Tips for CDE meet?

[Searched for prior discussions on this topic, without success.]

Was diagnosed T1 approximately two months ago, and seem to have finally achieved some stability in BG numbers although occasional spikes do occur. While I recognize that meeting with my CDE is tailored to my specific needs/regimen/maintenance, I still would like general tips from TuD members that might make the second meeting with CDE Tuesday 12/22 as productive as possible.

During first session CDE expressed no issues with my food choices, and we reviewed portion sizes and the importance of frequent sticks. Since then, nearly everything I’ve learned about diabetes has been off this site.

So… please share, from the experiences you’ve had, specific questions I should consider asking tomorrow?

Thanks in advance.

-vicki

Hi EV

Congratulations in getting your BG down to stable numbers so soon after your diagnosis!

I would consider asking the following questions:

  1. During the holiday season, are there limitations to what kinds of sweets you can eat, and what are your carb ratios for those sweets? Typically carb ratios do not change regardless of what kinds of carbs you eat (a carb is a carb is a carb), but when you eat sweets or anything high in fat content, it creates a different kind of “spike” in your BG levels. Ask the CDE how the fat and sweet break down should be handled by your injection timing and dosages.

  2. If you’re going to stay up later, to spend time with visiting family, should you change the time that you are going to inject your basal (if you’re still on MDI - multiple daily injections). If you’re on the pump, the only thing you need to consider is if your basal rate should change due to your being awake. You may need a different basal dosage because your body is still burning carbs due to being awake.

  3. If you were to become ill during this season, how should you handle your insulin intake? I know that when I’m sick I’m, firstly, not very hungry, and secondly, my BG will rise up to 200 or 250 without any food/drink consumption- and won’t come down until the sickness has gone away. Consider asking your CDE if you should be concerned with this (should it happen) and if you should change your intake regimen / carb ratio / correction bolus.

These questions might open up the discussion with your CDE to others. I can’t really think of anything else if you’re already under pretty good control of your BG. Just keep in mind that your care regimen will change over the years and you will need to keep a close eye on your BG levels and insulin needs on a normal basis. If you see a change that lasts for a few days, call your doctor and discuss if you need to change your intake.

Congrats on getting through the first 2 months!

Are you comfortable with any instructions you’ve been given about how to treat lows and highs? If not, ask!

When it comes to treating lows, outdated advice instructs people to eat some pure glucose (glucose tabs, gel, regular soda, etc.) and then have a snack. Depending on how much insulin is “on board” and how much activity has recently been done/is planned, the have-a-snack advice may end up overtreating the low, and lead to a high later.

Because we’re fighting signals from our bodies to FEED ME during a low, I think it’s important to learn to treat the low, not feed the low. During the past couple of years I’ve vowed to use glucose tabs, etc., to treat lows instead of eating for lows. Of course, if tabs aren’t handy, I’ll grab whatever is. But I do credit this for helping me get better at avoiding huge highs after lows.

As for highs, do you have instructions on a correction factor (1 unit insulin to lower a high blood sugar by __ mg/dl)?

And, have you been able to include physical activity without going too high or low? Figuring out how to control blood glucose levels while exercising with type 1 can be a pain. I don’t know about you, but I hate to have to eat something to be able to exercise (the reason I’m exercising is for weight control and lowering blood glucose). So learning how to adjust insulin, time exercise and meals is a good skill to start learning.

Best wishes for your second appointment.

Wonderful questions! Thank you, it’s exactly the sort of feedback I am looking for.

Be well, this season and always!

-vicki

Great suggestions, Kelly. I feel somewhat a dullard for not crafting some of these questions on my own, although they’ve crossed my mind in some fashion.

I do have an idea of how to treat a low (juice) but am not at all clear as to whether then to eat or not; sometimes I do, other times I don’t. Conversely, I have no clue of how to correct a high other than at a meal, which is to use a sliding scale in addition to the meal-related I:C ratio. If I have a high two hours after a meal, I don’t have clear instructions on correction.

Exercise doesn’t seem to be an issue (other than that I don’t do it enough). I test before walking and correct with juice if low; I test following, but now realize that I test only immediately after and not at any specific subsequent interval thereafter. Should probably consider changing that…

Thanks for your input, and be well.

-vicki

Vicki

I agree with Kelly

If you’re high after a meal, you should have a correction factor lined up. Because it is totally possible for us to overeat compared to what we “think” we’re going to eat during our meals. Mine, for example, is 1 unit for every 25 points over my target. So, if I’m at 200 two hours after my meal, I will have to inject 4 units to correct it down to 100.

Also, I’ve found that my correction for lows is 15g carbs for 75 points. Therefore, if I was in the 50s and drank a whole container of Juicy Juice (15g) , I would be around 150 after an hour. So, my low correction is actually pretty sensitive. (makes for some really interesting days unfortunately)

So, these are also very great questions. :slight_smile:

Correcting for a low post-meal is a new concept for me, to be sure. I am very curious, though, how injecting to correct a post-meal high would not result in stacking. Another point for clarification tomorrow…

Now I must recant the “achieved some stability” remark of my opening post because I do have post-meal highs, particularly if my meal was something difficult to calculate or different from the norm. I also seldom am able to inject much more than a few minutes before eating, so I will ask how that timing affects the high afterward.

Also, do you have any experience with planning high- versus low-glycemic index foods? I printed a guide from www.mendosa.com but haven’t been brave enough to read through the 98-page results.

-vicki

Honestly, I’m not sure about the glycemic index food charts. Every mention of them points to losing weight, so i’m not sure if it’s supposed to be pointing out which foods are easy to break down once ingested? Sorry, I don’t have experience with this. :frowning:

Hi E V,

You’re doing great! At two months after diagnosis, I was in tears not knowing anything. I didn’t even know what I needed to know to ask questions.

