With lock down I'm using this time to better my diabetes

[JaseB]

Hi guys

Well I've got some time with lock down, I would like to look into my ways of doing things and try improve if needed

I would say my diabetes is relatively well controlled but I work hard and micro manage a lot to try keep it in balance.

Here are my specifics:
I am 48yrs of age and I have been a diabetic for around 32 yrs and I weigh 80kg
I use Protaphane twice a day, 16 units morning and 16 units evening
I use Novorapid 3 times a day before each main meal, I try for 7:30 (8 units), 12:30 (7) & 18:00 (6) but it doesn't always happen
I eat very healthy and very similar daily
I find I am very sensitive to any changes, if I'm sick, if its hot or cold, if I'm in the office or on the road, if I'm stressed or not... etc
I know this is normal but I feel mine is very exaggerated.
I find myself having to micro manage with insulin and honey to try stay in my range, it feels worse as I have got older

Just wondering if anyone can see anything above that would maybe seem incorrect and could be done better, I'm happy for advice.

My main concerns is that sometimes I feel like at times I'm having to change my insulin levels from 8 units to possibly even 12 and then at other times decrease it to possibly even 4 for a few days at a time or even up to over a week or so. During these times I can get caught off guard with a high or low trying to catch up with how my body is now reacting to the insulin. I can at times get caught up in a spiking motion as I'm trying to overcome a persistent low and by that time I'm going high then need to give extra insulin to try stop it and it goes back into a low even though I eat early as it comes back into the top of the range.

I was even considering maybe changing my rapid acting to long acting ratios so that I have more long acting and less rapid. Thanks for any input

Cheers
Jason

 

[Geoffrey Ryder]

HI, I AM 58 AND HAVE HAD TYPE 1 DIABETES FOR 46 YEARS. IT SOUNDS LIKE WHEN YOU GO LOW YOU ARE TAKING TOO MUCH SUGAR TO COMPENSATE, WHICH THEN SENDS YOU HIGH, TRY A LESSER DOSE OF CARBS WHEN YOU GO LOW, JUST ENOUGH TO RAISE YOUR BLOOD SUGAR TO ABOUT 55MMOPL OR 7.5 IN OLD TERMS. I HAVE HAD THE SAME PROBLEM BUT FOUND THIS DOES WORK FOR ME.

 

[KK123]

I use Novorapid 3 times a day before each main meal, I try for 7:30 (8 units), 12:30 (7) & 18:00 (6) but it doesn't always happen

Hi there, when you say you 'try for', do you mean you are on fixed units of novarapid? What sort of meals do you eat and what is your carb to insulin ratio (if you carb count?). It sounds like an overhaul might be in order, ie going back to basics and testing whether your basal is at the correct amount and then a re look at your meals just to check whether the carb count is still correct and the amount of insulin for those carbs. Apologies if you have done all this as I see you are an old hand at this. x

 

[Jaylee]

Hi guys

Well I've got some time with lock down, I would like to look into my ways of doing things and try improve if needed

I would say my diabetes is relatively well controlled but I work hard and micro manage a lot to try keep it in balance.

Here are my specifics:
I am 48yrs of age and I have been a diabetic for around 32 yrs and I weigh 80kg
I use Protaphane twice a day, 16 units morning and 16 units evening
I use Novorapid 3 times a day before each main meal, I try for 7:30 (8 units), 12:30 (7) & 18:00 (6) but it doesn't always happen
I eat very healthy and very similar daily
I find I am very sensitive to any changes, if I'm sick, if its hot or cold, if I'm in the office or on the road, if I'm stressed or not... etc
I know this is normal but I feel mine is very exaggerated.
I find myself having to micro manage with insulin and honey to try stay in my range, it feels worse as I have got older

Just wondering if anyone can see anything above that would maybe seem incorrect and could be done better, I'm happy for advice.

My main concerns is that sometimes I feel like at times I'm having to change my insulin levels from 8 units to possibly even 12 and then at other times decrease it to possibly even 4 for a few days at a time or even up to over a week or so. During these times I can get caught off guard with a high or low trying to catch up with how my body is now reacting to the insulin. I can at times get caught up in a spiking motion as I'm trying to overcome a persistent low and by that time I'm going high then need to give extra insulin to try stop it and it goes back into a low even though I eat early as it comes back into the top of the range.

I was even considering maybe changing my rapid acting to long acting ratios so that I have more long acting and less rapid. Thanks for any input

Cheers
Jason

Hi,

Welcome to the forum.

With your Protaphane. From memory it can get grey & cloudy?
Are you gently rolling the vial with the little glass ball inside in order to mix the consistency of the contents prior to each injection?

