Trying to resolve issues I,m now having after 26 years, type one Diabetic ?!

[1nick]

Hi Nick
I understand you want to know what has caused this sudden change in how insulin behaves for you, but you may never get a real answer. There are lots of things that might cause changes, body weight is one as is a change in insulin resistance, both of those fluctuate as we get older sadly 🙂 as do hormone levels. Insulin is a hormone and interacts with all the other hormones in the body in complex ways so a change in other hormone levels could have an impact. People tend to assume it's just us gals who have hormones shooting around the place but the same is true of chaps, it's just not as obvious. There are other things too that impact how insulin behaves, including but not limited to the amount of exercise you take, how much muscle mass you have, how quickly your digestive system digests food. When you look at all those factors it's hardly surprising there are changes in requirements. If you're worried that there might be something wrong and that's why your insulin requirements have changed speak to your doctor about it, they should be able to reassure you.

It must be difficult if you've been doing the same thing for 20+ years and then suddenly you find it isn't working, but if I were you I'd concentrate on trying to establish the right dose of basal insulin and then working out what to inject with food will be easier. As Trophywench said it might be a good moment to revisit your team and perhaps a DAFNE course or something similar, having support whilst trying to work out how to adjust your insulin regime will be really crucial I think. For what it's worth it looks very much to me like your basal insulin dose may be much too high, and essentially you're just topping up with rapid when you need to take the edge off. This is quite similar to how mixed insulin works really but with a little bit more control. The current advice with two insulins is that the basal (Tresiba) should just be used to cover your basic functions like moving and breathing (keeping you ticking over) and then rapid should cover your food intake. Very few of us without a pump get that absolutely spot on, but the closer you get to that aim the more control you have. If you weren't taught to carb count then a course or time with a dietician will be invaluable for that because you need to work out how much insulin you need for a specific amount of carb which can be a bit mind boggling at first . If you have been taught to carb count and are good with all of that then some basal testing would be a really good idea.

How often do you see your team? Again as the very wise Trophywench mentioned, people tend to assume that if you've been at it for 20+ years you know everything there is to know about diabetes which might not be useful at this stage. You might want to have a chat with them about more close contact, and ask them to assume you're a newbie for a little while just so you can identify if there are areas you've missed. The positive in all that is that once you've finished you'll have the skills and experience to adjust again should your requirements change in the future 🙂

Evening KookyCat

Thanks for your input to my questions and yeah, I do believe that the only thing maybe is the basal levels but one thing which tells me different, is that if I inject 1 unit less than 23 the norm of Tresiba, then I wake at 4:00 to urinate with a high blood sugar reading of 14-16 and if I take I unit more than 23 I have a low blood sugar of 2.4 at 7:00?! This is where the suggestion of taking Tresiba in the morning may help me.

The team are trying to help me at present but have come back telling me, all is really good with my blood tests taken 1 week ago and now they are suggesting I go and see them, where they are testing my bloods at 9:00 then again at 11:00. I am not sure what they are seeking but in 4/5 weeks time, I will be undergoing these tests.

I have always been a carb counter, my body weight has remained unchanged at 74kg with a height of 1.760m, my digestive system works very quick as I could eat anything and just go straight into a game of football, long cycle ride or run a lengthy distance. I am an active guy who has muscles where there are required for an active guy (that's not a guy who goes to a gym).

I suppose at the end of the day, I'm a guy who likes hearing, having and knowing answers, to quick.

 

[1nick]

Thing is - if you (or anyone not just you) only test pre meal and bedtime - no-one has the slightest idea how high or low you go in between or when you do it.

Just because some of the glitches you body throws out are coinciding with some of your blood tests at the moment - does NOT mean you haven't always had glitches! 5 blood tests = 5 seconds of every day in which there are 86,000 seconds. So - what's your BG doing all of the other 86,395 every day? Answer - you haven't got the slightest idea really except the really obvious things like some of the time it will be going up and ditto down whilst thirdly for some of it, it remains level. Useless, in other words.

My clinic has a loan CGM. It's a 'cloaked' system so the wearer can't see what it's recording until they go back to the clinic a week later and have it downloaded - and then work through the graph with the DSN, discuss it and jointly decide what changes need to be made. I think you'd benefit greatly from using one for a week!

Evening Jenny

This sounds brilliant 🙂 I must ask the team if they have one I could trial with.
How does it connect to the body and what does it work of, if its not blood Jenny?

Regards
Nick

 

[trophywench]

It's a sort of cannula - not very long, far less than the length of needles we used to use on insulin syringes! inserted into your skin. It looks like a plaster on the outside but with a bit of plastic on the top of it, attached to a sort of 'lead' which is then attached to a bit of machinery which records the readings taken from your interstitial fluid.

This fluid is there, just under the outside of your skin. You know if you graze yourself but it doesn't bleed, just 'weeps' a colourless liquid? That's interstitial fluid! And - you can measure the glucose in the fluid - in a similar way you can with blood.

The algorithm(s) in the machine and the software you download the results to, convert the fluid results to their equivalent BG levels, so they can be easily understood. The one we have - you have to enter your actual BG directly into the machine 4 times a day. This is to directly compare the two methods - the CGM one that you don't normally go by - and the answers you DO base all your calculations on.

Last time I borrowed it I was using a One Touch meter and every reading except 2 for the whole week, agreed completely with the CGM reading. BUT - we could see what my BG actually does, every moment of every day for a week. Very very useful and led to some fiddling with times and doses.

When I eventually progressed to my first pump - my DS said to the consultant that I was a perfect candidate for the simple reason that her instant comment on looking at my CGM graph several years previously had been 'Well one thing we CAN say safely Jenny - your BG certainly does do what it wants to do, whenever it wants to do it!' (I was actually having a mental breakdown at that time and though offered a pump, said I didn't honestly feel I could cope with learning how to use it)

Cannula inserted in tummy in my case - machine with a clip that attached to a waistband, or you could stick it in a pocket. Could have a quick shower but not wallow in a bath or go swimming for the duration. Placed it by the side of me in bed, and that's where it stayed. Lots of micropore over the looped up 'lead' - so it wasn't 'taut' - helped it not get jerked about and stay attached.