Type 1s: How is everyone keeping bloods under control?

Low carb is the only thing that works for me. It keeps sugars low but as an added bonusnincna take small doses of insulin and i don't go low.

I test a minimum of 4 times per day and probably up to 12 times on a bad day. I just do what I need to do. I used to do the LCHF at one time in the past but gave that up when I had real high cholesterol readings from that... so for me I'd rather eat more balanced diet of the foods I'm allowed to eat and it seems to work better for me all round (My diet is restricted because of another illness). But the reality of this disease is that food isn't the only thing that affects blood sugar. For me having illnesses that impact on my BGL's has been the hardest thing to manage. Any time my body is fighting something, I find it hard to get good control of my BGL's. I find that out of all the stuff I'm dealing with it is the diabetes that I have some control over at least because insulin helps and so does food if I'm too low. My other stuff I'm dealing with it is hit and miss with drugs, etc. For example if I'm having severe spasms I'm supposed to take strong painkiller with sedative and go and lie down immediately. That doesn't work when I'm at work or I can't swallow because of the spasm. At least with my BGL's if it is high I can use insulin, or treat a low and I find it usually comes right eventually. Oops sorry I'm probably ranting a bit... just giving you my perspective what I think about controlling my BGL's. Also when I see my endocrinologist these days he wants to discuss my overall health and he said I'm doing well considering what I'm having to deal with. My last hbA1c was 7% which was my highest in a while, I got a bit upset about that. But my endo said well you've had a nasty time in the past year so 7% is actually very good for you (I had been hospitalised a few times, on antibiotics for about 34 weeks)

Dr. Bernstein's Diabetes Solution, 4th edition by Richard Bernstein, MD changed my life. It's a good book. He's a type 1 diabetic, diagnosed at age 12, now his early 80's. He's enjoying vibrant good health, no diabetic complications. His book led me to the low carbohydrate diet. It changed changed everything for me. Learn more by doing a search on his name on YouTube. Last A1c was 5.4%. I crossed over into type 2 diabetes about 10 years ago. I don't take any medication.

@Kerryannhogan Also look at Gary Scheiner - Think Like A Pancreas.

For tight control many find they need to test 10 times/day or use a Freestyle Libre to get full 24 hr views.

For those on Levemir, depending on dose, we can split into two 12 hr doses. If you are on something else just ask and someone will know.

For you post meal spikes you have two tactics to apply. (1) take the Rapid before you eat - start at 10 mins and increase the gap until you see an effect (2) reduce carbs, ie more carbs=bigger spikes.

Try Carbs and Cals App if you need help with Carb Counting.

hi @Kerryannhogan , I test at least 7 times a day & I have a continuous glucose monitor.

I split my levemir 50/50. I also sometimes split my bolus if I'm eating something v fatty, so I'll take half before & half after or half in my tummy & half in my bum - I think the pumps have special bolus waves to help with this.

I have found injecting 20-40 mins (depending on the meal) before I eat to really help with the spikes - I found this by taking the approach @steve_p6 suggests, see how you go with 10 minutes before & work backwards.

Do you carb count? Have you done DAFNE or similar?

Is your dr who says "it's fine" an endocrinologist or a GP? My HbA1C is 43 and while that sounds fine on paper it is really only that low because I'm hypo twice a day and to be honest I see my low HbA1C as a sign of my poor control (I'm not saying that is the case for everyone, I'm sure it is possible to get a low HbA1C with good control) and I would expect any endo wth a patient with 39 reporting a lot of time in the 2s to actually be quite concerned and to be talking about higher target levels.

Before, I got a real sense of how and what different foods did to me, I tested up to ten times a day.
Since then and a small restriction on my strips, I check only about 2-3 times a day, unless I think I need to.
Control is critical to my condition. I have to keep control unless I want to be ill!
It's all about food and wHat is bad for you.

Dexcom G5, Accu-Chek Aviva Expert and test up to 10x a day, Levemir split basal injections, Novolog(Novorapid) Echo pen so I can inject in .5unit increments.

However, for me it's more about my routine and being consistent with it rather than my diabetes equipment.

