Hi guys. I have been diagnosed in March this year. I am clearly still honeymooning, because I only need 8 units of Lantus daily. My bolus insulin is Humalog.
I am a rather weird case bolus wise, because while one unit brings my BG down by 60 mg/dL, it can only cover about 10 grams of carbs (sometimes only 8 in the morning) … unless I eat high carb meals, in which case the ratio seems to be 12-13 instead. I suspect that at low dosages, the bolus insulin is absorbed less efficiently.
Anyway, I diligently pre-bolus (typically 15 minutes), and have reduced my daily carb intake to about 20-100 grams per day. I also made an effort in losing weight, and I was successful - after leaving the hospital, I weighed 87 kg. Now I’m at 74.5 kg, and with a BMI of 23.9. When I was diagnosed, I had DKA, which made me lose about 5 kg, so I was at 92 kg before all of this happened. (I did nothing special to lose weight, I simply reduced my meals to stay at a calorie deficit, sometimes even fasting. My electronic scale tells me that I’ve been mostly losing fat.)
BG control wise I am trying to get the most out of my Libre, and so far it worked very well. Sure, I’m still honeymooning, but if I don’t bolus carefully, I can easily spike to >180 mg/dL. However, that has happened only once since I was in the hospital. And, my last HbA1c was 5.3%. My daily mealtime spikes usually stay below 140 mg/dL, since as said, I pre-bolus, and also eat slowly when eating fast acting carbs like bread.
I read TONS of stuff about T1D. Maybe too much. One big problem of mine is anxiety. When the BG rises, I get nervous. Somehow I developed a big fear of high BGs. In the past, it drove me mad if the BG was at, say, 160 mg/dL after the bolus insulin ran out in case I mis-bolused. Felt like the end of the world and that any spike will 100% net me complications. I think everybody here will agree it ain’t. 160 mg/dL are nothing to worry about if I bring that down quickly enough, and if it doesn’t happen too often or stays there for too long. My fasting BG is around 90 mg/dL.
So, the questions:
I am using Lantus, however people have recommended Tresiba. This forum seems to be full of Tresiba fans. However, I also want to start exercise. And, as said, I’m honeymooning. This is a rather confusing combination, because I’ve read that very low basal doses like the one I use can interfere with the action profile of basal insulins, meaning they don’t last as long. Also, if I exercise, I have to lower basal, which is tricky with Tresiba. I have read here though that some people did not have as many post-exercise problems with Tresiba as with other basal insulins. So, I want to use up my current Lantus cartridge and then give Tresiba a chance. Or what do you think?
For the Lantus -> Tresiba transition, I think it would be good to do this over a weekend, to be better able to constantly check my BG. I suppose it will be elevated and require regular correction bolus until Tresiba is set in right? But what about the people who needed weeks to get Tresiba to work stable?
Exercise: If you use Tresiba, how do you combine it with exercise?
In the long run, I want to get a closed loop. I am very tech savvy, have been developing software for about 20 years by now (mostly C and C++). Any of you here looping? How much does it make your T1D management easier, and what is your time-in-range (also what is your target range)? And, does a closed loop make sense in an “untethered” manner, that is, closed loop + low-dose Tresiba for example?
To get back to the anxiety, I am trying to come with some guidelines to put my mind more at ease. My current one is: I aim for keeping things in tight control 90% of the time. 7% of the time I moderately exceed the target range. In 3% of all cases, all bets are off (this covers infections, unusually high stress levels etc.) Currently I am way above that - 99% time in range, 1% below. This will probably get worse after honeymoon, but this is another reason why I’m thinking about Tresiba, pumps, closed loops etc. to “prepare” myself so it does not get much worse. Anyway, do you think this 90%/7%/3% rule is good? I have a target range of 70-160 mg/dL, and as said, a target fasting BG of 90 mg/dL. And, any other tips for dealing with high BG anxiety?
As an extra to #5, what are fasting BG ranges you’d consider “safe”? I ask this to further put my mind to rest. As said, I try to keep a target fasting BG of 90, and generally keep it in a 80-100 range. But I suppose even 110 would not be so bad, right? What is a fasting BG level that you would consider worrisome? What would be your threshold? 115? 120?