How am I doing?

Type 1 and LADA
1

Hey,

I’m a type 1 diabetic, 23 years old, diagnosed 3 years ago. That was my first encounter with the disease and the nurses pretty much told me everything I needed to know before sending me home. Since I’ve been diagnosed I educated myself on the topic and learned a lot out of experience but during this three years I guess I have never really met, or spoken to another diabetic. Although I have regular appointments with my doctors and everything seems to be going fine (A1C 6.4), I’ve been thinking that I need a new approach.
Because I often wonder how my diabetes maintenance compares to others, I’d like to give you a idea of how I cope with my diabetes, wondering if some things appear strange or just completely wrong to other diabetics.

Up till now I’ve always maintained a pretty intensive control, meaning, although I don’t eat regular meals neither at regular times, I do check my BG up to 12 times a day ( is this a lot ?). I have done a trail with the “guardian cgms” but I rapidly turned it down (just couldn’t live with the idea of….). I’m still on shots and since I eat irregular that may go up to 8 times. I have no idea what “counting carbs” is all about but I make estimations according to the type of food and the weight, which most of the time are sufficiently accurate according to me. Hypoglycemic and hyperglycemic episodes are daily issues for me. I can easily have up to 2 lows in a day ( is that normal ? ).
Although I always accepted these lows as part of keeping a tight control, over time this has often caused a feeling of uncertainty (which might also have something to do with the fact that I don’t always feel comfortable doing my thing in public). Since I have daily duties which demand my full concentration or a confident approach, I’ve recently decided to abandon the tight 70-150 mg/dl criteria and allow myself to go up to 200 in order to feel more certain and be able to concentrate fully on something else than my BG-level (This way I often attend my exams (law student) with a 200+ BG, which has a lot of downsides as well). I guess I have to go this high because stress and physical activity can easily disturb my balance. Does quality of life come first or am I going the wrong way here ?

Yeah… !? so… ? this is what we all go trough every day, these are the choices we all have to make as a diabetic!??? Let me know, I would just like to hear it from another diabetic.

Thanks

2

if your a1c is 6.4, you’re doing good. My experience with hypos and hypers is that they are inevitable. If it ain’t broke, don’t fix it is what I always say. I can identify with feeling uncertain, but it sounds like you have a grip on the dynamics of your individual case/condition. It’s a crazy thing and each of us have our own deviations from the norm

Just don’t ride a high bg too often or your a1c will go up.

3

Hey anexco,

Just read your posting. You sound okay to me =)

dxd at 20… must have been a tough time – coming into your own and then saddled with the burden of a chronic disease? Sounds tough.

I have no idea what “counting carbs” is all about but I make estimations according to the type of food and the weight – cool – but you do realize that a pound of beef and a pound of rice are different, yea? No one really cares about exactly how you figure out your insulin dose, but if you are having troubles, then measuring the amount of total carbs (carb content * weight) make it easier for some of us.

I do check my BG up to 12 times a day ( is this a lot ?) … it’s more than average but not “crazy” I average 7.5. The pumpers forum average is about 10

Hypoglycemic and hyperglycemic episodes are daily issues for me. I can easily have up to 2 lows in a day ( is that normal ? ). Depends on how low. Some folks feel sick at 75 and then go get something to eat. They count that as a low. Some people fall down and need an ambulance. What is it doing to your life? Some people get ferociously angry and start fights when mildly low – again… what’s it doing to your life.

There are a lot of strategies out there. I have used insulin for 31 years, back in the day when insulin really sucked. My strategy then was to take too much insulin and eat whenever I was low. The insulin I took R + NPH lasted for 4 and 16 hours – so you didn’t need a lot of shots per day but you better be around food. I did the lantus/humalog thing for a while and now I am on the pump. I had a1c’s 6.4-6.8 and had very, very low incidence of “bad” lows (maybe 2 in 31 years).

Does quality of life come first or am I going the wrong way here ? No, I think quality of life is most important. There is a balance of “watching” what you eat and being a carb fanatic. There is overdose/eat/overdose thing that becomes cumbersome and then there’s a more realistic solution – the key is finding what you can sustain without burnout. Of course, keeping your blood sugar in the normal range helps prevent complications.

I am only guessing but if you’re you so worried about a low you drive your sugar over 200 just for a class then you’re doing something wrong. A lot of folks on basil shots have to split doses or overdose to keep fasting sugars reasonably low, the problem is that if you are fasting, then you are also dropping. Maybe it’s time to re-do your basils with a CDE or if you are comfortable then you can adjust your dose yourself. I could be way off base, too. =)

Best of luck,
Joe

4

I was in sort of the same boat as you - dx 3 weeks before the bar exam, and I started going into honeymoon just before the exam. I brought a lot of jelly beans and peanut butter and jelly sandwiches into the exam with me (got special permission from both NY and NJ to bring in extra stuff) and was eating like crazy during the sucker. On the first day, I checked my BG at the break, which was probably about 1 hour post huge load (PBJ and 20-30 jelly beans), and was at 100 . . . my advice: run yourself high for exams. I’d rather be minimally “out of control” for a few days than collapse in the middle of the Javits Center on game day. (Besides, the stress of waiting for the exam to start is going to put your sugar through the roof anyway.)

