how can I improve my control?

[keep_going]

Please let me know if I should post this elsewhere...

I've had t1 for 28years. Currently using levemir am 9u and pm 8u, and humalog 1u to 10g carbs.
HbA1c running just around 7.8% but it has come down since I had my gall bladder out and I've been more physical - I hope this continues to improve.
While recovering from my op I took the time to very carefully record all food and blood results onto paper and it turns out I am matching up my insulin and carbs well during the day, but I was probably having night hypos and sleeping through. My levemir was reduced and this seems to have stopped and my consultant is happy with all my results atm.

I am not so happy though. I still get higher am reading that need 1,2 or 3 corrections. I have had a few night hypos that I have slept through but that seems to happen if I make a correction before bed...so I might want to do one if I am running at 10mmols to reduce it down to 7mmols. So on one hand it looks like I need more levemir but if I do I get more night hypos.
DSN said managing diabetes is clunky, but I used to have much better control overnight than I have now...I am not sure what has changed other than getting older...

What do I do if my consultant and nurse actually think my diabetes is okay? I've not been in this position before (my clinic is now far busier than it used to be and of course underfunded).
I am currently reading Dr Bernstein's book which is v interesting.

I also feel like diabetes is catching up with me a bit now too...my last eye test showed that I do have some background retinopathy which really shook me tbh.

Thank you for any insights, suggestions or experiences you might share with me.

 

[Juicyj]

Hi @keep_going - Yes your post is fine here.

What I would do if I was in your shoes is to try some basal fasting tests: http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Ideally try it 2-3 times to establish patterns, getting your background right is fundamental to everything else and also more importantly you can then see what is going on and adjust your background if necessary.

In regards to night time hypos I purchased the libre recently which was good at showing me what was happening overnight, would you consider purchasing one ?

I too have had background retinopathy which came back clear this year so it is reversible

 

[keep_going]

thx @Juicyj that's a good plan...one that kind of skipped through my mind recently. It;s useful info about testing 2 hourly because I may have only done one in the night. I'm going to do it.

I totally agree, getting the basal right is so important which is why I can't understand my consultant thinking mine is ok!

I recently had a cgm fitted for 5 days and I was surprised how up and down it was at night - is it like this for all diabetics with reasonable control? Even with the results from this I haven't had any more adjustments suggested. I have previously done the DAFNE course but haven't' known where to start changing things recently which maybe down to the foggy head I've had which I think has been to do with night hypos.
I have considered buying a cgm and maybe the time is right now. Because of the cost of the sensors I thought it would at least be useful to use them once a month or bi monthly to keep a track of things. I will look further into this again now.

V good to hear about reversing background retinopathy...something I'm becoming more aware of since reading about lc diet but not something mentioned at my clinic which is really disappointing.

Diabetes can really suck at times and I've been a bit low about it these last few months so I appreciate this space to talk about it, thx

 

[rachel162]

Hi @keep_going

Firstly, wow! Operation and becoming more physical and improving your results?! Congrats, love seeing when people are trying to improve and by the sound of it, it's (at least mostly) working.

In terms of what to change I'd definitely second the CGM recommendation...I got one around six months ago and it was literally life changing, and will probably highlight to you what your biggest problem area and hence first to adjust will be. If not, then just focus on the one thing that annoys you the most

I don't think you should be too up and down overnight if your daytime control is reasonable. My CGM highlighted a lot of overnight ups and downs which I've now almost completely eliminated, although a pump does make that easier. I would agree with lowering your levemir if you were having hypos, but perhaps this has now highlighted your dawn phenomenon slightly more, hence morning rises? When on injections you could increase morning bolus ratios or add an extra bolus upon waking to help combat this.

I'm surprised at your consultant saying that your basal was ok if in your opinion solving one problem has caused another. Although perhaps compared to others they'd seen that day you seemed a lot better in comparison! Unfortunately if your control already seems reasonable it will probably be assumed that you're just trying too hard to iron out seemingly minor creases. But if it's a problem for you and you have to deal with it then it is a problem, so you may have to try slight adjustments yourself and find what works for you...unfortunately it's very individual.

