Low carb breakfast (well low for me)

[trophywench]

Ah - it was not stated that these were Libre hypos, just that they were hypos - and of course it's only when you actually get to 3.3 measured properly by a fingerstick test, or lower that our brain cells die. The really annoying thing about Libre is that every time you retest after discovering and treating the low, which you obviously do to make sure the remedy worked - it's reported as another hypo. Bollards, cos it's the same one.

 

[Deleted member 33898]

For me, getting my basal dose right is key and it needs tweaking quite often to keep it right as my needs change frequently due to not having a regular routine. Some days I can be very active and doing manual physical work and other days more sedentary although still a basic level of activity mucking out four horses.
I don't have a set routine with meals either. Some days I graze on low carb snacks all day and that gives me a great opportunity to assess my basal dose. Other days I might have 3 meals a day, or two or just one.... again, useful for seeing how level my basal is keeping me in the absence of food and bolus insulin. I guess that is another reason why the Sugar Surfing works so well for me.

Learning to eat low carb is difficult to begin with because we have bulked out our plates with carbs pretty well all our lives and indeed there was an element of guilt in eating just the tasty bits like curry with no rice, when I first started. And "how do you eat without bread?" was an impossible question in those early days, as it is a carrier for so many foods either as a sandwich or on toast, but I have now developed a whole range of interesting recipes and snacks and treats which are low carb that I really enjoy and despite being a bread and tatties lover, I don't miss or crave them now. I might occasionally eat a small portion to be sociable when eating out but they are often not as good as I remember and not worth the BG upheaval. Eating more fat (cheese, cream in my morning coffee, full fat coleslaw and creamy Greek natural yoghurt and full fat mayonnaise and fatty cuts of meat) and discovering lots of different low carb veggies has been the key to making it enjoyable and sustainable. Last night I had a plate of ratatouille cooked in plenty of olive oil and balsamic and a splash of port and herbs with a couple of slices of smoked bacon as my evening meal. It wasn't a huge plateful but it was incredibly tasty and filling. I had a couple of boiled eggs and a packet of pork scratchings and some olives and a bottle of water at lunchtime as a snack type lunch as we were out with the horses. These things might not appeal to you, but there are other things to try which might suit you better.

I've been very hesitant about changing my basal. I've been afraid to make a change. It's pretty much always the same dose at the same time every night. Some nights my glucose rises as soon as i fall asleep, some nights it stays steady and rises rapidly in the middle of the night and sometimes it starts falling gradually as soon as I go to sleep but generally waking up with an in range level. Been going through all my food logs and libre data and not a clue. Makes me want to give up recording info all together, it just feels like a big waste of time. I've got to a point were I wanna rip off the sensor and chuck everything in the bin. I went for a walk last night after dinner because I was higher than usual, plummeted to 2.8 , treated with what usually works and flew back up higher than when I started, had to correct it. The enjoyment of life has been sucked out of it. I've read 3 books on diabetes, constantly checking info online, checking my levels and logging everything, its exhausting when I'm getting no where. The low carb diet seems to be the solution pushed more than anything but I hate most low carb foods. At this rate what is the point anymore. Burn out quickly with the life I lived before or suffer slowly until the complications arrive.

 

[trophywench]

Stop exaggerating! Nobody wants or needs to starve. Low carb food is merely smaller portions of the same ruddy food!!

 

[rebrascora]

So sorry to read that you are struggling with the randomness of it all.
Low carb is very much a minority approach when it comes to Type 1 so don't feel pressured to go for that option. The vast majority of people manage fine with a normal diet, but you have to understand that there are a lot of factors which affect BG levels. Food, exercise and medication are the 3 main players but lots of other things can mean different outcomes from very similar circumstances and you always have to remember that everyone struggles to manage their levels at different times. If it helps you to know this, I have had nocturnal hypos the last 2 nights (2.9 and 3.5 last night) despite a basal reduction and no evening bolus or lunchtime bolus for that matter yesterday..... so just 4 units of Fiasp yesterday morning plus my basal doses. I will be doing another basal reduction tonight to 0 units (down from 2 units last night and 5units last week) Levemir and just run on my reduced morning dose of 22 (down from 24) units and see how that goes. I need to constantly adjust my basal to keep me right. I am not losing sleep over those hypos other than waking up, munching JBs and going back to sleep (usually within minutes), but obviously I need to take steps to address them hence a further basal reduction as basal is the only possible cause.

