Five months on and some open questions

Newly Diagnosed
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At 31, I was incorrectly diagnosed with T2D by my PCP, prescribed medication, and landed in the hospital with DKA 4 days later. My A1c was 15. After my brief stay in the hospital and a revised hypothesis (later confirmed with antibody tests ordered by my endocrinologist), I still had ongoing neuro symptoms and was rather shocked by the whole series of events. Nobody in my family is diabetic.

I threw away almost all of my food and rehabbed my diet. My diet collapsed down to a handful of meals in order to try to figure out how to manage my blood sugar, but by the end of 2021, I had started looking for new options (for diversity and joy). My mental health was not great, but definitely not the worst it’s been. I struggled with feelings of bitterness and resentment. I still do… I’m seeing a psychologist, but progress is slow.

Around the New Year, some pain in my wrists became semi-permenant. I’ve seen a neurologist and it is likely carpal tunnel, we will test tomorrow. On top of that, my carbs: units insulin seems to have shifted in the last two weeks. I expected it to shift (I had some function left, but also an immune response that was literally off the measured scale), but I’ve moved from 18-20:1 to 12-15:1 and while I didn’t know where I would end up, that feels pretty dramatic.

I just switched CGMs (Abbott => Dexcom), so I don’t have a full 30d stats block, but it’s currently showing a 96% time in target (80-140) with an average of 111 and std deviation of 15 and that’s pretty representative of what the other one showed. I had my A1c read for the first time since I was hospitalized this morning. Diabetically, unless my CGMs have been off, I think I’m doing ok (I really wish I could pull the average down another ten points though).

I realize these questions may be more appropriate for my doctors; I don’t take random responses on the internet as medical advice and will follow up, but I would appreciate any experience people are willing to share.

Does it ever get easier or just more normal?

Are the magnitude/timing of my carbs:insulin shift normal or concerning? Should I be expecting more shifts? How often? Do these shifts ever go in the other direction (I can’t see why they would)?

I’m currently in a position with my basal where I can either go up 10-15 points overnight at 7 units or drop 20+ points (and run the risk of hitting an alarm) with 8 units. I find it generally easier to keep myself lower when I’m on 8 (duh), but the nights are harder to manage. Any thoughts or advice here? My pens don’t do half steps, so I’ve been thinking about splitting it to half as much, twice as often.

Most of the graphs I have seen for “normal” blood glucose following meals show a sharp rise followed by a steady drop off and the targets I usually see discussed are 140 post meal and 120 a couple of hours later. That is generally not my experience. If I inject after the food is prepared and before I start eating, I am not usually peaking until 2+h have passed. This makes the 120 target 2 hours post meal feel challenging. I don’t really know what to ask for this one… is this diet? Do I need to change the timing of my insulin?

This is long… thanks for anyone who takes the time to respond.

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@FlickeringEchoes Hi Ryan, and welcome to the JDRF TypeOneNation Forum! You’ve asked a wide variety of questions and I’ll try to respond - let me know if I miss something you want to talk more about. I’ve had diabetes since I was a kid and now I’m in my 80s and experienced much, including having difficulty “accepting” MY diabetes; you will get to the point of acceptance once you realize that you’ve got this thing for a lifetime and you desire to move on and LIVE a full and fulfilling life. As a note: I’m making suggestions here based on my experience living with diabetes and not a a medical professional or as medical advice. The statistics you share in your fourth paragraph are VERY impressive, results not achieved by many people.

One point I make when speaking about diabetes with other PwD [Persons with Diabetes] is that the one constant with managing T1D is CHANGE; insulin needs change over the course of time - this includes both I:Cr [insulin to carbohydrate ratios] and basal doses. I use an insulin infusion pump and I have 13 “timed periods” during the course of a day because my basal needs vary, and my I:Cr change significantly during the day - my I:Cr vary from 1:10 to 1:19, and my basal rate per hour from 0.0 to 0.5. Those are the stats from just one of the several Profiles I have programmed in my pump and they were developed by much trial & error and hit % miss. My current Lab Test [not the error prone finger-stick] HbA1c = 5.5 and I eat just about any food imaginable; I count carbs and dose appropriately for foods I consume. Over the years, my daily insulin usage has varied from 18 units at diagnosis to more than 80 units and more recently [reading from my pump] my 30 day insulin usage is 18.4 units - basal = 5.3 and bolus 13.1 to cover the 200 - 250 grams of carbs I usually eat. My standard deviation is no longer as impressive as yours.

