Later life type 1

[Inka]

It’s far better to run a bit high than risk another hypo, especially early in diagnosis @Toooldfortype1

 

[rebrascora]

Hi
Do you know why the hypo might have happened? Knowing why it happened can help decide what to do at the next meal....
What did you have for breakfast and how many units did you inject for it and what was your waking reading?
What are you planning to have with the roast chicken? If you are just having chicken and veg then don't inject for it, but if you are going to have spuds and a Yorkie and perhaps a small pudding for afters, then you are best to inject some meal time insulin.

 

[Mumpie_olgran]

Hi
Do you know why the hypo might have happened? Knowing why it happened can help decide what to do at the next meal....
What did you have for breakfast and how many units did you inject for it and what was your waking reading?
What are you planning to have with the roast chicken? If you are just having chicken and veg then don't inject for it, but if you are going to have spuds and a Yorkie and perhaps a small pud then you are best to inject some meal time insulin.

I really don't know what was behind it. Woke up 8.3 today (9.0 yesterday). Had exactly the same breakfast and done the same activity too. Which was basically nothing on both days. Then hit 3.8 vs 8.7 yesterday
Breakfast is always oat porridge with berries and bananas as it was pre-diagnosis too
Maybe I'll just stick to the non carb bits of the meal and not inject at all

 

[Inka]

So many things can affect blood sugar @Toooldfortype1 - your own failing insulin production, whether you’re stressed or relaxed, where you inject, your digestion, etc, etc, etc. As long as you’re sure you didn’t make a mistake and did everything right/the same, don’t blame yourself. More than 42 things can affect our blood sugar. It’s one of the most frustrating things about Type 1.

Hypos can be scary and even mild ones can shake you up a bit. You’ve done everything right. Test as much as you need to to reassure yourself. Take it easy.

 

[rebrascora]

OK, so it may well be your Lantus which could now be a bit high. This can happen when your pancreas gets help from the injected insulin which takes some of the stress off it and then it gets a bit of a resurgence of activity. At the moment it is just a one off incident and with diabetes you look for patterns before making adjustments rather than adjusting for individual events.

I think your course of action is probably a good one, but maybe just have one or 2 pieces of potato without insulin and see what happens.
Do keep hypo treatments close to hand as often they come in 2s or 3s, but a couple of spuds with lunch should prevent that happening.

 

[Mumpie_olgran]

Hi there bit more advice please. I stuffed up a bit on my dosing today which is unlike me but there we go. Basically forgot my Lantus in the monring and so only injected that one at lunchtime. As I was already showing 4.3 at lunch I didn't bother with novorapid at the same time. Lunch was salad and 2 pieces of brown toast. I've been steadily climbing since and now showing 12.5
Question is would you bump in a smaller dose of novorapid now (2 units or something) or just wait to see what it's like nearer supper?
Thanks in advance

 

[rebrascora]

It won't be the first or the last time you make a mistake, so don't worry about it.
If it was me I would inject the small correction you suggest.
Do you have Libre to keep an eye on your levels?
I think my main concern might be that there is a chance of you going low through the night with your Lantus being a few hours late. It is unlikely but worth bearing in mind, especially if you don't have Libre to alert you to low levels.

 

[Inka]

12.5 isn’t horrendous. I’d wait till supper personally and see how things are going.Also, do you actually know your correction factor or was the two units a guess? With late Lantus and being newly diagnosed, I’d be wary of correcting too much and/or too early.

 

[Mumpie_olgran]

Thanks both. No I don't have a Lantus yet (it's ordered though)
The 2 units was a guess based on my standard meal dosage being 4 units
Maybe half way house of 2 units plus banana at same time??

 

[rebrascora]

If you don't have Libre yet to be able to monitor levels closely and you haven't been given guidance on corrections then I think it might be best to let it ride until your evening meal. You are likely still in the honeymoon phase where your own body is chugging out a little insulin here and there itself, so it may already be producing a bit to bring you down and may manage to reduce that 12 by this evening. Better to play it safe when you are still newly diagnosed.

 

[Mumpie_olgran]

If you don't have Libre yet to be able to monitor levels closely and you haven't been given guidance on corrections then I think it might be best to let it ride until your evening meal. You are likely still in the honeymoon phase where your own body is chugging out a little insulin here and there itself, so it may already be producing a bit to bring you down and may manage to reduce that 12 by this evening. Better to play it safe when you are still newly diagnosed.

OK thanks I'll go with that. Wait til this evening and see what's what
BTW any guidance on how long the honeymoon period can last? Big misnomer that IMO...

 

[Inka]

Thanks both. No I don't have a Lantus yet (it's ordered though)
The 2 units was a guess based on my standard meal dosage being 4 units
Maybe half way house of 2 units plus banana at same time??

