Newly Diagnosed with Type 1,New Joiner! Questions & Help Please

[helli]

Our livers drip glucose most of the time (they stop when they are dealing with toxins like alcohol).
The purpose of the basal insulin is to breakdown this glucose and maintain stable levels.
They assume your liver releases glucose at a steady rate.

To understand your basal (and bolus/NovoRadpid, if interested), you can Google "Abasaglar profile". I think it is supposed to last 24 hours but some find it does not make it past 22 hours which may be the suggestion for an evening top up of 4 units.

Before I had a pump, I used to take Lantus which is biosimilar to Abasaglar and never needed the second dose - we are all different.

 

[Type1Post30]

Our livers drip glucose most of the time (they stop when they are dealing with toxins like alcohol).
The purpose of the basal insulin is to breakdown this glucose and maintain stable levels.
They assume your liver releases glucose at a steady rate.

To understand your basal (and bolus/NovoRadpid, if interested), you can Google "Abasaglar profile". I think it is supposed to last 24 hours but some find it does not make it past 22 hours which may be the suggestion for an evening top up of 4 units.

Before I had a pump, I used to take Lantus which is biosimilar to Abasaglar and never needed the second dose - we are all different.

OK thank you, useful info again

 

[rebrascora]

You intuition is good in that taking an extra 4 units of Abasaglar on a night will likely cause a greater risk of hypos through the night and particularly when you are doing exercise on an evening as that in itself can drop your night time levels whilst you sleep. Exercise can have a BG lowering effect over the following 48 hours.

The rise in BG toward morning may well be what is called Dawn Phenomenon and is a result of the liver pumping out extra glucose in anticipation of you starting the day ahead and needing more energy (a throwback to prehistoric days when we didn't have kitchens with cupboards and fridges of food and we needed to get up and hunt or forage for breakfast), but as @helli says, your Abasaglar may well have run out by then so your body can't deal with that glucose.
With a waking reading of 7 I don't think it is a concern at the moment as that is a good waking reading, but dipping down to 4.1 in the night is not ideal (just a bit too close to the red line for comfort). What are your daytime readings like? Just wondering if reducing your morning Abasaglar a bit might stop things dropping too low in the early hours but still keep your levels in range during the day.

Great that the Lift tablets and biscuits with peanut butter strategy kept you out of the red last night.

It is common for non diabetic people to find their BG levels dip through the darkest hours of the night and then rise again in the morning, but everyone is different and it can change over time. I was dipping like you are in Nov last year. Now I start going high in the late evening and struggle to keep my levels from going too high. Things rarely stay the same with diabetes and you learn different strategies to cope with those changes.

Basal insulins have a particular profile of activity. Some are more uniform and longer lasting than others, but the body is rarely uniform in it's basal needs, so finding a basal insulin which has a profile which, as closely as possible, approximates your body's need is important. People on insulin pumps can adjust their basal insulin hour by hour to match the amount their body needs at different times of the day. Those of us on Multiple Daily Injections (MDI) have to try to find the best balance with just 1 or 2 injections a day and once it is in, you can't take it out again so if it is too much at certain times of day/night you will hypo. Tweaking the time you inject and sometimes splitting the dose between 2 injections and varying those doses independently can all help or changing to a basal insulin which might have a slightly different profile of release which may suit your body better. These are all quite clumsy adjustments compared to the finesse with which your clever little pancreas used to perform the job, so it is always going to be a best fit rather than ideal.

 

[SB2015]

One thing that you could discuss with your DSN is switching your background to Levemir. This is one which lasts a bit shorter time and is worth splitting to separate morning and evening dose. When I did this it enabled me to make adjustments to each one as necessary without impacting the other. So if I had a busy day I used to reduce the morning dose but keep the evening one the same. If I was getting night hypos I was able to reduce my night dose and leave the daytime one.

It all takes time to get things settled and matched to what you need. In the early days it is difficult to be patient, but just keep plugging away, keep in touch with your team and keep asking questions. As you will see there are very different experiences, as we are all different, but it can be good to read what has worked for others.

keep in touch.

