Hi. This is Chadha, 22. This is my first post here. I was diagnosed in June 2000 as T1 IDDM. Had been on MDIs until November 2013. I have always been rotten kid. I smoked in my adulthood, had booze also, sometimes so much. I never cared about diab unless I used to see glucometer screening above 350 mg/dl. I quit smoking more than a year, but still my glucose control wasn't good. The average I used to be around 250, and go as high as 300-400s n few times even close 500. Hb1AC n all other things never settled down, how would they be. I didn't have diabetes education nor I ever cared about it. Anyways, last year in May, I was hit by neuropathy, the pain and tingling was so intolerable that I wanted to cut it apart. Then once I did deducate myself about diabetes, I was able to lower my HB1AC to 6.4 in September from 9.5 I guess. After the recent transition from pump in November last year, my HB1AC climbed to 7.5 on 1St Jan. I haven't been able to see good readings. I have always been a night owl, lately my schedule was changed I started sleeping on time and waking up so, my levels seem to be settling down on their later i figured out because of the increase in activity my insulin needs started going lower. Prior to my changed schedule I was despaired to see high readings daily, every time I used to give correction bolus. I didn't have enough money to buy pump, but still my family got me one after breaking all the funds, mostly all and got myself one, nevertheless I wasn't able to get the control. I bought pump to lower down my HB1AC to 6.0 at least but rather it turned out to be counterproductive. I developed this guilt also. And started going in kinda depression, some folks told me I sounded depressed, though I have always known that the high numbers make me angry and despaired, I just don't like them high, in 200s. Before I changed my scheduled I ran a basal test and my readings were -
1:15 AM - 126
3:15 AM - 105
4:15 AM - 107 [ fell asleep here]
6:40 AM - 97 [ woke up]
7:52 AM - 89
9:10 AM - 117.
And now that my schedule is changed again, I have started going in hypos, twice at least. And the basal testing is so demanding that I burn out. It seems every time there is change in schedule, I will have to do basal testing [a challenging n very time consuming job].
I wanted to mention - I have been on the couple of forums before coming here, but the support the info available here is really very wide that it made me one of its member from just a guest. THer support here is immense and I know IMA get lots of help from wonderful folks of TUDIABETES.
I think we all feel burned out at times. And part of it is simply that we try so hard to perfect and we are not perfect and never will be. Sometimes, it is just stepping back and doing a good job, even though it is not perfect. After all, a good job done promptly is far better than a perfect job delayed for a while. I monitor my overnight basal levels by simply checking my waking numbers. I am fortunate I don't have to worry about overnight lows, I can just do a good job by checking how much I rise overnight. Perhaps you can do some similar things with basal testing?
Do you have a CGM (continuous glucose monitor)? Seems to me that it would help with a lot of your testing/hypo issues. Not cheep, but I get 3 weeks out of my Dexcom sensors. A CGM might be better for you than a pump. You still have to test, but the CGM tells you the direction you BG is heading, and it has an alarm for hypos and one for highs.
Those BG readings seem pretty stable...the group is about within the range of error for most BG meters. Seems like the schedule change should produce a reasonable consistent change in basal rates, so maybe you could just cut back a few units on basal insulin after a schedule change and see how it is affecting your numbers.
Also, a lot of us test 8-10 times a day. If your job is physically/mentally demanding, then those activities are going to lower the amount of insulin you need. If I exercise for an hour or two, my insulin needs tend to go down for hours (possibly a day). I took my son to a convention last year where I was walking non stop for 3 days, and my basal needs were nearly cut in half.
Yeah, high BG numbers aren't good for my depression/anger either. Also, take daily vitamins and have you doctor do blood testing if you can. I have a pretty significant vitamin D deficiency and my B12 was low when I was on metformin.
Finally, a lot of us have had some success with a lower carb diet. Dr Berstein is a proponent of something like 30 carbs a day (supplementing with protein, oils, and low carb vegetables) which is extreme, but it seems that many of us eat around 100 carbs a day. I think ADA guidelines are really high.
I'd say those basal numbers are pretty awesome, -30 points might be a shade "hot" (too much) insulin but, frankly, I'd take it. I'd guess the 117 is from not eating. If I don't eat in the AM, my BG will fly up all on it's own. I'd say you are kicking some major ■■■ at getting your diabetes in order, from 350+ BG (not to mention smokin' and drinkin') to 6.0 or even 7.5 is significantly better for your long term prospects.
When my numbers get out of whack which mine have recently, I usually try to check my pump data to see what times are the most out of whack. If I get a day where I have a bunch of crappy readings, there it's one thing but I think that to make adjustments you want to look at a week and see which times of day have the most crappy readings and start making adjustments at that time. For me, a lot of times, it's breakfast but sometimes lunch will be involved or lows before dinner or whatever. If I "clean up" one problem, it often will carry down the clock to several other readings and lead to a great feeling of success that you can use to build on it. Bad numbers don't mean you are bad at all. You sound like you know what you are talking about and are capable of doing what you need to do but maybe need to be easier on yourself and consider your successes more than problems. If you build on the successes, you can eliminate the problems, one at a time, or maybe 2-3 at a time, if my theory about things carrying through the day works for you too.
