3 days after major 1st DKA

[mitchsi]

Hope the week goes well at home @mitchsi - I still remember the feeling of the loss of ‘safety net’ when I left hospital and qualified people weren‘t stopping by to check in on me several times a day.

It can feel a bit daunting to go solo initially - a little like your first drive alone after passing your test when you realise it is now all down to you. This feeling passed quickly, and pretty soon you’ll get to know your own diabetes, its foibles and inconsistencies, better than anyone.

One thing I’d say, from a few years of experience, is don’t expect your ‘right’ doses to stand still for all that long. It’s certainly worth putting in the time to get them tweaked to work as well for you as possible, but diabetes doesn’t sit still for long, and before long you’ll notice things are drifting again and you’ll have to tweak the doses that used to work perfectly.

It’s part of the game we have to play I’m afraid.

Hi Mike,

Thanks for the response, yeah it was a bit odd being sent home with injections to do myself, having a needle phobia hasn’t been much fun but getting over it after a week.
Hasn’t been too bad except when levels are rising pretty high and being at home but it’s worked out so far and the diabetes team are reviewing my meds. Glucose is still too high overall so expect an adjustment today.
One day I had great control and yesterday looks bad, there’s a lot to get to used and to understand.

My wife bought a good book that I’m reading that I’m sure lost have, ‘think like a pancreas’, I’m looking forward to the section on how to handle exercise.

Thanks, Steve

Sounds like you are off to a great start @mitchsi - well done!

Yes, Think Like A Pancreas is a popular book with many here.

thanks - if I don’t take control and be positive then I’ll go down a dark rabbit hole so I only have 1 real option.

 

[mitchsi]

Yes I liked Think Like a Pancreas. Coming to terms with exercise (and / or simple activity) is not easy. Most aspects of diabetes management fit that scenario though.

I loved the proposal by another member (sorry can't remember who to give you the credit!) that trial and error should always be looked on as trial and learning. We don't try anything with our D wanting an error, but willing to recognise a lesson if needed. I don't do strenuous exercise any more, but often find I've reduced my bolus dose by 50% to mitigate a busy day, OR am ready to take a lot of extra snacks. My CGM is a true lifesaver for that.

Yeah I can see it’s a cycle of continual improvement and understanding. I can also see I’ll be getting frustrated as well by major deviations for one reason or another.
Fortunately within my profession (Engineering) I’m ok with maths/algorithms so having this CGM gives me something to focus on.
Interesting what you say about exercise and reducing the bolus which makes sense but 50% reduction is quite something. I was used to strenuous exercise 1.5hrs of karate in one session, I’m curious how that will go in the future.

Thanks and all the best

 

[Proud to be erratic]

Yeah I can see it’s a cycle of continual improvement and understanding. I can also see I’ll be getting frustrated as well by major deviations for one reason or another.
Fortunately within my profession (Engineering) I’m ok with maths/algorithms so having this CGM gives me something to focus on.
Interesting what you say about exercise and reducing the bolus which makes sense but 50% reduction is quite something. I was used to strenuous exercise 1.5hrs of karate in one session, I’m curious how that will go in the future.

Thanks and all the best

The 50% cut was a recommendation by my Consultant, who is a co-author on a technical paper addressing exercise preparation.

Aerobic exercise seems to reduce one's natural insulin resistance, so insulin on board goes further; and that reduction can linger into the next 24 hrs.

Anaerobic exercise can initially increase BG - which might seem counterintuitive. A suggestion is that our brain interprets the anaerobic exercise as putting our body at risk and thus is causing the liver to release glucose from its store - creating an evolutionary fight or flight response. This is of some interest to me, even though I don't set out to create anaerobic conditions in my own activities or exercise. The normal mechanism for glucose release from the liver store is by the circuitous route of the brain recognising the falling BG and instructing the pancreas to send a messenger to the liver (using the hormone glucagon, only found in the pancreas); the brain has no capability to communicate directly with one's liver - a peculiarity of human evolution apparently, other mammals are fine with doing this. My curiosity and interest because I had a total pancreatectomy. A Consultant speculated that my Adrenaline or Cortisol could somehow come out to play, instead; but she wasn't certain that her hypothesis was correct. There's a lot they don't know about the finer points of Endocrinology.