-I wake up at 4am nearly every day. That helps me catch any dawn phenomenon or blood sugar rises very early.

-I am very active and my exercise is primarily based around powerlifting and bodybuilding. For general health I jog about 15-20miles a week. Having a lot of extra muscle mass helps create a "buffer" as I can store quite a bit of glycogen which is extremely effective at keeping my levels in range.

-Perhaps the most effective aspect of my routine is my low carb/high protein diet. It's a bit unconventional as I eat 250-300g of protein a day (equates to about 3g of protein for 1kg of body weight). That much protein can absolutely cause hyperglycemia but for me the rises are very gradual and easier to control. The excess protein also seems to be extremely effective at avoiding hypos. If I ever need to lose a few extra pounds I simply reduce my total protein intake and keep everything else the same.

As far as timing my injections, I generally inject just as I begin to eat. My pancreas still produces some insulin and my initial natural insulin response is fairly good, but becomes extremely poor after about 30-60 minutes. Consequently, I tend to inject 2-4 times throughout a meal rather than all at once before.

Think Like A Pancreas by Gary Scheiner, exercise, keeping a daily record, leaving 4 hrs between meals, leaving at least 4 hrs between last bolus and bed, timing the bolus to try and match the spike, no snacking. I used to test around 8 times a day but a lot less now I have the Freestyle Libre. On Lantus and Novorapid, inject Lantus once a day. Getting your basal rate right, is, I think, the most important part. Having the Novopen echo that gives half units also helped to get better control.

Hi @Kerryannhogan , if I was 4.5 pre-meal ( and not planning any exercise) I'd take a half unit less than the total carbs and inject just before eating. It might take me a bit over 7 when it's at it's peak, but once the insulin and food had finished what they're doing, I would expect to be around 6. I'm on 1 unit for 10g, I'd only split the dose if it was high in fat. I wouldn't think it's possible to keep your blood sugars below 7 all the time. Hope that makes sense.

Kerryannhogan said:

Thankyou all for your replies, I can see that everyone has different ways to help them so I was intrigued to know what everyone else does that's so different to me, hopefully I can take away some of the stuff you have advised me with and regain some control to my bloods. I will definitely read the books!

.... whenever I try to keep my bloods under 7, they rise and then dip low very quickly, I'm not sure what I'm doing wrong.

Click to expand...

It could be that you need to alter the timing of your bolus injection. It sounds like maybe the insulin isn't working in time to deal with the food, so you go high but then drop down low later as the insulin kicks in. This can happen to me at breakfast if I don't time my bolus right.

If you get the timing of your injection spot on, you may then be able to reduce the amount of insulin slightly as it'll be able to match your food better. Again, this will help with lows.

I have a pump and I normally test 7-12 times a day. I always test two hours after meals. I aim to be below 8 two hours after eating generally.

Is any one nil my mouth? Fed via peg through the stomach, has insulin twice a day, test three times a day. Just want to know what blood sugars are.

TorqPenderloin said:

Dexcom G5, Accu-Chek Aviva Expert and test up to 10x a day, Levemir split basal injections, Novolog(Novorapid) Echo pen so I can inject in .5unit increments.

However, for me it's more about my routine and being consistent with it rather than my diabetes equipment.

-I wake up at 4am nearly every day. That helps me catch any dawn phenomenon or blood sugar rises very early.

-I am very active and my exercise is primarily based around powerlifting and bodybuilding. For general health I jog about 15-20miles a week. Having a lot of extra muscle mass helps create a "buffer" as I can store quite a bit of glycogen which is extremely effective at keeping my levels in range.

-Perhaps the most effective aspect of my routine is my low carb/high protein diet. It's a bit unconventional as I eat 250-300g of protein a day (equates to about 3g of protein for 1kg of body weight). That much protein can absolutely cause hyperglycemia but for me the rises are very gradual and easier to control. The excess protein also seems to be extremely effective at avoiding hypos. If I ever need to lose a few extra pounds I simply reduce my total protein intake and keep everything else the same.

As far as timing my injections, I generally inject just as I begin to eat. My pancreas still produces some insulin and my initial natural insulin response is fairly good, but becomes extremely poor after about 30-60 minutes. Consequently, I tend to inject 2-4 times throughout a meal rather than all at once before.

