Worries and anxiety about high blood sugars

[Natalie123]

Hi all, I get anxious about having high blood sugars and I tend to panic, do too many corrections because I'm trying to get it down as quickly as possible and then go low later. I know I shouldn't do this but I get really upset when I go high. It used to happen when I went above about 16. Now that I have my new pump, I start to get stressed when I hit 12.

I think part of this problem is caused by the fact that I am a perfectionist and I think in a very black and white way, especially when it comes to myself. My diabetes team say that I should aim for 4-8 before meals and going up to about 10 after meals is normal but if I eat more than about 20 - 30g carbs I'm lucky to stay below 12, it's so unpredictable. They then say that I'm doing well even though I don't think I am.

I just wondered if people would be comfortable sharing how they deal with being high? How often do people go above range and for how long? I'd say on a typical day, I'll go above 10 two or three times for anything from a few minutes to 3 hours. I'll probably go above 12 once a day / every 2 days and above 16 about once a week.

I guess there's a rational part of me that says I'm doing ok, my HBA1c is good and my diabetes team are happy, but the anxious part of me takes over and tells me that everyone else is perfect and I'm failing. Everyone here seems to be so 'on top of things' and in control of their diabetes but I feel like I'm either out of control or being controlled by my diabetes if that makes any sense? I've had good control recently but now I'm totally exhausted by dealing with my diabetes and any unexpected highs leave me feeling like a failure. The only way I feel in control is avoiding carbs but I also feel restricted and a bit frustrated because I miss being able to eat a bigger range of foods. I prefer low carb meals for other health reasons but I would really like to able to enjoy a sandwich, a jacket potato or a pizza from time to time without feeling guilty. For example I had a cheese and tomato toastie in a cafe yesterday, I thought I'd carb counted correctly but then my blood sugars started to dip, I ate something else thinking that I'd over estimated and then, an hour or two later I start to climb up to about 14 where I sit for an hour before dropping again. Surely I should be able to eat 2 slices of bread and a small handful of crisps? Sorry for the really long rant! I feel a bit better for writing it all down.

 

[Inka]

@Natalie123 I think being too much of a perfectionist was part of my burnout - and you definitely don’t want burnout because it’s horrible. What I did was to lower my expectations. Think about it: you could probably have perfect sugars if you stayed in hospital your whole life on an insulin/glucose drip - but that’s not life, is it? On the other hand, you could pretty much forget all about the diabetes, not test, eat what you want, miss boluses, etc etc - but that would be reckless.

As with most things, the answer is in the middle. Do enough to keep reasonable control, but also live your life. Living your life includes eating a healthy, varied diet, including carbs, and eating the foods you enjoy. More than that, too much carb restriction actually causes insulin resistance and can make things harder. I know that personally because that’s what happened to me. It was actually harder to get good results eating minimal carbs.

Another thing to do that helps a lot is to keep things simple as far as food is concerned. For example, I have the same or very similar breakfasts and lunches most days. I know how much insulin to have for them, and that works the majority of the time (because perfection is impossible with Type 1). You can gradually build up your carbs and insulin for breakfast and lunch, keeping to this idea. Then do your evening meal, working through the kind of meals you have, eg increasing the amount of potato, pasta, etc.

Finally, when I was first diagnosed, we had to be back in range by the next meal and only tested before eating. Try reducing the amount of times you check your sugar, and even if it is a little high, if it’s back in range by the next meal, then that’s a win. Adjust your Libre high alarm too so it’s not sounding and stressing you out. My consultant told me to put mine at 15. She understands that although we have targets, everyone will spike, and stressing about it will do more harm than good because it will cause panic and overcorrections and rollercoaster sugars. Better to go along at 10 then have multiple 18s plunging down to the 2s or 3s. So, raise your targets a little. That can bring such relief.

 

[Natalie123]

Thanks @Inka You're right, I'm only just getting over autistic burnout, I don't need burnout from diabetes too! It's really hard to find that balance though. I hope you've recovered from your burnout now?

I'm an all or nothing kind of person and I know that's just how I am but it's not a helpful way to think, I have to try to remind myself not to do it but I also find it difficult to know where the middle is! I don't expect an answer to that, I'm just thinking whilst typing! I will adjust my alarms a little, they are set at 13 at the moment which is perhaps a bit too low. I've always been quite insulin resistant, I don't know why, it's been like that since diagnosis and doesn't seem to matter what I eat (I used to eat lots of carbs but still needed high doses) and my weight doesn't seem to affect it either. I'd really like to be more sensitive to insulin because I feel like I've done something wrong to need more than everyone else!

 

[rebrascora]

Your insulin resistance may be because you run your levels a bit higher, rather than innate insulin resistance. Fiasp seems to be particularly prone to demonstrating insulin resistance when levels are above 10.

