Hi. I’ve had type 1 for almost 20 years (LADA). Does anyone else dread the hospital reviews, or is it me? I come away feeling stupid and reckless. I find it almost impossible to give them the straight answers they want - I don’t remember to check my sugars 2 hours after eating; I can’t remember what happened a few nights ago when my reading wasn’t great; I sometimes don’t respond straight away to a low sugar overnight cos I’m ’sleepy’ (low sugar sleepy). I am only now finding out that low sugars cause organ damage, not just high sugars causing neuropathy etc. There is so much info I’m only now getting incidentally, which I’d have wanted to have known earlier - although I understand you can’t be overloaded at once with it all - but a bullet point fact sheet would be good, stating what the % targets readings are for example. I’ve googled lots, but stuff like that doesn’t come up. Does anyone have any good reads to suggest? Thanks.
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Review appointments and information.
- Thread starter ladyLADA
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Inka
Well-Known Member
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- Type 1
What insulins are you on @ladyLADA ? Have you got the Libre?
There are a couple of books often recommended for Type 1s/LADAs here:
Think Like a Pancreas’ by Gary Scheiner.
And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too).
You should always treat a low ASAP even if it’s nighttime and you’re sleepy. If you don’t, there are the immediate risks of dropping lower, which can cause seizures, unconsciousness and worse, but long-term repeated and/or prolonged lows can cause you to lose your hypo awareness and can cause potential issues with your brain function and heart too, I believe.
I don’t get asked questions like that at my review. Is it because you’re struggling a bit with control? Ask anything you want here. Nothing is ‘silly’.
There are a couple of books often recommended for Type 1s/LADAs here:
Think Like a Pancreas’ by Gary Scheiner.
And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too).
You should always treat a low ASAP even if it’s nighttime and you’re sleepy. If you don’t, there are the immediate risks of dropping lower, which can cause seizures, unconsciousness and worse, but long-term repeated and/or prolonged lows can cause you to lose your hypo awareness and can cause potential issues with your brain function and heart too, I believe.
I don’t get asked questions like that at my review. Is it because you’re struggling a bit with control? Ask anything you want here. Nothing is ‘silly’.
Hi. I’ve always been on Novorapid, but have just changed to Fiasp. I take Tresiba at night. My HbA1c result's have always been ok. When I referred to the nighttime hypos, I meant I can be a bit sleepy with the low, not sleepy and being ‘lazy’ - my Libre alarm has sorted this now tho I’m testing out the Deexcom One (from yesterday). I just get a bit overwhelmed after my hospital appointments, and feel a bit down for a while, cos I leave feeling that I’m not text book perfect and that is down to me not doing everything exactly as I’m supposed to. I don’t eat at the same times each day; I forget to check bm 2 hours after eating so I’m not entirely sure what my post meal bm is; my brain doesn’t function well with all the variables re foods etc, so I don’t particularly change my ratios for different foods as such, but do so ad hoc (so to speak). They didn’t seem to get when I explained that, if I wake up high, and give a correction dose (I give 1 if my machine says to give 2) I’m constantly checking cos I know I’ll be dropping in a couple of hours, but if I don’t give a correction dose I will remain high or go higher, so I can’t win
Line drawn for a while - we keep going don’t we. Got to confront a telephone review next week, re the new insulin (altered due to a manufacturing change). Thanks for your response and I’ll check those books out too. I’ve also found a good channel (or pod??) on YouTube called ‘She’s Diabetic’ - insightful and realistic
Line drawn for a while - we keep going don’t we. Got to confront a telephone review next week, re the new insulin (altered due to a manufacturing change). Thanks for your response and I’ll check those books out too. I’ve also found a good channel (or pod??) on YouTube called ‘She’s Diabetic’ - insightful and realistic
Tdm
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- Type 1
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- She/Her
Yes, 'She's diabetic' is good ..have you seen 'type 1 talks' ? i'd recommend that for practical tips.
As for blood glucose 2 hours after eating, i don't do that. I thought it was a type 2 thing, whereas us t1s have cgms ( eg dexcom) so we have better info and don't need a snap shot in time.
I do still test blood glucose time to time to check my sensor, or if treating a low as a fingerprick shows changes before your cgm
As for blood glucose 2 hours after eating, i don't do that. I thought it was a type 2 thing, whereas us t1s have cgms ( eg dexcom) so we have better info and don't need a snap shot in time.
I do still test blood glucose time to time to check my sensor, or if treating a low as a fingerprick shows changes before your cgm
- Relationship to Diabetes
- Type 1
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- He/Him
Sorry to hear how your appointments make you feel
I think that feeling of ‘going to see the headmaster’ is familiar to many of us, and I know I’ve had appointments over the years which have made me feel exactly the same.
Partly that can be our own brains focussing on what we perceive as shortcomings, and partly it can be the style of the HCP / consultant. Some are more gifted at encouraging, and working through challenges as a team.
Be kind to yourself and give yourself massive credit for making it through 20 years with this infuriating, illogical, fickle and downright contrary condition.
As for “why was that number like that there?” I’d say it’s because you have type 1 diabetes, and there are 30-40 factors that influence your blood glucose levels. Even if you behaved exactly the same every day, your diabetes would still throw curve balls from time to time.
That’s absolutely fine. There’s no need to eat to the clock. It helps if your basal is set right (and this can vary through the year), but you shooild be able to skip meals and eat (or not eat) pretty much whenever and whatever you choose.
