Hello, new here, type 1 for 15 years

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I believe there are different products that you can try if you have a reaction to the adhesive. One option is to apply a patch to your skin that you are not allergic to and apply the Libre on top/through it, or I think there is a skin prep/barrier that you can use. Also, some people find that they are allergic to the adhesive on one brand of CGM but don't get a reaction with another make that I guess uses a different adhesive. Not sure if you have tried any of these options but my concern is that if you may be having nocturnal hypos with an HbA1c that low and if this is a long standing pattern you are at risk.
Also taking the full dose of Levemir in the evening is a concern and may be contributing to that possible nocturnal hypo situation. Levemir is designed to be taken in 2 doses morning and night. Many of us need less basal insulin during the night so taking a single dose in the evening would be giving you the maximum activity of the insulin at a time when you probably need it least. Levemir generally doesn't last 24 hours and if you are on a low dose usually just 12-16 hours, so splitting it gives you the ability to cater for a difference in your basal needs between day and night with a little bit of overlap. It is a wonderful basal in my opinion for enabling you to match your body's needs to account for this day night disparity and also for exercise. My evening dose (anywhere between 0-5 units) is MUCH less than my morning dose (20-24 units). My daytime needs are pretty stable and I can go weeks and sometimes months without adjusting it, but my night time needs are very susceptible to exercise and I have to adjust it on a near daily basis to prevent hypos. I could not manage this nearly as well without CGM but it makes the world of difference both physically and mentally to be able to balance your night time levels and thereby, get a good night's sleep.

I am not sure if @helli had some issues with an adhesive on one of the CGMs and may have some tips for overcoming it.
 
Ichigo Daisuki said:
Hello 🙂 Thank you very much for your reply. I've never heard of the echo pens, but they sound amazing. I'll have to ask if my gp will prescribe them. My endo told me, my HbA1c is 28.
I go hypo maybe 3 times a week and my comfort zone is between 4 and 5, so I have very little margin for exercise, stress, temperature increase etc.
I've been told to aim for 48 but I'm having issues with aiming for 6mmol on average as they suggested, it makes me sluggish. Some of my hypos are very low, like 2.5 if I dose as nornal and then exercise and take a hot bath. It's not always easy to factor in. Any advice?
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That’s a worryingly low HBA1C @Ichigo Daisuki There’s no need to run so low and in such a tight range. I’ve tested lots of my non-diabetic friends’ blood sugar and they commonly go up to 8 or so after a meal. Occasionally, there’ll be 9s or 10s.

The range on the Libre (3.9 - 10) is a far better range to aim at than 4-5mmol. I was told 4-10 with occasional brief spikes above that. Hypoglycaemia is often thought of as an annoyance, but it can be deadly. Even if it’s not deadly, prolonged/frequent hypoglycaemia can damage brain cells and cause cognition issues and personality changes. It can also causes seizures and heart problems.

You really need to stay in a sensible (ie higher) range in order to maintain your hypo awareness. I’ve had Type 1 almost 30 years and I try to stay above 5. It makes a huge difference. It doesn’t mean I run high - just that I have a safety cushion and good hypo awareness while maintaining good control.
 
I agree with others. I don’t think you are running at a safe range, and it is likely that you will be impairing your hypo awareness (if it hasn’t taken a dent already) because some “below 4s” might be happening for an extended period before your symptoms kick in - especially if you are venturing into the 2s with any regularity. 😱

I know what you mean about the sluggishness - but this is very likely to be temporary while your ‘glucose thermostat’ resets, which usually only takes 2-3 weeks.

Have you seen the Time In Range recommendations? 70% 4-10 with no more than 3-4% below 4.0 is a great benchmark and offers significant reduction in risk of developing complications. There’s no need to limit yourself to 4-5. Guidelines suggest 5 is a minimum on waking to protect against undetected overnight hypos. 🙂

Hope you get access to the Echo!

