# Advice please



## Gwynn

Sent home after a week in hospital. Type 1 diabetes. New diagnosis. Very little information. Blood sugar steadily rising then this morning right down to 5.2  is this time for panic or just normal variation. I feel fine. Normally it is around 9.


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## Inka

Welcome @Gwynn  What insulins are you taking and when?

It’s normal to be started on slightly lower doses than you actually need as you don’t want to risk hypos early on and it’s better to bring your blood sugar down gradually. Were you given a carb amount for each meal?


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## Inka

A good book often recommended here is _Type 1 Diabetes in Children Adolescents and Young Adults_ by Ragnar Hanas. Ignore the title - it’s informative for adults too. There’s also the Learning Zone tab at the top of this page - and lots of Type 1s here who can help with any questions you have no matter how trivial.


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## SB2015

Welcome to the forum @Gwynn.  Sorry to hear of your diagnosis but pleased that you have found us.  I was also diagnosed with T1 as an adult (53).  There is indeed a lot to get your head round at the start, but keep in touch with your team who will work with you to gradually bring your levels down to normal levels.  Having said that our levels do vary and it is impossible to keep in target all the time.

In the simplest terms with T1 some antibodies in you have hanged up on your Beta cells and destroyed them. This will have been going on for a while and if you think back you have probably been feeling poorly for a while, with excessive thirst, tiredness, losing weight and going to the loo lots.
I know that I felt so much better physically once I had the insulin in me.

The target for people with T1 is to stay between 4 and 10 as much as possible.  We all rise whenever we eat any carbohydrates which all get turned into glucose once inside us.  The insulin you inject will deal with this over a few hours and bring you down again. Your team will work with you to learn how to adjust your doses.

Be patient as they will want to bring your levels down gradually.  You have already got your levels into single figures.  This will become easier to do as you learn more.  The book @Inka mentioned by Ragnar Hanas is excellent and I still dip into it at times.  The age reference can be ignored T1 is T1.

I have found the people on here a great source of help and support.  My first venture into using forums, and I am so glad I took the plunge.  Keep in touch, and fire away with any questions that you have.  Nothing is considered silly on here. just ask.


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## everydayupsanddowns

Welcome to the forum @Gwynn

Fore away with any and all questions you have - nothing will be considered too obvious or ‘silly’.

Sorry to hear you don’t feel you’ve been given much information to go on 

The Ragnar Hanas book would be a good investment to fill in a lot of the blanks. Another popular one is ‘Think Like a Pancreas’ by Gary Scheiner.



Gwynn said:


> Blood sugar steadily rising then this morning right down to 5.2 is this time for panic or just normal variation. I feel fine. Normally it is around 9.



Good question!

BG will fluctuate according to many things (up to 42 factors can be involved!) including obvious things like insulin doses and carbohydrates you eat, but also activity/exercise, illness, alcohol, stress, and even the weather(!)

The guidelines to aim for are usually given as 5-7 before breakfast, 4-7 before other meals and no higher than 9 by 2 hours after eating. Those are tiny TINY targets, and you don’t need to stress about every wobble, but just try to keep within 4-10 for as much of each day as you can manage


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## trophywench

@Gwynn - the Diabetes UK Learning Zone (orange tab at the top of the page) is a good place to start!


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## Gwynn

The poor hospital staff did seem to be swamped. I left thd hospital with a pamflet about didt but ti assn't much use. 

There is so much to learn. I will take a while to get to gips with it all. To be quite honest, I was terrified when I got home, wondering what to do. The district nurses came a few times and were good to talk to. 

I have finally got the meds. Oh, the hospital sent me home with a few days of meds leaving me in a quandry of how to start up the local GP to provide an ongoing prescription. I had one injector needle left in the end!

My reading this evening is 11.9. Mind you I have eaten a little more because of the morning test reading scare. The diabetic nurse rang to tell me to lower the evening dose of insulin. 

I do feel a lot better than I did though, which is good


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## Gwynn

So I presume that it is all about awareness of the carbs we eat.


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## Vonny

Glad you're feeling better @Gwynn, and have some support in place via the district nurses. Yes, carbs are the thing with diabetes, although as a type 2 I have a simple solution, ie don't eat them! As a Type 1 I think you have to balance your insulin with whatever you're eating so it seems a lot more complicated to me. There are plenty of T1s here who can give you continuing support and advice about that. Hope you stay feeling better.


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## Inka

Gwynn said:


> So I presume that it is all about awareness of the carbs we eat.



I replied about carbs on your other thread @Gwynn 

https://forum.diabetes.org.uk/board...losing-weight-help-please.89784/#post-1015712

It sounds complicated to start with but you’ll soon get the hang of balancing your carbs with insulin. There are online training modules for when you’re ready, and experience is a great tutor too.