 

[trophywench]

I've always considered having Type 1 as a personal medical experiment - ie I have always been happy to conduct the appropriate medical experiments on myself. The main advice about this is to ONLY EVER change ONE thing at a time hence I'd rarely if ever change both basal and bolus insulin doses the same day.

The opposite of exercise having been lucky with my health really all my life until a few years ago I tripped up and fell full length flat on my face, except I saved my face - and normally old women break their wrists and mess up the palms of thei hands doing this, so why didn't I do that? Because I actually tripped whilst walking out of a carpark on the ruddy speed bump immediately inside the entrance/exit so hands landed on the down side of it - and my left kneecap bore the whole brunt - that's why. Had to open me up, pin and wire the jigsaw and stitch me up again, OMG that hurt - and I needed THREE times my normal amount of insulin to control my BG! Was weeks before I was off crutches and could start reducing it again - and months before it was actually back to normal. What an age to get your very first broken bone - when you're well over 60!

A mate said when I regaled them with this tale of the scar later - "Well - you were obviously walking far too fast then, weren't you?!" (Note to @everydayupsanddowns - we need an interrobang, please!)

So on that occasion though still loath to change both basal and bolus together at the time - I flippin had to, like it or not.

 

[trophywench]

Oh yep - effects of exercise can and do last up to 48 hours. We were told 'strenuous' like eg football with kids, running about with them or dogs lasts an awful lot longer than 'gentle' like eg a walk to the next bus stop - about 200 yards along our partic road!

Neighbour just got another dog - a retired greyhound he'd recently adopted, who we both met for the first time yesterday and husband told me immediately and laughing that it was my turn this morning to take her a walk, cos Fred said he'd been taking her about 5 miles in a morning since he got her. (Fred's rarely here these days cos most of the summer he spends at his sited mobile home in Skegness) I replied 'Oh that's a shame for her then cos she won't know her own way home to here, yet!' and we all giggled like kids cos they both know I often struggle walking anyway much these days, as does my OH and we both formerly could quite easily cover a couple of miles on foot when/if we needed/wanted to. OH 'walked the streets' for a living once - reading elec and gas meters for Siemens. He reckoned 40 miles a week on average.

 

[mitchsi]

I've always considered having Type 1 as a personal medical experiment - ie I have always been happy to conduct the appropriate medical experiments on myself. The main advice about this is to ONLY EVER change ONE thing at a time hence I'd rarely if ever change both basal and bolus insulin doses the same day.

The opposite of exercise having been lucky with my health really all my life until a few years ago I tripped up and fell full length flat on my face, except I saved my face - and normally old women break their wrists and mess up the palms of thei hands doing this, so why didn't I do that? Because I actually tripped whilst walking out of a carpark on the ruddy speed bump immediately inside the entrance/exit so hands landed on the down side of it - and my left kneecap bore the whole brunt - that's why. Had to open me up, pin and wire the jigsaw and stitch me up again, OMG that hurt - and I needed THREE times my normal amount of insulin to control my BG! Was weeks before I was off crutches and could start reducing it again - and months before it was actually back to normal. What an age to get your very first broken bone - when you're well over 60!

A mate said when I regaled them with this tale of the scar later - "Well - you were obviously walking far too fast then, weren't you?!" (Note to @everydayupsanddowns - we need an interrobang, please!)

So on that occasion though still loath to change both basal and bolus together at the time - I flippin had to, like it or not.

Heck, by coincidence my mother fell after tripping over a speed bump in a car park a few months ago but broke her wrist and bruised/cracked some ribs, she was in a great deal of pain so I can feel for your experience (although my mother is early type 2 not type1).

The exercise aspect will need some working out for, hard karate sessions and getting back into weight lifting. But really early days so I’m trying to be patient, atleast my meds have now been adjusted to get me into the green.

 

[mitchsi]

The 50% cut was a recommendation by my Consultant, who is a co-author on a technical paper addressing exercise preparation.

