Getting harder to control when maintaining a low BG.

[ImSpiritus]

Hello all,

Apologies for the long thread, but wanted to try and get as much info that could help.

Whilst I am type 3c I am treated as T1 and therefore thought I would ask here.

First though I have to say I am glad I sugar surf otherwise the amount of hypo's I could have had this past week would have seen me lying out cold on the floor.

All levels shown in mmol/l

Method
MDI Basal / Bolus
Libre

Current BG levels.
Maintaining around 5.2 - 5.4

Ratio
1:10

Problem
This past week my Breakfast ratios have been swinging between 1:9 and 1:12, this never used to be a problem when I was in the up half of my target zone (3.9 - 10) but since managing to maintain my BG in the lower half the difference in swings have seen me hit quite a few hypos. Luckily as I surf I can catch these quickly and I microcarb (e.g I react according to level, so if I am at 3.9 I would only eat half a jelly baby instead of scoffing 4, so bringing my levels up slowly but with a steady climb rather than it shoot up.)

A prime example of the problem I have is not knowing what my ratio will be for that meal because the amount of insulin for a ratio of 1:9 is a huge amount when it compared to 1:12 whilst maintaining a BG of 5.2

Breakfast contains 45g Carbs and as a creature of habit I have the same breakfast daily.

If BG is 5.2 at a ratio of 1:9 then I would normally have 5u (or 4.5 to be on the cautious side.)
If BG is 5.2 at a ratio of 1:12 then I would normally have 3.5

But, because I dont know my ratios as they are bouncing then if I was 1:9 but I went with 1:12 then the difference of that 1.5u if my starting BG is 5.2 would see my BG drop to 1.3 (Never gotten that far as I monitor fairly often once it reaches 5.0)

It was so much easier when my ratios were a consistent 1:10 but now I am managing at a lower level they are bouncing so much.

Question(s)
Other than my current self management by sugar surfing, is there any way I can steady out my ratios whilst maintaining current fasting BG or do I need to increase my fasting to a higher level until they do steady out again?

Since NICE guidelines are "Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or
lower, to minimise the risk of long-term vascular complications".

I am currently at 6.4% according to my last HbA1c with an expected A1c of 6% - 42 mmol on my next one if I now have to run higher due to my ratios going loopy then my HbA1c would look worse and since funding for the Libre is to improve or maintain good levels if they get worse could they stop funding me for the Libre?

 

[Muneeb]

There's a range of factors that affect the ratio, and I never get why people try and get into the gram level per unit of insulin, because its just not predictable enough to be that accurate. There could be a whole host of reasons why it occurs, maybe the late night meal was high in fat/protein, maybe basal insulin didn't act as it should have, maybe increased stress levels, exercise etc. The list goes on.

I have found that on the morning my ratio doesn't adjust, but rather I need a consistent 1.5-2 units extra on the morning, more likely to foot on the floor phenomena.

A low hba1c doesn't mean better control, I would be more worried about the SD/variation and the frequency of hypos/hypers.

I can keep the exact same routine and eat the exact same food, but some days just require more/less insulin. We can't have perfect management because the means we have for control are not perfect.

 

[ImSpiritus]

@Muneeb

"I never get why people try and get into the gram level per unit of insulin, because its just not predictable enough to be that accurate".

When your fairly newly diagnosed and all you have is Carb Counting and the courses you attend are all about Carb Counting then you should understand why. That is one of the reasons I have started sugar surfing, but that way of managing may not be for everyone.

 

[Fndwheelie]

I’m not type 1, but have you confirmed the libre readings? I tend to find it reads slightly lower then my finger pricks.most sensors I’ve used are 0.5-0.7 lower or up to 1mmol/l. I think libre are great to pick up trends, but not accurate enough to decide if you need half a jelly baby.

 

[ImSpiritus]

Hi @Fndwheelie,

I've always found the difference between my libre and fp even with the time delay has been no more than .6 difference. There was a difference when my BG was up and down faster than a roller coaster. But now generally steady. Time in target around 92%. My current issue is that when I was steady at 8/9 mmols my ratios were pretty consistent and that was any time of the day. Even when I had flu my BG remained steady. But since pushing it lower and i can have a consistent line of 5.2 to 5.5 meals vary but always steady up or down rarely out of target range but now ratios seem to be messed up.

Surgar surfing is about reacting and being proactive in your management that microcarbing and micro bolus (hard to do as on mdi and pen only does 0.5u). Each action can influence my BG.

Sugar Surfing for me has been great but I'm still new to having my tag along friend Mr D and trying things that can help me manage and I like to know the reasons behind things. We are all unique and 1 size definitely doesn't fit all, so I am of the mind that I have to get on with it and do the best I can.