Struggling

[Kel3]

I posted a couple of months back because my levels were out of range, and things improved slightly but have now gone so wrong again and I literally feel like I don't know what to do anymore. My HbA1c last May was 54. I contracted covid in August and for the next 3 months things were a nightmare and my HbA1c went up to 60. I've worked with my DSN and things improved a little but I have just had my latest result and it is now 63. I am trying so hard and thought heading in the right direction, but obviously not.

I should probably add that alongside Type 1 I also have a rheumatology condition - MCTD, and this has been flaring so my DSN feels this could be why it is currently uncontrollable. I am seeing my rheumatologist next month.

I just don't know what else to do and thought someone might have some ideas? I have even ordered a book to see if that helps in any way. I have had type 1 for 20 years and always had pretty good control until now. Thanks.

 

[trophywench]

So - any illness disease or injury we happen to have when we also have diabetes is likely to cause our BG to increase, hence it's no real surprise that a rheumatological condition would affect it adversely (since anything involving inflammation is the main culprit for that) and you'll get glitches in BG control whenever the MCTD is paying up and not plodding along in a stable way.

I would have thought that the only thing to do is plenty more BG testing and dose adjustment - do you have at least a Libre if not a full CGM as well as your BG meter to get alarms when your BG goes high (and low) so you can treat that before it gets out of hand, and are you on MDI or use a pump?

What has the D Consultant had to say about it, as you've only mentioned the SN?

 

[Kel3]

So - any illness disease or injury we happen to have when we also have diabetes is likely to cause our BG to increase, hence it's no real surprise that a rheumatological condition would affect it adversely (since anything involving inflammation is the main culprit for that) and you'll get glitches in BG control whenever the MCTD is paying up and not plodding along in a stable way.

I would have thought that the only thing to do is plenty more BG testing and dose adjustment - do you have at least a Libre if not a full CGM as well as your BG meter to get alarms when your BG goes high (and low) so you can treat that before it gets out of hand, and are you on MDI or use a pump?

What has the D Consultant had to say about it, as you've only mentioned the SN?

I have a libre 2 and that obviously does help. I am currently on MDI, a pump has been mentioned it my control does not start going in the right direction. I am hoping to stay on MDI if I possibly can.

I haven't seen my consultant for a couple of years although I had a telephone call with her in May/June time last year, but it was literally a quick 5 minute call as she was happy with everything (as was I). Things have all gone pear shaped since August.

 

[rebrascora]

Hi. Sorry to hear you are feeling frustrated with your diabetes and it isn't going as well as you would like.

Firstly, whilst 63 isn't ideal it's a long way off being terrible, so try not to be too despondent and get things too far out of perspective, particularly when your other condition is impacting things.
Are you on steroids for your rheumatology condition?

If your levels have been creeping up due to inflammation, have you increased your basal dose(s) to balance it? That would be the first thing I would check by skipping some meals and see what my levels did in the absence of food and bolus insulin and overnight of course and then decide if I needed to adjust my basal insulin. Libre makes this so much easier than it used to be via finger pricks. It may be that a change of basal insulin would help you manage your levels better or perhaps some dose adjustment. If levels are pretty stable in the absence of food and bolus insulin, then you need to look at meal time ratios. If you are spiking high then coming back down into range, then it is likely a timing issue. Can you show us a photo of a typical day's Libre graph and see if we can spot areas that you could possibly work on to improve things?

 

[Pumper_Sue]

I have a libre 2 and that obviously does help. I am currently on MDI, a pump has been mentioned it my control does not start going in the right direction. I am hoping to stay on MDI if I possibly can.

Why do you have an aversion to a pump? A pump would solve a lot of your problems after half a day you don't even notice it's there 🙂

Can you do a basal test ? This would be a very good starting point for you. Once that's more in range you can move on to other adjustments.
Having others conditions can and do impact on your blood sugars, so be kind to yourself.

 

[Kel3]

Hi. Sorry to hear you are feeling frustrated with your diabetes and it isn't going as well as you would like.

Firstly, whilst 63 isn't ideal it's a long way off being terrible, so try not to be too despondent and get things too far out of perspective, particularly when your other condition is impacting things.
Are you on steroids for your rheumatology condition?

