Feeling Down

Type 1 and LADA
1

Hello everyone. I’ve decided to write here because I don’t know where else I can express myself. If I did it anywhere else, nobody would understand where I’m coming from.

I am so frustrated with this disease. My fasting BG’s the past two mornings have been 230. This morning I pretty much flipped, I was so upset. Every time I feel like I’m finally getting the hang of testing and my shots, I get numbers like these. Maybe it’s my diet. Maybe it’s stress. Maybe it’s lack of sleep… Whatever it is, it makes me feel like a complete and utter failure when it comes to managing my health.

This was a horrible way to start my day today. I just needed to vent. Thanks for listening.

~Amanda

2

I feel your pain. First, you have to remember that sometimes things happen with T1D that are totally and completely beyond our control. All you can do is try to tease out what is causing this issue and address it as best you can. It sounds (and I may be wrong) that you are experiencing the “dawn phenomenon.” Is it possible that you’re dropping really low sometime in the middle of the night and then rebounding? I don’t know if you’re on the pump or not, but now might be a good time to look into that if you aren’t. The pump really cured me of my dawn phenom issues.

Being a woman with T1D is hard. We have crazy hormones and those hormones can necessitate changes to our regimen on a weekly or even daily basis. For example, I know that the week before I get my period, my BGs go high. I up my TDD by close to 10 units during this period, and even then I’m still high sometimes (and I’m generally fairly insulin sensitive, so this should tell you just how much those dang hormones can affect us!) Then, about a day or two after my period, I am really prone to wicked lows. Sometimes I can go a whole day without hardly bolusing more than a unit for each meal during that time. It’s weird.

Stress too can definitely wreak havoc on BGs! When I get stressed, my BGs go up. The hormones we produce when we’re stressed (those “stress hormones” like epinephrine) make you more insulin resistant. I’ve never found a good way to deal with this, but just understanding the correlation helps me.

Diet obviously plays a huge role in the management of T1D. Another thing that has helped me improve my numbers this past year has been going “lowish” carb. I try to keep my carbs around 100g/day. I have noticed that doing this really helps keep away the big fluctuations. I still fluctuate and still have times when I’m well over 200, but they are definitely less common and easier to deal with when they do happen.

Also, you don’t mention this but I wanted to throw it out there (because you mentioned lack of sleep) - caffeine can cause BGs to go up. If you’re drinking a lot of caffeintated beverages, that might be causing the higher numbers.

Finally, keep in mind that because you were more recently diagnosed, you may be seeing the last of your “honeymoon” period. If you’ve lost the last remnants of your beta cell function, that is going to cause your insulin requirements to go up. Have you talked with your endo about increasing your basal insulin?

Hope this helps and hang in there. Even D veterans go through bad times. Sometimes you have to just let it ride and tweak little things in your life (diet, schedule, doses, etc) to see what the culprit is.

3

I actually wouldn’t be surprised if I am going through the dawn phenom you had mentioned. I’ve noticed before that as soon as I wake up, I feel shaky and low, but then an hour later when I check my BG, it’s shot up. I haven’t talked to my endo about it yet. I did mention it to the CDE that I met with a month ago and she told me I should definitely consider the pump if I’m having those morning issues. I’m not yet on one. So much to think about. :-/ Thank you for your input and advice! I really appreciate it. :slight_smile:

4

When I was first diagnosed with insulin-dependent diabetes in 1998, my endo and I tried MDI. Although my numbers were quite good during the day, I had a problem with dawn effect that we simply couldn’t control with MDI. So I got a pump. Long story short – with the pump I woke up this morning with a BG of 92. This is fairly typical for me. In order to do that, my pump supplies basal insulin as follows:

midnight - 3 AM: 0.25 u / hr
3 - 7:30 AM: 0.9 u / hr

and smaller amounts during waking hours.