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## Annemarie

Don’t be alarmed if pyou get diverse and conflicting results. One reliable fact about diabetes is it is usually unreliable. I once smelt my neighbour’s breakfast bacon, I’d already had my insulin then breakfast but at 10:30 I gave in and tucked into a bacon butty! Ooh the joys! Then I waited and watched for my BG to go off the scale; it didn’t it went from 6:8 to 7:4. However, when I tried it again a few days later my blood glucose went so high it got vertigo! the same has happened with pasta. Moderation and common sense is my best tool


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## Gwynn

I wrote a longish post but the web site had an error and I lost it. 

Here"s another attempt. 

I have a freestyle optimum Neo blood glucose meter. I do not know what calibration reading is within limits. 

Does anyone know what the limits are? 

Does the little meter automatically store the calibration result or do I have to do something?


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## everydayupsanddowns

Gwynn said:


> I wrote a longish post but the web site had an error and I lost it.
> 
> Here"s another attempt.
> 
> I have a freestyle optimum Neo blood glucose meter. I do not know what calibration reading is within limits.
> 
> Does anyone know what the limits are?
> 
> Does the little meter automatically store the calibration result or do I have to do something?



I haven’t used the Optium Neo - do you mean checking with a ‘control solution’? Usually there are instructions on the pot for what control test results are within expected limits.

Many meters also recognise control test results and don’t included them in averages etc.


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## Gwynn

I spoke to the diabetic nurse yesterday and shecadmitted that she knew nothing about calibration but she th3n wentvand found out as much as she could. 

It turns out 5hat she said that many people never calibrate their blood testers. 

I rang the Abbott manufacturer who was realy helpful and is now sending me some new calibration fluid for free. Apparently the limits are written on the instruction leaflet, but mine were not. Still, again very helpful. 

My blood sugar has been very stable this first week at about 6 to 9. With one minor upward shift to 11.

I think that I thought that it all had to be balanced all the time and that even a slight deviation would spell instant disaster. No one had explained that it is a constantly moving gentle adjustment. So I was panicing. If there had been someone to talk to face to face I would have found it easier. 

This mornings reading was 6.0


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## trophywench

And no meter lasts forever either - they do start to wear out, like cars.  They are only guaranteed to be within 10 or 15% of lab results when they leave the factory, not after they've spent years in the bottom of my various handbags being carted about home, relatives' and friends' homes, office, client's premises and holiday destinations (and beaches etc) worldwide!


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## Gwynn

I am confused about my morning blood sugar readings. They are low and getting lower each day. I have tried increasing my evening carbs but to no effect. 

The diabetic nurse has already advised that I reduce my evening insulin by 2 unts, which I did, to no effect over the last week, the BS morning levels just kept on decreasing. 

Last night I reduced the insulin even more but only slightly By 1 unit) and increased the carbs a lot (for me) but this mornings blood sugar reading was even lower bordering the lower limit. 

Any advice. 

It is seriously worrying me. 

I shall ring 111 today to ask for advice. Being a weekend the doctors, consultants and advisors will not be working sadly.


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## everydayupsanddowns

What sort of levels are you seeing @Gwynn?

And how much difference are you seeing between your night-time and breakfast readings?

Depending on when you eat your evening meal, often the main insulin acting overnight is your basal, so if you are eating your evening meal around 6pm, and seeing significant drops overnight it may well be worth reducing your basal dose further, but best to discuss with your nurse if you are unsure.

Which insulins are you taking? Some basals take 2-3 days to adjust to new lower doses.


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## Gwynn

My evening readings seem reasonable between 5.5 and 6.7. This mornings reading was 4.6 and has been steadily decreasing day on day. 

I am on 500mg Metformin 3 times a day and Novomix 30 which is 16 un8ts at 6am and 8 units at 4pm.

What is this 'Basal'. What does it refer to. Is it one of the insulins? How do I know or work that out? 

I eat 7 times a day. Carefully worked out small meals. 

I have decided to shift my night meal to 10pm from 9pm. It is usually the same as my breakfast. Cornflakes 20g, milk 209g, banana 100g. 

The odd thing is that the day time seems well controlled


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## Gwynn

Just to add a little more it went from 6.7 in the evening to 4.6 this morning even though in the evening I had increased my carbs with the g over where the day time would give me a bs rise of about 2. 5. 

Ah a minor correction to my last post.. Yesterday evenings reading was 7.6

So it went from 7.6 to 4.6 overnight. A drop of 3. Really unexpected but pretty typical for overnight at the moment.


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## Inka

@Gwynn Your Novomix contains a fast-acting (bolus/meal) insulin and a slow insulin (basal/background) mixed together in a specific proportion. Therefore you can’t alter your basal without also altering your bolus. It’s quite an inflexible regime. You might do better on a basal/bolus regime where the two insulins are separate, making it easier to adjust the amount of one of them.

For now, if it was me I’d look at reducing the evening insulin further, and also st an alarm for approx 2am to test blood sugar so I could eat if it’s heading too low.

I was on mixed insulin for the first week after diagnosis but it was soon changed as it didn’t suit my needs at all. Other regimes are more flexible and easier to adjust.


