Type 1s with good BG daily control.

[Ali11782]

I am just wondering if there is anyone on here who has most of the time good libre graphs etc. I just wanted to hear what you do, what works for you etc.

Alison

 

[helli]

What do you mean by "good"?

Seventeen and a half years after my Type 1 diagnosis, I have a HbA1C of 45 and TIR of around 80%.
I eat a huge variety of food (some very carby, some less so), exercise most days (about an hour of high intensity cardio four or five days a week) and have a job which varies from mundane to highly stressful.
I work from home and have done for about 6 or 7 years.

My diabetes is managed via Libre 2 which I read using xDrip and a Medtrum pump with Fiasp insulin.
As I sit at my desk, I keep a close eye on my blood sugars and often correct - if my levels are lower than 4.5 and falling, I suspend my basal; if they are over 10, I give myself a bolus.
I carb guestimate. Most of my bolus doses for meals are given over 2 or 3 hours rather than all up front.

This probably sounds high maintenance. The pump makes things much easier and so does the ability to glance at my phone to see my level. I choose to manage my diabetes via corrections because, for me, it impacts my life much less than limiting my diet or maintaining exactly the same exercise at exactly the same time every day. I am a natural "tweaker" - always making adjustments - and love variety in my life.

 

[SB2015]

When I used the Libre the thing that had the biggest impact on my management was the timing of my pre-bolus through the day. It took some trial and improvement to get each part of the day sorted but worth it.

I still use a sensor, and on the occasions when I am not able to pre-bolus, for example when eating out, I really notice that my low fells change to mountains. Levels still settle afterwards but it impacts on TIR. It doesn’t stop me going out for meals.

 

[Inka]

Define good I don’t have a Libre but my HbA1C is always very good and my finger pricks are generally in range apart from the odd occasion.

What do I do? Eat a normal healthy diet, try to keep active, test lots and get on with my life.

 

[Ali11782]

Thank u. By good I suppose I mean healthy, managed well. Do you eat regular or just when you feel like it?

What do you mean by "good"?

Seventeen and a half years after my Type 1 diagnosis, I have a HbA1C of 45 and TIR of around 80%.
I eat a huge variety of food (some very carby, some less so), exercise most days (about an hour of high intensity cardio four or five days a week) and have a job which varies from mundane to highly stressful.
I work from home and have done for about 6 or 7 years.

My diabetes is managed via Libre 2 which I read using xDrip and a Medtrum pump with Fiasp insulin.
As I sit at my desk, I keep a close eye on my blood sugars and often correct - if my levels are lower than 4.5 and falling, I suspend my basal; if they are over 10, I give myself a bolus.
I carb guestimate. Most of my bolus doses for meals are given over 2 or 3 hours rather than all up front.

This probably sounds high maintenance. The pump makes things much easier and so does the ability to glance at my phone to see my level. I choose to manage my diabetes via corrections because, for me, it impacts my life much less than limiting my diet or maintaining exactly the same exercise at exactly the same time every day. I am a natural "tweaker" - always making adjustments - and love variety in my life.

 

[rebrascora]

It is my impression Alison that you are expecting to see more flat lines on your graph and that isn't normal. BG levels rise and fall all the time. From the traces you have posted they are really very good. You could perhaps improve the timing of boluses on occasion but I think it may be your perception of what is normal or achievable which is unrealistic.
Someone posted a link to an article last year of a Libre graph from a non diabetic ultra marathon runner and it was quite refreshing to see the peaks and troughs day and night and understand that healthy fit people with fully functioning pancreas don't get flat lines either.

Focus more on Time in Range than the graph and improve that as much as is reasonable but if you are getting 70% TIR you are doing well. Anything above that is brill. Don't worry about the odd peak or trough outside of range. It happens, even to fit non diabetic marathon runners too.

 

[Inka]

@SB2015 is quite right about pre-bolusing too. Using insulin appropriately is the most important thing we can do IMO.

 

[Ali11782]

It is my impression Alison that you are expecting to see more flat lines on your graph and that isn't normal. BG levels rise and fall all the time. From the traces you have posted they are really very good. You could perhaps improve the timing of boluses on occasion but I think it may be your perception of what is normal or achievable which is unrealistic.
Someone posted a link to an article last year of a Libre graph from a non diabetic ultra marathon runner and it was quite refreshing to see the peaks and troughs day and night and understand that healthy fit people with fully functioning pancreas don't get flat lines either.

Focus more on Time in Range than the graph and improve that as much as is reasonable but if you are getting 70% TIR you are doing well. Anything above that is brill. Don't worry about the odd peak or trough outside of range. It happens, even to fit non diabetic marathon runners too.

I'm not bothered by flat lines, more healthy control over my food intake and what a graph would you perhaps look like with that.

 

[rebrascora]

Thank u. By good I suppose I mean healthy, managed well. Do you eat regular or just when you feel like it?

