Thank you for your time and help! Reading what you have written really helps me to understand what affects what.
Well, everything is relative. I'm a retired Civil and Structural Engineer, so I try to understand the logic of what causes what - but DM is far from logical in so many ways, without the DM fairy waving her wand. Hence lots of trial and error.
Reading about your situation puts mine in the shade. You have far more to deal with than I do!! And there was me feeling sorry for myself 🙂
Kind of you to comment, but you give me more credit than I really deserve. I'm grateful to still be alive, so now it's just a matter of getting on with the challenge!
Interesting what you say about exercising before taking bolus. It's always my preference to ride the long commute before eating. Have always had the tendency to feel a bit sick if eating directly before riding. I eat as soon as I get off the bike.
My usual order is to wake, take 8 Lantus Glargine basal, then if having breakfast, usually 4 units of Novorapid.
The nurses tried to fix my amount of rapid, but I do adjust it depending on what im putting in. I'm not carb counting, just guessing. I do read packets to see what carbs are in certain foods, but try to guess the rest. It kind of works most of the time, but I do find myself adding one or two units when injecting probably through guilt to stop myself going high. I need to stop that bit as the hypos are not good.
Carb counting is the only sensible way forward for you. You are too young to hope you can successfully muddle along! On the plus side NICE, in their recent update to their Guideline [Type 1 diabetes in adults: diagnosis and management, NICE guideline [NG17] Published: 26 August 2015. Last updated: 31 March 2022]
empasised that all T1s should receive structured education:
specifically:
1.3.1 Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example, the
DAFNE (dose adjustment for normal eating) programme.
[2015]
1.3.2 Offer the structured education programme 6 to 12 months after diagnosis. For adults who have not had a structured education programme by 12 months, offer it at any time that is clinically appropriate and suitable for the person, regardless of how long they have had type 1 diabetes.
[2015]
A course such as DAFNE done Face to Face is not only potentially very informative, but brings you alongside other T1s, allowing you to exchange experiences.
There are so many factors in the mix, what seems like a straightforward bit of maths, is also very subjective; and this is something best helped by formal training. Meanwhile, one thing you could try is to have one meal that is standard and repeatable - every day. Breakfast can lend itself to this. Then accurately weigh the components and work out the total carbs. You will then know your insulin dose for that many carbs and can deduce the ratio you are using. Thanks to Libre you can easily establish if the bolus you are taking is appropriate for that standard meal and thus confirm that ratio for that meal.You also see how much prebolus time is appropriate for the time of day. If your BG is dropping too much as you are eating, then the insulin has arrived before the carbs have been digested; so pre-bolus is too long. If BG rises rapidly as you eat then the insulin hasn't yet got into your blood stream and the prebolus time is too short. You will need several days to confirm your findings; a single meal is too small a test.
One disadvantage of Libre is that it gives you more insight than you sometimes need! It can tempt you to react when that reaction isn't necessarily needed. Your comment about adding insulin to stop yourself from going high is a case in point: being regularly and consistently high is definitely not good for your body - IN THE LONG TERM. But modest periods spent "out of range", ie above 10, are not a disaster, unless you are unlucky enough to feel below par when high; I don't seem to have this problem. So being slightly high at this stage shouldn't be feared, while you learn how best to manage your DM, without the fear of hypos.
Equally, you now know that being hypo is unpleasant and debilitating - but you also know it is not a disaster to sometimes be a little below 4. This presumes that you are using the alarms to forewarn you when you are dropping and heading off that potential hypo. Then you can resist the urge to panic when you are low and treat a mild hypo 'mildly', ie take some rapid carbs such as dextrose, JBs or Lucozade - then wait ... a full 15 mins ... and then check by finger prick (as well as monitoring your Libre) if you are recovering. If you are recovering, then resist that urge to do more, just let things naturally take their course, with perhaps some further slower carbs later in the form of a biscuit (say) to give some longevity to your recovery.
All of this management is to reduce the possibility of getting on the hypo/hyper rollercoaster, that becomes a real blight on your day.
I got ill for the first time since diagnosis recently. That threw everything I thought I knew out of the window. I had to throw insulin in. Where I might take 4 rapid normally, I had to take three times that. It was madness. Something I'm sure you are very used to!
@Pattidevans has commented upon illness affecting BG, at her post (#26). Unfortunately T1 can make you more vulnerable to a variety of ailments. As it can for me as a T3c. Sometimes my BG elevates inexplicably and I now know to speculate if I am going down with some medical complaint, that will arrive in the next 48 hrs! What is happening is that your body is fighting the incoming illness and releasing extra glucose as part of that fight.
My DSN advised me to increase my bosul doses by 20%; but others on this forum have expressed caution - that 20% is too much. It works for me, particularly since Libre gives me great visibility of trend as well as a snapshot of 'now'. I also have found, by trial and error, that my natural insulin resistance increases as my BG increases. So I have a correction ratio for when I'm above 9 to get me back to 6; and a stronger (harder) correction ratio for when I'm above 13. You might want to set your mid-range target at 7, or even 7.5, in these early days and give yourself a comfort buffer as you get used to making bolus adjustments.
All for now, got a busy day tomorrow. Regards.