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## Inka

Just to add that if you’re newly diagnosed @Gwynn then your need to now decrease insulin could be due to the ‘honeymoon period’ where the injected insulin has given your failing beta cells a rest and they’ve recovered a tiny bit and are making a little insulin themselves. 

You mention 7 meals that are “carefully planned” - do you mean planned by a dietician for you? Do you mean 3 meals plus snacks? Generally twice daily insulin needs 3 regular meals and sometimes snacks in between and last thing at night.


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## KARNAK

Hello @Gwynn I know its early day`s and I agree with @Inka ask if you can
go on a Basal/Bolus regime its a lot more flexible, your figures are very
reasonable and it doesn`t follow you will get the same readings from the same 
meals. I would ask you to reconsider the amount of carbs you have assessed
in your milk I`m sure you don`t sit in the bath to eat your cornflakes, depending
on what milk you use.

I use semi skimmed and have 200ml every morning in a glass which is 9.6g of 
carbs so if you are using 209g of carbs of milk I hope you have a big enough 
breakfast bowl. Its easy enough to work out look at the Nutrition Info label on 
the product and it will tell you the amount of carbs per 100ml using a measuring
jug add the amount of milk you require then using the amount of carbs per 100ml
just equate it to to the amount of milk you need. I can give the proper equation
but I think your head has enough to deal with.

Remember small steps at a time stick with the forum and your Diabetes team
soon you`ll be wondering what all the fuss was about.

One last point sorry if you already know in the UK carbs and sugars are basically
classed as glucose so if the label say`s 5g of carbs of which sugars are 5g dismiss
the sugars part its still only 5g in total, hope this helps.


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## silentsquirrel

KARNAK said:


> Hello @Gwynn I know its early day`s and I agree with @Inka ask if you can
> go on a Basal/Bolus regime its a lot more flexible, your figures are very
> reasonable and it doesn`t follow you will get the same readings from the same
> meals. I would ask you to reconsider the amount of carbs you have assessed
> in your milk I`m sure you don`t sit in the bath to eat your cornflakes, depending
> on what milk you use.
> 
> I use semi skimmed and have 200ml every morning in a glass which is 9.6g of
> carbs so if you are using 209g of carbs of milk I hope you have a big enough
> breakfast bowl. Its easy enough to work out look at the Nutrition Info label on
> the product and it will tell you the amount of carbs per 100ml using a measuring
> jug add the amount of milk you require then using the amount of carbs per 100ml
> just equate it to to the amount of milk you need. I can give the proper equation
> but I think your head has enough to deal with.
> 
> Remember small steps at a time stick with the forum and your Diabetes team
> soon you`ll be wondering what all the fuss was about.
> 
> One last point sorry if you already know in the UK carbs and sugars are basically
> classed as glucose so if the label say`s 5g of carbs of which sugars are 5g dismiss
> the sugars part its still only 5g in total, hope this helps.


I am thinking these are total weights, not carb weights!


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## KARNAK

Oh @silentsquirrel you are correct and I stand corrected 209gs would be 200 ml.

Sorry @Gwynn me and my silly reasoning didn`t cross my mind it would be weight,
liquid is usually measured in quantity rather than weight e.g.  metric or imperial. 
I hope you can forgive my now obvious mistake whose a Richard the Head.


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## everydayupsanddowns

It’s unusual for someone newly diagnosed with T1 these days to be given metformin and a mixed insulin @Gwynn - it’s not what NICE suggests in the guidelines any more.

Like @Inka says, mixed insulins are much less flexible than basal:bolus. I think you’d find it much easier long-term to move to more injections with separate basal and bolus doses. That way you can learn to adjust your meal doses based on what you are going to eat


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## Inka

How was your blood sugar this morning @Gwynn ?


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## Gwynn

Well On advice from the diabetic nurse, I am now on 12 units in the morning and 2 units in the evening. I started at 18/12. 

I may, after speaking to them reduce to 10/0 today. Who knows. 

My blood glucose levels just won't budge from around 4.5 no matter what I seem to do. Now thats a lot better than when I went into hospital with a level of 54. Not 5.4 but 54. I felt very poorly too. 

I feel better now than I ever have done in my life (apart from all the stress). 

Is it possible that I may not have diabetes at all?  Perhaps a silly thought. 

