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Either Hypos or highs!

C

Clarky

Member
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Been type 1 for ten years now. Started with continuous glucose monitoring 5 months back with a dexcom g6.

My levels seem to be hugely effected by my work load. Some days I'm office based and my levels sky rocket, other days I'm site based and hypoing. I weigh my food, carb count and eat the same foods daily. I've tried adjusting my long term insulin to avoid the hypos, which results in high levels and vice versa, causing hypos. Everyday produces unpredictable results. The same foods cause different spikes or lows. I've gone over to fiasp fast acting insulin, which is faster than my previous nova rapid, which helped a little with the highs, but not a lot.

I guess if I could get a happy medium between my office work days and my site days I could work to improve my overal levels, but with such a big difference between the two, I'm really struggling. I've spoke with my doc and have been told to count carbs better, which is laughable and no help at all.

Here's an example of how different my levels can be whilst at work.

More active site day.
7am - BG 5.5 - 40g carbs - 2units fast acting.
10am - BG 4.3 and falling. 66g carbs - 4units fast acting.
1pm - BG 3.9 and steady. 66g carbs - No insulin
4pm - BG 4.3 and falling.

Office based day.
7am - BG 5.0 - 40g carbs - 4units fast acting.
11am BG 8.8 - 66g carbs - 8units fast acting.
1pm BG 16 and rising - 3units fast acting correction.
3pm BG 18 and rising - 3 units fast acting correction.

5pm BG 3.9 and falling.

Does this sort of variation seem normal to anyone?

I take 13 units of levemir at 10pm and 13 units at 10am.

Thanks for reading.
 
On a normal working day sitting at a desk, I'll take 20u of fiasp for breakfast and maybe a few more u later on. That lets me eat a few biscuits during the day.
On a pottering around day, mending things, packing, stuff like that, I'll take 13u and probably need to eat.
On an active day (walking, cycling, whatever), I'll take 8u and need to eat a fair amount during the day.

So yes, variation due to activity seems entirely normal to me. And it's why I don't let people tell me that carb counting is the be all and end all of sugar management, because exercise is a much bigger thing.

I change my fast acting insulin to match what I'm doing, and if I'm active I'll take the excuse to eat with it.
 
Clarky said:
Some days I'm office based and my levels sky rocket, other days I'm site based and hypoing. I weigh my food, carb count and eat the same foods daily.
Click to expand...
Most diabetics need to adjust their short acting for exercise. On the site based days you are exercising when working. Seems like you need to eat with less bolus or without altogether on 'exercise' days and with more on sedentiary days.
On different kind of days your carbs to insulin ratio seems to be vastly different. Maybe it would help if you compared active days with active days when finding your ratio, and sedentiary days with sedentiary days, which gives you 2 different ratio's to use depending on the kind of day it will be.
 
Not a pump user myself, but I wonder if that would be a solution, as then you could change your basal rate in real time.... No, it's not uncommon for insulin ratios to change during exercise, though yo do seem to be a fairly extreme case.
 
These scenarios are very common with pump usage.
As you may be aware, when using a pump you can set up basal profiles matching your basal needs at different times of the day (the disadvantage of injections assume we need the same amount of basal 24/7). This can be adjusted temporarily when exercising or new basal profiles can be used if you always exercise at the same time of the day.
For example, I have a daily basal profile, a climbing profile (I climb every Monday from 6:30pm to 10pm) and a spin profile (I spin 3 times a week at lunchtime).

I find this much easier than eating more before exercise or reducing my bolus.
Especially as these approaches do not take into consideration the BG drop for the next 24 to 48 hours whilst my liver is restocking my glycogen reserves.
 
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