I have been a type 1 diabetic for 4 yrs. My a1c stays between 7.3 and 7.5. I want it 7.0 and below and can not get it there . I started wearing the dexcom 2 yrs. ago being told it would help me reach my goal and have been on symlin. I am not exercising because of all the bs fluctuations. Can anyone help ? I need a support system. I feel helpless at times and not to mention extremely frustrated. Thank you Tricia
Hi Tricia, I'm sorry you're having so much fluctuation and you're so frustrated which is understandable. What does your endo/doc say about it? I think you can definitely get them under better control, it may take time with changes in diet, exercise and maybe some oral meds. I was diagnosed last year and went lo carb pretty quickly. This helped me a lot although I still have a lot of fluctuation too. I think you have to exercise no matter what, even if it is just a walk or some housework. The first thing I do when my bg goes up is dose insulin, then drink water then exercise if it's really high, if it is spiking up that will often help stop a spike for me too. I'm on symlin too, this has helped my hunger symptoms quite a bit. Have you tried increasing your basals etc? And maybe bolusing more for meals? I have started alpha lipoic acid and I have been taking melatonin for a while to help sleep(increased that) and my insulin needs seem to be decreasing, I'm not sure if that is reason yet though. Don't give up, you will improve your control somehow, I'm sure of it. Do you keep a log of what goes on and look back at it when you spike etc.?
Tricia here's what I would do.
First check if the basal insulin is ok. Basically you want to have no fluctuations in your BG during fasting. Here's how to do it: Basal Test
Next check if you are bolusing correctly your meals. That is the amount and the timing of insulin. Try not to overlap boluses giving 4+ hours between meals.
In my opinion to reach a tight control eating choices (don't make me say diet!) are fundamental. I changed my habits recently and I've got a great control with that!
Facing obstacles is part of what we do daily. I know it can be wearing from time to time. But that's what makes us pretty and strong.
Just keep in there and you are gonna achieve a perfect control on your BG!
So having a CGM can really help, if you can't measure it, you can't control it. But despite what many of us have been taught, controlling our diabetes isn't just a matter of taking the prescribed insulin doses, and counting carbs. We need to learn adjust our insulin dosing, so both meee and rick made great suggestions. And rick pointed you to website called integrateddiabetes.com that describes basal testing. But I would ask you to also invest in yourself. Buy the books "Think Like a Pancreas" by Gar Scheiner who runs integrateddiabetes.com. Another good book is "Pumping Insulin" by Walsh
And once you have addressed the insulin issues, you can work on your diet. And again, we have been told that we should just be able to eat whatever we want and dose our insulin. But for many of us, that is just not true, we need to control and restrict carbs to reduce blood sugar swings. And I would assure you, that if you work with us and put all these things together, you can get better control and there is no reason you cannot tame this beast.
I really appreciate all of you giving me ideas and thoughts to ponder. I will take these things and run with them. Rick, do you take symlin? How should I basal check while on Symlin? In other words, if I fast lunch , but took Symlin with breakfast, how accurate would that be? But if I don't take Symlin with breakfast, even with increasing my bolus amount I still run high thus keeping me from fasting. Does that make sense?
Is it just me or does all this number crunching and basal checking make your brain feel like mush.
No, I'm not on Symlin. But that shouldn't be a problem, just make sure you have digested your prev meal and start your basal test (accordingly to the link).
However, I don't really know how Symlin works therefore can't be sure if my thoughts are correct.
Breakfast is the most difficult meal to handle because of the long fasting of the night. When you eat it's more likely your BG is gonna skyrocket fast.
I personally tried a mix of both low carb breakfast and pre bolus to solve this specific problem.
Really mushy but it's part of the game! Keep it up! (not the BG ;) )
Smylin mimics the natural hormone amylin, which is produced alongside insulin. Amylin controls the emptying of your stomach. Normally, when you eat a big meal your stomach gets this signal to release measured amounts of food into your digestive system. But for those of us who are pancreatically challenged, this doesn't work right and your entire meals goes "whoosh" and you have a big blood sugar spike. So Smylin helps slow the release of food from your stomach to more "normal" levels. The GLP-1 drugs (Byetta, Victoza and Bydureon) also act along this pathway and some T1s have reported that they help as well.
It should be fine to take your Smylin as normal at breakfast and then do you fasting test later in the day. A prerequisite to a valid basal tests is starting with a normal blood sugar.
Thanks for the explanation. I've read about those on various books but prefer not to give advices on drugs I don't use and know perfectly.
Just out of curiosity: is Symlin (or the mimetics) easy to dose and manage?
Symlin is actually very difficult to dose and manage. Everyone needs a different dose, at a different timing and needs to reduce their insulin by a different percentage while using Symlin. Then some people have problems with side effects so they can't manage it. Some find it does little for their blood sugars (although they can manage with less insulin), some find they don't lose any weight (if that is their goal). But some people do get through all that and have good results with either spiking control or weight loss or both.
Personally, I would advise the OP to stop Symlin while she gets her doses (I:C, basil, ISF) figured out as it muddies the water quite a bit and makes just too many variables. Then once she stabilizes she can go back to it if she wishes.
