to bleed or not to bleed

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neil2

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Relationship to Diabetes
Type 1
Hi every one I've been type one brittle diabetic from 27 now 67 . put a subscription blood test cassette for Accu-chek tool. Wondered why I have not herd any thing checked with GP I'm told I'm told I've been doing to many blood test a day . I do 6 and if I go out on the bus to Coventry I do another test . How many do you do in a day thanks for your help.
 
Do you have a continual glucose monitor (cgm) like libre, dexcom?
If so then you only really need to do finger prick tests to check the cgm, eg before treatment decisions or to confirm cgm is accurate, or when cgm is warming up/fails.
When i was on libre i checked before eating, more out of habit than anything, ie 3 times a day. Now on dexcom i test a lot less.
If you don't have a cgm, why not? As a t1 you are entitled! They are great.
 
Yes hello I did have a device part stuck to my arm but my sugar drops so fast that the sensor did not read it I had a hypo at the dinner table even with Lucozade in front of me so I don't trust them any more like I said I'm a brittle diabetic but thank you any way.
 
If you’re a brittle diabetic @neil2 and struggling with hypos, ask if you could have the Dexcom G7 sensor. It’s amazingly accurate - much better than the Libre, I’ve found. It also has more and more refined alarms, allowing you a far, far greater chance of warding off hypos. I have it and it’s utterly brilliant.

As for fingerpricking, before my sensors, I’d prick 8-14 times a day, depending on what I was doing. I’m pretty sure they’re not allowed to restrict testing strips. I think Diabetes U.K. had a campaign about it. Tagging @everydayupsanddowns in case he’s around and able to comment on that.
 
I second rhe G7 for much improved recording and sensitivity. My D is considered brittle (no panc'y after my Whipple) and I can fall very rapidly. G7 has brought to me a confidence in the tech that I had not imagined possible and a sense of relief that I could look at my phone (or the Receiver/Reader) and know it was very close AND the alerts will definitely warn me when my BG is crashing

Before I was using Libre 2, my 1st 12 months after my Whipple, I needed to fp at least 7 x daily just to calculate meal boluses and corrections and to confirm the very frequent hypos - without extra tests to allow me to drive. In practice a 50 test AccuChek cassette might last only 4 days. Then I had Libre 2 for a further 12 months and the reliability and accuracy of that was poor so my fps barely reduced. I tried Dexcom One, which was a bit more reliable and slightly more accurate, but still far from good.

Then in some desperation I self-funded Dex G7 and discovered this new world of reliable and accurate CGM - with associated reduced stress by not needing to fp - I can now go several days without a single fp, after usually an initial calibration in the first 24 hours.
 
neil2 said:
Yes hello I did have a device part stuck to my arm but my sugar drops so fast that the sensor did not read it I had a hypo at the dinner table even with Lucozade in front of me so I don't trust them any more like I said I'm a brittle diabetic but thank you any way.
Click to expand...

I just noticed you mentioned Lucozade. I used to use that a lot and it was great, but since the Sugar Tax, they’ve reduced the amount of sugar/glucose in it a lot so I don’t use it anymore. One of the few intact sugary fizzy drinks is the original Coca Cola. You can get little 150ml cans of that which are great for hypos. I also use Lift GlucoShots. They’re small, concentrated and not fizzy so easy to get the glucose in quickly and comfortably.
 
I should add, @neil2, that my greatly improved CGM accuracy and reliability has allowed me to trust the alerts with the consequence of much improved Time in Range (4-10) and I don't seem to have such brittle BG. It's as if the reduced glucose variability has reduced my brittleness; but maybe its just simply that my responses to my CGM alerts has brought about faster response and improved control.
 
Thanks for the information I have to see a non diabetic nurse at 9:30 on Monday .
 
Inka said:
As for fingerpricking, before my sensors, I’d prick 8-14 times a day, depending on what I was doing. I’m pretty sure they’re not allowed to restrict testing strips. I think Diabetes U.K. had a campaign about it. Tagging @everydayupsanddowns in case he’s around and able to comment on that.
Click to expand...

When I was on fingerstick checks I was using 8-10 a day. That dropped significantly when on sensors - though I do check when levels are changing rapidly.

