sugar surfing by Stephen Ponder

[linda321]

Has anyone read this book? I thought it looks interesting. But it's expensive, so I want to know if it is relevant to me.

Have you found it useful? Is it aimed at children? Is it aimed at pump users?

 

[catapillar]

It's really aimed at CGM or flash glucose monitor users. I think it can be used without, but not terribly easily.

 

[tim2000s]

You can get it as an ebook on Amazon for £6.50.


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[linda321]

Would you recommend it @tim2000s?

 

[paulliljeros]

Hi @linda321 I have read it and thought it was brilliant. I do have CGM, and as @catapillar states, it is aimed at that, but you will still be able to get glean an awful lot of information and if nothing else, it may encourage you to consider CGM or Libre GM, if you haven't already. Another book to consider is Think Like a Pancreas, which is, off memory, slightly less targeted at CGM, but I would personally strongly recommend any T1 to read both.

Edited by a mod

 

[catapillar]

If you are interested in finding out more about sugar surfing, I would recommend finding a diabetes podcast where Steven ponder is interviewed - do a google for the juice box podcast + Steven ponder & you should find an hour long programme of him explaining the approach.

 

[tim2000s]

Would you recommend it @tim2000s?

Yes. It's what I do. I kind of fell into it once I got hold of a Libre, then discovered there was this US doctor out there that was describing exactly what I was doing and having success with.

I think it's great and it really helps to manage variability as well as improve the average!


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[steve_p6]

I found this a really good summary for using CGM in Type 1. It references Ponder too.
http://static1.squarespace.com/stat...037013bba01309ded/1460546437629/CGM+guide.pdf

 

[linda321]

Thanks @steve_p6! That is really helpful. I have had my libre since Christmas and feel like I don't really understand the figures or act on them very well. I still have averages in the 9's and time in target under 50%.
I am going to order the kindle version of Sugar Surfing.

 

[paulliljeros]

Thanks @steve_p6! That is really helpful. I have had my libre since Christmas and feel like I don't really understand the figures or act on them very well. I still have averages in the 9's and time in target under 50%.
I am going to order the kindle version of Sugar Surfing.

Something to bear in mind is i regret not getting the paper veraion. I find the ebook quite difficult to quickly reference and bookmark and refer back to. everyone is different, and its possibly my stupidity, but i will never buy a reference book in electronic format again.

 

[linda321]

Good point @paulliljeros . Thanks for that. I have Think Like A Pancreas, and reference it all the time. Hmmm, should I shell out for the paper version? I think I will listen to the podcast that @catapillar suggested first.

 

[catapillar]

I bought it on kindle & gave up (possibly because my kindle is from out of the arc!) and got a hard copy version recently.

He's been on quite a few podcasts (I love a podcast) so it's worth doing a little search, having a listen & seeing if you like the sound of the approach. If you are looking for something to help you figure out how to utilise the libre then sugar surfing might be helpful.

 

[shivles]

Sorry to bring up an old thread but I've been reading this the last couple of days

I'm a bit confused, from what I'm reading basically you give your bolus and then if the rise is too steep give another tiny dose of insulin to kind of round it off, then be on the look out for a low that might happen because of the extra dose, giving glucose as needed to ward off the hypo.

Is this right? It seems a bit mad lol

 

[azure]

I'm going to tag @tim2000s for you @shivles as I've not read the book. Hopefully he can help

 

[iHs]

Not exactly......it depends on when the bolus was given and the amount of time left for its course of action to finish...the IOB on the Vibe is aggod guide. What might help a bit more is to give 90% bolus upfront and then correct back to a target every 2hrs as this will also help to confirm whether the initial bolus given at 100% works out the same as the 90% plus any corrections.

 

[tim2000s]

Not quite @shivles you use sugar surfing as a way to beat unexpected rises ans try to maintain a flat line. So you bolus upfront for your food as normal, and then if that proves to be wrong, you bolus some more to stop a spectacular high occurring. When you are correcting, you're trying to come back to your target, not go low, so treating the impending low should be (as normal), occasional and not all the time.

It's something that takes a bit of trial and error to get used to but is amazingly effective once you get the hang of it. And it's way easier with a pump and the very small doses that they can give.

 

[shivles]

Not quite @shivles you use sugar surfing as a way to beat unexpected rises ans try to maintain a flat line. So you bolus upfront for your food as normal, and then if that proves to be wrong, you bolus some more to stop a spectacular high occurring. When you are correcting, you're trying to come back to your target, not go low, so treating the impending low should be (as normal), occasional and not all the time.

It's something that takes a bit of trial and error to get used to but is amazingly effective once you get the hang of it. And it's way easier with a pump and the very small doses that they can give.

As an example I'm thinking of my daughters spike after breakfast, I pre bolus and give her the meal when she starts to drop and I'm sure the insulin is working, she spikes sometimes 8-9 mmol. .. its a very steep rise followed by a very steep drop which eventually keeps going until she goes low. I get that normally such a spike suggests not enough insulin was given but if she eventually drops then obviously not...

Is the only way to stop this to change what she has for breakfast? The team are extremely reluctant to suggest I change her from a carby breakfast

 

[catapillar]

Sorry to bring up an old thread but I've been reading this the last couple of days

I'm a bit confused, from what I'm reading basically you give your bolus and then if the rise is too steep give another tiny dose of insulin to kind of round it off, then be on the look out for a low that might happen because of the extra dose, giving glucose as needed to ward off the hypo.

Is this right? It seems a bit mad lol

The main thrust of sugar surfing is: in diabetic management, there are no rules.

So if you are looking for a do x + y hard and fast guide, that might explain the confusion? But the principle is to try to keep blood sugar in range by making frequent adjustments with micro bolus and micro carbs while you are still in range. This does demand fairly close vigilance or setting the cgm alarms very narrowly, or adjusting the cgm alarms depending on what you are doing.

And I would pre bolus so I was under 5 before eating and that would hopefully stop any too high a rise. But if it did look to be going over 8 I'd add in more as a correction (but a pre bolus is aimed at avoiding the need for correction).

I think your daughters TDD must be pretty low? So it might be difficult to implement micro blousing with only half a unit to go down to.

 

[catapillar]

As an example I'm thinking of my daughters spike after breakfast, I pre bolus and give her the meal when she starts to drop and I'm sure the insulin is working, she spikes sometimes 8-9 mmol. .. its a very steep rise followed by a very steep drop which eventually keeps going until she goes low. I get that normally such a spike suggests not enough insulin was given but if she eventually drops then obviously not...

Is the only way to stop this to change what she has for breakfast? The team are extremely reluctant to suggest I change her from a carby breakfast

Could be an interplay with basal?

Could be worth playing around with macros (adding in fat/protein) or just looking at lower go carbs - equal amount of carbs that release a bit slower/steadier.

 

[shivles]

I think your daughters TDD must be pretty low? So it might be difficult to implement micro blousing with only half a unit to go down to.

She has about 11 units total a day... not sure what the average is for her age. I appreciate I probably won't be able to get great control with the techniques but I should be able to greatly improve her levels. I have learnt that once she hits 9mmol I give a half unit and she comes back down nicely to around 5