregnancy. Use your +30% for the day, and if you shut it down, place it to get -30% to get a four-hour run and see what that will do for you. If those are heavy booze days, the same advice will work. In either case, obviously, there’s no guarantee on the 30% figure; it only felt like a great starting place. You’ll have to play the actual numbers to learn what works for you.

If your heavy temp rate days do not have a lot of exercise or booze, then maybe the basal rate of 0.3 per hour is a lot for you. Attempt 0.2 units per hour. Bear in mind, when it comes to insulin, there’s no such thing as too little or too much. Like Goldilocks, you need just what you need. Not a drop more rather than a fall less.

Of course, remember that Your Diabetes May Vary and since I am not your doc, please make certain that you talk to your personal endo and that.

Ralph, type 2 from Montana, writes:I am on Medicare so my insulin costs are very OK. While I see the price for many others versus what I pay, I am appalled. What is behind those prices?

Wil@Ask D’Mine answers: Supply and demand. Global economics. Greed. Take your choice.

Unknown type 1 from somewhere in the USA writes: I have had type 1 diabetes for 16 years and have been out of control. I only found out I am pregnant and am trying to control my sugar, but if it gets about 160 I am feeling really low. How do I fix this to attain normal sugars? Please help.

Wil@Ask D’Mine answers: Oh God, I hate getting letters like this. It breaks my heart. But I am glad that you wrote. I’ll bet you are suffering “relative hypoglycemia,” where your body thinks you are low when you are not. It happens in those who have been running high for some time. The body gets duped into thinking that high is normal. Under normal circumstances you can reset your body by bringing your down sugars gradually over a span of a time. It’s sort of the opposite of mountain climbers, who have to acclimate a bit at a time into the thin air as they move up Mount Everest, or deep sea sailors who have to take breaks to decompress while coming up in the bottom.

The problem here however, is that these are not normal conditions. This strategy takes some time, and you and your baby don’t have the luxury of time. Elevated levels of sugar are somewhat toxic to the embryo. This is there (again) where I have to remind you that I am not a doctor and you need to be under the care of a great one. What you and your doc have to do is to get your insulin around where it has to be to get your sugars down to where they will need to become, and do it in the minimum quantity of time that does not leave you feeling hypo. If your healthcare team ordered a big growth in insulin doses, you might have to adjust to this by noodling it up a bit daily. Perhaps you have to have a week or 2 to get there, including 5% or 10% of the rise daily in order for your body can adjust.

But do it and do it today. Your baby is counting on you.

Mark, type 1 in New Jersey, asks:Can diabetics donate organs?

Wil@Ask D’Mine answers: Of course. Just do not donate your pancreas; nobody wants that piece of junk! But seriously, yeah, a number of our equipment may not be in the best of shape from the diabetes, however if your liver does not work at all, you’d be very happy to have a battered second-hand one out of a individual with diabetes that does not need it.

But do you know what happens in this state? Every day we literally bury body parts that dead people do not need anymore; and within another plot over, we bury those who have died from lack of having those parts.

Additionally, new interesting fact: Joslin Diabetes Center in Boston is now signing up long-time diabetics to donate their parts to diabetes research as soon as they kick it. For information on that, see: ” I Had Away My Diabetic Body.”

So on the whole I’d say: Do not be selfish. Be a donor. Diabetes or not.

This is not a medical advice column. We are PWDs publicly and publicly sharing the wisdom of our collected experiences — our been-there-done-that knowledge in the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are just a little portion of your whole prescription. You still require the expert advice, treatment, and maintenance of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is made for Diabetes Mine, a consumer health blog focused on the diabetes community. The content isn’t medically reviewed and does not adhere to Healthline’s editorial instructions. For more information about Healthline’s venture with Diabetes Mine, please click here.

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