Whqt do people do to become more confident

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Inka said:
You probably think I’m a pain asking for all the details, but to my mind, the thing to do is find out what’s causing the drop: the Levemir injection you’ve recently done; the bolus you’ve just injected; the end ‘kick’ of Humalog from the previous bolus; your own insulin; a combination of those things.

So, I’d try to rule some of those out. I’d delay my Levemir by one hour so you’re not injecting around your evening meal. If you don’t get the drop then, it would suggest your Levemir is the likely culprit. Working in that way, you could do similar for each potential suspect and then find the most likely cause of the drops. One thing I’ve discovered with Type 1 is to assume nothing. It’s best to logically prove or disprove things one by one. You might have already done something along the lines.
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Hi inka, i did have the evening levemir dose delayed by 45 mins then realised that its what gave me my pre beakfast drop last tuesday asit was overlapping my breakfast drop.

I did find a smear of blood on my leg in the evening later on, so wondered perhaps i did nick something just enough to kick start my bolus
 
It is not uncommon to hit a capillary and it bleed. That doesn't mean you injected into a blood vessel.

With the tiny doses of Levemir you are taking, taking it 45 mins later is not going to make any appreciable difference in respect of dropping your morning levels. There is a 3 dimensional graph somewhere which shows the activity of Levemir and the lower the dose, the sooner it tails off, so if you are only taking 2 units or 1 unit I think is your current evening dose, most of that is going to be used up in the first 8 hours of activity after injecting.
 
gillrogers said:
Hi inka, i did have the evening levemir dose delayed by 45 mins then realised that its what gave me my pre beakfast drop last tuesday asit was overlapping my breakfast drop.

I did find a smear of blood on my leg in the evening later on, so wondered perhaps i did nick something just enough to kick start my bolus
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If you took your evening Levemir at 6.45pm rather than 6pm that wouldn’t give you a pre-breakfast drop. Your very small dose wouldn’t last that many hours and would be petering out. When I take a pump break I use a small dose of an isophane basal which has a similar profile of action and it’s pretty much run out by around 9hrs.

If you’re dropping from your bolus before you’re absorbing your food, then inject your bolus just before you eat or split it and inject some before you eat and some after.
 
Inka said:
If you took your evening Levemir at 6.45pm rather than 6pm that wouldn’t give you a pre-breakfast drop. Your very small dose wouldn’t last that many hours and would be petering out. When I take a pump break I use a small dose of an isophane basal which has a similar profile of action and it’s pretty much run out by around 9hrs.

If you’re dropping from your bolus before you’re absorbing your food, then inject your bolus just before you eat or split it and inject some before you eat and some after.
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I dropped 15 minutes after i gave my morning livermir and started dropping just afyer i finished my breakfast aboit an hoir and a half after i gave my levemir.
 
Well thats that, just heard from the hospital and ive only been put on the pathway for a pump only. I stupidly thought it was the closed loop as that was what i was talking about. Then she proceeded to direct me to cbt therapy which doesnt work for me
 
Even on a closed loop system, which you will likely migrate to in the near future, of you get a pump, you need to be able to manage in manual, because these systems can and do occasionally fail, so you need to be able to manage in manual mode at the drop of a hat or go back to injections. None of it is foolproof. I would not be overly upset that you are not on a direct pathway to HCL, it will happen in due course if you want it, but you need to learn the basics first.

I wish I could send you some confidence, because I know how absolutely crippling it is when you lose it.

Sending you (((HUGS))) as I can tell you are incredibly disappointed when in fact you should be really pleased that they are putting you on the pathway for a pump. One step at a time and most of the pumps are now being configured to allow HCL so it is only a matter of time. Work towards getting the pump first. The HCL will follow.
 
It is great to hear that you are on the list for a pump. As @rebrascora has said if you are using closed loop you still need to know what to do in manual. I use manual during the warm up (2 hours at the start of the week/new sensor) and also at times when my loop is not working for some reason. There are plenty of reasons why I need to be able to use manual. So once you get your pump and have got used to the basics, use that time to get to know it well. This also helps you to understand what the looping is doing and to work out what variables to change.

