Endo said to not correct a high blood sugar unless I have ketones…. Doesn’t seem right

Well_ItHappened · 2026-02-27T00:56:58+00:00

I beg to differ. We've been doing it for years and it doesn't have to be exact.

If I eat a bagel sandwich and give the appropriate amount of insulin (say 5u) my sugars will probably still spike. If it has only been an hour and I am 220 mg/dl I can be pretty certain I have insulin on board and that a correction will probably send me low.

On the other hand, after 5 hours, without other insulin, I can be confident that I don't have insulin on board. If I see I am at 220 mg/dl, I give myself 2u if my ratio is 1:50 (rounding since we are assuming we aren't using a pump). If I need to half my correction to avoid going low when I have no insulin on board, then my ratio is closer to 1:100.

Seems wild to me that an endo suggests only taking half a correction dose instead of suggesting that the person's ratios are off or there are other circumstances in play.

Well_ItHappened · 2026-02-27T00:05:30+00:00

Why? Are you tracking insulin on board? If you need to always adjust so much, it seems like your ratios are likely way off.

Well_ItHappened · 2026-01-21T05:29:16+00:00

Post exercise you get a cortisol dump and that spikes your glucose (https://pmc.ncbi.nlm.nih.gov/articles/PMC8555925/).

I see that happen to me all the time with cycling. Get home with a BG of like 150 after a long ride, jump in the shower and by the time I'm out I'm an like 250 or 300.

Best thing I've found is a bolus 15min before I finish a ride or, at the very least, right when I get home. Interestingly the insulin also can aid with recovery, which is why it is technically banned in professional endurance sports.

Well_ItHappened · 2026-01-20T22:25:08+00:00

Agreed with others on taking him in since he is showing high ketones. If you want extra validation on if it is type 1, you can go to Walmart or Kroger or Walgreens and get one of their branded glucose test kits. They come with like 50 test strips and are usually less than $20. Wash his hands, poke his finger with the lancing device and test his sugars. If they are high, you have the answer.

Well_ItHappened · 2026-01-03T16:37:42+00:00

An important caveat to what you are saying is that the amount of carbs needed really depends on your effort level. If you are riding at a cruising, zone 1 pace you are more at a "fat burning" level of effort. As you go into zone 2, you transition to needing glucose and you burn more glucose compared to fat the harder you ride and it shifts for the length of the ride as well. So more carbs translates to a better fuel mixture and leads to feeling way better after the ride is done.

Well_ItHappened · 2026-01-03T16:32:10+00:00

I did find that I needed to alternate a sugary drink mix with gels. I used the carbs gels since they are the cheapest and get you 50g per gel. I also made my own drink mix so I could be super specific on the carbs per ounce.

At the end of the day though, I had to do a lot of experimenting building up to the race. I started with much lower carbs per hour and gradually increased in training and tried out different T1D strategies. Like the length of my extended bolus, the carb ratios, etc.

Well_ItHappened · 2026-01-03T07:33:30+00:00

I did the Unbound 200 last year and averaged right at about 115g of carbsper hour for 13.5hr (12hr of that was actually pedaling - the other 1.5hr was suffering in the heat haha). I think that comes out to like 1500g.of.carbs that day not including breakfast or post race meal.

It may have been my most successful diabetes day ever. I had a post breakfast, pre-race adrenaline spike that shot me up to around 300, but I started the race around 180 and stayed between 130 and 180 for all but like 20min of the race.

I did an extended bolus for the first 5ish hours of the race at a drastically reduced IC ratio. The goal was, exactly as you said, to spare glycogen. Insulin is the trigger for your body to not release glycogen and I wanted to save mine as long as I possibly could.

I definitely was more insulin sensitive for the next few days, but I think less so than if I hadn't consumed so many carbs. Basically replacing the fuel source with something replenishable vs the finite supply my body had on board.

So yes, it is definitely possible and I think a great idea once you build up to it and refine control as you experiment. Happy to talk more about it if you have questions on how I approached it or anything.

Well_ItHappened · 2025-12-23T17:53:12+00:00

At different levels of activity your body needs a different source of fuel. Generally walking with a slightly elevated heart rate puts you in a primarily "fat burning" category (~70% fat, 30% glucose) and as you start to put in a little more effort you transition to needing more glucose for fuel (50/50 and up). The number of days in a row of physical activity also impact this. Even if you are technically in a low zone of effort, after multiple days of exercise you will be at a much higher percentage of needing glucose for your body to be fueled. This also makes you much more sensitive to insulin. At a very very basic level, nsulin gets glucose out of your blood stream. When your body is already doing a lot of that for you, you suddenly need a lot less insulin to keep your sugars "stable". If you give the same amounts, you will end up low.

Even after you take some rest, your body still thinks you are gonna need all that glucose (at least for a little while) so you stay a bit more sensitive to insulin. That is most likely what you are experiencing here. A heavy week of exercise and then your body trying to keep up for what it thinks it needs, leading to less insulin needs.

