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How do I get my average down?!

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Relationship to Diabetes
Type 1
Been diagnosed about 7 months ago now and Nurse has told me i need to try and get my levels down below 10 if possible.
I am finding this difficult.

As an example everyday I have a bagel about 11am at work, prior to my meal I am reading at 9.5 so I take 2 units and eat my roll and an hour later read to be at 10. Perfect!

The next day I think “right let’s get my average down” so I take 3 units for my bagel. Half hour later it falls to 3.5?!?
how can I lower my average. Does anyone recommend a half pen? So I can inject 2.5 units instead?
 
@Hellospringett - I doubt VERY much if nursie expected you to keep your BG below 10 especially that soon after eating carbs. In fact actually - I'm damn sure she doesn't!

It's the 9.5 before eating you may need to reduce - but it all depends on your usual day before 11am as to whether that's sensible or not.
 
How long did it take for your BG to reduce back down to 9.5? - remember that mealtime insulin carries on working for a few hours (c 4.5), with the 'efficacy' of it gradually reducing after the first 2, understand that Humalog (which I've never used myself) can have a bit of a 'sting' in its tail though.
 
Been diagnosed about 7 months ago now and Nurse has told me i need to try and get my levels down below 10 if possible.
I am finding this difficult.

As an example everyday I have a bagel about 11am at work, prior to my meal I am reading at 9.5 so I take 2 units and eat my roll and an hour later read to be at 10. Perfect!

The next day I think “right let’s get my average down” so I take 3 units for my bagel. Half hour later it falls to 3.5?!?
how can I lower my average. Does anyone recommend a half pen? So I can inject 2.5 units instead?

I can tell you how I managed this. I use Humalog as bolus and Abasaglar as basal.

On the advice of my Diabetes Nurse and Dietitian, I routinely upped my basal injection by about 2 units every 3 days from a start of 8 to 22. I stopped when I realised my morning readings were about the same as my bedtime readings. Looking at my records, this took about 3 weeks.

At the same time, I implemented a strict timing regime for eating. Breakfast at 9am latest. Lunch no less than 4 hours (preferably 5) hours later at maybe 1-2pm and dinner at 6pm. I wanted to make absolutely sure that the previous meal bolus had left the building before piling in more insulin. You can't make sense of your readings if you start overlapping meals and injections. I also try to eat broadly the same amount of carbs at each meal.

Again, at the same time, I started upping my bolus to food ratios from 1:10 to about 1:7 over a period of 3 weeks.

Finally, I try to stick to the same amount of exercise each day at roughly the same times.

By eating roughly the same amount of carbs (healthy ones to prevent immediate spikes) at the same time each day, and exercising in a consistent way, I try to remove as much variation (outside my insulin amounts) as possible because I believed that this would help to get my levels under control ASAP.

At the start, I was averaging readings of about 14.0 per day. One week after diagnosis I was down to averaging about 10.0 per day with some wild swings in individual results. After Two weeks, those wild swings in pre-meal readings had largely tightened and I was averaging about 9.0. After 3 weeks, that came down gradually to 9.0 then 8.0 and finally I am averaging pre-meal readings of about 6.0 to 7.5, 8 weeks after diagnosis.

I now know my ratios and basal for the moment.

Next job was to start making sure I tested 2 hours after eating to eliminate spikes and to inform my actions if I did have a spike. I can mostly get rid of any spikes by immediately walking a few miles or taking a correction bolus (I rarely do this because I want to avoid hypo-hyper-hypo-hyper cycles) or whatever.

For me, the key was consistency in as many things as possible. From there I can start experimenting with treats or changes in carbs per meal. For now, other than the odd panicky situation I seem to be doing OK. That was quite a rapid drop in blood sugars though (3 weeks from a diagnosis of about 35.0) and apparently that's probably causing me some of my nerve pain although that's starting to become more manageable.

Your process will be different but I hope this helps you in some way and gives you some ideas to try out.
 
Welcome to the forum @Hellospringett

I think @pm133 has given you such a comprehensive answer I will just encourage you to come back with any other questions. Nothing is considered silly on here. just ask.
 
@Hellospringett the first thing I would look at is whether your blood sugars are stable. they may be higher than you (and your nurse) would like but if you take food out of the equation (e.g. overnight), do they remain pretty level?
If that is the case, then your basal is likely to be ok.

The next question would be to consider your bolus.
How do you calculate this?
Do you count your carbs and calculate your dose based on an insulin to carb ratio?
Do you calculate your correction dose based on how high you are and what your insulin sensitivity factor?
Or do you have fixed doses which you tweak if a bit high?

If the latter, I would talk to your nurse about DAFNE or equivalent to learn about carb counting and dosing.

Unlike @pm133 I am not strict on the timing of my meals or the amount of carbs in each. That is not appropriate for my life, job, family, etc. and would be too restrictive for me. However, I am happy with my diabetes management (last Hb1aC was 45). This is achieved through understand my insulin doses and doing the maths every time I eat.
 
Welcome to the forum @Hellospringett

As you are still quite early in your pancreas-impersonation career it may well be that you still have a few beta cells gamely soldiering on (some T1s keep a small amount of insulin production going for decades!). This can be very helpful in ‘smoothing off’ the corners of your estimated doses, but it can also provide some occasional confusion.

I would second the suggestion of systematically checking your basal insulin dose to make sure that is able to hold your BG steady between meals and overnight (well... as steady as possible), before looking at your meal doses. There’s a good write up about basal insulins here which may help.

As you are on very small insulin doses, I do also think a half-unit pen would be a very good move. It may involve switching to NovoRapid if you are using Humalog and no suitable pens are available, but the Novopen Echo is very handy and has a memory of your previous dose timings which can be very useful.

If you’d like to delve a bit more into carb counting this nuts and bolts guide may help

Or you could do a full online course here
www.bertieonline.org.uk
 
It may involve switching to NovoRapid if you are using Humalog and no suitable pens are available

The half-unit pen for Humalog is the HD Luxura and available on prescription 🙂 @Hellospringett, if your nurse is a proper DSN rather than a GP ‘expert’ nurse, then they should be well aware of it. it’s rather a snazzy-looking pen too and has a metal casing so very robust.
 
It may involve switching to NovoRapid if you are using Humalog and no suitable pens are available

The half-unit pen for Humalog is the HD Luxura and available on prescription 🙂 @Hellospringett, if your nurse is a proper DSN rather than a GP ‘expert’ nurse, then they should be well aware of it. it’s rather a snazzy-looking pen too and has a metal casing so very robust.

Thanks @Inka I wasn’t sure. When I last used humalog (and Lantus for that matter) pen choices were a bit limited. Though I did like the memory function on my Memoir 😛
 
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