A few Q's from a newly diagnosed T1

[Robert18264]

Hi all, I was diagnosed with T1 4 weeks ago and have a few questions that have come up. Not seeing the DSN for another 3 weeks so thought here would be a good place to ask.

1. Insulin temperature - do I need a cooler pouch thing for my insulin pens? I've seen a lot of talk about keeping insulin pens chilled in the fridge etc but I am out and about a lot and frequently away from home for a few days.

2. Shaking the pens - I read that shocks and knocks to the insulin pens can break down the protiens and make them less effective. How sensitive are we talking here? Can I run for the bus if I have them in a little case in a rucksack? I like to go out dancing and was wondering if a few hours of flailing about in a bag would be bad.

3. Correction - How do you calculate correction doses? I have been high after meals a few times due to bad calculations but wasn't sure how much insulin to use without food. Is there an equation to work out how far one unit would bring me down? I'm taking one unit for 20g carbs as I'm still in the "honeymoon period".

4. Lethargy - I felt great for a couple of weeks after getting some insulin in me but now I've gone back to feeling tired and lethargic. Not quite as bad as before my diagnosis but still not great, is this normal? I guess there could be other factors involved but I got pretty excited thinking this was how I would feel from now on but it didn't last. Pretty dispiriting.

5. Long shot - Any punks on here know why The Germs have the diabetes symbol as their band logo? I nearly got this tattooed on me as a teen which would have been a crazy premonition

That's probably enough for now, any help greatly appreciated.

 

[azure]

Welcome @Robert18264

You didn't ask this, but if you'd like a great book about Type 1, Think Like A Pancreas is a fantastic one

To answer your questions,

1) I used re-useable insulin pens where you just put a new cartridge in when needed. I keep my cartridges in the fridge but the one in use in the pen is at normal room temperature (insulin is generally ok out of the fridge for 28 days) Obviously, don't leave your pen on a sunny windowsill, etc.

2) My pen got ("got" because I use a pump now) plenty of shakes during my busy day and were fine.

3) To calculate a correction dose, you need to know your correction ratio (how much 1 unit of insulin drops you) As you're newly diagnosed, I suggest you speak to your DSN for advice.

4) If you lost a lot of weight prior to diagnosis, it can take a while to feel back to normal. Also, it takes a while for your blood sugar to get controlled, and that can affect your energy too.

5) I don't know : D

 

[azure]

Re 5, I just googled and found this:

http://pictograms.blogspot.co.uk/2007/07/logo-5-germs.html

.

 

[noblehead]

. Insulin temperature - do I need a cooler pouch thing for my insulin pens?

Insulin is fine at temperatures below below 86°F (30°C), if you think your pen is going to be exposed to temps above this then invest in a Frio Wallet.

Shaking the pens - I read that shocks and knocks to the insulin pens can break down the protiens and make them less effective. How sensitive are we talking here? Can I run for the bus if I have them in a little case in a rucksack? I like to go out dancing and was wondering if a few hours of flailing about in a bag would be bad.

The insulin will be fine.

BTW welcome to the forum @Robert18264

 

[Juicyj]

Hello @Robert18264 welcome to the forum

Love your crazy premonition story.

Lots of friendly folk around here so happy to help.

 

[Jaylee]

Hi @Robert18264 ,

Warm welcome to the forum..
I can't add much more to what's already been said..
The pens are pretty robust.. I've gigged across Europe with em..!

Question nimbler five..? (The blue circle.) Based on the singer Crash's certain substance use thing?
I'd say it was a reference to how the drug is prepared over a gas burner..

Though that still doesn't explain what's going on with this "merchandise..."

I thought it was a straight 1 to 4 mix with sand?

 

[Robert18264]

Thanks for the tips! Going camping next week so I think I will invest in a Frio, tents can get pretty hot in the sun. Will try and get in touch with DSN re: correction dose.

@Jaylee do you have any specific tips for musicians? I play the drums and have played 4 gigs since diagnosis, but I have had a mild hypo before each one. I think due to a combination of loading in gear (we have a lot of heavy amps) and a ramping up of adrenaline/nerves pre show. Rode it out with lucozade and bananas and am actually playing a lot better now I am absorbing some nutrients!

Re: Germs, yeah I think it's a weird coincidence. Though I just remembered they have a song called we must bleed which has the lyric "I'm not one, I am two" plus their record is called (GI)!

