Every days a new day and another day that goes wrong

[gillrogers]

Every days a new day and another day that goes wrong and still no supoort where i need it. Im tryi g to sort to many problems out and cant do it on my own. And its just getting worse and my predicted hba1c is heading towards 80!
I keephearing that ive got good control buy hows that? Im hardly ever below 10mmol now. The right basal is now giving me so much problems at lunch time and this reducing resistance isnt helping. Bolused 20 mins after eating yesterday and still staryed crashing down after 30 minutes of it being injected. Ended up gaving to stop it with a glucose tab and exoected a spike and didnt get one but still ended up at 11 for dinner. I was on my own and pannicked when i started getting double arrows vand the stick test showed my blood was ahead of the libre (thats how my alarms gets missed so im not letting me get down that far) .
Im feeling i will never get out of this viscious circle and rhe dbns are just leaving me to the inevitable as i cant get any physiological support what so ever.

 

[Inka]

Can you post your Libre graph and meal/injection times @gillrogers ? I’ve probably already asked this so apologies, but where in your body are you injecting your bolus?

 

[Wendal]

Hi Gill, so sorry to hear about your troubles and are having such difficulties.
Am sure we will try and help explain why things happen as best we can but sometimes diabetes just goes it’s own way and can’t be explained.
Hiwever consistent patterns usually have an explanation and we will try and help if you give us as much info as possible.
Is important to try and step back and take a holistic view as often we get so caught up in the day to day management that we allow any daily challenges to overcome us and test our resilience.

 

[gillrogers]

@Inka , Breakfast aboit 7.40, prebolus 13 minutes yesterday,
lunch 1pm and bolus 20 minutes from start of eating.
Dinner at about 6.30pm last night bolused 13 minutes after start of eating. Massive high spike from omlette st lunchtime i think. Ive seen a pattern where this happens but usualkyonly go to 18.

Basal 3 units at 6am, 2 uniits at 6.45pm


Im injecting into my thighs and im very skinny. I pinch up and inject on a slight angle.

 

[gillrogers]

Hi Gill, so sorry to hear about your troubles and are having such difficulties.
Am sure we will try and help explain why things happen as best we can but sometimes diabetes just goes it’s own way and can’t be explained.
Hiwever consistent patterns usually have an explanation and we will try and help if you give us as much info as possible.
Is important to try and step back and take a holistic view as often we get so caught up in the day to day management that we allow any daily challenges to overcome us and test our resilience.

Thank you. What do you mean by a holistic view?

 

[Lucyr]

@Inka , Breakfast aboit 7.40, prebolus 13 minutes yesterday,
lunch 1pm and bolus 20 minutes from start of eating.
Dinner at about 6.30pm last night bolused 13 minutes after start of eating. Massive high spike from omlette st lunchtime i think. Ive seen a pattern where this happens but usualkyonly go to 18.

Basal 3 units at 6am, 2 uniits at 6.45pm


Im injecting into my thighs and im very skinny. I pinch up and inject on a slight angle.

You really didn’t need to treat the bg dropping with glucose tablets, you need it to drop if you want to get your a1c down. Looks like you aren’t having enough insulin with some of your meals as each on you finished higher than you started, and maybe your correction factor isn’t enough as you didn’t get back down to normal bgs.

I know you panic about hypos but if your bg is above 10 then even if you’re dropping fast you’re not immediately going hypo you can watch it and see what happens.

 

[gillrogers]

You really didn’t need to treat the bg dropping with glucose tablets, you need it to drop if you want to get your a1c down. Looks like you aren’t having enough insulin with some of your meals as each on you finished higher than you started, and maybe your correction factor isn’t enough as you didn’t get back down to normal bgs.

I know you panic about hypos but if your bg is above 10 then even if you’re dropping fast you’re not immediately going hypo you can watch it and see what happens.

Thank you Lucy, yes it will look like I’ve not had enough insulin because I’ve had glucose when I didn’t need to. Trouble is I panic at the double down arrows in suggah and brain takes over badly. When the drops happen I’m sat down doing nothing. I know from experience if I get up and do something while that’s happening it drops faster than the libre can keep up with and I miss the alarms which is why I watch it. It takes me 20 minutes as opposed to the 15 before I start releasing the glucose after I’ve eaten it. I just can’t grasp it at all and I never will until I get the physiological help I need too or a pump. Pumps not going to happen because I can’t get the basics right so my consultant tells me. ‍♀️

 

[Wendal]

Thank you. What do you mean by a holistic view?

