Type 1 Diabetes Management

[Callum Brown]

Hi, my name is Callum Brown I am a type 1 Diabetic from Perth Western Australia. I have had type 1 diabetes for 13 years now. My A1c is 8.3 and my control is not the greatest. I have trouble trying to keep a baseline on my levels and always having to make corrections.

For example I will wake up in the morning at about 6am with my levels at approx 6.0 I will count my carbs and dose accordingly to what I am about to eat, I will take my insulin 15-20 minutes before meals. With various different breakfasts I have tried from low carb/low GI just to eating less so I don't get spikes, but no matter what after 1 hour of breakfast my levels peak at 14-17 and will after 4 hours drop back in range or stay up depending on how physical I was having to make a correction. This process repeats every meal everyday I have tried changing insulin (currently on fiasp and tojeu) been on insulin pumps tried keto and I can't get any stable control. All I see on youtube or Google is every other diabetic have this constant slow curve they never go over 8.0 and if for 1 instance they get to 10 it's the end of the world? I'm so confused I really just want this control and I can't get it work with educators and endocrinologists to control and they keep telling me I'm doing fine but everywhere else I see differently. Am I the only type 1 that is like this? I don't drink alcohol I don't use drugs, I eat healthily I exercise why is this happening to me can someone please help?

 

[EllieM]

Hi @Callum Brown and welcome to the forums.

All I see on youtube or Google is every other diabetic have this constant slow curve they never go over 8.0 and if for 1 instance they get to 10 it's the end of the world?

I feel your pain. Let me assure you that I for one am not one of those diabetics. I think the people who are doing well tend to post about it (why wouldn't they, they are doing great) but there are many more of us who struggle to some extent or other.

The international standard that T1s are supposed to aim for (as in they are doing very well if they achieve it) is 70% in a range of 4 to 10. And I personally think that some people genuinely have bodies that are easier to keep in range than others, for lots of possible reasons. I'm not saying that the people who achieve perfect control don't work very hard to get it, I'm sure they do, but other people may work hard too and it's not their fault that they can't get the same results. Diabetes is complicated, and all you can do is the best you can with the situation you are in. And mental health is important too, spending all day stressing about your levels is not a great way to live (in my opinion).

And if it's any consolation, over my 54 years of T1 I've had many years with an hba1c higher than 8.3% , though it has been better than that since I got a cgm. But I still get days when my bg decides to go up and up for no apparent reason,, and once it's over 10 or 11 for any length of time I become a lot more insulin resistant and it's much harder to get down.

Just wondering, how confident are you that your basal is correct (you've done basal rate testing?) , how confident are you about your insulin ratios and have you experimented with different times for pre-bolussing? And sorry about the endless questions, but which pump did you try? (I've been on a pump for 4 months and though I'm not sure my TIR is that much better it is easier for me to manage highs and lows.)

And remember, in the days before cgms people's bgs peaked after meals and we probably didn't know about it, because we just tested before meals.

There are a lot of very experienced T1s here who may be able to make some helpful suggestions (or at least give some moral support). Once more, welcome.

(edited to correct typo, 7 to 10 should be 4 to 10)

 

[Fairygodmother]

@ Callum Brown, Your waking blood sugars are amazing! Mine can vary from day to day, and even though I do basal tests and seem to have fixed the long-acting, for now, there’s a multitude of stuff that affects my insulin needs.
54 years of trying to be a beta cell has been, on occasion, exhausting, the source of new swear words, jubilation if I get it right, envy of those who don’t have to count and jab when the Type one toddler has a tantrum, and even lots of time to exist beyond Type One.
I wonder if the breakfast rise you are experiencing is the Dawn phenomenon coupled with a need to dose differently for breakfast?
I agree with Ellie, it’s very hard to be perfect, and it’s very easy to become discouraged when we’re not, despite working so hard to stay in range.
I suspect, if you look behind the scenes, a great many of us with Type One have highs and lows that we can’t easily explain.
Our bodies are far more complicated than anything that can be fitted into an Instagram post.

 

[Luke2]

Hi,

I’m pretty much always in range (98% TIR) but I was only diagnosed in Jan so probably still in the ‘honeymoon’ phase.

A few things that make a big difference to me though:

- have nailed down 15g carbs to 1 unit of insulin.

- I have done a lot of testing with pre bolussing. Mornings I bolus 25/30 mins before breakfast, I then usually stay in range. If I do 15/20mins I usually peak outside of range. Afternoons/evenings I pre bolus 15/20 mins as I’m a lot more sensitive to insulin at this point.

- i inject for snacks, anything over 15g carbs.

- I split bolus for any meals over around 70g carbs. If I whack all my insulin in I’ll usually hypo and then have a massive spike an hour or two later.

- High fat/protein meals with high carbs (pizza etc) I’ll definitely split bolus. I usually split these 60/40. I’ll whack 60% of the insulin needed and then I’ll set a timer for an hour and 30 mins, then add the additional 40%.

- Final thing for me is once I’ve eaten I usually try do something a bit physical. I’m a very active person anyway but even if I do some household chores or go for a walk, it makes a big difference.

A couple things with being relatively new to all this. We are all different, we react differently, don’t try and be some else. I see these folks on Instagram who have great graphs etc but work on the small things for you. Set yourself a small goal, for instance reducing your weekly average glucose by 0.1mmol. This helps me

Well done for fighting it for 13 years

 

[Antje77]

For example I will wake up in the morning at about 6am with my levels at approx 6.0 I will count my carbs and dose accordingly to what I am about to eat, I will take my insulin 15-20 minutes before meals. With various different breakfasts I have tried from low carb/low GI just to eating less so I don't get spikes, but no matter what after 1 hour of breakfast my levels peak at 14-17

I found I have a significant rise in the morning even if I don't eat breakfast. It's a variation on the dawn phenomenon called Foot on the Floor effect, where my helpful but stupid liver dumps some glucose in my bloodstream to help get me going for the day.
It can be you're seeing this effect, especially because it doesn't seem to matter what type of breakfast you have.

I mostly solved the issue by injecting for it as soon as I wake up, before my feet hit the floor. Glucose is glucose after all, no matter if it comes from my food or from my liver, and glucose needs insulin to deal with it.
If I have breakfast, I simply inject separately for it.

I also found that I need a lot more insulin for the same amount of carbs in the morning than later in the day, and I usually need a longer pre-bolus than 20 minutes if I want to avoid spikes.
No two diabetics are the same, your body will likely react differently from mine so don't assume that what works for me will be the same for you, but those three things may be worth looking into for you.

Good luck!

T1s are supposed to aim for (as in they are doing very well if they achieve it) is 70% in a range of 7 to 10.

Did you mean to write 4 to 10?

 

[EllieM]

Did you mean to write 4 to 10?

Yes, I did, I've edited my post, thanks very much

 

[Juicyj]

Heya @Callum Brown

Welcome

Agree with the above could be a combination of factors for the rise, Dawn Phenomen so liver doing a dump, as well as bolus ratio being incorrect for the morning dose. Changing your ratio is straight forward - do you change your ratios yourself, otherwise consult your team.

I have found I am more insulin resistant too in the mornings so I tend to eat low carb/high protein but still take a bolus shot for it, this has helped me keep my levels below 10mmol/l in the morning now, otherwise i'd shoot up to 14/16 mmol/l and sit there until lunchtime.

I have also found when levels rise that a walk and lots of water help to bring things down too.