Good luck with law school! If you have any questions of the law school type, let me know . . . .

5

Wow! 6.4 is great! I’m also 23 years old and have had Diabetes for 3 years. :slight_smile: My A1C was 8% this week and I’m very upset. I also check my blood sugar up to 12 times a day, and I’m on the insuling pump. I’m curious to get some tips for you. I’m getting pretty frustrated. I agree that quality of life needs to play a role in controlling diabetes, but I haven’t quite found a balance. This week I tried to really eat on a schedule and eat carefully, but it didn’t work. Once you find something that works for you, stick with it…and you seem to have found what works for you. Good luck and great job!

6

Hi Anexco,

I’m Type 1 also. Glad you’re here! I’ve learned more from my own research & from Tu D than from doctors & nurses, who are usually too conservative.

Don’t want to rain on anyone’s parade, but the choice is yours–better control or not. An A1c of 6.4 isn’t terrible at all, but remember that it’s an average. If you have a lot of lows, you’re average looks better than it may be. My last A1c was 5.1, but I’ve had really high highs balanced out my low lows. My A1c looks good on paper, but I know it’s near as good as it appears because I know the control isn’t there.

Great that you’re testing that much & making corrections!

Highs cause damage to every system in our bodies. Lows, though not as damaging in this sense, prevent us from functioning normally, as you know. Some believe that the swings between highs & lows is damaging & risky.

Allowing frequent BG of around 200 isn’t healthy. Quality of life–indeed & I understand. But, quality of life can also include quality of long life without diabetic complications. Hard to think about this when you’re young & under the stress of law school.

Learn to count carbs. It’s not hard at all. Get a scale like Eat Smart, which shows carbs for 999 pre-programmed foods.

You’re just kind of guessing now & carb counting will give you better tools to know your real insulin needs. Lows are not indicative of tight control. Just means that you’re over-doing insulin, not matching insulin to food, activity level, etc… We all have high & lows since they are too many factors beyond our control & efforts, but we can narrow the margins. Learning what your carb/insulin ratio is & how certain foods effect you will put you in control.

Our bodies get used to highs. Once your BG is more stable & closer to “normal,” you’ll be able to handle school without having to maintain high BG to concentrate.

7

Having read Gerri’s post, I realize that I need to clarify my last post. Don’t run in the 300s for your exams - but you’d probably be safer (and not as worried) staying around 140 rather than around 85. For me, a BG of 85 would have me worried as hell the whole time that I was starting to go hypo, and since (for me) hypos can feel a lot like exhaustion, which was my usual exam state . . . .

When I took the bar, since I was so recently diagnosed, on the advice of doctors, I was trying to keep my sugar around 160-180, which was a hell of a lot better than it had been 3 weeks prior!

Gerri is, of course, right about carb counting, etc., and about the dangers of running in the 200s.

Your best bet, however, is graduating from law school and not having to take the exams any more!!!

8

I would like to start by thanking you all for replying, it means a lot to me.
It pleases me to hear that I’m not completely off the beaten track.

After reading and thinking about what you all have written, I have to conclude once more that there are indeed some unquestionable basics to which we all yield, but when it comes down to the daily decisions we make in managing our diabetes, these last ones, are mostly personal opinions on how we feel most comfortable living with the disease. I just wanted to know if I still knew what those basics were.

For some people, even with a rigid diet it’s hard to keep there sugar in control ( to the point that they’re actually asking me for tips! ), others have more succes (A1C: 5.1 !!! wow! ).

DOV: Ah exams, I sometimes think they’re just there to annoy the diabetics among us. I guess I’ll try to learn to cope with stress first and then see if I have the nerve to aim at 160. I’ve seen stress do some very strange things with my BG. But as you know “nemo censetur ignorare BG”!

ps: I’m from Belgium (as you may have noticed while reading), so i’m a stranger to your legal education. No law schools here, just plain university.

KIM: If you have any questions, feel free …

GERRY: I took a look at you’re Eat Smart scale and although it looked interesting at first sight I’m just not sure if it will work for me. For example: I eat the same whole-grain bread from the same bakery every morning. I generally don’t even allow myself to eat one from another bakery even if the bread is called the same name, it may contain different ingredients, sufficient to mess things up. How would the scale know this. Do you measure the carbs in your vegetables and meat/fish ? Not even to mention that it might be impossible for me to buy it from Belgium and I might not be familiar with the pre-encoded products.
The easiest way for me is to be consistent, some sort of routine in what I eat and how much I eat of it.
But seeing this is the time for CHANGE I’ll give it another thought.

Thanks !

9

Exactly–consistency & routine & portions–you got it!