Does it ever get easier? I don’t know if it is any easier, but right now diabetes, although I’m constantly aware, is so ingrained in my that it is jost a part of my life and fits in. Keep in mind, that when I was diagnosed to “best” a doctor could give hope for was that I might double my age or possibly live for as many as 10 years. What helped me was about 10 - 15 years in, I made the decision to not let diabetes define me, but rather that I would make diabetes fit my life and not hold me back. I have done just about everything I’ve wanted, many varieties of work from laborer to CEO of a national company, and most of all I’ve enjoyed living. I worked for more than 50 years, doing college with honors at night while raising a family and retired just after reaching 70th, and then found volunteer work including serving as math tutor at a nearby college. Days not at school, rode my bike 20+ miles in hot Florida sunshine and rain, and now walk 4+vto 6+ miles every day. My advice is to think positive, be flexible with your diabetes and recognize changes as they happen and make adjustments.

A word of caution, when changing insulin dose, including I:Cr, do it gradually and observe what happens before making additional changes, if needed. Learn about your body and what works for it - there aren’t two of us exactly alike and what works for for someone else my harm you.

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I’m sorry you were misdiagnosed, that it was so painful, and that damage was done. Some of that may be reversible, but I fear that some of it may not be. Time will tell.

111 is a fantastic average, and 96% time in range is awesome. Congratulations! That’s plenty good.

It does get easier and more normal. Like anything does with practice and experience. You learn how your individual body responds to stuff and what it needs. You learn where you can have room to relax and where you need to be vigilant. The first year is always the hardest, but you’re doing great.

The body also tends to change the most in the first year or so in terms of carb ratio and such, as your remaining insulin production capacity goes out in fits and starts. There will be other adjustments in the future, but hopefully not that drastic.

The rule I was taught, and which I still firmly believe, is that it’s better to be a little high than a little low.

The damage from high blood sugars is gradual and somewhat reversible. It’s much more a matter of your A1C (which averages the last 3 months, more or less) than it is your hour to hour fluctuations. Complications come from buildup of excess sugar in your blood vessels and organs, but that buildup breaks right back down when you have lower sugar levels later. I’ve been diabetic for over 30 years and still no signs of complications even though I’ve hit some pretty high sugar levels from time to time.

The damage from low blood sugars, however, is a much bigger risk. If you don’t have enough sugar in your blood, your cells can’t get the energy they need to function. That’s especially true for your neurons. Going low can cause immediate permanent brain damage. It’s even riskier at night because going really low puts you at risk of slipping into a coma and if you’re not awake to feel yourself heading in that direction, you might not be able to treat it in time.

That said, if you want better control, especially while you’re asleep, and you’re already on a Dexcom, you might want to talk to your doctor about getting an insulin pump. My Tandem Tslim X2, for example, directly receives data from my Dexcom sensor every 5 minutes and automatically adjusts my basal rate based on not just where my blood sugar is now but whether it’s trending up or down and how much insulin is already in my system. It’s not perfect. I still get nighttime high blood sugars that I’m working on with my doctor. But it’s better than it was when I was taking 5 shots a day. Luckily, my insurance covers the pump, Dexcom, and supplies.

The graph of your blood sugar spike from food will depend on what you’re eating and how much you’ve been exercising, among other factors. Complex carbs digest more slowly than simple sugars, for example. (This is why I abhor the carb counting system which just lumps everything together. I know the exchange system was more work and more restrictive, but it led to a much more balanced diet.) Half a cup of orange juice and half a cup of spaghetti may roughly the same number of grams of carbs, but the OJ will make your sugar spike very quickly and then will burn out and leave you at risk of dropping low a couple of hours later. The pasta, on the other hand, will digest more slowly, leading to a more gradual rise, but it will also stay with you longer, keeping your sugar levels up for hours.