My older sensors (Libre and Enlite) weren’t advised to use for boluses, so I would check 3-4 times a day pre-meal.

Plus checks around driving (if you are unsure about how your sensor is tracking) are legally required.

GPs shouldn’t restrict T1 monitoring if hospital clinics agree that the frequency of checks are appropriate for the individual circumstances of the person.

Do you have contact with a hospital DSN @neil2 ? Could you ask them to send a message to your surgery?
 
neil2 said:
Thanks for your help I'm on 4 injections a day 3 Novo rapid 24 -28 units and 1 Levemir at night 44 units thats just gone up by 2 units .
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Levemir is usually taken twice a day, morning and evening, to provide better cover over the 24hrs. The dose can be split unevenly, eg someone might have 20 units in the morning and 12 units in the evening. Perhaps that’s contributing?
 
Levimir lasts around 12hrs so half the day you will have a basal dose, the other half nothing.
That will not be helping with your blood sugar levels one bit
By the way, are you carb counting?
I would strongly recommend you give a cgm another go. Even if you can't trust it to be up to the second correct, it will give you a general idea of trends. For example you could have used the graph to work out that your basal was running out, and when.
 
Tdm said:
Levimir lasts around 12hrs
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I believe the life of Levemir is dependent upon dose. @Inka has previously shared a three dimensionAl graph show longevity of Levemir.
From memory, the dose the OP takes probably only last 12 hours as you say but it is not the case for all which is why it is “usually“ taken twice a day (but not always).

Sorry for my pedantry but if someone newly diagnosed starts taking Levemir on very low doses, the comment about it lasting 12 hours could be confusing.
 
I was going to qualify that remark, but thought it may make my post a bit long...but thanks for clarifying.
Like everything with diabetes, your diabestes may vary!
And thats one of the great things about cgms, we can see what a insulin/ food item etc does in *our* body...including overnight.
 
Tdm said:
Levimir lasts around 12hrs so half the day you will have a basal dose, the other half nothing.
That will not be helping with your blood sugar levels one bit
By the way, are you carb counting?
I would strongly recommend you give a cgm another go. Even if you can't trust it to be up to the second correct, it will give you a general idea of trends. For example you could have used the graph to work out that your basal was running out, and when.
Click to expand...
Levemir might only last 12 hours with the tiny does you are using but the larger the dose the longer it lasts, so 44 units may well be lasting 20hours or longer.

It is still better to split the dose so that you fit your body's needs better, but there are times when a single large dose (22u) in the morning is what I need and none at night, although mostly I still need 2 or 3 units at night, unless I have been very active. It is certainly possible that a single dose of Levemir works for some people, just like Lantus does, but I also think that many people don't test to find out what they need and just take advice from a DSN, who almost certainly doesn't see the full picture, especially if people are not using CGM or not making notations on their Libre.
 
Ooops, seems i was under a misunderstanding about levemir! I thought it was a 12 hrs approx insulin but i think i just extrapolated from it being taken twice a day.
My bad!
Still, i've learnt something.
 
Tdm said:
Ooops, seems i was under a misunderstanding about levemir! I thought it was a 12 hrs approx insulin but i think i just extrapolated from it being taken twice a day.
My bad!
Still, i've learnt something.
Click to expand...

There is usually quite a bit of overlap with split doses, but because it has a peak of activity and then tails off, the impact of the overlap is generally minimal. But with your doses being so small, it is entirely possible that they are not lasting much more than 12 hours. It isn't even so much the larger doses, as the dose per kg of body weight.
I love that 3D graph showing the activity rate for Levemir for different doses/kg, but as with everything diabetes related, we shouldn't take it as gospel, as there will be many bodies that have not seen the graph (or read the book 😉) and therefore have no idea that they are supposed to follow that graph! 🙄 :rofl:
 
Tdm said:
Ooops, seems i was under a misunderstanding about levemir! I thought it was a 12 hrs approx insulin but i think i just extrapolated from it being taken twice a day.
My bad!
Still, i've learnt something.
Click to expand...
Ha ha, just realised where i got the 12 hrs from - i had a daphne follow up and i remember that for 5 days i had the daphne dsns telling me it was 12 hours!
Still, this has been v useful as may go onto levemir in future
 
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