If I can keep my levels below 8mmols most of the time, I don't need nearly so much insulin, but once levels are above 10, I need at least double what I would need below 8. As a result, once I get above 10 I inject insulin but I don't eat anything until my levels come down to 5 or 6mmols and it can sometimes take 2 hours to come down, especially in the morning. Keeping below 10 as much as possible has been key to reducing my insulin needs and exercise also has a significant impact. I really find I have to be heavy handed with Fiasp once my levels go above 10 . In fact I have my high alarm set at 8.2 and when the alarm goes off I usually have to inject 2 units.

I used NovoRapid before Fiasp and whilst it was really pretty sluggish for me, I didn't find it lost efficacy above 10 like Fiasp does for me, it just took longer to work. To me Fiasp is only worthwhile if I can keep my levels below 10 as much as possible.

 

[HayleyR]

Hi @Natalie123 🙂, I've had the condition over 30 years and you would think that I should have it all under control but no, some days are so frustrating and I can't always work out why levels have gone high or suddenly dropped. I basically try to do my best to manage the condition but don't allow it to completely dominate my life!
BTW, what a cute ***** cat

 

[Inka]

Has anything affected the insulin resistance, good or bad @Natalie123 ? I’m insulin sensitive but things that have affected mine are pregnancy, hormones, and a very low fat plant-based diet - which improved my sensitivity hugely, even though I’m very sensitive anyway.

Exercise can help too. It doesn’t have to be proper exercise. Just something like a 15 minute walk after each meal or housework/tidying or running up and down the stairs can help a lot.

Another question because I can’t remember - are you looping with your pump?

 

[trophywench]

Who told you 'we' were all doing better than you, and why haven't they (whoever they may be) bothered to tell 'us' ?

We are all individually perfectionists but the 'thing' about that is, nobody except us ever wants us to aim that high. It took me a very long while to a) discover that fact and b) even longer to persuade myself that perfectionism was absolutely not necessary, whether in my personal life or management of my blood sugar.

Just as well I did decide to laugh at myself for being daft, cos last year my body decided to reward me for previous good behaviour with the diagnosis of CLL - Chronic Lymphocytic Leukaemia. Because I now have far too many white blood cells in comparison to my red ones, it shot my HbA1c up from the low 50s to the low to middle 60s - and there's (apparently) absolutely nothing that either I or anyone else, can reasonably do, to change that. No point whatsoever in aiming for this that or the other, when that 'L I F E' thing still occurs anyway come what may!

 

[Natalie123]

Has anything affected the insulin resistance, good or bad @Natalie123 ? I’m insulin sensitive but things that have affected mine are pregnancy, hormones, and a very low fat plant-based diet - which improved my sensitivity hugely, even though I’m very sensitive anyway.

Exercise can help too. It doesn’t have to be proper exercise. Just something like a 15 minute walk after each meal or housework/tidying or running up and down the stairs can help a lot.

Another question because I can’t remember - are you looping with your pump?

Switching to a pump helped significantly. Exercise helps a little but I'm already doing as much as I can at the moment - I walk during my lunch break 3 days a week, go to the gym or do a home workout 30 - 60 minutes 3 or 4 times a week and go for a walk / birdwatching at the weekend. I think it's just the way my body is to be honest. I needed large doses even when I was underweight so it's not weight related. There was one point where I needed to use two insulin cartridges for one basal injection before I switched to a pump! I now have a total daily dose of between 45 and 60 depending what I eat.

Yes, I've recently started looping.

 

[everydayupsanddowns]

Sorry to hear about your struggles with anxiety @Natalie123

@SB2015 has shared some thoughts and strategies overcoming perfectionism and unrealistic self-expectations in this thread:

Thread 'Successful strategies so far in dealing with depression and Diabetes'

Apr 29, 2017

I found it tempting to hide away over the last couple of months.

After 9 years of Diabetes I finally hit a wall as HbA1c reached the mid 40s and so no longer improved, spinal stenosis gave me numb feet over night, an MRI showing lesions on the brain and I watched my Mum die of Dementia. Depression descended.

Thanks to Rosie on here I eventually asked for help, but there was a one year waiting list for any talking therapies. I was able to pay for counselling and I thought I would be up front about some of the strategies that I have already found helpful in the hope that these may be of...

• SB2015
• Replies: 75
• Forum: General Message Board

• 

I guess there's a rational part of me that says I'm doing ok, my HBA1c is good and my diabetes team are happy, but the anxious part of me takes over and tells me that everyone else is perfect and I'm failing.

I think the really powerful thing about what you’ve posted there, is that you recognise that your thoughts aren’t helping you, and aren’t accurately reflecting reality. Your stats suggest your TIR would be substantially better than average. I’d think you are probably in the top 10% of the T1 population in terms of management?

@Bruce Stephens sometimes shares a post by Partha Kar where he recognises how challenging it can be to manage T1. I’ll try to find it…

 

[everydayupsanddowns]

Here it is:

https://forum.diabetes.org.uk/boards/threads/hi.108977/#post-1304236

 

[Natalie123]

Thanks @everydayupsanddowns, those links are really helpful. I think I know that I'm being unreasonable with myself but it's really hard to listen to that rational part and stop listening to the anxiety.