Aerobic exercise seems to reduce one's natural insulin resistance, so insulin on board goes further; and that reduction can linger into the next 24 hrs.

Anaerobic exercise can initially increase BG - which might seem counterintuitive. A suggestion is that our brain interprets the anaerobic exercise as putting our body at risk and thus is causing the liver to release glucose from its store - creating an evolutionary fight or flight response. This is of some interest to me, even though I don't set out to create anaerobic conditions in my own activities or exercise. The normal mechanism for glucose release from the liver store is by the circuitous route of the brain recognising the falling BG and instructing the pancreas to send a messenger to the liver (using the hormone glucagon, only found in the pancreas); the brain has no capability to communicate directly with one's liver - a peculiarity of human evolution apparently, other mammals are fine with doing this. My curiosity and interest because I had a total pancreatectomy. A Consultant speculated that my Adrenaline or Cortisol could somehow come out to play, instead; but she wasn't certain that her hypothesis was correct. There's a lot they don't know about the finer points of Endocrinology.

That’s very interesting thanks for taking the time to share.
Unlike the few who wear a CGM, hardly anyone sees what their body is doing in real-time so it will be invaluable once I get back to exercise. Although having this condition is pretty crappy the science like you mentioned is quite fascinating to learn the mechanisms of the body especially in terms of sport.
Regards,

 

[helli]

Coming to terms with exercise (and / or simple activity) is not easy.

I am not sure what you mean by "coming to terms with exercise".
When I was diagnosed, I had registered to do the Moon Walk (a 26 mile night time walk through London in aid of Breast Cancer). I had no "coming to terms with it": I was going to do the walk come what may. For me, this was the motivation I needed to get out and exercise in a safe environment with my insulin and dextrose in preparation for the walk. This was before the advent of the Libre (or any other CGM) which would have made it much easier.
My advice for exercise when first diagnosed is "don't shy away from it". Take it easy and build it up learning how your body reacts to your activities bearing mind different types of exercise will have different effects and those effects may change as you get fitter.
For example, I need to stop my basal (I have a pump so it is possible) when doing my spin class activity but increase it by 40% when climbing. This took some trial and learning to get to what suits my body, I would not recommend halving your insulin from day one, especially as weight lifting is more likely to increase your BG.

 

[Tdm]

That’s very interesting thanks for taking the time to share.
Unlike the few who wear a CGM, hardly anyone sees what their body is doing in real-time so it will be invaluable once I get back to exercise. Although having this condition is pretty crappy the science like you mentioned is quite fascinating to learn the mechanisms of the body especially in terms of sport.
Regards,

I found excercise the hardest thing about diabetes to crack. I find propping up blood sugars with glucose the best, taken in advance of bs getting too low, for walking etc at least. As i am only on 2 units of basal insulin, reducing that isn't really possible.
But, basically, over time you will learn how to do everything.
A word of warning...cgms read intersitial fluid, but this is about 15 min behind blood glucose so, in an attempt to 'bring your reading more up to date' libre extrapolates - so libre tends to overestimate lows and highs, then realises it was wrong and redraws its graph in retrospect (i have a dexcom which doesn't do this...it gives you the facts and you take it from there)

 

[SB2015]

It may well have been @SB2015 , another ex Maths teacher. The method of solving equations known as "Trial and Improvement" is often miscalled by pupils "Trial and Error"!

Trial and improvement is good description of what we try to do day to day, but it is important to remember that we will never get our levels perfect. ‘Trial and error‘ always sounded so negative and as if the problem was finished and for us (and my students) there is always more to do.

Another book I like is Type 1 Diabetes in Children, adolescents and young adults by Ragnar Hanas. Ignore the age reference (I was 53 at diagnosis and just ignored the chapter on starting school). All clearly explained, well referenced and regularly updated.

Give yourself time to get settled into this ‘new normal’ and tap into the wealth of experience available on here. No questions are silly. Just ask.

