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Hi, I'm being treated as a T1D.

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Wolder

Member
Relationship to Diabetes
Type 1
Hello,

I hope you’re all well.

I have yet to receive an official diagnosis as the results of my antibody test haven't arrived, though I am currently being treated as a T1D.

In February 2018 I was diagnosed with Crohn’s at the age of 25. For those who don’t know, Crohn’s is another autoimmune disease which causes inflammation of the digestive tract. Fortunately, it’s never caused any issues (touch wood). In late 2019 I noticed that I was becoming increasingly thirsty, but my Crohn’s consultant told me that this was a common symptom of Crohn’s and told me to just drink plenty of water. Throughout 2020 my thirst increased, and I was finding myself having to go to the toilet between 6-10 times a day. Again, my Crohn’s consultant told me that this was a symptom of the disease. During the summer of 2020 I began to lose weight unintentionally. I weighed 12st 12lbs in June 2020, and by February 2021 I weighed 11st 2lbs. Again, my Crohn’s consultant told me...you get the picture. It seems these symptoms had nothing to do with Crohn's.

By October 2021 I had developed further health issues. I was feeling very lethargic and struggled to eat. I was falling asleep during my lunch breaks, and would have to take at least an hour-long nap at the end of the working day. By this point my weight had dropped further – I now weighed 9st 2lbs, which is nothing for somebody who’s 6’0”.

Later that month I learned that several distant relatives have haemochromatosis, which can cause diabetes, so I finally had my blood tested in late November, and in early December I was told that my HbA1C was 110 mmol/mol, and was asked to attend a meeting with a diabetes specialist nurse a few days before Christmas. I attended this meeting, and within a few minutes they tested my blood ketone levels, which read 6.2 mmol/L. I was taken to A&E, and within an hour my blood ketone levels had increased to 7.2 mmol/L, and my blood glucose was 20.3 mmol/L. At this point I weighed 8st 8lbs.

After five days in hospital (including Christmas day) I was discharged. In the fortnight since then I’ve regained quite a bit of weight (now weigh 9st 12lbs) and strength, don’t feel the need to drink anywhere near as much as I did beforehand, and my average blood glucose level last week was 7.7 mmol/L (which is far better than it was, but there’s obviously plenty of room still left for improvement). I'm not falling asleep during the daytime either. The only issue I’ve had since being discharged from hospital have been night sweats. I’ve never experienced them before, but most nights I now wake up sometime between 03:00 and 05:00 absolutely dripping in cold sweat. I’ve read that hypos can cause this, but when I measure my blood glucose levels at 08:00 they’re usually high - almost always between 8.5 to 9 mmol/L. Am going to take a Ryvita right before I go to bed tonight to see if that does anything.

I am now using Novorapid (8 Units before breakfast, 10 Units before lunch and dinner) and Toujeo (20 Units). I have been told that I’ll soon be contacted by a diabetes nutritionist and will be taught to carb count. I am scheduled to attend a Libre 2 presentation later this week, and will hopefully receive a Libre 2 monitor very soon.

Sorry for such a long introduction. I’m looking forward to learning more about this disease. If you can recommend any resources to help me manage my blood glucose levels, or provide me with any advice, it’d be gratefully received.
 
Hi and welcome.
Sop very sorry that your symptoms were put down as part of your Crohn's for so long and that it came to such a dangerous level before you were diagnosed. Good to hearthat you are regaining weight.

20 units of Toujeo sounds like quite a large starting dose for someone who has lost quite a lot of weight and is newly diagnosed and I am very worried that you are hypoing through the night possibly quite badly and then getting a rebound as your liver kicks in and releases glucose to counteract it. Please set an alarm to wake up and test your levels at 3am. Cold sweats are almost always hypos when you are diabetic so please keep yourself safe and check this out. It is not safe to assume that because you are waking up with a decent or high level than you are not hypoing through the night and if your liver becomes depleted you could end up in a situation where it can't rebound you, so please check this out tonight if you see this message before you sleep.
What BG level do you go to bed on?
 
You should always keep hypo treatment on your bedside table and your test kit close to hand too so that you don't have to wander through the house or worse still negotiate stairs in the middle of the night when you are sleepy and hypo. That is a recipe for disaster so keep hypo treatments stashed in a few places. I keep some in the bathroom as well because a hot bath or shower can very easily drop your levels, particularly if you have just come back from a run or gym class or whatever.
 
Hi and welcome.
Sop very sorry that your symptoms were put down as part of your Crohn's for so long and that it came to such a dangerous level before you were diagnosed. Good to hearthat you are regaining weight.

