New here - type 3C

[Proud to be erratic]

Hi again Sean,
Now out of hosp and home so a little better placed to review what you said.

Today though, first day on Tresiba, haven't gone above 15 even with a bit of a treat lunch! So it looks promising.

How is the Tresiba treating you? Give it a few weeks to settle you, but in conjunction with your Libre try to optimise your basal to keep you stable during the night. A search for basal testing will help you manage that aspect. Because our basal needs vary through a 24 hr period you can't optimise Tresiba for that 24 hr period. Until you've stabilised what is viable with your basal the rapid bolus will always be chasing the basal deficit. So try to get your basal best fit and a good nights sleep is a reasonable objective.

Sugars used to be lower last year, have been very healthy this year and they've remained above 10. Work in progress.

Don't get too anxious right now about sitting in the 10s. Not perfect, but better than sitting in the low 4s.

This might seem a strange, left flanking, response, but: everyone naturally has a degree of insulin tesistance; T2s have this in spades. But our natural insulin resistance affects the responsiveness of any insulin we inject. If your BG is already high your bolus should comprise a mix of correction to bring your BG down and bolus for carbs you intend to eat. But I find if my BG is above 8 (better 7) then until the correction component has done its thing, then the food component seems to get overwhelmed by the need to correct (ie lower BG). So I've learnt to not start eating until my BG is no higher than 8 and if 8 is actually falling. Libre allows me to monitor this. Sometimes I have to wait a long time before I can start my meal, including this evening when I bolused @6.15 pm, actual BG 11.8 and didn't start eating until 9.50, with BG 7.8. It's a long wait, my dinner was spoilt, but BG managed reasonably.

I also find my correction ratios need to be more agressive (hardened) when I'm much above 12; again it's about altered (increased) insulin resistance when BG is higher. There are some 42 factors that can affect BG (ref Adam Brown in his article for Diatribe); several of these can be explained using the vocabulary of increased insulin resistance.

Many evenings my pre-bolus is only 15 mins, but this week recently discharged from hosp and recovering from surgery, with Covid, nothing is very normal.

The other aspect to such pre-bolus delays is my carb count gets distorted. Typically my NovoRapid bolus will last 4 to 4.5 hrs in my system, albeit significantly tailing off in the last hour. Tonight I bolused for 45gms carbs, but ate less than 25. Meanwhile because of the big delay most of my bolus had dissipated and I had to be cautious about NOT eating my full meal with relatively little insulin left on board. Again, Libre allows me to monitor the trend and make adjustments as things unfold; I had a plan for a certain meal at a certain time. The plan got adjusted to fit the new scenario. I could never realistically exercise this level of DM management without Libre. Its not sustainable in the long term even with Libre but right now I'm learning more and more about me and my DM.

Hope this provides you with some help in finding your way forward - or "work in progress". Lean heavily on Libre for trend monitoring (but check it against actual BG if in doubt); are you familiar with the limitations of Libre? If not there's lots in these posts about Libre 2 limitations. Sometimes technology is only as good as your understanding of when to be cautious.

 

[sean123]

Hi again Sean,
Now out of hosp and home so a little better placed to review what you said.

How is the Tresiba treating you? Give it a few weeks to settle you, but in conjunction with your Libre try to optimise your basal to keep you stable during the night. A search for basal testing will help you manage that aspect. Because our basal needs vary through a 24 hr period you can't optimise Tresiba for that 24 hr period. Until you've stabilised what is viable with your basal the rapid bolus will always be chasing the basal deficit. So try to get your basal best fit and a good nights sleep is a reasonable objective.

Don't get too anxious right now about sitting in the 10s. Not perfect, but better than sitting in the low 4s.

This might seem a strange, left flanking, response, but: everyone naturally has a degree of insulin tesistance; T2s have this in spades. But our natural insulin resistance affects the responsiveness of any insulin we inject. If your BG is already high your bolus should comprise a mix of correction to bring your BG down and bolus for carbs you intend to eat. But I find if my BG is above 8 (better 7) then until the correction component has done its thing, then the food component seems to get overwhelmed by the need to correct (ie lower BG). So I've learnt to not start eating until my BG is no higher than 8 and if 8 is actually falling. Libre allows me to monitor this. Sometimes I have to wait a long time before I can start my meal, including this evening when I bolused @6.15 pm, actual BG 11.8 and didn't start eating until 9.50, with BG 7.8. It's a long wait, my dinner was spoilt, but BG managed reasonably.

