so i'm currently in the process of looking for a new place to live which oberisoully isn't stress free and just wondering if I should consider adjusting until I've found the house)(I know I need to e weary as I know for some people stress can make it go either way)
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do you tend to adjust for stresss.
- Thread starter rayray119
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Hi @rayray119 ,
I'm far from an expert at this. But so far I've found most stress to be unquantifiable and certainly not in advance.
When I'm starting to get some sort of medical ailment, I sometimes get a hint in advance by my BG rising and staying high. But it can take another 24 or 48 hrs before I find out what that ailment (problem) is. Meanwhile I'm trying to correct by bosul doses alone, not sure if its a medical matter or just got something else wrong. When my basal was Levermir I could adjust my basal, once I knew the problem was triggered by a medical 'thing' and I would increase by initially 20% and monitor. Now I'm on Tresiba and can only get corrections with my bosul anyway.
If I'm getting stressed by something like a frightening or tense film or TV programme, I see my BG rising on my CGM; but I do nothing and usually that dissipates on its own, or if late in the evening I just apply a small correction as I go to bed.
But stress from domestic or family 'events' (such as your plan to move house) is, for me, impossible to anticipate so I can only manage it during the day, bosul dose by bosul dose. I very rarely stack insulin (and my Endo at an appointment last week commented on that being a very good way to manage my DM) so if necessary I wait 3 or 4 hrs before the next correction. I think, even if I was back on Levermir, I still wouldn't adjust my basal for the scenario you are describing. You could see a house you like and feel great, then it can't happen and you get stressed, then things look likely again.... and you can imagine it's so unpredictable for twice daily basal correction. To make that worse, you might change a basal dose then circumstances change in the next few hours and you've got the dose wrong! By day you can "chase the sugar" by either extra snacks or an insulin tweak that occurs from basal changes, but that can be tricky when working and very difficult by night.
Finally, you are currently on MDI regulated only by finger pricking. So it's even more difficult for you to know where your BG is going to be in 4 hrs time. Juggling with your basal on a half daily basis seems to me to be a recipe for great difficulty. You need to do some fasting checks, get your basal as right as it is reasonably possible to achieve (perfection is not possible) then trust that and manage your BG in response to what finger pricking is telling you.
I know you have previously been having difficulty in getting sufficient test strips. Has that improved now?
I'm far from an expert at this. But so far I've found most stress to be unquantifiable and certainly not in advance.
When I'm starting to get some sort of medical ailment, I sometimes get a hint in advance by my BG rising and staying high. But it can take another 24 or 48 hrs before I find out what that ailment (problem) is. Meanwhile I'm trying to correct by bosul doses alone, not sure if its a medical matter or just got something else wrong. When my basal was Levermir I could adjust my basal, once I knew the problem was triggered by a medical 'thing' and I would increase by initially 20% and monitor. Now I'm on Tresiba and can only get corrections with my bosul anyway.
If I'm getting stressed by something like a frightening or tense film or TV programme, I see my BG rising on my CGM; but I do nothing and usually that dissipates on its own, or if late in the evening I just apply a small correction as I go to bed.
But stress from domestic or family 'events' (such as your plan to move house) is, for me, impossible to anticipate so I can only manage it during the day, bosul dose by bosul dose. I very rarely stack insulin (and my Endo at an appointment last week commented on that being a very good way to manage my DM) so if necessary I wait 3 or 4 hrs before the next correction. I think, even if I was back on Levermir, I still wouldn't adjust my basal for the scenario you are describing. You could see a house you like and feel great, then it can't happen and you get stressed, then things look likely again.... and you can imagine it's so unpredictable for twice daily basal correction. To make that worse, you might change a basal dose then circumstances change in the next few hours and you've got the dose wrong! By day you can "chase the sugar" by either extra snacks or an insulin tweak that occurs from basal changes, but that can be tricky when working and very difficult by night.
Finally, you are currently on MDI regulated only by finger pricking. So it's even more difficult for you to know where your BG is going to be in 4 hrs time. Juggling with your basal on a half daily basis seems to me to be a recipe for great difficulty. You need to do some fasting checks, get your basal as right as it is reasonably possible to achieve (perfection is not possible) then trust that and manage your BG in response to what finger pricking is telling you.
