Type 1 Diabetes Management

[JenaKatie13]

I am a 13 year old girl and through the night I am mostly low. My mam has to check me my blood all night and she gets 2/3 hours sleep most nights. The hospital has told us before bed and through the night do not have slow acting carbs when my blood is in the 4s. This has not worked at all for me. They say my body should still produce some glucose but my body has not worked the same way as everyone else since I was a little girl with many health issues. Can we have some advice to help control my blood sugar levels through the night and through the day
- Jena xx

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[azure]

Hi @JenaKatie13

Can you tell us a little more about what insulins you take and when, and when you were diagnosed?

 

[JenaKatie13]

Hi @JenaKatie13

Can you tell us a little more about what insulins you take and when, and when you were diagnosed?

I have been diabetic since 3rd Novemeber 2016 l. I take insulin (Novo) with ever meal and when I am high. I have 16Lev morning and night. xx

 

[donnellysdogs]

Are your doses fixed (by the nurse) in quantity or are you and mum changing your doses by yourselves yet?

Have you got 1/2 unit pens? If you havent, please ask your Nurse for pens that you can give say 15.5 units instead of 16.

Have you and Mum read the book "think like a pancreas" by John Walsh?
I think this explains things better than nurses in short appointments...

 

[JenaKatie13]

Are your doses fixed (by the nurse) in quantity or are you and mum changing your doses by yourselves yet?

Have you got 1/2 unit pens? If you havent, please ask your Nurse for pens that you can give say 15.5 units instead of 16.

Have you and Mum read the book "think like a pancreas" by John Walsh?
I think this explains things better than nurses in short appointments...

I am on carb counting so my insulin is sorted by my monitor. I have 3 pens 1 spear, 1 for my novo, 1 for my lev. We have not read that book but we have started to read one about type 1 diabetes and how to deal with it. We're can we find this book? This may help us. Thank you xx

 

[noblehead]

Have you and Mum read the book "think like a pancreas" by John Walsh?

@donnellysdogs The author of the book Think Like a Pancreas is Gary Scheiner, John Walsh is the co-author of the book Pumping Insulin.

@JenaKatie13 Going to bed on bg levels in the 4's really isn't advisable as the potential for a hypo is greatly increased, especially if you already have a tendency to go low through the night. Get your mum to show your diabetes care team your bg results from the night-time testing and they will advise you both on adjusting your levemir insulin.

 

[donnellysdogs]

@JenaKatie13 Noblehead is right with authors. You need the book by Gary Scheiner. Amazon sell it.

Ok. Then it may be that your background insulin (basal) is a little bit too much as really like @noblehead said 4 is too low for going to bed.
Your mum and with you need to ask if lowering a basal would give you better readings during night and also to give your mum and you decent better sleep.

Do your pens dial up in 1/2 unit doses or 1 unit?
I would suggest that if they are 1 unit pens that you ask for pens from your dsn that will allow you to alter doses by 1/2 units..gives you more flexibility to fine tweak.

You both sound as if you are learning this all well, so well done. Also for finding the forum. You can get great help here. Parents can too!!

 

[azure]

I have been diabetic since 3rd Novemeber 2016 l. I take insulin (Novo) with ever meal and when I am high. I have 16Lev morning and night. xx

I agree with the above comments about asking if your Levemir dose can be lowered.

If I'm understanding you correctly, your team are telling you not to eat carbs when you're in the 4s at night? That sounds unusual. I have a pump now but even then I like to be in the 5s, and when I was on injections I liked to be around 6.5. It's not right that your mum's getting such little sleep. That must be hard.

So maybe ask about a nighttime snack too? If you keep going low overnight, something clearly needs altering.


Here's a link to the fantastic book, a Think Like A Pancreas:

https://www.amazon.co.uk/Think-Like...4025619&sr=1-1&keywords=think+like+a+pancreas

It's a great book for Type 1s

 

[JenaKatie13]

Thank you all for the help I will talk to my nurse on Thursday xx

 

[catapillar]

The hospital has told us before bed and through the night do not have slow acting carbs when my blood is in the 4s

That sounds like very strange advice, like contrary to all standard diabetic management advice. Do you think you might have misunderstood them. Usually the advice is if you're in the 4s to go to sleep have some slow acting carbs to see you through the night.

Your body doesn't produce glucose, it stores glucose from what you eat. It stores glucose in your muscles - that's why people running marathons eat this glucose gels half way round, because they've used up the glucose in their muscles and they're replacing it. It also store glucose in your liver.

