Evening All!
Hope we're all well? its cold and wet here too but lets be honest we were back to work with bump yesterday and anything is a bit jaded after a hol
So wondered if i can pass some thoughts by you all, as it seems like I've been feeling a bit lonely and rather like I'm the the only one paddling this canoe
I've ha this condition for 25yrs now and the last 6 months I'm really struggling, my partner think the yo-yo bloods co inside with the Libre fitting but I feel this is only as it's exposed the real patten rather than the split second check of the usual BM.....I want to keep the Libre but I'm not gaining the more level blood I'm like though the A1c is much,much better over all than it's been for the last 3 years....... I wonder if any of you have ever had counselling for the condition- I tend to anxiety bouts and when something in my life isn't proceeding to the plan I'd expect, I try and control it more and more.... with the diabetes I try and low carb but even doing this they reads aren't steady and then I get frustrated and go off the rails and totally off the rails
and eat the wrong thing
also anyone invested in the miow miow
worth the money?
Does any follow the Dc Bernstein method of control? and if so have you had success in the self hypnosis? I feel if could go totally cold turkey on the carbs for a period i could break the habit?
well sorry for the essay, LCHF dust cakes and tea for anyone who waded through it, there's no urgent reply needed, but if anyone has and thoughts or ideas it would be appreciated- I should mention my diabetic nurse is excellent and very supportive and I'm trying to get a pump but it does take a long time
thanks for reading team you're super helpful xx
Hi, welcome, and thanks to everyone for all the tags, my notifications blew up
In a nutshell, I have a MiaoMiao on my Libre and follow (mostly) Bernstein’s methods for T1 management combined with Sugar Surfing. My rig is Libre+MiaoMiao with an iPhone 8 running an unofficial app called Spike, and my readings are displayed on my Fitbit Ionic watch. I also use an Omnipod insulin pump, meaning I can take tiny doses.
I’ll run through how I do things bit by bit, but I’ll start by stressing that as a scientist, I’m happy with lots of numbers coming way, and cool with experimenting on myself and interpreting the results to give me a better outcome. A Libre with or without a MiaoMiao won’t just give you better control because you have one - you need to know how to interpret what it’s telling you, and then know how to act appropriately. But it’s like watching a series of 24 compared to eight still photos from the entire thing.
Let’s start with food - Bernstein recommends limiting yourself to 30g carbs a day, and those from vegetables. So no grains, grasses like rice, root veg, legumes or starchy stuff in general. He suggests dividing this allowance 6/12/12 across your three meals. His principle, that he calls “the law of small numbers” (scientifically not a law at all, more of a hypothesis, but I digress) says that small amounts of carbs = small doses of insulin which means small errors in dosing and therefore smaller glycemic excursions. In other words, less and smaller spikes and hypos - these are my traces for the last two days, the black one is Spike, and the other is the standard Libre app which you’re probably familiar with.
I’ve certainly found this “law” to be true for me since I started it some 15 months ago, and in two decades of T1 it’s the only approach I’ve found that works. Your mileage may vary! Now, I don’t follow his 6/12/12 distribution of carbs throughout the day. I don’t eat breakfast, as I’m just not hungry in the mornings. I’m quite insulin resistant until around noon, and get an impressive “foot on the floor” rise as my liver decides to join the party for the day, so I don’t really want to add food into the mix. I generally have a 3-5g carb lunch, so again lower than he suggests - it means I can get on with my afternoon’s work without having to even think about how the carbs or insulin in my system might be affecting my levels. I can pretty much ignore diabetes for my working day; I know I’ll be running steady. I tend to have up to 15-20g carbs in my evening meal, but often less. So at most I’ll have 2u of insulin as a bolus (using my standard 1u:10g ratio in the evening) for any carbs and maybe an extended bolus over four hours depending on my protein source. When low carbing to this extent, after a couple of months you begin to need to bolus for protein as well, typically at half the ratio you would for carbs. I have to dose for every g of carb from my veg (if you’re eating pasta etc, the carbs in your veg are soaked up by the much larger dose you’re taking for the pasta) when I sit down to eat, and the protein over a longer period. For example, last might I made prawn and avocado mayonnaise. 4g carbs and 15g protein - so 0.4u as I sat down to eat plus 0.75u over 4 hours for the prawns. So that’s food - a bit trickier for me because I don’t eat meat or dairy, but the positive effects have been well worth the sacrifice. Steady sugars and feeling well for the first time in 20 years.
Sugar Surfing is a technique for management that I started doing when I first had the Libre, and have found so much easier now that I have MiaoMiao, because I have alarms set to tell me BEFORE I go out of range. The idea is that you regularly glance at your level, and take action before things get out of hand. If you’re pre-bolusing for a meal you inject, then watch for your levels to begin to drop before you start to eat. Combined with low carb (for me) it’s a winner of a combination. I keep a tight target range of 4-7mmol - basically I aim for non diabetic levels. So I’ve set my Fitbit to gently buzz my wrist when I hit 6.6 for a high and 4.4 for a low - and that gives me plenty of time to either take a microdose of insulin to nudge them back down a bit or a couple of dextrose tabs to nudge them back up. You’ll see on the Spike trace above where I’ve done this. The fluffy turquoise line is the extended prawn bolus.
The last element is my Omnipod pump - which means I can take doses in 1/20 of a unit increments. It allows for much tighter control but does require more effort - although having said that, when I was on MDI, I was taking up to 18 0.5u Novorapid shots a day to nudge my levels down. You need to be very accurate in your carb (and protein) counting, but again, I find it worth the work.
I’ve only had all this knowledge and tech in the last 15 months, since January last year. But the improvement in my HbA1c has been remarkable:
Dec 2017 on MDI, typical high carb/low fat diet & fingerprick - 94
March 2018 on MDI & Libre alone plus low carb - 50
April 2018 on MDI, Libre+MiaoMiao & low carb - 43
August 2018 ditto - 40 - got pump 2nd August
December 2018 with all the toys and low carb - 37 - started a very stressful job, plus volunteer stuff
March 2019 ditto. - back up to 40, due to erratic working hours, I think.
I should add that I have minimal hypos, rarely below 3.6 if they do happen - and they come on very slowly indeed, so I can deal with them with little more than 6g dextrose and turning the pump off for half an hour.
So, as a method of T1 management, mine is pretty full on, but once I’d fine tuned it to suit my life, it doesn’t really require much work at all. I still go out to eat, I don’t feel like I’m missing out. For years I was literally disabled by swinging blood sugars, as I just could not get my doses and timings right to match my food - many here can; I couldn’t. It wasn’t for want of trying! I was almost diagnosed with chronic fatigue or fibromyalgia, I was so bad. But now I’m teaching full time plus volunteering with the ambulance service as a community first responder and really enjoying life.
And you apologised for _your_ essay
I hope this is of some use!