Most importantly, Chadha, I want to congratulate you at taking things in hand and making such a radical improvement in your diabetes management! Way to go! Pumps are complicated and take time and effort to get them programmed correctly. Your numbers sound excellent, but not if you are experiencing too many lows. I would try making small changes, especially in the times you see lows. Add a small amount of basal to those particular hours (being sure to do it two hours before the times the lows occur). Personally, I don't do basal testing. I just keep careful records and slowly make changes to what I see. If I'm up late or wake up during the night I do try and test to see if anything odd is going on then, but I now have it pretty steady. (Most of the time anyway). I agree with those who say it's never going to be perfect. Now that you have come down from those severe highs I'm sure you want it to always be great, but even those of us with great management have times we spike or drop for no reason. If it's a pattern I tweak my numbers and then sit with them awhile before making more changes. Keep up the good work!
If he is having hypos then I would say reduce the basal by a small amount not add a small amount. I don't do basal testing either but I do have a dexcom and can track where my highs and lows tend to occur.
I have always admired Dr Benrstein's work n his approach to fight the D. Scott, no I dont have CGMS. After I bought the pump my dr advised me to wear CGMS for 3 days n share the results to tweak the doses, frankly speaking the three days amt was higher than my monthly supplies of pump. I have been going low frequently n then I go high, somehow there's been a consistent pattern of Peaks n Valleys.
Acidrock, thanks for the encouragement. Sometimes it is very hard to hold yourself n stand tall when you are messed up, during these situations we need moral support as well. I have to manage all things on my own, no help from family. But I'm adult i can take good care of myself. I have been frequently going in hypos n later highs. Last evening I climbed to 278 gave myself SUper bolus [correction+ 2hours basal] and set TBR to 0 for next two hours. Before dinner it was 77, after 45mins from the last carb bolus n food, I dropped to 43. Panic set in and I immidiately ate lots of carbs. 2 glucose tabs+ 2 Indian sweets. 2 hours Post Prandial was 108,I went to sleep, 2 hours later 168 at 2AM just to see whether there has been some defect in the night basal or require insulin for DP or not. WOke up at 7:30 with 237. I don't like tha game of PEaks n Valleys. WIll be seeing my doc at the earliest but this may take 3-4 days. Today is sunday, will make appojtment on monday and hopefully on THrusday or Friday I will see him.
Not even in a psoition to run basal tests because of the frequent lows.
Thanks Zoe. I know there are gonna be times when we will spike n drop but the my latest readings seem to be the permanent ones. Of course there is a BIG need to adjust the basal. If all goes well I will start with Overnight Basal testing. After I dropped to 43 from 77 last night within an hour of eating, I panicked. The basal tests are very demanding, and I hate after every change in schedule we need to tweak the doses again n make permanent changes. T1 is never easy.
True, Brian. But I'm going through permanent fluctuations not the random ones. I wish T1 would be lil easier. Are all the posts here in this thread I'm getting from Pumpers only?
Chadha - You are overall doing very well. Learning how to change basals is a very important skill and not easy. As much as we would all like to set up a basal profile and simply stick with it, our bodies change and our basal insulin demand changes. If we don't adjust, we go low and then rebound high and our whole day gets metabolically compromised.
Just pick the most problematic part of the day when your worst lows occur and work on them first. Like Zoe said, lower the basal rate two hours before the problem time. My basals range from 0.4 to 1.2 units/hour. I make my changes in 0.1 unit increments. Some people like to take smaller steps like 0.025 units per hour. I like to take the 0.1 unit increments first and then fine tune later, if needed.
Write stuff down to help you identify cause and effect as well as other longer period trends. I've used Gary Scheiner's basal testing protocol to good effect. I believe it's a solid way to develop a sense for making these adjustments. Once you go through a process like this, you may find it easier to make smaller adjustments without going through the entire protocol. It takes practice.
CGMs are a great tool if you're inclined and you have access through insurance or other means. It's not cheap.
It's not always easy to correct a basal rate problem in a day or two. I've struggled with some adjustments for many days, even a week or two. But then your body will change its basic needs again. Wash. Rinse. Repeat!
From that, were you at 278, bolused for dinner and correction and then waited 2 hours and were at 78? The missing number from the account would be the "active insulin" or "insulin on board" although I dunno if the Accu-check tracks this or not as I've only used Medtronic. If it's dinnertime and I have a huge correction on board that's still firing away, I might cut my dinner bolus a bit which might have helped avoid the 48.