20 units of Toujeo sounds like quite a large starting dose for someone who has lost quite a lot of weight and is newly diagnosed and I am very worried that you are hypoing through the night possibly quite badly and then getting a rebound as your liver kicks in and releases glucose to counteract it. Please set an alarm to wake up and test your levels at 3am. Cold sweats are almost always hypos when you are diabetic so please keep yourself safe and check this out. It is not safe to assume that because you are waking up with a decent or high level than you are not hypoing through the night and if your liver becomes depleted you could end up in a situation where it can't rebound you, so please check this out tonight if you see this message before you sleep.
What BG level do you go to bed on?
Hi, thank you for the advice.

I will set an alarm for 3AM tonight and bring my BGM to bed with me. I keep a box of glucose tablets beside my bed, but was told to only use my BGM four times a day (before each meal and once before bed), so I've been leaving it downstairs at night. I've probably been following the advice I was given too strictly. Will keep some tablets in the bathroom too from now on. Was not aware that a warm shower could cause levels to drop.

On Christmas night my Toujeo dose was increased to 22 Units - I was waking up each morning feeling lightheaded, mildly confused and with blurred eyesight on that dosage. I was told this was normal, but I reduced the dose to 20 Units the night I was discharged, as I didn't like the side effects. The reduction of 2 Units made a big difference - I no longer wake up with confusion or eyesight issues - I'm just soaking wet.

My BG levels aren't too stable yet I'm afraid. My bedtime BG levels for last week:

Monday: 6.2 mmol/L
Tuesday: 7 mmol/L
Wednesday: 6.3 mmol/L
Thursday: 8.3 mmol/L
Friday: 6.5 mmol/L
Saturday: 6.3 mmol/L
Sunday: 5.2 mmol/L

My BG levels are at their highest in the morning, which I understand is referred to as the 'Dawn Effect'. I typically go to bed at 00:30 most nights, but I eat my dinner quite late (21:00) and take my Toujeo at bedtime, right after measuring my bedtime BG levels.
 
Waking up in a cold sweat sounds exactly like a hypo. Test your blood sugar and treat if necessary. Nocturnal hypos can be dangerous. You might also need a bedtime snack. Many Type 1s are told a minimum blood sugar to go to bed on eg 8mmol.

What you were told about limiting your testing to four times a day is daft. You test when you need to. If you drive, you should be testing before driving, for a start. You also need to test before and during exercise.

I highly recommend the following two books:

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)

Welcome to the forum. There are lots of helpful people here so do ask whatever questions you want 🙂
 
Testing lots is the single biggest factor which will help you to understand your body and your diabetes and how it responds but most importantly help to keep you safe. You should also have been told to test anytime you don't feel well/right.

I would also like to say that those bed time readings are remarkably stable for someone newly diagnosed and in fact 3 years down the line I would quite happily swap you!!
What you should be doing is having a snack to bring your levels up above a set level when they are lower. The nurse should have suggested that you don't go to bed below say 8 or perhaps 10 at bedtime to protect you from dropping too low through the night, particularly with a basal insulin like Toujeo which is a once a day long acting insulin. I have a shorter, acting twice a day, basal insulin called Levemir, which I can adjust the 2 doses independently. Most people need more insulin through the day when they are active and less through the night, particularly that 3am-5am period when the body is in it's deepest sleep, so I have a much bigger dose of Levemir in the morning than I do in the evening to balance the glucose my liver releases. Toujeo (and Tresiba) both give you a very even amount of basal insulin day and night, which means it can drop you low in that darkest period of the night.
Good for you, by the way, taking the initiative in reducing the dose when it made you feel poorly. Good diabetes management is all about taking responsibility for managing your condition yourself and becoming your own expert, because you live with it day by day and meal by meal and moment by moment. There is a certain amount of intuition involved in that process and a lot of testing and experimenting, always with one eye firmly on keeping yourself safe and erring on the side of caution. It really bugs me that nurses discourage you from testing more and I remember I felt so guilty about testing more that I bought my own test strips so that I could experiment and learn and feel safe. Insulin is a very powerful and dangerous substance and getting the dose right is a very imprecise science, so lots of testing really should be encouraged rather than discouraged.