Your incident with a high and then a low and then a high may be down to timing of your bolus, the exercise and the food you ate and maybe even the order that you ate that food in. What was your premeal reading and how long did you prebolus?
Foods like pizza and creamy pasta meals and maybe fish and chips etc can be tricky and need a split bolus to deal with them, so maybe half the dose up front prebolused depending upon your premeal reading and then the other half an hour or two later. Sometimes I need to split it into 3 or 4 doses for a low carb higher protein meal. It took me a record 5 bolus injections to cope with a Chinese buffet the other week! Then yesterday eating very little and all low carb I just needed 1 bolus injection at breakfast and still hypoed through the night TWICE!! The only thing that really bothers me about it is that it is ruining my Libre stats. The important thing is that I am doing my best to understand which insulin is causing the problem and make appropriate adjustments to try to prevent it happening again.... it can only be my basal in my case since I hadn't had any bolus insulin since breakfast, so it is pretty easy to see what I need to do and as long as I address that tonight again then I have managed my diabetes well, even if the results look shoddy!

I think what reassures me about my diabetes management longer term is that I have far better tools (modern basal/bolus insulins and testing equipment) to manage my diabetes now than my uncle ever did. He was occasionally found in a DKA coma and admitted to hospital at various times throughout his lifetime (diagnosed in his 20s) as well as having had fits from very low hypos at times and he still made it to 84 with all his limbs and eyesight and kidneys which I don't think is a bad innings although he did suffer with dementia the last couple of years. He did exercise regularly and I think that may be an important factor. He was still cycling regularly at 80.
I am pretty certain that your BG management will be far better than my uncle's could ever have been so cut yourself some slack and try not to worry about long term impact.... just do your best in the "here and now". When things go wrong, try to figure out how you could have done better, ie did you make any silly obvious mistakes.... I know I certainly do sometimes .... but otherwise you have to learn to shrug and just move on. Being more relaxed about it may well give you better results just purely from reducing stress.

One thing I would recommend if you haven't done it is an intensive insulin management course like DAFNE or whatever your local equivalent is. I benefitted both in confidence and practical skills and particularly in adjusting my basal doses, even if much of the carb counting (DAFNE stands for Dose Adjustment For Normal Eating) didn't apply to me because I low carb. Just spending a week with other Type 1 diabetics was incredibly beneficial as well as having my stats overseen by a highly qualified and specifically non-judgemental DSN (DAFNE educator DSNs have to pass specific assessment for that characteristic because any negativity is recognized as hindering improvement in patients)

Anyway, I hope that helps you to realise that you are not alone in being frustrated with your management. A month ago I was doing brilliant and now my levels are misbehaving which almost certainly means for me that my basal needs are changing. It ebbs and flows like this all the time and I have learned to just roll with it, try the usual tactics and after that, just wait for it to settle down into stability again. If you keep chasing the dragon's tail, it just wears you down.

 

[Leadinglights]

I've been very hesitant about changing my basal. I've been afraid to make a change. It's pretty much always the same dose at the same time every night. Some nights my glucose rises as soon as i fall asleep, some nights it stays steady and rises rapidly in the middle of the night and sometimes it starts falling gradually as soon as I go to sleep but generally waking up with an in range level. Been going through all my food logs and libre data and not a clue. Makes me want to give up recording info all together, it just feels like a big waste of time. I've got to a point were I wanna rip off the sensor and chuck everything in the bin. I went for a walk last night after dinner because I was higher than usual, plummeted to 2.8 , treated with what usually works and flew back up higher than when I started, had to correct it. The enjoyment of life has been sucked out of it. I've read 3 books on diabetes, constantly checking info online, checking my levels and logging everything, its exhausting when I'm getting no where. The low carb diet seems to be the solution pushed more than anything but I hate most low carb foods. At this rate what is the point anymore. Burn out quickly with the life I lived before or suffer slowly until the complications arrive.

You mean you hate meat, fish, eggs, cheese, vegetables, salad berries, nuts, avocados, yoghurt, cream to name but a few.
Surely you can eat normal foods and adjust your insulin accordingly.

 

[rebrascora]

Surely you can eat normal foods and adjust your insulin accordingly.

I know you mean well, but that sentence really belittles the complexity of matching insulin to what you eat, be it low carb or otherwise, especially when you are also trying to balance liver output with basal insulin and it is hard to tell what is what, particularly for someone relatively newly diagnosed, who is struggling.