 

[Whittsend]

Hi all,

I have recently been diagnosed with Type 1 Diabetes and naturally it has been quite the shock at the age of 32. I would consider myself fairly active, running 15-20k per week and also playing various other sports when I can! I was rushed into hospital on the 21st of June having probably gone the best part of 2 months without producing insulin, consequently my ketones were through the roof and I was lucky I went in when I did. Anyway, it is great to meet the team and I was hoping I could run a few questions past the group

1. I bought a Dexicom to consistently monitor my blood glucose levels with alerts set up but now find myself waking up in the middle of the night and having to eat as my levels are too low. This probably happened before I purchased the product (last week) but I was none the wiser. How important is it to eat in the middle of the night if you are below 4mmol/l? Or could I turn my alerts off and sleep through it until the morning if I generally feel ok? Alternatively what is a quick healthy snack to eat each evening before I go to bed based on experience.
2. My sugar levels seem to drop quite significantly when I exercise, and quickly when I am running. I probably need a level close to 12mmol/l to ensure I can complete a 45 minute run. Is there any foods which I can eat before hand to help ensure they stay relatively stable throughout?
3. I was told initially my my doctor to take 20 units of the long acting insulin in the morning and 6 units for each meal. Can I adjust this quite significantly dependent on what I am eating? For example I might have just fish and salad one evening which means I would need less units.

I will be speaking my DSN over the next few days but wanted to run this past the community first.

Thank You!
James

Hi James
Commiserations on joining the diabetes club - I can feel your pain, having been diagnosed Type 1 myself last July at the tender age of 64. Now that IS a shock!
By the time you read this you'll have seen the fantastic pieces of advice from others on the forum (thanks everybody, your contributions are continuing to be a personal help). Regarding your no.2 query I'm also struggling a bit with exercise (but not at your level of performance) and BG levels; I can plummet from ~9 to ~4 in less than 20 minutes just mowing the lawn! So I'm taking it very slowly as it seems I'm very insulin sensitive and trying to work up to resuming parkrun this Saturday (albeit at a sedate walk).
Something mentioned on a Libre users' webinar relating to exercise and diabetes may prove useful:

During exercise​

• Use high GI, typically 10g snack for fast acting release e.g. 2x jelly babies
• During exercise complex carbs e.g. fructose keeps BG up. Isomaltose, isotonic sports drinks, 50/50 mix of water and fruit juice
• Try to take on board 30g carbs per hour of activity at 10g every 20 minutes

One piece of advice I received from a consultant shortly after diagnosis was that if my bedtime BG was below 8 the I should have some carbs 'to see me through until the morning'. His suggestion was something slow-release like a bowl of porridge with full fat milk. I know everyone is different, but it certainly works for me (25g dry weight oats + milk) and sees me through until the Dawn Phenomenon kicks in.
Hope this helps.
Stay with it!
Dave

 

[Type1Post30]

You intuition is good in that taking an extra 4 units of Abasaglar on a night will likely cause a greater risk of hypos through the night and particularly when you are doing exercise on an evening as that in itself can drop your night time levels whilst you sleep. Exercise can have a BG lowering effect over the following 48 hours.

The rise in BG toward morning may well be what is called Dawn Phenomenon and is a result of the liver pumping out extra glucose in anticipation of you starting the day ahead and needing more energy (a throwback to prehistoric days when we didn't have kitchens with cupboards and fridges of food and we needed to get up and hunt or forage for breakfast), but as @helli says, your Abasaglar may well have run out by then so your body can't deal with that glucose.
With a waking reading of 7 I don't think it is a concern at the moment as that is a good waking reading, but dipping down to 4.1 in the night is not ideal (just a bit too close to the red line for comfort). What are your daytime readings like? Just wondering if reducing your morning Abasaglar a bit might stop things dropping too low in the early hours but still keep your levels in range during the day.

Great that the Lift tablets and biscuits with peanut butter strategy kept you out of the red last night.

It is common for non diabetic people to find their BG levels dip through the darkest hours of the night and then rise again in the morning, but everyone is different and it can change over time. I was dipping like you are in Nov last year. Now I start going high in the late evening and struggle to keep my levels from going too high. Things rarely stay the same with diabetes and you learn different strategies to cope with those changes.

