When is the right time for insulin

[Millie74]

Your routine sounds a little like my younger sister's, she teaches dance & MTC stuff. (That's been online. With the COVID happening.)

Hypos, keep fast acting carbs handy, with my gigs liquid form is easier if you are "vocal" in what you do..
Lucozade or Coke.
I must admit porridge for me regarding the bolusing of is a little like pizza or pasta.? I platau higher hours later.
The current amount of carbs you say you consume daily would need less bolus to deal with. However the timing of the dose is key with anything you eat regarding fitting the working profile of the insulin to compliment how your meal is digested?
Long acting insulin alone for me (when the basal rate is happy.) would not take care of 10g of carbs. I would need to bolus for it.

Hope this helps.

This post really helps. Thank you.

Lucozade to hand seems a good idea when teaching dance.

I think I will need to self fund libre with my activity levels.

 

[KK123]

This post really helps. Thank you.

Lucozade to hand seems a good idea when teaching dance.

I think I will need to self fund libre with my activity levels.

Hi Milly, I would say just have a good read about Libre and its limitations. I do like it (it would cost a £100 a month to self fund). It is always around 15 minutes behind what your blood glucose is actually doing, ie, if I were to look at my libre reading now it would be telling me what my levels were 15 minutes ago. That's easy enough to calculate when you are going along but if you are hoping to use it for real time activities (ie, a dance class) then you would need to factor that in as your levels are likely to be changing rapidly in a high exercise routine). It is great for showing trends but again if I were to check now, it may show a down arrow meaning I was trending low....15 minutes ago. x

 

[EllieM]

Lucozade to hand seems a good idea when teaching dance.

Look at the carb content on the lucozade carefully. They recently reformulated it to have less sugar and you may find that it is no longer the best hypo treatment.

 

[EllieM]

It is great for showing trends but again if I were to check now, it may show a down arrow meaning I was trending low....15 minutes ago.

I haven't used the libre 2 so don't know how customisable the alarms are. I use a dexcom which is a similar system and it has its low alarm set to 4.4. It's usually pretty easy to catch a hypo in time.

 

[Swillbos]

Hi Milly,

One very strong positive is that your exercise routine is predictable, ie. you know the timing (and presumably also the intensity?) of each class/block of classes in advance. Whatever insulin regime you start with, this is something you can plan around.

I was on basal insulin (the long-acting one) only for the first 18months and have now been on bolus as well for the past four months. There is so much to take in when you first start out on insulin....you just about get your head round the fact that there are two types (oh and mixed for some people!) and then someone kindly points out that different insulins have different timing profiles ie they take effect over differing lengths of time (lots of graphs on the Web). For example I am on Humulin basal; as I understand it this is one of the older (cheaper) shorter-lived 'long-acting' insulins, and tends to peter out after c.16hrs, whereas others will give a full 24 hour coverage. I split my dose and take 8units at 8.30pm and 6units at 8.30am, logic being that I am much more active in the day than at night. I found David Cavan's book, 'Take control of Type 1 Diabetes' really helpful on this subject. I don't want to burden you with yet another thing to worry about, rather suggest that the timing and possibly splitting of basal doses might be a helpful tool in your armoury.

A basal-only routine will be time-limited, but does have the benefit of simplicity and low likelihood of hypos. In those 18 months I only had one proper hypo, and really that was my own stupidity..... Your needs will be quite different because you do so much intense exercise. I would like to try a Libre sometime but can't justify the expense at the moment. In addition to my NHS strips, I do, however self-fund an Accu-chek cassette, which I find really helpful for testing when I am out walking, or (distant memory!!) out in town shopping/wining and dining. Lot less fiddly than strips, discrete and for some reason seems to need less blood - probably not an issue for you, but I often struggle to get a big enough blob for my test strips, and especially if I am feeling stressed about a potential hypo.

Fingers crossed for you, it really is a marathon not a sprint!

Susan x

 

[Mike d]

Look at the carb content on the lucozade carefully. They recently reformulated it to have less sugar and you may find that it is no longer the best hypo treatment.

They reduced sugars by 50% in 2017 and even further in 2018. Now it's not recommended for diabetics unless they're aware of that change.

Good call EllieM

 

[Jaylee]

This post really helps. Thank you.

Lucozade to hand seems a good idea when teaching dance.

I think I will need to self fund libre with my activity levels.

I've been in bands with other T1s bass players both, funny enough.
They always keep it handy by the cab. As a singer when I feel it comming on. You just can't heve bits of food in your throat.
Using your voice to teach. I'd call it a similar activity to public performance..

I self fund my sensors. Have done for a couple of years. Though there is hope for me with NHS funding. recently had a CCd letter from my endo addressed to my GP recommending them prescribed.

Look at the carb content on the lucozade carefully. They recently reformulated it to have less sugar and you may find that it is no longer the best hypo treatment.