I think in some respects Libre is a blessing and a curse, particularly in the early days when it is so easy to be overly critical of yourself.... and expect perfection.... when you simply don't yet have the skills and experience to balance everything. It takes time and practice and even then you still get spells where if doesn't work as you expect and it is frustrating.

 

[Deleted member 33898]

You mean you hate meat, fish, eggs, cheese, vegetables, salad berries, nuts, avocados, yoghurt, cream to name but a few.
Surely you can eat normal foods and adjust your insulin accordingly.

with the exception of vegetables, salad and berries, I only use those others to bulk up my meals because I shrunk my carb intake. That became a problem for me because I still haven't gained back any weight I lost due to the diabetes. The more I reduce the carbs, the more I'll have to up all those low carb foods. Yet I'm told by the dietician to increase all my carbs. There is no enjoyment for me with these low carb foods by themselves. I never bothered with eggs and nuts before but now I eat them just to keep me from losing more weight. I think its great many have found this way work for them but I don't think it will ever be for me which leaves me stuck until some miracle.

 

[rebrascora]

If you don't enjoy eating low carb, then you absolutely don't have to as a Type 1, so don't be waiting for some miracle, but you will need to experiment to find a good balance of food and insulin and it will take time and patience and getting it wrong quite a bit before you start to get it right. Don't be frightened of getting it wrong because those are the times when you learn more.
There is absolutely no need to starve yourself. What sort of things do you want to eat? Start with your favourite meal and practice it once a week for a couple of months if necessary until you figure out the best strategy for it. Keep good notes of pre meal BG levels and insulin doses. Post on here with the meal and what happened afterwards and we should be able to help you. Gradually work your way through different meals one at a time until you work out strategies that work for them most of the time..... there will always be occasions when it doesn't work but most of the time is good enough.

 

[Leadinglights]

I know you mean well, but that sentence really belittles the complexity of matching insulin to what you eat, be it low carb or otherwise, especially when you are also trying to balance liver output with basal insulin and it is hard to tell what is what, particularly for someone relatively newly diagnosed, who is struggling.

I think in some respects Libre is a blessing and a curse, particularly in the early days when it is so easy to be overly critical of yourself.... and expect perfection.... when you simply don't yet have the skills and experience to balance everything. It takes time and practice and even then you still get spells where if doesn't work as you expect and it is frustrating.

Apologies I didn't mean to imply that it was a simple thing to cope with all the adjustments needed to achieve a healthy balance, I know full well what struggles people have when trying to get to grips with all the implications of a diagnosis.
It perhaps highlights the lack of support people are getting from their diabetic team that they feel they cannot have the varied diet they enjoy. No offence intended in my comment.

 

[Deleted member 33898]

So sorry to read that you are struggling with the randomness of it all.
Low carb is very much a minority approach when it comes to Type 1 so don't feel pressured to go for that option. The vast majority of people manage fine with a normal diet, but you have to understand that there are a lot of factors which affect BG levels. Food, exercise and medication are the 3 main players but lots of other things can mean different outcomes from very similar circumstances and you always have to remember that everyone struggles to manage their levels at different times. If it helps you to know this, I have had nocturnal hypos the last 2 nights (2.9 and 3.5 last night) despite a basal reduction and no evening bolus or lunchtime bolus for that matter yesterday..... so just 4 units of Fiasp yesterday morning plus my basal doses. I will be doing another basal reduction tonight to 0 units (down from 2 units last night and 5units last week) Levemir and just run on my reduced morning dose of 22 (down from 24) units and see how that goes. I need to constantly adjust my basal to keep me right. I am not losing sleep over those hypos other than waking up, munching JBs and going back to sleep (usually within minutes), but obviously I need to take steps to address them hence a further basal reduction as basal is the only possible cause.

