Feeling a bit despondent

[Lucie75]

Hi all,

Went to see someone at my diabetes unit yesterday and left feeling really down. She basically told me my control was completely erratic and that I have to completely change the way I do things in order to improve it.

Don't get me wrong, I have known this for a while but nobody has ever said it to me so directly before. The major problem I have is that I have very little hypo awareness. I've always been told before to run higher sugars for a few weeks to ge them back but this has never really worked. This lady said to run higher for 3 months (that's such a long time to be higher!) and I need to change the way I treat hypos etc.

I've had diabetes for 25 years and am quite 'old school' with it. This will be a complete change in my thinking process and I'm not sure how to get my head round it.

I used to inject set amounts of insulin and then eat according to my dose, of course I've known for a little while that people now do it the other way round - alter the dose to match the carbs. I thought I was doing this for the last few weeks but obviously not correctly. I would test pre-meal and carb count, but also do a correction according to the pre-meal reading. I've been told to not do a correction at all, so if I am say 10.0 pre-meal, I still want to aim for 12 - 13 post-meal. This is to ensure I've got my ratio right, but it just feels wrong. I'm also not meant to let my sugars go below 6.0 AT ALL, not even pre-meal, and I just don't know how I'm going to do it. My control was all about correction doses, and has been for years.

Of course she's given me guidelines about what to do etc etc, but so many factors affect your bg, how will I not go hypo even once in the next 12 weeks? To say I'm feeling a little vulnerable and lost is a bit of an understatement.

 

[Debloubed]

Hi Lucie, I think I may have said this before but you must battle to get on a DAFNE course! I totally relate to your story as I used to feel that way too, just fed up with it all! Type 1 is hard enough as it is without the added battle of being unsure about how much insulin to inject for which foods - have you considered buying the Collins gem carb counting book? there is a fomula for working out your insulin ratio's too (I have it at home, I will pm it to you, remind me!!) and then you could start to calculate with a bit more confidence maybe? With the right ratio you shouldn't need to correct at every meal, correction doses are for the exception, they shouldn't be used as the rule.....

Keep at it!!

Deb

 

[Derek27db]

Hi Lucie

I was all over the place, had no hypo awareness, Hba1c in double figures and a couple of long term complications raising their head and as hard as I tried to change my ways I still couldn't get my head around it. I got as far as stopping being bothered.

That was when my clinic put me forward for our nearest DAFNE course and it's helped me a lot. Doing a week course where you focused entirely on DAFNE and discussing it with people in the same situation helps give you strength from the knowledge. It's not instant success or control, I still get off days but I don't worry because I now know how to adjust and fix any lapses I have. And with a DAFNE educator only a call away for advise I have a back up that gives me confidence to keep going with it.

That was 18 months ago and the most noticeable change has been a drop in my Hba1c to 8.8, not ideal but a positive improvement People also say me mood is more stable and happier but I wasn't aware I was moody before lol

Education and knowledge with someone to back that up is key I think so don't be scared to keep asking questions.

Good luck in turning things around, one day at a time is the best way to take things

Derek x

 

[hanadr]

Lucie
As Mother of 2 small children, you really Need that DAFNE course. In the meantime, get hold of a copy of Dr. Bernstein's Diabetes Solution. there's a chapter on working everything out.
And unless you are in a potentially dangerous place and have recently taken insulin, Hypos are not that dangerous,just unpleasant. Long term highs are much more risky.Be careful if you drive your litttle ones. Nevertheless, It wouldn't hurt to teach George to make a 999 call. My daughter was about that age when she learned and she was able to give information, when Daddy had a BAD hypo, with seizures in the supermarket. She knew name, address, phone number and "Daddy needs some sugar".
A hypo may scare them, but they are a long way off being able to see danger ahead
Hana

 

[cugila]

Lucie75 stated, The major problem I have is that I have very little hypo awareness. I've always been told before to run higher sugars for a few weeks to ge them back but this has never really worked. This lady said to run higher for 3 months (that's such a long time to be higher!) and I need to change the way I treat hypos etc.

Did she give you an indication as to how much higher, numbers ? Surely she wouldn't be wanting to put you into mega high territory, it all depends on what sort of numbers you ran at on a daily basis.
How low did you actually think was OK ?

There is another method which may be more suitable. You can also test your blood sugar more often; some people test as often as 12-15 times per day, thus, providing themselves more data to make more rapid adjustments. Patients can also increase protein intake and reduce carbohydrate intake, thereby reducing insulin requirements, which reduces the overall risk for low blood sugar.

Whichever method the you choose, it is important to restore awareness of low blood sugar in order to prevent major incidences of hypoglycemia. A major incidence is defined as one in which you require assistance. For example when a someone loses consciousness or has a seizure. Although seizures are rare they are quite dangerous and can result in short-term or permanent cognitive damage as well as the loss of driving privileges in the UK.

There are quite a few here who think that hypo unawareness is something to not be bothered about but it can be a serious problem for Type 1's. Getting it back is not easy but has to be a good thing to do in the long run, for your health's sake.

Good luck with your efforts.

 

[Debloubed]

And unless you are in a potentially dangerous place and have recently taken insulin, Hypos are not that dangerous,just unpleasant.

I couldn't disagree more, my last serious, debilitating hypo was at home and I hadn't injected insulin since lunchtime and had eaten lunch (hypo happened around 5pm). If my daughter hadn't been around and been able to call 999/family cavalry then it could/would have been pretty dangerous for me..hypo's are unpleasant but they can be as dangerous as highs, just in a different way..

 

[sugar2]

(((Lucie)))))) I have only lost awareness for a short period of time when I was pregnant, and keeping my BS under extra tight control. I was told then, that if it continues after my baby was born, they were going to "run me high". I think I was told 3 months, at around 10ish. the thought hoffofied me, it goes against evrything we do to control our diabetes.
As it happens, my HbA1C, and control got worse, ie higher, ost birth, and it went back to teh 7s after being in the 5s. It is tricky, as hypos as hypo unawareness can ruin lives (Sorry Hana, I usually agree completely, but will have to differ on this one!)Not knowingthat youcan drive, or "pop to teh shops" or even be alone in the house in case you go hypo is extremely dibilitating.

Personally, I would give teh diabetes specialist nurse a call, and get further help. I think they see this as a side effect of good control, and you can afford to be a bit high for a while. This doesn't happen to everyone though, and I am sure Fergus can give some useful advice. There are ways of getting a good HBA1c and not losing hypo awareness.

DAFNE is great, and if nothing else wil give you some one on one time with some specialists who may be able to give some more advice.

 

[kegstore]

Lucie, it does sound as though a course of some description would be useful to you, as your DSN is telling you only half the story and not giving you parameters within which to work. Next to useless in other words. There's nothing to be achieved with chastisement in this situation, and your DSN needs to tell you how to achieve the goals set out for you.

Regarding hypo unawareness, it may be that this is affecting you because of your history of poor control (autonomic neuropathy), in which case running higher numbers is going to do absolutely nothing for you. I'm afraid once gone in this situation, the signs are very difficult to retrieve, unless some clever person has worked out how to repair damaged nerves while I wasn't looking!

Changing insulins may help, so this is certainly something worth discussing with your team, but there's no guarantee. My hypo unawareness nosedived sharply as soon as I started on NovoRapid, in fact I had another ambulance/hospital incident just yesterday, and I am investigating other insulins as a possible replacement.