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Any such thing as too much insulin ?

Discussion in 'Type 1 Diabetes' started by Mad76, Jun 26, 2020.

  1. Marie 2

    Marie 2 LADA · Well-Known Member

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    I think they like at least 70% TIR. I have my TIR range set at 3.6 to 8.9 and I stay 98%-100% TIR. I achieve 100% all the time. what I aim for and is hard for me is 14 days in a row at 100%. There is always one day that screws it up!! Most diabetics do not get close to that high of a TIR percent and they really don't need to.

    Honestly most people do not achieve that goal, and for most you just don't need to achieve that high of a percent. I think you are doing great at being at 70% TIR. Experience really helps to know how to control your BG level.

    I do not low carb, but I do have a Dexcom CGM, an Omnipod pump and I prebolus.

    PS, I'm also retired now and that has helped a lot as at my workplace I could never count on if I would have lunch or when or if I would get to finish it. So I could not prebolus for my major meal of the day as I also worked late.
     
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    #21 Marie 2, Jun 26, 2020 at 11:06 AM
    Last edited: Jun 26, 2020
  2. kev-w

    kev-w Type 1 · Well-Known Member

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    My 'range' is 4.1-8.1 and I'm around 70% in range and my HBa1c is/was around 5.7%, I don't low carb/wouldn't dream of low carbing and eat around 150g carbs a day, porridge 7 days a week, 4 slices of wholemeal bread a day and rice with my tea but l have an active lifestyle so (until lockdown :p) never see a weight rise.

    'Balance' is the key, avoid highs/lows but don't fret if you get them, sometimes despite the maths T1 does its own thing anyway and if you spend too much time overanalysing it doesn't help.

    And as I always say, not all carbs are equal, complex ones can mimic your insulins uptake with practice.
     
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  3. Mad76

    Mad76 Type 1 · Well-Known Member

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    Thank you

    When you say avoid highs and lows
    Do you mean out of range highs and lows ? Or do you mean try to get a straight line on the libre? Because even when I'm in range all day on a good day theres lots of ups and downs. The consultant said bg will rise after eating so it's ok, but I've seen lots of amazing people on here with straight lines on their libres. I've never ever ever had this
     
  4. Mad76

    Mad76 Type 1 · Well-Known Member

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    That's amazing!
     
  5. Mad76

    Mad76 Type 1 · Well-Known Member

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    Thanks for the recommendation, I've got this currently downloading on my kindle
     
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  6. ert

    ert Type 1 · Well-Known Member

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    100% isn't realistic. I'm low carbohydrate, so week by week I am between 4 and 7, but that's not to say that I don't get a random hypo or high for no particular reason. I just act on them quickly by eating fruit or dexter for below 4's and run intervals if I hit 7. My HbA1c is still top of the normal range of 4.7% - 5.3%, which means it's taking longer than 2 hours to get my blood sugars back down after eating - usually 4 - 5 hours, which matches the injected insulin curve.
     
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  7. Marie 2

    Marie 2 LADA · Well-Known Member

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    Keeping your levels flatter is a matter of timing of a prebolus. Prebolusing is probably the most important thing I learned the earliest. I prebolus half my bolus amount a half hour before I eat and the other half when I eat. I have a friend that preboluses a third 20 minutes before she eats. It's a matter of figuring out what works for you. (That does not work for a higher fat meal).
     
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  8. kev-w

    kev-w Type 1 · Well-Known Member

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    Aye ones way out of range and don't fret the rest, somewhere on here recently I posted a photo of a non diabetic's libre line, someone who works with diets & diabetics and her line was bouncy with 4 or 5 drops to 3.8 and a right spike up to 9.

    I'd expect a rise of around 4mmol after food, dropping off with the insulin working away.
     
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  9. KK123

    KK123 Type 1 · Well-Known Member

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    Hi Kev, I saw something similar online about a man (a Doctor) who was not diabetic but wore a device for a few weeks and ate a variety of meals (very high carb, medium, low and no carb). His graphs were very interesting, very similar to the American Dow!!!! They regularly went into double figures but generally came down quickly, but most of the time his levels were up and down the whole day long whether he ate or not, whether he exercised or not and a multitude of other variables. Several tests were done before, during and after in order to establish whether he had a glucose intolerance etc and the answer was no, he was perfectly normal in all aspects. (Obviously you could say ah but was he by going into double figures but as far as the experiment went he was certainly deemed to be a non diabetic). The moral of the story?, carbs raise glucose levels to 'dangerous levels' if you consume too many for YOUR body if only for a short time. I sometimes think all they need to do is lower the cut off level for diagnosis and the entire population could be classed as diabetic or at least glucose intolerant. x
     
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  10. UK T1

    UK T1 Type 1 · Well-Known Member

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    Oh, non diabetics won't have straight libre graphs, but the key thing my DSN always tries to instil is avoiding the big yoyos. Pre-bolusing has been the key for me. I do manage to minimise mealtime increases that way. If you're regularly yoyoing it can also decrease hypo sensitivity, so I try to avoid it.

    Always realise that we are all human! It is unrealistic to never have spikes, never yoyo, be 100% in range etc. However, you don't want to allow yourself to miss trends by saying that to yourself.

    I had my 3 month libre review in Feb, I'd noticed I was waking, having levemir (I split my dose am and pm) but no breakfast, and my bloods were always rising a bit by lunch. It was maybe 1-2mmol never taking me above 7 so I sort said 'not ideal but not a problem'. I'd chuck an extra unit or two into my lunch bolus to bring myself in range again and didn't mind doing that. My team highlighted I might just need half a unit more levemir. I tried it and it worked.

