Glucose Variability

Hi @billpearson,

Sounds you're having fun at the mo - taking this a bit at a time....

So the DAFNE course is brilliant - you've been counting carbs since the 80's but in that time the training and knowledge has altered hugely, you'll be amazed and delighted by what they can now tell you about how food works in the body and blood stream. I found (did DAFNE in 2006 (or 8)), was diagnosed in 1973 and learned a heck of a lot of new stuff.

This is essential to pumping (and now HCL where a brain 'semi-replaces' your pancreas - you need to tell it the carb amounts when eating, but anything else it works out and takes any of your work away - amazing stuff).

Ultrafast insulins - (I'd recommend you try Lyumjev if you need an ultrafast as it based on humalog) may help - however if you've spent years using your current insulin it might be as simple as site rotation to make it work better (I over-injected my legs and got huge resistance - I've since found new locations make it all work really well again).

The difference between Dex and Libre - Dex 1+ is the Dex G7 (with functionality turned off) Dex One is the G6 (with less functions in the software). My comparison between the 1+ and L2 is the 1+ is 'slightly' more accurate but not massively so if you struggle to get moved from L2 to 1+ its not that big a deal. The L2 is being removed from manufacture and replaced by L2+ (extra day but the same kit) in July this year (in the uk anyway) - so they will need to change that anyway.

I've found over the years the Diabetes teams (had many different ones as time goes by) can be a bit sweeping with changes to keep you safe - they don't want you dropping low (as that could be immediately life threatening) so might cut too much insulin, and work forward to get you at the right level. I implement recommendations cautiously and step down rather than big cuts - but thats my preference to manage changes slowly.

Does sound a bit like it might be insulin resistance - I'd honestly give injecting 'somewhere new' on your body a go and see if it changes how you react to the insulin - just be ready with lucozade in case it kicks in 'as expected' rather than what you have.

For the future - HCL (pumps and intelligence) are life changing - you only need the fast acting insulins (ultrafast works better as it responds to the changes faster than 'Fast' (like humalog) insulins - I went DIY as the HCL wasn't available to me when I started my changes (3 years now) and it works really well - I have a FCL (fully closed) where I don't do anything other than monitor and add insulin etc when the pump runs out ( I do need to tell it about pizza and difficult foods) and its like having my long-lost pancreas back - thats the next stage for the commercial systems, and you'll love it.

Hope that helps a bit

Hello @billpearson

With the greatest respect to your team - no one knows you better than you. Personally I would take any advice given with a pinch of salt and remembering that they don't live with this 24/7. Making such a drastic change in insulin doses isn't what i've been told, 2-3 units perhaps if the need really warranted it but not around a 44% reduction. I was also given the advice to change one thing at a time over a week to measure the result first before next adjustment. In regards to hypos and 24 hours, from an exercise point of view it's something I do factor in if I have an high intensity activity to keep levels slightly elevated but it's not something I would change my basal ratio for unless it was a repeat event with a pattern, so unsure if this is the case with you, but regardless such a big reduction will raise your BG levels.

I refer to glucose variation as 'time in range' and yes is important now as it was always considered that hypos can affect the HbA1c which isn't a wholly accurate guide for measurement,, my DSN is also keen to use this data, I know that I prefer to keep my range fairly tight and to try and avoid the swinging highs and lows but am using TIR as my guide now, despite keeping my TIR at around 80% my HbA1c is still 52 and has been for over a year now.

Personally I do not adjust my basal unless I do some fasting tests first to rule this out - it is the most important guide to managing insulin and is the starting point to look at before doing anything else.

Trust you gut Bill, do what you feel is right, after all it's our lives that are affected so it's vital we take full ownership.

Hi @billpearson we are now able to have a choice on Libre/Dexcom. It is in the guidelines. If you ask for it they cannot be awkward about prescribing.
Sounds like they are putting too many obstacles in your way.

Juicyj said:

With the greatest respect to your team

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I don't think your team deserves any respect whatsoever. You are being given the run around, you are being given irresponsible advice, I don't know whether you are perhaps being discriminated against because of your race, age, or how you come across; or whether the specialists at your clinic are just burnt out and have "quiet quit", or indeed if the comfort of being authority figures has gone to their head. But you are being given a poor excuse for medical care. Your doctors are not behind you.

billpearson said:

She told me that I shouldn't worry about HbA1C results and Glucose Variability is far more important.

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This is typical of how modern medicine is increasingly operating. Throw out common sense, find some pretext, some excuse; gaslight the patient. I've been through boatloads of this; I know the tactics and strategies. Lot of red flags in how the system is treating you.