My partner is T1 and a teacher...

[SunnyDays26]

I've been with my partner for a while now but we have noticed that he gets incredibly high BG levels when he is at work. He is a teacher so we can't do much about the stress. We are improving our diet and sleep regime which is great. He uses Lantus (14 and 20) and Novarapid (1:10). He's not experienced this before.
During time off, his BG levels are so much better.

Anyone else experienced this? Any thoughts?

 

[adrian1der]

Does he eat with the children in the canteen at lunch? If so could he be miss measuring the carbs?

 

[helli]

I imagine if your partner has been a teacher for a while, he'll have a pretty good handle on the carbs in school dinners - they don't change that much.
But the stress may be different at the start of the year, especially after returning from the pandemic.

Is it possible to change his insulin to carb ratio or take his bolus earlier?
It may also be worthwhile talking to his diabetes team about the possibility of a pump so he can adjust his basal according to stress at different times of the day.

 

[rebrascora]

Hi and welcome

If he is going high throughout the day (rather than just after one meal) on a regular basis then it is likely that his Lantus dose is not meeting his basal insulin needs. Basal insulin needs change for any number of reasons and stress is certainly one of them.
Am I correct in understanding that he takes his Lantus as a split dose ie morning and evening rather than just a single dose? If so, then it is likely an increase in his morning dose will sort the problem, but he may need to consider a reduction in his evening dose in case the tail end of the morning dose and his evening dose cause him to go too low overnight. If he is not confident to adjust his basal insulin himself, then he needs to speak to a DSN about it and ask about an education course like DAFNE or whatever your local equivalent is. DAFNE stands for Dose Adjustment For Normal Eating, but it is about so much more than carb counting and bolus insulin. It is about teaching you to manage your BG levels in a whole host of circumstances and to identify when a basal (Lantus or whatever) dose needs adjusting and by how much to adjust it and how long to wait before you can adjust it again if needed. The emphasis is on giving you the information to keep yourself safe and improve your diabetes management and the format is based on sharing your experiences so that you learn from each other and to be honest a big part of the benefit of the course is simply spending time with other Type 1 diabetics because you can gain so much from sharing your own experiences, both practically and emotionally/mentally.

Many people assume that once their basal insulin dose is set then that is it but basal needs can vary significantly over time, seasons, personal circumstances, activity levels.... all sorts of stuff. Better BG monitoring (like Freestyle Libre) enables you to see when you basal dose needs adjusting, much more easily than before with just occasional finger pricks. If your partner doesn't have Libre, it is worth enquiring about it, as it is a real game changer in diabetes management.

Hope some of what I have suggested is helpful, but do encourage your partner to speak to his DSN if he hasn't had a DAFNE course and is not confident/authorized to adjust his basal insulin. Small dose changes with basal insulin can have a dramatic effect so best to be safe and seek advice. His local hospital diabetes clinic should have a helpline that he can ring to get advice. He may need to leave a message and a nurse will ring him back.

 

[helli]

If he is going high throughout the day (rather than just after one meal) on a regular basis then it is likely that his Lantus dose is not meeting his basal insulin needs.

If the problem is only whilst the chap is at work, then an increase in morning basal dose will mean that he is too high after work. Hence, my suggestion to discuss a pump which will provide more flexibility at different times of the day.

 

[Inka]

I've been with my partner for a while now but we have noticed that he gets incredibly high BG levels when he is at work. He is a teacher so we can't do much about the stress. We are improving our diet and sleep regime which is great. He uses Lantus (14 and 20) and Novarapid (1:10). He's not experienced this before.
During time off, his BG levels are so much better.

Anyone else experienced this? Any thoughts?

Apart from the pump idea from @helli which is a good one (he could set different basal rates for work days and weekends, for example), perhaps he needs different bolus ratios for his breakfast and lunch on work days eg 1:9 or 1:8? Also too is he correcting when he’s high? Could his timetable be contributing?

 

[trophywench]

Ideal candidate for a pump, but not sure right now would be the ideal time to swap - it's a learning curve alright with a pump and some rough days as well as good ones (well that's lifelong whatever regime we have) but building an immediate understanding of 'Aaah - that most likely happened because of whatever' simply takes time.

