Sugar surfing is taking over. The CGM is a tool. Every good tool needs a user’s guide. Sugar Surfing (a great read by Dr. Stephen Ponder) is the user guide. If you’re not already familiar with Dr. Ponder’s story, listen to our podcast with him recorded right before the conference hosted by our friends at Diabetes Solutions in OKC (another former podcast guest Kim Boaz-Wilson).
Somewhat familiar with the topic and actively employing surfing strategies intentionally and accidentally, I was ready for this conference. After all, being a student is my full-time gig, why not do some Saturday learning too? Now skimming through my notes, here is the list of the “diabetes lightbulb” moments that made me think, and has ultimately led to a new set of daily diabetes management habits. We here at the grind highly recommend attending a conference and snagging a book!
Diabetes is a process of proactivity
Too often I catch myself in reaction mode. High blood sugar alarm, then a correction. Low blood sugar alarm, then a snack. Instead, he speaks to a constant direction of the CGM line. Diabetes does not steer us. We wake up and steer the ship.
Take into account the flow direction
One number, 132, can mean vastly different things. With a double up arrow, it’s time for insulin. With a steady line, let’s hang out here. With a double down, perhaps it’s time for a shot of juice.
“Your control is no further away than your next 7 decisions”
This may be a general piece of life advice, but let’s apply it to diabetes. What he’s getting at is that diabetes management is only decision making. With practice and prediction, the quality of those decisions improve.
Never say “good or bad” sugars
This is common. It becomes a built-in aspect of our thinking. Good numbers or bad numbers. A good diabetes day or a bad diabetes day. The problem here is that it influences our overall state of being, possibly influencing the next diabetes decision, or causing an over-correction.
Calibrate on a steady trend
Especially in the first day of calibrations after the start of a new sensor, he was adamant that calibrations need to happen on steady lines, citing better long-term value of CGM accuracy. Makes sense to me. Also, he’s seen a benefit to giving an early calibration after the first calibration of a new sensor, about four hours after the first.
High excursions lead to mismatch calibrations
Say you have a few slices of pizza for lunch. You think you nailed it. One hour later the BGs are riding in range. Then the insulin wears off and the sugars sky-rocket into the 300s. Like a wise PWD, you correct and get back in range. Now it’s time for dinner. Dr. Ponder predicts that the CGM will now have a greater gap during the calibration, due to the high excursion. This is something I’ve casually noticed, definitely happens.
Use the CGM as a biofeedback tool
This is awesome. It works too. We all know what it feels like to be falling out of the sky (some by parachute, some by blood sugar). It’s a sensation that the body provides if we listen. He suggests (this may be great advice for kids to learn early) asking yourself if you’re falling, rising, or steady before taking a look down at the CGM, just to tune in better with the body. I plan to work on this skill.
In America, we run “basal heavy”
Traditionally, endocrinologists and CDEs will recommend a basal to bolus ratio of 50/50. Inside your pump this can be found. If you take shots, add up your boluses and compare to your Lantus/Tresiba/Levemir/Toujeo. Yet, Dr. Ponder thinks this is on the high side. In Japan, the basal/bolus ratio is closer to 30/70. Grazing for snacks is his hypothesis for the inequity.
“If you have more than three basal rates, you need a new endo”
This made me laugh when he said it.. Looking down at my pump I saw 4 basal rates. Perhaps I should stop trying to be my own endo.
If you’d like to find a Sugar Surfing Conference near you, simply check out his website SugarSurfing.com for upcoming events.
Ryan, Great job summarizing so much information! That was an awesome and very informative workshop I am so glad I went! Oh ya and loved the podcast with Dr. Ponder. Only one thing wrong with it…Way too sort!
Laurie, Great seeing you at the workshop. Looking forward to catching up soon. You’re so right, just too short. Installment 2 is on our goal list!