I also find my correction ratios need to be more agressive (hardened) when I'm much above 12; again it's about altered (increased) insulin resistance when BG is higher. There are some 42 factors that can affect BG (ref Adam Brown in his article for Diatribe); several of these can be explained using the vocabulary of increased insulin resistance.

Many evenings my pre-bolus is only 15 mins, but this week recently discharged from hosp and recovering from surgery, with Covid, nothing is very normal.

The other aspect to such pre-bolus delays is my carb count gets distorted. Typically my NovoRapid bolus will last 4 to 4.5 hrs in my system, albeit significantly tailing off in the last hour. Tonight I bolused for 45gms carbs, but ate less than 25. Meanwhile because of the big delay most of my bolus had dissipated and I had to be cautious about NOT eating my full meal with relatively little insulin left on board. Again, Libre allows me to monitor the trend and make adjustments as things unfold; I had a plan for a certain meal at a certain time. The plan got adjusted to fit the new scenario. I could never realistically exercise this level of DM management without Libre. Its not sustainable in the long term even with Libre but right now I'm learning more and more about me and my DM.

Hope this provides you with some help in finding your way forward - or "work in progress". Lean heavily on Libre for trend monitoring (but check it against actual BG if in doubt); are you familiar with the limitations of Libre? If not there's lots in these posts about Libre 2 limitations. Sometimes technology is only as good as your understanding of when to be cautious.

Hey, thank you so much for this, that's a lot of useful information that I'm glad to now know.
Glad you're out of hospital, too.
The Tresiba seems to be working well so far. Hit single figures this week.
I feel pretty comfortable with the Libre, not aware of any limitations but I'll have a look into that.

 

[Proud to be erratic]

He said because I'm type 3C, ie - damage to pancreas diabetes, that my pancreas sort of works and sort of doesn't - where it doesn't is in producing insulin, where it does is in producing glucose

About the above comment from the doctor, I’m not disputing it at all, I just I always thought the glucose came from your liver? Maybe someone much more educated that I will know the answer to that one.

Just for completeness my understanding is also that glucose is stored in the liver, not the pancreas.

However the pancreas has the hormone Glucagon and, slightly surprisingly, when one's brain recognises that more glucose is needed it can not directly tell the liver to open its glucose store. Rather it sends a message to the pancreas, telling the pancreas to tell the liver - which the pancreas does by sending the messenger hormone Glucagon. The pancreas also has a hormone called Somotostatin, which assists in balancing insulin and glucose releases; I'm not sure of the precise process for that.

I gleaned this info from Gary Scheiner's book, "Think Like A Pancreas" - which I think is a most useful source for DM management; the core functions of the pancreas don't seem to be covered in Dr Ragnar Hanas's book, but this book was originally focused on "T1 in children, adolescents and young adults", where I guess the incidence of pancreatectomies or pancreatitis is very rare.

The other triggers that I'm aware of for the liver to release glucose are: adrenaline; cortisol (often referred to as the stress hormone); and growth hormones which I, broadly at age 72, no longer have much of.

 

[EmmaL76]

Just for completeness my understanding is also that glucose is stored in the liver, not the pancreas.

However the pancreas has the hormone Glucagon and, slightly surprisingly, when one's brain recognises that more glucose is needed it can not directly tell the liver to open its glucose store. Rather it sends a message to the pancreas, telling the pancreas to tell the liver - which the pancreas does by sending the messenger hormone Glucagon. The pancreas also has a hormone called Somotostatin, which assists in balancing insulin and glucose releases; I'm not sure of the precise process for that.

I gleaned this info from Gary Scheiner's book, "Think Like A Pancreas" - which I think is a most useful source for DM management; the core functions of the pancreas don't seem to be covered in Dr Ragnar Hanas's book, but this book was originally focused on "T1 in children, adolescents and young adults", where I guess the incidence of pancreatectomies or pancreatitis is very rare.

The other triggers that I'm aware of for the liver to release glucose are: adrenaline; cortisol (often referred to as the stress hormone); and growth hormones which I, broadly at age 72, no longer have much of.

Wow… this is massively complicated !! But Thankyou. Maybe I should read the book, as I do have a problem with cortisol. These processes blow my mind.