It sounds to me like you’d benefit from seeing a professional dietician who specializes in diabetics. Ask your doctor about that. A good endocrinologist will likely have a dietician they regularly work with. You don’t necessarily need to keep up with them on a regular basis, but a couple of sessions can give you the educational grounding you need.

Likewise, the effects of exercise can alter your metabolism for hours after. If you’ve been working out or running around or something, that can have a noticeable effect on the curve of your sugar levels. Keep an eye on that and you can learn how your particular body responds to that.

As for timing… most people do find that taking insulin before eating works well. It gives the insulin time to kick in and meet the food as it digests. But it’s always a matter of trial and error. You’ll get the hang of it.

And, again, don’t stress too much about meeting the exact planned curve or being a little out of range now and again. Diabetes is a long game. If you’re sweating over every BG value every hour of every day, you’ll stress out and drive yourself nuts and then burn out from it. It’s just not sustainable. Learn to relax a bit. Keep your sugars under control, but don’t obsess over them and don’t worry if they slip a bit. It’ll be okay. More important to have room for fun in your life. Learning to cope with diabetes is about learning to live with it more than it is about constantly trying to wrestle it into place.

I hope this helps. Good luck. And if you have any more questions, ask away.

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Hi @FlickeringEchoes and welcome to the forum. As far as your can ratio, keep in mind that it can take some time for things to “settle” for lack of a better term as your doctor works to determine your basal regimen and carb ratio. I used to have a carb ratio of 1:15, then 1:12, 1:10 and I recently went to 1:8. I wasn’t happy about getting to the single digits but the pancreas wants what the pancreas wants - or needs, as the case may be, so don’t feel badly about it.
You will find you need to change or tweak things from time to time. I don’t think I saw how long you have been diagnosed with Type 1 but if you’re still new you’ll work closely with your doctor until you’re comfortable making changes on your own. The body’s needs change from time to time whether we’re diabetic or not: it’s just that we are aware of the changes and adjust on our own. You’re doing great! Keep up the good work. As @WearsHats said, going low is more dangerous in the short term than running high - and your numbers are great. Keep them at a level where you can function safely, enjoy life, and can sleep without worrying about going too low (even with a CGM).
All the best to you and we look forward to your questions and contributions.

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hi @FlickeringEchoes welcome to the forum.

“does it get easier or more normal”… for me, it gets more normal. I’ve described it for years as not ever getting easier, but getting more “routine”

in my personal opinion as a non doctor and armature scientist, your ratios are “way high” meaning that I take MUCH more insulin than you for both long acting as well as for meals per unit carb. for reference, I’m 55+ years old 5’-10" and 165 lbs.

20 “points” if you mean a change in 20 mg/dL please realize your finger stick blood glucose meter is +/- 12% to +/- 20% accurate… so if your meter says you are 100 mg/dL you may actually be 85 md/dL to 115 mg/dL (this was done at +/-15%) which is a 30 “point” spread. simply put, about 20 points isn’t really a trend when you know how inaccurate your finger stick or CGM actually is.

Insulin timing is everything. but so is carb absorption so things like glycemic index and the amount of fats can delay the timing of the sugar hitting your blood. For example, 10 grams of glucose hits your blood in 15 minutes. 10 grams of carb in a tiny fraction of a slice of pizza can take up to 4 hours to absorb. Rapid insulin takes 20 minutes to start working and peaks at about 60 minutes and trails off to nothing at about 4 hours (fda.gov) link here

now I can ALSO turn that on it’s head (like @Dennis ) if I go for a walk say at 90 minutes after taking that bolus, so another variable in pharmacokinetics is your activity level. Typically I can get insulin action in the 200% to 500% above typical if I go for a walk or engage in exercise.

it’s a lot to consider, don’t try to learn it all at once. we are here to help!