I eat when I have time and I feel like it and I can be bothered to cook. Some days I graze and others I have proper meals. Some evenings I eat at 6pm (rarely) and others I eat at midnight 😱. My diabetes is not perfectly managed because no one's is but my consultant is happy with my results. I average about 90% TIR and last HbA1c was 48.

If you want to spend 24 hours a day trying to micro manage your levels, then feel free to try, but you will still fail to achieve perfection or flat lines and the stress of it will probably just raise your levels anyway. It is a system in constant flux and you can only do your best. Some days you will be lucky and things will go really well, but other days it can be less predictable. You have to learn to roll with it. Identify the times when you made a mistake and can genuinely learn from it and improve but just shrug when you did your best and things still went haywire. Tomorrow is always a new day.

 

[Ali11782]

@SB2015 is quite right about pre-bolusing too. Using insulin appropriately is the most important thing we can do IMO.

Yes this is what I want to. Achieve, using it appropriately which with my negative, unhealthy attitude to food on a lot of days I feel it is hard to do. Ideally I want to achieve, breakfast, lunch and dinner and snacks only if necessary in between. This
Is what everyone would want but it's what I would like as I feel all over the place with food. What do I have, when do I have it, once I start I want more etc. It consumes my head a lot of the time. And now with diabetes I have to think more about food. I just want it to healthy and right for me.

 

[helli]

Thank u. By good I suppose I mean healthy, managed well. Do you eat regular or just when you feel like it?

But what is "healthy, managed well"?
I eat chocolate and cakes, I eat when I feel like it. I miss some meals and snack/graze between others.
I may not eat breakfast some days, other days I do ... but rarely the same thing two days running.
Most days I eat my evening meal 3 or 4 hours before going to bed. Other nights, I am snacking until I retire.

I guess what I do is set myself achievable targets.
These are not flat lines on the Libre or never going into double figures or never having a hypo.
They are targets to understand what caused the highs and lows and to try to do something different next time to avoid them and to maintain an average of between 5.5 and 6.5 mmol/l most days (and understand when I don't achieve it)

 

[rebrascora]

I'm not bothered by flat lines, more healthy control over my food intake and what a graph would you perhaps look like with that.

So it is your relationship with food which is your concern. I have this issue and for me, low carb has been the answer so far. I have foods which I can eat which don't require insulin or just small amounts and I can eat those whenever I like and just do a correction if my levels start to rise. Things like cheese and olives and nuts and pickles and pork scratchings and boiled eggs with mayonnaise, a slice of ham with coleslaw etc. Personally I couldn't justify injecting insulin to have a Mars bar or a Snicker because one would lead to 2 or 3 and I would be back to where I was pre diagnosis and I would feel guilty that the NHS was having to fund my "habit" in insulin to cover it. So whilst my eating disorder isn't fixed, I have a solution which works for me with my diabetes and helps me to control/live with my eating disorder and I feel so much fitter and healthier than I have in a lot of years, which is a bonus.

 

[Lucyr]

Not a T1 but a T2 on MDI so similar treatment. I don’t use a libre full time but use it part time to learn about foods and prebolusing. I would say pre bolusing makes the single biggest difference to my time in range. My recent time in range is better than my 90 day TIR as I’ve been working on refining the prebolusing with different time lengths for different meals, over the last few months.

I’ve had too many hypos recently as my pancreas produces some insulin seemingly at random when it feels like it, but I tend to treat in the low 4s which keeps the %hypos down

Edit to add: my last a1c was i think 55. Libre predicts an a1c of 50. Ive not really gone much below that, and to be honest not sure what I’d be able to change to get it any lower other than reducing carbs.

 

[rebrascora]

They are targets to understand what caused the highs and lows and to try to do something different next time to avoid them and to maintain an average of between 5.5 and 6.5 mmol/l most days (and understand when I don't achieve it)

Would just like to say that an average of 5.5-6.5 seems unrealistic to me at the moment.... maybe when I am 15 years down the line. I'm not being critical of that (quite the opposite... kneeling and bowing emoji) but just wanted Alison to know that that might be an unrealistic target for her too. My Libre average is usually low 7s and I am very happy with that although would like it to be lower, but accept that it is not achievable at the moment and my consultant is still very happy.

 

[Deleted member 25429]

I was diagnosed 2 years ago type 1 . My hba1c was 35 a month ago . I am not obsessive with it, and I have a good relationship with food . Go to bed at 5 wake up between 4 & 5 . I am low carb but really enjoy the foods I do eat . I walk a lot as we have 3 dogs . If I want something to eat I just inject to cover it . I work with figures so view diabetes in the same way .

 

[Inka]

Yes this is what I want to. Achieve, using it appropriately which with my negative, unhealthy attitude to food on a lot of days I feel it is hard to do. Ideally I want to achieve, breakfast, lunch and dinner and snacks only if necessary in between. This
Is what everyone would want but it's what I would like as I feel all over the place with food. What do I have, when do I have it, once I start I want more etc. It consumes my head a lot of the time. And now with diabetes I have to think more about food. I just want it to healthy and right for me.

