Beaten up by highs and lows

[DianeD]

Basel abasaglar 12 units in morning (working a treat)
Bolus Turapi no idea what ratio to do
Used to walk 7 miles a day now can't to 10mins without a hypo
Hate food. Don't know how to carb count properly and getting it wrong or the bolus wrong. 1:10 gives me spikes 1:8 gives me hypos 1:9 can go either way, then the roller coater starts. Feeling so ill all the time. How do I stop it?

 

[Inka]

Do a basal test @DianeD Don’t just assume it’s ok. Then, if you’re going to go for a walk, reduce your mealtime bolus beforehand and/or eat extra carbs. You’ll probably also need top up carbs on your walk, but from what you’ve said (going hypo after 10 mins) you’ve got too much insulin onboard. You now need to determine which type of insulin is too much (might be both) then reduce it.

Some people mistakenly run too low so that any activity pushes them into a hypo.

 

[Inka]

Also, get a half unit pen for the Trurapi. If it doesn’t do half unit pens, ask to swap to Novorapid. While you’re sorting your basal and bolus doses, stick to easily countable meals.

Don’t hate food. It’s nothing to do with the food, it’s the insulin that needs tweaking.

 

[rebrascora]

Spikes are often a timing issue rather than not enough insulin. If you come back down to where you started by the next meal then the dose was right but you didn't give the insulin enough of a head start.
How long before eating do you currently inject your Trurapi?

I need much longer at breakfast time than at any other time of the day and with NovoRapid I needed about 75 mins before breakfast but with Fiasp I just need about 45mins but if my levels are low when I wake up (in the 4s) I can usually get away with 20-30mins. At other times of day (ie lunch and evening meal) I just need 10-20 mins.

As regards exercise, it is important not to exercise with active bolus insulin (Trurapi) in your system, so within 3 hrs of injecting for a meal, or if you do you need to significantly reduce the dose to allow for the exercise.

 

[Tdm]

I am on abasaglar too, and novorapid. I found the excercise the trickiest to deal with at first....my levels used to plummet like a stone, pretty much 10 min walking was my limit, then...
And so i tried to avoid excercise with active bolus insulin on board, which was all well and good but very restricting. My consultant suggested a more rapid insulin like fiasp so i had more time without bolis insilin...its an idea

But i found the sudden drops got less over time. I also worked out how to keep in range with a sweety or two. I know you can take less insulin, but i like sweets and diabetes is so tricky, and you may want to cut excerise short/ do more, so i find having a nibble as i go the best. Eventually, i worked it out.
And you will too.

You may find the occasional low carb meal before excercise means you have less bolus insulin on board and therefore the drops are less dramatic. Doing too much low carb can make you insulin resistant, though.

Do you have the libre 2? That can be a bit of a drama queen and may be exagerating things

With a 24 basal like abasaglar you can't really adjust for excerise...if you are staying stable overnight, you have it right for the basal.

 

[Tdm]

Also, were are your low alarms set? Setting your low alarm quite high (5, or even 5.5) before excercise gives you more time to head off the lows

 

[DianeD]

Thank you everyone. Yes I have libre2, you're not kidding it's a diva!
I've gone back to 1:10 and only eating ready meals so I know the carb count () I would never have eaten them before, despise UPF food. Done a basel test as per think like a pancreas, all good, so defo the bolus. Don't think trurapi come with 1/2 units but will check. Doesn't leave long between end of insulin and next meal, as you say quite restrictive. In the morning it's half an hour before breakfast, other times as I'm preparing. 3pm seems to be a favourite time for a low so no walking then.
Then there's this (hopefully attached) what the hell, ?

 

[DianeD]

1:10 gives me spikes after eating how do I know if that's because it's too close or too much. After a spike, there's almost always a low, rarely goes back to previous level, that only happens if the high doesn't really happen 3-4 points rather 6 or 7. No apparent reason why it differs. Changing both is not useful so with one to do first and by how much? At what point do I try the other one?
Thank you

 

[Inka]

Take one meal at a time, eg breakfast, then work out what works best for it. Breakfast is usually when we’re most insulin resistant so need the longest pre-bolus time. How high do you spike? Your chart above isn’t showing any spikes apart from the one at the end.

 

[SimonP]

You can exercise with bolus on board, but just take less than you normally would and take some snacks. If I'm eating less than 35g of carbs (a sandwich with 2 slices of bread for example) and am going to exercise, I won't bother to bolus for it at all. For something more substantial (say supper, which might be 60-80g of carbs), I'd only take 1/3 of my usual dose if I'm going to exercise.