 

[Proud to be erratic]

In principle there is little about your diagnosis that should ultimately change your ability to participate in sport to whatever level you aspire to. I was about to mention @helli who has regularly pointed this out - but I've just seen her comment a couple of posts above. Incidentally I'm NOT encouraging you to immediately reduce basal or bolus by 50%, just know that it could be a possibility (I do it sometimes) and is clearly recommended by a Consultant (mine by chance) whose name appeared early this morning in an entirely different place and this confirms to me that he isn't just lobbing out exciting and dangerous ideas. He is also the Head of a pancreatic transplant research facility and leads on guidance for people like myself with an unusual Type of D. Trial and learning is the way ahead.

There is a lot of useful discussion in the Exercise /Sport part of this Forum and several people who have either resumed an active level of sport after diagnosis or indeed taken up sport and extra activity to assist themselves in coming to terms with their diagnosis.

Meanwhile perhaps a few baby steps won't hurt as you explore the mundane business of accepting your diagnosis and understanding the many things that go into managing your D. Alas it's not simply about counting carbs and deriving basic ratios for insulin to carbs - although those are fundamentals. But more subtle aspects such as stress levels, or ambient temperature along with keeping the D management commitment in proportion and not letting that commitment overwhelm daily family life with time. This is the strength of this forum - plenty of views and opinions, but not too much domineering dogma thanks to great moderation by the moderators.

 

[mitchsi]

In principle there is little about your diagnosis that should ultimately change your ability to participate in sport to whatever level you aspire to. I was about to mention @helli who has regularly pointed this out - but I've just seen her comment a couple of posts above. Incidentally I'm NOT encouraging you to immediately reduce basal or bolus by 50%, just know that it could be a possibility (I do it sometimes) and is clearly recommended by a Consultant (mine by chance) whose name appeared early this morning in an entirely different place and this confirms to me that he isn't just lobbing out exciting and dangerous ideas. He is also the Head of a pancreatic transplant research facility and leads on guidance for people like myself with an unusual Type of D. Trial and learning is the way ahead.

There is a lot of useful discussion in the Exercise /Sport part of this Forum and several people who have either resumed an active level of sport after diagnosis or indeed taken up sport and extra activity to assist themselves in coming to terms with their diagnosis.

Meanwhile perhaps a few baby steps won't hurt as you explore the mundane business of accepting your diagnosis and understanding the many things that go into managing your D. Alas it's not simply about counting carbs and deriving basic ratios for insulin to carbs - although those are fundamentals. But more subtle aspects such as stress levels, or ambient temperature along with keeping the D management commitment in proportion and not letting that commitment overwhelm daily family life with time. This is the strength of this forum - plenty of views and opinions, but not too much domineering dogma thanks to great moderation by the moderators.

Thanks for the words, I’m learning from the experienced here and won’t reduce my meds by 50% it was surprising and interesting how much the effect of exercise could be.
I’m also into diving, sailing not just weights or running which I can do in the comfort of my own home. I did find people discussing diving with the Libre which was encouraging.
So I’m looking forward to getting back into it but it seems I’m not feeling 100% after a week from the DKA, I’m impatient and so I’m getting frustrated with the situation.
I need to establish a routine with my diet and exercise schedule but I’m only a week out of hospital and need to chill a bit more.

Appreciate everyone’s input and am pleased with this forum, it will be a massive help going forward.

So many questions but I’m trying to take it easy.

Have a great weekend

 

[mitchsi]

I found excercise the hardest thing about diabetes to crack. I find propping up blood sugars with glucose the best, taken in advance of bs getting too low, for walking etc at least. As i am only on 2 units of basal insulin, reducing that isn't really possible.
But, basically, over time you will learn how to do everything.
A word of warning...cgms read intersitial fluid, but this is about 15 min behind blood glucose so, in an attempt to 'bring your reading more up to date' libre extrapolates - so libre tends to overestimate lows and highs, then realises it was wrong and redraws its graph in retrospect (i have a dexcom which doesn't do this...it gives you the facts and you take it from there)

Thanks, yeah I learnt about the delay with the Libre but still it’s pretty good. Nice background info thanks.
I’ll probably try to start exercising early next week and gauge the effect on levels.
Do you eat a meal 1st then train, spill it it or eat after, my preference would be to eat my main meal 1st.