Whatever - needs a good chat with his 'team' who hopefully will be able to suggest helpful things if the forum's suggestions don't !

 

[Sally71]

My daughter’s basal needs are different depending on whether she’s at school or not, so it wouldn’t surprise me in the slightest if someone’s insulin requirements are different depending on whether they are at work or at home. On a pump you can set several different basal patterns for different days. Don’t know how you’d manage that with injections but it’s something to discuss with his medical team maybe.

 

[rebrascora]

If the problem is only whilst the chap is at work, then an increase in morning basal dose will mean that he is too high after work. Hence, my suggestion to discuss a pump which will provide more flexibility at different times of the day.

Yes, I appreciate that a pump may be the ideal fix, (until that cure is developed of course) but obviously a pump takes months (at least) to get authorized and then training after that, so a short term solution is worth exploring. Also, it isn't entirely clear from the OP's initial post whether her partner is high all day and night during the working week or his levels drop back down when he gets home on a night and if they drop down to normal or still slightly high etc. Without knowing more info we can only speculate and offer suggestions that may improve the situation.

 

[Pumper_Sue]

Stress does cause higher BG's, so logic says increase insulin to counteract it. Also if he is having less exercise than lockdown again increase insulin to compensate for this.
Diabetes is like having a set of scales trying to balance everything 🙂

 

[SunnyDays26]

Does he eat with the children in the canteen at lunch? If so could he be miss measuring the carbs?

Hi, no he does not thankfully.

I imagine if your partner has been a teacher for a while, he'll have a pretty good handle on the carbs in school dinners - they don't change that much.
But the stress may be different at the start of the year, especially after returning from the pandemic.

Is it possible to change his insulin to carb ratio or take his bolus earlier?
It may also be worthwhile talking to his diabetes team about the possibility of a pump so he can adjust his basal according to stress at different times of the day.

He takes his own lunch in thankfully but does sometimes have school dinners. I think this might be a good idea. They have just started him on Libre but seemed hesitant about the pump. I do think this is something that he needs to explore further. Thanks!

Hi and welcome

If he is going high throughout the day (rather than just after one meal) on a regular basis then it is likely that his Lantus dose is not meeting his basal insulin needs. Basal insulin needs change for any number of reasons and stress is certainly one of them.
Am I correct in understanding that he takes his Lantus as a split dose ie morning and evening rather than just a single dose? If so, then it is likely an increase in his morning dose will sort the problem, but he may need to consider a reduction in his evening dose in case the tail end of the morning dose and his evening dose cause him to go too low overnight. If he is not confident to adjust his basal insulin himself, then he needs to speak to a DSN about it and ask about an education course like DAFNE or whatever your local equivalent is. DAFNE stands for Dose Adjustment For Normal Eating, but it is about so much more than carb counting and bolus insulin. It is about teaching you to manage your BG levels in a whole host of circumstances and to identify when a basal (Lantus or whatever) dose needs adjusting and by how much to adjust it and how long to wait before you can adjust it again if needed. The emphasis is on giving you the information to keep yourself safe and improve your diabetes management and the format is based on sharing your experiences so that you learn from each other and to be honest a big part of the benefit of the course is simply spending time with other Type 1 diabetics because you can gain so much from sharing your own experiences, both practically and emotionally/mentally.

Many people assume that once their basal insulin dose is set then that is it but basal needs can vary significantly over time, seasons, personal circumstances, activity levels.... all sorts of stuff. Better BG monitoring (like Freestyle Libre) enables you to see when you basal dose needs adjusting, much more easily than before with just occasional finger pricks. If your partner doesn't have Libre, it is worth enquiring about it, as it is a real game changer in diabetes management.

Hope some of what I have suggested is helpful, but do encourage your partner to speak to his DSN if he hasn't had a DAFNE course and is not confident/authorized to adjust his basal insulin. Small dose changes with basal insulin can have a dramatic effect so best to be safe and seek advice. His local hospital diabetes clinic should have a helpline that he can ring to get advice. He may need to leave a message and a nurse will ring him back.

