Dr. Stephen Ponder workshop on “Sugar Surfing”

Wow.  I learned some mind-blowing things from the workshop this morning.  So much, in fact, that I’ll probably have to divide it up into posts.  I’ll just write a quick, broad summary of my notes from the presentation, and then delve into interesting details of different tricks in different posts.  I think the main point of Dr. Ponder’s workshop is that nothing is truly predictable.  Even if we look up the number of carbohydrates in a particular meal, the portion size might be off, or our body might react to carbs from one source differently than it reacts to carbs from another source.  The idea, then, is that you keep things as normal and predictable as possible, but you know how to be proactive early on when you notice that things aren’t panning out the way you planned.  In order to be properly proactive, though, you have to have some baselines tied down.

Dr. Ponder began the workshop by giving some examples of the way traditional diabetes wisdom doesn’t always make the cut.  He explained, for example, that the amount of sugar in your body when you bloodsugar is 110 varies person to person based on weight and other factors.  Because of this, traditional wisdom, like 15 grams of carbohydrate per low doesn’t do the same thing in everyone.  He explained that by experimenting and varying, each individual diabetic can better learn how to react to her own life situations.  In order to do this, you need a cgm that is well-calibrated and a basal rate that you know works.  The cgm is imperative because different trends mean different things.  A bloodsugar of 125, for example, could be a quick stop at 125 en route to a spike of 400 or en route to a low.  You need to know which way your bloodsugar is moving and how quickly in order to take the correct action, if action is needed, when you see the number.  You’ve also gotta be able to isolate the variables by having a basal rate that isn’t affecting things.  To test your basal rate, skip a meal, or eat a few hours later, and check to see that your bloodsugar is stable.

Once you know you’re well-calibrated and the basal rate is accurate, you can begin to play with intervention.  Intervention may not look the same in each situation.  For example, if you’re rising and you’re already at 300, it may take you far more units of insulin to bring the number down than if you intervene at 160.  It’ll also take more time as inertia is at play.  You have to be careful, it takes awhile for the insulin to really be on board working, but you can eventually, by testing out different scenarios over and over again, learn the amount you need to react to any specific situation.  Because you have the cgm, you can observe how quickly you’re dropping and take action to prevent a low from an over-correction earlier.  The key to making this work, though, is accurate data, consistent data, and patience with your data.

The other big thing you can learn by analyzing the data is timing.  How long does it take your insulin to hit your bloodstream?  Insulin interacts differently with different foods, but it generally does not peak while the food you’re eating peaks.  By watching different patterns, though, you can learn when to take insulin for the ever-impossible pizza or sushi meal.

I re-attached my cgm after the presentation.  I think that basal rates are correct, but want to pay more attention to testing this around every meal for the rest of the weekend and noticing if my bloodsugar stays stable when I don’t eat.  My next goal is to develop a comprehensive system for recording.  If I want to know what to do when I eat a heavy breakfast and then go to spin class, I need to understand that type of breakfast independently and the effects of spin class independently.

Dr. Ponder has been diabetic for over 50 years and has been able to achieve A1Cs in the 5s.  My current goal is only to make progress on my current A1C, which is 6.9.  Let’s see how the experiment goes!

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