Use your CGM for this. It’s what it’s good at. I find it more helpful to look for overall trends rather than focussing on one-off diabetes randomness.
Are you adjusting doses based on the approximate carb content of the meal? Or are you going more by experience and eating similar things day to day?
Sounds like you have some sort of bolus calculator, but that its settings could probably do with tweaking to better match your needs. One of the benefits of a bolus / correction calculator is that you can make smaller adjustments to fine tune things and not have to worry about keeping the maths easy to work stuff out in your head. So you can have ratios and correction factors that suggest fractions of units (1u:11g or 1u:12g and 1u:3.3mmol/l or 1u:4.2mmol/l or whatever) and then round the dose at the end. It can also help to have half-unit pens for a bit more finesse.
In terms of target ranges, the commonly suggested ones (from the NICE guidance for T1) are:
5-7 before breakfast
4-7 before other meals
no higher than 9 by 2 hours after food.
You might also find the International consensus recommendations for Time in Range helpful for interpreting your CGM data
SB2015
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- Relationship to Diabetes
- Type 1
Sorry that your appointments leave you feeling down.
Your description of your daily routine sounds very normal for those of us living with T1/LADA. We all forget things, there is no need to eat at the same time each day, we are dealing with a lot of variables every day.
You have already had some practical suggestions for tweaks to make things a bit easier, and it is good advice to focus on @everydayupsanddowns link to realistic time in range.
I think that it would be useful for you to let your team know how you feel after your appointments. I think that there are some HCPs who focus on the numbers rather than the person.
Another recommendation from me for T1 in children, … by Ragnar Hanas. Very clear and well indexed.
I still dip in as prefer to be able to annotate info that I read rather than reading on a screen. Having said that I learn so much from others on here, and find that I can ask absolutely any questions.
let us know how the phone review goes and how you get on with the change to FIASP
I’ve been using Libre for about 2 years - it’s great for the trends, and cos I drive a lot for work it avoids finger tests throughout the day, but I do find the variables between the 2 readings quite wide, which leaves me not overly confident do go by the cgm reading predominantly. For instance, the sensor reading has been 3.9 with downward arrow, but my blood reading was 6.6 - I do find it difficult to relate my 2 readings to the train track analogy that Abbott giveSorry to hear how your appointments make you feel
I think that feeling of ‘going to see the headmaster’ is familiar to many of us, and I know I’ve had appointments over the years which have made me feel exactly the same.
Partly that can be our own brains focussing on what we perceive as shortcomings, and partly it can be the style of the HCP / consultant. Some are more gifted at encouraging, and working through challenges as a team.
Be kind to yourself and give yourself massive credit for making it through 20 years with this infuriating, illogical, fickle and downright contrary condition.
As for “why was that number like that there?” I’d say it’s because you have type 1 diabetes, and there are 30-40 factors that influence your blood glucose levels. Even if you behaved exactly the same every day, your diabetes would still throw curve balls from time to time.
That’s absolutely fine. There’s no need to eat to the clock. It helps if your basal is set right (and this can vary through the year), but you shooild be able to skip meals and eat (or not eat) pretty much whenever and whatever you choose.
Use your CGM for this. It’s what it’s good at. I find it more helpful to look for overall trends rather than focussing on one-off diabetes randomness.
Are you adjusting doses based on the approximate carb content of the meal? Or are you going more by experience and eating similar things day to day?
Sounds like you have some sort of bolus calculator, but that its settings could probably do with tweaking to better match your needs. One of the benefits of a bolus / correction calculator is that you can make smaller adjustments to fine tune things and not have to worry about keeping the maths easy to work stuff out in your head. So you can have ratios and correction factors that suggest fractions of units (1u:11g or 1u:12g and 1u:3.3mmol/l or 1u:4.2mmol/l or whatever) and then round the dose at the end. It can also help to have half-unit pens for a bit more finesse.
In terms of target ranges, the commonly suggested ones (from the NICE guidance for T1) are:
5-7 before breakfast
4-7 before other meals
no higher than 9 by 2 hours after food.
You might also find the International consensus recommendations for Time in Range helpful for interpreting your CGM data
I take sugar cos of the downward arrow, but am mindful that I’d don’t want my bm to be high, which can be what happens then, but obviously, the reverse can happen too ♀️ With this in mind, the time in range records on the Libre don’t represent what my bloods are, cos the 2 readings are so wide. I’m assuming they always ask about the 2 hour post meal bm to help confirm my insulin:carb ratio is correct. I’m very grateful for everyone’s comments on this platform
I’ve ordered the 2 books recommended here thanks for those. The FIASP seems to be working ok - haven’t noticed anything different. Telephone review was ok thank you - review in 6 months now, although the Dr annual review will be due first
rebrascora
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Bolus (meal time) insulin has a 4-5 hour activity, so testing 2 hours post meal will not tell you a lot about your insulin to carb ratio. You really want to see where your levels are 4-5 hours later, usually before your next meal to assess if the dose you injected for the previous meal was correct and brought you back to where you want to be.... usually mid range. IF your basal dose is holding you steady, then being too high or too low at that time would tell you if your previous meal bolus was near enough correct. The important thing to know firstly, is that your basal (long acting) insulin dose is holding you steady between meals and of course overnight and if not, adjust that first.
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