    By increasing my basal a little I had less total insulin than when I had to correct. This is obviously a small correction but they add up, and could have lead to weight gain. I also think you misunderstood with the basal:bolus ratios. The standard initial trial is usually a 50:50 split. So your bolus doses would add up to your total basal. That is guidance of course and doesn't work for many! A basal test would show you if you are having more bolus than you need to correct for a lack of basal (as I was doing).

    We were told to have targets between 5.5-6.5 on the libre, but the standard AGP report on libre view says to aim for above 70% of the time between 3.9-10mmol/L with every 5% increase in time in range being 'clinically beneficial'. It also says to aim for a less than 36% variation.

    I'd personally say that is a very loose aim and would not be happy with those targets. I feel quite ill if my bloods vary lots (headaches, feel sick) but my libre graphs are still no where near straight lines most days!

    If you haven't logged onto libre view recently then I'd recommend it, real eye opener!
     
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    #30 UK T1, Jun 26, 2020 at 9:02 PM
    Last edited: Jun 27, 2020
  11. Daibell

    Daibell LADA · Master

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    I will add to other posts that I think the Consultant gave poor advice. T1s can't just eat what they want. It all depends on your body's metabolism and other factors. Insulin enables the body to metabolise carbs and like a non-diabetic, if you eat too many you may gain weight and develop insulin resistance. Insulin resistance means you have to inject a lot more insulin to make it work. So control the carbs so you don't gain weight and stay in a good BMI region.
     
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  12. Ushthetaff

    Ushthetaff Type 1 · Well-Known Member

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    To get 100 % I believe you would do nothing but check sugars and try to constantly chase the numbers and then you still wouldn’t achieve it . Hmm ( asks himself if that’s what life is all about .) it’s hard enough work to keep bloods where they are now . I’ve taken a look at various posts here and realised that blood sugars whether you type 1 , 2 etc etc vary for a countless and various amount of reasons , some controllable some not , that’s why we are diabetic our body doesn’t do it for us . And I am yet to find anyone as good as our body lol
    Stay safe
    “ these are not the droids you are looking for “
     
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  13. SueJB

    SueJB Type 1 · Well-Known Member

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    Interesting, I've never heard about the ratio balance @kev-w but not sure I quite understand.
    If bolus insulin is 20 then basal would be 10....................... is that right?
     
  14. kev-w

    kev-w Type 1 · Well-Known Member

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    Hi Sue no, for the 'ideal' ratio a bolus of 20 would be with a basal of 20, I don't think it's a hard and fast rule but as it appears to work it's the ratio I aim for give or take a couple of u in the bolus. :)
     
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  15. SueJB

    SueJB Type 1 · Well-Known Member

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    Now I'm totally confused @kev-w
    So this means equal amounts of basal and bolus??:arghh:
     
  16. Marie 2

    Marie 2 LADA · Well-Known Member

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    @SueJB. It’s not something you have to do. It is a general rule to thumb so to speak and just a guide? But if your basal is 20 then your bolus would be about 20. But individuals vary. And of course low carbers ratios would usually have lower bolus. It seems to be my basic average although my basal right now is 24, my bolus is also averaging 24 but my actual bolus can range from 20-30.

    But it's just a starting guide that is usually about right, but it can vary person to person and it doesn't mean any other ratio is wrong.
     
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  17. porl69

    porl69 Type 1 · Well-Known Member

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    Hmmmm, will disagree with you on that. As long as you can count carbs and bolus for what you eat you can eat whatever you want. I am 78kg and eat a massive amount of carbs daily
     
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  18. Daibell

    Daibell LADA · Master

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    As I said in my post, it all depends on your metabolism etc. I've seen many posts from T1s over the years who have followed the 'eat what you like' advice, have a high BMI and are injecting very large amounts of insulin, It may be your BMI at 78kg is below 25 but some others won't be able to achieve that.
     
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  19. UK T1

    UK T1 Type 1 · Well-Known Member

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    As others have said this is a very basic/vague/rough guide. Your total daily basal should be close to/roughly/almost the same dose as your total daily bolus.

    In reality it will fluctuate and depend on lots of things, but if you find you're regularly having eg. twice the total daily dose of bolus to basal, it might be worth chatting to your diabetes team who might suggest helping you increase your total daily basal and decrease your total daily bolus.
    Eg I have 4+9 u basal at the moment = total daily basal of 13u
    I carb count 1:15 ratio so what I bolus varies but as I don't have much appetite and just happen to naturally prefer lowish carb (was never a conscious decision was my usual diet long before I was diagnosed) my total daily bolus varies between 5-15u.
    So it does vary but generally works out fairly even split between total dose basal and bolus per day.

    I hope I've made it very clear it is only a rough guide and doesn't take into account other health conditions or 'extreme' lifestyle choices (meant loosely!) Like incredibly low carb or incredibly high exercise. Very much the rough guide they start you on when calculating doses for multiple daily injections.

    I do find it useful to do the sums every now and then if I find I'm having to start changing my carb counting ratios or correcting. Usually I see my basal isn't right and that is having the knock on effect with how much bolus I need. Hope that helps!
     
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  20. SueJB

    SueJB Type 1 · Well-Known Member

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    Thanks @UK T1 it helps
     
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