Glucose rising mystery

I have never followed the regime you mention so can't offer much advice: I was happy to use MDI and inject every time I ate because my life is not predictable - I don't know what I will eat, when I will eat it and how much exercise I will do in between.

However, I notice you mention the difficulty with "clean up, test BG during working hours." This suggests to me (forgive me if I am wrong) that you do not test during the day and your good control is based on hB1AC and the tests you do at other times of the day.
Based on this assumption (which may be wrong), I wonder if it would benefit you to have a Libre as a one-off to understand what is happening to your BG between tests. You may be fine. Or it may be an eye-opener to unexpected highs or lows which could make you rethink how you would like to control your BG and what changes you may want to make when forced to do so when your current vials become unavailable.

iReloaded said:

I have asked about getting a flash glucose monitoring system and have been informed this is again not possible due to NHS constraints.

I do agree that it would be beneficial to see what my BG is during the day as I am sure there are some highs and lows throughout my day that I would like to know more about. A flash monitor would make it a heck of a lot easier as I would not have to clean up to check the BG, however I would require an extremely rugged, water, oil and gas tight component to do the measuring, all be it this would be my issue to find and not the NHS and considering I have several components used throughout my daily working life that conform to these requirements I am sure I could find, or have custom made a device or casing for a device suitable for these needs

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If you have a Libre, the BG results are stored on the sensor for 8 hours so you only need to “flash” the sensor every 8 hours (or less if you don’t mind missing some results: it would be better than the knowledge you have today). This could mean you do not need your reader during work to see what has been happening.

There are watertight ways to cover the sensor which may also exclude gas and oil. You could try tegaderm. I use a waterproof sport tape (it appeared on one of the Lidl weekly events) which works well. I presume you wear extra protective suiting to protect yourself from water oil and gas too? The advantage of the libre is that you can take a reading through layers of waterproofing and clothing so if you clean your hands for any meal/hydration breaks then you could do it then.
If your employer is a uk one then your ‘reasonable’ need for bs checking would come under the Equality Act and DDA.

iReloaded said:

Hi all, shame this is my first post but hey ho.

So I've had T1D for 12 and a bit years now and always been on 2 injections per day of Humulin and Humalog mix, mixing both in a syringe to accommodate for the daily tasks and food intake. For the past 12 years this has worked perfectly and I have never had a Hba1c over 9 (over 7 if you take away my first ever one) with only one hypo in these 12 years. So from this I hope you deduce that I do have good control and am aware of what I am doing when mixing the insulins.

My issue has arisen in the past 2-3 months, my blood glucose levels simply do not want to stay level no matter what I am changing. An increase in the insulin does bring my BG down but then sometimes I have a BG of approx 4 before bed, have a kikkat and bang its like 20 in the morning. Previously having just a kikkat prior to bed with a BG of 4 would result in a certain low during the night.

I wondered if anyone else has had a similar issue to this or if anyone knows of a solution to these issues?

I point blank refuse to go to the 4 injections a day routine with novorapid or the likes as my work life simply does not allow for time to go clean up, test BG during working hours and then inject myself, plus the hospital have told me I would need to inject every time I ate a "substantial amount" and that would be approx 6-8 times a day. They have also said I do not meet the requirements for an insulin pump as my Hba1c is so low, it would need to raise to above 16 mmol for circa 12 months for them to even consider it. I have not however asked about if I were to purchase the pump and then be prescribed the consumables on the NHS.

I am also aware that they are planning to cease production of my medication in the vials I am currently issued it in, so if I must change (which it seems I do) then I would like to find the right solution for my problem so that I can have another 12 years trouble free with my T1D

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It sounds like dawn phenomenon and that your Humulin is peaking too early, leaving you with not enough basal insulin when your DP kicks in. Would you consider taking a shot of Humulin at night or a different basal insulin such as Levemir at night? Levemir lasts 10-12 hours on small doses, so you could take it at night just to cover you during sleep and then continue your usual routine during the day.

iReloaded said:

I have not however asked about if I were to purchase the pump and then be prescribed the consumables on the NHS

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A pump would save you from having to pull out a pen or syringe multiple times a day, but not from testing. If anything you have to test more often with a pump to make sure there is no interruption in your basal delivery which could result in quick DKA.