I think three regular meals is the way to go. Allow yourself a bit of leeway and don’t stress if you have to miss or delay a meal. To my mind, our base should be healthy eating - plan out some healthy meals, then take the insulin that’s required for those.

Food isn’t just fuel, it’s nutrition too. So three meals gives you a chance to get in plenty of nutrition. When I use a Meal Planner, I make it easier by deciding on the kinds of meals I’m going to have. I eat a lot of vegan food but am actually pescatarian, so, one week I might say to myself “two fish meals, two vegan, two vegetarian, one ‘spare’ (spare can be anything that I fancy or that fits in). That gives a framework to build on.

Breakfast and lunch are simpler. I generally have a few options for those only so I didn’t have to think.

Plenty of veg, reasonable amount of fruit, whole grain carbs - and an expectation that we won’t achieve perfection and with a family we sometimes have to go for the easy option and that’s ok.

Routine is good. I tend to have the same amount of pasta each time I have it as that removes one thinking process and one variable.

Mainly, we have to enjoy life. Type 1 was a terminal condition until insulin was discovered, and I’m sure as hell that Banting and Best and co didn’t go to all that trouble so we could sit around all day peering at graphs and letting diabetes be the main focus of our life 🙂 It’s a tool to allow us to live - in all senses of the word.

 

[Ali11782]

I think three regular meals is the way to go. Allow yourself a bit of leeway and don’t stress if you have to miss or delay a meal. To my mind, our base should be healthy eating - plan out some healthy meals, then take the insulin that’s required for those.

Food isn’t just fuel, it’s nutrition too. So three meals gives you a chance to get in plenty of nutrition. When I use a Meal Planner, I make it easier by deciding on the kinds of meals I’m going to have. I eat a lot of vegan food but am actually pescatarian, so, one week I might say to myself “two fish meals, two vegan, two vegetarian, one ‘spare’ (spare can be anything that I fancy or that fits in). That gives a framework to build on.

Breakfast and lunch are simpler. I generally have a few options for those only so I didn’t have to think.

Plenty of veg, reasonable amount of fruit, whole grain carbs - and an expectation that we won’t achieve perfection and with a family we sometimes have to go for the easy option and that’s ok.

Routine is good. I tend to have the same amount of pasta each time I have it as that removes one thinking process and one variable.

Mainly, we have to enjoy life. Type 1 was a terminal condition until insulin was discovered, and I’m sure as hell that Banting and Best and co didn’t go to all that trouble so we could sit around all day peering at graphs and letting diabetes be the main focus of our life 🙂 It’s a tool to allow us to live - in all senses of the word.

This is exactly how I want it to be for me.
I need to stop being influenced by external things that's I am not in control of.
I shall get there. It is all so simple in theory lol I think half my problem is adapting the fact we actually do not need much food to live. But yet we are bombarded with food stuff all the time. When you break it all down, a daily requirement is not much

I do not eat meat or fish. Love my cheese.
Alison

 

[Ali11782]

So it is your relationship with food which is your concern. I have this issue and for me, low carb has been the answer so far. I have foods which I can eat which don't require insulin or just small amounts and I can eat those whenever I like and just do a correction if my levels start to rise. Things like cheese and olives and nuts and pickles and pork scratchings and boiled eggs with mayonnaise, a slice of ham with coleslaw etc. Personally I couldn't justify injecting insulin to have a Mars bar or a Snicker because one would lead to 2 or 3 and I would be back to where I was pre diagnosis and I would feel guilty that the NHS was having to fund my "habit" in insulin to cover it. So whilst my eating disorder isn't fixed, I have a solution which works for me with my diabetes and helps me to control/live with my eating disorder and I feel so much fitter and healthier than I have in a lot of years, which is a bonus.

Really helps thank you

 

[Deleted member 25429]

This is exactly how I want it to be for me.
I need to stop being influenced by external things that's I am not in control of.
I shall get there. It is all so simple in theory lol I think half my problem is adapting the fact we actually do not need much food to live. But yet we are bombarded with food stuff all the time. When you break it all down, a daily requirement is not much

I do not eat meat or fish. Love my cheese.
Alison

I couldn’t live without cheese … in a way I was lucky as I had just lost 7 1/2 stone before diagnosis so had a much better relationship with food than I used to have . I don’t eat fish and rarely eat meat .

 

[everydayupsanddowns]

I am pretty happy with how my BG management is going at the moment. 80%+ in range (4-9) for the last 30 days.

Yesterday was 95% I think (hard to be 100% sure because of how Dexcom shows the days.

This is my 24 hour graph. A few dips into the low 4s, and a brief excursion to about 12 after Eve meal (unexpectedly rose to 10 just before eating). Approx 170g of carbs (plus a few jelly babies on dog walks)



At this sort of level I am more than happy. I occasionally get 100% 4-9 but those days are rare, and not what I aim for. 70-80% is plenty, as long as my below 4s are few.