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#1
Fountain

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Hi, I'm back with some more questions. :)

I know that each person is different but in general would you say it's common or "normal" to have wide swings in blood sugar readings for T1? My SO has been testing their blood sugar about 4 times a day and sometimes it will be in the 50s (obviously low) so they eat something then just a few hours later it will be in the upper 100s or low 200s. Is it common to have this much fluctuation in a day? I have tried to ask SO about this but they say part of having T1 is that there will be highs and lows and they just have to do the best they can to correct highs or lows. They say it is normal for this to happen but, to me, it seems like this is a lot of yo-yo'ing. I guess I'm asking whether a tighter control on insulin delivery or food choices could minimize huge swings? Is it bad to have this much change? (I would think it's hard on your body over the long-term.) (They use a pump for insulin delivery.)

Thanks in advance for your thoughts.
“Whether Mr. Mutt with his own hands made the fountain or not has no importance. He CHOSE it. He took an ordinary article of life, placed it so that its useful significance disappeared under the new title and point of view—created a new thought for that object.”

#2
Steal

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Hi, I'm back with some more questions. :)

I know that each person is different but in general would you say it's common or "normal" to have wide swings in blood sugar readings for T1? My SO has been testing their blood sugar about 4 times a day and sometimes it will be in the 50s (obviously low) so they eat something then just a few hours later it will be in the upper 100s or low 200s. Is it common to have this much fluctuation in a day? I have tried to ask SO about this but they say part of having T1 is that there will be highs and lows and they just have to do the best they can to correct highs or lows. They say it is normal for this to happen but, to me, it seems like this is a lot of yo-yo'ing. I guess I'm asking whether a tighter control on insulin delivery or food choices could minimize huge swings? Is it bad to have this much change? (I would think it's hard on your body over the long-term.) (They use a pump for insulin delivery.)

Thanks in advance for your thoughts.


How long has your partner been Type I? I have been Type I for 25 years and certainly there are times where lows happen, but it might be that your partner is taking too much for the low. Sometimes when you are low and shaky and hungry, it can be hard to realize that you should stop. For me, I have just a few glucose tablets and then retest 20 minutes later and if I need more, then I have more. If I am very low, I will certainly have more, but usually 15g of glucose or carbs will be enough for me. Do you know what their A1C is? This is the average of their blood sugars. Mine is currently 5.5 and if your partner can get this to be in tight control with less lows and highs overall, it will help to minimize any issues in the future. I am also on the pump and found that it has really helped, but it is necessary for me to really use all the features. I continue to reevaulate my basal rates and carb-insulin ratios. I got myself into very tight control before my first pregnancy and have since had 2 happy, healthy little ones and maintained my tight control. Certainly some food affect me more than others. I avoid most pasta all together and I hardly ever eat any potatoes. These are just like cake icing for me, so I find it easier to avoid. One of the things that helped me is keeping track of food and the affect on my blood sugar 30 minutes, 1 hour and 2 hours after. The most important thing is to try to maintain stable sugars and that these numbers stay in the non-diabetic range, if possible.

I hope that your support can help your SO. Good luck to you both.
~Steph
32 Years Old
Type I (age 6), Minimed Pump User (age 18)
Proud Mommy of two girls: Silver (July '10) and Izzy (Aug '11) (They are 13 months apart)
Current A1C: 5.5%
Full Time Teacher

#3
Richard157

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A T1 with experience should not have frequent highs and lows. Perhaps your SO has not correctly established carb ratios, insulin sensitivities, and basal rates. If your SO is not familiar with those items then you might recommend the book "Pumping Insulin" by John Walsh. Some people refer to that book as the pumper's bible. It is well written.

I had far fewer highs and lows after using my pump for a few months. I also test 12-15 times per day and keep a very close watch on my blood sugar levels. I had some bad highs several months after I started pumping in 2007. I was experiencing scar tissue. I rotate sites to avoid this. Scar tissue is not visible, but it causes poor absorption of the insulin and that can result in very high blood sugar. To avoid scar tissue I use site rotation and use different body parts for my infusion sets. While taking all the right steps there should be very few highs and lows, but they will occasionally happen.
Type 1 for 68 years, A1c = 6.1, pump with MM 523 Revel, I have good health.

You never know how Strong you are until being strong is the ONLY choice you have!

