Anxious, Worried and Stressed

Hiya,

Just to say hello and that I think you have come to the right place. As I am a type 2 I am not really up on the things you need to know, but we have lots of Type 1s who will give you the advice you need to get back on track. I can imagine that you are worried, but you are taking great steps to get your blood sugar sorted and to protect your eyes from any further deterioration.
I am tagging @daisy1 who gives great information to new members.

You have taken some great first steps. Welcome.

P

Hi lordbladdermere, I am a T1 and have been for more than 30 years now. I was put on Tresiba some 4 years ago but I didn't experience all the troubles you're having. The only different thing in my therapy was that I have always used Tresiba before sleep, but that shouldn't mean much… I am on NovoRapid as well, before meals of course. Anyway, everyone is different, so there's no reason to feel worried if you are struggling to adjust. (By the way: trying a new insulin is all very well, but should Tresiba prove unsuitable, there's plenty of different solutions. I did have a lot of problems with Lantus, which I solved switching to Tresiba.)
I strongly suggest you contact your medical staff for help. Talk about your worries and your struggle to adjust: they will be able to solve your problems so much better than any of us fellow T1s.
As for your problems with retinopaty – mind: I am no doctor or anything, I am just speaking out of my bit of personal experience – they may get better, when your BG values get a little more in range than they are now. Studying may have put your sight a little under stress, so don't get discouraged. One step at a time, and your sight may recover instead of getting worse. Try and not be over-anxious; for instance, can you speak with some fellow T1 where you live? Making friend with someone who really can understand could perhaps help putting things in perspective, when you feel (or the fellow T1 feels) overwhelmed.
Write again if you feel like it and let us know how you are managing, ok?
Best wishes and a hug!

Hi Sean,

The thing about Tresiba is that it is a pain in the bottom to get the dosage right, but when you do, it is really, really worth it. It is really stable, and definitely lasts the full 24 hours. I've been on it for about a year, and am still tweaking the dose slightly. Personally, I take it in the evening, but I think @Cumberland might take it in the morning?

I know it's easy for me to say, but try not to stress too much about your eyesight. We have lots of members here who have had some level of retinopathy without any real impact for quite long periods - @himtoo springs to mind. Also, I'm far from an expert, but when I did the DAFNE course a few years ago, there was a girl who had developed maculopathy, but managed to reverse it by getting her levels back under control.

Are your tutors at college aware of your diabetes? Having a good support system in place can really make a difference.

Hi, I’ve been T1 for 24 years now and it’s only in the last few ,(since it came out) that I’ve been taking Tresiba. I also take Humalog. How often are you adjusting your Tresiba? It is a pain to wait for the adjustments to take effect but I’ve found that since being on it I’ve had the best numbers I’ve ever had. I started taking it at night but then switched to mornings. This was purely because of my work rota and I found that there was little difference with my numbers. How are your fasting numbers overnight? If you’re sliding down or are reasonably flatline, then it’s not the Tresiba that’s the problem.

@lordbladdemere

Hello Lord bladdemere and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you need to and someone will help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

Hi. It's easier to balance the Basal if you don't split it. With Tresiba lasting 24 hours why split it? You could save a shot. Discuss options with the nurse. Do you carb-count your Bolus? Quite a few users say they have never been told or taught what to do. It's essential and easy if you aren't already doing it and it provides the best control.

lordbladdemere said:

Hey thanks so much for the reply! Can I ask I've always be under the assumption you take novorapid after a meal ? Does it work better for you to take it before ? Also thanks so much it's been quite stressful with college recently so I really appreciate you taking the time to reply

Click to expand...

Novorapid takes up to 20 minutes to start working after injecting, for some a bit longer. If you don't inject until after you've eaten you blood sugar will start rising before your insulin is even in, let alone working. And when your blood sugar is high your cells will be surrounded by glucose and it will take longer for the insulin to start working because it will have to battle it's way through the crowd of glucose surrounding the cells to get to the cell before it can start to work.

While novorapid is marketed as a fast acting insulin, in reality it do isn't work instantly or even that fast. You are advised to inject before eating and many people pre bolus (ie then inject 20-30 minutes or more before eating) to combat post prandial spikes.

