Is routine key?

[Maco]

Something I’ve started noticing since going back onto a pump in January & having my CGM fitted is that routine seems to be a massive key player in the fight for tight control. I’ll give a few examples of what I’m noticing.

When I first started the pump, every time I went to the gym & did weight training my BG would spike massively. Usually to atleast 15/16mmol, but the longer I’ve had the 780G fitted and the longer it’s adjusted to my body these spikes don’t happen anymore at all.

Now when it comes to food, I usually sit down Sunday night & plan my diet for the week ahead. What foods, what weights & what snacks to meet my macros for the gym. For the last 10 nights each meal was the same & my time in target range had stayed at 100% for the full 10 days. Easily the most time I’d ever spent in target. Anyway on Sunday gone I decided to swap up a few of the carb & protein sources, for example sweet potato instead of white potato for evening meal & salmon instead of mince or tuna. Breakfast continued the same & for lunch I kept to my usual 200g of rice but again swapped mince for chicken.

All meals are weighed out, so I know exactly how many carbs/fats are present & exactly how much insulin to take. I started this new diet yesterday & my insulin resistance just seems to of gone crazy, waking up at 5/6mmol. After breakfast shooting up at 10/11 which is high for me lately & no matter how much corrective insulin I give it doesn’t budge for a good 4/5hrs. With lunch it seems perfectly fine like it’s been other weeks, then again with the evening meal 6/7mmol before & raising to 10/11 after the meal & running at that level until 3/4am.

To me it’s as if I’ve changed a routine & my body is taking time to adjust to it, anyone else had anything like this?

 

[ert]

You could start by meal skipping to test your basal. My basal requirements change often.
I can tolerate fewer carbs for my first meal of the day. For you: could you try cutting the carbs in your breakfast and dinner and eating more at lunchtime?

 

[Maco]

You could start by meal skipping to test your basal. My basal requirements change often.
I can tolerate fewer carbs for my first meal of the day. For you: could you try cutting the carbs in your breakfast and dinner and eating more at lunchtime?

I’m on the 780G so the pump controls my basal. Breakfast & dinner are my lowest carb meals, both 40Gs & dinner 70G. What’s weird is the carb amounts have always been the same just this week I’ve changed the sources

 

[In Response]

Routine may help with diabetes but routine does not suit my life.
I do not want to put my life on hold (apart from for pandemics) or follow the same routine and plan my meals weeks ahead.
So, to manage my life rather than just diabetes, I go for balance and don’t strive for perfection.

 

[Maco]

Routine may help with diabetes but routine does not suit my life.
I do not want to put my life on hold (apart from for pandemics) or follow the same routine and plan my meals weeks ahead.
So, to manage my life rather than just diabetes, I go for balance and don’t strive for perfection.

The diet isn’t for my diabetes, it’s for my gym lifestyle to support my goals in the gym. Trust me if I wasn’t at the gym I’d eat what I wanted when I wanted but unfortunately I’m addicted to training & wanting to look good.

 

[adheco]

Something I’ve started noticing since going back onto a pump in January & having my CGM fitted is that routine seems to be a massive key player in the fight for tight control. I’ll give a few examples of what I’m noticing.

When I first started the pump, every time I went to the gym & did weight training my BG would spike massively. Usually to atleast 15/16mmol, but the longer I’ve had the 780G fitted and the longer it’s adjusted to my body these spikes don’t happen anymore at all.

Now when it comes to food, I usually sit down Sunday night & plan my diet for the week ahead. What foods, what weights & what snacks to meet my macros for the gym. For the last 10 nights each meal was the same & my time in target range had stayed at 100% for the full 10 days. Easily the most time I’d ever spent in target. Anyway on Sunday gone I decided to swap up a few of the carb & protein sources, for example sweet potato instead of white potato for evening meal & salmon instead of mince or tuna. Breakfast continued the same & for lunch I kept to my usual 200g of rice but again swapped mince for chicken.

All meals are weighed out, so I know exactly how many carbs/fats are present & exactly how much insulin to take. I started this new diet yesterday & my insulin resistance just seems to of gone crazy, waking up at 5/6mmol. After breakfast shooting up at 10/11 which is high for me lately & no matter how much corrective insulin I give it doesn’t budge for a good 4/5hrs. With lunch it seems perfectly fine like it’s been other weeks, then again with the evening meal 6/7mmol before & raising to 10/11 after the meal & running at that level until 3/4am.

To me it’s as if I’ve changed a routine & my body is taking time to adjust to it, anyone else had anything like this?