Hi Gill I mean looking at the issue as a whole so the bigger picture. I would normally use the term strategic but that is a bit corporate for this forum.
So look at getting the background things right that work for you rather than the day to day stuff.
So you try things one at a time so try and get your basal right and “ stabilised”,to decide whether you want to go low carb or a more normal diet,how much exercise do you want or able to do etc.
Then focus on what works for you so when is best time for you to bolus and what may just help you better control your BG so for me a brisk walk after a meal works very well rather than if I lie/ sit down and do nothing.
If you are getting so immersed with the daily movements you can concentrate too much on trying to micro manage the changing levels so you often end up dealing with the consequences rather than the underlying causes.
Once you can better control/ manage the underlying picture you should be more relaxed when dealing with specific situations.
Again I find once you get comfortable with dealing with lows so have a plan for say responding to a low alarm ( treat it more like an alert) and you will find you make more timely and measured decisions rather than maybe overreacting in a bit of a panic.
Being proactive rather than reactive and trying to take control rather than let the diabetes control events.
I know it is not easy but we are here to help and very best wishes.

 

[gillrogers]

Hi Gill I mean looking at the issue as a whole so the bigger picture. I would normally use the term strategic but that is a bit corporate for this forum.
So look at getting the background things right that work for you rather than the day to day stuff.
So you try things one at a time so try and get your basal right and “ stabilised”,to decide whether you want to go low carb or a more normal diet,how much exercise do you want or able to do etc.
Then focus on what works for you so when is best time for you to bolus and what may just help you better control your BG so for me a brisk walk after a meal works very well rather than if I lie/ sit down and do nothing.
If you are getting so immersed with the daily movements you can concentrate too much on trying to micro manage the changing levels so you often end up dealing with the consequences rather than the underlying causes.
Once you can better control/ manage the underlying picture you should be more relaxed when dealing with specific situations.
Again I find once you get comfortable with dealing with lows so have a plan for say responding to a low alarm ( treat it more like an alert) and you will find you make more timely and measured decisions rather than maybe overreacting in a bit of a panic.
Being proactive rather than reactive and trying to take control rather than let the diabetes control events.
I know it is not easy but we are here to help and very best wishes.

Oh I see what you mean, yes I try to fix one thing at a time, fixing my basal is the biggest problem as I’m so sensitive to a lot of things like stress, and the weather. and when it comes to bolus I’m sensitive to movement and I’m not talking exercise, I mean just doing the washing up after dinner before an hour to hour and a half after bolusing and that will kick of a fast drop that will go on until I stop it with glucose. And stress is a big thing for me up and down like a yo-yo due to a daughter with a complex emotional needs problem that uses very risky strategies for coping, that results in me calling police and ambulances on a regular basis. Now my husband is out of work and we are battling universal credit etc just so we can pay our rent and food. The stress can also affect my bolus if for example I get an emergency with her just after I’ve eaten. I’ve been trying for so long now to get this sorted and deal,with my gremlins over hypos that I’ve lost my way completely. Another problem is my resistance to the insulin has reduced dramatically, so I’m now bolusing lunch and dinner after I’ve eaten. I can’t find a steady bolus timing time for my meals,like I used to have before my resistance dropped. I just keeps fluctuating. Every time I try to take control like i did yesterday it bites me in the bum. I’ve been slapped down so much by it that I can’t find my way back and the professionals keep treating me like I’m a seasoned pro at diabetes and should know what I’m doing with it now. They forget I’m a LADA with no experience of it and don’t know how to deal with the problems. Also I had a friend who ended up in a diabetic coma and consequently severely brain damaged through a severe hypo. If I didn’t know that I’d probably be a lot better than I am with it.