 

[mitchsi]

Trial and improvement is good description of what we try to do day to day, but it is important to remember that we will never get our levels perfect. ‘Trial and error‘ always sounded so negative and as if the problem was finished and for us (and my students) there is always more to do.

Another book I like is Type 1 Diabetes in Children, adolescents and young adults by Ragnar Hanas. Ignore the age reference (I was 53 at diagnosis and just ignored the chapter on starting school). All clearly explained, well referenced and regularly updated.

Give yourself time to get settled into this ‘new normal’ and tap into the wealth of experience available on here. No questions are silly. Just ask.

Thanks,
Once I finish with this book I’ll take a look at the one you mentioned.

 

[mitchsi]

I am not sure what you mean by "coming to terms with exercise".
When I was diagnosed, I had registered to do the Moon Walk (a 26 mile night time walk through London in aid of Breast Cancer). I had no "coming to terms with it": I was going to do the walk come what may. For me, this was the motivation I needed to get out and exercise in a safe environment with my insulin and dextrose in preparation for the walk. This was before the advent of the Libre (or any other CGM) which would have made it much easier.
My advice for exercise when first diagnosed is "don't shy away from it". Take it easy and build it up learning how your body reacts to your activities bearing mind different types of exercise will have different effects and those effects may change as you get fitter.
For example, I need to stop my basal (I have a pump so it is possible) when doing my spin class activity but increase it by 40% when climbing. This took some trial and learning to get to what suits my body, I would not recommend halving your insulin from day one, especially as weight lifting is more likely to increase your BG.

Yeah my attitude is to make T1D a smaller part of my life as possible for my own head and for my families. So I have no intention of stopping anything but recognise I need to adjust and plan better.
I’m struggling at the mo with diet and decent snacks. I was doing low carbs and going into keto sia now and again, I’m sticking with ‘low’ish’ carbs but snack food is so carby and I don’t want high fat either as I need to calm that down - anyway this is another thread topic :-D

 

[helli]

Do you eat a meal 1st then train, spill it it or eat after, my preference would be to eat my main meal 1st.

In my experience, I avoid having any acting fast acting insulin “on board” when I exercise. Therefore, I try to avoid eating 4 hours before I start.
The reason for this is that exercise (especially cardio) makes me far more sensitive to insulin. So minimising the insulin on board will reduce the risk of hypos when exercising.
Some people will eat before exercise but take less insulin on the assumption that the exercise will increase insulin sensitivity. Something worth trialling for you, your body, your exercise and your lifestyle.
I tried it and never found the right insulin reduction and tend to call in at the gym on the way home from work (before dinner) anyway.

I would also recommend trialling the best BG to start exercise. With the assumption that exercise will cause a BG drop, some people start their levels high. I find i am very sensitive to high BG causing me to feel sluggish and the “strain” of exercising in that state will push my levels higher.

 

[mitchsi]

In my experience, I avoid having any acting fast acting insulin “on board” when I exercise. Therefore, I try to avoid eating 4 hours before I start.
The reason for this is that exercise (especially cardio) makes me far more sensitive to insulin. So minimising the insulin on board will reduce the risk of hypos when exercising.
Some people will eat before exercise but take less insulin on the assumption that the exercise will increase insulin sensitivity. Something worth trialling for you, your body, your exercise and your lifestyle.
I tried it and never found the right insulin reduction and tend to call in at the gym on the way home from work (before dinner) anyway.

I would also recommend trialling the best BG to start exercise. With the assumption that exercise will cause a BG drop, some people start their levels high. I find i am very sensitive to high BG causing me to feel sluggish and the “strain” of exercising in that state will push my levels higher.

Thanks Helli,
Interesting info, I’ll certainly consider that. I’ll break into exercise slowly anyway to assess how I react to the different exercises.

 

[SB2015]

In my experience, I avoid having any acting fast acting insulin “on board” when I exercise. Therefore, I try to avoid eating 4 hours before I start

Thanks Helli. I had not thought of using that approach. This might get me back in a swimming pool. I have been reluctant since looping as when I take the pump off I will have no info at all, which makes me nervous. I just need to bite the bullet and do it, as I managed before all the tech!