My diet is very very strictly controlled and I use an App that I wrote to ensure I eat sufficiently and correctly. Is the strict diet helping or masking things? I don't know yet. I have 7 small meals a day, two of them being 'main' meals (if you can call them that) 

Thanks for all your help at the beginning. I was in a real panic with little information or support and blood glucose levels all over the place. Mind you my diet wadn't well controlled then

If you are interested I will let you know how I get on


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## grovesy

Gwynn said:


> Well On advice from the diabetic nurse, I am now on 12 units in the morning and 2 units in the evening. I started at 18/12.
> 
> I may, after speaking to them reduce to 10/0 today. Who knows.
> 
> My blood glucose levels just won't budge from around 4.5 no matter what I seem to do. Now thats a lot better than when I went into hospital with a level of 54. Not 5.4 but 54. I felt very poorly too.
> 
> I feel better now than I ever have done in my life (apart from all the stress).
> 
> Is it possible that I may not have diabetes at all?  Perhaps a silly thought.
> 
> My diet is very very strictly controlled and I use an App that I wrote to ensure I eat sufficiently and correctly. Is the strict diet helping or masking things? I don't know yet. I have 7 small meals a day, two of them being 'main' meals (if you can call them that)
> 
> Thanks for all your help at the beginning. I was in a real panic with little information or support and blood glucose levels all over the place. Mind you my diet wadn't well controlled then
> 
> If you are interested I will let you know how I get on


Was the 54 a lab result as meters don't go that high!


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## Inka

Gwynn said:


> Well On advice from the diabetic nurse, I am now on 12 units in the morning and 2 units in the evening. I started at 18/12.
> 
> I may, after speaking to them reduce to 10/0 today. Who knows.
> 
> My blood glucose levels just won't budge from around 4.5 no matter what I seem to do. Now thats a lot better than when I went into hospital with a level of 54. Not 5.4 but 54. I felt very poorly too.
> 
> I feel better now than I ever have done in my life (apart from all the stress).
> 
> Is it possible that I may not have diabetes at all?  Perhaps a silly thought.
> 
> My diet is very very strictly controlled and I use an App that I wrote to ensure I eat sufficiently and correctly. Is the strict diet helping or masking things? I don't know yet. I have 7 small meals a day, two of them being 'main' meals (if you can call them that)
> 
> Thanks for all your help at the beginning. I was in a real panic with little information or support and blood glucose levels all over the place. Mind you my diet wadn't well controlled then
> 
> If you are interested I will let you know how I get on



Don’t let the honeymoon fool you @Gwynn Shortly after diagnosis I was on 1 unit of basal per day (yes, that is ‘one’). I still had and have Type 1 even though my basal remains on the low side.

Have you had a chance to talk to the nurse about a basal/bolus regime as mentioned by me and others earlier in this thread? Mixed insulin means you can’t reduce one portion of the mix without affecting the other portion - which is very inflexible. Even if you wish to remain on two injections a day, it would be better to have two separate insulins (fast and slow) that you mix to your own proportions so you can adjust each element separately.

I can’t comment on your diet without seeing it, but Type 1 is not a condition caused by bad diet. It’s an auto-immune condition. Obviously we all need a healthy diet diabetic or not, but Type 1s achieve control by appropriate use of insulin.

Of course we’d love to hear how you’re getting on! Please do keep replying here and tell us more


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## Gwynn

It was a lab result and the doctor today said that it was actially 130!  No 54 (where I got that from I do not know) 

Ok so the diabetes may be real. A short lived dream shattered. Yes it was caused by my long term use of hydrocortisone for another condition. No one warned me that it might happen so it was a complete surprise. 

I have been advised that reducing to zero tonight and monitoring the result is fine and perfectly safe.


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## Inka

*Yes it was caused by my long term use of hydrocortisone for another condition. No one warned me that it might happen so it was a complete surprise. *

That must have been a shock @Gwynn Does it count as steroid-induced diabetes then? I don’t know much about that. My comment about it being auto-immune was related to Type 1. Have they told you any more about your diagnosis? Is there any hope it might improve?


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## Gwynn

Sadly yes it was caused by the hydrocortisone I am told. 

Things do seem to be improving. I am down to 0U in the evening and 10U in the morning. The decrease in the morning will continue until my blood glucose readings start to rise. They stubbornly stay fixed between 4 and 5 at the moment. 

Tomorrow morning will be interesting as that will be my first reading on 0U from the evening before.

I am not sure how far the reductions will go yet. I am taking things slowly and carefully with advice. 

The original diagnosis was pretty much a garbled mess. The consultant said it was type 1 diabetes followed by it might be type 2 followed by it might not be diabetes long term. By the end of the very short consultaion I was completely confused, not actually knowing what I do have. 

The one brilliant outcome of it all is that I feel well and hope that will continue.


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## everydayupsanddowns

Gwynn said:


> The original diagnosis was pretty much a garbled mess. The consultant said it was type 1 diabetes followed by it might be type 2 followed by it might not be diabetes long term. By the end of the very short consultaion I was completely confused, not actually knowing what I do have.



Glad you are being kept a close eye on @Gwynn - and good to know that you are in regular contact with your clinic.

Hope the new doses work out, and you get a little clarity over your diagnosis soon


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## Gwynn

Yesterday I reduced my evening insulin to zero and removed the associated metformin tablet.  I kept my late meal to 10pm. 

The result is that this morning my blood glucose level at 6am is 5.1.

It is just one result and I will have to see how things progress over the next few days, but it is a good result. It is the first time it has been over 5 in weeks. 

What I was getting worried about was that every morning the result was lower than the previous morning the decline never stopped. It was getting ever closer to 4 each day. 