Working out how pre-bolusing timing might work for you would be easiest done with a cgm or a libre because you can see when your blood sugar starts curving down. Obviously if your going to experiment with pre bolusing you need to be cautious to avoid hypos, ie have something ready to eat and test every 5 minutes while you're working out the time it takes for novorapid to start working for you.

Gary Schneier's article, strike the spike has good info on pre bolusing - https://www.diabetesselfmanagement....blood-glucose-management/strike-the-spike-ii/

lordbladdemere said:

Hey thanks so much for the reply! Can I ask I've always be under the assumption you take novorapid after a meal ? Does it work better for you to take it before ? Also thanks so much it's been quite stressful with college recently so I really appreciate you taking the time to reply

Click to expand...

Hi there, taking Novarapid after a meal is almost certainly not ideal. It takes time to start working and if you’ve already eaten it’ll be chasing rapidly rising sugars.

The advice I got was to take it just before my first mouthful of food of the meal. However, i subsequently learnt about pre bolusing (injecting before the meal) which for me on Novarapid was generally 40 mins before breakfast and 15-20 mins before other meals. This led to a massive improvement in my bs control. Doctors are fine with pre bolusing and many on here do it.

Please search on pre bolusing as it will dramatically improve your numbers.

However, I’m conscious you’re trying to get your Tresiba settled, you’re switching to low carb... adding a third change is added complexity. You’ll really need to keep on top of testing as if you pre bolus too early you risk hypo. So experiment with the meal start, 2 mins before, 4 mins before etc.

But out of Tresiba, low carb and pre bolusing I’d get the pre bolus sorted most urgently. Or at least immediately switch to injecting with your first mouthful of the meal.

But test test test as this will lead to a big change in your numbers versus injecting after the meal has finished.

lordbladdemere said:

Does it work better for you to take it before ?

Click to expand...

It makes an amazing difference injecting novorapid before a meal. It's called "pre-bolusing". It takes a bit of practice to figure out timings and the timings often differ depending on the GI of the food involved.

But the basic idea is that insulin takes a bit of time to be distributed around the body and get to work, so, if you pre-bolus, let it get to work, it'll then deal head on with the glucose coming in from food. Whereas if you bolus after a meal, there's going to be a spike from the food and the insulin will be playing catch up.

It's definitely worth experimenting with.

I tend to inject about 20 mins before a meal, perhaps 25 to 30 for high GI foods like ravioli, but only 10 to 15 for low GI, like brown rice. And I'll make a few adjustments to the timing and dose if I'm steady or trending down or up at the time. But that's just me. You'd obviously need to practice with it. Many people will eat the same sort of meal a few days in a row and extend the pre-bolus by 5 mins each time to figure out the "sweet spot".

Here's a pic to show the difference it makes. Left hand side at just before 18:00, I have a 9u shot, I'm about 5.5 on a downward trend from a small 1u correction shot earlier, about 30 mins later, I have 75g carbs, can't remember what it was, maybe ravioli on toast. Instead of a spike, I get a gentle spoon shaped curve down to just above 4, rising back up to about 6. That simply wouldn't have happened if I'd bolused with or after the meal: it would have been getting on for 10 or more.

Unfortunately, it doesn't always work out that way, but it's sweet when it does!

lordbladdemere said:

I've always be under the assumption you take novorapid after a meal ? Does it work better for you to take it before ?

Click to expand...

Easy to find out if you're willing to use some extra test strips. Eat, inject, test every 30 minutes or so. If you spike real high before it starts to drop, your food is working before your insulin and you could try injecting before eating. Working that way for a while, I found out I had to inject 30 to 50 minutes before eating, depending on the food I ate. I only injected right before eating when I was lowish and could use a nudge up in my blood glucose.
I'm on Fiasp insulin now, which works faster than novorapid, so I can now inject right before eating.
Another trick I use is choosing what I eat depending on my bg. When I'm highish, I'll wait with eating until it gets lower, or I eat something with very few carbs.
Good luck!