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Thank you. We’ll see if I can keep it up when my diet starts expanding again. As another poster mentioned and I agree with, these numbers are coming from a period with as little change as I could manufacture and I don’t think that’s sustainable over years (for my own sanity). Step one was getting control though.

Well, that’s disappointing, but not surprising at this point.

I really appreciate your perspective. I’ve never been much of a dreamer; a quiet and contented life are all I really wanted. I’ve had a lot of trouble seeing my way there since August… it’s nice to see dreams live.

After fourish days of using my old ratio with essentially the same meals and needing multiple hours of exercise to get back to a spot I was comfortable going to bed with, I cut 40% of the carbs out of my daily diet (via portion reduction). I figured this would reduce the blast radius in case the numbers started shifting again. If things are quiet for a while, I’ll adjust portions again, but I am still hesitant to use larger amounts of insulin.

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By the end of the year, the only symptom that I still had from the hospital (seeing spots, my eyes having trouble focusing, pins and needles in a hand and toes) that persisted was occasional pins and needles in my big toes, so I am optimistic that most of it is reversible. That has disappeared completely with the medication to manage my wrists, so I don’t know if I still have it. I suspect the probably carpal tunnel is not unrelated, but… bodies are complicated and none of my doctors have said anything about it yet. I hear misdiagnosis is unfortunately common for T1D though.

That’s what I have been trying to stick to.

I had been pretty resistant to a pump because of how disruptive to my sleep I found the upper arm placement of the freestyle and a concern that a pump would only exacerbate that. I’ve found it easier to reliably sleep with the gut placement of the dexcom, so I may look at pumps. While this whole chain of incidents has exposed many frustrations in the US medical system, my insurance has been generally pretty good about supplies. My supplies are affordable, but I haven’t checked on pumps yet.

I expect that the carb counting system is easier to apply, much like the sliding scale for insulin (2/4/6/8 units if my reading was 200/250/300/350 when I next ate, with no mention of trying to plan) that I was prescribed when I left the hospital. Not optimal, but good enough to get people started (and assuming that an endo can see them inside 3 months…). I have been told a dietician may be helpful, but it had been a lower priority than all of my other various medical needs and I should find the time for it.

My psychologist would like you. I wouldn’t say I obsess, but I am attentive. Especially since my ratio has been in flux, I’ve set alarms to make sure I check my numbers and can respond if things go weird. Other times, I can go hours without checking. Relaxing… well, I’m wound pretty tight by nature, so I’ll call that a work in progress.

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I’m 5’8" and 155lbs. There’s obviously a lot of other factors at play, but to hear that I’m very high… I thought 20 was pretty unwieldy, to be frank.

I don’t fingerstick unless it’s a sensor change day or I feel different than my sensor indicates, at this point. I stuck every day for my first few sensors and found they consistently leaned off in a single direction for their whole lifespan. I wouldn’t be surprised if my sample size was too small and they can flip-flop though. I understand the margins of error, and I choose to believe the general magnitude and direction of change since it is relatively consistent over multiple samples (regarding the nightly changes from the different basals).

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@FlickeringEchoes - since you describe yourself as tight wound there are some very good trackers that might help you note patterns in addition to keeping records. I pay for an annual subscription to MyNetDiary but there are a number of free ones such as MySugr and Glucose Buddy. Pencil and paper work just fine for some though.
If you haven’t read it yet take a look at Think Like a Pancreas by Gary Scheiner. He has Type1 and works in the diabetes field.

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Thanks for the suggestion, I’ll take a look.

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This is exactly backwards. There are good reasons to adjust your carb intake. But take your insulin to meet your carbs. If you’re adjusting your carbs to meet your insulin… I usually hesitate to tell people they’re doing things the wrong way because we’re all individuals and we’ve all got complex things going on in our lives. But that’s one thing that’s fairly clear-cut. If you can afford your insulin (and it pisses me off that there are so many people who have to ration their insulin, but that’s a whole other discussion), the dose should be the end of your process, not the beginning. You eat what your body needs (or what the occasion calls for, etc.), you figure out what else might factor in, and you take the appropriate amount of insulin to cover that. You will need to take more insulin in the years to come, as your body changes and your remaining insulin production capacity dies off. I’m taking 10 times as much now as when I was first diagnosed. But it’s what my body needs and insulin doesn’t have side effects. It has two jobs and that’s it. It lets sugar into your cells so they can function, and it serves as the primary (though not sole) regulator of how much sugar is floating around in your blood. Take as much insulin as you need for your body to work right. That’s the bottom line.