Your mileage, of course, may vary …

Gerry

5

Hang in there. Work on the basal at night.
You may never get it in line with MDI, but wake up at 4 and 5 and see where it’s at. Correct it and determine what your basal shot at bedtime could be without going low.
It’s the pits, Amanda. But sometimes you can figure a shot that minimizes it.

6

Amanda:

If we knew why each time then we might be able to solve it. My doctor, a respected endo, asks me why my blood sugar swings so much? I tell him the same thing every time, hey I guess I’m a swinger!! He laughs and says that we control about 50% of the equation, which means we do not control about 50%. Sure food and exercise are big big factors, but so is body chemistry, sleep, anxiety, happiness, social pressure, and for all we know the color of the living room carpet. My point is, give yourself a break, and control what you can hope the rest settles correctly. Sure control eating and exercise, but don’t fret about the color of the carpet, after all had it been green, you might have been 250. Really who knows?

Rick Phillips

7

I wasn’t ever to really beat dawn phenomenon until I got a pump and put some basal boosts in the middle of the night. For a long time, I’d eat very low carb breakfasts and shoot up and go for a walk and eat some carbs when it started to crash when I got home.

An interesting thing someone posted in “FLATLINERS CLUB” was this pic of a “straight” person w/o diabetes’ BG on a CGM that shows DP to be “par for the course” 230 may be a bit higher than these folks but perhaps it’s just a shift in your metabolism or something like that?


8

If this has only happened the last two mornings, then it may be something other than basal. If it is your basal that needs to change, and if you don’t want to switch to a pump, it is worth spending time trying to adjust your basal long-acting insulin. For example, are you using Lantus or Levemir? Are you taking two injections a day or only one? What’s your split between the two injections? And what time are you taking your injections? I was able to get rid of what I thought was a dawn phenomenon by tuning my long-acting insulin, so it might be worth it for you to give it a try too.

9

Hmm…I’m using Lantus and doing two injections a day. Although the CDE I spoke with said I could do one a day if I wanted, that it really didn’t matter when I was taking my basal insulin. I take those injections right before breakfast (around 7:00 a.m.) and dinner (around 6:00 p.m.). So how would I adjust my insulin? Maybe take more in the evening? Take it just before bed time rather than dinner? I have a feeling this is something I’m just going to mess with to get it right, isn’t it? :-/

10

Yes, I think it is something you’ll need to experiment with. I can tell you what worked for me, but you’re likely to need something different. Like you I was taking two equal shots a day of Lantus, about 12 hours apart. In my case, I switched from Lantus to Levemir, stayed with two injections a day but changed the timing (first shot still when I wake up but second shot is later at night (10:00pm). I tried taking more at night than morning, but after moving to the later timing I found an equal split injection worked best for me. I also increased the overall amount of basal since I found I wasn’t taking enough.



I kept pretty good records while I was figuring all of this out. Make a single change for a few days and see what the effect is. If it works better keep it, otherwise undo that one and try the next. I think the most important changes for me were to increase the overall amount and to move the evening shot to be later. Part of taking more basal was realizing that I was taking far too much bolus with each meal, so that changed too. I resisted changing the injection timing since it was so convenient to do what you’re doing and take it before my evening meal - but I set my cell phone to alarm every night at ten and found this works to remind me. If you keep a pretty regular schedule you could try taking it when you go to bed - my hours are too irregular to do that.



I’m not sure whether the change from Lantus to Levemir made any difference. My main reason to make the switch was that Levemir has a shorter action time, so I thought it would work better when I was experimenting with taking more at night than in the morning. Since I’ve ended up back with equal doses in the morning and night it may not matter. But having spent the time to get the Levemir working there’s no reason for me to try to switch back at this point. But if you’re happy with Lantus you could try some of the other changes before you try Levemir - probably worth it since you probably have a couple months worth of Lantus in the fridge anyway.

