Day 42 – Loop – Micro-boluses – Free APS

A few days ago I enabled micro-boluses in Free APS and its been working remarkably well at managing any post prandial blood sugars highs. I have only setup a 45% partial bolus being administered when deemed necessary, but at this stage I feel its performing as I want it to. I still count carbs and administer ‘fake’ or ‘extended’ carbs and simply use the micro-boluses as a tool to quickly administer insulin in place of an extended high temporary basal, which would do the job a little more slowly. Tonight I test this on Chinese food. 🙂

In the chart below we can see that I ate a hearty dinner, and then decided to eat some raisin toast. I managed to stay in range almost the entire evening after all these carbs. Amazing. I would never have even considered doing this before Loop, and if I did I would have anxiety the entire time.

UPDATE: The night went well and overall I am very happy with the results. If I am honest though, I think my expectation in the beginning of this experiment was that Loop would autonomously manage my blood sugar with very little input from myself, but I have realised and this is not the case, and adapted my management to include pre-emptive blood sugar correction. I am certain that Loop would indeed make these decisions, but keeping my finger on the pulse allows me to obtain the level of blood sugar control I am after.

The goal: Eat Chinese food and stay in range

The strategy: I went onto MyFitnessPal and found honey chicken, pork pieces and mixed veg. I added them into the dinner section and calculated the insulin required for the carbohydrate, protein and fat macros. I was not sold on the bolus amount for the carbs and ended up only injecting 70% of the calculated amount, but Loop quickly started administering micro-boluses to correct this. The ‘fake carbs’ ( I don’t really know why this name has gained so much traction in the diabetic community, since proteins and fats end up being synthesised into glucose (carbs) through gluconeogenesis, and are thus sugars (real carbs) being generated by the body at a slower rate than the exogenous carbs we eat) for protein and fat were then added to Loop with a 4.5 hour digestion period. This will allow Loop to attribute blood sugar changes to carbs (from gluconeogenesis) for up to 6 hours, and be able to micro-bolus or increase basal for them.

The outcome: I noticed that after an hour I had a substantial amount of insulin on-board and my blood glucose (BG) was dropping at a rate that could not be sustained by the food I had eaten, so I ate another 20g of faster acting carbs. An hour after that I had a mild hypo (3.7 mmol/l) and ended up eating again to correct this. I believe a better strategy may have been to inject 60% of the bolus up-front and then monitor for an hour before injecting the remaining bolus. Then again, this may have been just a carb-counting error on my part.