I also wonder how many carbs are in an Indian sweet? It might be that your 108 was on the way up. Before I had the CGM, if things were getting interesting, or moving a lot, I might double check a second time 20 minutes later to see what's going on. The 108-->168---> 237 is kind of a line that might just show the carbs going. I find that nighttime carbs seem to take longer to work but also linger longer.
I hope your doctor can give you good advice but a lot of times, you have to figure out the tactical solutions.
Acid, I tell you the whole story now - It all started with 65 in the afternoon, so I went out to my most favorite Street Vendor and ate that food as my lunch. That food is high in carbs, GI and fat as well. SO on the 65 I drove to that food vendor and gave extended bolus for 15 mins, then had an extra piece of Indian Bread and bolused for it after 20mins [Multiwave/Dual bolus - to cover Fat and Carbs both] when I reached home. 2 hours PP spiked to 222, I waited as it showed IOB/BOB/ACtive Insulin on the remote, I waited. As I suspected to spike further, after 3 hours it climbed to 278. I took SUper Bolus here [Correction Bolus+ basal for next two hours] and set my pump TBR to 0 for next 2 hours. I went out with a friend on a walk [1.5-2KMS], after I returned it was 77 after 2 hours from Super bolus and this was my pre dinner as well.
I put the carbs in my pump and after making all the calculations, it advised me to take 5.0[5.5 - 0.5] as pewr my targets.
I bolused, delayed to 20 mins as Indian Bread/Roti/Chapati is high in GI and I always give gap of 10-15 mins depending upon the reading.
AFter 40 mins from last bolus I dropped to 43. Panicked. Had 2 glucose tabs Of 4g each+ 2 Indian sweets that I had no idea about and decreased TBR by 30 percent.
I checked 2.5 hours after the last bolus it was 108. I was sure of going higher as didnt know about the sweets so, put an alarm to the time which will be somewhat 4 hours from the last bolus. IT climbed to 168[2AM] and finally woke up at 7-8 with 237. My fasting comes high daily and I suspect DP here, when I was a night owl I was able to escape from it as I used to sleep by 4-6 in the morning but not anymore.
After 237 gave correction bolus. after 2 hours and before Breakfast it was 173. It's been around 1 hour from my breakfast and I'm again feeling hypo now.
Learning how to adjust basal isn't easy at all. At the moment I can' think from where to begin. It mostly starts from Post Breakfast, so can't say whether it is my breakfast bolus or the overall basal or both due to change in activity and daily routine. I may be running basal test tonight, lets hope I be able to do it. I have read Pumping insulin also but I didn't like Walsh's approach also, his approach of making small changes 4-8 hours before there is change in reading was somewhat difficult and that's when I stopped reading that book, while Garry's approach was easy.
I dont have CGMs neither I can get one, here in India we have no Insurance system to cover meds or other therapy, so we are on our own.
Until few days back I have only read in the books n on web that how Diabs go in hypo first and then highs and then it makes the whole control erratic n impossible at times but now it is a reality to me.
Have been trying to reach my Dr on monday.
The benefit of doing a basal rate test like Gary Scheiner's protocol is that it separates the effects of the basal and bolus insulin. Once you get your basal rates reasonably close then you can better determine the right insulin to carb ratio and insulin correction factor.
Don't expect to complete basal testing in a day or two. My last thorough test took about two weeks. Many tests are scrubbed because the BG is too high or too low when entering the test period. It is definitely worth the effort, however, especially when you can confidently sleep through the night with a stable and in-range BG.
Don't expect a great deal of practical help from the doc. Most docs are not well practiced with the details of day-to-day BG management. I hope for your sake that your doctor knows how to perform basal rate testing, but it would surprise me.
Good luck. Don't stop trying! Because good control is hard it encourages people to give up. It is worth the effort! And besides, you need to learn to be the expert in how your BG metabolism works. No one else has as much at stake as you do!
Thanks, Terry. Today all the time I had put my TBR to 90% to avoid hypos, though I ended up with targets somewhat above my range but at least it saved me from the frequent episodes of hypos. I never ran basal test during the day and evening. I wonder how people manage morning/day basal testing, because we as T1s tend to spike after waking up until eat someyhing n bolus forvit. I have always observed this in my case n heard from other T1s also. Some call it Dawn Phrnomenon but to me it doesnt look like DP. Did you face the same problem… If yrs how you cope up with this.
I think the fasting basal test might provide slightly skewed data. I've been working out in the AM, pretty hard anaerobic stuff. It works out OK during the week but, if I sleep in on Saturday I already hit some DP issues that really blow up more the later in the day it gets. I also think that it does odd things to your metabolism if you don't eat that might skew your results off. I've never actually done basal testing so maybe I'm clueless but if you test your basal fasting, you might get different results if you test it munching away.
