Hello, really struggling with control

[fay96]

Hi, I really want to get better control of my blood sugars and would love some advice.

I am type 1 diabetic and my Hba1c is at 72, I am trying to sort out an appointment with a diabetes team since I haven't heard anything since COVID started, so I thought I would come on here.

I'm struggling to find the correct dose for me. I'm on Tresiba for the long acting and I noticed I was dropping a lot during the night, so I have been reducing it steadily, starting from 21 and now I am 15. Now I have noticed I still drop, but mostly when I'm on an empty stomach. For example, today I was at 12 mmol at 8am and didn't exercise or eat till 2pm and it dropped to 7 mmol. I dont know if this normal or not? Its the same at night, if I have a banana before bed I won't drop as much compared to not having anything.

Sorry maybe this is too much for a post, but I would appreciate any help. I would love some general advice on control as well. I'm worried about the future tbh and I need to get better at this.

 

[Inka]

Welcome @fay96 🙂 The job of your basal is to keep your blood sugar steady in the absence of food, so if you’re dropping unless you eat, then it sounds like your basal is still a bit too high for you.

How long have you been diagnosed? Have you always used Tresiba? If so, you might find you’re better off on a twice daily basal insulin like Levemir or one of the isophane insulins. These allow for more flexibility, different doses for day and night, and adjustment for exercise too to some extent.

Are you carb-counting and adjusting your mealtime insulin according to your ratio? That’s one way to get better control (in fact, it’s crucial). Do you have a Libre or other CGM?

There are a couple of books often recommended for Type 1s here:

Think Like a Pancreas’ by Gary Scheiner.

And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too).

 

[fay96]

Welcome @fay96 🙂 The job of your basal is to keep your blood sugar steady in the absence of food, so if you’re dropping unless you eat, then it sounds like your basal is still a bit too high for you.

How long have you been diagnosed? Have you always used Tresiba? If so, you might find you’re better off on a twice daily basal insulin like Levemir or one of the isophane insulins. These allow for more flexibility, different doses for day and night, and adjustment for exercise too to some extent.

Are you carb-counting and adjusting your mealtime insulin according to your ratio? That’s one way to get better control (in fact, it’s crucial). Do you have a Libre or other CGM?

There are a couple of books often recommended for Type 1s here:

Think Like a Pancreas’ by Gary Scheiner.

And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too).

Hi Inka 🙂, thank you for this!

I've been diabetic for 17 years now, I was diagnosed when I was 10 years old. I was on Levemir when I was first diagnosed, but I have been on Tresiba for a long while now, I can't remember what it was like with Levemir.

I have a Libre, been on it for a couple months now and it's helped a lot already. I've been trying to carb count as well but with me changing the basal dose, it gets confusing. I think I need to sort the basal dose first. I've noticed as well with my menstrual cycle that my sensitivity to insulin changes, do you know if this is common?

Thank you for the book recommendations as well!

 

[Inka]

Yes, it’s best to sort the basal dose first @fay96 because that’s the foundation on which you build. If your basal dose is wrong, it makes everything else harder to sort. However, I really think you should consider going back to Levemir. You mentioned changes to insulin sensitivity due to your menstrual cycle. This is extremely common. A ultra-long acting basal like Tresiba makes it impossible to deal with this, but with Levemir you can make adjustments and see the result very quickly. You could then adjust it to help the changes in sensitivity.

 

[fay96]

🙂 Yes, it’s best to sort the basal dose first @fay96 because that’s the foundation on which you build. If your basal dose is wrong, it makes everything else harder to sort. However, I really think you should consider going back to Levemir. You mentioned changes to insulin sensitivity due to your menstrual cycle. This is extremely common. A ultra-long acting basal like Tresiba makes it impossible to deal with this, but with Levemir you can make adjustments and see the result very quickly. You could then adjust it to help the changes in sensitivity.

Yes the Levemir sounds much better, its been a headache trying to figure out the Tresiba. I will speak to my GP about making the change 🙂

 

[everydayupsanddowns]

Welcome to the forum @fay96

Sorry to hear how long it has been since you’ve been able to grt some input from your clinic. Covid really did throw a spanner in the works didn’t it!

I agree with @Inka that getting your basal adjusted correctly for you is a really good place to start - otherwise any adjustments you make to bolus doses or correction factors can be skewed by the overactive (or underactive) basal.

There’s a method of systematically checking your basal dose explained here which might be a good starting point - even though it’s a bit of a faff to do.

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

Once you have your basal basically right you’ll know if there are times during the day when it’s a little under or a little over, and can adjust other doses accordingly. Plus it should make tweaking your meal ratios and correction factors a little easier?

Good luck with it!