Dynamic Glucose Management

Video: Dynamic Glucose Management explained

The video below is the recommended starting point for seeing how the three pillars fit together before working through the detail.

Watch: Dynamic Glucose Management overview (YouTube)

The mechanism: fast movers and slow movers

Between meals, the tools available to shift glucose divide cleanly into two speeds. The default approach, correcting highs with insulin and treating lows with sugary drinks, relies almost entirely on the slow ones.

Rapid-acting insulin peaks around 90 minutes after injection and keeps lowering glucose for roughly four hours. When corrections stack on top of each other before the earlier ones have finished, the combined effect eventually overshoots and glucose drops sharply. Sugary drinks are similarly slow to arrive and hard to titrate. The data shows the problem is rarely the amount; it is the lag between acting and seeing a result.

The fast movers change that picture. A short burst of activity tends to bring a between-meal high down within 10 to 30 minutes, far quicker than the three to four hours a correction dose needs. Pure glucose, taken in measured amounts, lifts a low predictably and can be stopped before it turns into a rebound. Same goal, faster and more precise tools.

Where the framework came from: a documented before and after

The framework emerged over more than a decade of lived Type 1 self-experimentation and clinical practice. The clearest single illustration of why it works is a direct comparison of the same festive day, one year apart, captured on CGM.

Christmas Day 2018, the slow lane

The plan was conventional: correct highs with insulin, prevent lows with cola, high alert set at 11.0 mmol/L (200 mg/dL). Carbohydrates were weighed and counted, insulin delivered 20 minutes ahead. An hour after Christmas dinner glucose climbed steeply, and it took five separate corrections over five hours to return to range. The meal dose was 10 units for around 200 g of carbohydrate; corrections added another 15 units, a total of 25 units, roughly 150% more than the meal alone. Three portions of cola were then needed to catch the drop that followed. Glucose was, by the end of the day, thoroughly outwitted.

Christmas Day 2019, the fast lane

The same food, the same 10-unit meal dose, the same 11.0 mmol/L (200 mg/dL) alert, but fast movers throughout. When glucose nudged up after lunch, 10 minutes of high knees brought it back almost immediately, exactly as the Activity and movement page describes. Before dinner, glucose drifted low; rather than a full treatment, three dextrose tablets produced a controlled rise back to mid-range without overshoot. As Christmas dinner pushed glucose upward, short bursts of activity across the afternoon held it in range through to bedtime. In range overnight, no insulin stacking, no glucose stacking.

This was a deliberate demonstration, not a daily routine; no one eats a full Christmas dinner every day, and no one needs that volume of activity to manage diabetes. What the two traces show, side by side, is how much the choice of tool speed changes what is possible.

The four movers, one at a time

The two traces above turn on four tools. Insulin corrections and sugary drinks are the slow movers; short activity and pure glucose are the fast movers.

GAME, SET and MATCH: the three pillars

The comparison resolves into three pillars, each with its own page. Work through them in order.

How Dynamic Glucose Management compares with AID systems

What follows describes what automated insulin delivery did and did not do in one individual’s diabetes. It is a single individual’s own data (n=1), not a general claim about AID performance across all users.

In that individual’s data, their own use of DIY looping, Control-IQ and the 670G each sat at around 85% time in range with roughly 3% time below target. That is solid control. Dynamic Glucose Management during waking hours pushed the same person’s figures to around 99% time in range with roughly 1% time below target.

The reason sits in the mechanism. AID systems are excellent overnight, when liver glucose output is the main variable and insulin alone can manage it well. During the day, food, activity, stress and unpredictability enter the picture, and insulin, a slow mover, cannot keep pace with those variables as quickly as fast movers can. In the same personal data, AID typically held around 50% of time in the tight non-diabetic range of 3.3 to 6.7 mmol/L (60 to 120 mg/dL); Dynamic Glucose Management raised that to around 80% during the day.

The practical read is that the two approaches complement each other: an AID system overnight for safe sleep, Dynamic Glucose Management during waking hours. The framework asks for time, attention and persistence, which some people will find engaging and others will not. Both responses are reasonable; it is an individual choice based on individual circumstances, and one worth talking through with your care team.

What the evidence shows in children and young people

The framework has been taught beyond one person. A CGM structured-education programme built on Dynamic Glucose Management was introduced at Birmingham Children’s Hospital for children, young people and their families, and has been published in the peer-reviewed research record (Pemberton et al., Pediatric Diabetes, 2020); the write-up is available in the Research section. The published programme improved time in range and reduced problematic hypoglycaemia, with the largest gains in those who used the framework most consistently.

The strongest drivers of improvement were the three the framework foregrounds: short bursts of activity to bring between-meal highs down, adjusting pre-meal insulin timing to the glucose value and trend arrow, and treating lows with pure glucose rather than sugar.