Anyway, if you wake up sweating definitely do test but if you aren't waking up with it then do set an alarm to check. I am horrified to think you might have been waking up like that and not testing because the nurse gave you such strict instructions about testing. Please keep your testing kit close to hand at all times as well as hypo treatments. Get into a habit of it. I have a little rucksack/handbag which goes everywhere with me including by the bed at night and contains everything, so I don't have to think whether I have everything I need. I run in it I ride my horses with it, I go shopping with it, it is by the shower when I get washed, it goes out socially with me (fat chance these days 🙄 ) If I leave the house it is on my back and I have got to the point it is a bit like putting my seat belt on, something feels wrong if I don't have it on. It is a good habit to form.
 
Waking up in a cold sweat sounds exactly like a hypo. Test your blood sugar and treat if necessary. Nocturnal hypos can be dangerous. You might also need a bedtime snack. Many Type 1s are told a minimum blood sugar to go to bed on eg 8mmol.

What you were told about limiting your testing to four times a day is daft. You test when you need to. If you drive, you should be testing before driving, for a start. You also need to test before and during exercise.

I highly recommend the following two books:

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)

Welcome to the forum. There are lots of helpful people here so do ask whatever questions you want 🙂
Thanks Inka,

Funnily enough I ordered a copy of 'Think Like a Pancreas' at the weekend, and hopefully it should be with me at some point today. Thanks for recommending Hanas' book too, I think I'll have plenty of bedtime reading soon.
 
Testing lots is the single biggest factor which will help you to understand your body and your diabetes and how it responds but most importantly help to keep you safe. You should also have been told to test anytime you don't feel well/right.

I would also like to say that those bed time readings are remarkably stable for someone newly diagnosed and in fact 3 years down the line I would quite happily swap you!!
What you should be doing is having a snack to bring your levels up above a set level when they are lower. The nurse should have suggested that you don't go to bed below say 8 or perhaps 10 at bedtime to protect you from dropping too low through the night, particularly with a basal insulin like Toujeo which is a once a day long acting insulin. I have a shorter, acting twice a day, basal insulin called Levemir, which I can adjust the 2 doses independently. Most people need more insulin through the day when they are active and less through the night, particularly that 3am-5am period when the body is in it's deepest sleep, so I have a much bigger dose of Levemir in the morning than I do in the evening to balance the glucose my liver releases. Toujeo (and Tresiba) both give you a very even amount of basal insulin day and night, which means it can drop you low in that darkest period of the night.
Good for you, by the way, taking the initiative in reducing the dose when it made you feel poorly. Good diabetes management is all about taking responsibility for managing your condition yourself and becoming your own expert, because you live with it day by day and meal by meal and moment by moment. There is a certain amount of intuition involved in that process and a lot of testing and experimenting, always with one eye firmly on keeping yourself safe and erring on the side of caution. It really bugs me that nurses discourage you from testing more and I remember I felt so guilty about testing more that I bought my own test strips so that I could experiment and learn and feel safe. Insulin is a very powerful and dangerous substance and getting the dose right is a very imprecise science, so lots of testing really should be encouraged rather than discouraged.

Anyway, if you wake up sweating definitely do test but if you aren't waking up with it then do set an alarm to check. I am horrified to think you might have been waking up like that and not testing because the nurse gave you such strict instructions about testing. Please keep your testing kit close to hand at all times as well as hypo treatments. Get into a habit of it. I have a little rucksack/handbag which goes everywhere with me including by the bed at night and contains everything, so I don't have to think whether I have everything I need. I run in it I ride my horses with it, I go shopping with it, it is by the shower when I get washed, it goes out socially with me (fat chance these days 🙄 ) If I leave the house it is on my back and I have got to the point it is a bit like putting my seat belt on, something feels wrong if I don't have it on. It is a good habit to form.
Good Morning,

I am due to receive a Libre 2 monitor within the next few days, so hopefully that'll be a big help. I'm hoping that it'll help me to more accurately chart any patterns. I'd also like to see how certain foods influence my blood sugars 30 mins, 1 hour, 2 hours and 3 hours etc. after eating them etc.

I do appreciate the advice, and it's really nice to write to somebody else with T1D. Hope you have a nice day.
 
Good Morning,

I am due to receive a Libre 2 monitor within the next few days, so hopefully that'll be a big help. I'm hoping that it'll help me to more accurately chart any patterns. I'd also like to see how certain foods influence my blood sugars 30 mins, 1 hour, 2 hours and 3 hours etc. after eating them etc.