 

[grovesy]

Oh I see what you mean, yes I try to fix one thing at a time, fixing my basal is the biggest problem as I’m so sensitive to a lot of things like stress, and the weather. and when it comes to bolus I’m sensitive to movement and I’m not talking exercise, I mean just doing the washing up after dinner before an hour to hour and a half after bolusing and that will kick of a fast drop that will go on until I stop it with glucose. And stress is a big thing for me up and down like a yo-yo due to a daughter with a complex emotional needs problem that uses very risky strategies for coping, that results in me calling police and ambulances on a regular basis. Now my husband is out of work and we are battling universal credit etc just so we can pay our rent and food. The stress can also affect my bolus if for example I get an emergency with her just after I’ve eaten. I’ve been trying for so long now to get this sorted and deal,with my gremlins over hypos that I’ve lost my way completely. Another problem is my resistance to the insulin has reduced dramatically, so I’m now bolusing lunch and dinner after I’ve eaten. I can’t find a steady bolus timing time for my meals,like I used to have before my resistance dropped. I just keeps fluctuating. Every time I try to take control like i did yesterday it bites me in the bum. I’ve been slapped down so much by it that I can’t find my way back and the professionals keep treating me like I’m a seasoned pro at diabetes and should know what I’m doing with it now. They forget I’m a LADA with no experience of it and don’t know how to deal with the problems. Also I had a friend who ended up in a diabetic coma and consequently severely brain damaged through a severe hypo. If I didn’t know that I’d probably be a lot better than I am with it.

Would a change of team, get you more support?

 

[helli]

I think your problem is that fear of hypos.
Two downward arrows when your BG is above range is not a problem. Abbott themselves say if you see this above range, "if this is between meals, consider doing nothing and scan again later".

It is not surprising your HBA1C is high when your BG is always so high. And, I don't mean the spikes but the lowest you see is still high compared to most people's target.
Some time ago, it was suggested that you gradually change your target and aim to be around 9 mmol/l (and not react immediately to down arrows) and then, when you are comfortable at that level, target 8 mmol/l.

 

[gillrogers]

Would a change of team, get you more support?

Ive no idea, i have a phone appointment with my gp on Monday , i am going to ask ger if i can move to Bristol instead of Gloucester.

 

[gillrogers]

I think your problem is that fear of hypos.
Two downward arrows when your BG is above range is not a problem. Abbott themselves say if you see this above range, "if this is between meals, consider doing nothing and scan again later".

It is not surprising your HBA1C is high when your BG is always so high. And, I don't mean the spikes but the lowest you see is still high compared to most people's target.
Some time ago, it was suggested that you gradually change your target and aim to be around 9 mmol/l (and not react immediately to down arrows) and then, when you are comfortable at that level, target 8 mmol/l.

Yes that was last week, and im trying to get there. Doesnt help when I keep loosing insulin when on injecting. Yesterday my possidge oats gad a change of carbs which i addressed accordingly, seemed to work exceot for that 4g glucose when starting to drop while waiting for breakfast to kick in. This morning its not worked. Ive gad the correction accordingly and its not worked. Going to up my night time basal as 3.5 prooved too much with a drop of over 3mmol in 2 hours at lunch time. So perhaps the tail end of 2.5 evening units will suffice. Other complications is my humalog seems to last 5 hours . Its all too overwhelming with my fear especially when im on my own like yesterday.

 

[Inka]

@Inka , Breakfast aboit 7.40, prebolus 13 minutes yesterday,
lunch 1pm and bolus 20 minutes from start of eating.
Dinner at about 6.30pm last night bolused 13 minutes after start of eating. Massive high spike from omlette st lunchtime i think. Ive seen a pattern where this happens but usualkyonly go to 18.

Basal 3 units at 6am, 2 uniits at 6.45pm


Im injecting into my thighs and im very skinny. I pinch up and inject on a slight angle.

Have you tried splitting your bolus, eg half just before you start eating and half X minutes after the start time of your meal?

I completely understand how scary the double down arrow is. Splitting your bolus would reassure you that that drop was spread over two different points in time. Also, I know you’ve mentioned regular insulin before (non-analogue). The drop from that is slower and I’ve never seen a double arrow drop from it.

 

[Lucyr]

Trouble is I panic at the double down arrows in suggah and brain takes over badly.

Stop using shuggah then? Set low alarms on libre at a point appropriate for treating to prevent a low and just use that.