 

[TheBigNewt]

My correction is 1 unit Novolog for about 2mmol/l (or 35 in US units) of glucose over desired. I am hard pressed to "correct" at bedtime however. Only if I'm over 11-12 and last took Novolog 4 or more hours prior.

 

[Jaylee]

Thanks for the tips! Going camping next week so I think I will invest in a Frio, tents can get pretty hot in the sun. Will try and get in touch with DSN re: correction dose.

@Jaylee do you have any specific tips for musicians? I play the drums and have played 4 gigs since diagnosis, but I have had a mild hypo before each one. I think due to a combination of loading in gear (we have a lot of heavy amps) and a ramping up of adrenaline/nerves pre show. Rode it out with lucozade and bananas and am actually playing a lot better now I am absorbing some nutrients!

Re: Germs, yeah I think it's a weird coincidence. Though I just remembered they have a song called we must bleed which has the lyric "I'm not one, I am two" plus their record is called (GI)!

Brilliant another "muso!"

Lol, I'm a singer. (So i can just swan in with a mic.)
seriously. I do on occaisions carry my own PA & the quick turnaround of bands (where PA provided) setting up I pitch in too...

My personal "ritual" is not to eat anything after lunch on the day of a gig. (13.00h) I can't stand singing on a full stomach. By the time of the show, my bolus has worn off from lunch.. I like singing for my supper.
During the end evening/night my basal will be tailing off. Despite this I find my levels during the activity relatively consistent twix the mid 5 & 6 by the end of the night.(regardless of being an hour past Lantus time!)
That's not to say I don't keep a bottle of something handy stageside.. If a low occurs? (More likely in the first set.) It's minimal &'easily corrected for me on the fly..
It's only after the gig is over I'll eat.

Oddly enough I've been in two metal bands with two different T1 bass players. They've had more noticeable problems when low with bolus still on board..

 

[GrantGam]

Rode it out with lucozade and bananas and am actually playing a lot better now I am absorbing some nutrients!

You'll soon be as good as the gorilla in the Cadbury's advert!

A warm welcome to the forum Little to add here by the way, but I agree that you shouldn't worry too much about your insulin, it's really quite robust and can tolerate quite a lot.

1u of bolus insulin will typically lower you somewhere between 2-3 mmol/l. But as already suggested, your DSN will keep you right

 

[Shannon27]

Hi all, I was diagnosed with T1 4 weeks ago and have a few questions that have come up. Not seeing the DSN for another 3 weeks so thought here would be a good place to ask.

1. Insulin temperature - do I need a cooler pouch thing for my insulin pens? I've seen a lot of talk about keeping insulin pens chilled in the fridge etc but I am out and about a lot and frequently away from home for a few days.

2. Shaking the pens - I read that shocks and knocks to the insulin pens can break down the protiens and make them less effective. How sensitive are we talking here? Can I run for the bus if I have them in a little case in a rucksack? I like to go out dancing and was wondering if a few hours of flailing about in a bag would be bad.

3. Correction - How do you calculate correction doses? I have been high after meals a few times due to bad calculations but wasn't sure how much insulin to use without food. Is there an equation to work out how far one unit would bring me down? I'm taking one unit for 20g carbs as I'm still in the "honeymoon period".

4. Lethargy - I felt great for a couple of weeks after getting some insulin in me but now I've gone back to feeling tired and lethargic. Not quite as bad as before my diagnosis but still not great, is this normal? I guess there could be other factors involved but I got pretty excited thinking this was how I would feel from now on but it didn't last. Pretty dispiriting.

5. Long shot - Any punks on here know why The Germs have the diabetes symbol as their band logo? I nearly got this tattooed on me as a teen which would have been a crazy premonition

That's probably enough for now, any help greatly appreciated.

Hi!
I've been diabetic since I was 4 years old, nearly 22 now but I understand most of your points, so i'll go through them one by one

1. A cooler pouch would be ideal, however the injections themselves work for up to 2 weeks at room temperature. It generally takes me a week to get through a pen so I carry it around with me and its been fine.

2. Carrying round the pens shouldn't knock the insulin enough to cause it to break down! They're generally pretty sturdy things. Just make sure before you inject that there's no air bubbles in the insulin. If there is, set the pen to 4 or 5 units and point the needle up into the air so the air bubble rises to the top, the 4 or 5 units "test" should get rid of it.