Phew. Lets hope this is a turn around that settles.


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## Lucyr

Interesting reading your experiences so far. One thing to note about metformin is that it doesn’t work instantly, so stopping it may have a gradual effect on increasing your blood sugar. Something to be aware of as you see how things go.


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## Inka

Good to hear @Gwynn That must be reassuring.


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## everydayupsanddowns

Good to hear @Gwynn

Hope you get a little stability for a while.


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## Gwynn

I will note the comment re metrormin! 

Thanks


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## Gwynn

So now I am on 8 units in the morning. Zero units in the evening. Zero metformin in the evening. 

This mornings reading was 4.7 a little lower because I had reduced what I ate slightly in the evening. I will correct that this evening. 

It seems almost under control. This evenings reading and tomorrow mornings reading will be interesting.


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## everydayupsanddowns

Good to hear. Long may it continue!


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## Gwynn

This mornings reading was 5.1 and this evenings was 5.3.

I had reduced my morning insulun down 2 units to 6 and removed my midday metformin. I also reduced my carb intake in the day time. 

So far things seem better but the one thing I seem to have gleaned on this forum is that everything is forever changing and nigh on imposdible to pin down. 

I had a good meal of mince, carrots and mashed potato this evening. Carefully weighed. Two more small meals to go before bed. 

It will be interesting to see the reading tomorrow morning. 

As far as I can I have very carefully controlled my carbs intake. Might actually be helping. It is certainly better than the chaos at the beginning.


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## Lucyr

Your readings are great so what you’re doing seems to be working well!


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## Gwynn

I decided to just lower my carb intake by a small amount yesterday evening and as I thought would happen my fasting blood glucose level this morning had dropped to 4.7. So it looks like I have to keep my evening carbs up a little, or get up in the middle of the night and snack. I prfer to eat a little more in the evening. 

Today I have lowered my morning insulin by 2 units again and reduced my morning carbs too. However, since my fasting blood glucose level was lower than I want I have increased my morning carbs accordingly. This should take care of the evening blood glucose test resut. 

And just to add to things. I noticed that I was feeling a bit hungry following my snacks recently. Looking at the data it became obvious that my main meals were significantly stronger in cals and carbs than the snacks. Today I have tried to balance all meals and snacks carbs whilst keeping to what I feel are the right morning and evening carb amounts. 

What makes it all even harder is ensuring that the calories don't go above a certain level or I will start to gain weight. 

Its a lot of juggling and balancing, but its worth it if the outcome is good. 

Besides I have nothing much else to do at the moment.


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## Lucyr

Is there any reason you don’t want your morning glucose to be 4.7? I don’t follow why you’d need to eat more at night because of a perfect morning reading?


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## everydayupsanddowns

Lucyr said:


> Is there any reason you don’t want your morning glucose to be 4.7? I don’t follow why you’d need to eat more at night because of a perfect morning reading?



I think it’s because @Gwynn ‘s readings have been consistently dropping, and 4.x gives not much wiggle room. 

As I understand it, NICE guidance for T1s is to aim for 5-7 as a waking level, because readings lower than that are associated with potentially long periods of undetected overnight hypoglycaemia, particularly with longer diabetes duration.


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## Lucyr

everydayupsanddowns said:


> I think it’s because @Gwynn ‘s readings have been consistently dropping, and 4.x gives not much wiggle room.
> 
> As I understand it, NICE guidance for T1s is to aim for 5-7 as a waking level, because readings lower than that are associated with potentially long periods of undetected overnight hypoglycaemia, particularly with longer diabetes duration.


Ah I see that makes sense. Was thinking more that a T1 taking no evening insulin at all surely doesn’t have to worry much about severe hypos in the morning, but I guess the honeymoon could be why the blood sugars are normal in the morning.


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## Inka

Lucyr said:


> Ah I see that makes sense. Was thinking more that a T1 taking no evening insulin at all surely doesn’t have to worry much about severe hypos in the morning, but I guess the honeymoon could be why the blood sugars are normal in the morning.



I have a pump and can have the exact basal I need, but even then I’m nervous about waking up in the 4s. It always pays to be cautious with overnight numbers when you’re on any insulin at all. As @Gwynn has been drifting low, it makes sense to be very careful, as he’s meticulously doing


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## helli

Hi @Gwynn 
Congratulations on your great diabetes management. 
I notice you are, understandably, concerned about waking to a low blood sugar reading. 
Unfortunately, as you are on fixed insulin doses, you are likely to be "feeding your insulin" - eating carbs to use your insulin. If you were on the basal bolus regime mentioned earlier, you would be able to eat the carbs you want and dose accordingly. 
If you are happy with your current approach then there is no point in changing but, as mentioned, it is more restrictive.


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## Gwynn

Yup spot on. I am very nervous of morning readings below 5. Tomorrow morning will be better!!! 

To be honest I am learning as I go. It is all new. 