That’s good to hear. Well done. I’m glad you got the right diagnosis, got back on track, and reversed the bulk of it. It is likely that excess sugar buildup in your capillaries would have exacerbated the carpal tunnel. Hopefully you can get that back on track, too.

Depends on the pump. An Omnipod sticks the whole pump to your arm, and that will likely be uncomfortable for you. But a Tandem or Medtronic pump will use a small cannula that’s smaller than the Dexcom sensor, and the pump is attached via a thin tube. (Tandem will work with Dexcom, but Medtronic has their own CGM which is usually less accurate and doesn’t last as long and is physically larger than the Dexcom.) You can put the cannula in your abdomen or leg, so you should hopefully be able to find a spot that’s comfortable for you.

That said, seems like you’re doing pretty well with injections so far. You don’t have to switch over. There can be disadvantages to it. But I switched from injections to pump 3 years ago, after nearly 30 years of injections, and it’s made life simpler and control better and easier for me.

Dietician is part of diabetes 101. It’s not urgent and it’s not that complicated. But it’s fundamental to getting you started on the right path and giving you the tools you need to navigate the twists and turns ahead. Frankly, everyone should learn this stuff. Instead, people have to pay for Weight Watchers to teach them. (My diabetes nurse when I was first diagnosed was so mad about Weight Watchers. Because it was what she’d been teaching diabetics for decades and here was this huge national program making millions teaching the same stuff to others and she’d never thought to do that.)

Learn what your body needs. Learn how different foods affect it. Learn portion sizes. Learn where you can be flexible. Figure out what you should be eating based on your individual body, goals, activities, etc. And then you can work on fitting that into your lifestyle (which is probably a bilateral compromise). And once you’ve got all that set, then you can find the amount of insulin you need to take and when you need to take it.

Diabetes is always a work in progress. But, like anything, it’s got a learning curve. It gets easier with practice and experience. It becomes second nature. And you learn when you need to pay attention and when you can relax. It’s good to be aware of your BG value. It’s bad to be constantly interrupting yourself to look at it every 5 minutes and freak out every time it goes over 150. You’ll get the hang of it.

Depends on your body and how much insulin resistance you have. I used to take 36 units of lantus twice a day (it never really lasted the full 24 hours for me, so I did much better splitting it) and then… let me see… I think it was like 12 units of insulin to cover breakfast, which was 15-20 grams of carbs? But more like 25 units for dinner which was 60 grams? I insisted on sticking to the exchange program rather than carb counting, so I’m not sure of my ratio. After decades of eating the same amount at the same time of day, it was just easier to keep up with that, and my body was used to it. Anyway, with the pump I only take Humalog. The pump handles the basal as it sees fit and my carb ratio is 1:5 and that seems to work pretty well. But I end up taking about 80-100 units a day. But that’s what my body needs.

It’s a lot to take in. But it’s okay. You’re doing great. And it does get easier. You always have to be aware of what you’re doing and make more conscious choices. But, honestly, most people would be better off if they did the same. That’s why Weight Watchers makes so much money. If you take care of your diabetes, you’ll be healthier for it. Sounds like you’ve got a good doctor to keep you on track, and we’re here to help, too.

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This change was not “I only want to/can afford to take X units, how many carbs can I eat”, it was risk mitigation. I reduced my carb intake because I am still not confident in the ratio I am seeing. While that ratio feels uncertain, it feels safer to eat fewer carbs and use less insulin. All of the ~12:1 time has been within the span of one pen so far, so I have this back of the mind concern that it could be the product. If I spring back to ~18:1, I could be dozens of grams of carbs under and that seems sub-optimal.

