Some T1 questions

[Pandy8]

Good afternoon,

Thanks for your support over a previous thread. My T1 husband has made some changes (reduction of basal) and things are a bit better, but still very erratic. He has been in touch by email with his DSNs who have given him another pat on the back - 95% within their range and they seem unkeen to change his basal for another as he seems to be doing well in their terms. Could you please help us with the following:

1. What do you suggest is a good target for BG before a session in the gym or a run? ( high intensity)

2. Is it possible to manage the time between mealtimes without having to correct in one direction or another?

3. Is it possible to go through the night without a hypo/hyper and what do you suggest BG should be before sleep?

4. Do emotions affect BG? Or is it that low BG or quickly changing BG makes you feel extra vulnerable/sensitive?

5. Should you do a finger prick test when the BG alarm goes off? Or doesn’t it matter? His Libre goes off at 4.5.


Husband is always on the go so I’m beginning to wonder if he is taking too much bolus given the energy he expends between meals, which then puts him into a cycle of lows and highs and munching etc

Many thanks.

 

[Bruce Stephens]

1. What do you suggest is a good target for BG before a session in the gym or a run? ( high intensity)

Exercise is complex. There's a couple of relevant videos in this list: https://www.youtube.com/playlist?list=PLcxxXajQFnx7rtCsE8ppVKN6uQYPpg7Ga

2. Is it possible to manage the time between mealtimes without having to correct in one direction or another?

3. Is it possible to go through the night without a hypo/hyper and what do you suggest BG should be before sleep?

Sure. Relies on getting the basal levels right, especially for the night. During the day it's easy just to eat a snack to fix a low, or add a correction before the next meal.

4. Do emotions affect BG? Or is it that low BG or quickly changing BG makes you feel extra vulnerable/sensitive?

Both can happen. (The answer to the question "can X affect BG" is almost always "yes".) How lows and quickly changing BG change mood is really individual and variable. Plenty of medical professionals will report handling people who become aggressive or violent (whereas I tend to get sleepy).

5. Should you do a finger prick test when the BG alarm goes off? Or doesn’t it matter? His Libre goes off at 4.5.

Depends a bit. When the Libre doesn't match what you feel, it's recommended to check. And if you're not sure you've eaten enough to correct a hypo, using finger prick tests is a bit more reliable (Libre has more of a time delay because it's reading interstitial fluid and feeding that through a prediction algorithm).

Overall, though, 95% in range is really impressive. But if it's taking too much effort then his healthcare team need to understand that so everyone can agree on some balanced approach that's acceptable.

 

[Pandy8]

Thank you, this is all v helpful. Yes, I think the DSNs have absolutely no idea of the stress and sleepless nights involved in the good stat. Can’t really blame them as the downsides haven’t been fed back to them, I suspect.

 

[helli]

1. What do you suggest is a good target for BG before a session in the gym or a run? ( high intensity

Depends what happens to your husband's blood sugars when he does these exercises and how long he dies them for. We are all different and different exercise has different affect. For example, high intensity interval training typically causes to blood sugars rising whereas longer constant run typically causes levels to fall. Unless our levels are too high or we are under stress which can cause levels to rise.
I try to start between 6 and 8 for an intense cardio workout. Any lower and I risk hypo; any higher and I feel sluggish.

I learnt what my body does through trial and error because I only care what happens to me not the average person with Type 1.

Remember it is common to become more sensitive to insulin for up to 48 hours after exercise so I usually reduce my basal by 15 to 20% at the next daily dose

Is it possible to manage the time between mealtimes without having to correct in one direction or another?

Yes, especially if
- you have basal set correctly
- your insulin to carbs ratio is correct for that time of day
- you do not aim to be in target 100% of the time. We are not full time pancreases and do not have the same insulin as a fully functioning one

Is it possible to go through the night without a hypo/hyper and what do you suggest BG should be before sleep?

Yes, if you have your basal set correctly and you have little or no bolus on board.
I try to go to bed more than 4 hours after my last bolus dose with a level around 6. However, I know it is common to aim for a level around 8.

Do emotions affect BG? Or is it that low BG or quickly changing BG makes you feel extra vulnerable/sensitive?

Yes and yes
Stress can affect our levels and our levels can affect our emotions.

Should you do a finger prick test when the BG alarm goes off? Or doesn’t it matter? His Libre goes off at 4.5.

ABSOLUTELY YES.
Libre is less accurate when high or low so it is advised to always test with finger pricks before making any corrections. Otherwise you risk over correcting and yoyo-ing.


Managing diabetes can be stressful but trying to CONTROL it is much more stressful. Being 95% in target could suggest your husband is trying too hard to control his diabetes. There are so many things that affect our levels that it is near impossible to live and have levels 100% in range. We need to learn to live with Type 1 rather than letting it take over our lives.

 

[Inka]

I was going to say what @helli said above - 95% is a brilliant result! The target is 70% in range. It does sound like he may be too focussed on ‘perfection’ and risking burning himself out. I can’t remember if you said he exercised a lot before, but that’s one reaction to a Type 1 diagnosis that can go too far. Far better to pace himself - both physically and mentally. I’d also suggest that a little relaxation of targets may actually improve things for him and reduce the highs and lows.

Just to focus on your Q4 - yes! Low blood sugar can make you feel weepy and down and panicky; high blood sugar can make you jumpy and irritable. However, do be cautious about attributing normal emotions to blood sugar. Sometimes we just feel sad/irritated/impatient like anyone else.

 

[leonS]

With a target range of 4 to 10, 20% above range and 4% below is fine. Most T1s will not achieve near to 95%.
I finger ptick test only after I have treated a hypo and waited 15 mins or so. It would be another 15 mins before the Libre registers a change. Note that 4-5 is NOT a hypo.