Timing of insulin is really important regarding post-meal highs. When food hits before insulin there will be highs, assuming you’ve calculated the dose correctly. This is as much an art as science & takes a lot of tweaking. Ratios can also change over time.

The only way to fine tune doses & timing is keeping logs of doses, BG & meals. Record morning fasting, before meals, two hours after meals, before & after exercise, before bed along with doses. A pain, but it reveals patterns.

I’m not convinced that glycemic index is at all helpful for Type 1s. The research I read that determined GI of foods was done with non-diabetics. Certainly a whole different ballgame. Digestion of carbs begins the moment they hit the mouth, unlike protein & fats. The other issue with low GI food is eating something with so much fiber that it slows digestion & effects BG later. This may be helpful for Type 2s to not get a sugar rush at once, or for people who don’t have diabetes. But, sooner or later the carbs will hit. I’d rather it be sooner while I’ve still got insulin than hours later when insulin is gone. As Marps said, a carb is a carb.

Another topic you might want to discuss is how hormones effect BG.

Like Marps, I’m sensitive to carbs. It only takes 1 gram of glucose to raise me 10 pts to correct lows, so the 15-15 guideline doesn’t work for me. Everyone is different regarding correcting highs as well. One unit of rapid acting lowers my BG 60 pts.

Hello Gerri – Thanks for ringing in!

Trust me, there’s been plenty of tears and frustration in the last two months! I still have moments but they are fewer and farther between, mostly because I learned a long time ago that I have only a certain measure of control over ANYTHING. But, boy, when they said this is more art than science they weren’t kidding! It has certainly addled my linear brain.

Hormones’ effect on BGs – I have added it to my list.

Thanks, everyone, for very helpful points!

-vicki

Hello, Vicki:) and glad you are doing well. Looks like you have gotten some good input already…just will add my thoughts to the thread.

Ask them to give you clear guidelines on treating highs…usually means they need to provide education on insulin-on-board and unit/mg-dl to bring you down. One of the primary drivers of higher HgA1c’s is the post-prandial spike in T1’s…if you conquer this…glucose variability goes down and much better and safer to get tight BGs. First step is to have good guidelines and track how you respond w/ blood sugar readings. It is a little easier on the pump because it calculates many of these things for you after you enter ratios, etc. With injections…they need to give you a handy diagram and clear correction guidelines to use.

Also ask for clear guidelines as to how to treat lows. I would recommend finding a reliable, portable, quick absorbing:) glucose to tote around w/ you. CDE will have some recs… I use Smartie candies now days…have used glucose tabs in the past. Everyone has their favs…and favs change over time. Goal is to be safe and keep you within normal ranges…not to over treat. Problem w/ food is that there is a level of inaccuracy in the portions and usually take longer to work. Only time I use food to treat, is if low blood sugar right before I eat…then I add a little faster acting carbs at the beginning of my meal. Smarties candies are great because you can take as many as you need (15 small discs in 1 roll = 6g CHO as dextrose) to bring me up to where I want to be given my blood sugar when I am low. I use 2g to raise me 10mg/dl. It is not perfect, but works better than always taking 15g glucose. Have them review best treatment for you and how to keep you in a reasonable zone after treating lows.

Echo Gerri’s recs about taking records w/ you. Should have at least a week’s worth…try to get before and after food, morning and evening…and if you can, a 3a.m. number. This may be as simple as checking blood sugars and having your meter w/ you when you at your appointment…they will download it and look at trends. This will help the educator make any changes to basals, bolus ratios, etc. w/ more information.

Good luck and hope it goes well:) Glad you are here with us!

Vicki,

It may not feel like it at the moment, but I promise that you’re miles ahead of most! Really.

There’s so much info, much of it conflicting, that it’s overwhelming. Then, just when you think you’ve got a handle, ratios change. It’s the diabetes gods. They are pranksters:)

My husband is linear, too. He has to solve problems & fix things. He keeps trying to get his head around the perfect formula for me. There is none, but he doesn’t believe me.

Blessed be the linears; we’re at least fun to laugh at!

The world needs linears!

Hello Patricia, and thanks for the welcome!

I did hear that Smarties were absolutely the best thing to carry around. I have the requisite bottle of juice (which annoys me a bit because they’re always 10-oz bottles!) and have considered Smarties but can’t quite find an ideal container to outsmart the cellophane.

As for a 3AM number to take to the appointment, I have one if only by default. Had what I think was my first overnight low last week – woke up sweating, and if I hadn’t read on this board that sweating is a symptom of crashing, I would not have thought to test.

You mention faster-acting carbs at the beginning of meals if your number is low; if my number is low I subtract one or two units per endo recommendations. What do you consider “low,” and is your method one that was recommended or your own tweak learned through experience? Along those lines, since I seldom have lead time between shooting insulin and eating, I wonder if I should consume the low- or no-carb foods first to prevent those after-meal highs.

Thanks very much for your comments!

-vicki

Hi Vicki

Low. for me, is around 50. It depends on what you consider scary. Some people freak out at 60, some wait til 40. It depends on what you feel comfortable with. I can function at 30, but not well. :slight_smile:

Knowing your carb correction ratio at times like that is imperative. 15g will raise me 75 points, so if I overeat, I will get a rebound high about 30 mins after comsumption. Then, you end up correcting and injecting when you already don’t feel well from the original low.

I’ve found that a low carb granola bar is small enough and wrapped in its own cellophane to fit inside my purse. Most are exactly 15g carbs and they digest pretty quickly because they’re mostly natural.

Very good questions Marp. I think I will be asking a few of those myself on my next visit.