I appreciate the perspective, even if I am not thrilled with the possibility of that being my future. I expect that larger injections would require deeper sites.

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I see. You’ll get the hang of it. Find your levels. Sorry I misunderstood. I hope your doc can help you find your footing. But you’ll get there in time.

Like I said, it’s been over 30 years for me. And I’m apparently unusually insulin resistant. My body is still producing a high volume of GAD-65 antibodies, too. And I’ve got some other health issues. It doesn’t mean that you’ll get to the same place.

But, no. I’ve never needed bigger needles or alternate injection sites. The pump pushes insulin through the cannula gradually, and it’s a fairly small/short cannula in terms of depth under the skin. Back when I was taking injections, I was using small needles, too. Much smaller than the needles that were available in the early 90s.

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Ryan @FlickeringEchoes a few bits to keep in mind as you develop your diabetes management skills, varying your diet and adjusting your insulin to achieve a healthy lifestyle that will permit you to live a full and active life that involves work, socialization, adventure, and fulfillment. Much of this has been said above and on many other Topics of this forum.

  • Set some goals for yourself; you are still very young and have a lot of life ahead of you. By all means, don’t place yourself on a shelf thinking you are to “delicate because I have diabetes” to see the world and live.
  • Before you begin, decide for yourself a number that is “too high” / “too low”; keep in mind that the expert opinion sets acceptable range for adult humans [with or without diabetes] at 70 - 180 mg/dl. ADA states that a PwD should fall in this range at least 70% of the time to avoid complications. It could be enlightening to find a willing partner with a disposition similar to you who will agree to eat the same measured meals as you and accept BGL checks - before eating and at one hour post meal
  • body needs insulin; compare mg/dl change with yours. Being above range momentarily happens - prolonged time above range need to be addressed.
  • Every body needs insulin even when not eating, the body also needs carbohydrates from some source. There isn’t any right or wrong level for injected/infused insulin other than what YOUR body needs. Concerning I:C ratios: you have been doing an effective job finding your correct ratio, so when you eat more carbs with similar glycemic rates, even triple or quadruple carbs your I:Cr should work properly and not send you “too low”.
  • Is an insulin infusion pump needed for better management? Not necessarily, a pump will not provide better management all by itself, and in fact, many PwD have more effective management with VGM and injections. Results of an ADA study indicate that between 2010 and 2019 effective diabetes management appears to have declined; that period also includes a rapid increase in use of “diabetes tools”. [Note: I use a Tandem t-Slim x2 pump; my 4th pump.] The reasons for the apparent decline in management are not yet conclusive but, IMO, it may be because of “Plug 'n Play” mentality where people let the machine replace human intelligence.
  • Try to get yourself included in studies and trials of new diabetes management protocol, devices and medicines. If you are anything like me, you will find the experience rewarding and helpful - even if the study doesn’t prove successful like many of the projects in which I was involved. From what you have written so far, I can see that you are using and benefitting from a few diabetes “tools” that I helped bring to life.

Bottom line, live and enjoy!

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There is already so much good info here! Just wanted to pop in and say you’re doing great! It sounds like you’re starting to grasp stuff and an average of 111 is phenomenal! The only thing I really want to give encouragement on is the question you asked on whether it gets easier.

You will have days that feel great and like you’re doing everything perfect and your blood sugars are incredible and then you’ll have days where you’re still doing everything right but your blood sugar has a mind of its own. So basically the sooner you’re able to accept that there’s things you can control like what you eat, how much insulin you take and your activity level there’s many things you can’t (illness, altitude, hormones, etc.) the easier I think it gets. It’s never going to be “easy” but as you continue to learn about what works for you and what doesn’t, and feel more confident in treating lows and highs (it takes time) diabetes kind of just becomes second nature. After 16 years with it, I can honestly say that I really don’t remember what it’s like to not have diabetes anymore it kind of just becomes like breathing and I know what I need to do to take care of me which definitely makes it feel easier than it did when I was first diagnosed. I always joke that if T1 is cured in my lifetime and I literally don’t have to check my sugars or take insulin I really will be apprehensive about how to eat :joy: you’ll learn to rock and roll with the betes and eventually it will just become more of an annoyance than anything. I saw it mentioned above to but don’t let this diagnosis stop you from living life! It can be a real pain in the butt, but life with it can still be enjoyable.

