Diabetes - control of fluctuating sugar levels

minniver

Im wondering if someone can give me some advise. Im 33 and was diagnosed with type 1 diabetes just over 1 year ago. It came out of the blue, i was trying to get pregnant and from this I had to have surgery. Just before going into theatre, (all gowned up etc) they tested my blood and the rest is history.
I accepted it very well as saw it as not being the worst thing that could happen to you. I have adopted a very very healthy diet, i exercise regularly (40 min power walk 4-5 times per week) I quit smoking and overall i really feel great. I do allow myself a nice few glasses of wine during the weekends and sometimes some g&t's also after a meal, so my social life is still good, which is important to me.
however .. i just cannot seem to get as good control on my diabetes as i should. my A1C is 7.5 - it was 7.1 a few months ago. The problem seems to be hormonal, at different times of the month, (im female) my levels go all over the place and i was just wondering if anyone else is the same. i treat the increases with more insulin, but no sooner am i catching up but i have to start easing back .. and the vicious circle continues.
can anyone offer any advise ? im going to see an acupuncture specialist this evening, to see if she can help as i dont think i can eat any better.
Im also trying to get my A1C down so that i can try pregant

Thanks in advance for any help

mike65

Sadly I'm a bloke so can't coment on any hormonal cycle, do you keep blood records, if so how much do they spike by and does it co-incide with menstruation?

Have a read of this http://www.insulin-pumpers.org.uk/menstruation/

Mike.

minniver

Thanks alot mike, i read the link and it was very good, at least there is evidence of what im going through and its not just me.
how long have you diabetes ? how are you finding it ? Im still a bit new to it all. although i sometimes feel i cant really do any better.
have u any tips ?

tbh

minniver, what I'm going to say to you know is just my own point of view - there are probably people and doctors who would be aghast at my attitude, but I reckon you are doing ok. My own doc tells me that an average blood sugar under 10 is ok, and that's what I go for. I think, and I'm no expert, that if you try too hard, sometimes it can have the opposite effect - you do everything right, eat the right things, and still your bloods are all over the place, which makes you think "ahh shag it, I'll just stop testing my bloods". A lot of diabetics I've spoken to feel the same. In my view, it's a frustrating disease, I can do something today with a result of x, and do exactly the same thing tomorrow with a result of y. I've had diabetes 12 years, no complications so far *touches wood* and I'm just doing my best. I don't go mad with sugar or anything, but my sugars certainly wouldn't be 5.0 every time. I think you'll find a lot of the diabetics in here are the same. DOn't be afraid to call your medical team if you get frustrated or have any questions - it helps build up their knowledge of the condition as well. Hope to hear more from you on here as well.

tbh.

minniver

tbh .. it is a BREATH OF FRESH AIR to get your comments, you have no idea how good that is to hear, I totally agree with you and i really feel i cannot do any better, (other than having no life ! and even then i wouldnt always have perfect sugar readings) I accidently stumbled across this site yesterday and already i feel the better of it so thanks again.
The hospital are always expecting u to do better ... i think they think we are robots. I have also gained weight since diagnosis (about a stone) im not overweight, but i would love to shift it .. and i just cant .. i think insulin is responsible here, i walk so much and eat the best foods .. what else can i do ?
Thanks again .. you have made my day !

tbh

glad to hear it minniver that's what the forum is for, so it's nice to hear you got use out of it.

You'll find as you go along that certain things make your sugars soar, and other don't have a big effect, it's just trial and error really. It's really hard being on top of it all the time, and I think that in hospital, they give you the worst case scenario in the hopes that it'll just make you take it more seriously - that's not to say that you can ignore what they say of course but I think all you can do is do your best.

I found I gained weight as well, but I think it was because I was over-eating out of fear - I didn't want to go low, so I'd pile the food in just to be on the safe side. I'm on a basal-bolus regime now (one long acting injection a day and four short acting) and it's really helped me. You could talk to your doctor about that if you're not on it already.

the main thing is, relax You can't compare yourself to the ideal diabetic, cause none of us are like that (well, maybe CathyMoran! ), just do the best you can, and if you've anything you get frustrated about, remember you're among friends here. It was a big relief to me when I started talking to the other lads and lassies in this forum, thats for sure.

robinph

As tbh sai, don't get too caught up in trying to get perfect numbers every time. You hba1c's are actually better than mine are at the moment and I've been doing this for years, but sometimes things just don't go quite right for no aparent reason.

It is worth keeping a good record of your numbers for a few weeks and then taking them along to see your specialist nurse though. I was having some trouble a while ago with highs followed by lows and never being able to get things back to a sensible level most of the time. But they might be able to spot something else in what you are doing that could make it easier to keep the numbers at the right levels more of the time. For me that was making a change to when, and how often, I was taking the basal insulin rather than trying to constantly fix the highs with increasing the bolus dosages which can then have you going round in cirles trying to fix the situation.

tbh

me too actually Rob - increasing my lantus from 24 to 28 made no difference whatsoever, but going 28 to 32 was a massive difference.

my average doses now are:

Lantus: 32
Novorapid: 12 (bf) 8 (lunch) 12(dinner)

robinph

They had tried increasing the Lantus a couple of times for me also, but that just seemed to cause more problems at other times of day. So they eventually reduced the overall dosage ( I don't think the pen would have been able to give the next dose up ), but I now take it twice a day instead and it is far more effective at keeping my levels relatively stable despite my lack of paying enough attention to what is going on most of the time.