3. Correction doses vary depending on the person. I generally work on a "1unit for every 2 above 7", which works for me. There is an equation someone told me, which is 100/total daily dose, which is your long acting plus total fast acting. For example I do an average of 62 units per day, so 100/62 = 1.6. My pens don't do .6 of a unit unfortunately so I round up.

4. Lethargy, the reason I have recently really started looking after myself. It can be caused by multiple reasons: you could simply not be getting enough sleep. Low blood sugar causes some fatigue during and after they've been treated. My problem was high blood sugars - as I drive a long way to work I tend to let myself go high before driving, as a hypo could cause a lot worse problems. However high blood sugar can result in not enough oxygen getting to your brain, causing drowsiness and fatigue when you shouldn't be drowsy or fatigued.

5. I have never heard of these guys ha!

Hope this helps!

Shannon

 

[Robert18264]

Thanks @Shannon27 I think my lethargy might be down to using an old Toujeo pen. They told me at the diabetes clinic that they last 28 days out of the fridge and yesterday was the 30th! Whoops! It deffo felt the same as before I got any insulin and my blood sugars have been creeping up in the last week. Swapped for a new one today so will see if that helps. I am also getting tested for a bunch of vitamin deficiencies as my blood count is low.

@Jaylee I am the drummer in our band and it is very tiring music to play, basically as much exertion as I can possibly manage in half an hour! Don't think I could do it without a good meal in me. Also generally playing between 8 and 10pm so going 7 to 9 hours without anything to eat would leave me about as weak as a kitten sounds like you have your system down to a tee though

Thought of more questions:
6. Is the Basal dose supposed to keep you even (as in, without food over time blood sugar stays the same) or does it bring you down slowly?

7. Does the time of day make much difference to the effect of your bolus? I'm taking 24 hour acting toujeo at 11am-ish just because that's what time it was when the nurse showed my how to do it at my first appointment. But it looks like most people take theirs at night, is there any particular reason for this?

Thanks for all the replies all, this is helpful stuff!

 

[pinewood]

Thanks @Shannon27 I think my lethargy might be down to using an old Toujeo pen. They told me at the diabetes clinic that they last 28 days out of the fridge and yesterday was the 30th! Whoops! It deffo felt the same as before I got any insulin and my blood sugars have been creeping up in the last week. Swapped for a new one today so will see if that helps. I am also getting tested for a bunch of vitamin deficiencies as my blood count is low.

@Jaylee I am the drummer in our band and it is very tiring music to play, basically as much exertion as I can possibly manage in half an hour! Don't think I could do it without a good meal in me. Also generally playing between 8 and 10pm so going 7 to 9 hours without anything to eat would leave me about as weak as a kitten sounds like you have your system down to a tee though

Thought of more questions:
6. Is the Basal dose supposed to keep you even (as in, without food over time blood sugar stays the same) or does it bring you down slowly?

7. Does the time of day make much difference to the effect of your bolus? I'm taking 24 hour acting toujeo at 11am-ish just because that's what time it was when the nurse showed my how to do it at my first appointment. But it looks like most people take theirs at night, is there any particular reason for this?

Thanks for all the replies all, this is helpful stuff!

Welcome to the forum!

On (6), yes, it is supposed to keep your blood sugar nice and steady (in the absence of food, exercise, stress etc.). It should not bring the level down. Ultimately, the aim of the basal is to give you a "straight line" in the absence of any external factors that affect your blood sugar.

On (7), unfortunately there is no simple answer as everyone is different. I assume you mean "basal" rather than "bolus"? I take my basal (Lantus) at night, simply because I find it easier to remember as part of my daily routine (I take it just before bed). I would never cope with doing it at 11am as - if there is too much going on at work etc. - I'd probably end up forgetting or delaying it. I think the best advice on when to take your basal is, initially, to just choose the time that is most convenient for you. For most people, that is right after waking up or right before going to bed. If, after a few weeks, it transpires that you're seeing some weird rises or trends then at that time you might like to post here again and it may be that changing the time could help.

 

[TheBigNewt]

At our hospital and outpatient clinic the pharmacy instructs patients (most are Type 2) to take the basal Lantus at bedtime. Personally I take mine in the morning. Something about taking insulin and going to bed doesn't sit right with me. It seems to work. I don't refrigerate pens after I start using them. My Lantus pens last 12 days, Novolog about 20 days, but my Lantus vials lasted 40 days no problems with that ever. The only time I'd cool insulin was if I were leaving it in a car in Phoenix for part of a day, which could be really hot.