Basal insulins have a particular profile of activity. Some are more uniform and longer lasting than others, but the body is rarely uniform in it's basal needs, so finding a basal insulin which has a profile which, as closely as possible, approximates your body's need is important. People on insulin pumps can adjust their basal insulin hour by hour to match the amount their body needs at different times of the day. Those of us on Multiple Daily Injections (MDI) have to try to find the best balance with just 1 or 2 injections a day and once it is in, you can't take it out again so if it is too much at certain times of day/night you will hypo. Tweaking the time you inject and sometimes splitting the dose between 2 injections and varying those doses independently can all help or changing to a basal insulin which might have a slightly different profile of release which may suit your body better. These are all quite clumsy adjustments compared to the finesse with which your clever little pancreas used to perform the job, so it is always going to be a best fit rather than ideal.

Thanks again for the info, so helpful. My day time reading at the moment is averaging 7.9, so not too bad. Also thanks for the narrative reg. the Dawn Phenomenon - genuinely quite interesting! I did go for a run earlier and ate a couple of hours later (taking 4 units of the Nova Rapid) and my alarm went off during the meal as my levels dropped to 3.2 during the meal! They have picked up now and I am pretty consistent around the 4.2 mark. I am definitely going to have to have a snack before I got to bed though to avoid me dropping too low again.

 

[Type1Post30]

Hi James
Commiserations on joining the diabetes club - I can feel your pain, having been diagnosed Type 1 myself last July at the tender age of 64. Now that IS a shock!
By the time you read this you'll have seen the fantastic pieces of advice from others on the forum (thanks everybody, your contributions are continuing to be a personal help). Regarding your no.2 query I'm also struggling a bit with exercise (but not at your level of performance) and BG levels; I can plummet from ~9 to ~4 in less than 20 minutes just mowing the lawn! So I'm taking it very slowly as it seems I'm very insulin sensitive and trying to work up to resuming parkrun this Saturday (albeit at a sedate walk).
Something mentioned on a Libre users' webinar relating to exercise and diabetes may prove useful:

During exercise​

• Use high GI, typically 10g snack for fast acting release e.g. 2x jelly babies
• During exercise complex carbs e.g. fructose keeps BG up. Isomaltose, isotonic sports drinks, 50/50 mix of water and fruit juice
• Try to take on board 30g carbs per hour of activity at 10g every 20 minutes

One piece of advice I received from a consultant shortly after diagnosis was that if my bedtime BG was below 8 the I should have some carbs 'to see me through until the morning'. His suggestion was something slow-release like a bowl of porridge with full fat milk. I know everyone is different, but it certainly works for me (25g dry weight oats + milk) and sees me through until the Dawn Phenomenon kicks in.
Hope this helps.
Stay with it!
Dave

Hi Dave, good to meet you. I am now fully embracing joining the diabetes club! Everyone has been so helpful on this thread, makes you recognise there are a lot of good people in the world despite what we read in the papers every day! My run today was good, ie I left the house with a BG level of 8.9 and it remained pretty level for the first 20 mins or so of the run. They did then begin to drop slowly and I think I ended with them being sat around 5.5, which again was a level I was happy with. I am starting to see that my levels do remain pretty consistent throughout the day but the running definitely has big implications on the levels. Let's see what happens to them later this eve!

 

[Type1Post30]

Our livers drip glucose most of the time (they stop when they are dealing with toxins like alcohol).
The purpose of the basal insulin is to breakdown this glucose and maintain stable levels.
They assume your liver releases glucose at a steady rate.

To understand your basal (and bolus/NovoRadpid, if interested), you can Google "Abasaglar profile". I think it is supposed to last 24 hours but some find it does not make it past 22 hours which may be the suggestion for an evening top up of 4 units.

Before I had a pump, I used to take Lantus which is biosimilar to Abasaglar and never needed the second dose - we are all different.

Thank you for this! That makes sense regarding the basal insulin - I will Google the Abasaglar profile just so I am clear on its longevity each day.