 

[JaseB]

HI, I AM 58 AND HAVE HAD TYPE 1 DIABETES FOR 46 YEARS. IT SOUNDS LIKE WHEN YOU GO LOW YOU ARE TAKING TOO MUCH SUGAR TO COMPENSATE, WHICH THEN SENDS YOU HIGH, TRY A LESSER DOSE OF CARBS WHEN YOU GO LOW, JUST ENOUGH TO RAISE YOUR BLOOD SUGAR TO ABOUT 55MMOPL OR 7.5 IN OLD TERMS. I HAVE HAD THE SAME PROBLEM BUT FOUND THIS DOES WORK FOR ME.

Thanks Geoffrey. Thanks I know what you mean but in the situation I need the sugar, it becomes persistent and can stay in a low for quite some time, even up to an hour and then spikes the other way. I tell myself the exact things you mention but I think the main problem lies elsewhere. I am doing some investigating. I think 2 things, As I have got older I haven't really allowed or adjusted things for any body changes. I think I've just got comfortable in how I've done things over the years rather than looking into newer and better options. Thanks again

 

[JaseB]

Hi there, when you say you 'try for', do you mean you are on fixed units of novarapid? What sort of meals do you eat and what is your carb to insulin ratio (if you carb count?). It sounds like an overhaul might be in order, ie going back to basics and testing whether your basal is at the correct amount and then a re look at your meals just to check whether the carb count is still correct and the amount of insulin for those carbs. Apologies if you have done all this as I see you are an old hand at this. x

I mean I try for those similar meal times. Normally my meals are very similar and I will aim for the same amount of insulin daily. I do adjust insulin levels for a few reasons, if my sugar levels are not where they need to be at that meal time, if my insulin is not responding well at the time and of course if the meal size is different. I don't carb count, I always check what foods have what carbs when I first buy them but I prefer to learn what foods do what through experience as I find carb counting slow and frustrating. Saying that I'm happy to do carb counting during my lock down as a point of learning. I do believe an overhaul is required. No apology needed, I think I may stuck in older system which have worked for years so I keep at them. If you or anyone reading this can guide me to an easy to read, all in one place if possible, reputable source which shows methods from start to finish on how to setup a new age "how to diabetes" kinda thing Thanks again for your help

 

[JaseB]

Hi,

Welcome to the forum.

With your Protaphane. From memory it can get grey & cloudy?
Are you gently rolling the vial with the little glass ball inside in order to mix the consistency of the contents prior to each injection?

Hi Jaylee. I use the pens so no glass ball inside but yes I shake it up before use. I have heard long time ago, someone said to me about doing this gently but it didn't seem to make any difference back then to how it reacted as an insulin. Do you know anything about the gently concept?

 

[Jaylee]

Hi Jaylee. I use the pens so no glass ball inside but yes I shake it up before use. I have heard long time ago, someone said to me about doing this gently but it didn't seem to make any difference back then to how it reacted as an insulin. Do you know anything about the gently concept?

Hi,

It was a very long time ago. The stuff was cloudy & in a clear "suspension fluid?"
It needed to be mixed in consistency. There was a little glass ball in the vial a little like the ball bearing in a paint spray can.
But unlike vigorously shaking a spray can. It was suggested by the manufacturer at the time the vial was gently rolled or tipped end to end, prior to performing an airshot then injecting.
Shaking vigorously can cause any air bubbles to scatter within the vial which is why a gentler action was preferred.

There are some instructions that may help you on 3 of 6, here. (With regards to "resuspending.") https://www.novonordisk.com.au/cont...au/Patients/Documents/Ins Susp Penf PIL 5.pdf

 

[Goma5]

Hi jaseB - glad the lock down is opening up new opportunities for you! For carb counting have a look at the nutracheck calorie counter app if you have a smart phone. You load your ingredients in there by weight and it gives you the carb output, you can even bar code scan packets to make. It quicker. You soon get a good idea of what meals contain. The subscription allows you to record day to day but the free version still allows you to do the same and not save a log. I found it immensely useful at first and now just check the odd thing.

From your persistent lows- it sounds like doses being off(perhaps change in activity is affecting insulin sensitivity) or maybe your eating very slow release foods which are messing up your timing-pizza and pulses anyone!

 

[JaseB]

Thanks guys. I didn't reply as I couldn't remember this website a few weeks later.

I'll go through what I have done when I get some time as I have altered quite a few things and hopefully others can learn from my mistakes and trials.

I'm interested to know about something please.

First question - As I have said before I take a 12hr basal injection in the morning and another in the evening and also 3 short acting injections before each main meal. I have always only altered my short acting insulin when knowing I am going to have a low activity day (like sitting in the office) or a high activity day (like working in the sun). I'm now thinking I should also look at my basal injection... Is it a good idea to adjust this amount slightly on hard work days but not sure if that would result in an immediate effect or would it take a few days for the basal adjustment to take effect?

Second question - And also the reason for my previous question. After a lot of research and positive feedback from those doing it I'm looking at doing intermittent fasting. Has anyone done this and have any advice for diabetics in particular?
(I have done a few days of skipping breakfast and the short acting insulin. Therefore I rely on the basal to take me to lunch. The results so far have been excellent but I'm thinking if I now go out and work, doing harder labour in the sun I may go low on my current basal level.)

Thanks Jason

 

[UK T1]

Hi, sounds like lockdown has been positive, congratulations! Yes by all means adjust your basal, there are a few things to consider when doing this and your diabetes team should be able to help you.

I will reduce it before a particularly active day (eg planned hike or long cycle) but my basal is different from yours. I see an initial fairly quick change most of the time, but it can also take 2-3 days for the change to come into effect.

Your basal should enable you to go about your day without a meal if you want. Look up 'basal testing' whereby the idea is that your blood glucose levels should remain within range when you fast, and so also skip a bolus dose. It sounds as thought this is sort of what you've already done? I regularly skip bolus injections as I often opt for 'brunch' rather than breakfast and lunch and have no issues with two main meals a day.

Your basal requirement will change, so be prepared to make small adjustments. If you're planning on skipping breakfast but being more active it might be wise to be cautious and contact your diabetes team who can advise how much to lower your basal by so you prevent the risk of a hypo. This will be trial and error and when I first played around with it I accepted the fact that I might be a bit higher than wanted over risking hypos, but I quickly realised how much effect a half unit change in basal has one my body.

I'd recommend contcting your diabetes team for advice on adjustments. Good luck!

 

[JaseB]

Hi, sounds like lockdown has been positive, congratulations! Yes by all means adjust your basal, there are a few things to consider when doing this and your diabetes team should be able to help you.

I will reduce it before a particularly active day (eg planned hike or long cycle) but my basal is different from yours. I see an initial fairly quick change most of the time, but it can also take 2-3 days for the change to come into effect.

Your basal should enable you to go about your day without a meal if you want. Look up 'basal testing' whereby the idea is that your blood glucose levels should remain within range when you fast, and so also skip a bolus dose. It sounds as thought this is sort of what you've already done? I regularly skip bolus injections as I often opt for 'brunch' rather than breakfast and lunch and have no issues with two main meals a day.

Your basal requirement will change, so be prepared to make small adjustments. If you're planning on skipping breakfast but being more active it might be wise to be cautious and contact your diabetes team who can advise how much to lower your basal by so you prevent the risk of a hypo. This will be trial and error and when I first played around with it I accepted the fact that I might be a bit higher than wanted over risking hypos, but I quickly realised how much effect a half unit change in basal has one my body.

I'd recommend contcting your diabetes team for advice on adjustments. Good luck!

Thanks UK T1. Yeah that is what I was asking so your information helps me a lot.
During lockdown I have been doing through the night tests over a few weeks and I have found that my Basal through the night does well at 7 units in keeping my levels similar. During the day I'm at 20 units for an office day and 17/18 units for a normal outdoor day. At that my sugars seem to stay fairly level. I would like to try a full day or 2day fast at some point to see how I react. Thanks again for your help

 

[NicoleC1971]

I mean I try for those similar meal times. Normally my meals are very similar and I will aim for the same amount of insulin daily. I do adjust insulin levels for a few reasons, if my sugar levels are not where they need to be at that meal time, if my insulin is not responding well at the time and of course if the meal size is different. I don't carb count, I always check what foods have what carbs when I first buy them but I prefer to learn what foods do what through experience as I find carb counting slow and frustrating. Saying that I'm happy to do carb counting during my lock down as a point of learning. I do believe an overhaul is required. No apology needed, I think I may stuck in older system which have worked for years so I keep at them. If you or anyone reading this can guide me to an easy to read, all in one place if possible, reputable source which shows methods from start to finish on how to setup a new age "how to diabetes" kinda thing Thanks again for your help

I like the project. Sounds as if you are doing a good job and wonder if you will ever find a regime that doesn't need constant tweaking...If so, forget it!
I have 2 useful tools (freestyle libre and a pump) which help me know what's going on and give me a little more flexibility e.g. variable basal rates (for sick days, pmt,).
I also do low carb because I am keen to avoid carb counting/bolus calculations and weight gain/insulin resistance issues.
Books I've read that I recommend are Think Like A Pancreas (not sure anyone can be that clever but.._) and Bright Spots and Landmines. Both written by actual type 1s but in American so you will need to translate the blood sugar info.