I was really alarmed when I first came home from hospital and the readings were all over the place, high and low. The morning readings were very low and getting lower every day. I am amazed that I didn't become ill again. So I redoubled my efforts to get my head around it all as best I could. Talk about confused, at first. 

Things seem ok now and controlable. So, no relaxing, I am awaiting something to upset things that I hadn't thought of. I hope there isn't anything but.... 

And I wonder why they put me on such a higher (?) dose of insulin at the hospital especially as I wasn't eating properly there, nor were they monitoring dietary things at all. Mind you I have no idea what a high dose is, so it could have been a normal default level.


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## Gwynn

This 'split' approach to taking your insulin - does that involve twice as many injections? Or is part of it by tablet. 

How does the metformin fit into the picture. I remember someone mentioning that they were surpised that I was taking both the metformin and insulin.


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## helli

Gwynn said:


> This 'split' approach to taking your insulin - does that involve twice as many injections? Or is part of it by tablet.
> 
> How does the metformin fit into the picture. I remember someone mentioning that they were surpised that I was taking both the metformin and insulin.


The "split" means injecting insulin every time you eat carbs (bolus) and once per day (basal) for background. I have been doing this for more than 15 years. It quickly became second nature and fitted my varied life and diet much better than the fixed dose regime as it allows me to eat what and when I want (or can if I am stuck in meetings).
I cannot comment on Metformin as I have never taken it.


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## Gwynn

How did they/you work out how much basal/bolus? Or did 'you' work it out and tell them so that you can order the right prescriptions for you. Is the type of insulin that you take for the background daily dosage a different type. Ie is it a slow acting type (or are they all slow acting) 

Considering my experience at the hospital I am not sure that I feel able to trust them to get it right, just now. I feel that I am dealing with a lot whilst I am getting used to this new way of life. 

Later on I will consider the split approach as it sounds a good way forwards, but not until I know what I am doing, better than I do now. 

But thanks for the info.


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## helli

Gwynn said:


> How did they/you work out how much basal/bolus? Or did 'you' work it out and tell them so that you can order the right prescriptions for you. Is the type of insulin that you take for the background daily dosage a different type. Ie is it a slow acting type (or are they all slow acting)


There are two types of insulin for basal bolus - the slow acting which is the background and fast acting which is the bolus. 
There are some guidelines around dosing but it does require some tweaking as we are all different. 
I was suggested a dose for basal and then adjusted it if my blood sugars did not stay stable when fasting (overnight). 
Once we were confident with the basal, we could work on the bolus dose. It is common to start with a ratio of 1 unit for every 10g carbs and then adjust this if it is too much or not enough. 
Bolus can also be used for corrections - over time I learnt how much 1 unit of fast acting insulin would reduce my blood sugars by if I didn't eat anything. 

The important thing is that diabetes is something we need to self manage. It is not a case of being prescribed a fixed dose of 2 tablets a day because there is so much that affects our blood sugars and we shouldn't have to live each day exactly the same.


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## trophywench

Each of us needs as much insulin as we need - and that won't be anything like anyone else's need!  Every single one of us is different.  However brilliant a hospital is, it is always a guesstimate!

Eventually there will actually be one expert in the world for Gwynn's diabetes.  None of us know him - but you do.  His name is Gwynn!


----------



## Gwynn

I don't think I am expert yet by a long way. But I am so grateful for your helpful suggestions and comments. 

Just had a very nice tea, a bit late as we had an electrical problem as all the lights and everything went off. Ho hum, its been a challenging year so far
Electrician to visit this week sometime.


----------



## rebrascora

Interested to know what you had for tea??? You can't tempt us like that and then not give details! Always interested in new ideas for meals.


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## Gwynn

It was beef mince, potato, & carrots. One of my favourites. A bit heavy on calories though so I have to have a smaller portion. 

Later on I have some strawberries and raspberries to look forward to. 

Balancing my carbs during the day seems to have curbed the hungry feel I was getting between main meals. Quite tricky to work out though whilst balancing everything else.


----------



## rebrascora

Thanks for elaborating. Sounds nice but unfortunately it is a bit carb heavy for me.


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## Gwynn

Yes at 43g carbs it was the only thing on the menu for tea. 

And oh, calamity, the strawberries and raspberries I had saved for later on were mouldy!!! I had to substitute some nectarines instead. All good. 

I should have checked them before. Whoops. 

So, that is carb heavy. How do you divide your carbs across the day. And, how many carbs do you consume in a normal day


----------



## everydayupsanddowns

Gwynn said:


> How do you divide your carbs across the day. And, how many carbs do you consume in a normal day



I think you will get as many answers are there are members of the forum, and huge varieties among the T1s too, as well as between the various diabetes types.

I tend to eat around 150-170g of carbs most days, but with the marvel of insulin I’ll occasionally have single evening meals which are more than 100g by themselves (sorry T2s!).

Personally I’ve ended up mostly having pretty consistent breakfasts and lunches with only moderate carbs (20g and 50g) and more variety in the evenings which are 60-70g of carbs and upwards.