One thing I have really learned on my DAFNE course this week is the importance of regular testing and carb counting. Pretty much get these right and your control will be spot on.

I appreciate your circumstances may limit your ability to do this but testing is sooooo important either by traditional methods or Libre

iReloaded said:

I assume the libre would not react well to liquid?

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Libre is waterproof.
Not sure how it reacts to various chemicals but the sensor is under the skin so wouldn't be affected. It is only the transmitter that you can see on, for example, Theresa May's arm.

iReloaded said:

my work life simply does not allow for time to go clean up, test BG during working hours and then inject myself......................every time I ate a "substantial amount" and that would be approx 6-8 times a day.

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Welcome to the forum, please don't take this first bit harshly ................

I've no idea what you do as a job but it sounds messy!* You say you won't go on MDI due to time to clean up, test, jab and eat, yet you currently have time to eat 6-8 times a day, presumably mostly during work..........when it sounds like you'd have to 'clean up' to eat anyway? A test and a jab is what? 60 seconds if that.

I guess from your posts you probably don't test BG that much during the day either (but your hba1cs are pretty good so you must be doing something well), but would add another 'vote' for using the Libre even just as a one of - your clinic may be doing a free trial, worth asking!

*really intrigued, and all I can think of is a sewer inspector?!

I have to confess to being really intrigued as to what you do for a job too

That sounds so interesting to a science nerd like me. Perhaps a pump might be a good alternative to injecting?

Mel dCP said:

That sounds so interesting to a science nerd like me. Perhaps a pump might be a good alternative to injecting?

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He did however says

They have also said I do not meet the requirements for an insulin pump as my Hba1c is so low

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So I'm guessing that probably isn't an option
Unless they can be persuaded that given his job it is necessary - but I don't know if stuff like that is ever taken into consideration.

Rokaab said:

Unless they can be persuaded that given his job it is necessary

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I'm not having any luck on that front, but I think @Juicyj may have had some success with that argument?

Rokaab said:

He did however says

So I'm guessing that probably isn't an option
Unless they can be persuaded that given his job it is necessary - but I don't know if stuff like that is ever taken into consideration.

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Aye, I didn’t miss that bit, but I wonder if his employer (assuming he’s not self employed) would help with that, under the Equalities Act 2010 they have to make “reasonable adjustments” and that would certainly be a reasonable adjustment given the problems with injecting while on the job. A CGM and remote controlled pump would mean he could manage his diabetes without having to perforate himself while working. Worth asking about!

Hi @iReloaded

Firstly the Libre reader is not waterproof and you have to take care with the reader to not expose it to moisture, the sensor is more robust however and can be covered with tegaderm if there's any concern with over-exposure to water or potential for catching it.

A pump is a viable solution - however a couple of things, are there magnets in the environment you work in as these will affect the pump, also you will need to do a Dose Adjustment for Normal Eating course (5 day course) to ensure you understand carb counting, handling illness etc etc. When I was assigned a pump there was another guy who worked on roofs and was suffering uncontrolled BG levels as he refused to test/inject whilst at work due to the nature of what he did and that he didn't want hypos whilst being up on a roof, I am not sure of his grounds in getting access to the pump, however you can argue regarding 'this affects your quality of life' and your ability to work safely in your line of work.

The Medtronic 640g works with a CGM system called 'smartguard' which allows the pump to turn off insulin supply if you drop below a preset level and the same again for if you go high as it will increase the bolus supply, it only uses a quick acting insulin which is split between a basal supply and bolus supply, and the basal can be adjusted based on activity levels, however if there is a blockage or the cannula breaks free and there's no insulin supply then there is the potential for DKA which can come on quickly, the pump has an alarm but if you're wearing protective clothing for work or working in a noisy environment then it would be difficult to hear this. The pump can be funded by the NHS however the CGM would have to be self funded, unless there are unusual circumstances such as lack of hypo awareness which would necessitate the need for using it. However what's important with using a pump is being able to do frequent BG tests, as there would be alot of adjusting of ratios in the first month of using it, it's not a one size fits all solution and requires careful monitoring.