I know you have previously been having difficulty in getting sufficient test strips. Has that improved now?
i'm usally testing two hours after eating anyway to get a idea of parents or hows it go. so well I still might not see as much as would if my libre. i'm currently getting around the test issue by ordering when the cannot reorder until a date to delay problems f needing to explain myself. a nurse I spoke once tried to get not to the do the 2 hour after check and I was like no i'm not going to stop doing that because it helps me to get a idea of how things. the adjusting basel and an informed discussion. right now i know there's a reason on why i running higher and know why that is bassed on previous ocusiions so that's way i thought okay lets try hal a unit extra) so yes i'm not just 2 4 tests and making dicuions on that). the whole reason i changed to livermir was that it was a lot more flexible then trisbria. trisbria would be a nightmare with my pump. with livemir its not a complete diseter if i get the wrong does as its waters of before hand. i know being on mdi isn;t the best for job but it would have. but doing the checks you mettioned.
hey sorry hope none of this came across in the wrong way
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Hi rayray, your dispraxia is teasing me ... ability!
Adjusting your Levermir and making informed decisions means, to me, that you might need to make extra finger pricks.
You have to assess (guess really) what your forthcoming day's activity is likely to do to your BG - or have a fixed morning basal and regulate through the day by snacks and bosul. Then in the evening assess (again guess) what your day's activity is likely to do to your sleeping BG and apply an adjustment. This is tricky and needs, in my opinion, several weeks of experience and tight record keeping to understand when the day has (or hasn't) affected your overnight patterns. I personally wouldn't trust a single 24hr experience and would want a lot of repetition before drawing a conclusion and making adjustments. All of this is so much more difficult without Libre.
Last week my Endo said he fully supported the posssibility of my moving onto a pump BUT not yet. He felt I needed to get beyond all my current diabetes erratic behaviour before taking on what would be a challenging few months moving onto a pump. For instance he's suggested further changes to my carb:insulin ratios, my timings for prebosul and a slight tweak to my bosul. He did this after a lengthy study of my Libre data on LibreView and pointing out trends that he was spotting with his experienced eye. I am happy to accept his advice; it made sense to me. So even if I get a yes in 6 months time, it could still be a long time before the pump is actually funded and with me.
I'm still a little concerned for you that you seem to be accepting that you are running high and not working to lower your BG. One observation that my Endo made to me, was that if I'm low, but have good hypo awareness and able to respond quickly with Jelly Babies (or similar), then the risk to me is very limited. Repeated lows could affect my hypo awareness, but that is correctable. The likelihood of me going into a coma is very, very slim - not least because I have Libre and a CGM app. But the damage to me, particularly my narrowest blood vessels, by being high for too long is a bit more of a risk. Now, I'm nowhere near that risk at present, but I don't intend to let that become a risk. He did remind me that the first 2 simplest ways of lowering BG is by staying fully hydrated and being active, options I presume available to you. Of course also using extra insulin to correct, when appropriate.
Long post, hope the dialogue helps.
2 hrs after eating is great, as you say to see how it goes. I haven't worked out what 'parents' means, but think I've got the spirit of what you're saying. Anyway, 3 meals per day plus 2 hrs later = 6 tests, minimum. I usually expect also to test as I get out of bed (unless I use that reading for my breakfast bosul and before I go to sleep to see if I need a sleep time correction. Hence you could need a minimum of 7 or 8 test strips daily. I drive, so I need extra for driving.
Agreed.
Not sure what point you are making here. But if the opening remark that 'you are currently getting round it' means that you've found a solution - then fine. The longer that you can make that 'getting round it' work, the more you are creating a precedent for testing at a certain frequency and the harder it becomes for your GP to try and enforce a reduction. Sometimes, the GP needs a precedent to justify to the Practice CCG why they are prescribing above the guideline that they get from either NICE or the CCG. Its playing 'politics' and is a game that we, the Patients, should not be dragged into - but it happens!
Was that a GP Surgery nurse or a DSN? If the DSN is challenging you then there is a deeper problem, since a DSN should understand T1 needs to check frequently; whereas a Practice nurse sees diabetes from the perspective of T2s, and frequently GP surgeries have a policy ( wrong sometimes) of discouraging T2s from testing - then transfer that thought process into what T1s should do (also wrong).