Good luck, hopefully with the combined experience of the forum we can help brighten things up a bit for you

R x

 

[Kristin251]

I am in favor of Bernsteins recommendations and follow it as such. It allows me to take very small doses of insulin and rarely do I need correction doses. It did take a while and lots of testing to find my doses for each meal and I keep the macros the same so the limited guess work now.

Warning, if you switch to a low carb diet your insulin requirements will be MUCH less

 

[keep_going]

Hi @keep_going

Firstly, wow! Operation and becoming more physical and improving your results?! Congrats, love seeing when people are trying to improve and by the sound of it, it's (at least mostly) working.

In terms of what to change I'd definitely second the CGM recommendation...I got one around six months ago and it was literally life changing, and will probably highlight to you what your biggest problem area and hence first to adjust will be. If not, then just focus on the one thing that annoys you the most

I don't think you should be too up and down overnight if your daytime control is reasonable. My CGM highlighted a lot of overnight ups and downs which I've now almost completely eliminated, although a pump does make that easier. I would agree with lowering your levemir if you were having hypos, but perhaps this has now highlighted your dawn phenomenon slightly more, hence morning rises? When on injections you could increase morning bolus ratios or add an extra bolus upon waking to help combat this.

I'm surprised at your consultant saying that your basal was ok if in your opinion solving one problem has caused another. Although perhaps compared to others they'd seen that day you seemed a lot better in comparison! Unfortunately if your control already seems reasonable it will probably be assumed that you're just trying too hard to iron out seemingly minor creases. But if it's a problem for you and you have to deal with it then it is a problem, so you may have to try slight adjustments yourself and find what works for you...unfortunately it's very individual.

Good luck, hopefully with the combined experience of the forum we can help brighten things up a bit for you

R x

yes, activity helps so much! usually I find after a physical time my bg is better for a couple of days...so if I'm more physical every day it's good.

Right, so I'm looking into getting a cgm now...in the UK we don't get them on the NHS as too expensive...even though losing a limb would be more expensive I need something a little life changing atm - this could be it! yes, at the moment I'm adding an extra bolus upon waking which works well...but I find annoying in that I feel I should need that and that I wonder how long my bg has been up while I'm sleeping and not correcting it.

It turns out my consultant is holding the fort of the dept atm because the other consultant is off on long term sick...they are overwhelmed and as you suggest, I'm probably one of the better controlled diabetics he sees.

thx v much for the chat

 

[keep_going]

I am in favor of Bernsteins recommendations and follow it as such. It allows me to take very small doses of insulin and rarely do I need correction doses. It did take a while and lots of testing to find my doses for each meal and I keep the macros the same so the limited guess work now.

Warning, if you switch to a low carb diet your insulin requirements will be MUCH less

I'm nearly half way through the book atm and finding it interesting.
How did your basal levels change?
A cgm would def help if I embark on this. I need to figure out the UK versions of some of the foods he suggests...and I'm not keen on eating foods with artificial flavours and sweeteners which must be on the jell-o he suggests for example. I don't particularly like jelly (UK version) but the cream part is ok
Do you cook for a family? I find it hard enough to meet everyone's likes and dislikes as it is...it can feel too much at times so my fall back is jacket potatoes!!

 

[isjoberg]

I don't know about prices of CGM but have you looked into the freestyle libre? I've had diabetes for 19 years and although my control has been OK, that's all it is, just OK and not great. As I can get the data immediately from the freestyle libre I've finally been focusing on making sure my basal rate is correct and that i'm not overcorrecting my doseage. Would highly recommend, you can learn a lot from the 2 weeks the sensor lasts!

 

[keep_going]

I don't know about prices of CGM but have you looked into the freestyle libre? I've had diabetes for 19 years and although my control has been OK, that's all it is, just OK and not great. As I can get the data immediately from the freestyle libre I've finally been focusing on making sure my basal rate is correct and that i'm not overcorrecting my doseage. Would highly recommend, you can learn a lot from the 2 weeks the sensor lasts!

Yes, that's what I think I will do. Especially useful when I do the night time Salford diabetes thing in the first reply I had...let's face it...it will be my dh who needs to set the alarm and wake me every 2 hours and using libre he can scan me and turn over! (I would prob sleep through any noise unless it is a child crying...