I suspect that in the not too distant future many on pumps will be able to migrate to looping. Getting a pump is a good start. Come back with questions about which ever one you end up using.
 
I know I'm a long way out of comfort zone in commenting here - but:
gillrogers said:
I dropped 15 minutes after i gave my morning livermir and started dropping just afyer i finished my breakfast aboit an hoir and a half after i gave my levemir.
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Firstly @gillrogers I don't understand. If you dropped 15 mins after am basal what do you mean by started dropping 90 mins later, just after finishing your b'fast? What are the timings of basal and that first drop (which presumably levelled off) and at what stage in that mix did you add bolus to the basal insulin already taken on board?

Secondly if you are repeatedly dropping after b'fast in this way then there is a mis-balance between timings and size of doses vs arrival of glucose into the blood stream. At that moment in time you have too much insulin and / or too little glucose. If that drop sustains itself and takes you into hypo then that reinforces the imbalance.

So what is your standard b'fast and how many carbs are you assuming from that meal? Is your insulin ratio too strong for that meal? Hence too much bolus; OR is there too much basal on board? Hard to tell right now.

Is the meal routinely too slow in digesting in relation to insulin arriving so do your prebolus timings need adjusting or converting into a post-prandial b'fast bolus? One clear advantage of taking a post-prandial b'fast bolus is that you strongly reduce the chance of going hypo - which I've read elsewhere in this thread is something that particularly bothers you. Yes it could make you "highish" initially. If that "highish" never gets brought back down after b'fast then that could be a normal scenario that others encounter whereby our insulin resistance increases as BG increases, particularly in the mornings. You can either consider a bolus correction and step away to let that do its job or increasing your b'fast bolus dose a little to compensate for that increased insulin resistance.

But as said earlier by @rebrascora it would be really beneficial for you to make your b'fast and lunch meals very repeatable both in size and timings for several days, at least a week, to reduce 2 of the bigger variables in a complex list of factors affecting BG. During those 6 or 7 days resist changing anything - unlees you are still reaching hypo terrirory when obviously treatment is essential and fresh parameters are needed for this trial. Ideally also with standard activity or exercise patterns over those 6 or 7 days. Hopefully that will give 6 or 7 days of clean data from which clearer repeat patterns can be revealed.

I know that we don't usually live standard lives with rigorously standard routines. But a few days to get a clear picture would help the analysis AND it might help your own confidence to just let those 7 days unfold and find out you can manage and not feel that something must be tweaked immediately because yesterday didn't work.

I was increasingly poorly supported in the last 3 months of my first year after surrendering my panc'y. But after 9 pretty miserable months of completely unpredictable BG and feeling rough as well as blind to the bigger picture I started to experiment, trying slightly different things. What helped was that I'd been hypo so many times, sometimes extremely low, and felt dreadful during some of those hypos, but realised that none of those had made me unconcious never mind killed me. A hypo or 2 more was manageable if it helped me understand better what was happening overall. I was at least very confident about how to treat my hypos. I then was given Libre and suddenly I could see cause and effect pretty well straightaway.

Apologies if this is terrain you've already covered. But my perception from following this thread but hastily reading is that another input might help and hopefully not further confuse. Good luck.
 
Gosh so much experimenting to sort so many problems, just adds to my muddles as im still trying to sort out bolus timings with fluctuating basals all the time.
 
gillrogers said:
Gosh so much experimenting to sort so many problems, just adds to my muddles as im still trying to sort out bolus timings with fluctuating basals all the time.
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Sincere apologies I've worded my previous remarkss badly.

I am in effect suggesting: pause - no further changes (unless actually hypo); have 6 or 7 days as repeatable as is possible in carb content, timings and both bolus and basal insulin from waking, for both breakfast and lunch - to get a clear sight of what is really going on. From that you'd be extremely unlucky if a distinct pattern of BG behaviour didn't become a lot clearer. Any one day might show a somewhat different graph or responses to a previous day, which would be normal; but by repeating a very standard routine for 6 or 7 days a much clearer overall pattern should emerge.