Yes, absolutely right in my opinion. I drive and wouldn't consider making a long journey without a working fuel guage. And I won't cross the road without checking for traffic immediately before I cross, rather than looking and crossing 10 mins later!
Truthfully, I'm not sure what point you are trying to make in this paragraph:.
Adjusting your Levermir and making informed decisions means, to me, that you might need to make extra finger pricks.
If running higher then an extra half unit makes sense
I've lost the plot, sorry.
Yes there is merit in using the more flexible Levermir, but adjusting your basal is something of an art, rather than a science.
You have to assess (guess really) what your forthcoming day's activity is likely to do to your BG - or have a fixed morning basal and regulate through the day by snacks and bosul. Then in the evening assess (again guess) what your day's activity is likely to do to your sleeping BG and apply an adjustment. This is tricky and needs, in my opinion, several weeks of experience and tight record keeping to understand when the day has (or hasn't) affected your overnight patterns. I personally wouldn't trust a single 24hr experience and would want a lot of repetition before drawing a conclusion and making adjustments. All of this is so much more difficult without Libre.
I think that is jumping the gun. When you get the go-ahead for a pump then the change of insulin can be pert of the actual fitting process. But, you are now on Levermir, so moving on ...
I'm assuming you mean the Levermir wears off over 12+ hrs, if you got the dose wrong.
Actually you don't know that MDI isn't the best option for working, you are assuming that. Everything that I read suggests there is a lengthy transition process from MDI to pump and with your somewhat irregular working patterns finding the right moment to make that transition is going to be challenging. Also, if in the early days of that transition pumping is a bit wrong, will your work regime allow you to pause and make pump adjustments? Then pause again and check you have the adjustment right.
Last week my Endo said he fully supported the posssibility of my moving onto a pump BUT not yet. He felt I needed to get beyond all my current diabetes erratic behaviour before taking on what would be a challenging few months moving onto a pump. For instance he's suggested further changes to my carb:insulin ratios, my timings for prebosul and a slight tweak to my bosul. He did this after a lengthy study of my Libre data on LibreView and pointing out trends that he was spotting with his experienced eye. I am happy to accept his advice; it made sense to me. So even if I get a yes in 6 months time, it could still be a long time before the pump is actually funded and with me.
Well done on persisting with the fasting checks.
I'm still a little concerned for you that you seem to be accepting that you are running high and not working to lower your BG. One observation that my Endo made to me, was that if I'm low, but have good hypo awareness and able to respond quickly with Jelly Babies (or similar), then the risk to me is very limited. Repeated lows could affect my hypo awareness, but that is correctable. The likelihood of me going into a coma is very, very slim - not least because I have Libre and a CGM app. But the damage to me, particularly my narrowest blood vessels, by being high for too long is a bit more of a risk. Now, I'm nowhere near that risk at present, but I don't intend to let that become a risk. He did remind me that the first 2 simplest ways of lowering BG is by staying fully hydrated and being active, options I presume available to you. Of course also using extra insulin to correct, when appropriate.
Long post, hope the dialogue helps.
i'm going to do a couple next week once I know it there's nothing interfering with it. no i'm diffifatty not aceeting it and trying to find a solution what makes you think i'm acetping it. i only correct above 10 as that what I was insutred to do. i think I may accdienttly make here that things or worse then are(I was saying there's a situation which It inpaooritate). i also changed my carritatiage). is me saying i'm happy if i wake up below 10? why are you corncerd for me is it city posts i make?
actully i do now that i can't adjust my background for difeenrt times of days and it would worth trying it. and the unpredictable of how active t is. for example i wouldn't want reduce my morning livermir if i was working in afternoon.
i think sometimes might miscomutate. i did comfrim that my even background was right. acouple of weeks ago when there's nothing in it the way. but i'm now suggesting*due to something that happened yesterday that it would have been the food). i have also tested and found out i was low and not reconigesed. i'm trying to understand why you think i accept problems when actually giving me a headache trying to work them out
Was that a GP Surgery nurse or a DSN? If the DSN is challenging you then there is a deeper problem, since a DSN should understand T1 needs to check frequently; whereas a Practice nurse sees diabetes from the perspective of T2s, and frequently GP surgeries have a policy ( wrong sometimes) of discouraging T2s from testing - then transfer that thought process into what T1s should do (also wrong).