Your incident with a high and then a low and then a high may be down to timing of your bolus, the exercise and the food you ate and maybe even the order that you ate that food in. What was your premeal reading and how long did you prebolus?
Foods like pizza and creamy pasta meals and maybe fish and chips etc can be tricky and need a split bolus to deal with them, so maybe half the dose up front prebolused depending upon your premeal reading and then the other half an hour or two later. Sometimes I need to split it into 3 or 4 doses for a low carb higher protein meal. It took me a record 5 bolus injections to cope with a Chinese buffet the other week! Then yesterday eating very little and all low carb I just needed 1 bolus injection at breakfast and still hypoed through the night TWICE!! The only thing that really bothers me about it is that it is ruining my Libre stats. The important thing is that I am doing my best to understand which insulin is causing the problem and make appropriate adjustments to try to prevent it happening again.... it can only be my basal in my case since I hadn't had any bolus insulin since breakfast, so it is pretty easy to see what I need to do and as long as I address that tonight again then I have managed my diabetes well, even if the results look shoddy!

I think what reassures me about my diabetes management longer term is that I have far better tools (modern basal/bolus insulins and testing equipment) to manage my diabetes now than my uncle ever did. He was occasionally found in a DKA coma and admitted to hospital at various times throughout his lifetime (diagnosed in his 20s) as well as having had fits from very low hypos at times and he still made it to 84 with all his limbs and eyesight and kidneys which I don't think is a bad innings although he did suffer with dementia the last couple of years. He did exercise regularly and I think that may be an important factor. He was still cycling regularly at 80.
I am pretty certain that your BG management will be far better than my uncle's could ever have been so cut yourself some slack and try not to worry about long term impact.... just do your best in the "here and now". When things go wrong, try to figure out how you could have done better, ie did you make any silly obvious mistakes.... I know I certainly do sometimes .... but otherwise you have to learn to shrug and just move on. Being more relaxed about it may well give you better results just purely from reducing stress.

One thing I would recommend if you haven't done it is an intensive insulin management course like DAFNE or whatever your local equivalent is. I benefitted both in confidence and practical skills and particularly in adjusting my basal doses, even if much of the carb counting (DAFNE stands for Dose Adjustment For Normal Eating) didn't apply to me because I low carb. Just spending a week with other Type 1 diabetics was incredibly beneficial as well as having my stats overseen by a highly qualified and specifically non-judgemental DSN (DAFNE educator DSNs have to pass specific assessment for that characteristic because any negativity is recognized as hindering improvement in patients)

Anyway, I hope that helps you to realise that you are not alone in being frustrated with your management. A month ago I was doing brilliant and now my levels are misbehaving which almost certainly means for me that my basal needs are changing. It ebbs and flows like this all the time and I have learned to just roll with it, try the usual tactics and after that, just wait for it to settle down into stability again. If you keep chasing the dragon's tail, it just wears you down.

Honestly I feel like an idiot for that outburst, I apologise. You have been very helpful with this post and previous ones.

I know about all the different factors which affect BG levels, its quite a long list =/ So you just get on with these mishaps really? I think when its a constant flow of issues I get down about it. The alarms on libre going off just ruins my day. Interesting with the basal amounts, so you take a small amount over night and a large dose in the morning? I find it difficult to figure out how much and when to take its driving me insane making a change. I keep thinking i'll just make matters worse. Been thinking if I take my evening dose earlier and top it up in the morning but then exercise is too close to taking the basal if I take it earlier.

I base my bolus timing off previous similar meals. Also I watch to see when levels start to drop meaning the insulin is working. So I started at 5.5 and dropped to 4.5 and then up to 9 just after an hour. I would let it go if the libre said it was steady or the line on the graph is starting to settle and go down but decided I had to walk cause I know it will keep climbing. I've tried all the tricks like eating in a certain order and having fat and protein to slow things down but it seems a working method only lasts soo long then stops having an effect. The 3 glucose tablets bringing me up soo fast and high shocked me, maybe because I hadn't tried them as a hypo treatment in a while I dont know. I have had some success with pizza but tend not to have it very often anyway. Anything with chips and potato usually isnt too bad but I thought chips were a no no. I have noticed pasta and rice always seem to cause some delayed spike in the middle of the night but do I just replace them completely. I know what you are saying, trying to learn to make adjustments for the future but it seems I keep making the same mistakes over and over again. I've tried soo many ways of looking at and recording what I'm seeing. It ends up being a waste of time. Everytime I have a meal I spend about 15 minutes looking back through logs on libre and lifesum to see what I did last time with the meal. End up not getting anywhere.

Wow that is quite a success story. Obviously sorry to hear of his dementia and passing. That's amazing he was cycling still, fantastic ! I guess just knowing all the complications is enough to freak me out everyday. You are probably right, the stress may be a factor. I think the mental turmoil is actually worse than the physical side at the moment for me. 2 year waiting list for therapy for those living with diabetes. They always bring it up and I say well isn't there a 2 year waiting list, which thats still the case.

