If it isn't one thing with diabetes, it's another — from trying to figure out our dosing needs to cross-over with other ailments to how we feel about sharing our D-issues with loved ones and others in our livesAsk D'Mine Mail Bag. We at the 'Mine are here to support you, especially each Saturday with our weekly in-depth advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil's addressing four fascinating "straggler" questions from the mail bag... which we thank you all for keeping full of great queries!

{Have questions of your own about diabetes? Email us at AskDMine@diabetesmine.com}


Mary, type 1 from Kentucky, writes: I've had type 1 for 49 years and have been pumping insulin for about 20 years now, presently using an Animas 2020. I have times when I have to set my temp basal rate up +30%. I usually set it as soon as I see what my day is going to be like, and time it to stop at 9pm or 10pm. With that in mind, I have been having lows during the night, any time from 2am to 4am. My basal rate is only 0.3 from 12am to 3am; could I be low due to a residual from the temp basal rate?

Wil@Ask D'Mine answers: Maaaaaaaaybe the 2am low, but no way could the temp rates you're describing cause you trouble at 4am. Like Elvis, the insulin has left the building by then. Even if you ran a +3,000% temp rate—not that you could—the volume of insulin is irrelevant. It's the end time of the rate that determines how long the extra insulin works, not how much you used.

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The effective real-world duration of action for fast-acting insulin I see in most folks is right at four hours. Now of course some experts will argue for three hours, others five hours; and the label will say six hours—but that's the tail ofOvernight Blood Sugar Happiness the action curve in a test tube, which isn't enough to lower a person's blood sugar out in the trenches.

If your temp rate ends at 9pm, I'd expect the bonus bolus to be gone by 1am. If you wrapped it up at 10pm, the last extra drop could still have an effect at 2am. That's why I said maybe. Even if the low were at 2:30 in the morning, I guess a bit of upstream insulin could have set you up on a downhill slide that didn't go officially low until after the insulin's run. But 4am? Nah. That's too late. It's either the basal or the residual effects of exercise or booze—both of which are common suspects when it comes to lows many hours downstream.

So... are you highly active on the days you use the temp rate? If so, I'd follow it up with a negative temp basal rate for a few hours at bedtime. Use your +30% for the day, and when you shut it down, set it for -30% for a four-hour run and see what that does for you. If those are heavy booze days, the same advice will work. In either case, of course, there's no guarantee on the 30% figure; it just felt like a good starting place. You'll have to play with the actual numbers to see what works for you.

If your heavy temp rate days don't have a lot of exercise or booze, then maybe the basal rate of 0.3 per hour is too much for you. Try 0.2 units per hour. Remember, when it comes to insulin, there's no such thing as too little or too much. Like Goldilocks, you need exactly what you need. Not a drop more and not a drop less.

Of course, remember that Your Diabetes May Vary and since I'm not your doc, please make sure to consult with your own endo and all that.


Ralph, type 2 from Montana, writes: I am on Medicare so my insulin prices are very OK. When I see the cost for others versus what I pay, I am appalled. What's behind these awful prices?

Wil@Ask D'Mine answers: Supply and demand. Global economics. Greed. Take your pick.


Anonymous type 1 from somewhere in the USA writes: I have had type 1 diabetes for 16 years and have been out of control. I just found out I'm pregnant and am trying to control my sugar, but when it gets about 160 I'm feeling really low. How do I fix this to achieve normal sugars? Please help.

Wil@Ask D'Mine answers: Oh God, I hate getting letters like this. It breaks my heart. But I'm glad you wrote. I'll bet you are suffering "relative hypoglycemia," where your body thinks you're low when you really aren't. It happens in people who have been running high for some time. The body gets tricked into thinking that high is normal. Under normal circumstances you can reset your body by bringing your sugars back down slowly over a period of a time. It's sort of the reverse of mountain climbers, who have to acclimate a bit at a time to the thin air as they go up Mount Everest, or deep sea divers who have to take breaks to decompress while coming up from the bottom.

The problem here however, is that these are not normal circumstances. This approach takes time, and you and your baby do not have the luxury of time. High levels of sugar are toxic to the fetus. This is that point (again) where I have to remind you that I'm not a doctor and you need to be under the care of a good one. What you and your doc need to do is to get your insulin up to where it needs to be to get your sugars down to where they need to be, and do it in the minimum amount of time that doesn't leave you feeling hypo. If your medical team ordered a big increase in insulin doses, you might have to adjust to this by noodling it up a bit every day. Maybe you need to take a week or two to get there, adding 5% or 10% of the increase per day so that your body can adjust.

But do it and do it now. Your baby is counting on you.


Mark, type 1 from New Jersey, asks: Can diabetics donate organs?Organ Donor Card

Wil@Ask D'Mine answers: Of course. Just don't donate your pancreas; no one wants that piece of junk! But seriously, yeah, some of our gear may not be in the best of shape from the diabetes, but if your liver doesn't work at all, you'd be very happy to have a battered second-hand one from a person with diabetes who doesn't need it any more.

But do you know what happens in this country? Every day we literally bury body parts that dead people don't need anymore; and in the next plot over, we bury people who have died from lack of having those parts.

Also, new fun fact: Joslin Diabetes Center in Boston is now signing up long-time diabetics to donate their parts to diabetes research once they kick it. For info on that, see: "Why I Signed Away My Diabetic Body."

So on the whole I'd say: Don't be selfish. Be a donor. Diabetes or not.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.



Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.