I do appreciate the advice, and it's really nice to write to somebody else with T1D. Hope you have a nice day.
Enjoy your LIbre 2 - it certainly helps.
Unfortunately, it is sometimes over sold and the limitations are not mentioned. In my experience, the key points are
- new sensors may not be very accurate for the first day or so after insertion. This is because our bodies are reacting to the alien object inserted in our arm. Not everyone has this problem but quite a few people chose to insert their sensors 24 to 48 hours before activating
- the sensors are calibrated to be most accurate at "normal" levels. They can under report when hypo and over report when high. So, always check with a finger prick before making any corrections ... and don't be afraid to use "too many strips."
- if you apply pressure to a sensor it can report a false low. This is one of those things that is popular enough to have a name "compression lows". They are most likely to occur at night when you lie on your arm in your sleep. If you see a dip every night, set an alarm to check with a finger prick and consider a different location for your next sensor.
- some sensor are just "bad". Some people experience more problems than others but I recommend doing some finger prick checks during the life of a sensor (they can drift) to check they are still reading within 1 mmol/l. Do you checks when your levels are flattish as the sensor readings are 15 minutes behind finger pricks. If you find the sensor i out by a long way, report it to Abbott and they will replace.
- CGMs read Interstitial Fluid and convert this to blood sugar. Interstitial Fluid Readings are 15 minutes behind finger pricks. LIbre 2 algorithm attempts to manage this delay by extrapolating the current trend and predicting the current value. This is great when the trend has continued for the last 15 minutes. If you have just eaten or just treated a hypo, the trend will change direction and Libre will take time to catch up. As a result, it may predict a higher or lower reading and you will appear to take longer to recover. This means it is really important to use finger pricks when treating a hypo and checking your levels have recovered.
 
So pleased you are getting Libre as it really is a game changer. The important thing to remember is that you need to double check lows and highs before taking action. It can cause what is called a compression low if you lie on it so always best to double check. What I was going to say in my previous post but didn't want to make it too long winded is that I scan my Libre and average of 30 times a day to see what my levels are doing and have done since I got it. Compared to 5 finger pricks a day, that is a huge amount more data plus of course what it records whilst I am asleep, so it really jopins the dots and helps you to understand your body better. In fact, I sleep with my reader under my pillow so that I can scan with minimum of effort if I wake up. It is a great reassurance.
 
Welcome to the forum. You have made an good choice to connect with people on here. The medical professionals are invaluable but advice from others who live daily with the conditions who are able to share their experiences is also invaluable. I have found that chatting to and knowing other people who are going through the same experience as me has really helped with the mental aspect of coming to terms with the recent diagnosis. I am not that experienced in the whole thing as yet but you seem to be managing you BG levels really well. I know all about weight loss so well done you for regaining so quickly!!
 
Welcome to the forum. You have made an good choice to connect with people on here. The medical professionals are invaluable but advice from others who live daily with the conditions who are able to share their experiences is also invaluable. I have found that chatting to and knowing other people who are going through the same experience as me has really helped with the mental aspect of coming to terms with the recent diagnosis. I am not that experienced in the whole thing as yet but you seem to be managing you BG levels really well. I know all about weight loss so well done you for regaining so quickly!!
Thanks.

Sorry to hear that you experienced weight loss too. I am already finding this forum invaluable. As you mention, it's great to learn from others who are in the same boat, and quite comforting too.
 
The only issue I’ve had since being discharged from hospital have been night sweats. I’ve never experienced them before, but most nights I now wake up sometime between 03:00 and 05:00 absolutely dripping in cold sweat. I’ve read that hypos can cause this, but when I measure my blood glucose levels at 08:00 they’re usually high - almost always between 8.5 to 9 mmol/L. Am going to take a Ryvita right before I go to bed tonight to see if that does anything
Hi Wolder, The night sweats could well be a night hypo, and the higher levels in the morning could be died to a bounce back, and a dump of glucose in response. Have you checked your levels during the night?

I am very pleased that you have found the forum and hope that you find it helpful. You have had a rocky ride in getting your diagnosis of T1. Do come back with any questions that you have.
 
Interstitial Fluid Readings are 15 minutes behind finger pricks.
Hi @helli . I think the 15 mins was for the original Libre.
Freestyle claim 2.4 mins lag for Libre 2, although I spent several days unscientifically testing their claim and decided it was nearer to 5 mins for me: my BG is so unstable that it's tricky to find decent periods when it's stable.
 
