only high or low, no middle

[nevenaves]

I was diagnosed with type1 diabetes when I turned 40 (now I am 44). Nobody in my family has/had it. At first, I was told my pancreas was still active and I was taking very small doses. Then a very stressful 3 years came, I didn't take care as much as in beginning and I increased my doses (life happen and it took me a while to learn to put my diabetic needs before everything else). Recently my body stopped reacting to Lantus. So, since NY I am using tresiba. I started with 18 units, now I am taking 12 units every evening at 22h. For the last 3 weeks, I have been having hypos at least 10 times a week. Sometimes even 3 times a day, and the worse of all, I don't even feel them coming. At first, I thought that it is because I changed my exercise regime, but for the last 2 days I haven't been exercising at all and I had 4 hypos. I became very insecure when I am taking my lunch dose of Novorapid (for breakfast and dinner ratio is 1:12, but for lunch is 1:6) as from day to my body reacts differently to the same amount of carbs. I've been told that finding the right dose is a trial and error process, but these errors are freaking me out. I live in Malta. So, I don't have access to Libra sensors via my social security and I usually order them from UK when I go on a vacation. Do you have any advice for me? They are all very welcome. Thank you.

 

[boggle]

You could look at possibly reducing the carbohydrates in your meals. You might then be able to lower the amount of insulin and reduce the peaks and troughs.

If you are still experiencing a high amount of stress, try and take some action to reduce this. If you want to share more details maybe we can help with this.

Good luck

 

[boggle]

I'm not a type 1, but you might want to consider lowering your basal dose.

 

[EllieM]

For the last 3 weeks, I have been having hypos at least 10 times a week. Sometimes even 3 times a day, and the worse of all, I don't even feel them coming.

Sounds like you may need to reduce your insulin, that is too many hypos. Are you able to discuss this with your diabetic team? Basal is usually the first thing to check out (look up basal testing), but as tresiba is very long acting any changes will take a while to take effect.

I've lost hypo awareness in the past when I had too many hypos and when I lost it 3 years ago my consultant told me to aim to keep my blood sugars above 6 for a while. That worked for me and I now have awareness back but I am also lucky enough to be able to afford to self fund a dexcom, which warns me before I go hypo and makes me feel a lot safer at night. Do you live alone or with family/friends? Hypos are easier to manage if you live with people who can look out for you if you go badly hypo...

 

[In Response]

In addition to reducing your insulin as @EllieM mentioned, I wonder if you are over treating hypos if you are then going too high.
The usual advice is 15g fast acting carbs then when your levels have risen above 4.0 eat 15g slower acting carbs but I found this was too much for me so reduced it. Again, this takes some trial and error.

As someone with Type 1 with the tools to manage carbs (insulin), I chose to learn how to use those tools rather than go low carb. In fact, I found low crab harder work as I need to bolus for protein at different ratios for different types of protein. However, I do find very carby meals more challenging to bolus for. So, I do not avoid sandwiches but I rarely have doorstep sourdough toasties.

My other thought @nevenaves is whether you have tried splitting your bolus. More carby or more fatty meal can take longer to be absorbed so our body needs the bolus later. Classic examples are pizza and curry but you may find it is true for a bread based lunch. Again trial and error will show you what works for you but as a starter, you could try halfing your insulin and taking the first half at your usual time and the second half an hour later.

 

[sgm14]

Talk to your endo/doctor.

When I first went on insulin, I had a lot of highs and lows and my endo told me that I should stop worrying so much about the highs and concentrate on getting rid of the lows first. He also said that I would probably find that I don't have so many highs when I had the lows sorted. Once I had the lows sorted, he said I could then move on to try to sort out the highs.

One of the problems I found, was that the advice I was given to treat a low was to take 20 fast acting carbs and then 20 slower acting carbs (if I was not due to eat a meal soon). But this was usually way, way too much. For example, the last time I took 15 carbs my blood sugar rose from 3.4 to over 15.

So because I was trying to avoid going high after lows, I was trying to treat them (or avoid them) with a lot less. Sometimes this worked, but quite often I would find a temporary rise, only for my BS to start failing resulting in another low. Hence I got lots of days with multiple lows.

When I stopped trying to avoid the highs so much, I was able to treat the lows better and so avoided the multiple lows per day scenario and also I was better able to avoid the lows.

But I'm Type 2 on insulin, so I am not sure if this advice applies to everyone.

 

[NicoleC1971]

I was diagnosed with type1 diabetes when I turned 40 (now I am 44). Nobody in my family has/had it. At first, I was told my pancreas was still active and I was taking very small doses. Then a very stressful 3 years came, I didn't take care as much as in beginning and I increased my doses (life happen and it took me a while to learn to put my diabetic needs before everything else). Recently my body stopped reacting to Lantus. So, since NY I am using tresiba. I started with 18 units, now I am taking 12 units every evening at 22h. For the last 3 weeks, I have been having hypos at least 10 times a week. Sometimes even 3 times a day, and the worse of all, I don't even feel them coming. At first, I thought that it is because I changed my exercise regime, but for the last 2 days I haven't been exercising at all and I had 4 hypos. I became very insecure when I am taking my lunch dose of Novorapid (for breakfast and dinner ratio is 1:12, but for lunch is 1:6) as from day to my body reacts differently to the same amount of carbs. I've been told that finding the right dose is a trial and error process, but these errors are freaking me out. I live in Malta. So, I don't have access to Libra sensors via my social security and I usually order them from UK when I go on a vacation. Do you have any advice for me? They are all very welcome. Thank you.