Just leave it. It’s not worth the risk of a hypo - and to be clear, a bad hypo can cause a seizure and worse. If in doubt, err on the side of caution.

 

[Mumpie_olgran]

Just leave it. It’s not worth the risk of a hypo - and to be clear, a bad hypo can cause a seizure and worse. If in doubt, err on the side of caution.

Got it, will do
Thanks

 

[rebrascora]

BTW any guidance on how long the honeymoon period can last?

As long as a piece of string.... For me I think it was about 2 years, but you never truly know when it has come to an end unless they do a C-pep test to check and it comes back zilch! I had 3 stages where my basal insulin doses increased over a period of a month or two and then stabilized for a few months and then increased again. The last one was just after I had my first Covid vaccine and my basal needs almost doubled over the following 2 months and have been pretty much the same for nearly 2 years now, give or take a few units for more or less activity, so I am guessing that was it.

 

[Mumpie_olgran]

As long as a piece of string.... For me I think it was about 2 years, but you never truly know when it has come to an end unless they do a C-pep test to check and it comes back zilch! I had 3 stages where my basal insulin doses increased over a period of a month or two and then stabilized for a few months and then increased again. The last one was just after I had my first Covid vaccine and my basal needs almost doubled over the following 2 months and have been pretty much the same for nearly 2 years now, give or take a few units for more or less activity, so I am guessing that was it.

Thanks rebrascora, and out of interest do you do all the fine tuning of your basal needs yourself or do you take some additional outside input? Different way of asking whether this is all stuff I'll learn in due course

 

[helli]

BTW any guidance on how long the honeymoon period can last?

I never had my insulin production tested (my diagnosis pre-dated the now common c-peptide tests) but my insulin dose gradually increased over 8 years. The increase was in fits and starts with about 6 months in between and no major changes to my body or lifestyle during that periods. So, I estimate my honeymoon lasted 8 years. Thankfully, it was pretty constant rather than having a pancreas which would suddenly burst into life when I least expected it.
About 12 to 18 months after diagnosis, I became confident to change my own basal and bolus doses. Don't forget your bolus insulin to carb ratio can change as well as your total basal dose.

 

[Inka]

My honeymoon was a similar length to @helli ‘s I found it went in stages and each stage was quite long. Sometimes it’s only really apparent when you look back. My basal amount is fairly small so that makes it harder to determine exactly when my honeymoon ended.

I had a C Peptide test years after diagnosis as part of the MODY testing protocol, and I was still making a tiny amount of insulin. Minuscule. Probably enough to process one pea

 

[TheClockworkDodo]

I've just passed 12 years with diabetes, and so far as I can tell my honeymoon period is still going strong 🙄
I have another medical condition which led to my diabetes though, so it's probably to do with that.

I wouldn't normally recommend correcting between meals unless your blood sugar goes over about 14 (and then I'd err on the side of caution and make it one unit, not two), otherwise I'd save the correction dose until the next meal time, maybe inject a bit early for the next meal though.

 

[rebrascora]

Thanks rebrascora, and out of interest do you do all the fine tuning of your basal needs yourself or do you take some additional outside input? Different way of asking whether this is all stuff I'll learn in due course

It was after my DAFNE course (6 months after diagnosis) that I fet ready to start adjusting my basal dose myself and another year or so before I had acquired enough experience to feel like I really knew what I was doing and that probably coincided with getting Libre (a real game changer). Now (4 years diaversary coming up) I feel very confident and cannot really imagine a situation where I would seek professional help with my insulin adjustment either basal or bolus, but my diabetes is much less conventional than others here, partly because I eat low carb and don't stick to a regular routine of meals or exercise/activity and sometimes my sleep patterns get all out of synch too, so I don't really follow any of the guidelines and protocols regarding adjusting my insulin. I always keep a close eye on keeping myself safe but my management is very fluid and based on intuition and experience and responding to my Libre info rather than actual carb counting, carb ratios or even correction factors, although I have a very loose 1:10 ratio that I apply when eating out with more normal carb levels. It would be very difficult for a health care professional to look at my data and give me advice because of the reactive way I have of managing my levels, but it works very well for me and in my opinion, takes the pressure off my diabetes management because I am not weighing and measuring and calculating at each meal. I just use small amounts of carbs or insulin to nudge my BG levels up a bit or down a bit as required to keep in range on my Libre graph. If I ate a normal diet with more carbs I don't think this would work but low carb suits me in other ways too, so this unconventional approach works well for me both physically and mentally.

 

[Mumpie_olgran]

Thank you. Looks like my Libre trial device is arriving today so I can soon indulge my nerdiness
I'm a much more conventional eater than what you've described so I'll keep plugging away closer to the text books. Very good to hear that you're in close control for how it works for you. Gives me something to shoot for!