My BG levels aren't too stable yet I'm afraid. My bedtime BG levels for last week:

Monday: 6.2 mmol/L
Tuesday: 7 mmol/L
Wednesday: 6.3 mmol/L
Thursday: 8.3 mmol/L
Friday: 6.5 mmol/L
Saturday: 6.3 mmol/L
Sunday: 5.2 mmol/L

My BG levels aren't too stable yet I'm afraid. My bedtime BG levels for last week:

Monday: 6.2 mmol/L
Tuesday: 7 mmol/L
Wednesday: 6.3 mmol/L
Thursday: 8.3 mmol/L
Friday: 6.5 mmol/L
Saturday: 6.3 mmol/L
Hello and welcome.
My hypos come at 5.1 mmol/L so that when my readings are below 6.5 at bedtime, I have to take a handful of fresh berries and sometimes also a yogurt. Even though my bed becomes a river, hypos never wake me up. Luckily, my wife always senses something is wrong. So, get to know your hypo number and ensure you stay above it.

Sunday: 5.2 mmol/L
 
Hi @helli . I think the 15 mins was for the original Libre.
Freestyle claim 2.4 mins lag for Libre 2, although I spent several days unscientifically testing their claim and decided it was nearer to 5 mins for me: my BG is so unstable that it's tricky to find decent periods when it's stable.
The algorithm used by Libre 2 attempts to take into consideration the lag by extrapolating the current trend. This is great when the trend remains unchanged in the 15 minutes but if it changes direction (e.g. correcting a hypo or reaching a peak), the Libre can over predict highs and lows.
 
The algorithm used by Libre 2 attempts to take into consideration the lag by extrapolating the current trend. This is great when the trend remains unchanged in the 15 minutes but if it changes direction (e.g. correcting a hypo or reaching a peak), the Libre can over predict highs and lows.
Thanks @helli ,
Yes, the whole business of what exactly is going on becomes quite murky or confusing when I try to "rummage" and get my brain around this. But from what I have read one of the improvements between the original Libre and Libre2 is the reduced time lag; original was 15 mins and Libre 2 is claimed at 2.4 mins by Freestyle. So I was gently querying (politely challenging) your use of 15 mins - when I think that is now out of date. BUT I could be wrong in challenging: perhaps I've misunderstood some aspect.

The over prediction for highs and lows, ie out of the range 4-10, I certainly experience and because I have Diabox on my android phone giving me CGM from Libre 2, I see this as it is going on: over prediction that eventually catches up and settles. Having Diabox doing this is a bit of a mixed blessing; on the one hand the visibility is good, but conversely it adds to the confusion by having 3 BGs: Actual, Libre 2 and (usually) something in between from Diabox! For me, when in range the accuracy of the no is unimportant I just need the trend; but if close to and about to become hypo the no becomes more significant. Hence a decent understanding of the time lag is important.

I welcome technology in general. But I am still cautious in how it is interpreted when things are being "calculated". I like to have an underlying or innate awareness of what the answer ought to be before accepting that answer. I am a Civil and Structural Engineer and old enough to have done the calculations manually for beam and column designs in complex structures; then computer programmes came along with built in assumptions that didn't always apply and the young engineers fresh from Uni accepted the computer answers because "they must be right", not being aware of the built in assumptions. To some extent this is the case for BG algorithms from interstitial readings.

Anyway, yet one more thing to get on top of or ?
 
I don't focus too much on the time lag - it is very dependent on how fast my levels are changing.
I know to correct at 5 .5 to avoid a hypo when my levels are falling quickly (especially when exercising) but happy to sit around 4.5 and not correct if I am stable.
 
I spoke to a diabetes specialist nurse earlier today and mentioned that I was still experiencing night sweats. She relayed this to a diabetes consultant, who has now prescribed Tresiba in place of the Toujeo I am currently using. My night time BG levels have been too high to attribute the sweating to hypoglycemia. I will be using Tresiba for a few weeks to see if the issue improves. I kicked myself as soon as I put down the phone as I failed to ask why they thought Tresiba could benefit me. I assume they believe I've been having some sort of allergic reaction to Toujeo. Really hope this resolves the issue.

Received my Libre 2 today too, and am attending a Libre webinar tomorrow. Have been advised (wisely) not to apply the device until after the webinar. On paper it appears to be a really impressive piece of kit.
 
I don't focus too much on the time lag - it is very dependent on how fast my levels are changing.
I know to correct at 5 .5 to avoid a hypo when my levels are falling quickly (especially when exercising) but happy to sit around 4.5 and not correct if I am stable.
Yes, likewise except my trigger is 6.5 if falling rapidly; but that's a consequence of my brittleness. The time lag is more relevant when I'm already mildly hypo and wanting to know is it going to get worse or has the corner already been turned, because I was taking JBs during the fall.
 
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