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I’ll second Dennis’s advice.

But I came back because your comment about needle size stuck with me. (Er, no pun intended this time.)

Generally speaking, you don’t need a bigger needle for a bigger dose. Delivery works the same way. It just takes a little longer. If you’re using a syringe or a pen, you hold the plunger a few more seconds, and it gets there.

If you’re using a pump, what happens is you’ve got a thin durable plastic tube that leads from the pump to a short cannula under the skin. Basically just an extension of the tube. Not much bigger than the needle you’re using now. I’ve got very sensitive skin thanks to a nerve disorder and I honestly don’t feel it. The cannula is held in place by a plastic disc about the size of a nickel and some adhesive tape, much like the Dexcom sensor, but less than half the size.

Right now, you’re probably taking something like Lantus once or twice a day to provide basal insulin. As Dennis said, your body always needs at least some insulin in the system. Insulin is what lets sugar into your cells, and that’s the fuel they need to function. Lantus is designed to provide a steady background dose. But your pancreas would naturally just produce and release a slow trickle. What the pump does is closer to what your body would naturally do. Instead of a cocktail of insulin with a slow release timing agent, the pump just releases a slow trickle of insulin through the cannula. In my case, it’s a baseline of 2 units per hour. So, every 5 minutes, it gradually gives me about 0.3 units. But because it’s connected to the Dexcom, it can adjust that as needed. If I’m running high, it can give me a little more. If I’m running low, it can give me a little less.

If I’m running really high or if I’ve had something to eat, I can tell the pump to give me a bolus. Same thing as taking a shot of Humalog. It will help me calculate the right amount based on the carb ratio and correction factor in my personal profile (as worked out based on existing data with the help of my endo). So if I need an extra couple of units because I miscalculated lunch, I don’t have to wait for dinner to fix it and I don’t have to worry about stabbing myself with another needle. The pump just releases it through the cannula that’s already there. If I go see some friends and they put out a bowl of popcorn and we’re just hanging out and I decide to have some even though it’s between meals, I can take insulin to cover that just by pushing a couple of buttons.

Every 3 days, I pull out the tube, remove the insulin reservoir from the pump, give it a new filled reservoir, and insert a new cannula in a different site. Instead of 5 shots a day, I get one needle every 3 days.

As Dennis said, though, it can be easy to rely on the pump to do more than it should. And it’s not always great having a loose plastic tube attached to your body. I get mine caught on kitchen knobs, which isn’t fun. (I bought a spooler to help with that, but it’s not perfect.) And the pump can get annoying with all sorts of alarms. It’s extra super cautious because your life depends on the pump working properly. If the cannula comes out or something happens to the tube or the site gets blocked or something, you can get dangerously high sugars in a matter of a couple of hours, and it can take half a day to get back on track. (You should always have a backup insulin pen handy and ready to go, just in case. And a replacement cannula.) It can be frustrating to work with the things sometimes. Not to mention the fuss of getting them through airport security.

There isn’t a perfect solution to diabetes, unfortunately. I find that for me the benefits of the pump far outweigh the drawbacks. It may be different for you. But it’s an option to consider, especially if you’re worried about fluctuations in your BG between meals.

Anyway… You’re doing great already. Keep it up. We’re cheering you on.

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If/when you look into pumps, you will be assigned a rep who will arrange for training and start the authorization process rolling. They will take your insurance information and determine your coverage and out of pocket for the device itself and for your supplies. Trying to determine coverage on your own may be frustrating, so leave it to the pros. They can also recommend a supplier to work with for your supplies.