Sorry, didn’t know you’re in Belgium when I suggested that scale. Perhaps you can find one similar. Good question. The scale can only calculate raw ingredients not processed products, but using it at home for cooking will help you judge portions & their carbs when you’re not eating at home. No way to judge your bread, but you know how this effects you. Most bread (fairly thin slices) are estimated to have about 15-20 carbs per slice. The particular scale I mentioned has values for meat, fish, nuts, poultry, veggies, fruit, cheese, even herbs. I’ll be damned if I’m going to count carbs in a teaspoon of herbs:) Gives in metric, along with sodium content, fat, etc. It also gives the cooked & raw carb counts. This does make a difference, interestingly. Raw veggies have less carbs than the same thing cooked. Who knew?

There are several very good on-line carb counters–many thousands of foods listed. They are also lots of good sites for low carb recipes, not that you have much time to cook with your studies!

Yes, I measure carbs for everything I eat. Realize it sounds daunting (& not much fun), but it’s easy & soon becomes second nature.

Meat, poultry & fish have no carbs. Eggs are 1 carb per egg. Oils & fats have no carbs. Doesn’t that make it easier! Some shellfish has some carbs, like scallops. Cheese has 1 carb per ounce (guess that’s 28 grams). Dairy products like cottage cheese, sour cream & milk have significantly more carbs per serving. Cream cheese is low carb. Heavy cream has very few. Generally, the higher the fat content, the lower the carbs. I use unsweetened almond milk for some things because it’s very low carb.

All grains & grain products are high carb. Fruits are also, especially tropical fruits. Juice is really high carb. Some vegetables are high carb–potatoes, tomatoes (really a fruit), winter squash, Some veggies are very low carb–asparagus, cabbage, broccoli, cauliflower, summer squashes, turnips, cucumbers, green leaf lettuce & other greens. Look up on an on-line carb calculator the foods you generally eat to get an idea. It’s all about proper portion size, too, of course.

Keep in mind that eating food that has a lot of fat will slow down how carbs are absorbed. Many us experience the problem of having BG being in a good range 2 hours post meals only to have it shoot up 4 hours after eating. This can happen if the meal has a lot of protein &/or fat.

About 50% of the protein we eat gets turned into glucose eventually. It’s not fast acting like carbs, but just something to consider in adjusting your insulin to food. What I’ve been told is to try to eat the same amount of protein per meal from one day to the next. Not the same food, but just the same amount.

Sorry, not trying to overwhelm you, really. Just wanted to pass on the things that no one told me that had me confused & frustrated.

10

Law school is essentially three years of absolute, unadulterated hell, punctuated by screaming professors and 3.5-6 hour periods of sheer horror called “exams” - that part, I’m sure, ain’t so different. Basically, take all the overachievers, throw them in class together, and have hundreds of pages of reading a week, preferably cases from the 1800s. (I’m exaggerating slightly for effect, mind you, but you get the drift.)

I actually wonder if, had I not been studying for the bar, I would have been diagnosed when I was. I think it was the stress of knowing that three years and $220,000 of education rested on faking my way through a 2 day exam that put my sugar up to the point where I became symptomatic. My A1C was 10.8, but it was clearly “front loaded” based on my blood sugar levels at the time of diagnosis. Even on insulin, while I was sitting waiting for the bar exam to start, stress shot my sugar up way past 200. I don’t remember the exact number, but it was not a pretty one.

11

Anexco,

To add to Gerri’s email… You can go to www.CalorieKing.com and it will give you the carb count on just about every food you can think of, including restaurant meals, either by the restaurant name or as a general food type (italian, indian, chinese, etc.) Calorie King also has a paperback book they put out and you can buy from their website.

I’ve been a T1 diabetic for 8 years and have always used some sort of carb counting book to help me. Calorie King’s is by far the best I’ve come across. Unfortunately, I just checked their website and they cannot ship online orders international, but the website is always free and you can use it to look up carb counts as long as you have an internet connection!

12

I didn’t have a chance to read the other responses… But I think if hypoglycemia is a daily thing, it would be really helpful to start counting carbs. Every unit of insulin you take covers a certain number of carbs–if you don’t know that number, you’re never going to be in control. You shouldn’t have to allow yourself to go up to 200 just to be sure. I’ve done pretty well counting carbs and eating less of them… I eat 14 carbs a meal (9 for breakfast) and 130 is a high reading for me. Usually 105-115 after meals, 80s fasting, and I haven’t been low about almost two months. (though maybe thats partially because I’m still honeymooning)

Good luck.

13

I am 22 and coming up on 3 years since I was diagnosed. When I found out my sugar was 588 and all they did was hand me a bag of needles and insulin and sent me on my way! It took a year before they put me in diabetic edu. classes which were SOOO helpful!! I met with a nurse and a dietitian, they taught me how to count carbs, how many to have for each meal ect… I would strongly suggest that you check that out if you arent sure about counting carbs. The other thing that really helps me is exercise, that in combination with the diet that they put me on keeps me on track but the diet alone didnt do it completely. If you have any questions let me know!
Good Luck!
Ashlee