11

I am on MDI and have the dreaded Darn Phenomenon. To manipulate your basal, you can increase your nightime dose and stagger the times. However, Lantus pretty much lasts 24 hours, so no matter what you do, it is impossible to peak your Lantus by more than about 25%. If you need a substantially higher overnight basal, you either need to use an insulin with a more pronounced peak or shift to a pump. I actually use NPH (yes, I know, it has its problems), it lasts 14 hours and has a more pronounced peak. Using NPH I can get an overnight basal dose three times my dose during the day. Some people also augment their Lantus with a nightly NPH dose.

12

Actually, this shows the effect of a meal at 7:30am. These non-diabetics don’t show any DP. And I hate them.

13

Hi Amanda. That IS a crap way to start the day! Here’s something that will either help you feel better or worse (I’m hoping for the former). I’ve had diabetes for 33 years, and MY fasting blood sugar was 345 today. I’m a seasoned pro at this, but I still don’t always “win”. I’m a firm believer that all we can do is our best, and then let the outcome be what it will be. There are lots of tools at our disposal, but there are also many variables that affect blood sugar, and which we can’t control.

I think one of the very best things a diabetic can work on, and which we sometimes overlook in our focus on wrestling that dastardly number into submission, is emotional tools. Your sugar this morning probably felt physically fairly crappy, but I’ll bet the emotional toll was WAY worse. It’s a totally reasonable reaction to feel like you’ve failed when the outcome you work hard for isn’t reached, but the thing is that it’s a setup, because you CAN’T always get that outcome. The tools we have just don’t control all the variables at play. What I do is try my best to get a good outcome and then try to accept whatever it is, do what’s needed to fix unwanted results, and move on with my day. Maybe take a few minutes to call your diabetes all the foul names you can think of, stomp around your room a bit (there’s no need to be “mature” about this), do a shot and then actively change your thoughts to something else (hopefully something good!) that’s going on for you today. It’s really really hard, when you’re in the throws of that frustration, but if you can achieve it you’ll feel better.

Good luck!!

14

Thank you Emily. :slight_smile: I would definitely have to agree that it takes an emotional toll. Makes me feel like a failure a lot of the time when I can’t get that morning BG under control. Ugh! But I like your take on it. :slight_smile:

15

Hey Amanda-
I definitely understand where you’re coming from. There is so much (unnecessary) guilt that comes with diabetes. Some of the best advice I ever got was to not think of blood sugar numbers as “good” or “bad” just “in range” or “not in range”. Taking the emotion out of the actual blood sugar number has really helped me keep things in perspective. Don’t get me wrong, I still get really frustrated, but it helps to see it for what it really is, and that it’s not a reflection on your personal level of dedication or self-care abilities. We have to remember that until someone hands us a bottle of insulin that works just like the insulin in a working pancreas does, no amount of effort on our part is ever going to make our bodies react the way a “normal” body would. So, if we don’t have good enough tools to work with, why the heck should we feel guilty if we can’t get things “in range” 100% of the time? :slight_smile: We shouldn’t. That’s how I see things anyway. :slight_smile:

And please vent any time! That’s what we’re all here for. Many people have said that this disease is truly a “life sentence” and the day-in, day-out, continuous, monotonous struggle can really take a toll sometimes. We’re all here to help each other through it!

16

You have gotten a lot of good advice and I loved what Emily had to say! I just wanted to add that you are so new to diabetes. When I was only a couple of years in I was only just starting to figure out how to use insulin and had not even begun to figure out what worked best for me diet-wise (and 18 years later that is still a work-in-progress). I would say that I didn’t really master the art of using insulin until after I had been diabetic for about 8 years (and since then I would say I have lost touch with it and no longer that great at using it, but I have done some things with my diet that make it less important). Plus, as a previous poster mentioned, you may still be making a bit of your own insulin here and there, which can really complicate things.

17

The curve looks eerily similar to mine and seems to show peaking that’s a shade early for breakfast that makes me think there’s something else going on.