 

[adheco]

You touch on an old problem Maco that in my experience is making the necessary mental adjustment to a long-term condition such as diabetes. After 71 years as a Type 1 that aspect is the one I meet most often when lecturing to health professionals or others with the same condition. The problem it seems to me is that diabetes offers little in the way of options and is entirely unforgiving. When I was diagnosed in 1950 any form of exercise was out of the question. Even getting back to school was difficult. No one was prepared to take responsibility for a sickly, weak boy. It wasn't until my late teens that I got a bike and starting racing without my parents' knowledge. All that came to an end after a serious accident when diabetes showed its unremitting side, so until the first lockdown I attended spinning classes twice a week. I have no meaningful diabetic complications for one reason in my opinion. And that is consistency. I have just about the same number of carbohydrates, 95 daily, as I started out with and I eat at roughly the same times each day using the same insulin doses I have taken for decades. I am fully aware that diabetes is the most powerful influence in my life and has to be observed constantly. That is not to disregard the fact that I have been cared for with help, advice and compassion by medical professionals at the Royal Free Hospital for all of my diabetic life and by family members who fully understand the prospective ravages of uncontrolled diabetes. There is also a social dimension to diabetes. I was told by my consultant recently that if a person in a hypoglycaemic coma is taken to the Royal Free Hospital by ambulance, spends a couple of hours in A&E being straightened out and goes home by ambulance, that will cost the hospital upwards of four thousand pounds. I fully appreciate that life is so different today and that the need to appear just so is very important but in my experience diabetes come first at all times. All of us owe so much to those who have come before. For the first twenty years of my illness prescriptions were paid for at a shilling (5p) an item at a time when the average male workman earned not much more that £2 each week. I regularly needed twelve items, a big family-budget spend item each month. When I complained about blunt needles my father would resharpen them and they were used until finally they broke. The barrels and plungers of ancient syringes were strangers to each other long before most of the numbers were boiled away. A new syringe was big money. So I am immensely grateful for the great strides that have been made in diabetes care but the condition persists and my view is that it has to take a primary place in spite of the disarming recipes in some diabetes magazines and the huge array of tempting produced foods that invariably spell lasting problems. So good luck to you and you adherence to a full-on gym regime but remember diabetes must be given full attention. There's nothing better than being alive long past one's sell-by date.

 

[Maco]

You touch on an old problem Maco that in my experience is making the necessary mental adjustment to a long-term condition such as diabetes. After 71 years as a Type 1 that aspect is the one I meet most often when lecturing to health professionals or others with the same condition. The problem it seems to me is that diabetes offers little in the way of options and is entirely unforgiving. When I was diagnosed in 1950 any form of exercise was out of the question. Even getting back to school was difficult. No one was prepared to take responsibility for a sickly, weak boy. It wasn't until my late teens that I got a bike and starting racing without my parents' knowledge. All that came to an end after a serious accident when diabetes showed its unremitting side, so until the first lockdown I attended spinning classes twice a week. I have no meaningful diabetic complications for one reason in my opinion. And that is consistency. I have just about the same number of carbohydrates, 95 daily, as I started out with and I eat at roughly the same times each day using the same insulin doses I have taken for decades. I am fully aware that diabetes is the most powerful influence in my life and has to be observed constantly. That is not to disregard the fact that I have been cared for with help, advice and compassion by medical professionals at the Royal Free Hospital for all of my diabetic life and by family members who fully understand the prospective ravages of uncontrolled diabetes. There is also a social dimension to diabetes. I was told by my consultant recently that if a person in a hypoglycaemic coma is taken to the Royal Free Hospital by ambulance, spends a couple of hours in A&E being straightened out and goes home by ambulance, that will cost the hospital upwards of four thousand pounds. I fully appreciate that life is so different today and that the need to appear just so is very important but in my experience diabetes come first at all times. All of us owe so much to those who have come before. For the first twenty years of my illness prescriptions were paid for at a shilling (5p) an item at a time when the average male workman earned not much more that £2 each week. I regularly needed twelve items, a big family-budget spend item each month. When I complained about blunt needles my father would resharpen them and they were used until finally they broke. The barrels and plungers of ancient syringes were strangers to each other long before most of the numbers were boiled away. A new syringe was big money. So I am immensely grateful for the great strides that have been made in diabetes care but the condition persists and my view is that it has to take a primary place in spite of the disarming recipes in some diabetes magazines and the huge array of tempting produced foods that invariably spell lasting problems. So good luck to you and you adherence to a full-on gym regime but remember diabetes must be given full attention. There's nothing better than being alive long past one's sell-by date.

