Type 1: Yo- yo tests, need advice!

[lilgoff]

Hi, I am a type 1 diabetic of 34 years I have no complications, but really struggle to control my blood sugars, since moving to spain I have lost the support of my diabetes care team ( only have a GP here). my last Hba1c was terrible and I am trying desperately to improve it. Today has been a typical example of my yo-yoing blood test results and I thought i 'd put them up here and see if anyone has any advice! At getting up 08.30 BG 209, took 21u lantus, 1u humalog, at 9.07 BG 33, took 40g fast acting carb to get me to work,10.30 BG84 further 18g slow carb, 12.42 BG328! If some one can see a pattern I am missing, would be great help!

 

[azure]

Hi @lilgoff The first thing I'd do is look at your basal insulin. Do a basal test and see if that's right. Basal is the foundation of good control. Once you're sure your basal is ok, then you can look at your meal ratios and things like advance bolusing to,avoid spikes.

 

[lilgoff]

Wow quick response! unfortunately I have been out of the loop on diabetes education for a while, how do you check your basal insulin? My dose has remained unchanged for the last three or four years. Thank you for your help

 

[lilgoff]

Thank you, will check it out

 

[GrantGam]

@azure has given you the best advice for your situation and @mahola the preferred method to go about it

Once basal insulin and I:C ratios have been set, then you can work out a daily carb intake which allows you to have good control. It doesn't have to be ultra low, but we tend to find that a "moderate" intake prevents the yo-yo problems that diabetics can encounter with BG.

Once you get your fasting basal sorted out, you may want to apply this rough calculation to match your basal dose to your chosen daily carb intake.

Total daily insulin dose = basal (your dose calculated from basal rate testing) + bolus insulin dose (amount to be calculated from applying your I:C ratio to your daily carb intake)

Once you have your total daily insulin dose (TDD) you can set your new basal rate by making it 40-60% of the TDD.

The above might sound like gobbledegook just now, but it will make sense soon. Hopefully someone can put me right if I've made any statements here that aren't true, @azure?

 

[azure]

I think your statements are true @GrantGam1337 but not for everyone. We're all different and the rules are more of a general suggestion, if you see what I mean?

So a starting point rather than a rule

 

[GrantGam]

I think your statements are true @GrantGam1337 but not for everyone. We're all different and the rules are more of a general suggestion, if you see what I mean?

So a starting point rather than a rule

Yes indeed I do - definitely a rough calculation rather than a rule

One thing I should have said is that any adjustments made to your basal insulin dose @lilgoff, should be no greater than 10% at a time.

 

[novorapidboi26]

Diabetes care would be a deal breaker for me if considering a move abroad....

What you do know may be a better question than what you don't know....

do you adjust your insulin?

 

[lilgoff]

I attended DAFNE course when it was first rolled out across the uk, so I am familar with the basal/bolus concept, I have no problems adjusting doses etc. I think for me life has changed quite alot, used to work night shifts (10years plus) but since living in spain I work days. Also I have switched to a fairly low carb diet to help control my sugars. I must admit my last hbA1c was i wake up that I need to re educate and take control of my diabetes again!

 

[tim2000s]

If you want further, easily accessible education that you can do at your own pace, then I'd recommend www.bertieonline.org.uk. It covers everything in this topic and walks you through it.

There's also the www.t1resources.uk webiste that has loads of helpful stuff about different aspects of living with T1 @lilgoff

 

[lilgoff]

Thank you I ll have a look, I think I have some studying to do

 

[GrantGam]

I attended DAFNE course when it was first rolled out across the uk, so I am familar with the basal/bolus concept, I have no problems adjusting doses etc. I think for me life has changed quite alot, used to work night shifts (10years plus) but since living in spain I work days. Also I have switched to a fairly low carb diet to help control my sugars. I must admit my last hbA1c was i wake up that I need to re educate and take control of my diabetes again!

We can all do with re-educating now and again, and in all honesty, every day is a school day

After converting your readings to mmol/l, there doesn't seem to be anything obvious as to why your BG plummeted from 11.1mmol in the morning to 1.8mmol/l after 1u bolus insulin. Equally, why after 40g quick acting carbs that your BG only rose to 4.7mmol/l. The only thing that would make sense is that you have far too much basal insulin on-board. And after you saying that you've gone 'low carb', that is very likely.

As everybody has suggested, get your basal rate testing completed as soon as you can and then from there you will manage to tighten your control.

Good luck @lilgoff

 

[lilgoff]

Thanks @GrantGam 1337 will have a go at basal testing, think it will be interesting!

 

[GrantGam]

Thanks @GrantGam 1337 will have a go at basal testing, think it will be interesting!

Just keep a tight eye on your BG when doing the basal testing; lows of 33mg/dl (1.8mmol/l) are pretty serious and can land you in a lot of trouble. To be honest, you might want to even try a 10-20% reduction of Lantus before starting the basal rate testing... I am no Dr and I'm only offering advice, so you should really check in with your GP before making big changes unless you feel comfortable. It's also very important that you get in touch with a local diabetes care team so they can give you professional medical advice, should you need it.

Let us know how everything goes.