What matters more though, is what will suit you better, fit in with your lifestyle, and give you BG levels and fluctuations you are happy with


----------



## trophywench

I don't particularly 'low carb', but there again don't eat masses anyway, rarely eat more than 100g carb a day as it happens, never have  - and absolutely no reason whatsoever why you or any other T1 should deliberately aim for lower carb than 43g for one of your main meals.  That IS low carb for a normal bloke!!


----------



## Gwynn

It is interesting and helpful hearing how others cope and as you say, eveyone is different. 

Tomorrow morning will be interesting as I raised my carbs slightly puposely this afternoon and evening to see how that will affect tomorrow mornings reading. This afternoon it was 5.1, tomorrow morning I am aiming for 5.5 to 6 knowing that the BS drops quite a bit during the night. However this is not a betting mans game. It could be anything although more likely to be in that range. 

Interesting, my daily carb intake seems to be around 240g. Is that need I wonder because of the insulin and metformin. 

The whole thing is fascinating and yet terrifying with a lot of stress if the readings go astray. Perhaps I will chill out more as time goes on and I understand things more. 

Am I alone in being a bit slow on the uptake in this at diagnosis? Do most people struggle at first? 

One of the posters quite rightly said that I have to take control which I am trying to do.


----------



## SB2015

I would be surprised if anyone takes on board all that we need to know at the start.

I found I picked up on some bits of advice, and then found that it needed to change after a while as things settled.  Be patient with yourself and take things step by step, and fire away with absolutely any questions that you have.  You are not alone and there is plenty of experience to draw on on here .


----------



## trophywench

Well I do believe around 240g carb a day is what the NHS reckons average carb intake is for adults, so congratulations Mr Average!  LOL

If it isn't harming you, I see no reason to change it for the sake of changing it.


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## rebrascora

Gwynn said:


> So, that is carb heavy. How do you divide your carbs across the day. And, how many carbs do you consume in a normal day


Since I am guessing this was in response to my post, I will also reply... 

I usually have somewhere between 40g and 70g carbs a day. I usually only have breakfast (10-30g carbs) and evening meal (20-30g carbs) although I may have a chunk of cheese or a few nuts or a boiled egg with mayonnaise or some olives in the middle of the day, depending on how busy I am. What I love is that I eat so much less than I did but I don't feel hungry anymore, even when I don't have lunch.

I was initially misdiagnosed as Type 2 so I spent 6 weeks learning to eat very low carb to try to bring my levels down through diet. By the time they realized I needed insulin I had broken my carb addiction and wanted to stay this way. I find it easier to just inject for 2 meals a day or sometimes just one at the moment as I am doing enough exercise to not need insulin on an evening sometimes. I feel fitter and healthier than I have for 30 years following a low carb higher fat way of eating and really enjoying my food.... tonight I had rack of lamb with red currant glaze, cauliflower cheese and celeriac chips. I may have a chunk of cheese and a small glass of wine before bed.
Low carb doesn't suit everyone but I find it really beneficial for my weight, general health, enjoyment and BG management. Takes a lot of getting your head around at first though, especially when you have spent your whole life basing meals around carb rich foods (bread, pasta, potatoes etc), but once you get the hang of what to buy and how to cook it, it just becomes easy.


----------



## Gwynn

This mornings reading (at 6am) was 5.3

Excellent.

So far things are moving in a good direction. 

Its a bit like I'm walking on my tip toes on egg shells. You may find this a bit silly but I do find it all quite stressful. The odd thing is that I am a bit squeemish so I was expecting to be ripped apart at the prospect of obtaining blood and injecting often, but no, that part has not phased me in the slightest. A surprise to me. What has freaked me out is the variability 
, lack of control, and a tough start with so little information. 

I do tend to worry about things so this fits perfectly in feeding my worrying nature. Thankfully the members on here have really helped to quell my fears and help me move forward and take a level of control. 

Still, one day at a time... 

Today a prawn salad for lunch. Nice, and again minced beef for tea (got to use it up). 

So a quick question for you. What happens if I get to the point where I reduce my insulin and metformin to zero and is it possible as a type 1 diabetic? . Does that mean that if I want to eat something extra then I should cover it by taking some insulin. Of course I will ask the diabetic nurse for advice. 

Has anyone else here managed to reduce their meds to zero or am I missing something important?


----------



## Robin

Gwynn said:


> Has anyone else here managed to reduce their meds to zero or am I missing something important?


Sometimes people find when they’re newly diagnosed that they go though what’s called the 'honeymoon period' where their pancreas manages to put out enough insulin to keep them going, especially on a low carb diet. Most type ones, it has also been found, still continue to produce a bit of their own insulin, Sooner or later, though, the pancreas doesn't put out enough insulin to cover all bases, and you are then reliant on insulin doses. Even if you didn’t eat any carbs at all, the liver trickles out glucose the whole time in the background 24hours a day, to keep your brain and other vital organs supplied with fuel.