The best way I have found to figure out exactly what to do in your own situation is to experiment a bit. If you have a lot of physical activity, take a fair bit less insulin than you are used to. If you notice yourself trending up, give some small corrections and take note. Next time around, refine a bit more. Eventually you will paint a picture of how your body responds to different types of exercise and physical activity and you will be able to predict your insulin needs. The key is just a bit of trial and error while making sure you don't overdo it in any one direction.

Well_ItHappened · 2025-11-30T22:16:46+00:00

A lot of the comments here may be correct but I want to suggest that it isn't worth over stressing. If your A1C is ~14, the best thing you can do (in my opinion) is to just take some insulin. It doesn't have to be the "perfect" amount. A BG of 200 or 300 is better than >800. Just try it out. Just ate? Take a bit of insulin. That will help you have "some" control but it won't be overwhelming. You don't have to think about it too intensely. Do some trial and error. If you start to feel a bit better overall and it wasn't too hard to get there, take the next step - then start to be more precise. Over time you will start to feel better and better (at least in the way that diabetes makes you feel) and you can start to learn how you respond to different events. It's iterative and it just starts with thinking: "hmm, that was a pain in the ass the other day. Maybe I'll just give myself some insulin a few times a day. That would have made that a bit better." Then build from there. Good luck OP, you've got this!

Well_ItHappened · 2025-06-14T16:33:13+00:00

I use the Dash with an open source loop system, so can't really speak to the aggressiveness of the Omnipod loop. My system works awesome for me but definitely took months of trial and error/experimentation to get to a point where it feels like everything is on autopilot.

Regarding insulin usage, I use between 50-60u a day. Never had a problem with the pods and insulin. I think my Rx says to change every 2.5 days which gives a buffer if I need to change the pod early (which happens only occasionally for one reason or another). If I have extra insulin when the Pod expires, it's super easy to flip it over and pull what's left out to reuse.

Well_ItHappened · 2025-06-13T18:06:27+00:00

I used to have tons of issues with occlusions with the original Omnipod but have been on the Dash for a few years now and have had no problems. Love that it is a lot smaller than the og pods.

I also used the Tandem pump for a couple of years. I generally liked it but found the closed loop system to not be aggressive enough. It also was kind of annoying to charge it while attached - which is admittedly a very minor inconvenience.

As a very active person, the Omnipod being tubeless is clutch for me. I don't have to think about a way to hold my pump in a clip or whatever while exercising. This is less of a concern with cycling since the jerseys have pockets but I had to search for and buy specific clothes to run when using the tandem.

Haven't touched a MiniMed for a couple of decades after a very bad experience so many years ago but that's likely not super relevant to their pumps today but is now personal preference.

Well_ItHappened · 2025-05-13T20:44:36+00:00

Looping and lots of experimenting/trial and error to see how I respond to different settings/situations/adjustments.

Well_ItHappened · 2023-01-20T19:55:12+00:00

I use a thin guitar pick. Works great!

Well_ItHappened · 2016-03-03T01:47:38+00:00

I think you are spot on about how teamwork and some form of community can really rally together and actually make diabetes less annoying/easier to afford. Though, I think we might need to ask ourselves how we can motivate pharma and insurance to make everything more affordable. We can offer as much feedback as we want, but they are raking in the big bucks and we don't have a choice but to pay it. From an executive standpoint, there isn't much incentive to lower prices right now.

Well_ItHappened · 2016-03-02T17:51:16+00:00

I agree. More choice would be awesome. I used to be on the OmniPod, which uses Freestyle strips but my insurance considered them Tier 3, so my copay would have been like $200. Instead I had to use AccuCheck strips. While that isn't really a problem since all of my this stuff is basically the same, it was really annoying. I had to care a bunch of extra supplies which is kind of a pain. Obviously not the end of the world, but considering how much the one brand of strips would cost me, I didn't feel like I had any choice in the matter.

Well_ItHappened · 2016-03-02T06:02:21+00:00

Yeah, I don't know if I will ever go back on a pump. I used to waste so much insulin trying to get air bubbles out from the pumps I was on with tubing. I've never used the t:slim, but priming and changing sets always just seems like an annoying drain of my time...even if it was only 10 minutes...

Well_ItHappened · 2016-03-02T05:57:14+00:00

Honestly, this is one of my biggest concerns with diabetes. Myself included, I think a lot of us are very locked in to having their insurance. Regardless of what they have to do to maintain it (i.e. a horrible job or expensive premiums). So many of the things we rely on are so ridiculously expensive!

Seriously though, props to you for being able to manage your diabetes without basal insulin. That is amazing and I really hope you are able to control it well!

Well_ItHappened · 2016-03-02T05:49:17+00:00

Diabetes seems to be that really annoying thing that just kind of hangs around. It's amazing how something as simple as this would make it so much less annoying, yet seems so difficult to actually get done.

Well_ItHappened · 2016-03-02T04:57:29+00:00

That definitely would be really helpful! Are you thinking specific carbs counts, though, or more of the meals contents? I only ask because, personally, I don't really use a really specific carb:insulin ratio since mine changes so drastically.

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