It's DAFNE here too but I doesn't look to be starting up again anytime soon, they'll be a huge back log of those who missed out during the pandemic. I have a feeling I already know most of what they would teach but as you say being there with other diabetics would be a real boost.

If you don't enjoy eating low carb, then you absolutely don't have to as a Type 1, so don't be waiting for some miracle, but you will need to experiment to find a good balance of food and insulin and it will take time and patience and getting it wrong quite a bit before you start to get it right. Don't be frightened of getting it wrong because those are the times when you learn more.
There is absolutely no need to starve yourself. What sort of things do you want to eat? Start with your favourite meal and practice it once a week for a couple of months if necessary until you figure out the best strategy for it. Keep good notes of pre meal BG levels and insulin doses. Post on here with the meal and what happened afterwards and we should be able to help you. Gradually work your way through different meals one at a time until you work out strategies that work for them most of the time..... there will always be occasions when it doesn't work but most of the time is good enough.

See I have done all this. If you saw the notes I've kept in the last, it's quite detailed. Maybe too much detail is my problem or not being able to analyse it all properly. I might try even making some sort of meal plan and stick to the same set meals for a while. Something I regularly eat would be fish (no batter or anything like that ) rice , plenty of veg, hot sauce(less than 0.5g carbs) and cheese . I don't know if that sounds strange or not. It's one of those ones though that I reckon is giving me a high in the middle of the night for whatever reason. Only way to fix that is getting up and bolusing everytime which isn't ideal. Maybe something I need to reduce in that meal but I'm still not sure.

Yes much appreciated, all that info. I just have to stop comparing myself to those showing all these great levels. Thanks for taking the time.

 

[Benny G]

@phil90 Success is a funny thing, and managing diabetes requires both knowledge, skills and an awareness of your immediate situation.

It sounds like you have done some reading up, and think perhaps your control should be better than it is. You can ease up, widen your goal posts to score some points. Skills require practice: Practice is messy. Give yourself time and space, set smaller achievable goals, then gradually aim up. Set your high and low glucose values further apart; play with the timing of prebolus, corrections, and learn to manage and (stack) small doses.
Learn to use your libre to guide your decision-making.

If you are looking at your libre graph and scratching your head, you can post a screen shot (either as a private message or on open furum) and compare notes with seasoned veterans.

Be kind to yourself.

 

[nonethewiser]

with the exception of vegetables, salad and berries, I only use those others to bulk up my meals because I shrunk my carb intake. That became a problem for me because I still haven't gained back any weight I lost due to the diabetes. The more I reduce the carbs, the more I'll have to up all those low carb foods. Yet I'm told by the dietician to increase all my carbs. There is no enjoyment for me with these low carb foods by themselves. I never bothered with eggs and nuts before but now I eat them just to keep me from losing more weight. I think its great many have found this way work for them but I don't think it will ever be for me which leaves me stuck until some miracle.

There has to be a middle ground Phil, diet like low carb isn't going to resolve all your problems just same as any other diet going knocking around, found that out myself all those years ago.

Middle ground for me was learning more about condition & working more with diabetes clinic, with small changes it eventually falls into place where you can get decent results & not have to restrict diet to much or be constantly think about condition all of the time. Think insulin pump woul be ideal for yourself so would press your clinic team to get one, won't resolve all problems but it should solve your basal issues out by having numerous basal rates & ability to reduce basal for when you exercise.
.

 

[Proud to be erratic]

Hello @phil90 ,
There are so many aspects about this thread it is difficult to know where to start a response.

Firstly, good on you for wrestling with your diagnosis, for exploring the boundaries, for your curiosity leading to research in books and on line, for tapping in to this forum's accumulative knowledge - and for wanting to improve your management of your DM. Of course there is a high level of self interest in doing this; you want longevity as well as a decent quality of life and you certainly don't want true hypos interfering with your day. But well done.

I've picked up that you are on Novorapid, but couldn't spot what basal and whether you take that 1x daily or twice. I couldn't find what your latest HbA1c is. Nor did I find what TIR you are achieving; given that you started this thread in late April, it could be useful to know if things have improved in the last 30 days, as well as the last 90 days. I don't know if your weight is relevant to your diet. Is alcohol part of your daily life? I like a glass of wine or whisky, but Libre reveals that it definitely interferes with my digestion and BG. So the goal posts aren't too clear.

