Awesome article that I feel I've been waiting YEARS to read. Every day is a roller coaster after almost sixty years of type one. It is a combination of watching my cgm like a hawkn despite its occasional irregularities and inaccurate readings, and using affreza, when things really go insane (not quite daily). My control is excellent but that is really only because I regard control as a full time job, in addition to my regular full time job. (-: Thanks so much for all you do for this community.
Very interesting article. I move from MDI to a tandem pump during the year. Was on MDI for about three years. Just went back on pump for travel. Easier for me. When on pump I change infusion site every two days and use steel cannulas. When on MDI I will use IM injection to bring down BS faster. Didn’t occur to me to use muscle all the time. May have to try when I switch. Thanks for all of your information. Just had too much desert at a party. Went for a two mile walk and all back to normal. Oh and I don’t use the tandem controlIQ. So not at the mercy of an algorithm
Ditto the above comments. I always appreciate your clear writing and descriptions of complicated topics, plus the witty comments you throw in here or there. Thanks much.
After 48.5 years of T1D (not that I’m counting…), I’ve experienced plenty of roller coaster rides and frustrating CGM readings. Thankfully, no hospitalizations for DKA and only 3 ambulance trips for bottoming out in the middle of the night. Your article put into words many things I’ve experienced, and it has been validating for me to realize that I’m not entirely to “blame” for experiences I’ve had.
Our 28-year-old son has had T1D for 7 years. He started his diabetes adventure with MDIs and now uses an Omnipod 5 and Dexcom 7. I’m happy and relieved to say that he’s doing really well, and I’m going to share your article with him to increase his understanding now and in the years to come. Thank you, Dan!
Excellent insight. Daily injections here 🙋🏻♂️. There is no secret sauce to this shit, but consistency and curiosity, with a sprinkling of trial and error, is a good place to start. Keep up the great work.
thank you to whoever linked this on Reddit, enabling me to find your blog Dan. i'm a highly-technical dad of an 8 y/o T1D, dx'd at 3 during COVID, and this is the kind of stuff i need. he's getting older now and more independent, but he still has very little idea about how to manage himself yet. i'm feeling some extreme burnout from being his caregiver for 5+ years and hopefully your material will help us move to the next chapter of this stupid book we have no choice but to read.
Great article as usual! I was recently reading about IM injections and its impact on muscular hypertrophy. Not something everyone is focused on, but a fascinating topic nonetheless.
In line with your conclusion, one motto I live by: "movement is medicine". As T1Ds, this must be the most important and necessary adaptation to our lives.
Thanks for this article Dan. It validates me in so many ways. 46 years of T1D and I’ve used every insulin and method of administration available over those years. Most recently on the OmniPod 5 and Dexcom G7. The G7 adds its own layer of frustration when it jumps or dives 60 points in 10 minutes… makes me crazy!
I find myself lucky that Lyumjev takes 40 minutes to start working and food takes 40 minutes to get into my system so I can mostly bolus when I start eating. Unless my pump site decides that it’s had enough. I used to love roller coasters as a kid but they kinda lost their thrill… lol
Thanks for this! I've lived well with T1D for 49 years, the last 10 using a pump, now on Mobi with steel cannulas, and CIQ with my version of "sugar surfing". I SO relate to this article - I get great absorption only from my arm sites now, even with consistent rotation, etc. I was trying thigh sites again when I read this, and had the most frustrating/roller coaster few days!
It worries me that I only have one area left for sites where I get the kind of tight control that allows me to feel great, sleep well, and live how I want.
Part of this is due to my sensitivity to infusion sets. If I wear it where there's any pressure, I.e. hips and belly, from pants, I quickly get very irritated/itchy reactions at the site. Not the same as the absorption issues, but even more limiting. Curious if you have addressed this? I think I'm extra sensitive but can't be the only one... thanks again!
You ask if I’ve “addressed this”? That is, talked about?
No, I haven’t talked about and likely won’t. That’s too much in the weeds on specific and nuanced individual experiences, not really a broader, universal issue that I tend to focus on. I have heard similar problems with the adhesives for CGMs.
That said, you said you’ve been using a pump for ten years… that lines up with the theme of this article about lipodystrophy. You didn’t indicate whether your CURRENT problems are better or worse than when you were on MDI. Lipodystrophy is often one of the main reasons pump users revert back to (or just convert to) MDI. There’s a tipping point at which the frustrations with pumps don’t outweigh their benefits. But you’re the only one that can assess that.
Awesome article that I feel I've been waiting YEARS to read. Every day is a roller coaster after almost sixty years of type one. It is a combination of watching my cgm like a hawkn despite its occasional irregularities and inaccurate readings, and using affreza, when things really go insane (not quite daily). My control is excellent but that is really only because I regard control as a full time job, in addition to my regular full time job. (-: Thanks so much for all you do for this community.