Hi Ellie,

You are quite correct. I think the ingeredient change was done a fair while back.?
It still works for me but then due to the fact I don't use insulin doses to chase larger amounts of carbs.
I tend to only need a nominal amount to nudge me back in the zone.
With gigs, if I drop. The "culprit" is clearly the basal. Coupled with activity & more insulin sensitivity in the evening..


@Millie74 , you will work this out for yourself as you go along.
I'm sure there will be many questions.

I'll tag in @NicoleC1971 . Who does PT health stuff. (If I'm guessing right, she would be experienced dealing with classes as well as the "1 on 1.")

 

[KK123]

I haven't used the libre 2 so don't know how customisable the alarms are. I use a dexcom which is a similar system and it has its low alarm set to 4.4. It's usually pretty easy to catch a hypo in time.

Hi Ellie, no, I haven't used the libre 2 either but I'm hoping they will change me to it at some point, it would be much better with the alarms.

 

[Hertfordshiremum]

Hi Ellie, no, I haven't used the libre 2 either but I'm hoping they will change me to it at some point, it would be much better with the alarms.

Hi I have just tried the Libre 2 and found it much more accurate than previous Libre and both alarms worked extremely well and woke me up at night. Excellent. I would recommend.

 

[Jaylee]

Hi I have just tried the Libre 2 and found it much more accurate than previous Libre and both alarms worked extremely well and woke me up at night. Excellent. I would recommend.

Yep, I have to admit with the L2 I have found less need to calibrate with the app I use. If at all.
I tend not to use the alarms. Fully hypo awair. It's more like the speedo gauge on a car for me an at a glance correction, making sure I don't break the "limit."

 

[Millie74]

Hi Milly,

One very strong positive is that your exercise routine is predictable, ie. you know the timing (and presumably also the intensity?) of each class/block of classes in advance. Whatever insulin regime you start with, this is something you can plan around.

I was on basal insulin (the long-acting one) only for the first 18months and have now been on bolus as well for the past four months. There is so much to take in when you first start out on insulin....you just about get your head round the fact that there are two types (oh and mixed for some people!) and then someone kindly points out that different insulins have different timing profiles ie they take effect over differing lengths of time (lots of graphs on the Web). For example I am on Humulin basal; as I understand it this is one of the older (cheaper) shorter-lived 'long-acting' insulins, and tends to peter out after c.16hrs, whereas others will give a full 24 hour coverage. I split my dose and take 8units at 8.30pm and 6units at 8.30am, logic being that I am much more active in the day than at night. I found David Cavan's book, 'Take control of Type 1 Diabetes' really helpful on this subject. I don't want to burden you with yet another thing to worry about, rather suggest that the timing and possibly splitting of basal doses might be a helpful tool in your armoury.

A basal-only routine will be time-limited, but does have the benefit of simplicity and low likelihood of hypos. In those 18 months I only had one proper hypo, and really that was my own stupidity..... Your needs will be quite different because you do so much intense exercise. I would like to try a Libre sometime but can't justify the expense at the moment. In addition to my NHS strips, I do, however self-fund an Accu-chek cassette, which I find really helpful for testing when I am out walking, or (distant memory!!) out in town shopping/wining and dining. Lot less fiddly than strips, discrete and for some reason seems to need less blood - probably not an issue for you, but I often struggle to get a big enough blob for my test strips, and especially if I am feeling stressed about a potential hypo.

Fingers crossed for you, it really is a marathon not a sprint!

Susan x

Thank you. Does sound like a marathon. So do you think that I could get away without purchasing the libre yet?

I really prefer the sound of long acting only first. I hope this might be suggested.

 

[Millie74]

In

Hi Milly, I would say just have a good read about Libre and its limitations. I do like it (it would cost a £100 a month to self fund). It is always around 15 minutes behind what your blood glucose is actually doing, ie, if I were to look at my libre reading now it would be telling me what my levels were 15 minutes ago. That's easy enough to calculate when you are going along but if you are hoping to use it for real time activities (ie, a dance class) then you would need to factor that in as your levels are likely to be changing rapidly in a high exercise routine). It is great for showing trends but again if I were to check now, it may show a down arrow meaning I was trending low....15 minutes ago. x

Interesting. Thank you. Teaching my classes is my biggest concern.

£100 a month is a lot. Depends how long would have to self fund for.

 

[Millie74]

Each sensor lasts 2 weeks & I usually buy them from Abbott (the manufacturer) which are a bit more expensive but do get replaced quickly if broken. You will struggle to get it on prescription, in most areas it’s not considered required unless you have poor control or zero insulin production.

I’ve self funded for 8 months or so & don’t regret it, just about to move up to the Libra 2. With having an active job I’d say your better off with it, maybe you can treat it as a business expense.

Thanks for the information. It’s a shame it is do hard to get on prescription. It may be worth funding though. I can imagine if I do, I wouldn’t want to go back to finger pricking.