Secondly you've been T1 for less than a year and you mention "so many factors" affecting BG. One factor for you will be the possibility of your ailing pancreas intermittently contributing and confusing your interpretations.

Thirdly, I particularly agree with @Benny G about measuring success at this stage and his list of things to try - but only one at a time! And you can't interpret anything from a single result, so each experiment needs a decent set of results to provide a platform to interpret from.

Much of your dialogue has been with @rebrascora who has an exceedingly low carb diet and who, from my perspective, pushes boundaries by stacking insulin - which I'm uncomfortable about doing myself. She also uses changing her basal to assist in her daily BM management. I eat around 200-250gms of carbs daily, not as a target, its just what I want, when I want and I start with a breakfast of either 104 or 96 gms; those nos are divisible by my breakfast ratio of 1:13. I have a very inflexible 1x daily basal, which is optimised to keep me away from hypoland while I sleep and which I rarely alter. I regulate by using my bosul, knowing that if I've misjudged the dose (or something else comes into play) I can correct by eating a snack if low or a correction after 4+hrs, (usually at my next meal if I'm hungry). I aspire to be close to 6, a recent change from 7, with my recent improved BG stability.

What @rebrascora both have in common is that we're both relatively new to this, that we've both found very different ways of accommodating our DM and, by complete coincidence, we're both sugar surfing. Or at least I think I am, in principle, even though I'm not yet near a pump.

It takes time to work this all out. I made stopping having hypos my first priority quickly followed by getting off the low, high, low roller coaster; I'd be happy to sharevhow I tackled that. I'm retired and have the luxury of no work schedule to adhere to; I fully appreciate that you don't have that luxury.

I hope some of this helps. You might find it helpful to read your first post again and update us on where you think you now are after 30+ days of this thread; writing that down here, might prove useful to you as well as us.

 

[Proud to be erratic]

Sorry @phil90 , what I should also have said is that you, @rebrascora and myself have in common is the use of Libre to provide vastly superior visibility of what is happening to our BGs minute by minute. Hence our ability to respond artificially, which our panc'ys no longer do for us.

 

[trophywench]

There are simple things you can easily do about some of what's bothering you. eg. you say the Libre alarms drive you potty - so turn the alarms off.

The scans of the Libre are not sufficiently accurate to rely on wholly to base insulin calculations on - only to find out whether you're shooting upwards or downwards at an alarming rate of knots, in which case you do a fingerprick and base your calculations on the fingerprick results.

Bit like blood pressure readings - if they want you to monitor your BP yourself the instruction they give you is to take it twice a day - morning and evening - for 5 days in a row. You are to measure it, 3 times in a row on both occasions. Each time - sit down and relax for 15 minutes first. Then take reading 1. 5 -10 mins later, take reading 2, ditto for 3. Now - ignore reading 1. For morning readings - now take average of readings 2 & 3. For evening readings, having ignore reading 1, take the better of 2 & 3. On morning 6, report the 5 days answers to the doc. for advice re any medication dose changes.

It is not at all whatsoever necessary to try and micro-manage either BG or BP. (unless you are in intensive care at death's door in which case, you wouldn't be doing it yourself!)

Nobody dropped dead instantly nor had a foot drop off/kidney to fail/eye blinded by their BG spiking to 23.0 after eating a whole trifle on Boxing Day cos you'd gone to the trouble of making it then nobody wanted any so sod you I'll eat it then, or a whole packet of Jaffa cakes one other day when they felt depressed.

Oh yes - been there, done both - more than once I'm sure - but I'm still here !!

 

[Deleted member 33898]

There has to be a middle ground Phil, diet like low carb isn't going to resolve all your problems just same as any other diet going knocking around, found that out myself all those years ago.

Middle ground for me was learning more about condition & working more with diabetes clinic, with small changes it eventually falls into place where you can get decent results & not have to restrict diet to much or be constantly think about condition all of the time. Think insulin pump woul be ideal for yourself so would press your clinic team to get one, won't resolve all problems but it should solve your basal issues out by having numerous basal rates & ability to reduce basal for when you exercise.
.

i ended up at the clinic quite a few times and they keep telling me everything is grand but I need to work on the constant up and downs throughout the day. It's the variability in my glucose I hate at the minute. I did have a good few months until end of January when I caught covid. After that its been difficult to keep stable. There was a lot of work put into to getting them good and now I feel like I have to find another answer. A pump was mentioned but they said I wouldn't be eligible for that for a while. They said it would take away some of the burden but obviously it still requires plenty of work. The only option available to me from them is to switch over to different insulin, both basal and bolus.

