Hi guys just wondering if i could get some advice and opinions.
I was diagnosed type 1 mid jan this year. This past week i have been having trouble maintaining control. I developed a nice steady rythem of 1 unit bolus (novarapid) to cover breakfast, lunch and dinner, with 7 units lantus. All this kept my bloods between 4-6mmols.
Im under a slight bit of stress at the moment and my blood is all over the place. Monday i woke up at 8mmols which is just out of the blue. No diet variation or anything, i actually eat routinely the same thing every day. 2 hours after breakfast i was 11 mmols?! The next day i had good control until night time when i had my chicken and salad meal. Shot up to 9mmols when a bolus always brings me below 6. This morning i got up and my fasting was 5.9 which isnt too bad, but 1 unit with my oats and 2 hours later im 8mmols.
It seems that sometimes 1 unit covers me, other times it doesnt. Would the added stress im under contribute a bit to this or is this a sign of the honeymoon ending? Its annoying that my readings can actually drop 1mmol within 5 minutes. Should i try cover with 1.5units or 2 units? Thanks :)
Hi guys just wondering if i could get some advice and opinions.
You need to gear your mealtime bolus to what you're actually eating, timmy, rather than just take one unit across the board, though that might have worked for a bit. You want to get in the habit of counting the carbs you are eating and then figuring out an insulin to carb ratio. Some people start with 1:15 (1 unit of insulin for every 15 carbs) and then, depending on results, wiggle it in either direction until you get good results.
Hi timmy -- I've been tracking with your postings over the past several days,and as you know from one of my replies (hopefully you saw that), I never had a honeymoon. And from what you've written here, it does sound like something could be changing in you. I'll say this -- your insulin intake seems very low for a T1, so that would indicate that you are in honeymoon (possibly), as you have suggested (1u of fast-acting never ever covered me for anything...). There is no set timing to honeymoons, no five-weeks-and-you're-out sort of thing. It's different for every body (two words on purpose). So, it could be that your honeymoon is drawing to a close and it's time to get back to your Endo to see what's up and set new insulin intake levels. That said, stress and adrenaline and worry can all contribute to radical BG shifts, so you must consider what you are experiencing right now -- is it any different than earlier in the week? If so, can you mitigate it to see if you can return to some normalcy?
Welcome to the crazy roller coaster we call Diabetes. I think since you are newly diagnosed you can expect random weird episodes like you are experiencing. I found that to be the case the first two years or so after diagnosis. As soon as I thought I had something figured out, it would suddenly change. There are so many variables that can affect us like your stress level, health and a million other things.
I think the thing to keep a strict eye on now is your basal level. If that is set correctly you will better be able to adjust to the change in insulin needs in relation to the foods you consume. I did find as a newbie that sticking to the same foods was really helpful in figuring things out as you start to exit the honeymoon stage.
In a way it is a relief when your pancreas is finally nonfunctional. At least you can rule out random pancreatic action from the equation.
The kind of frustration you feel right now will come and go with this disease...it's just the way it works. But the necessary adjustemets do get easier.
I think it's great to ask as many questions as you can. No questions are too small or too silly. I have read on these forums every day since my diagnosis and it never ceases to amaze me that I learn something new every single day about this disease. Information is our greatest tool in managing this disease.
thanks Zoe :)...atm im at 1:30. It just works out that i can eat 30gms of carbs with oats, 30gms at lunch and night is the same. I actually snack throughout the day the rest of my carbs but in dribs and drabs to make up 150 a day total. Othertimes i will eat say 30grams prior to exercise in the afternoon and not bolus.
thanks Michael. Yep 1 unit is bugger all i know haha, but it what used to cover me for my higher carbs meals (30gms as mentioned above). The problem i am finding is there is no pattern. I can be good all day and have a low carb meal and shoot up to 9mmols, but then back to 8 within 5 minutes sort of thing. If there was more of a pattern i could increase my dosage is needed. I guess i will need to document this a fair bit more
thanks drsoosie! It is a frustrating disease for sure. Things go nicely and all of a sudden you get big highs (or lows!) out of nowhere. In some ways im hoping the honeymoon ends too so i can find a set dose!