this was unforullty and actual dsn(fully knowing I had an hypo without realsing it)
this was unforullty and actual dsn(fully knowing I had an hypo without realsing it)
I got a dsn apoiment tommorow but i find nurse spoken but when I spoke to over the phone oce her advice seemed fveey off :"its better to be high then low because then we can get idea of parrtens and I was like that that doesn't mak any sense)
i think there were septarte points i know you don't use a basel insullin
Kaylz
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"tresiba would be a nightmare with my pump" was what was said so I'm not seeing how that could be separate points but never mind
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@rayray119 you had one incident when you tested and were a bit low.... I think it was Mid-high 3s if I remember rightly and didn't realise until you tested for your bolus but then felt it quite quickly after you tested. I don't think that really constitutes a loss of hypo awareness. It may well just have been a case of your levels dropping very slowly so your body didn't feel it and perhaps you were out in the cold or engrossed in doing something and didn't pick up on it as soon as you might ordinarily do.
If I am right I don't think that is anything to worry about as regards loss of hypo awareness. Sometimes I can feel a hypo coming on in the mid to low 4s and sometimes I am down to mid to low 3s. The important thing is that I do feel it, even if it just happens to be after I have tested or scanned. That doesn't mean that I have lost hypo awareness, just that sometimes I spot it earlier than other times.
Your waking readings have been a bit high recently and may well have been high most of the night from things you have said on the "waking average" thread. I don't know if that is what @Proud to be erratic was referring to about your levels being high. If you were using Libre you might find your % TIR has dropped a bit since going back to finger pricking but I understand your lack of confidence in Libre and reluctance to use it again.
I do agree with Roland that a pump will involve a lot of adjustment and from what I read, even very experienced Type 1s have problems with getting them set up in the first few months and figuring out the best setting for them and often seem to have hypos during this period.
I do wonder if your attitude towards Libre might indicate how you would also respond to a pump in those early days and perhaps not want to push through those difficulties. It is a 4 year commitment and a big investment by the NHS and if you are reluctant to stick at the Libre and figure out a way to make it work for you, then you can understand their reluctance to put you forward for a pump at this time. I think that may be why they want you to go back to the Libre so show some perseverance because you will need that if/when you start on a pump.
If I am right I don't think that is anything to worry about as regards loss of hypo awareness. Sometimes I can feel a hypo coming on in the mid to low 4s and sometimes I am down to mid to low 3s. The important thing is that I do feel it, even if it just happens to be after I have tested or scanned. That doesn't mean that I have lost hypo awareness, just that sometimes I spot it earlier than other times.
Your waking readings have been a bit high recently and may well have been high most of the night from things you have said on the "waking average" thread. I don't know if that is what @Proud to be erratic was referring to about your levels being high. If you were using Libre you might find your % TIR has dropped a bit since going back to finger pricking but I understand your lack of confidence in Libre and reluctance to use it again.
I do agree with Roland that a pump will involve a lot of adjustment and from what I read, even very experienced Type 1s have problems with getting them set up in the first few months and figuring out the best setting for them and often seem to have hypos during this period.
I do wonder if your attitude towards Libre might indicate how you would also respond to a pump in those early days and perhaps not want to push through those difficulties. It is a 4 year commitment and a big investment by the NHS and if you are reluctant to stick at the Libre and figure out a way to make it work for you, then you can understand their reluctance to put you forward for a pump at this time. I think that may be why they want you to go back to the Libre so show some perseverance because you will need that if/when you start on a pump.
Proud to be erratic
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No worries. I am now completely unconcerned! My misunderstanding, which came from a few remarks you made in various recent posts. I know you don't intentionally miscommunicate.
With an HbA1c of 47 you are doing extremely well; my most recent was 52 and I was happy with that.
Your comment about being instructed to only correct if above 10, would sit a little uncomfortably with me. My optimum target is to be at 6. So if I go to bed at 8 or above I take a small bedtime correction; but I have Libre and alarms so I'm happy with this.
Well I hope your DSN appointment goes well tomorrow. I also find her remark a little strange. Perhaps she was thinking that because you are currently without Libre it's better to be a bit high? If time allows in your appointment ask her to clarify what she meant and her rationale for that. Have you got a list of questions for her?
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