Let us know how you get on 🙂
 
Hello Maria @Ichigo Daisuki ,
I'm a relative newcomer to this D malarkey at 3+ yrs, so I can't add real value to all you've been told so far. However 3 things struck me in reading through your story so far:

I changed to the 1/2 unit NovoEcho reusable pens nearly 2 years ago and I'm really glad I did. I think @rebrascora has summed up the benefits wonderfully. I'm slightly colour blind and I'm naturally able to worry myself silly about using the wrong pen anyway! [I refuse to agree that I can be obsessive!!]. So I've put a prominent sticker on my blue for basal pen, which gives it a tactile feel to make it different; (the sticker is a gold star - to remind me that I've done really well, again! Every day.) My red (for rapid) pen gets no special decoration. But joking apart the red and blue pens do otherwise look slightly similar in poor light.

I also around that time changed from Levermir to Tresiba as my basal, which has a very long 40 hour profile and so is a once daily injection which also has the added benefit of not needing to be taken at a precise time. Today's jab is topping up yesterday and I've deliberately optimised my Tresiba to give me a very steady and safe background cover through the night. I then use my Novarapid to manage my food cover, plus any corrections that I might need during the day and evening. My Tresiba is very fixed for months at a time. I'm not saying Tresiba "will" be perfect for you; but something to consider, rather than getting into twice daily Levermir and needing to vary your Levermir am and/or pm to match daily changing circumstances.

The 3rd thing that struck me was sometimes this forum attracts a longstanding T1 - who at first glance I might have thought didn't need help from the forum. Then it can become apparent that the developments in D management over the last 10+ years have passed them by and there are various "upgrades" of D kit and better practice that could be routinely prescribed / advised to longer standing insulin dependent folks - but hasn't been. CGM including the latest recent extra variants is a classic example; reusable pens (with their built in memory caps) is another; and the enhanced 4mm 32guage needles (that you already have) would be a third example. With the latest short but fine needles, also comes much stronger advice to change the needle every jab; my T1 cousin with over 40 years under his belt finds the idea of regular needle changes very alien, having started with just 2 stainless steel needles that had to be boiled for sterilising .... and once he starts telling me about that we digress into all sorts of other D things that I am aware of and he isn't .... So my underlying point is that the tech and the theory for D have progressed hugely in the last few years, or so it seems to me.

I wonder if today's best practice would include strongly encouraging you to attain a somewhat higher HbA1c? 28 suggests you spend a fair amount of time hypo or below, perhaps much more than you realise without the helpful 24hr CGM graphs; time in range (TIR) is automatically extracted from the CGM data and I think you would find that singularly revealing.

I've found out more about my D and gleaned D management tips and tricks from this forum that don't seem to exist in the books I've read or have been offered by medical professionals. Anyway welcome, it's been interesting reading your story.
 
Thanks for the tag @rebrascora
Thankfully I have never had issues with CGM glue. However, my skin is not happy with the glue used on my pump. I now use Hyperfix tape between by skin and the pump. It provides a good barrier but, as it is gone, it does not impact the pump. I have heard others using it for CGMs.
 
Thanks @helli. I had a feeling I wasn't quite right but I was pretty sure you had some issue and would know of a possible solution.
 
Ichigo Daisuki said:
How has your routine changed over the years?
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I moved from pens to a pump, with a bit of a battle to get one. This reduced the night hypos and made exercising a lot easier.
I then self funded the Libre until it became available on NHS. That helped me see what was happening between meals and surprised me with size of the spikes I was getting after meals. I found it helpful in working out the timing of my blouses before meals which have helped to strike those spikes. However it also pushed me into thinking I could get better and setter control....... and burnout.
More recently I moved to a different pump so that I can use a closed loop where the pump and sensor have ‘a chat’ and make any necessary adjustments to my basal insulin withou my intervention most of the time. For me it has taken away so much of the work involved but there are also regular alerts and alarms, wanting me to check things. For me still worth it.
So massive changes in just the last 15 years.
 
Another relative newcomer here but loooooong time T1 (nearly entire life) and I’ve also both missed jabs and injected wrong insulin. The latter quite recently - switched to pens from syringes and they look scarily similar... that was complicated… Don’t beat yourself up. Too many people in medical teams who don’t live with it seem only too happy to do that. It’s ok to screw up. We all do it…
 
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