Edit: Just becasue you seemed to be comparing sizes*
Humalog: 4 (bf)
Lantus: 18 (10am'ish)
HL: 10 (lunch)
HL: 12 (dinner)
L: 12 (10pm'ish)


*of insulin dose

minniver

Thanks folks, really appreciate the advise. I am high dosages of Insulatard .. 39-40 at night and boost in the morning of 4-6
then usually novarapid is 8 for bf, 14 for lunch and 14 for dinner (or 7 when im walking)
i was on lantus but now on insulatard because im under preconception care.
After reading what you both said, im going to relax about it all, do my best and u r right, this may even improve things.
thanks again, i will be back on for more discussions.

mike65

So its not a disater then minniver!

I agree about the long-term bloods, 7-7.5 is hardly a disaster or anywhere near. Specialists vary in how tough they can be, mine's a (nice) Nazi! He wants me down to about 5 (was 6.4 last time). I dunno if 5 is really viable but if I get below 6 that will be very good by most standards.

My intake averages are Levimir - 27 & Novorapid - 4-7-8 and I won't hesitate if I need an 'in-between' shot of a few units (ie I fancy a crunchy bar!).

how long have you diabetes ? how are you finding it ? Im still a bit new to it all. although i sometimes feel i cant really do any better. have u any tips ?

I'm type one since Christmas 1978 (13 years old), so I've seen it all by this stage! I have a clean report card and have generally been considered a model pupil, that may have changed last night I was due a meeting but have a nasty bug so cried off. The only area of slight concern is highish blood pressure 150/80, its not off the scale but I'm on a couple of "low-dose" pills to get it and my cholesterol levels down (btw my level (5) would be fine for a non-diabetic).

My only tips are, remember its 'only' diabetes' yes complete neglect might kill you early or cause blindnes/limbs to fall off etc but you have to "put it in its place" and not spend all day everyday worrying about an extra buscuit or a glass of wine. Obviously be aware of the dangers of low suger esp if you drive alot always have money and some carbs handy.

Mike.

minniver

thanks again folks, will let u know how i get on.

God im really going to enjoy by glasses of wine this weekend !:D

SeaSide

mike65 wrote:

I agree about the long-term bloods, 7-7.5 is hardly a disaster or anywhere near. Specialists vary in how tough they can be, mine's a (nice) Nazi! He wants me down to about 5 (was 6.4 last time). I dunno if 5 is really viable but if I get below 6 that will be very good by most standards.

I got taken into a dark room and beaten cos I was over 6.5 so its not all bad

I kinda worry about some of the comments though. For the record how many bottles a week does a few glasses of wine mean you get some awfully big glasses nowadays. Also just because your toes haven't fallen off yet doesn't mean they are there for ever.

minniver

I would prob drink 2 bottles of wine per week. I dont think thats bad ? and also, how would wine make my toes fall off? it never makes my sugars high (if anything i need to make sure i have a snack before going to bed, to prevent a low) any comments anyone ? is that too much wine ?

mike65

Poor control leads to poor blood circulation which leads to in the worst examples bits at the extremities being chopped off. Bad control also leads to loss of vision, kidney failure etc. All of this CAN BE AVOIDED with a little wit and disipline.

Mike.

Alanstrainor

Hey Minniver,
I've been a diabetic for the last 9 years, i'm 18 at the moment (male), and like the others have said your averages seem pretty alright to me, but if you are concerned or just want better control i think the pump is the way to go. I went onto the pump last October and i haven't looked back. my averages were just fine when i went on to the pump, decided to go for the pump to give me more freedom with meals and more control over highs and lows, and it's brilliant, my a1c is in and around 6.0 without too many lows.

Johnny Meagher

I would be at the back of the class here! Maybe 8-9 HBA1C. Lot's of highs, immediately "treated" with Novorapid (very short acting insulin). My regime is Levemir (very long acting) 28 9am'ish and 5 lunch 5 dinner Novorapid, no brekkie, can't do brekkie, like getting sick backwards, brekkie for me. I really don't eat much. Weight is constant. I've really grown to hate hypos, especially at work so err on the side of long term complications when calculating dosages Smoke like a trooper. Don't give out to me, that's my consultant's job. Total YoYo control in general. Is there any secret? Put up with more frequent hypos? But god, hate that, eaten dinner and get a low and have to eat more, more getting sick backwards. But hypos are bad for you too. I drink a good bit, not binge, but frequently. Say 3 tinnies strong cider (current tipple) a night. I've lost a lot of hypo sensitivity also, could be 3 and not know except that I can't sleep, never had a hypo emergency though. I think such a thing a fickle diabetes may exist, maybe we can bust ourselves and never really have a hope of good control. Not saying that is my case however. Oh don't mind me, moan, moan, moan.

robinph

Johnny Meagher wrote:

I drink a good bit, not binge, but frequently. Say 3 tinnies strong cider (current tipple) a night.