Hello. I think all type 1s feel for you as managing the hypo/hyper rollercoaster does feel like an art even if it is a science.
My advice would be to get hold of the FSL 2 when you are next in the UK and then do a zero carbs basal testing day just to see how your basal is working across a typical 24 hour period. Be safe and have the hypo supplies ready or pitch the basal test rate at a lower level.
I know that there are other variables (illness, exercise, pmt, stress and coming out of your honeymoon period) but having a reliable basal rate is the normal starting point.
I'd agree with the other poster suggesting low carbs as way to help smooth out dosing errors. I do it because I am lazy and want to eat real food without having to weigh out the carbs or scan a barcode. I exercise quite a lot and tweak any bolus I am taking (I still need a little for protein) to allow for that e.g. in the meal before the exercise.
The goal of your diabetes team should be to get your blood sugars more 'time in range' not just having a good hba1c and I think having this many hypos, especially without warning, isn't right.
On that basis , another option is to consider a pump, which allows you more flexible dosing to better mimic ehat the body does. It helps you to calculate boluses and correction doses mathematically so that you don't accidentally stack up your insulin doses when trying to correct a high. All of that is possible with your pen but I'd say having a pump makes it easier.

 

[nevenaves]

You could look at possibly reducing the carbohydrates in your meals. You might then be able to lower the amount of insulin and reduce the peaks and troughs.

If you are still experiencing a high amount of stress, try and take some action to reduce this. If you want to share more details maybe we can help with this.

Good luck

I'm not a type 1, but you might want to consider lowering your basal dose.

Thank you for your reply. My meals are usually breakfast-oatmeal/Weetabix and lunch sandwich/salad with some bread 30-40 gr of carbs and dinner is my main meal 40-60gr. I do yoga after breakfast (40 mins) and go for a 30 mins walk for my break at work (sunny Malta). In summer the walk is out but I go swimming. Exercise is also my main stress-relief mechanism.

 

[nevenaves]

Sounds like you may need to reduce your insulin, that is too many hypos. Are you able to discuss this with your diabetic team? Basal is usually the first thing to check out (look up basal testing), but as tresiba is very long acting any changes will take a while to take effect.

I've lost hypo awareness in the past when I had too many hypos and when I lost it 3 years ago my consultant told me to aim to keep my blood sugars above 6 for a while. That worked for me and I now have awareness back but I am also lucky enough to be able to afford to self fund a dexcom, which warns me before I go hypo and makes me feel a lot safer at night. Do you live alone or with family/friends? Hypos are easier to manage if you live with people who can look out for you if you go badly hypo...

I decreased tresiba from 18 to 12; thank you for the tip to keep my BG above 6. I live alone, so I am thinking of ordering the sensors more regularly.

 

[nevenaves]

Hello. I think all type 1s feel for you as managing the hypo/hyper rollercoaster does feel like an art even if it is a science.
My advice would be to get hold of the FSL 2 when you are next in the UK and then do a zero carbs basal testing day just to see how your basal is working across a typical 24 hour period. Be safe and have the hypo supplies ready or pitch the basal test rate at a lower level.
I know that there are other variables (illness, exercise, pmt, stress and coming out of your honeymoon period) but having a reliable basal rate is the normal starting point.
I'd agree with the other poster suggesting low carbs as way to help smooth out dosing errors. I do it because I am lazy and want to eat real food without having to weigh out the carbs or scan a barcode. I exercise quite a lot and tweak any bolus I am taking (I still need a little for protein) to allow for that e.g. in the meal before the exercise.
The goal of your diabetes team should be to get your blood sugars more 'time in range' not just having a good hba1c and I think having this many hypos, especially without warning, isn't right.
On that basis , another option is to consider a pump, which allows you more flexible dosing to better mimic ehat the body does. It helps you to calculate boluses and correction doses mathematically so that you don't accidentally stack up your insulin doses when trying to correct a high. All of that is possible with your pen but I'd say having a pump makes it easier.

I am trying to avoid the pump as long as possible, but will definitely take your advice to get the new FSL and go for a zero carbs basal testing day. Thank you.

 

[NicoleC1971]

I am trying to avoid the pump as long as possible, but will definitely take your advice to get the new FSL and go for a zero carbs basal testing day. Thank you.

Fair enough . It took me 30 years to get onto a pump. Once they sync wih the fsl etc. (as mine does with Dexcom) life will get easier and it may be worth hooking up to one!