College gal needing some supp

Hi all,

I made it a goal of mine to really get myself in tip top shape when I started college two years ago. In high school, I admit I got lazy and started checking much less frequently, even as bad as once a day and winging boluses based on how I felt. At my worst I reached an A1c of 11. I always have gotten good grades, still do, and am a high achiever, so sometimes it just seemed easier to munch blindly and study than actually check and measure and so on. I made huge leaps and tried so hard the past couple of years. I found a great endo and team that I love near my school and completely took over my slef care but still cannot get lower than a 9 A1c and its disheartening. I wear my dexcom, am checking more and eat relatively low carb, granted I don't measure as well as I should, but I just don't know what to do anymore. My doctor and nutritionist are helping, but it seems that there is just one hurdle after another!!!! I need a boost and especially in the less structure summer time, I've really slipped. Working at a camp, I come home exhausted, and am ravenous and pig out! I know its awful and just screws my sugars up, but I can't stop. Some support would be much appreciated :-)

How confident are you that your rates/ ratios are set accurately? I am also a fan of pigging out however I spend a lot of time fine tuning my dosing so that it works ok when I let 'er rip on a giant burrito or whatever.

If the numbers are a bit "off", OTOH, then the discrepancies can get magnified with larger "doses" of food? Testing more is the way to go but I also feel like sometimes people are hesitant to say "it's high after lunch every day, what if I changed my "lunch ratio" to a slightly lower number? If you have that situation, and are seeing numbers that aren't where you want them (e.g. 9 A1C?) then maybe it's time to start nudging the doses to get things in line? If your doc is responsive, it's possible that they may be of use? I don't run anything by my doc and just watch the CareLink reports on my pump and make changes when I see stuff drifting off, even a little bit.

I know that you may feel like you know how to do this and your doctor can teach you the rest, but really we are all students here. I really doubt that your problems are simple that you come home exhausted and binge. An A1c of 9% corresponds to an average blood sugar over 200 mg/dl, I suspect there is a lot you could do all around to improve things. And when you have improved control comes you should feel better.

So I'd like to suggest two books. You can get them out of the library, but I think there should be on everyones shelf. The first is "Pumping Insulin" by John Walsh and the second is "Think Like a Pancreas" by Gary Scheiner. Please consider getting these book and kick back this summer and do some reading and truly become a student of diabetes.

I went through the same thing in college. In hindsight, I think part of it was hormonal - even when I did quite a bit right, I would still have an A1c in the 9s. I think I was probably still experiencing the hormonal effects of puberty and this wasn't helped at all by the constant schedule changing that occurs during college courses (that alone wreaked significant havoc on my BGs).

By my junior year, I had found some things that helped.

1. I brought all my own food with me. Each day I packed an insulated bag filled with foods that I knew I could eat. Even if I didn't test all day and did everything else wrong, this helped keep me away from carb-laden foods on campus.

2. I started testing between each class. I just made it a habit that whenever I went to the bathroom between classes, I would also test while in the stall). This prevented me from having to test in the middle of class and led to a little less "blind dosing" when taking insulin.

3. I started testing faithfully again in the morning. I had fallen out of this habit at some point and once I got back into it, I did a bit better. Yes, there were still days where that AM test was only one of three tests I did all day, but it was better than nothing. Since you have CGM (which didn't exist back when I was in college!) you have it a little easier. Use the CGM!!

If you're living on campus, don't get the college meal plan (if they tell you have to get it, you can get a medical exemption). College campus foods are HORRIBLE. You'd do a lot better getting a small refrigerator and hot plate and making your own food.

I would check out this organization & its resources:
College Diabetes Network | Connecting Students with Students

It's hard work to take care of oneself in college, WITHOUT diabetes. You're doing the right thing by reaching out for ideas/strategies/support.

Thanks for the advice. Bsc, my problems are more complicated than that. I’m normal weight but have high levels of insulin antibodies and am resistant which doesn’t help my matters. It seems like I have to take so much to cover. I even cover for plain protein. Thank God I don’t really have problem with lows but the highs are zingers. Otherajor problem is I’m super carb sensitive. Recently whic has helped my doctor reccomeded blousing combo 60:40 over three hours which really seems to help mimic my bodies food processing. But something uncovered? Anything? I shoot up to 350 no problem. It was explained to me that the antibodies make the insulin work slower, it’s delayed. Also have hypothyroid so the hormones prob aren’t perfect either. So no my problems are by simply that I binge, but I sure am trying where I can! Also thanks MyBustedPancreas- I’m going to try getting off the meal plan! Great advice!

Yeah, I was able to get out of the meal plan in college and it was a HUGE help. HUGE. The cafeteria had the WORST possible food imaginable and not having the plan forced me to plan and prepare foods that were a bit better than what was available in the cafeteria. If they give you any issues with getting off the meal plan, get a note from your doctor ASAP.

The insulin resistance may diminish once you're a little older (mine did). I don't know how old you are, but will assume you're under 23 or so, and you can still be feeling the effects of puberty.

Have you looked into Symlin? I have not tried it, but some folks have reported that it helps with managing BGs post-meals and making their insulin work more effectively. Or what about Metformin? I know some other T1s have reported success with that. Don't be afraid to throw out these suggestions to your team. As long as they aren't contraindicated for some reason, they may be worth a try to see if you gain any benefit.

I will. I'm 20 so you may be right. Either way, thank you for your advice and support- its just nice to know that others are/have dealt with similar problems! I know I'm not alone with diabetes, but sometimes it feels that way in regard to some of the challenges it presents. So the encouragement is much appreciated! I'm still in the race!

I'm sorry my comments weren't more helpful. Anti-insulin antibodies are a real concern. They were common during the days of animal insulin, the foreign insulin was identified by the body and attacked. The anti-insulin antibodies roam the body essentially deactivate your insulin. The condition is more uncommon today, but it still occurs, generally with the modern analog insulin formulations. It is extremely rare with human insulin.

This type of reaction can induce insulin resistance since the immune reaction can deactivate the insulin you take. It can also induce highly variable responses since your immune reaction may not be consistent. I have heard that antihistamines can help reduce the reaction. You might talk to your doctor about trying an over the counter antihistamine.

But some doctors will try to switch insulin's. Since different insulin's have different insulin molecules, you may only react to a particular brand of insulin (like Humalog). In the end, if you find you react to all insulin's, then you are in a tough situation. There is a hospital procedure called desensitization, but that would really bite.

The other suggestion I have is to perhaps talk with your doctor about Regular (R). R is actually bioidentical to human insulin, but it is made synthetically. Since it is identical to human insulin, it may no cause a reaction and would be much more consistent and effective. And when you eat low carb, since R is slower than the rapid analog insulin's, it may be a better match to higher protein meals avoiding the need for the combo bolus.

ps. Since I follow a very low diet, I also cover protein. I count half the grams of protein as carbs. I follow the guidance of Dr. Bernstein in his book "Diabetes Solution."

pps. I have a T1/Celiac friend your age, a junior this fall. Her school made her special meals and last year (sophmore) placed her in on campus apt with kitchen as an accomdation. I believe all part of the Americans with Disabilities Act.

ppps. And I'm sorry if my initial suggestions weren't helpful. I do want to help.

Thank you bsc. I’ll look into your suggestions and appreciate your help