This is great, thank you. He has recently had the Libre so he is using that and noticing his high patterns so much more. I guess that it good really because before he would not do much and it would just be a number but actually seeing the graph makes him think. I think he needs to talk with the nurse a bit more, thank you!

Apart from the pump idea from @helli which is a good one (he could set different basal rates for work days and weekends, for example), perhaps he needs different bolus ratios for his breakfast and lunch on work days eg 1:9 or 1:8? Also too is he correcting when he’s high? Could his timetable be contributing?

He is trying to correct. I have noticed a few highs are from way overcorrecting a hypo but then he just lets it run higher and higher. His timetable might be contributing for sure as he is FT but have encouraged him to speak with work.

Ideal candidate for a pump, but not sure right now would be the ideal time to swap - it's a learning curve alright with a pump and some rough days as well as good ones (well that's lifelong whatever regime we have) but building an immediate understanding of 'Aaah - that most likely happened because of whatever' simply takes time.

Whatever - needs a good chat with his 'team' who hopefully will be able to suggest helpful things if the forum's suggestions don't !

I agree but might be good in the long run. Thanks!

My daughter’s basal needs are different depending on whether she’s at school or not, so it wouldn’t surprise me in the slightest if someone’s insulin requirements are different depending on whether they are at work or at home. On a pump you can set several different basal patterns for different days. Don’t know how you’d manage that with injections but it’s something to discuss with his medical team maybe.

I agree. I have never known him to struggle this much.

Yes, I appreciate that a pump may be the ideal fix, (until that cure is developed of course) but obviously a pump takes months (at least) to get authorized and then training after that, so a short term solution is worth exploring. Also, it isn't entirely clear from the OP's initial post whether her partner is high all day and night during the working week or his levels drop back down when he gets home on a night and if they drop down to normal or still slightly high etc. Without knowing more info we can only speculate and offer suggestions that may improve the situation.

Apologies, I should have been clearner. He is high all day (anything from 10-16) and his levels drop when he is at home but he still remains slightly high (9). At night he does tend to be better (unless he hasn't jabbed for something!)

 

[SunnyDays26]

Stress does cause higher BG's, so logic says increase insulin to counteract it. Also if he is having less exercise than lockdown again increase insulin to compensate for this.
Diabetes is like having a set of scales trying to balance everything 🙂

This is true. He is not too active so increasing activity levels might also help 🙂

 

[SB2015]

I was on MDI when teaching, and I found my Levels were difficult to manage initially.
things that helped were
- taking my own lunch, so knew the carbs
- swapping your basal to Levemir which was a more effective one for splitting so I could change dose for weekday and weekends.
I know @helli has sorted so that she can pre-bolus for lunch. That would certainly have made a difference to my afternoon spikes. I think now if I was teaching I would simply check and deliver during the lesson if necessary just to get my bolus in in time for me.

I certainly think that a pump would help, as it would enable your partner to make much finer adjustments to his basal, which it does sound like it is the issue since he is high all the day. I know it takes a bit of time to sort out, but I think It would be valid to ask for time off to sort this Initially. I suspect the consultant would support this. If they continue to run high it will not help in the long run.

 

[Inka]

He is trying to correct. I have noticed a few highs are from way overcorrecting a hypo but then he just lets it run higher and higher. His timetable might be contributing for sure as he is FT but have encouraged him to speak with work.

I think it’s sometimes hard to push for what you need, especially with something like teaching, but if your partner can identify problems and discuss them then that would be best. He shouldn’t need to run high like that, and employers have to make reasonable adjustments for Type 1 eg allowing him to bolus earlier for lunch or whatever.

If he does decide to try for a pump, then some can be controlled via an app on your phone, so that would make making adjustments easier. But I do think the fact it’s hard to find time to manage diabetes during the school day could be a large part of the problem. It makes it hard to nip things in the bud.

 

[Bloden]

Hi there @SunnyDays26. When I was teaching, I would often go high in class. This could happen when my students were annoying and there was a discipline issue, but also when I was enjoying a class: good stress and bad stress! The only solution I came up with was having a correction dose between classes, especially when the Libre was showing an upward trend.

I hope your partner finds a solution.