Click to expand...

What is your daily carb intake then?

I would run 22-30 miles a week and definitely staying active and reduced carbs has enabled my honeymoon to continue...

pms-pms said:

Is any one nil my mouth? Fed via peg through the stomach, has insulin twice a day, test three times a day. Just want to know what blood sugars are.

Click to expand...

Not yet.. But can see it coming in the future as stomach is just not working..
Bloods vary according to bowel emptying (or not)....

Kerryannhogan said:

always being in 2s from going too low but they always hit the teens after every meal and my doctor said its fine

Click to expand...

I would find another doctor!! Your diabetes is totally out of control, you're developing complications after only 2 years, it is definitely not fine.

Kerryannhogan said:

if someone has a blood count pre meal of 4.5 and eats something to keep the bloods under 7 but some of the food may cause a rise even if its included with the healthy meal, would they inject 15 mins before and then 2 hours after?

Click to expand...

No, the ONLY reason I would do that is if I often hypo within the first hour after eating.
If my sugar is 4.5 before eating I will simply take a bit less insulin compared to a sugar of 6. If you frequently split your dose like this it may be contributing to your big spikes, because it means there is less insulin in your body at the point where the meal is digesting fastest.

In your situation I would start by backing off on the insulin until the hypos are eliminated, because all the hypo food/lucozade you consume complicates things, and actually the hormones a hypo creates can destabilise things for hours after. (Avoiding hypos for a while also improves hypo awareness.)

If you are testing so often it can be hard to know how to adjust your dosages. Because fast-acting insulin lasts roughly 4 hours in your body, the usual approach is to see where your sugars are at around 4 hours after a meal (this is assuming you didn't take extra food or hypo treatment or insulin in between; if you did that must be taken into account).

If I had massive spikes and constant lows I would be suspecting my basal (long acting) is too high during the day. The pump will give you full control of your basal levels at different times of day so this could be a big help. (Be aware that changing your basals will make you need different amounts of fast-acting, though.)

I need 12 units of basal at night but practically zero during the day until about 7pm, my endo is baffled! This only started 8 months ago; before that my basal needs were more consistent.

Good luck, feel free to PM me if you have any questions.

teacher123 said:

What is your daily carb intake then?

I would run 22-30 miles a week and definitely staying active and reduced carbs has enabled my honeymoon to continue...

Click to expand...

On most days, it's less than 50g.

There are days I eat more (and some days I eat A LOT more), but I'm usually good about running/exercising extra to cover those additional carbs/calories.

TorqPenderloin said:

On most days, it's less than 50g.

There are days I eat more (and some days I eat A LOT more), but I'm usually good about running/exercising extra to cover those additional carbs/calories.

Click to expand...

Yes more or less the same for me. I don't have breakfast and usually a salad with some form of fish for lunch, then for dinner it's usually greens and chicken/pork/fish. I tend to find Sunday the hardest day because I take a break from all sport and easy to go overboard with carbs. I usually increase protein on Sundays to provide greater satiety and repair from Saturday long runs.

Hey Kerry!

I am just about 2 years now myself - I can say that the biggest thing i employ to keep things in check is eating low carb, and exercise.

Whenever I am going to eat a meal I think about what i WANT to eat and then think "How can I remove as much carbs as possible?" Often times it's eating a salad instead of fries, or instead of having a sandwich I do a lettuce wrap or just eat everything off of a plate so as to avoid the bread lol

The next big thing is to get to the gym as much as I can to keep in shape, and keep the metabolism up. Exercise tends to raise insulin sensitivity so it ensure my insulin doses stay as effective as possible.

I also like to check my sugars 2 hours after each meal, and if they are higher then 10mmol/L i get up and go for a brisk walk for rough 10-15min, which always helps to bring them down much faster then insulin ever could. I walk pretty much whenever my sugars are high instead of insulin because I find a 2-4km walk will take me down much faster. Rain or shine, night or day, I get up and out and walk my route (I really should get a dog - It would make it seem less creepy I am sure but oh well lol)