 

[Millie74]

Hi @Millie74. I'm an oldtimer T1, diagnosed 51 years ago as a child, so I've experienced many different forms of T1 treatment (from fixed dose insulin and no glucometers up to cgms at the present day).

Insulin is your friend. Even those on keto diets need it to survive, and 100 years ago T1 diabetics lived for months/years on a keto diet and eventually died, because insulin wasn't available yet.


My understanding (possibly incorrect) is that keeping your levels normal will keep your insulin production going for as long as possible.

There are Olympic athletes with T1, you can lead an active life with it. If you start on small doses now then you can gradually work out how it affects your body. If you can afford a cgm then you can set alarms so you don't go hypo - the cgm will warn you before your glucose level goes low.

If you want to eat low carb, then do so. There is a facebook group Typeonegrit who follow Dr Bernstein's book and you may find them helpful.

Don't let diabetes stop you from leading the life you want but as a T1/LADA you have to recognise that insulin will eventually be part of that life.

Good luck. You can do this.

Thank you. Good advice. So it’s ok to carry on low carbing with insulin. As in not dangerous? But low carbing without insulin and LADA can be?

 

[EllieM]

Thanks for the information. It’s a shame it is do hard to get on prescription. It may be worth funding though. I can imagine if I do, I wouldn’t want to go back to finger pricking.

It's not as bad as you think. I had to stop using the libre after a year when I became allergic to the sensors (and they not only gave me a rash but the readings lost any relation to those on my glucometer). I ended up testing about 8 times a day (before meals, bed, before and during exercise etc) but quickly got used to it. Now I self fund my dexcom, which seems like a real luxury compared to the libre 1 (alarms plus I've managed to get my redings to transmit to a watch), but I still recognise that this may not be a permanent solution.

And the only reason I had to test so often is that after half a century of diabetes my hypo warning is/was relatively poor....

 

[searley]

You are in a good situation really as far as insulin goes because your body still produces some

So a slight over/under dose sort of get compensated for by the body..

Insulin is nothing to stress about just takes being organised.. and in the early days when you don’t know why you feel in a certain way do a blood test

Carry some fast acting glucose an a cereal bar

Many discussions I’ve had with my care team say I’ve probably extended my own insulin production by starting insulin early - which they agree makes control easier

 

[Millie74]

It's not as bad as you think. I had to stop using the libre after a year when I became allergic to the sensors (and they not only gave me a rash but the readings lost any relation to those on my glucometer). I ended up testing about 8 times a day (before meals, bed, before and during exercise etc) but quickly got used to it. Now I self fund my dexcom, which seems like a real luxury compared to the libre 1 (alarms plus I've managed to get my redings to transmit to a watch), but I still recognise that this may not be a permanent solution.

And the only reason I had to test so often is that after half a century of diabetes my hypo warning is/was relatively poor....

Hi. I didn’t think about a possible allergy to a sensor. That’s a pain. So you coped ok finger pricking 8 x per day? To be honest I do 6 tests now with finger prick. I was more worried about hypos whilst exercising or sleeping at night.

I heard the Dexcom is more expensive?

 

[Millie74]

Thanks. I have heard that many think it’s good to start early. I’m not sure what they’ll do with me as they’ve asked me to record my results before the 3 meals and bed. It is generally always 8 before breakfast, but before lunch and evening meal on low carb only around 7. I did a porridge and pizza experiment for them Saturday and was 9.7 before lunch and 10.4 before bed. But I prefer eating low carb.

 

[becca59]

I am a type 1. In general I eat fairly low carb as I prefer the type of foods I am eating. Some days I eat absolutely nothing, and I mean nothing. Other days I eat shed loads of carbs. Perhaps when I am eating out at restaurants (in the good old days) or when I am at someone’s house and they have gone to the trouble to cook. Or as now on my holidays. I have maintained my weight for 7 years at a level below the previous 30+ years and have an HbA1c of 45 with an 80% time in range. Insulin has allowed me to do that. It is not the enemy, and is nothing to be ashamed of. It is the lifeline towards a normal life. Hypos happen yes. But you learn to manage them. I tend to munch jelly babies and just keep going. You will manage too. It will require some work but will be worth it.

 

[Millie74]

I am a type 1. In general I eat fairly low carb as I prefer the type of foods I am eating. Some days I eat absolutely nothing, and I mean nothing. Other days I eat shed loads of carbs. Perhaps when I am eating out at restaurants (in the good old days) or when I am at someone’s house and they have gone to the trouble to cook. Or as now on my holidays. I have maintained my weight for 7 years at a level below the previous 30+ years and have an HbA1c of 45 with an 80% time in range. Insulin has allowed me to do that. It is not the enemy, and is nothing to be ashamed of. It is the lifeline towards a normal life. Hypos happen yes. But you learn to manage them. I tend to munch jelly babies and just keep going. You will manage too. It will require some work but will be worth it.

Thanks. That all sounds really positive and flexible. How do you manage on days you eat little/ nothing? Doesn’t that throw your insulin requirements out? Do you have a libre?