You might want to try a different drink as cider is way too high in sugar content. I restrict myself to only having cider when I'm at Glastonbury and can get the proper stuff now.

mike65

Dry cider is okay though some are drier than others and I only drink it now and again anyway. Always choose Blackthorn!

Mike.

DrIndy

Its best to go forward with your concerns to your nurse specialist to help tease everything through.

As a rule, fixed meals and fixed insulin is the key. Rigid mealtimes help too. I met a guy who had a HBA1C of 5.8, type 1 diabetic for 20 years and that was his secret, but he was a real nazi to himself and refused to eat hospital dinners until 6pm and he would always have his breakfast at precisely 8am and lunch at 1pm.

Alcohol will shoot up your blood sugars, independent of the sugar content. Are you using diet tonic with the gin?

The problem though with very tight blood sugar control is more frequent hypos and immunity to those can be quite troublesome.

Keep a tight diary with exactly what you are doing (diet, snacks, alcohol, exercise) and exactly how much insulin you are using for a full month and then go to your nurse specialist for advice.

An option is a flexible sliding scale where you vary your short acting intake depending on how much you are eating - (extra units for bigger portions etc), but this depends of good education on what the glucose load is with each type of food - but since the creation of ultrashort acting insulins such as novarapid, it is possible to take the insulin after the meal so you know more precisely how much you need. Its something to talk over with your specialist nurse too if you feel up for it.

Aside from diabetes, complications arise from blood pressure and cholesterol, the so called metabolic triangle - but is much more relevant to type 2 diabetes. Tight blood pressure control (less than 125/75) has been shown to be much more effective in reducing complications than tight blood sugar control as has tight cholesterol control. As these complications take years to develop, but are not reversible when they arrive, it is best to tackle any of those problems as early as possible.

Johnny Meagher

DrIndy wrote:

Keep a tight diary with exactly what you are doing (diet, snacks, alcohol, exercise) and exactly how much insulin you are using for a full month and then go to your nurse specialist for advice.

DrIndy is replying to minniver but just to copper fasten, got my slap on the wrist today from the Junior at my check up. The above is what I've been told to do. Spreadsheet time!! Problem is of course the erratic sugars I'm getting necessitate the monitoring to see the pattern in order to tackle the problem but this same close monitoring will itself probably eradicate the problem. Bit of the old "what gets measured gets done"! Yes, cider, strong, dry, 6%. I'd love to know the relationship between "some" alcohol putting sugar up and "a lot" putting it down. Never binge but in the past I found the whole of the next day the sugars were lowish. Seems like drink little or a lot but don't drink moderately!

BC

DrIndy wrote:

Alcohol will shoot up your blood sugars, independent of the sugar content. Are you using diet tonic with the gin?

I'm type 1 and find the complete opposite of this.
First thing i was told about alcohol my by consulatant is that is lowers blood sugars. Isn't that why its so important to eat after drinking??

For me personally i find red wine & white wine lower my sugar levels. Red wine lowers is more than white (presumably because it has less sugar).

Beer increases my sugars initially but not by much. A few hours after drinking beer i usually go a little low. I find this the best option for alcohol as the sugar & alcohol tend to effectively balance each other out keeping my levels relatively stable.

I don't touch spirits anymore. Vodka & diet soft drinks give me very severe lows and obviously i wouldn't go for a full fat soft drink.

Johnny Meagher

BC wrote:

I'm type 1 and find the complete opposite of this.
First thing i was told about alcohol my by consultant is that is lowers blood sugars. Isn't that why its so important to eat after drinking??

I'd be interested to see what others' experience of this is, my experience is that some alcohol puts sugar up and a lot puts it down over an extended period of time, whole of next day after a binge. Naturally the doctors advise against drinking a lot... :P It may be the case that "alcohol" itself lowers the sugar but the "carbo" in the drink raises it until the volume of alcohol supersedes the carbo? Oh I have a big book on DiaB, I should read it. :P

Terry

My friends girlfriend (type 1) drinks cider.
I recall her saying something about it not being as bad.
Is this correct?

Johnny Meagher

Terry wrote:

My friends girlfriend (type 1) drinks cider.
I recall her saying something about it not being as bad.
Is this correct?

I don't mean to send the thread off topic. I drink lots of cider, my current tiple. I am inclined to think it sends the sugar up. Am currently doing one month detailed tracking of bloods including my tinnies! I'll let the world know what I learn.

DrIndy

To clarify - alcohol is toxic to the liver. If you flood your system with alcohol, it is not able to break down glycogen to release glucose via glucagon when your pancreas detects that blood sugars are going down too low - hence you are at risk of hypos.

However, as your liver get so work on the alcohol, it reduces and converts it back into glucose - hence afterwards, you go very high.

This is unpredictable and the effect varies between people - but as a rule will make your blood sugars chaotic.

Its best to tease this out with a CNS in diabetes to find what is ok for you with a good blood sugar diary.