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How to keep tighter BG control on Insulin?

Discussion in 'Type 1 Diabetes' started by thetallerpaul, Apr 14, 2012.

  1. thetallerpaul

    thetallerpaul · Well-Known Member

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    Hello all,

    Just a quick q having been speaking to some of the Type 2's on here. They seem to be working to much lower BG's than I'm expecting to and was wondering is there anything a Type 1 can do to be better in control of their BG's?

    Thanks

    Paul
     
  2. ebony321

    ebony321 · Well-Known Member

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    Hi,

    Depends on the T2 really and what sort of treatment they are using. If they are diet controlled or take medication that does not put them at risk of hypoglycaemia then they are often able to aim for lower blood glucose levels.

    Type 1's, Type 2's on insulin or medication that can lower blood glucose into Hypo territory (3.9mmol and under) it isn't as acheiveable. Not saying it can't be done but there are more risks involved.

    Strictly speaking towards Type 1 diabetes personally in my opinion to be able to gain better control you need to;

    Be able to carb count and effectively adjust your insulin dose according to how many carbohydrates you are eating. If you aren't eating carbs but still have protein this can also effect your blood glucose as the body can turn protein into glucose also. The amount of fat you eat within your meal can affect the rate in which your body proccesses the carbs into glucose which can delay the absorption of carbs giving you a spike in BG much later on.

    Be aware of how exerise affects your body and BG's, strenuous exercise and mild exercise can affect it differently. Sometimes your BG's can rise during and after but will return to a reasonable level afterward or it can rise and require a correction or it can drop and require treatment. This varies from person to person so the only way to know how YOU are affected is to experiment, have your meter at the ready and of course always make sure hypo treatment is close by!

    Sickness - Learn how your body reacts to illness, colds, infections, pain and medications. These and more can affect your BG also, many people find they require more insulin when fighting infection. Sometimes people know they are going to fall ill because they find their BG's creeping up then low and behold the sniffles arrive! :lol: If you are going on a carb counting course such as DAFNE it should teach you how to adjust your insulin due to illness and prevent those nasty ketones from sneaking up on you if you are poorly and your BG's start to rise. Also check the label on any new medications, this will tell you if you need to check with your pharmacist if you are fine to take them with having diabetes.

    Testing - probably the second most important tool after insulin for a type 1. Testing testing and more testing is key to good control. Know where you BG is at and you can learn your body far quicker and better. I test alot because i use an insulin pump anywhere from 6-15+.. i would recommend at LEAST testing for the following;

    Waking up - this will indicate when teamed with your bedtime reading how your BG's have done in the night. You should go to bed and wake up with roughly the same BG, i personally would start testing during the night if i had more than a 2mmol difference between the two, just to make sure i'm not rising or going low in the night.

    Before meals - this is a given one, know what you are before eating so if a correction is required you can dose accordingly, if your BG is low you can either treat immediatly or dose lower than normal to allow the carbs in your meal to bring you up to a suitable BG.

    After meals - this one for me isn't a nessecary, i will test 2 hours after meals if i've had a large carby meal or a meal that i know has alot of fat content to check how my insulin is doing at preventing spikes or dips. I always always check after pizza because i have to run my bolus for 4 hours with my pump because the carbs are very complex so takes longer to process. Alot of T2's will test 2 hours after meals if they are diet only or on meds when they experiment with new foods to make sure their BG's are returning to a suitable level.

    Before bed - As explained in the waking test you want to make sure your going to bed with a good BG to keep you steady through the night. I will eat something if my BG is lower than 5.5mmol. Only a small snack to prevent me going low. Good control isn't just about preventing the highs, you gotta keep away from the hypos too!

    Testing inbetween for me is if; i feel poorly, before/during and after exercise, if i suspect my BG is low. I also occasionally test during the night to ensure my basal insulin is still accurate while i'm meant to be in dreamland! :)

    Keep a diary - Keeping a diary for me is the only way i know if i'm having high or lows that are caused by the wrong dose of insulin, patterns in your BG's that indicate you always go low after dinner so your bolus is too high for example. Over time you will learn to read them and spot where you could use a small tweak here and there. Knowing how to adjust your insulin according to your results is something you will also learn to do on courses such as DAFNE and is an invaluable skill to have!