#4
Fountain

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Steal they have been T1 for over 15 years. Their A1C is higher than it should be - I can't remember exactly what they told me but I know it is too high and so do they. They say they are working on getting it lower - trying to exercise more - but I worry that we are not doing everything we can. We don't eat fast food, but are both vegetarians so we do eat pasta. I have asked them a couple of times if they thought a low-carb diet would help but they said it doesn't really matter, since they have a pump. SO does all the cooking because of our work schedules and because they have to eat more regularly/frequently than I do.

A T1 with experience should not have frequent highs and lows. Perhaps your SO has not correctly established carb ratios, insulin sensitivities, and basal rates. If your SO is not familiar with those items then you might recommend the book "Pumping Insulin" by John Walsh. Some people refer to that book as the pumper's bible. It is well written.

I had far fewer highs and lows after using my pump for a few months. I also test 12-15 times per day and keep a very close watch on my blood sugar levels. I had some bad highs several months after I started pumping in 2007. I was experiencing scar tissue. I rotate sites to avoid this. Scar tissue is not visible, but it causes poor absorption of the insulin and that can result in very high blood sugar. To avoid scar tissue I use site rotation and use different body parts for my infusion sets. While taking all the right steps there should be very few highs and lows, but they will occasionally happen.


This is what I was worried about. SO has used a pump for several years (more than 5 at least) and seems to have a good understanding of basel rates; I'm not sure if they factor in carb ratios or long-release carbs (is that what they're called?). I know they have read "Pumping Insulin" in the past. They do have problems with poor absorption, especially if the site has been in for longer periods (3+ days). The problem with that is the SO is very thin and honestly doesn't have anywhere else other than their hips that has enough "fat" for a site, so they have to keep using the same two sites, essentially.

Whenever I try to discuss my concerns with SO I get the "it's fine; this is part of being diabetic" or "you read something in a book, but that doesn't mean it's right for everyone." I guess there is only so much I can do. All of this is compounded by the fact that SO does not have health insurance so trips to the endo are not as regular as they perhaps should be. :( I know I cannot force them to change anything if they think what they are doing is right/good enough but I guess I feel like it shouldn't be fluctuating so much...
“Whether Mr. Mutt with his own hands made the fountain or not has no importance. He CHOSE it. He took an ordinary article of life, placed it so that its useful significance disappeared under the new title and point of view—created a new thought for that object.”

#5
PinkRose

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Hi, I'm back with some more questions. :)

I know that each person is different but in general would you say it's common or "normal" to have wide swings in blood sugar readings for T1? My SO has been testing their blood sugar about 4 times a day and sometimes it will be in the 50s (obviously low) so they eat something then just a few hours later it will be in the upper 100s or low 200s. Is it common to have this much fluctuation in a day? I have tried to ask SO about this but they say part of having T1 is that there will be highs and lows and they just have to do the best they can to correct highs or lows. They say it is normal for this to happen but, to me, it seems like this is a lot of yo-yo'ing. I guess I'm asking whether a tighter control on insulin delivery or food choices could minimize huge swings? Is it bad to have this much change? (I would think it's hard on your body over the long-term.) (They use a pump for insulin delivery.)

Thanks in advance for your thoughts.


To be perfectly honest that range is quite normal in most T1s, particularly those who do not pump. In fact most T1s can & readily do spike to more than the lower 200s if they've miscalculate the right bolus for their meals & then find out about it 2 hours later :(

If he/she is testing only 4 times a day, then a lot of data is missing. T1s do have a lot more fluctuation & volatility in sugars as a norm. It is not possible to be a well controlled T1 without testing frequently each day.

T1 bg management is a daily challenge that can be unpredictable - it's a bit like hoping the atom won't split sometimes!

#6
Steal

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Steal they have been T1 for over 15 years. Their A1C is higher than it should be - I can't remember exactly what they told me but I know it is too high and so do they. They say they are working on getting it lower - trying to exercise more - but I worry that we are not doing everything we can. We don't eat fast food, but are both vegetarians so we do eat pasta. I have asked them a couple of times if they thought a low-carb diet would help but they said it doesn't really matter, since they have a pump. SO does all the cooking because of our work schedules and because they have to eat more regularly/frequently than I do.



This is what I was worried about. SO has used a pump for several years (more than 5 at least) and seems to have a good understanding of basel rates; I'm not sure if they factor in carb ratios or long-release carbs (is that what they're called?). I know they have read "Pumping Insulin" in the past. They do have problems with poor absorption, especially if the site has been in for longer periods (3+ days). The problem with that is the SO is very thin and honestly doesn't have anywhere else other than their hips that has enough "fat" for a site, so they have to keep using the same two sites, essentially.