Very interesting article. I move from MDI to a tandem pump during the year. Was on MDI for about three years. Just went back on pump for travel. Easier for me. When on pump I change infusion site every two days and use steel cannulas. When on MDI I will use IM injection to bring down BS faster. Didn’t occur to me to use muscle all the time. May have to try when I switch. Thanks for all of your information. Just had too much desert at a party. Went for a two mile walk and all back to normal. Oh and I don’t use the tandem controlIQ. So not at the mercy of an algorithm
Ditto the above comments. I always appreciate your clear writing and descriptions of complicated topics, plus the witty comments you throw in here or there. Thanks much.
After 48.5 years of T1D (not that I’m counting…), I’ve experienced plenty of roller coaster rides and frustrating CGM readings. Thankfully, no hospitalizations for DKA and only 3 ambulance trips for bottoming out in the middle of the night. Your article put into words many things I’ve experienced, and it has been validating for me to realize that I’m not entirely to “blame” for experiences I’ve had.
Our 28-year-old son has had T1D for 7 years. He started his diabetes adventure with MDIs and now uses an Omnipod 5 and Dexcom 7. I’m happy and relieved to say that he’s doing really well, and I’m going to share your article with him to increase his understanding now and in the years to come. Thank you, Dan!
Excellent insight. Daily injections here 🙋🏻♂️. There is no secret sauce to this shit, but consistency and curiosity, with a sprinkling of trial and error, is a good place to start. Keep up the great work.
thank you to whoever linked this on Reddit, enabling me to find your blog Dan. i'm a highly-technical dad of an 8 y/o T1D, dx'd at 3 during COVID, and this is the kind of stuff i need. he's getting older now and more independent, but he still has very little idea about how to manage himself yet. i'm feeling some extreme burnout from being his caregiver for 5+ years and hopefully your material will help us move to the next chapter of this stupid book we have no choice but to read.
Hey Jeff -- you prompted me to suggest this article: https://danheller.substack.com/p/youve-got-type-1-diabetes-let-the
Great article as usual! I was recently reading about IM injections and its impact on muscular hypertrophy. Not something everyone is focused on, but a fascinating topic nonetheless.
In line with your conclusion, one motto I live by: "movement is medicine". As T1Ds, this must be the most important and necessary adaptation to our lives.
Thanks for this article Dan. It validates me in so many ways. 46 years of T1D and I’ve used every insulin and method of administration available over those years. Most recently on the OmniPod 5 and Dexcom G7. The G7 adds its own layer of frustration when it jumps or dives 60 points in 10 minutes… makes me crazy!
I find myself lucky that Lyumjev takes 40 minutes to start working and food takes 40 minutes to get into my system so I can mostly bolus when I start eating. Unless my pump site decides that it’s had enough. I used to love roller coasters as a kid but they kinda lost their thrill… lol
Thanks for this! I've lived well with T1D for 49 years, the last 10 using a pump, now on Mobi with steel cannulas, and CIQ with my version of "sugar surfing". I SO relate to this article - I get great absorption only from my arm sites now, even with consistent rotation, etc. I was trying thigh sites again when I read this, and had the most frustrating/roller coaster few days!
It worries me that I only have one area left for sites where I get the kind of tight control that allows me to feel great, sleep well, and live how I want.
Part of this is due to my sensitivity to infusion sets. If I wear it where there's any pressure, I.e. hips and belly, from pants, I quickly get very irritated/itchy reactions at the site. Not the same as the absorption issues, but even more limiting. Curious if you have addressed this? I think I'm extra sensitive but can't be the only one... thanks again!
You ask if I’ve “addressed this”? That is, talked about?
No, I haven’t talked about and likely won’t. That’s too much in the weeds on specific and nuanced individual experiences, not really a broader, universal issue that I tend to focus on. I have heard similar problems with the adhesives for CGMs.
That said, you said you’ve been using a pump for ten years… that lines up with the theme of this article about lipodystrophy. You didn’t indicate whether your CURRENT problems are better or worse than when you were on MDI. Lipodystrophy is often one of the main reasons pump users revert back to (or just convert to) MDI. There’s a tipping point at which the frustrations with pumps don’t outweigh their benefits. But you’re the only one that can assess that.
As a newly diagnosed type 1 diabetic… this is a great read and I now have first hand knowledge on how to go about my dosing
The doctors, they don’t explain in much details.
yeah -- welcome to the club that no one wanted to join. and the annual dues are excessive. I should write more for the newly diagnosed, but I can point you to this one of mine from ages ago: https://danheller.substack.com/p/youve-got-type-1-diabetes-let-the