    Injections - been 14 months for me since i was injections but i still remember them like they were yesterday! Ensure you rotate your injection sites well, use an appropriate needle length for your size and change your needle EVERY time. Any redness, soreness sign of infection see a DR asap. They will probably give you some antibiotics to help things heal. If you don't look after your injection sites the absorption can be affected which can affect your control, so look after them well and they'll look after you :)

    Just realised how long this post is! my my! i hope this helps, i see form your signature you are not long diagnosed so some of this may be new and some you may be sick of hearing :lol: One thing i would recommend is don't compare your control to other peoples, no matter what type they are. Diabetes is controlled on a one to one basis, we are all so different. What some people acheive with ease others spend a long time to acheive. Effort, knowledge and determination will help you gain good control of your diabetes. I've been on the learning curve for over 3 years now and i'm still not anywhere near the straight so don't worry, take your time and you'll get there :)
     
  3. phoenix

    phoenix Type 1 · Expert

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    Paul,
    When you use external insulin to control your glucose you don't have an on/off switch.. not even with a pump. (though some people seem to be under the impression that you do)
    Rapid insulin doesn't start immediately and it has a tail. If blood glucose levels are back to normal or lowish at 2 hours they will tend to fall further during the next 2 hours.
    Basal insulin is also imprecise. People release glucose from the liver throughout the day but the amount varies. Basal insulins like levimir and lantus have flattish profiles and work well but they can't react to the ups and downs of glucose released. If you decide to go to the gym or a long walk you may have too much insulin in the body and end up hypo. Conversely stress or illness may raise the amount of glucose released and you then don't have enough background insulin to deal with it. Some peoples liver delivers very little glucose during the night and if they go to bed too low they will have a nocturnal hypo (sometimes unrecognised)

    How much insulin of your own you have may make a difference.
    Two thirds of the Joslin 50 year medalists have some insulin production of their own. The DCCT found that most people who were diagnosed as adults still had some insulin of their own and recently the Faustman lab seemed to confirm this. This can help keep basal levels more stable and perhaps help lower post prandial spikes but it can sometimes seem to be unpredictable. I think that on the whole it helps. I suspect that amount in people diagnosed as adults may be more than some of those diagnosed as children.

    T1s who have had the condition for some time also seem to lose some function (maybe signals) from the alpha cells which stimulate the release of glucagon/glucose from the liver. This is one reason that avoiding hypos may become very important; hence doctors and some people with D being frightened of keeping lower levels.
    T1s who were diagnosed as children may have had poorer control during adolescence; hormones, peer pressure etc This can lead to earlier complications including autonomic ones leading to things like delayed stomach emptying(gastroparesis). This complication occurs in according to some sources a third of T1s. This obviously makes insulin dosing even more difficult.


    My own levels are far less variable when I live a very regular life; meals at the same time, similar amounts and types of foods so I know how to bolus, exercise planned and done regularly (that makes a lot of difference; I need far more insulin if I become 'lazy for a while).

    Life however isn't always like that . Sometimes you want to be more flexible, other times things happen that are out of your control and you have to delay meals, rush around from here to there, sit in cars or planes for hours.... you know. (one of my highest levels in 7 years occurred when we drove home during a snow storm.(70km on snow chains)

    It is possible for some of us to have a lowish HbA1c. I had one that was too low (4.9%) I ran my levels too low overall and I was beginning to lose hypo awareness. I now have an HbA1c in the high fives, it is higher because I can now switch off some of the insulin during exercise, that's if I plan things correctly (using a pump) . My Hba1c is still too low according to my doctor (ie he still feels I'm at risk of dangerous hypos)

    The good news is that people who survive without complications do not necessarily have very low HbA1cs . |Three studies (that I know of), in the US, in the UK and in France all found that these people who had survivied long term(ie 50y+) without complications had an average HbA1c of around 7.2%
     
  4. noblehead

    noblehead Type 1 · Guru
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    Good posts ebony and Phoenix :thumbup:
     
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