Whenever I try to discuss my concerns with SO I get the "it's fine; this is part of being diabetic" or "you read something in a book, but that doesn't mean it's right for everyone." I guess there is only so much I can do. All of this is compounded by the fact that SO does not have health insurance so trips to the endo are not as regular as they perhaps should be. :( I know I cannot force them to change anything if they think what they are doing is right/good enough but I guess I feel like it shouldn't be fluctuating so much...


One thing that I have found is that it is not the trips to the endo that will determine my good health. I have learned how to be pretty on top of stuff. I am a pump user myself and change every 4 days or so. I had to do it so much more frequently while pregnant, that 4-5 days feels so wonderful! For me, the pump location is only a factor if I find that it doesn't work right away or that it never really comes down, by this I mean that the blood sugars hover around 120 or 130. For me, my normal blood sugars are in the 80s and I really try to keep myself there, so if my regular amount seems to hover and never come down passed 130, then the location may be to blame. If sugars have been normal and then after the pump location change, they rise or if they were normal for a few days and then randomly rise, it is the location. If there has never really been a normal blood sugar, then they may need to reevaluate their carb:ratio.

I have been a vegetarian since the age of 6 and still don't eat pasta. I find that tortillas tend to work better for me, so I make a lot of veggie enchilada casseroles. I am happy to send you my recipe, if you want it.

I think it is always hard to watch someone that you love being not as healthy as they should. I guess, I would encourage you to cook differently and see if that helps. The carb:insulin ratio may help and they might also benefit from the dual bolus, when eating pasta or other carb heavy food.

It took me some time to get my A1C down to the 5's and my own feeling of "normal" changed as this lowered. It helped to lose weight, which I did and it helped to be super vigilant with my blood sugars and insulin dosing, and it helped to eat super low carb, especially while determining my ratios. I also don't let my post food sugars go above 130. This has really helped me to maintain tighter control. I agree with Pinkrose. I test 15 times a day normally and closer to 20 when pregnant. I am always testing and it is just a part of me, like being vegetarian. When you face the truth of your blood sugars, you can bring them down.

My first reaction when someone who isn't diabetic says anything is to say that they don't understand. It is hard to know when you don't know. But, if you are someone that they love, I would hope that they can hear it from you. If not, please feel free to let them know that I am here and they can chat with me.
~Steph
32 Years Old
Type I (age 6), Minimed Pump User (age 18)
Proud Mommy of two girls: Silver (July '10) and Izzy (Aug '11) (They are 13 months apart)
Current A1C: 5.5%
Full Time Teacher

#7
Denedil

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Back before I started LCHF and pretty much ate what I wanted (and bolused accordingly) ,I had highs ( 200+) and lows (*60-) daily. Now I aim for (and pretty **** well maintain) between 70 and 140. A reading over 200 is now very rare (once or twice a month...drinking alcohol, regular tea/soda by mistake, other rarities)
I think it really depends on the individual and their own personal goals. FYI I pump, use a CGM and test 12 times a day.
Type 1 since 10 months old.
Low Carbing and loving it.
10/17 A1C 6.1 :D
11/23 A1C 5.7 :thumbsup:

#8
SCC

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I certainly fluctuate, and probably most of it is my own overcorrecting for carbs or lows. Then I am high and ratchet back down. My A1Cs run in the low 6's and my endo is happy with that as i stay out of trouble. I could do better, though and am now working on lower carb intake, nothing too drastic, just small steps. It's good for the most part.
-Susan
Type 1 - 48 years and counting
Pumping since Sept 07 (MM Revel 523)

#9
xMenace

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http://www.diabetesf...cose-graph.html

Virginia Woolf: “Consider how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness, how we go down in the pit of death and feel the waters of annihilation close above our heads and wake thinking to find ourselves in the presence of the angels and the harpers when we have a tooth out and come to the surface in the dentist's arm-chair and confuse his "Rinse the mouth-rinse the mouth" with the greeting of the Deity stooping from the floor of Heaven to welcome us - when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature”
Back on MDI and doing well. Trying Victoza and loving it. A1C 6.0, no major hypos; a few highs; lots of shots. Diagnosed Oct 19th, 1975.
HDL-101; LDL-64; TG-36; TOT-172


#10
PinkRose

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http://www.diabetesf...cose-graph.html


Interesting graph. However, in my quest for truth, I've been asking non-diabetics to volunteer their pinkies for a BG test, in the name of 'research'. And after a certain 10 year girl drank fruit juice with some biscuits - her BG was 155 1 hour afterwards. A 12 year old boy's fasting was 126. Of course I was going to hit the panic button by any means but neat graphs like this don't capture all of reality. Also recall my father's post-prandial after a heavy pasta meal to be 170 once! I don't think every non-diabetics BG movements follow this neat patter of never going above 120 after eating.