If you're going to be walking decent mileages quite regularly I'd also think about reducing basal a little (for those days and the following day or two). If I'm riding a decent distance, I may knock my morning dose (I split my basal so I can adjust it more easily) down to between 1/2 and 1/3 of the usual.

Rather than ready meals, make something and try to estimate how much (many) carbs are in it, see what response you get and repeat the process. While eating the same thing isn't great (though it probably better than many ready meals!), you will get used to how much insulin works for a given amount of pasta/potatoes/bread.

 

[DianeD]

That one was a surprise, I was just doing dinner not eaten at that point, that hasn't happened before. Bloods went too fast for sensor which died, does that when it changes too quickly. Usual spikes after food are around 6 to 7. Then go below 4 (just on picture).

 

[Inka]

That one was a surprise, I was just doing dinner not eaten at that point, that hasn't happened before. Bloods went too fast for sensor which died, does that when it changes too quickly. Usual spikes after food are around 6 to 7. Then go below 4 (just on picture).

Well, there’s your problem @DianeD ! 6 or 7 isn’t a spike. So, it seems like you’re having too much bolus insulin. Try 1:15 maybe and see how that goes.

 

[DianeD]

That one was a surprise, I was just doing dinner not eaten at that point, that hasn't happened before. Bloods went too fast for sensor which died, does that when it changes too quickly. Usual spikes after food are around 6 to 7. Then go below 4 (just on picture).

That's 6 to 7 points up

 

[DianeD]

Well, there’s your problem @DianeD ! 6 or 7 isn’t a spike. So, it seems like you’re having too much bolus insulin. Try 1:15 maybe and see how that goes.

Sorry that's meant to say 6 to 7 points up from start position not at 6 or 7, I thought it was supposed to be around 3 ?

 

[Inka]

That's 6 to 7 points up

Oh, ok! So pretty normal if your before meal blood sugar was in range. The fact you then go low suggests to me you’re having your insulin too close to your meal. If you have it further in advance of eating, you should then be able to reduce your insulin slightly with the result that your spike is less and you don’t go low later.

 

[Inka]

Sorry that's meant to say 6 to 7 points up from start position not at 6 or 7, I thought it was supposed to be around 3 ?

Not if you have Type 1! That 3 thing is for Type 2s who are diet only. It’s not relevant for Type 1s. Our target is to be back in range by our next meal 🙂 If we aim for too low a post-meal rise, we’ll be taking too much insulin which will basically make any activity impossible. Somebody here said they could barely walk across a room without going low. That’s too much insulin.

 

[DianeD]

Oh, ok! So pretty normal if your before meal blood sugar was in range. The fact you then go low suggests to me you’re having your insulin too close to your meal. If you have it further in advance of eating, you should then be able to reduce your insulin slightly with the result that your spike is less and you don’t go low later.

Ah, so I'm 20mins to half hour before breakfast at the moment. Was high for some reason today (usually 7) started at 9 went to 15 then dropped to below 4. So tomorrow go another 10 earlier and see?

 

[Inka]

Ah, so I'm 20mins to half hour before breakfast at the moment. Was high for some reason today (usually 7) started at 9 went to 15 then dropped to below 4. So tomorrow go another 10 earlier and see?

I’d go earlier in 5 minute increments just to be safe @DianeD For breakfast with a normal blood sugar, I find 30 mins in advance is good but your time might vary. Once I’d got my bolus time right, I was able to reduce my bolus amount a little, which was good (I reduced it by around 25%) That helped stop me going too low and meant I felt better through the morning and didn’t have to worry about normal activity.

 

[Inka]

Just to add - while you’re perfecting your breakfast timing, eat the same breakfast day after day until you’re confident the timing is good. If you have cereal, this means weighing your cereal. This is to remove one variable and keep your timing experiments more useful.

 

[DianeD]

I’d go earlier in 5 minute increments just to be safe @DianeD For breakfast with a normal blood sugar, I find 30 mins in advance is good but your time might vary. Once I’d got my bolus time right, I was able to reduce my bolus amount a little, which was good (I reduced it by around 25%) That helped stop me going too low and meant I felt better through the morning and didn’t have to worry about normal activity.

Sounds like a plan, thank you, I shall let you all know how it goes.

Silly question coming up.
Does it not matter what the peak is then so long as it goes back to prior level? I thought I needed to keep it within the 5 to 10 range