I expect that larger injections would require deeper sites.
Not to worry. I took injections for more than 30 years, with doses increasing and along the way. Today’s needles are fine, relatively painless, and get the job done - it may just take a little longer. Site rotation is key in order to avoid scar tissue suchlike affects absorption - in my 30+ years on injections I had very few problems with scar tissue, and I rarely have problems with my pump and CGM locations now.

The infusion sets come in a couple of different lengths - which one you use is generally based on amount of body fat. Your doctor or rep will recommend the one you should use.

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Wow great control! You’re definitely succeeding in that respect.

I was diagnosed age 32 in July 2020. It was psychologically very devastating for many months. I cried a lot. I’ve gotten better at managing now (I used to go LOW way too much, I was so afraid of highs), and even better psychologically. It still really sucks. But I’m not crushed all the time by the fact of having to take insulin, and manage it.

I am still angry though. I resent other people can take something for granted that I should be able to, too (eating whenever, whatever, w/out managing all the time).

This is going to sound trite and rude perhaps, but also, there are worse things than being Type 1. I have a chronic pain/effectively disabling condition that I would trade for just havingT1D in a heartbeat. Obviously many other things are bad and worse that people have to suffer through.

My long-acting insulin needs change a bit, but not much. Sometimes I need 10 units Lantus, other times 11, other times 9.

My bolus needs are pretty variable, sometimes as low as 5 carbs/unit, other times as high as 11. Depends on food, and then just day-to-day variation. I just try my best. I really hate going low, so I’ve gotten much more concerned over time with avoiding those, and then treating highs as needed. I try to stay as low and in range as much as possible. My last A1c was 5.1. I attribute this to only eating twice a day (lunch and dinner). Like you, I did this at first to get a better understanding of how insulin worked in my body, but then I just kept doing it. This gives me lots of time to reach and maintain a good fasting glucose level. Two meals/day (no snacking) is challenging enough to manage (for me). Adding more food = more variability = harder to control blood sugar. But, this is just what works for me, and while other people take this strategy (or even do just one meal/day), it’s just not feasible or workable or worthwhile for others, which is understandable. Try to find what works best for you. But, it may always be a struggle. I still have times where I have no clue if I’m going to end up much too high or too low.

Best thing is, do your best, know you’re doing your best, don’t sweat transient highs (again, evidence is you’re doing very well), eat healthy, and fit your glucose management to the content of what you want to eat (rather than the other way around - otherwise, at least in my case, resentment will rise even more). It’s hard. No way around it. But other people are in the same boat with you!

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Oh yeah, I wanted to add, about those post-meal glucose graphs that show “typical” high at two hours then nicely back down, with highs never going over 140 (or 120, or 150). That is not my body at all. My guess is, this is a graph for a non-Type 1 person, where endogenous glucose is functioning. For external administration of glucose, efficiency is just way down compared to the normal body. My glucose will go up and down up and down for four or five hours aftear a meal (again, I do not eat between meals, so all this is due to that one meal). Sometimes it doesn’t go above 115, other times it goes over 200 (that’s when I know I really blew it! but hey, I just correct, and all’s good). A really bad high is 250 - it’s unusual, but it happens (for me). Also, not taking enough insulin may mean you go high hours after eating, not right away. I may be under 120 for four hours, then suddenly it goes to 150, and only then can I say, “oh, guess I didn’t take enough.” Insulin dosing is about matching curves over time with food breakdown and glucose entry into bloodstream. It’s tricky. Take good notes (as much as you can/can stand), and learn how glucose from different foods work in your own body.

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I feel quite fragile right now. Right this moment, I think that’s more of the wrist pain and less of the diabetes because I’ve cut back on a lot of things until my doctors have a diagnosis because I really don’t want to make that problem worse. Even when that resolves… I have a lot of regrowing into my body to do.

I think i had a timing issue yesterday where I had a meal with a decent number of carbs, but they were all GI <30, so I dipped quite a bit before balancing out. Learned something about meal structures, but I wish it had been a less exciting evening.

I definitely don’t think it’s a near term thing for me, but it’s something I could see a bit further out. How do you find out about things like that, through your endo’s office? Watch the companies?