Sarah Howard
Sarah Howard (nee Tackett) has dedicated her career to supporting the T1D community ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
Sarah and her husband live in NYC with their cat Gracie. In her spare time, she enjoys doing comedy, taking dance classes, visiting art museums, and exploring different neighborhoods in NYC.
Consistently is the key word. Sometimes, and this varies by the day, might work.
I assume that the pump assumes that the equations assume that it is 05:30 to 11:00 when the ratio factor (insulin to carbs) is 1:14.
Other times of the day it is 1:12
Sometimes but not all the time. I think maybe 🤔 if I have a higher fat food. Especially nuts. Will be normal until about 3 am. Then continue to rise with higher than usual insulin dose.
The Dawn Effect, 6:00am to 8:30am. Basal rate changes from 0.49, to 1.0 units per hour. Carb ratio changes from 1:9 to 1.6 . Correction factor remains at 1:40.
With Tandem andControl-IQ,my basal rates are set highest for the dawn phenomenon, which for me starts at 6 am so I chose 6-9 am. It varies slightly the rest of the day.
I haven’t been able to discern a single time I need more i sulin. It varies from day to day. Sometimes over night. Frequently in the morning, but not always. Once i a while in the afternoon & evening.
Me, too, and it can be very frustrating sometimes!
I don’t use a CGM. Waiting until I retire to learn about that in another year. I’ve tried them before and didn’t work well because I could never calibrate them but there has been improvement. I’m highest after dinner because it’s my highest carb meal. I can only take to a certain limit of insulin and then I go low before my digestion catches up.
Calibrating Medtronic’s CGM is nigh impossible. Dexcom is very forgiving. You don’t have to be perfect. Occasionally I do calibrate. Like all mechanical devices some sensors are better than others. But often it is scarily accurate without calibrating. When it’s not, I calibrate and then it’s accurate. And their customer service doesn’t ask what you did wrong. They just ship a replacement overnight.
Thanks Mary. Yes it was Medtronic. I’ve thought about switching but haven’t had the energy to invest in learning Tandem and Dexcom. My endo’s PA told me I could use Dexcom with Medtronic but other things I have read here seem to indicate that is false. When I retire I hope to spend more time figuring this all out.
Unsure your system, MEDTRONIC seems very accurate and at least easy for me (if the CGM is at the edge of the range for error: 20% each can calibrate again to get the numbers closer). Although my numbers seem higher than a doc’s/lab it’s very close and consistent.
I also didn’t like the calibration and all its troubles with some previous cgm devices. Now I wear the Libre 3 and love it! Easy, accurate and no calibration!
MT: so you use Libre 3 CGM. What pump do you use? I’m thinking it is best to use a pump and a CGM from the same company so if there are issues, it is easier to get help.
I am effected by the Dawn Phenomenon. It starts between 4 and 6 am and will run until about 9 am. I have hear many reasons for it. My hopes it is due to my weight and I am 30lbs down and still going. It started after the weight gain.
The time when I need more insulin varies. Currently it is shifting again
It’s not so much more insulin as it is I need to take the insulin well in advance of eating in the morning until about 10.
My requirement for a higher basal goes up in the evening, probably because I am no longer on my feet, and no longer going up and down the stairs.
Not so much any more. I have 9 different “time zones” in my Tandem X2 pump, intergrated with my Dexcom G6. Each time zone has a separate basal rate, carb:insulin ratio and ISF. Since my schedule – which includes if and when I eat varies so much, I keep an eye on my BG graph on my pup and have my high alert st at 120 bg. I can take corrective action straight away, and often will correct and wait to eat until I am at target (80-90 bg).
We are similar in all these respects!
I have the Dawn Effect, but not always.Can’t plan for it, then.
Before I had a pump, just like you, I would sometimes have dawn phenomena and sometimes not. I was worried about programming more insulin starting about 3am as I thought if I am not going to experience dawn phenomena, then I would go too low. However, thankfully I never go low. Very strange. It is like I always have the dawn phenomena now and I wake up with excellent blood sugars because of the pump settings.
I don’t experience dawn phenomenon so much as feet on the floor phenomenon. Since I am retired and stay up very late most evenings, my feet don’t usually hit the floor until maybe 9:00 am. That’s when my glucose begins to rise.
Funny, my ‘feet on the floor’ effect is to drop! I make my coffee straight away. Even when I sleep later than usual, my BG will stay steady until I stand up.
I require almost 1/2 the basal at night. It’s so dramatic if I’m higher than preferred with little effect from dosing, as soon as I lay down levels drop. As soon as I rise (I get up later on weekends if I can) so do levels.
Same here. Time of day/night doesn’t matter. If I go to bed at 10pm or 2am, it will drop when I lay down. Same for waking up. I get feet on the floor no matter what time I wake up. THis makes adjusting basal hard unless I am able to go to bed and wake up at the same time every day, which I don’t.
Just post meal spikes cause me to need more insulin.
My insulin needs go up consistently about 10 p.m. I often end up staying up for 1-2 hours more putzing with it to come down and level off. It’s good all night then.
I don’t play that game. I still use the old method [70years ago].. One shot in the morning.. If I get high BG, I don’t eat and try to exercise.. Also I feel the dawn efect is mostly a game the CGM is playing and not a true BG value
I’ve had the opposite happen a few times. I had a few weeks when my lunch bolus seemed like it was super-charged and had to lower it to keep from going to low. Same thing happened later, but it was supper bolus. Both went back to normal in a few weeks.
I have a higher basal starting at midnight to account for delayed supper carbs.
My pump program has 6 timed settings for my ‘average’ day. So while 2 of those settings are slightly higher, changes for higher activity with manual temp basals occur, too.
I use smh and a pump with settings close to my needs for basal insulin I am losing weight so I generally need need less not more but I do use more in the day then at night
I get “boots on the ground” highs big time.
Then, right around bedtime, my sensitivity seems to go down… but, as soon as I’m asleep, it kicks back in. I had thought I had the basal for that worked out last year, but I think I need to work on it again.
Who was it who said, “Nothing lasts forever.”? They musta been diabetic! ;p
The time frames given don’t really apply. I generally use a higher basal rate at 5:00 am and 5:00 – 7:00 pm. The 5:00 am for the morning highs and the latter for dinner when I tend to eat a larger meal.
Not that I can tell