By changing even 2 bits of your MDI simultaneously, eg bolus timings and basal, you aren't giving yourself a fighting chance of identifying what input is causing what response. Nor by looking at a couple of days have you necessarily got a decent repetition to base the next possible change on.
 
Proud to be erratic said:
Sincere apologies I've worded my previous remarkss badly.

I am in effect suggesting: pause - no further changes (unless actually hypo)
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Hi @gillrogers i wouod agree with this. It seems useful to change one thing and then let that settle. By changing more than one thing ever6 few days it is difficult to see any patterns in what is going on. Perhaps write a list of things that you are thinking of changing and then just focus on one of those for a week. It might sound like a slow approach but I think it might increase your confidence with the changes that you choose to make.

Just pause, brother and choose one thing to change, then wait. (you would obviously need to treat any hypos that occur) keep notes on what is happening. Then again pause, breathe and choose one more thing, if necessary, to change.
 
Sorry Roland, that was me sounding off as id been feeling this for quite a while about "experimenting". Was nothing to do as such with your help. I hear and read about experimenting alot and not with just any help i ask for but when im reading about help with others. I know really theres no other way to find out these things. And to some degree i am doing that but my stupid fear fails me with getting results. Having said that the "plan of action" as i read it that you have just explained to me nakes sense. I do that now with breakfast and lunch anyway and im almost doing that with dinner. So i shall go and work on that strategy. Have also decided after my db nurses reaction this afternoon to me that this is thevway i roll with db so get used to it! I have to, got no frigging choice lol.

Im going to see if i can find someone who offers hynosis. I know i respond well to that to enable me to act with a positive active reaction towards hypos and heading towards them. Jyst need to find someone whos not expensive.
 
Are you seeing anyone about your anxiety? There should be a service that you can self refer to in your area to get some CBT or counselling or go on a course about managing the mental health impacts of having a long term condition. Otherwise ask your diabetes team if there’s anyone they can refer you to to help with your anxiety.

None of the graphs you’ve shared go anywhere near hypo, so it does seem more like you need to get your anxiety under control before you’ll be able to improve your blood sugars.

I know people are offering advice on basal tests and doses, but if you’re terrified of going even near 6/7 as it seems from your graphs, then you won’t be able to put any advice people give you to improve your blood sugars into practice properly, because I imagine if you had good bgs in the 5s say it would just intensify your panic about hypos.
 
Lucyr said:
Are you seeing anyone about your anxiety? There should be a service that you can self refer to in your area to get some CBT or counselling or go on a course about managing the mental health impacts of having a long term condition. Otherwise ask your diabetes team if there’s anyone they can refer you to to help with your anxiety.

None of the graphs you’ve shared go anywhere near hypo, so it does seem more like you need to get your anxiety under control before you’ll be able to improve your blood sugars.

I know people are offering advice on basal tests and doses, but if you’re terrified of going even near 6/7 as it seems from your graphs, then you won’t be able to put any advice people give you to improve your blood sugars into practice properly, because I imagine if you had good bgs in the 5s say it would just intensify your panic about hypos.
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Thanks Lucy, yes ive arranged some cbt.
I can get to 7s but my problems have been where i start dropping to soon. At injection time. Especially since i ditched the lyumjev because of that happening but much faster. Its been very confusing as to why its still happening as i had become clearly sensitive to the lyumjev and dont need that boost from it anymore.
Its compounded more at lunchtime when.my basal does a natiral drop of 1-2 mmol in an hour and more if its just half a unit too high. I cant work out bolus timings for it. Then add to the mix a basal drop every day for almoat a week.
Now im being confused even more because my basal is back on the rise on a daily basis.
Yes i have a fear of hypos , no i cant get to five now and struggle withba 7 because i would be hypoing most lunchtimes while waiting for lunch to kick it. Ive tried the snack 30 minutes before lunch then i get a bigger spike after lunch.
 
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