Hey, thanks for the reply. I massively agree with what you have said. Diabetes, especially type 1 has got to be the most complex disease out there. Just look at the affects something as simple as exercise or stress can have on your BG levels, something the average person doesn’t need to think twice about.
Routine is definitely key in my eyes, or being consistent long enough so that your body can adjust. I eat between 150-160g of carbs per day, spread out pretty evenly between meals. Anymore than that & my body seems to struggle. I think with diabetes you need to work out what works for you & what your body can handle.

 

[StewM]

I’d like this to be true and if it’s true for you just keep doing what you’re doing, but for me simply routinely eating the same food (and I mean the exact same food) and maintaining consistent routine levels of activity doesn’t prevent unforeseen outcomes in the slightest. I find the speed at which I absorb insulin varies massively from day to day and has a very pronounced effect on my overall control.

 

[Maco]

I’d like this to be true and if it’s true for you just keep doing what you’re doing, but for me simply routinely eating the same food (and I mean the exact same food) and maintaining consistent routine levels of activity doesn’t prevent unforeseen outcomes in the slightest. I find the speed at which I absorb insulin varies massively from day to day and has a very pronounced effect on my overall control.

I’ve had days like this, I literally eat the same food every day & each meal is weighed out exactly the same. I’ve had days when my BG has never gone above 5/6 eating these foods & then other days when I’ve ate my breakfast and a couple hours later my BG is 15/16mmol.

 

[Rokaab]

I’ve had days like this, I literally eat the same food every day & each meal is weighed out exactly the same. I’ve had days when my BG has never gone above 5/6 eating these foods & then other days when I’ve ate my breakfast and a couple hours later my BG is 15/16mmol.

Unfortunately I've come to the conclusion that the body is just a chaotic system and sometimes will just not behave and I have to accept this, all I can try and do is do the best I can and deal with the highs and lows when they unexpectedly turn up and not beat myself up about it.

With the newer tech it is now much easier to deal with but it can still just do weird stuff, I sometimes find that my carb ratio for dinner seems to change drastically (as in I need a lot less or I'll hypo a lot) for a week, or two, or three and then back to what it was, my basal rate seems to fluctuate (especially overnight- so much so that the auto-mode on my pump still has issues dealing with it.

In other words, do your best, but don't ever expect it to play fair.

 

[KK123]

I can see all sides here and in the end it's all down to a person's chosen lifestyle (not so much a choice as a necessity sometimes of course). I do think that once a body gets into a routine, whether that is the same exact exercise routine, or the same meals, or the same everything at the same time, it is happy to the point of laziness and won't do a thing more than it has to! Take exercise as an example, when you first start out you think you are dying and everything is aching, 6 weeks later it has no effect on your body and you have to do more to get the same aches. The body chooses the easiest route to anything (hence it grabs those carbs for energy because they're easy to use and only uses fats as a last resort if you force it to).

As to the question, I am sure routine does help to keep your levels steadier but honestly, I care not for routine, to me it equals boredom. Having said that I do make every effort to remain healthy outside of any routine, I adjust as I go along. I suspect @Maco, that it is your change of routine that is affecting you even though the amount of carbs are the same, like a domino effect, change one slight thing and a hundred others follow it! For example when you change your basal it can take a fair few days to kick in. I guess you could just wait and see if it settles down? I was told that trying to correct too often has the opposite effect, your body senses it's going to go lower than normal so goes into a panic and releases glucose from the liver! This flipping condition eh! x

 

[KK123]

Unfortunately I've come to the conclusion that the body is just a chaotic system and sometimes will just not behave and I have to accept this, all I can try and do is do the best I can and deal with the highs and lows when they unexpectedly turn up and not beat myself up about it.

With the newer tech it is now much easier to deal with but it can still just do weird stuff, I sometimes find that my carb ratio for dinner seems to change drastically (as in I need a lot less or I'll hypo a lot) for a week, or two, or three and then back to what it was, my basal rate seems to fluctuate (especially overnight- so much so that the auto-mode on my pump still has issues dealing with it.

In other words, do your best, but don't ever expect it to play fair.

Exactly!!!! When you think of how complex a 'normal' body can be and all of the hormones and things that work in tandem to keep it healthy, how on earth can WE try to emulate that by trying to mimic a pancreas. It's not possible to control it all to that extent so I too, settle for 'good enough'. x

 

[StewM]

Yeah, for me, the key is 'listening to what your body's telling you'. Which I know's a bit airy-fairy, but you can find the signs of slow insulin absorption before you start eating and just let yourself wait (if you have the time). Similarly, if your body's just not having it when you have a similar meal a few times, maybe change the meal.