In your pancreas there are two kinds of cells to know about. The first is the beta cells, they make insulin and, as you have type 1 diabetes, they are the cells being killed off by your immune system. The second is your alpha cells, when you get low blood sugar the alpha cells release a hormone called glucagon, this is a signal to your liver to release the glucose it has stored and raise your blood sugar. In a newly diagnosed type 1 alpha cells should be functioning in tip top form, but the alpha cells are vulnerable to getting worn out in a type 1 diabetic. It is not wise to rely on alpha cell action to solve your hypos - that would be thinking I'm in the 4s but I'm ok to go to bed without eating anything because my body will still have sugar in it because to get at the sugar your body's got to go through quite a complex hormonal process that might make you feel a bit unwell and could be easily avoided by eating some carbs before bed.

Maybe the advice not to have slow carbs when in the 4s was to have fast carbs in preference? As obviously, fast carbs will get you to a good number to go to bed on quicker.

If your dropping overnight that does suggest your basal dose is too high. The job of your basal insulin is to keep blood sugar flat when you aren't eating (to bump it up) or bolusing (to knock it down). So, in an ideal world, you should wake up at about the same number you go to bed at with a nice flat line overnight. You can do some overnight basal testing to see if your basal dose is working for you - https://mysugr.com/basal-rate-testing/

You might also want to look into the freestyle libre, which would show you what your overnight blood sugars looked like, or a CGM, which would alarm if your blood sugar dropped under a certain level. These would have to be self funded, but might allow mum a bit more sleep.

 

[himtoo]

hi there @JenaKatie13


some really good advice already -- so I will just say hi and welcome to you and your mam !!

 

[JenaKatie13]

That sounds like very strange advice, like contrary to all standard diabetic management advice. Do you think you might have misunderstood them. Usually the advice is if you're in the 4s to go to sleep have some slow acting carbs to see you through the night.

Your body doesn't produce glucose, it stores glucose from what you eat. It stores glucose in your muscles - that's why people running marathons eat this glucose gels half way round, because they've used up the glucose in their muscles and they're replacing it. It also store glucose in your liver.

In your pancreas there are two kinds of cells to know about. The first is the beta cells, they make insulin and, as you have type 1 diabetes, they are the cells being killed off by your immune system. The second is your alpha cells, when you get low blood sugar the alpha cells release a hormone called glucagon, this is a signal to your liver to release the glucose it has stored and raise your blood sugar. In a newly diagnosed type 1 alpha cells should be functioning in tip top form, but the alpha cells are vulnerable to getting worn out in a type 1 diabetic. It is not wise to rely on alpha cell action to solve your hypos - that would be thinking I'm in the 4s but I'm ok to go to bed without eating anything because my body will still have sugar in it because to get at the sugar your body's got to go through quite a complex hormonal process that might make you feel a bit unwell and could be easily avoided by eating some carbs before bed.

Maybe the advice not to have slow carbs when in the 4s was to have fast carbs in preference? As obviously, fast carbs will get you to a good number to go to bed on quicker.

If your dropping overnight that does suggest your basal dose is too high. The job of your basal insulin is to keep blood sugar flat when you aren't eating (to bump it up) or bolusing (to knock it down). So, in an ideal world, you should wake up at about the same number you go to bed at with a nice flat line overnight. You can do some overnight basal testing to see if your basal dose is working for you - https://mysugr.com/basal-rate-testing/

You might also want to look into the freestyle libre, which would show you what your overnight blood sugars looked like, or a CGM, which would alarm if your blood sugar dropped under a certain level. These would have to be self funded, but might allow mum a bit more sleep.

We are more concerned since I am going back to chool on Tuesday. My mam is really tierd and she can only sleep when I am at my dad's or my siblings dad. We have looked at what could help with such as a pump but with me not having a spleen nothing would work. I will see what they say tomorrow. Thank you x

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[catapillar]

You don't need a pump to use a cgm, they are completely separate.

I can't see any reason why not having a spleen would mean you can't use an insulin pump.

 

[donnellysdogs]

A libre - you would scan your arm or mum scan during the night and it last two weeks. To get a reading the sensor has to be scanned. It must bescanned at least once every 8 hours and it gives a nice graph of what has happened to your bloods.

A cgm can read your readings all the tine and can send the readings to a phone. Depending what type of cgm you hae depends on how many people you can let view your readings. I can view mine, and also my hospital at any time of day or night.
It does not need the sensor to be scanned to get a reading. Ie you could be in bedroom and mum in hers and she could set alarms for going high or low to alarm to her phone.

The only thing is that the vast majority of people have to pay for both types.

The libre can normally be trialled for two weeks through your hospital.

It is worth asking your DSN about.

I'm not sure why removal of your spleen should be stated as a reason for not having a pump. The only difference with a pump is that a very tiny plastic or steel needle stays in you with a pump feeding you insulin throughout the day. The needles dont hurt at all.

I hope you can ask about learning to lower your basal dose...