Yeah... seems like you need more info on your end just now due to the radical shifts. I know you work out a lot -- don't ever stop! -- but that said, I know that my sugars go all wacky on me when I am down in it riding the bike (and afterwards...). My Dexcom has done wonders for me, revealing the patterns that happen as a direct result of all that activity. Good stuff. Right now this is all new to you, AND you're in honeymoon which certainly doesn't help a bit, but eventually the patterns will begin to emerge. Only thing is, it changes day to day, even after 30 years of it! Oi!! I just try to do the best I can, and I hope you get to a point where it is not so vexing nor worrying for you. It's great that you are a tri-athlete, and there is no doubt in my mind that you will be able to keep this up until you are an old man. I still ride 12 and 24 hour races and I am 53. I just have to stay on track, and not sweat the ups and downs. They happen.
24 hr races, i thought i was nuts!
Dexcoms are 6 grand here in aus. A pump is 7. Ill wait out the honeymoon and prob get a pump which insurance covers (CGMS arent though!)
Let's be clear -- I roll the 12 hour races solo, but I was on a 4-man team for the 24, and it was still hectic (we did come in 3rd, so we podiumed, which was really cool for an old guy like me).
Yeah, the insurance thing for this stuff is such a drag. Sorry to hear it is currently out of your reach. When/If the time presents itself, do make the effort to check out a CGM. You, as an athlete, will find it very beneficial.
Yeah, it's a pita.
You're doing great with your routine but, because of your honeymoon, everything else is so imprecise for you. Your insulin production is, by nature, all over the board and there's no way to predict when it will kick in and when it will leave you high and dry. That doesn't necessarily mean your honeymoon is coming to an end. Sounds like you've been working hard and as you've been working on your IC ratio, correction factor, and basal dose, you could just be reaching the limit of your precision. A fraction of a unit less on your dosing, at this point, could translate into a bigger spike. Any variation in anything is going to be magnified.
You're doing everything you can so don't beat your head against a wall or worry too much. Be prepared to treat lows and correct highs and keep it up!
thanks FHS, i tried 1.5 units and that got me steady at 4.9/5 so that extra half unit made alot of difference!!
I'd suggest that instead of 30G w/o insulin before you exercise, maybe 10G to start out with and another 10G every 30-45 minutes or so? I usually just have maybe 2/3 of a cup of skim milk for 25-30 minutes of running but I don't usually eat more before if I'm going farther, I kind of keep an eye on my BG and see where it's at like 2-3 miles into it and try to keep it balanced in the low 100s as I chug along, if it spikes, I just skip the snack and run a bit more and it will usually wear off but, with less carbs, the spikes aren't as severe and are more easily controlled I think?
I also wouldn't get too excited about "finding a set dose" as my doses always shift, 27 years into it. Oops, it's 28 now I think or just about?
your doses still shift? I thought, sickness etc aside, they stabilise a bit! bummer !
.5 units dropped you 2 points on your BG?
Um yeah, don't worry about leaving your honeymoon phase anytime soon. =P
Yeah, they do stabilize a bit, or more to the point, they don't fluctuate as wildly as they do during the honeymoon.
They still show trends according to all kinds of variables that are predictable, more or less. For my pump, I have a couple of different basal programs depending upon the situation or site, and I'll still program in a temp basal if necessary. Bolusing is more predictable, but it still feels like a crap shoot on some days.
Yes, unfortunately, timmy, FHS is correct. I'm the same way, I tweak my basals (though that is, easier to do with a pump) but my I:C ratios stay pretty stable for long periods of time. Which, however, doesn't mean I don't have periods of being too high or low; I do and they seem to come in clusters for me followed by periods of stability. You do seem a bit set on the "fixed dose" idea - increasing from 1 unit to 1 1/2 for your bolus. It's funny I did that at the start too because the only endo I ever saw said "1 to 3 units with meals). Gerri was the one who explained it was more complicated than that and encouraged me to learn about I:C ratios. If nothing else, it allows for more variation in what you eat.
Yup. I had some weird shifts going into the marathon, like a month before the race, DP went *NUTSO* and I turned my early AM "bump" up 50%. Usually, an adjustment of .05U/hr-.10U/ hour will "cover" a change, whether more or less. At that time, I'd just done the biggest running week I'd ever done (PR 1/2 on Sunday, 20 miles 3:10 on the following Saturday...) and my AM BGs where through the roof! It took a couple of weeks to get it hammered out w/ a huge bump *and* I was really apprehensive that cranking tons of insulin would lead to some sort of race day disaster. It didn't although the race didn't go as well as I'd have liked as I ran too fast out of the gate, perhaps overconfident? I still beat the pregnant lady though...hee hee...