 

[Lucyr]

Yesterday my possidge oats gad a change of carbs which i addressed accordingly

I already explained this on your other thread too. The porridge didn’t have a change in carbs, you use an app which had the wrong data for one of them. If you’re going to use an app you need to still check the data against the packet.

 

[gillrogers]

Have you tried splitting your bolus, eg half just before you start eating and half X minutes after the start time of your meal?

I completely understand how scary the double down arrow is. Splitting your bolus would reassure you that that drop was spread over two different points in time. Also, I know you’ve mentioned regular insulin before (non-analogue). The drop from that is slower and I’ve never seen a double arrow drop from it.

No I’ve not split it that way. I’ve split at the correction. So currently with lunch Ive given the carbs cover 15 minutes from start of eating (but I’ve had 6g carbs 10 mins before to counteract that basal dip I keep experiencing from 2pm. Then I’ll have the correction anything from 13.35 to 14.30 depending on what it’s doing.

 

[grovesy]

Ive no idea, i have a phone appointment with my gp on Monday , i am going to ask ger if i can move to Bristol instead of Gloucester.

You can ask and see what he says !

 

[Inka]

No I’ve not split it that way. I’ve split at the correction. So currently with lunch Ive given the carbs cover 15 minutes from start of eating (but I’ve had 6g carbs 10 mins before to counteract that basal dip I keep experiencing from 2pm. Then I’ll have the correction anything from 13.35 to 14.30 depending on what it’s doing.

Right, so try splitting your meal dose if the drop is coming from your bolus. I’d try half the bolus just before eating and half maybe 30-45mins later. It’s all a question of experimentation. Splitting your meal bolus should stop the scary double down arrow as your drop will be more gradual.

Once you see the drop is gradual, it should help reduce your fear and panic about going too low.

 

[Wendal]

Oh I see what you mean, yes I try to fix one thing at a time, fixing my basal is the biggest problem as I’m so sensitive to a lot of things like stress, and the weather. and when it comes to bolus I’m sensitive to movement and I’m not talking exercise, I mean just doing the washing up after dinner before an hour to hour and a half after bolusing and that will kick of a fast drop that will go on until I stop it with glucose. And stress is a big thing for me up and down like a yo-yo due to a daughter with a complex emotional needs problem that uses very risky strategies for coping, that results in me calling police and ambulances on a regular basis. Now my husband is out of work and we are battling universal credit etc just so we can pay our rent and food. The stress can also affect my bolus if for example I get an emergency with her just after I’ve eaten. I’ve been trying for so long now to get this sorted and deal,with my gremlins over hypos that I’ve lost my way completely. Another problem is my resistance to the insulin has reduced dramatically, so I’m now bolusing lunch and dinner after I’ve eaten. I can’t find a steady bolus timing time for my meals,like I used to have before my resistance dropped. I just keeps fluctuating. Every time I try to take control like i did yesterday it bites me in the bum. I’ve been slapped down so much by it that I can’t find my way back and the professionals keep treating me like I’m a seasoned pro at diabetes and should know what I’m doing with it now. They forget I’m a LADA with no experience of it and don’t know how to deal with the problems. Also I had a friend who ended up in a diabetic coma and consequently severely brain damaged through a severe hypo. If I didn’t know that I’d probably be a lot better than I am with it.

Hi Gill,
As others have highlighted it appears to me your biggest challenge is the fear of going too low possibly due to your memory of your close friend and heightened by your own anxiety and compounded by other stresses that you have mentioned.
This seems to be leading you to take corrective action at a very high BG level ie 9 or 10 and hence that is your floor when in fact for many it is more of a ceiling.This fear seems to be impacting on your willingness to take enough insulin as your quantities do seem modest and with your current levels of hyperglycaemia you need to as Helli says try and reduce this gradually.
Why not set a low alarm which will alert you to the need to take action but at a much lower level so that your natural spike will not take you so high as you currently go.
Once you do that gradually you should gain more confidence and relying on your alarm should mean even if you get distracted by other events you can then take appropriate action.
First and foremost you need to look after yourself as unless you are healthy and well you are unlikely to be in the best position to look after others so please do take care.