 

[Type1Post30]

One thing that you could discuss with your DSN is switching your background to Levemir. This is one which lasts a bit shorter time and is worth splitting to separate morning and evening dose. When I did this it enabled me to make adjustments to each one as necessary without impacting the other. So if I had a busy day I used to reduce the morning dose but keep the evening one the same. If I was getting night hypos I was able to reduce my night dose and leave the daytime one.

It all takes time to get things settled and matched to what you need. In the early days it is difficult to be patient, but just keep plugging away, keep in touch with your team and keep asking questions. As you will see there are very different experiences, as we are all different, but it can be good to read what has worked for others.

keep in touch.

Great - I think I will mention switching to the Levemir based on what a number of people have mentioned. Does this mean I would need to take it twice a day though or could I take it once in the morning? I think ultimately I want more control over it and it sounds like that's what the Levemir would provide.
And yes the past 2 days have been the most beneficial for me in terms of info since I was diagnosed, I really appreciate the input from everyone! I had no idea how much info I would be receiving by joining this forum!

 

[rebrascora]

Might be worth discussing with your nurse, a reduction in your NR dose for your evening meal on the days you go running, to save you having to then fill up on so many carbs at bedtime.
You are currently doing what is called "eating to your insulin" rather than adjusting your insulin to meet your body's needs, and is why insulin gets a bit of an undeserved reputation for causing weight gain..... but it is still very early days in respect of your diagnosis and it takes time to get these things ironed out and learn how to adjust your insulin so you are not routinely needing to eat when you don't want to, so don't worry about it. it's just another strategy to try to balance things. Of course, if you enjoy your bedtime feast, then by all means continue as you are doing. You are obviously fit and healthy and burning off plenty of calories with your running!

 

[SB2015]

Great - I think I will mention switching to the Levemir based on what a number of people have mentioned. Does this mean I would need to take it twice a day though or could I take it once in the morning? I think ultimately I want more control over it and it sounds like that's what the Levemir would provide.
And yes the past 2 days have been the most beneficial for me in terms of info since I was diagnosed, I really appreciate the input from everyone! I had no idea how much info I would be receiving by joining this forum!

I switched to Levemir so that I could split the dose into two. It does mean an extra injection each day as you would need to take it in the morning and at night. However the extra flexibility I found made it well worth it.you can then make reductions on one of them without impacting the otherdose if you need to.

It sounds like you are getting your head round things. You are doing brilliantly.

! So I'm taking it very slowly as it seems I'm very insulin sensitive

This may be of use to both if you, I am very insulin sensitive, and found my management on pens so much easier when I got for half unit pens (at that time they were only available for children so mine came with stickers too!!!!). This enabled me to make adjustments of half units for both my bolus insulin (novorapid) and basal insulin (Levemir). I just asked my DSN and they were happy to provide these, and I think they come in ‘grown up versions’ now, although I found having different coloured pens for each very helpful. (It still didn’t stop me using the wrong one sometimes!!)

 

[everydayupsanddowns]

Is it normal to see your levels drop sporadically throughout the night too before rising again Assume so but wanted to check.
Regarding the basal insulin - is this supposed to stabilise my BG levels purely by reducing and glucose in my system throughout the day when I haven't eaten? ie does it act as a catalyst to absorb glucose similar to the Nova Rapid but just covers snacks etc throughout the day? My reason for asking is because I was told to take 4 units before bed, which I am currently not doing because I believe if I did my levels would drop too low, so it is just the 20 units in the morning.

Well there are a few overlapping things going on here I think.

The body does naturally have a period overnight where typically cortisol levels drop (cortisol is one of the hormones that raises BG). Often around 3am-ish.

The tricky thing is that insulin therapy is a pretty blunt tool to cover the complexity of what a fully functioning pancreas actually gets up to insulin-wise. I once heard it described as us delivering the wrong insulin, with the wrong profile, in the wrong place!

Your Absalgar is supposed to only be covering your ‘background needs’. The stored glucose that the liver releases 24hrs a day to keep you ticking over and fuelling all the stuff the body has to do even while at rest, or asleep. It is designed to last 24 hours (but in reality lasts longer for some, and shorter for others), and to gradually release fairly evenly over that time. Absalgar isnkt supposed to deal with any snacks or food at all.

