Aerobic/cardio – Page 3 – Dick The Diabetic's APS Adventures

30th Nov 2021

I have now been Looping for 41 days and I wanted to reflect on the reasons I started looping and the goals I wanted to achieve while Looping.

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A1C of below 5.5%

Time-in-Range exceeding 80% (3.9mmol/l -7.8 mmol/l)

Reduce diabetic burden

Decrease food anxiety whilst increasing food options.

Improved time-in-range during exercise with decreased exercise anxiety

Lets start with A1C and Time-in-Range (TIR)

If we look at my stats just prior to looping, I had an A1C of 5.6% and a time-in-range (TIR) of 78.5%. The GVI and PGS stats were also really decent (more on these metrics here https://bionicwookiee.com/2020/02/26/cgm-metrics-gvi-pgs/), with a GVI of 1.2 (non-diabetic) and a PGS of 29 (non-diabetic). A decent average of 6.4 mmol/l, and 3.4 % (1h4min) of time in the 3.0 mmol/l – 3.9 mmol/l range.

Now we look at my last month while on Loop. In order to reflect the learning curve involved from switching to a pump, I broke the stats into two (2) fortnightly blocks.

As can be seen in the charts above, some slight improvements are seen in all metrics discussed above with a 7.6% reduction in TIR and a 4.5% (-0.3) reduction in average blood glucose. The GVI and PGS metrics reflect modest variability and good control, as opposed to the previous non-diabetic results. I spent 22min (2%) in the 3-3.9 mmol/l range, down 10min from the previous periods 32min.

Reduce diabetic burden

This goal is subjective and difficult to quantify. Loop does make it easy to administer insulin, enable an over-ride, track carbohydrate absorption ( I was doing this with Spike) correct a hypo/hyper and even just wake up in-range. It does come with its own challenges and hurdles to overcome, like ensuring you have an up-to-date version, checking certificate expiry, ensuring your CGM is calibrated accurately, and then the challenges of constant site changes, reservoir and battery changes, insulin mixing and exercise.

Decrease food anxiety while increasing food options

It definitely feels like less of a burden to experiment with food or eat more carbs, as Loop can pick up any slack due to incorrect bolus calculations, or adjustments after exercise. I used to have 3.4 % (1h4min) hypos (3.0 mmol/l – 3.9 mmol/l) in a month due to incorrect dosing after exercise, but this number has significantly reduced to 2% (22min) while using Loop, as basal can be dynamically adjusted to fluctuations in blood glucose. Post prandial (meal) hyperglycaemia has also significantly been reduced, but I think in part due to Fiasp as it starts working immediately once injected.

MDI Average Carbs per day: 92.6 (*excluding ‘fake carbs’)

Loop Average Carbs per day: 121 (*including ‘fake carbs’)

*’Fake carbs’ are entered into Loop to manage the blood sugar spikes from gluconeogenesis (fat/protein synthesis into glucose)

Improve time-in-range (TIR) during exercise with decreased exercise anxiety

Unfortunately since switching to Loop the Python code I wrote to analyse blood glucose broke with the switch to Loop, so I only have the pre-loop analysis. I was quite happy with the control I had during exercise while on MDI.

I have included the table I have been updating while I work on the Python code, which doesn’t seem to accurately reflect the amount of hypo events I have experienced while running. On the whole cardio has been the item on my list I have struggled with the most, and has been a significant source of anxiety. I am quite certain that after a few months I will have a strategy nailed down and the anxiety associated with exercise will wane. As can be seen in the below table, I am currently focusing on running as its the exercise I am struggling to gain control over the most. I was able to stay in range for the entire duration of all my weight sessions.