Feeling out of control

[Brookemurph]

Hi all,
Been struggling with my type 1 a lot over the past week. I’m newly diagnosed and probably still honeymooning. I can’t seem to eat a meal of any size without shooting up high (above 10) within the hour and then I shoot back down just as quickly until I end up in the 3’s. It’s exhausting to be going low after every meal never mind if I want to exercise or drink some water in between. I’m carb counting at 1:10 and pre bolusing with 15 minutes but this is often making me go low before I even finish my meal.

Think I’m experiencing my first burn out and have no clue what I should be doing next. Any advice?

 

[Antje77]

I shoot back down just as quickly until I end up in the 3’s. It’s exhausting to be going low after every meal never mind if I want to exercise or drink some water in between. I’m carb counting at 1:10 and pre bolusing with 15 minutes but this is often making me go low before I even finish my meal.

The 1:10 ratio is just a starting point from where to find your personal ratios.
Have you contacted your diabetes nurse or consultant on adjusting your ratios?

 

[Brookemurph]

The 1:10 ratio is just a starting point from where to find your personal ratios.
Have you contacted your diabetes nurse or consultant on adjusting your ratios?

I wasn’t sure how to get an appointment but I was planning to call them tomorrow. I’ve been carb counting for a while now but this issue is quite recent, can they change just like that?

 

[EllieM]

I wasn’t sure how to get an appointment but I was planning to call them tomorrow. I’ve been carb counting for a while now but this issue is quite recent, can they change just like that?

Yes they can: eg illness, stress, exercise, weather (some T1s joke that the colour socks they wear in the morning can have an effect).
In your case, as you're in honeymoon, you've got the added factor that your pancreas is possibly throwing out random amounts of insulin in order to help. I would recommend that you keep in close contact with your team while you get the hang of things.

But usually the first thing to get right is your basal dose, are your levels in the morning simular to your ones at night? (That's assuming you are on a basal/bolus regime.)

 

[Antje77]

I wasn’t sure how to get an appointment but I was planning to call them tomorrow. I’ve been carb counting for a while now but this issue is quite recent, can they change just like that?

Yes, the amount of insulin you need isn't static at all!
Especially eaurly in diagnosis we often have a pancreas that does some spluttering, producing insulin in an unpredictable way. For some this means they need very little insulin for a while after initial higher doses. It's called the honeymoon period, and for some it's a blessing, their pancreas helping them keep them more stable, while for others it's a pain in the backside because their pancreas just acts drunk.

Apart from that, many of us don't have the same ratios throughout the day. Fot instance, I need significantly more insulin for the same food in the morning than in the evening.

I wasn’t sure how to get an appointment

If you're newly diagnosed, they should be guiding you, preferably with a diabetic nurse on call, and having regular contact with them through phone or email.

 

[Brookemurph]

Yes they can: eg illness, stress, exercise, weather (some T1s joke that the colour socks they wear in the morning can have an effect).
In your case, as you're in honeymoon, you've got the added factor that your pancreas is possibly throwing out random amounts of insulin in order to help. I would recommend that you keep in close contact with your team while you get the hang of things.

But usually the first thing to get right is your basal dose, are your levels in the morning simular to your ones at night? (That's assuming you are on a basal/bolus regime.)

yeah I’ve had my basal changed a few times and my dietician recently said it looks good. As soon as I start eating for the day I start to lose any kind of balance really

 

[Antje77]

As soon as I start eating for the day I start to lose any kind of balance really

What kind of numbers do you see?

I’ve had my basal changed a few times

You can discuss you bolus doses with the same person who changed your basal.

 

[Brookemurph]

What kind of numbers do you see?

You can discuss you bolus doses with the same person who changed your basal.

I spoke to my nurse this morning who didn’t help at all and only told me to contact my dietician. But I can’t get an appointment till May! This is what my days are looking like atm which mare significantly worse since I started carb counting.

 

[Antje77]

I spoke to my nurse this morning who didn’t help at all and only told me to contact my dietician. But I can’t get an appointment till May! This is what my days are looking like atm which mare significantly worse since I started carb counting.

Those are the graphs of a very well managed T1!
Can it be your expectations are a bit on the high side?
The usual standard goals for a T1 are to spend >70% of their time in range, between 4 and 10 with less then 25% above 10 and less than 4% below 3.9. Your TIR is way higher than that goal, well done!

What I see in your graphs is some sharp spikes, I guess after food, which come down again nicely. Although sometimes they drop a bit too much, which may mean your dose was just a tad too high.

 

[becca59]

@Brookemurph pre Libre/Dexcom we would not see our sugar fluctuations in real time. We were advised to blood glucose test 4-6 times daily only. Now we see what is happening on a second by second basis. It is unrealistic that we will not have peaks and troughs, trouble is we now see them and panic that we are not doing well. When we shouldn’t. As @Antje77 says, you are actually doing very well. Look at TIR and give yourself a pat on the back.

 

[Juicyj]

Completely agree with @Antje77 and @becca59 it's not where your BG levels are going it's where they land that's the focus, so 3-4 hours after eating, try to ignore the spikes, non diabetics get them and spikes at this level isn't an issue, the priority is avoiding the hypos which we generally get due to an insulin/carb miscalculation.

It's easy to get wrapped up in targets and we can set ourselves up for lots of stress when we over think it, it sounds like your doing great so try not to give yourself such a hard time.

 

[Brookemurph]

Thank you everyone. It’s just been so exhausting and I’m on my third low of the day today. I think adjusting my ratio is the way to go

 

[RoughcutAU]

From my limited experience I believe you are doing well. Not having a flash/cgm and only being diagnosed last year all I have to go on is fingerpricks. Sounds like it might be a blessing in disguise.

 

[StewM]

Is it only after Meals you're going Low? If so, like you say reducing your Bolus: Carb ratio should fix the problem. If you're getting Lows at other times, you might have to look at your Basal.

 

[Ipodlistener]

Thank you everyone. It’s just been so exhausting and I’m on my third low of the day today. I think adjusting my ratio is the way to go

Hey Brooke! I joined the gang in November. So I'm just like you. Getting the basal is key. Was on 14 units on discharge now 3 when I'm working. Which let's me bolus 1:15 ratio. Or 5 units of basal on rest days. My diabetes nurse got me to reduce my basal by 2 units at a time till I got to 10. Then 1 at a time till you find the sweet spot. I also set my Libre 2 alarms at 5.6 when at work to catch a low before it happens. I'm a postman so very active. Good luck you can do this!

 

[Ipodlistener]

Thank you everyone. It’s just been so exhausting and I’m on my third low of the day today. I think adjusting my ratio is the way to go

Before getting the basal right. I was just guessing at how much to bolus. Sometimes it'd be right. Sometimes not. However at some point it's all gonna need to change again. Lol