But your background needs are not likely to be absolutely constant through the 24 hours, so in the end your basal/background dose will end up being a bit of a compromise and is likely to be a bit too much at some times, and not quite enough at others.

Meal doses with differing ratios will most likely be able to cover over the differences, but may appear to be acting illogically at times, because x units for y food may also be having to cover z shortfall of background insulin (or overshoot) at different times. And, of course, all this can ebb and flow during the year!

All part of life’s rich pattern when pretending to be your own pancreas

 

[Type1Post30]

Thanks guys.
On another note. just a quick question on the Dexcom (for those who use it). Currently I have it positioned on my stomach which seems to be working better than on the back of the arm where I had it previously (ie not losing signal in the night) - Can I just sense check that my BG levels might be much higher through the Dexcom monitor than the finger prick if I were to do them both at the same time? At times I can get a reading of 6 by using the finger prick and then 9 on the BGM. I assume that would be the case as my stomach would absorb the blood sugars quicker than the time it would take for it to be absorbed in my fingers where there are fewer organs etc...

 

[rebrascora]

Generally speaking CGM and Flash Glucose sensors lag behind finger prick BG by about 15 mins because the filament is inserted into interstitial fluid rather than measuring blood glucose as you would with a finger prick and the interstitial fluid takes longer to exchange glucose with the blood stream. If you are getting a significant difference between the 2 readings then it is likely because your levels are changing rapidly and by the look of it your BG was dropping when you got a reading of 9 on the Dexcom and 6 with a finger prick. It is best to wait until your levels are stable with the Dexcom (ie you have 2 half hourly readings which are close together with an horizontal arrow) before checking against a finger prick and obviously not eating or drinking anything which might impact your levels or doing exercise during that time, to give the best chance of a fair comparison. You could also wait 15 mins after the finger prick to check the Dexcom to take into account the interstitial lag, but if you are checking when levels are stable then it shouldn't matter.

 

[Type1Post30]

Generally speaking CGM and Flash Glucose sensors lag behind finger prick BG by about 15 mins because the filament is inserted into interstitial fluid rather than measuring blood glucose as you would with a finger prick and the interstitial fluid takes longer to exchange glucose with the blood stream. If you are getting a significant difference between the 2 readings then it is likely because your levels are changing rapidly and by the look of it your BG was dropping when you got a reading of 9 on the Dexcom and 6 with a finger prick. It is best to wait until your levels are stable with the Dexcom (ie you have 2 half hourly readings which are close together with an horizontal arrow) before checking against a finger prick and obviously not eating or drinking anything which might impact your levels or doing exercise during that time, to give the best chance of a fair comparison. You could also wait 15 mins after the finger prick to check the Dexcom to take into account the interstitial lag, but if you are checking when levels are stable then it shouldn't matter.

Thanks, that makes sense

 

[Type1Post30]

Another question for the team regarding food - If I were to just eat Chicken and salad for lunch, albeit a big portion of it, would I need to take my fast acting insulin as well? There will be little to zero carbs in the meal so I would just like to know what the process would be then? Or am I ideally advised to have carbs during every meal whether I like it or not? I did have a banana with porridge this morning too which should see me through the morning.

 

[rebrascora]

If you are not eating carbs then you don't need meal time insulin.... at least at this stage. If you opt for a low carb diet in general, which is not necessary when you are Type 1, then you sometimes have to factor protein into your meal time injections, because about 40% of protein will break down to produce glucose in the absence of carbs but as a one off meal this is less likely to happen and it takes time to learn how your body responds to protein, so my advice would be to skip your meal time insulin if you are not having any appreciable carbs in that meal.

 

[Type1Post30]

If you are not eating carbs then you don't need meal time insulin.... at least at this stage. If you opt for a low carb diet in general, which is not necessary when you are Type 1, then you sometimes have to factor protein into your meal time injections, because about 40% of protein will break down to produce glucose in the absence of carbs but as a one off meal this is less likely to happen and it takes time to learn how your body responds to protein, so my advice would be to skip your meal time insulin if you are not having any appreciable carbs in that meal.

Thanks Barbara, super helpful.