Failing Safe: Sugar Surfing Lesson #9

Failure is the Sugar Surfer’s best friend. By failure, I mean blood sugar results or trends which don’t comply with the Surfer’s initial wishes or desires. Chaos is an accepted part of any system. And the more complex a system becomes, the more opportunity for chaos to randomly appear.

Success at Sugar Surfing™ has little meaning without some failures or setbacks along the way. Sugar Surfers must learn to fail safely and succeed cautiously. Since control of one’s diabetes truly exists “in the moment”, we must embrace the power of failure and the obligations of success.

To acquire a skill in any discipline, multiple attempts or trials must be made. Sugar Surfing is a skill, not a recipe, formula, or algorithm. At first, novice Surfers often miss their intended targets. However, with persistence, patience and practice, experience is ultimately born and success grows. It’s our individual experiences which act as the glue which holds the discipline of Sugar Surfing together. Failure is baked in to this learning process.

To embrace failure as a teacher does not mean you lose your chance to recover and ultimately succeed, even within a basic Sugar Surfing maneuver. It’s all about failing safely. Tangible examples of this fail-safe philosophy surround us in life. Co-pilots, airbags, seat belts, backup parachutes, and life preservers are everyday expressions of a fail-safe option or philosophy embedded in a process. Ocean surfers use ankle ties to not lose their surfboards in rough water. They often have spotters on the beach too. An effective “plan B” (or C, D…) is never a bad thing.

Sugar Surfers should have their own basic set of fail-safe tools and methods at their disposal. A readily available source of fast acting insulin, rapid-acting glucose and a method to measure blood sugar are obvious fail-safe tools. Frequent glances at the CGM is another. Fluidly adjusting CGM alert limit thresholds and rate of fall or rise alerts are others.

If I practice I-chaining, better known as chain-dependent insulin dosing, then I must have a readily available source of fast acting glucose if I have an unexpected fast BG drop occur. I also fail-safe by ‘braking” the dropping BG at a higher glucose level or threshold. Conversely, when I see a steady upward infection in my BG trendline after single-dosing for a food or meal with sustained blood sugar raising effects (in other words, a food which gradually raises my BG over time), then I need a fast-acting insulin source to pre-empt the rise and avoid an after-meal spike. Of course, these pre-emptive methods are best refined with practice and timing food and insulin, which is classic Sugar Surfing. There is a chapter about “pre-empting” in the book.

In my pocket, I carry a tube of glucose tabs or hard candy. In my car, I have sealed juice stored in the side pockets of the doors or beverage holder. I also keep these items also at the head of my bed, so I don’t have to stumble out of bed looking for a fast carb source should I get low during the night. When I travel, these items are in my immediate reach on the plane or train. The same applies for my rapid-acting insulin and CGM or BG meter.

The art of micro-bolusing and micro-carbing is based on this fail-safe philosophy. When learning to self-calibrate insulin doses as described in the book, start with the SMALLEST rapid-acting insulin doses and gradually attempt higher doses in later attempts to master the art of nudging or dropping a high level BG trend-line. When learning micro-carbing, the fail-safe option is to start with higher starting amounts of fast carbs and gradually reduce the amount used to correct mild lows. So...with insulin practice with low doses at first and work your way upward over multiple practice sessions, and with carbs do the opposite: start higher and work your way downward to achieve more subtle and nuanced outcomes. It's based on a fail-safe practice mentality.

Fluidly setting alert limits on the CGM is invaluable. I have a default setting which I aim to stay between all day. If I am trending outside this range, I will widen or adjust the settings to minimize unnecessary alarms since I already am aware of the variance and working to correct it. Once back in my target range and trending steady, I reset the alert limits to their “normal” ranges (for me).

If I am concerned about a late rising or rapidly falling trend line and I know I will be either busy or sleeping, I will raise or lower the limits to get an “early warning alert” of an impending high or low. I can also set the rate of change alarms to higher or lower levels of sensitivity for similar reasons. I’ve eaten meals with slow rise effects on BG. I might be trending between 90-110 mg/dL as I go to sleep. Knowing that a late rise might happen, I have lowered the high alert limit to as low as it can be set (120 mg/dL) to “catch” a rising trend, even if the rate of rise alert fails to pick it up.

Likewise, if I am aggressively treating a high BG, I might increase the sensitivity of the rate of fall alert AND set the low alert limit to it’s highest setting (100 mg/dL) to be able to react sooner to an impending low, or at least be alerted to the need to glance more often and steer the trendline into a new glycemic shelf through carb-braking or micro-carbing.

Batman has a bullet resistant costume, loaded utility belt, and a Batmobile loaded with fail safe options and tools for any precarious situation. Batman is prepared for the unexpected. Sugar Surfers may not welcome or enjoy the chaos that failure brings upon us, but they don’t fear it when fully empowered and prepared for it.

Failure makes us stronger and it should make us smarter too. It will always accompany us in one form or another. Act to build success on the back of failure. Fail-safe always. Share some of your own fail-safe stories.