If your levels have been creeping up due to inflammation, have you increased your basal dose(s) to balance it? That would be the first thing I would check by skipping some meals and see what my levels did in the absence of food and bolus insulin and overnight of course and then decide if I needed to adjust my basal insulin. Libre makes this so much easier than it used to be via finger pricks. It may be that a change of basal insulin would help you manage your levels better or perhaps some dose adjustment. If levels are pretty stable in the absence of food and bolus insulin, then you need to look at meal time ratios. If you are spiking high then coming back down into range, then it is likely a timing issue. Can you show us a photo of a typical day's Libre graph and see if we can spot areas that you could possibly work on to improve things?

I am only on Naproxen for my rheumatology condition at present, my consultant is reluctant to give me steroids due to my diabetes.

I have been upping my basal, so far I've gone up 3 units and I have tested it and it seems stable at my current dose. I have upped my ratios at each meal but I do think timing could be an issue, I tend to inject right before eating and I think I need to start injecting earlier. I don't really have a typical day at present but will have a look back at my libre graphs and upload if I see anything that looks like it is recurring.

 

[Kel3]

Why do you have an aversion to a pump? A pump would solve a lot of your problems after half a day you don't even notice it's there 🙂

Can you do a basal test ? This would be a very good starting point for you. Once that's more in range you can move on to other adjustments.
Having others conditions can and do impact on your blood sugars, so be kind to yourself.

I don't really know tbh, probably just fear of the unknown. I have ordered a dummy omnipod to have a little practice.

I have done a basal test and my current dose keeps it pretty level, as long as I don't eat I'll be fine .

Thankfully I am seeing rheumatology next week, so I may get somewhere with them hopefully.

 

[Pumper_Sue]

I don't really know tbh, probably just fear of the unknown. I have ordered a dummy omnipod to have a little practice.

I have done a basal test and my current dose keeps it pretty level, as long as I don't eat I'll be fine .

Thankfully I am seeing rheumatology next week, so I may get somewhere with them hopefully.

Fear of the unknown is the worst fear ever Nearly everyone who first starts on a pump is worried so you wouldn't be alone in that dept. Many people on pumps (old hands) pump buddy newbies so again not alone and someone always there to help.

Have you tried different carb ratios for different times of the day?

 

[Kel3]

Fear of the unknown is the worst fear ever Nearly everyone who first starts on a pump is worried so you wouldn't be alone in that dept. Many people on pumps (old hands) pump buddy newbies so again not alone and someone always there to help.

Have you tried different carb ratios for different times of the day?

Sorry for the delay in responding! I have been trying different ratios since my post, and upped my basal by a further unit and things have started to improve a bit. I've also been seen by rheumatology and am being seen by them again next month to try to get that side of things under control and hopefully that will help too.

 

[trophywench]

Unfortunately you can't actually do anything with the dummy Omnipod - so you'll just stick it on and be able to see how big it is in use.

The real ones come with a separate 'remote control' device which operates the pump - which you don't get with a dummy one.

 

[Proud to be erratic]

I am only on Naproxen for my rheumatology condition at present, my consultant is reluctant to give me steroids due to my diabetes.

I have been upping my basal, so far I've gone up 3 units and I have tested it and it seems stable at my current dose. I have upped my ratios at each meal but I do think timing could be an issue, I tend to inject right before eating and I think I need to start injecting earlier. I don't really have a typical day at present but will have a look back at my libre graphs and upload if I see anything that looks like it is recurring.

Hello @Kel3, I'm relatively new to DM and only 2 yrs in. With your 20 yrs managing this successfully until recently and as I read through you sound well tied in to your DSN - I'm duly cautious about pitching in here.

Back in October you said you were on Tresiba, dosing late evening. If that is still the case, then I found (and my DSN confirmed my perception) that changing Tresiba dosing takes several days to take effect - both when increasing and subsequently reducing doses. So it's a very blunt tool; but presumably if your rheumatology is both longstanding and not changing, then basal changes make sense.

I prebolus, always. I need 45mins before my breakfast bolus 'arrives', 20 mins before my lunch bolus and usually at least 10 mins for dinner. Like you, I don't have a typical day - other than I pretty well always have a breakfast (even if closer to lunchtime!), sometimes lunch and some sort of dinner c. 6.30-8pm. My meals fit in with my day!