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Arborist, anyone else? Just got libre

C

cleancutrees

Newbie
Diagnosed in 2016, aged 27, no family history of type 1 or 2 so came as a complete surprise.

I’m an arborist so most of the day I’m up a tree and have had to keep my sugars high to get through the day but it’s now resulted in high hba1c (77mmol).
Had a diabetic review yesterday and got a bit of a rollicking but they’ve given me a libre 2 to make it easier so keep tabs on my levels.

since being diagnosed I was pretty much left to my own devices. I was rushed to hospital upon diagnosis and was there for over a week. They showed me how to test and inject and sent me on my merry way 2 days before Christmas.

At my review yesterday they said I had retinopathy and now I have to count carbs and check my ketones. I’m stressing about it, it’s all very overwhelming all of a sudden, to go from being left to just get on with it to now having to track everything I eat.
 
Welcome to the forums @cleancutrees . Though it may seem overwhelming at first the libre should hopefully be a big help and you'll hopefully get the hang of things soon. It's a bit off that they've only now stepped in to help you but a lot of T1s have background retinopathy and the early stages can be stopped or even reversed by reducing your bg levels. (Speaking as someone who has been T1 for 52 years, had some spectacularly high hba1cs in my youth and has had background retinopathy for decades with no need for eye treatment yet.)

What sort of insulin(s) are you taking? Given your age you might prefer a pump in the long run but am guessing that they've got you on basal/bolus for now?
 
Welcome @cleancutrees
Libre should help you know what your levels are but, alone, it does not help you reduce them.
Carb counting is the thing that gives you that freedom. It is intimidating at first but it gets easier.

I do not understand why you have to run your levels high because of your job. I understand the need to minimise hypos high levels will be making your body feel sluggish and climbing trees much harder.

For a hobby, I rock climb. This type of exercise - short bouts of exercise with high adrenaline, raises my blood sugars and, if don't keep them in check, I have to stop after a couple of hours. However, with additional insulin, I can climb for twice as long.
This is easier to manage with a pump but, once I understood my body needed that additional insulin, I was able to manage it with extra injections.

Libre will be invaluable to help you understand why your levels do when you are climbing to give you the data that, with your team's help, can reduce your levels (without hypoing) and help.

Please learn teh limitations of Libre. If you expect it to replicate finger pricks all the time, you will be very disappointed, I would say the biggest limitation is that CGMs (including Libre) are designed to be most accurate at "normal" levels. For Libre this seems to be between 4 and 9 mmol/l/. Lower than 4 and higher than 9, levels should always be checked with finger pricks before correcting (unless you are feeling a hypo).
 
Hi, yes sorry to hear you've not had good support from the medics to date.

I can understand why even if you had good control that given your job it probably would make sense to run your BS during working hours on slightly higher end of a safe range to give you more of a buffer from hypos. But please don't think that a high BS gives you more energy to get through the day - it's quite the opposite in fact, you're actually sluggish as mentioned above.

I'd also say
1. as you improve your BS control, try to bring in down slowly over time. Your BS are very high at the moment (average meter reading of 12) but that means if you come down quickly to say 5 or 6 you may start to experience false hypo symptoms - dangerous in your job (well controlled diabetics will more normally get these in the 3s and 4s). So improve things gradually over several weeks.

2. this is boring, but you're looking to make this easy for yourself to adapt and stay safe at work. Good BS is getting the balance right between mainly i) carbs, ii) insulin, iii) activity. Yes there are dozens of other things that also affect it, but those are the key three variables. You can make it simple by say for the first couple of weeks before and during work eat exactly the same meals everyday. Reason for this is that you are then locking down one of the 3 key variables as a constant, meaning the variations you see in BS you can better attribute to what you did with insulin or activity levels. Obviously still eat snacks as and when if you are hypo.

3. hopefully like many others you will find the Libre lifechanging. But it does require you to scan it with your phone - I wonder given health and safety if you're even allowed phones or to handle untethered objects at height? Might be impractical to get your phone out, reach other arm etc. I'd run this past the medics and ask if you might instead qualify for a Dexcom or Libre 3 - these push the readings to your phone automatically, or even better if you have a smartwatch you can just look on there.
 
Hi @cleancutrees and welcome. Like @Ellie M I’ve had T1 for 52 years and had some less than perfect HbA1c results, and the occasional background retinopathy. The good news is that the background retinopathy responded well to better blood sugar control.
Having a Libre is a plus, though you’ll probably find it best to manage if it’s linked to a system where you can set the blood sugar levels to trigger an alarm, and that there’s a vibration alarm that you can feel as well as a sound that’d be blocked by ear defenders. @Antje77 knows more about ways to link the libre2 to systems than I do, I still use libre1.
The carb counting should become easier with practice: has the person who reviewed you suggested a carb to unit ratio for you, and a referral to a dietitian, and a follow up review to see how you’re getting on, or are they, once again, leaving you on your own? You might want to have a look at Bertie. Not a person, but an online course for carb counting.https://www.bertieonline.org.uk/
There are various apps that help with finding the carb value of foods, and the labels on packaging make everything much easier than it used to be. Carbs and Cals or MySugr are the two apps that come up most frequently on this site.
A good set of scales, one that measures in grams and has a reset button, also helps when working out what’s in a meal. Adding carbs bit by bit, calculating or assessing from the packet before eating is a chore, but there’s nothing amiss in muttering favourite swear words when needed.
You may also need a pocket you can reach easily when up a tree in which you can store glucotabs, or my favourite, jelly babies. If your Libre alarm’s set to vibrate at a level that’s still safe, but falling, then you can, I hope, preclude a hypo. Don’t want that safety harness, and that Teflon, being tested too.
Do come back here to ask and share. We’re not able to tell you what to do (apart from saying don’t fall out of the tree, and take jelly babies everywhere), but we’ve loads of experience between us and have usually been there and done that. But not the tree stuff. At least not me. Just smaller ones, like the rogue horse chestnut the grandchildrens’ conkers led to.
 
cleancutrees said:
Diagnosed in 2016, aged 27, no family history of type 1 or 2 so came as a complete surprise.

I’m an arborist so most of the day I’m up a tree and have had to keep my sugars high to get through the day but it’s now resulted in high hba1c (77mmol).
Had a diabetic review yesterday and got a bit of a rollicking but they’ve given me a libre 2 to make it easier so keep tabs on my levels.

since being diagnosed I was pretty much left to my own devices. I was rushed to hospital upon diagnosis and was there for over a week. They showed me how to test and inject and sent me on my merry way 2 days before Christmas.

At my review yesterday they said I had retinopathy and now I have to count carbs and check my ketones. I’m stressing about it, it’s all very overwhelming all of a sudden, to go from being left to just get on with it to now having to track everything I eat.
Click to expand...

Hi,

Welcome to the forum.

Some pretty good advice so far. Up trees is not for me, but I have worked in landscaping.
@Fairygodmother has already touched on the possibility of utilising the libre 2 with some tech to get a CGM experience.
I use a cheap sturdy smart watch to keep an at a glance track on affairs..

i can appreciate its all good & well being told by your HCP to keep tabs on the carb intake & wot not during a professional active working day..? I dare say you are not on the same work site every day either. But there are apps that can help you keep track with the easier said than done, staying in range. (Or at least a higher percentage in target.)

Best wishes..
 
Fairygodmother said:
take jelly babies everywhere)
Click to expand...
Or rather, "take fast acting carbs, such as jelly babies, everywhere".
As as vegetarian, jelly babies are not suitable.
Plus, I find classic sweets difficult to keep out of tempted hands from non-diabetics.
 
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