#11
Subby

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The graph needs to be seen as a mean only (the big blue line). Here are the results of that test (21 non diabetics over 2 days, no snacks, rigid meal times, food unknown) overlaid.

Posted Image
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#12
TommyC1

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Hi, I'm back with some more questions. :)

I know that each person is different but in general would you say it's common or "normal" to have wide swings in blood sugar readings for T1? My SO has been testing their blood sugar about 4 times a day and sometimes it will be in the 50s (obviously low) so they eat something then just a few hours later it will be in the upper 100s or low 200s. Is it common to have this much fluctuation in a day? I have tried to ask SO about this but they say part of having T1 is that there will be highs and lows and they just have to do the best they can to correct highs or lows. They say it is normal for this to happen but, to me, it seems like this is a lot of yo-yo'ing. I guess I'm asking whether a tighter control on insulin delivery or food choices could minimize huge swings? Is it bad to have this much change? (I would think it's hard on your body over the long-term.) (They use a pump for insulin delivery.)

Thanks in advance for your thoughts.


I don't think that is all that unusual. I am in a similar situation except that my A1cs are pretty good (6.2 in October). I am not satisfied with what I consider less than good control. But that and how I deal with it is my personal decision. Your SO will need to decide if they are satisfied or want to make changes. If they want to make changes this is a great place to tap into real world experience and see what has worked for others. But the first thing we will tell you is, this is what did and did not work for me, your milage may vary.

Lantus & Novalog MDI

#13
JJM335

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If we are going to be really analytical of this fascinating data, we need to remember that the lines show CGMS readings and not plasma glucose. I have been using CGMS more or less continuously for nearly 2 years. My experience (which may or may not be typical) is that the CGMS readings not only lag around 15 mins behind fingestick readings, but that they are less reliable where BG spikes or drops rapidly. When this happens the CGMS readings will almost always max out at a lower reading than a fingerstick. I assume that this is because the glucose level in interstitial fluid (where the sensor measures) takes some time to equilibrate and where the rise and fall is rapid it doesn't get a chance to catch up (the CGMS is much better where the rise and fall is slow).

Looking at the individual graphs, it's clear that many of the spikes are of short duration (less than 30 mins), not enough time for the sensor to catch up. If this is the case, we can assume that in these subjects the maximum BG at the top of each spike is almost certainly significantly higher than the sensor reading. This means that these non-D's are most likely experiencing plasma glucose levels that are 20-40 points HIGHER than the CGMS readout i.e. in the range 140-160 with a few as high as 180.

Joel

T1 since 1977
MM522/Apidra since July 08
Animas Vibe/Humalog since Nov 13
CGM - Self Funded - now with Dexcom G4


#14
xMenace

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Interesting graph. However, in my quest for truth, I've been asking non-diabetics to volunteer their pinkies for a BG test, in the name of 'research'. And after a certain 10 year girl drank fruit juice with some biscuits - her BG was 155 1 hour afterwards. A 12 year old boy's fasting was 126. Of course I was going to hit the panic button by any means but neat graphs like this don't capture all of reality. Also recall my father's post-prandial after a heavy pasta meal to be 170 once! I don't think every non-diabetics BG movements follow this neat patter of never going above 120 after eating.


Let me just say 20% variance. Pinkie tests are not reliable for such studies.

Virginia Woolf: “Consider how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness, how we go down in the pit of death and feel the waters of annihilation close above our heads and wake thinking to find ourselves in the presence of the angels and the harpers when we have a tooth out and come to the surface in the dentist's arm-chair and confuse his "Rinse the mouth-rinse the mouth" with the greeting of the Deity stooping from the floor of Heaven to welcome us - when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature”
Back on MDI and doing well. Trying Victoza and loving it. A1C 6.0, no major hypos; a few highs; lots of shots. Diagnosed Oct 19th, 1975.
HDL-101; LDL-64; TG-36; TOT-172


#15
JJM335

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Let me just say 20% variance. Pinkie tests are not reliable for such studies.


