Hi there

[Jan W]

Newly confirmed as type 1, although had diabetes for around 9 years now... managed with tablets, then mix of tablets and mixed insulin... since beginning of year referred to specialist who put me on basal/bolus regime... realised how little I knew about insulin and struggling with ratios and managing exercise now... basically really had confidence knocked... is this a familiar experience for anyone?

 

[Inka]

Welcome @Jan W 🙂 Type 1 is often missed in adults as they’re just assumed to be Type 2 because of their age. However, Type 1 is also a condition of adulthood and there are lots of people who develop Type 1as adults, including people in their 50s, 60s, etc.

What insulins are you taking? What problems are you having with your ratios?

 

[trophywench]

Yes! - same questions from me, too.

 

[Jan W]

Welcome @Jan W 🙂 Type 1 is often missed in adults as they’re just assumed to be Type 2 because of their age. However, Type 1 is also a condition of adulthood and there are lots of people who develop Type 1as adults, including people in their 50s, 60s, etc.

What insulins are you taking? What problems are you having with your ratios?

I am now on NovoRapid and Tresiba... previously on Novomix along with single lunch-time NovoRapid injection. I attended the DAFNE course a few months ago, and although it taught me things I never knew, it was overwhelming... also the guidance for managing planned and unplanned exercise really wasn't working and it upset me that I couldn't walk for my usual hour without fear of having a hypo. I now know that when I was on Novomix, my typical exercise (3 hours walking usually) was also managing my BG substantially. The change has confused and anxious.. I was also given freelibre sensor which as increased my awareness of my levels in a way I never knew before... my ratios are 10 for Tresiba; 1:10 (am); 1:8 ( noon); 1:12 (pm). I am still trying to work out ratios and my main worry is hypos, so I prefer to have higher target of 7... ratios were never discussed with me before this year, which was also the first time I saw a diabetes consultant... apologies for the lengthy reply and "thank you"...

 

[Bruce Stephens]

it was overwhelming

Can be, yes, so it's probably worth finding things to refer to. For example, https://www.bertieonline.org.uk/ and/or https://www.mytype1diabetes.nhs.uk/

also the guidance for managing planned and unplanned exercise really wasn't working and it upset me that I couldn't walk for my usual hour without fear of having a hypo.

It's possible you're a bit more insulin sensitive than is typical. Or maybe you walk faster than average or something. With a bit of experimentation (and talking it over with your DSN) I'm sure you'll find ways to do your customary walks without too much problem.

 

[Jan W]

Can be, yes, so it's probably worth finding things to refer to. For example, https://www.bertieonline.org.uk/ and/or https://www.mytype1diabetes.nhs.uk/

It's possible you're a bit more insulin sensitive than is typical. Or maybe you walk faster than average or something. With a bit of experimentation (and talking it over with your DSN) I'm sure you'll find ways to do your customary walks without too much problem.

Thank u for links and encouragement... just a bit of a shock and surprise as I never really knew or considered my lovely long walks were having such an impact, and would hate to give them up... as you say, experimentation is the only way forward. Thanks again.

 

[Bruce Stephens]

and would hate to give them up

No one's going to say you shouldn't do exercise!

 

[Inka]

Thank u for links and encouragement... just a bit of a shock and surprise as I never really knew or considered my lovely long walks were having such an impact, and would hate to give them up... as you say, experimentation is the only way forward. Thanks again.

You’ll still be able to do your walks. You’ll gradually build up strategies to allow you to do them and avoid hypos. For example, you can reduce your bolus for the meal prior to your walk, and/or you can also have a top-up snack. It is stressful exercising when you’re on insulin, but it’s bit like driving a car in that you gradually get the hang of things and things become routine.

If you’re still finding exercise difficult to manage, you could ask to change to a twice daily basal eg Levemir or one of the isophanes. The advantage to them is that you can adjust the daytime and nighttime doses separately, so you can make allowances for exercise. Two injections of basal work better for many people and the flexibility and reassurance they give are worth the extra injection.

 

[Bruce Stephens]

The advantage to them is that you can adjust the daytime and nighttime doses separately, so you can make allowances for exercise.

For what it's worth I do that when I go out dancing (which in my case is basically brisk walking, but for a couple of hours or so), but not so much for an hour of walking. For an hour of walking I'd reduce the previous bolus and/or eat something (or be ready to eat something), depending. (Actually for dancing I always reduce the bolus a bit, but often I need to reduce the following basal dose a tiny bit.)

 

[Inka]

Similar to me @Bruce Stephens Then for longer walks, eg a few hours, I reduce my basal too.

 

[Jan W]

You’ll still be able to do your walks. You’ll gradually build up strategies to allow you to do them and avoid hypos. For example, you can reduce your bolus for the meal prior to your walk, and/or you can also have a top-up snack. It is stressful exercising when you’re on insulin, but it’s bit like driving a car in that you gradually get the hang of things and things become routine.

If you’re still finding exercise difficult to manage, you could ask to change to a twice daily basal eg Levemir or one of the isophanes. The advantage to them is that you can adjust the daytime and nighttime doses separately, so you can make allowances for exercise. Two injections of basal work better for many people and the flexibility and reassurance they give are worth the extra injection.

Thank you for the advice...yes, think it's a bit of experimentation and all about timing I'm discovering... Will bear with it until it becomes second nature... thanks for the suggestion about basal too - might work better long-term

 

[everydayupsanddowns]

I am still trying to work out ratios and my main worry is hypos, so I prefer to have higher target of 7... ratios were never discussed with me before this year, which was also the first time I saw a diabetes consultant... apologies for the lengthy reply and "thank you"...

