Secrets of your success

#1

Hi everyone, don’t be alarmed, but I’m wanting to suck you dry of your knowledge and expertise and tips :slightly_smiling_face:.
A bit about me - I was diagnosed type 1 32 years ago when I was 10. My a1c in recent years has hovered around 7.2. I’m in England so don’t have a cgm (can’t get it on NHS and don’t have the cash to splash), but I am fortunate enough to have a Libre and use a Medtronic 640g.
I enjoy exercise, particularly running,but still struggle to manage lows afterwards, followed by big rises. This is what mostly happens, but, as you’ll all know with diabetes, not always!
I take about 20u insulin per day, and eat around 100g carbs per day.
Anyway, I’d like to get better overall control, increase time in range and, to be absolutely honest, reduce the sense of frustration I increasingly have.
If you are getting it right mostly, or just have found a peaceful place with it, please let me know. I would love to hear from you.
Thank you.

#2

You may want to pretty much stop all exercise for a few weeks except for a short walk when numbers go high just to take that variable out of the equation and lower your carbs until you have your BG stabilized where you want it. Once you have your food plan in order, then slowly re-introduce exercise and factor that into you insulin dose.

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#3

I kinda agree, except I would substitute basal testing/adjustments for diet changes.
Exercise is going to be disruptive to your BG system, so I would set up the basals so that you feel comfortable on a day-to-day level if you are not exercising. Set the basals and watch the data play out for a week without exercise so you know what is normal for work days and non-work days. Get the numbers where you want them. Sometimes this takes me a couple of weeks to get the settings right. Don’t change your basals in response to one day, or three days worth of data. Get a weeks worth of acceptable data with new basals.

Then, start adding in your running routine. You might need a temporary basal decrease to start an hour before you run. Try to figure out when to stop the decrease so that you dont go high afterwards.

Feel free to post the data so that we can troubleshoot it online, if you want. Exercise data is tricky. You may need to keep very detailed records. The data is always interesting, though.

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#4

It sounds like your biggest difficulty in maintaining time in range is volatility from exercise. This was the case with me as well. I’ve got help here and on other diabetes forums. An especially helpful guy was @Eddie2 or Eric who is a runner himself. I’m not sure if he is still on this forum but look up some of his old comments.

Recently I’ve switched to Loop with OmniPod pump. So now I set temp overrides to restrict my basal to zero during runs, and then use a post run override after run, to restrict basal only slightly to compensate for the increased insulin sensitivity. It takes some effort configuring these settings but they have kept me in range during and after most runs.

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#5

Hey @Trying, would you say that Loop made exercise easier or more difficult? How long do you run? An hour per day? I’m trying to get a sense of what my experience might be.

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#6

Thanks for all of your comments, it is incredibly focussing to post in the first place and wait for the answers to come in ( they always come in, you’re all so supportive!) it feels like such a step in the right direction, time spent just considering how one feels and what needs to happen next.
I wholeheartedly agree that basal testing is in order. I feel a bit exhausted at the thought of it though, as it’s such an intense thing to undertake, as well as going to work, family life… Sometimes I wish I could just take time out from normal life and concentrate only on diabetes.
I also agree that to remove one or more variables makes sense.
Man, I’m going to miss going to the gym for a couple of weeks!

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#7

I’m not familiar with a medtronic pump but I use an Omnipod. I decrease my basal by 50% starting a half hour before snorkeling for 2 hours. This works really well for me.
When I ride my exercise bike I don’t have to make any adjustments as it’s not enough “work” as snorkeling is.

A pump is great as you can better regulate when you actually need the insulin, I have about 10 basal settings on my pump for the day. I also try to 50% prebolus which is always one of the best tools to keep my BG’s down. If you haven’t done that, it takes extra care to do so, but gives you better after meal numbers.

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#8

Ha, I was told that I shouldn’t have need for more than 4 different rates and you have 10! Goodness, I have work to do.

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#9

Loop has definitely made exercise easier to handle. I was already using temp basals for running pre-loop but I have been much more successful staying in range since starting Loop. It takes a bit of trial and error setting up the Loop overrides, but they are working very well for me most days. My excursions from range have been short bursts of lows, but no where near as severe, and long as pre-Loop. This in itself is such a relief. Of course, Loop has been doing a fabulous job the rest of the day, too, keeping me in range. Really, I’ve never been able to achieve such consistent control before. I’ve been able to achieve 98+% time in range, with 12% standard deviation. Not everyday, but many days!

The only issues I have is changing the sensor with 2 hour warm-up, sensor failures, and OmniPod absorption. None of these are due to Loop, but I’m still trying to be more aware when these issues arise so I can take action!