 

[Proud to be erratic]

i ended up at the clinic quite a few times and they keep telling me everything is grand but I need to work on the constant up and downs throughout the day. It's the variability in my glucose I hate at the minute. I did have a good few months until end of January when I caught covid. After that its been difficult to keep stable. There was a lot of work put into to getting them good and now I feel like I have to find another answer. A pump was mentioned but they said I wouldn't be eligible for that for a while. They said it would take away some of the burden but obviously it still requires plenty of work. The only option available to me from them is to switch over to different insulin, both basal and bolus.

Phil, what basal are you currently on and did they indicate what options they could switch you onto?

 

[rebrascora]

Can you post a photo of a typical Libre trace which concerns you so that we can see if you are expecting too much or we can spot things that might be fixable and make suggestions. BG levels are rarely stable, so you may be trying too hard to fix something that isn't actually a problem. I say this because you mention worrying about Libre showing a 9 with an upward pointing arrow after your evening meal. Libre has an algorithm which tries to predict ahead to reduce lag between interstitial fluid and blood glucose. Sometimes I can get a 9 with a vertical upward arrow but it suddenly levels out at 9.5 and then starts to drop and sometimes the graph suggests it didn't actually go as high as 9. It is easy to respond too quickly to Libre. I think one of the key characteristics with Sugar Surfing is patience. It takes quite a bit of discipline for me to ride it out but usually it levels out and starts to drop if I have calculated things right. At your stage I am pretty sure I was still hitting low to mid teens quite frequently.

It may be that before Covid your own pancreas was smoothing off the edges and peaks for you and now after Covid you have perhaps lost some of that already limited insulin production which is making things more erratic. It may also be that your basal dose(s) are no longer correct.
Can you remind us which basal insulin you use and when you take it?

 

[Deleted member 33898]

Hello @phil90 ,
There are so many aspects about this thread it is difficult to know where to start a response.

Firstly, good on you for wrestling with your diagnosis, for exploring the boundaries, for your curiosity leading to research in books and on line, for tapping in to this forum's accumulative knowledge - and for wanting to improve your management of your DM. Of course there is a high level of self interest in doing this; you want longevity as well as a decent quality of life and you certainly don't want true hypos interfering with your day. But well done.

I've picked up that you are on Novorapid, but couldn't spot what basal and whether you take that 1x daily or twice. I couldn't find what your latest HbA1c is. Nor did I find what TIR you are achieving; given that you started this thread in late April, it could be useful to know if things have improved in the last 30 days, as well as the last 90 days. I don't know if your weight is relevant to your diet. Is alcohol part of your daily life? I like a glass of wine or whisky, but Libre reveals that it definitely interferes with my digestion and BG. So the goal posts aren't too clear.

Secondly you've been T1 for less than a year and you mention "so many factors" affecting BG. One factor for you will be the possibility of your ailing pancreas intermittently contributing and confusing your interpretations.

Thirdly, I particularly agree with @Benny G about measuring success at this stage and his list of things to try - but only one at a time! And you can't interpret anything from a single result, so each experiment needs a decent set of results to provide a platform to interpret from.

Much of your dialogue has been with @rebrascora who has an exceedingly low carb diet and who, from my perspective, pushes boundaries by stacking insulin - which I'm uncomfortable about doing myself. She also uses changing her basal to assist in her daily BM management. I eat around 200-250gms of carbs daily, not as a target, its just what I want, when I want and I start with a breakfast of either 104 or 96 gms; those nos are divisible by my breakfast ratio of 1:13. I have a very inflexible 1x daily basal, which is optimised to keep me away from hypoland while I sleep and which I rarely alter. I regulate by using my bosul, knowing that if I've misjudged the dose (or something else comes into play) I can correct by eating a snack if low or a correction after 4+hrs, (usually at my next meal if I'm hungry). I aspire to be close to 6, a recent change from 7, with my recent improved BG stability.