Great to hear you’ve had access to DAFNE - even though it was a little overwhelming!

I was late to the party with ratios too. I’d had many years (more than a decade!) of relatively stable doses with occasional ad-hoc increases and it was encouraging to be able to fine tune doses (particularly with adding or removing insulin with the aim of getting back to mid-range). My diabetes is a lot less ‘random’ these days, but getting ratios that worked well for me was significantly dependent on getting my basal insulin dose (and subsequently ‘pattern‘ on my pump) right for that particular time.

And when my basal needs ebb and flow (as they do for me through the year) one of the first signs can be that my normal ratios and dose strategies have stopped working. Tweak my basal and they settle down again!

 

[Proud to be erratic]

Hello @Jan W,

I am now on NovoRapid and Tresiba...

As I am.

my ratios are 10 for Tresiba; 1:10 (am); 1:8 ( noon); 1:12 (pm). I am still trying to work out ratios

Can I just check what you have written above:
Are you actually saying you take 10 units of Tresiba daily ....?

and your ratios for NovoRapid are 1:10 (am), 1:8 (noon), and 1:12 (pm)?

Your basal is not a ratio - it's just a dose that has been arrived at by trial and learning. Because it is Tresiba it is deceptively different from other basals and that could be significantly to your advantage at this early stage of learning to manage Multiple Daily Injections (MDI). Tresiba has a nominal 40 hr profile, ie yesterday's dose of 10 units should last 40 hrs so today's dose of 10 units is actually topping up yesterday's dose. This makes it possible to get a very stable basal for a sizeable part of any 24 hr period, for several months at a time.

I depend on Tresiba keeping me stable and safe through the night until breakfast and then I only use my NovoRapid bolus for all insulin aspects of my daytime BG management. Of course I use exercise and activity to help lower BG, as well as food (main meals, snacks and hypo responses) to nudge BG up when needed. This has the huge advantage of NOT needing to decide "shall I change my basal or change my bolus?" I leave my basal alone and only adjust my bolus - UNTIL it is very clear from my overnight CGM graphs that my basal needs tweaking because it is no longer keeping me steady through the night. This occurs less than 4 times a year and is easy to spot and easy to rectify.

It has been my experience that Tresiba is not explained well enough by Health Care Professionals (HCPs) because they don't understand that its longevity makes it different. This has led to bits of nonsense coming from hospitals in particular, telling me to alter or even stop my basal pre-op (WRONG) or change it post-op (potentially WRONG) or to split my Tresiba into 2 parts daily (NO POINT).

and my main worry is hypos, so I prefer to have higher target of 7...

I am also concerned about going low - mainly because my particular D is considered very brittle and I can drop like a heavy stone very quickly. I personally also now have a target of 7 - following a robust recommendation from my Consultant. To assist in sustaining that level I have my low "Alert" (= Alarm) set at 5.6 which normally gives me sufficient alert time to monitor my CGM closely and IF my BG starts dropping I can nudge back up with a very modest snack; then wait (= monitor) and repeat if the falling trend is continuing. This is a further process of trial and learning, finding out what type of snacks and what size are appropriate for me. Others can pass on what works for them (and why) but responses can be very different for anyone else.

ratios were never discussed with me before this year,

Nor me - I spent my first 9 months hopelessly adrift until I decided to get into the detail of understanding what was going on and learning how to carb count .

I hope this is of some help and not just adding to confusion.

 

[Tdm]

I found excercise very tricky to deal with at first, but you work it out...a bag of jelly sweets helps (or jelly belly beans which are handily about 1 carb each) ...the trick is to have them before your blood sugars plummet.
At first i restricted to excercise to after my bolus insulin was out of my system as my blood sugars would fall rapidly as i walked. But lately my sugars have been less inclines to plummet.
I prefer eating to reducing bolus because blood sugars sometimes do odd things and you can then react by eating more or less ...also, i like sweets.
You'll work it out, it may just take a little while.

 

[Bruce Stephens]

At first i restricted to excercise to after my bolus insulin was out of my system as my blood sugars would fall rapidly as i walked.

Yes, sometimes when I'm planning on going dancing I eat a low carb meal beforehand so I need less bolus. Regardless, I use half as much insulin as I usually would for the meal, but eating less carbs (and so using less insulin because of that) reduces the chance of hypos later presumably because there's less insulin involved.

 

[rebrascora]

Yes, sometimes when I'm planning on going dancing I eat a low carb meal beforehand so I need less bolus. Regardless, I use half as much insulin as I usually would for the meal, but eating less carbs (and so using less insulin because of that) reduces the chance of hypos later presumably because there's less insulin involved.

Also possibly because protein will be releasing glucose whilst you are dancing to help top you up as you are using it. I find protein release good for stabilizing levels whilst exercising as it starts about 2 hours after eating and just steadily releases for the next 4-6 hours, so if I time a low carb meal like an omelette right, I can walk for several hours with no sweets needed off the protein break down as long as my basal insulin is right, although of course I carry hypo treatments with me. That said, I have split dose Levemir and can adjust it to match quite closely what my body needs during the day and night, apart from a premptive correction dose of 2 units of Fiasp for FOTF every morning. With Tresiba that is more difficult or not possible, because as @Proud to be erratic explained you have to set the dose to keep you steady overnight and then use bolus during the day to make up any shortfall.

Understanding how basal insulins work and what might be the best one for your body and lifestyle is an important aspect of good diabetes management. I very much doubt I could manage with Tresiba because I need so much less at night than during the day and if I exercise a lot then I don't need any at night. Currently 20 units in the morning and just 1 at night.