I am a slow runner, mostly on trails with lots of hills, so I run anywhere from 1.5+ hours, depending on how much time I have each day.

I highly recommend you learning more about Loop and trying it, especially if you are already using Dexcom and OmniPod.

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#10

Those numbers are incredible. I would LOVE a cgm. Libre has so many positives on blood tests, mind you, so I do feel lucky to have it.
Regardless of tech though you are deserving of a massive pat on the back for achieving those figures.

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#11

Thank you, but really I could NOT achieve these numbers without the tech!!! Still a lot of work, yes, but now better outcomes! :slight_smile: Good luck getting your numbers in range, too!!

#12

Hi Charlotte, I have been a type 1 for 60 yrs. I chose to use none of the new technology and am doing well. I enjoy the freedom. I haven’t had an A1c over 5.6 in the past 20 yrs. Since I am now retired, I am finding that my diabetes is quite easy to control as long as I stick to a routine. My diet is plant based and low fat which greatly reduces insulin resistance. I eat close to 300 carbs a day. I take about 19 total units of insulin daily. I try to ride my exercise bike 7-10 miles a day.
My glucose levels always fall when riding.
For me being on a schedule with good food mostly cooked at home and daily time spent at the gym helps tremendously.

Of course when I was working and raising my child it was more difficult to stick to a schedule.

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#13

Interested in hearing more about your diet. How’d do you manage to consume 300g of carbs a day eating plant based? Does that include breads, grains, pastas, rice, etc.? When I hear plant based I think of primarily non starchy vegetables, but I’d love to hear more. Also, as you’ve said you’re older, how many calories do you consume per day? Keep up the great work! :+1:

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#14

Peep, I haven’t added up my calories lately, but I imagine I am eating about 1200. I am 5’1” and weigh 107.

I eat a lot of fruit, lentils, legumes, some rice, oat groats, sweet potatoes, pumpkin, lots of leafy greens, etc.etc. I don’t eat bread, pasta, or cereal. I eat a few seeds and nuts. Most of what I eat is organic and non processed.

I ate 30 carbs a day for 11 years and, for me, it caused several health problems. I have been eating low fat, plant based for going on 3 yrs now. The low fat greatly reduces insulin resistance. I love it. I no longer have horrible migraines and my blood pressure doesn’t drop suddenly as it was doing after years of low carbing.
My A1c while low carbing ranged from 4.7 to 5.1. It now ranges 5.2 to 5.6. I am willing to live with the difference because I feel so much better.

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#15

What you’ve described is basically what I’ve been reading in regard to such a diet, glad it’s working well for you.

Amazing work with your A1C. Do you mind me asking the frequency of hypoglycemia you experience by keeping such tight control?

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#16

Peep, I would rather run a bit low than high. I have to get quite low for it to affect my functioning. It doesn’t disturb me to be in the 70’s although I always make sure I am around 90 before driving. I like to start out the day below 75 so that I can eat immediately upon rising. Never in 60 yrs have I not woken up during the night if my glucose level for some reason drops too much. I have never been hospitalized with hypoglycemia. I worry much more about highs than lows. My husband has had to give me a shot of glucagon 2 times in 50 yrs and has had to assist me 2 other times that I can think of.

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#17

Have you considered purchasing a MiaoMiao device to turn your Libre into a CGM? When I was using the Libre it was an amazing addition. It costs about $200 USD but it is rechargeable and waterproof. Doing basal testing isn’t terribly difficult especially if you go about it by skipping only one meal per day thereby making it fairly achievable.

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#18

That’s excellent, interesting, and motivating to hear, thanks for the insight

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#19

I think its gonna take a lot of work to setup Loop, but I’m gonna try. I am most concerned about exercise. That produces the most chaotic data that I see. It gets very, very chaotic. I worry that no matter how good their predictive algorithm is, the interval of time that the insulin takes to respond is simply too long. But, under some conditions it may work very well. The final solution may just be to change how I exercise to something more predictable.

I need to work quickly to acquaint myself with the system before subjecting it to really tricky exercise conditions.

I’m gonna give it a go. Can’t make things any worse. Or can it? I’ll be very, very cautious. I worry that I may be trying to control something that is simply not controllable.

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#20

@CharlotteEngland, basal testing takes time and effort. I absolutely find that I need to cut down on “normal life” sometimes in order to properly manage my basals. That’s perfectly reasonable. Try to remember that taking care of yourself is a priority because if you dont take care of yourself, you can’t take care of anybody else.

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