What @rebrascora both have in common is that we're both relatively new to this, that we've both found very different ways of accommodating our DM and, by complete coincidence, we're both sugar surfing. Or at least I think I am, in principle, even though I'm not yet near a pump.

It takes time to work this all out. I made stopping having hypos my first priority quickly followed by getting off the low, high, low roller coaster; I'd be happy to sharevhow I tackled that. I'm retired and have the luxury of no work schedule to adhere to; I fully appreciate that you don't have that luxury.

I hope some of this helps. You might find it helpful to read your first post again and update us on where you think you now are after 30+ days of this thread; writing that down here, might prove useful to you as well as us.

I appreciate the support. Yes I'm on novarapid, usually 3 times a day for meals and a few more times for corrections. Generally taking about 4,6,6 doses for meals with ratios different throughout the day. I'm on levermir once a day before bed, 5 units. My first HbA1c was 99, then 56 a month later, 29 few months after that and back in March 30. TIR for 3.9 to 10 range generally 95% , the other 5% usually spent either in the low or high end, I have weeks were that 5% its all low then all high. Those blood results might look good but its mainly due to the amount of lows I've been having, for instance I've had a few 1.8s. Best way I can explain is probably through the graphs, can see the constant roller coaster. I realise it's not supposed to be nice and steady all the time but I feel sick and exhausted everyday from the jumps and falls. Is it normal to get the tingles in legs and feet and stinging eyes when bloods are high? My weight is a big issue for me. I know I need more calories but I'm afraid to add more carbs or fat.

I think as far as the pancreas still working, it definitely looks like things are changing. I think it was covering for quite a bit. For instance I never had regular highs whilst sleeping but now that is becoming increasingly common.

I have a difficult time trying to concentrate on one thing at a time. I already tried tackling one issue at a time at the start of my diagnosis by building on strategies. For example not exercising initially and trying to figure out my bolus and basal. Then exercising and seeing how things need adapted. I think it could be difficult to start from scratch again but might have to.

You eat around the same amount of carbs as myself per day. Do you mind me asking what sort of carbs you eat? Do you pair them with plenty of fat and protein? It is crazy how much I ate before that I don't now(or very small amount the odd time). Just all the nice stuff like sausage rolls, sweets, chocolate, crisps etc Could I eat them , probably but takes planning. I find its the spontaneity that diabetes robs, I hate that the most. Being at someone's house and the biscuits or cake comes out, oh no thanks I'd have to dose for that.

Sugar surfing looks like a good way of managing diabetes but I think I need to go back to basics first before trying it.

I think for me I've been soo fixated on preventing highs that hypos haven't bothered me as much even though they should. I'd love to get off the low high rollercoaster. By all means any advice you can offer would be greatly appreciated.

Yes I'll definitely come back to this thread and update.

Thank you

Phil

 

[Deleted member 33898]

Can you post a photo of a typical Libre trace which concerns you so that we can see if you are expecting too much or we can spot things that might be fixable and make suggestions. BG levels are rarely stable, so you may be trying too hard to fix something that isn't actually a problem. I say this because you mention worrying about Libre showing a 9 with an upward pointing arrow after your evening meal. Libre has an algorithm which tries to predict ahead to reduce lag between interstitial fluid and blood glucose. Sometimes I can get a 9 with a vertical upward arrow but it suddenly levels out at 9.5 and then starts to drop and sometimes the graph suggests it didn't actually go as high as 9. It is easy to respond too quickly to Libre. I think one of the key characteristics with Sugar Surfing is patience. It takes quite a bit of discipline for me to ride it out but usually it levels out and starts to drop if I have calculated things right. At your stage I am pretty sure I was still hitting low to mid teens quite frequently.

It may be that before Covid your own pancreas was smoothing off the edges and peaks for you and now after Covid you have perhaps lost some of that already limited insulin production which is making things more erratic. It may also be that your basal dose(s) are no longer correct.
Can you remind us which basal insulin you use and when you take it?

I have seen the libre do this with the lag. But I'll do random finger prick tests to confirm and it normally matches, sometimes higher than the libre reading. I do see the levelling out sometimes but normally I'll go for a walk to bring things down a bit, I dont like waiting for it to go too high. I'll only correct after 2 hours if a rise continues.

I definitely believe I've lost some of the ability to produce a bit of insulin. Yes Im taking 5 units before bed, so 11pm. I started on 12 when I was diagnosed. I've done plenty of basal tests but not 100% on next move everytime I test.