There are plenty of published studies on BG levels in non-D volunteers following ingestion of moderate or high GI carbs. BG levels were measured using analytical instruments which are much more accurate than a fingerstick. Short-lived spikes to over 8 mmol/L (in some cases as high as 9 mmol/L) were seen within 60 mins of ingestion of 50g pure glucose.

The mantra that BG levels of > 7 mmol/L are not seen in non-D's is unsupported by any good evidence. In fact all the experimental evidence points to higher levels occurring albeit transiently.

Joel

T1 since 1977
MM522/Apidra since July 08
Animas Vibe/Humalog since Nov 13
CGM - Self Funded - now with Dexcom G4


#16
Fountain

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Thanks everyone for your responses. I guess I am probably just worrying too much (as usual). I suppose I wish SO would test more often; but the glucometer strips are pricey, especially without insurance or a FlexSpending account to help defray the costs. SO also doesn't like to tell me anymore what their BG is when then test because I guess if it's high or low I make it seem like it's something they should have better control over. :( I didn't mean to do that; I am still trying to accept that it is not an exact science of "X carbs + Y insulin = Target BG". I am glad I found this forum; it's so helpful to be able to come here and ask questions.
“Whether Mr. Mutt with his own hands made the fountain or not has no importance. He CHOSE it. He took an ordinary article of life, placed it so that its useful significance disappeared under the new title and point of view—created a new thought for that object.”

#17
DanG

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I suppose I wish SO would test more often; but the glucometer strips are pricey, especially without insurance or a FlexSpending account to help defray the costs.


I can agree with SO.
I am trying to get by testing 1 time each day at bedtime, since it gives me an opportunity to correct.
Usually we can feel insulin coming to setting us low. There also might be indicators in SO to help detect high also.
SO seems to be handling things fine within the restraints.
When the going gets tough, we do what we gotta do.

#18
WendyL10

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Hi, I'm back with some more questions. :)

I know that each person is different but in general would you say it's common or "normal" to have wide swings in blood sugar readings for T1? My SO has been testing their blood sugar about 4 times a day and sometimes it will be in the 50s (obviously low) so they eat something then just a few hours later it will be in the upper 100s or low 200s. Is it common to have this much fluctuation in a day? I have tried to ask SO about this but they say part of having T1 is that there will be highs and lows and they just have to do the best they can to correct highs or lows. They say it is normal for this to happen but, to me, it seems like this is a lot of yo-yo'ing. I guess I'm asking whether a tighter control on insulin delivery or food choices could minimize huge swings? Is it bad to have this much change? (I would think it's hard on your body over the long-term.) (They use a pump for insulin delivery.)

Thanks in advance for your thoughts.


Just curious why you call your SO, they, them, their, why not just say he/she..no one cares..just seem odd to call one person a them, they...

#19
Subby

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Just curious why you call your SO, they, them, their, why not just say he/she..no one cares..just seem odd to call one person a them, they...


This is a strange post. If no one cares about the gender of someone's partner, which I agree is mostly the case, why would anyone care if gender neutral terms are used instead? Why do you care?

More to the point here though, is the issue of privacy. As long as we are not hurting anyone, we all have every right to withhold whatever information we choose when posting publicly, whether it be our full name, address, email, job, bosses name, favourite colour, or gender of anyone around us (or ourselves for that matter). And, hopefully nobody feels inclined for a second to provide reasons for whatever privacy they choose, to "curious" people such as yourself.
20 years T1. NPH and Novorapid.
Some essentials for my blood sugar control: dosing via i:c ratio and cf • basal testing when needed • daily 40 minutes moderate exercise (or close) • carbs somewhere below 120g currently • only eating carbs and carb/fat combos that do not cause a problem spike, with or without insulin.

#20
Steal

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I got a similar question on a different post in reference to this. I guess, for me, the issue is never how someone is referenced, it is that we or they have questions and those that can help are able to. I would never want anyone to feel out of place or obligated to share what they are not comfortable or choose not to and hope that the time that we spend on here discussing is less on semantics and more on providing information.
~Steph
32 Years Old
Type I (age 6), Minimed Pump User (age 18)
Proud Mommy of two girls: Silver (July '10) and Izzy (Aug '11) (They are 13 months apart)
Current A1C: 5.5%
Full Time Teacher




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