 

[noblehead]

6. Is the Basal dose supposed to keep you even (as in, without food over time blood sugar stays the same) or does it bring you down slowly?

They say if your basal insulin is set at the right dose your bg levels shouldn't fluctuate by more than 1.7mmol/l.

7. Does the time of day make much difference to the effect of your bolus? I'm taking 24 hour acting toujeo at 11am-ish just because that's what time it was when the nurse showed my how to do it at my first appointment.

According to the Sanofi website it just says to take the insulin at the same time each day and to pick a time that fits your schedule:

Toujeo® should be taken at the same time each day to help improve your blood sugar control. That’s why it’s important to inject Toujeo® at the same time each day.

Work with your doctor to pick a time that fits your schedule. Take Toujeo® at that time each day to help with blood sugar control around the clock.

https://www.toujeo.com/starting-on-toujeo

 

[Deleted Account]

Just to add to the comments on 7.
If you decide 11am is an inconvenient time, there is no problem moving the time. However as the insulin lasts for about 24 hours (if you google "Toujeo profile, you will see some graphs showing how it lasts in your body after injecting) in your system, you will want to reduce the amount of time you have overlapping doses (if you move it earlier) or a gap (if you move it later). My rule of thumb was to move my basal dose by about 30 minutes each day until it is at the time I want it. I didn't do this often: just when I travelled to a different timezone.

 

[ashMantra]

If I am going to do any long period of physical exertion, I adjust my pump to reduce the amount of insulin I get by about 50% or so for the duration. Without a pump an option is to sip a diluted energy drink (Yes - one with real sugar) or orange squash sparingly...

 

[PurpleChrisB]

Hi all, I was diagnosed with T1 4 weeks ago and have a few questions that have come up. Not seeing the DSN for another 3 weeks so thought here would be a good place to ask.

1. Insulin temperature - do I need a cooler pouch thing for my insulin pens? I've seen a lot of talk about keeping insulin pens chilled in the fridge etc but I am out and about a lot and frequently away from home for a few days.

2. Shaking the pens - I read that shocks and knocks to the insulin pens can break down the protiens and make them less effective. How sensitive are we talking here? Can I run for the bus if I have them in a little case in a rucksack? I like to go out dancing and was wondering if a few hours of flailing about in a bag would be bad.

3. Correction - How do you calculate correction doses? I have been high after meals a few times due to bad calculations but wasn't sure how much insulin to use without food. Is there an equation to work out how far one unit would bring me down? I'm taking one unit for 20g carbs as I'm still in the "honeymoon period".

4. Lethargy - I felt great for a couple of weeks after getting some insulin in me but now I've gone back to feeling tired and lethargic. Not quite as bad as before my diagnosis but still not great, is this normal? I guess there could be other factors involved but I got pretty excited thinking this was how I would feel from now on but it didn't last. Pretty dispiriting.

5. Long shot - Any punks on here know why The Germs have the diabetes symbol as their band logo? I nearly got this tattooed on me as a teen which would have been a crazy premonition

That's probably enough for now, any help greatly appreciated.

Welcome to the madhouse that is T1.

You will take a few months to settle in and get your head round everything. Make sure that you have your specialist's/support team's phone number, and dont be afraid to use it. Dont think you cant ask questions for another three weeks. Also dont panic if things dont settle down as quickly as you want them to. Your body has gone through a major change. You already seem to have accepted it so you are ahead of the game.
I wish you all the very best.
Love Chris (T1 for 42 years)

PS I keep my insulin in my kit all day and fridge it every night. Seems to work fine.

 

[bridia12]

My correction is 1 unit Novolog for about 2mmol/l (or 35 in US units) of glucose over desired. I am hard pressed to "correct" at bedtime however. Only if I'm over 11-12 and last took Novolog 4 or more hours prior.

At bedtime I shall correct for any BG number over 7, at 1:2.5. My son disagrees strongly.

 

[Shannon27]

At bedtime I shall correct for any BG number over 7, at 1:2.5. My son disagrees strongly.

I wouldn't recommend correcting 1u for every 2.5mmol above 7... yes it's what I do but never before bed. If you correct that much before bed, you're likely to wake up hypo a few hours later because you won't have eaten anything to counter the insulin in your system once you drop below 7. That's a daytime correction. For a night time correction I'd recommend the same ratio but only to be taken if you're above 10.