What are your goals and how closely are you hitting them? 7.3-7.5 seems to be an average of 163-169.
I agree with the suggestions here already. I found helped with that were treating lows with less carbs, since you mention BS fluctuations. If you run low and have 15G and it runs you high, try 10G of carb and see if maybe you don't go as high? Sometimes if your BG is only a bit off, it may not need a huge boost, particularly if you have "food on board" to go with the "insulin on board". This is, of course, somewhat challenging and you have to test a bunch to get results that work. If the dexcom is showing good results, I would rely on it to confirm you're coming out of the low but doctors and Dexcom or Insulet or whoever would probably say "test your BG w/ a meter".
I never tried Symlin but have been able to get ok results w/ pumping and testing and adjusting insulin doses. High I take more insulin and low I take less. I may sort of "cheat" because I eat pretty much the same thing for breakfast and lunch during the week. This gives me a useful "lab" with which to test my bolus ratios and basal rates and, if something gets off, I can usually spot it in a couple of days. It's also taught me that I don't have to be off by that much, even .1 or .2 G of carb/ unit or .025 and the numbers can 1) be off in the affected time period and 2) have "ripple" effects from the need to fix the off number that can throw off other numbers. One thing I read on another message board that I found to be useful was the suggestion to fix one time at a time, like lunch or dinner or whatever, save breakfast for later because there's so much going on. If you can get lunch (say...) figured out, then you can feel good about that and kick breakfast's butt.
RE support system, Tu is a great place to get answers, lay out tactical problems "I ate x took y insulin and my BG was 'woah'" or whatever and kibbitz and help people. The more data you can share, probably the better your answers will be. My issues (mostly rx stuff...) it takes about two days to get answers. Here, there are people floating around 24-7 since, with people in Germany, Australia, the Philippines, etc. the sun never sets on Tu.
Got it, tks Zoe!
I agree with Zoe that Symlin is not easy to dose and manage. When it’s started, it must be titrated (from a low starting dose to the higher therapeutic dose)to minimize unwanted side effects. One of the main side effects is nausea. I also agree that managing Symlin while also trying to establish acceptable BG control confuses the situation.
First and most important is to test you basal rate and confirm that the dosages are correct for your body. Remember that basal rate changes may not show the entire impact of Non-Meal BGs and I:C ratios for up to 72 hours.
Don't hurry or get frustrated. As may have pointed out, patience and basal are one of the keys to successfully managing this T1D crap 24/7.
Hang in the and read "Think Like a Pancreas" to help understanding what may be happing with your basal, I:C and hitting your targets.
My first thought was to test your basal dosing, so I was glad to see most every other poster responded in kind. (Ahhem, glad that I knew basal testing was warranted.)
I am on rapid acting insulin: Novolog. I'm guessing you are on a rapid insulin too? I am also on Symlin; have done well with it; and, am very happy. Although I would have liked too, few wouldn't, I haven't lost any appreciable weight and I'm close to two months of taking it.
The question at-hand though is why you're fluctuating. Once you have your basal under control, consider how you're timing your bolus doses. I typically bolus and take my Symlin 15-20 before I eat (basing my timing on what I am eating.) Many others [edited to add: bolus and] take Symlin after they eat. Some only cut their bolus by 20%; I cut mine by 50%. As many have said, Symlin is not easy, but I also didn't find it too difficult, but it worked for me, and I think that is, in part, what made the biggest difference in my control. Too, at a meal if you have a mix of high glycemic index (GI) foods with low GI foods, eat the low first, then the high.
The timing of when I bolused/ate (I learned about by reading "Think Like a Pancreas" by Gary Scheiner) made all the difference (in part) in the world to my control.
I am a relatively new Type 1 Latent Autoimmune currently on MDI and Symlin.
Tap
Tricia,
You've gotten lots of good advice here.... I 2nd all the same things:
1) Get basals adjusted so that when you are not eating, your BG is flat.
2) Get your correction (ISF) and carb ratios (I:C) set correctly (only AFTER the basal is adjusted, as the two influence each other )
3) If you eat a lot of carbs, consider reducing the amount per meal. I don't practice
Dr. Bernstein's 30 carbs a day, but small amounts do mean smaller errors, both up and down. Your swings will be less.
The books recommended above will help you with all that . And I'll bet your A1C's will start heading down and in 90 days you will be below 7, doing more fun things in your life, and worrying less about diabetes.
I wanted to add that women are facing more challenges due to their 28 day hormonal cycle. This is very individual though. Some women experience more problems some less. I have read about women taking birth control pills just to minimize these effects.
The result of the menstrual cycle can be that you have one week with homonally induced insulin resistance. This is usually (without any guarantee) the week before the menstrual bleeding. To counter the insulin resistance it will help to increase the basal dosage for this week. Some women wait for the first signs of resistance and start to adjust their basal. The key is to track your cycle to identify this pattern. It is a lot of work but you will have more control by integrating this important factor.
I know that because the female users of our Glucosurfer App asked us to keep records of their cycles: