12 Months From Diagnosis. Type1.

[Postleneo]

Hi all

I'm quite new to forum discussions and would appreciate any advice. I have been diagnosed T1D last September and have been trying to do everything as best I can by the book. After 12 months of trial and error my blood sugars are still not quite right. there are weeks where my sugars have ranges from 4.5 - 6.0 on average then there are weeks where my average is 8.0 - 9-5 pre meal. I carb count, weigh my food ( try and eat the same type of foods at the same time) but very rarely hit 9mmols 2 hours after my meal. I currently take Lantus and NovoRapid as the Bolus and am usually 14 mmol to 18 mmol 2 hours after food but this drops to approx. 6 mmol to 9.5 mmol two hours after that. My consultant has told me not to check at the two hour post meal just to check just before my meals. Bit confused at this as I have always been lead to believe the ideal target 2 hours post meal is just under 9mmol am therefore am a bit worried about any long term complications. That by the by, my main confusion is my blood sugars following sleep - I have been testing on waking (usually at about 5am) and can range between 5.5 and 6.5 mmol 2 hours later when I get to work and have breakfast my readings are anything from 8.5 to 13.5 mmol!! requiring a correction dose on top of the insulin needed to cover my breakfast. I have heard of the Dawn effect but the rise in blood sugars over just 2 hours seems a little excessive. I would very much appreciate any advice or suggestions on how I could combat this rise in a morning or is t the case of just accepting this - just worried for the long term.

Thanks

Chris

 

[catapillar]

Hi Chris / @Postleneo

the consultant's advice not to do post prandial testing is the DAFNE advice and is motivated by 1) not wanting you to panic and worry and 2) not wanting you to over correct/stack insulin.

But you are clearly already worrying. And if you know what your blood sugars are doing, you are 50% to getting them to do what you want them to.

Things that might be helpful to getting you to 75% (I'm afraid I thing the other 25% is pure dumb luck/magic) include:

• Basal testing - https://mysugr.com/basal-rate-testing/
• Bolus timing - http://www.diabetesselfmanagement.c...blood-glucose-management/strike-the-spike-ii/

As well as dawn phenomenon lots of people have issues with a more nuanced version of it - I heard it called feet on the floor syndrome - as soon as you get out of bed blood sugar starts climbing. Basal rate adjustments might help. As might bolusing and eating breakfast on waking instead of that big gap between getting up and breaking your fast.

 

[Juicyj]

Hello @Postleneo - DAFNE advice is to only test before mealtimes, the reasons why are that some type 1's would be tempted to correct and therefore run the risk of going hypo, so it's simple advice to say that corrections should be given along with the meal insulin dose before eating. I know some members strive to achieve better 2 hour readings so will take their bolus earlier on say 20 minutes before eating to avoid the spike.

Also in regards to your morning highs - I find that if I don't eat first thing that my liver will start dumping glucose and my levels will rise without any food/insulin on board, so I always try and eat something on waking, you could even try a small snack so at least your body has something to work on, say a yoghurt, piece of toast, just anything that will prevent the liver dump springing into operation ? give it a go and see what happens ?

 

[Postleneo]

Thank you very much for the info breakfast on waking and the info re bolus and basal testing have given me much to think about! Woke this morning at 5:00 blood sugars @ 6.1mmol so had 2 weetbix with full fat milk and gave 2.5 units to cover approx 27 grams carb will post results later. Again many thanks for advice

 

[Daibell]

Hi. The important thing with diabetes is to take control and make you own decisions based on the input from the medics, this forum etc. If you only test before meals you will never know whether your Bolus injection was correct. Yes, don't stack insulin unless you are confident you need to do a correction and won't risk a hypo. Make sure your Basal injection level is at the right level and then adjust your Bolus ratio. From what you say I suspect one or both may need a tweak? Are you keeping the carbs down to minimise blood sugar swings? Two Weetabix is higher than some of us would have for breakfast, but it's your choice as long as you don't gain weight thru too many carbs. I'm surprised you weigh your food. There is nothing wrong with that but most times food packaging will guide you or as my nice DN said 'just eye-ball' it.

 

[Diamattic]

As mentioned above regarding the 2 hour post meal highs - I am not in the UK so I am not sure what your guidelines are there but I was told here (in Canada) that if your sugars are high 2 hours post but return to <7.8mmol/l at 4 hours post then your dose is fairly correct but your injection timing is not quite right. You would need to leave a larger gap between dosing and eating (start at 15min, and if its still a high peak, try 20, then 25 etc...) until that peak lowers without hypoing.

It would have been nice if they told you the reasoning behind that 2 hours post meal spike rather then just 'stop testing' :/

 

[Nidge247]

I found cereals, bread and potatoes to be the main cause of highs and subsequent lows. Since swapping to a lchf lifestyle, I've stopped all those hypos and hypers, and my a1c is nicely down to 45 (from 101 at diagnosis).

Try swapping your cereal for berries, nuts and double cream; I was staggered at the difference it made to me.

High carb meals then taking insulin is like hitting yourself with a hammer then taking a painkiller; a mismatch and its pain either way! I've just bypassed the hammer approach.

I test first thing before breakfast, before driving and every two hours whilst driving. Before every meal and before bed. I don't test after meals as I don't find it necessary. Sticking to lchf you know what your body is doing, and it's never all that long to the next test anyway. I'm usually very close to guessing what the meter reads anyway, from how I'm feeling.