----------



## Gwynn

Yes, thanks... A honeymoon period. Makes sense. I wonder how long that will last.

 And let me guess, the amount of glucose the liver puts out constantly varies from person to person so there is no guide as to what to expect. Just keep monitoring things I guess. 

I'll let you know when the honeymoon period seems to be over. Did you have one and if so, how long did yours last?


----------



## helli

Gwynn said:


> I'll let you know when the honeymoon period seems to be over. Did you have one and if so, how long did yours last?


Some people find their pancreas splutters a little when they are first diagnosed with Type 1. One day, it works perfectly and the next day it mis-fires again. This means they experience ups and downs with their blood sugars because their body's insulin production is unpredictable. 
Others find their islets of Langerhan (the cells that produce insulin) die off slowly and gracefully, As a result, their injected insulin demands increase over time. 
Both scenarios seem to be called "honeymoon period". 

I experienced the latter. My pancreas is was one of the last remaining graceful parts of my body. Whilst I did not change my diet, exercise regime, weight or lifestyle, my injected insulin needs grew over 8 years. So I have always assumed my honeymoon period lasted 8 years. 

Because we are all different, some people's honeymoon lasts much shorter.


----------



## rebrascora

Can I just say that your control is amazing at the moment.
The readings you are getting, mostly in the 5s are absolutely brilliant and I hope this continues for you but just to let you know that many of us struggle to get those sorts of readings longer term for a variety of reasons, so don't be too concerned if you do start to get more variation.... that is normal too. You mention that you are a worrier, so I just want to put that out there that things may not always go that smoothly so don't panic if you get the odd 8 or 12 even. Those of us who have the Freestyle Libre system which monitors our levels every few minutes day and night have a range set between 3.9 and 10 and if we can keep within that range for 75% of the time, our health care professionals are pretty happy. Hopefully that gives you some context for your future expectations. 

With my honeymoon period there were 2 notable points where I needed to increase my basal insulin. The first was about 6 months after diagnosis and the second about 3 months after that. Recently, because I have been doing more physical work, my needs have reduced a bit, so it is very much a state of flux and trying to balance it as best you can. 
It makes you appreciate just how clever a fully functioning pancreas is.
We do have one member whose basal insulin needs dwindled to nothing but he still needs fast acting insulin to cover the food he eats. There was also a lady on my DAFNE course who had been diabetic for 50 years and just used about 5 units a day (2 basal and 3 bolus). She would hypo almost every night but her readings would go up into the teens during the day. She needed to be on an insulin pump to cope with her body's needs. There are some people who need 100 or more units of insulin a day..... so it really is a case of finding what works for you as an individual and being prepared to tweak that as needed. YOU become the expert in YOUR diabetes and the medical staff are there to help and support you with YOUR management of it.


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## Inka

Hi again @Gwynn You’re not alone in hating the variability and unpredictable nature of diabetes! It was something I found very stressful when first diagnosed. I was expecting to ‘take my dose’ of insulin every day and that would be it - but, of course, it’s a lot more complicated!

With regard to your question, as it’s possible you have Steroid-induced Diabetes rather than Type 1, in theory there’s a possibility your diabetes might ‘go away’. It doesn’t happen in every case, but it does in some.

Obviously if it is Type 1, it won’t but you’ll probably have a honeymoon period.

Your insulin regime suggests they’re not treating you as a Type 1. If I was you, I’d be asking a little more about that.

As for carbs - potato and mince is _not_ ‘carb heavy’, especially as you’ve clarified the carbs were only 43g. That is most definitely not carb heavy! Your diet is clearly working for you and you’re paying really close attention to everything and being very meticulous. You’re doing really well.


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## Robin

Gwynn said:


> Yes, thanks... A honeymoon period. Makes sense. I wonder how long that will last.
> 
> And let me guess, the amount of glucose the liver puts out constantly varies from person to person so there is no guide as to what to expect. Just keep monitoring things I guess.
> 
> I'll let you know when the honeymoon period seems to be over. Did you have one and if so, how long did yours last?


I was misdiagnosed as Type 2 to begin with, so spent my honeymoon period paring down my carbs to the bone and trying to contain it on Metformin and Gliclazide, then adding in a basal insulin until it was obvious they weren’t working. By the time I got properly diagnosed with a GAD test, I think my honeymoon period was over. It took nearly a year from first symptoms (rapid weight loss without trying, thirst and lots of weeing, and feeling I was wading through treacle) to getting on to a full basal /bolus regime.
And yes, you’re catching on fast with the 'No two people are the same' mantra!


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## SaraKaya

Hi Gwynn,
I was diagnosed with type 1 at 53 in September 2020 it’s  a strange old world but this forum is definitely a good place to find out things.
Since being in the forum I have now dabbled with fish and chips and even a three celebrations went past my lips the other night!
I spent the first couple of months scared of food and was very ‘worried’ about carbs but I am now getting the hang of it and I must confirm what everyone else is saying it really is an individual sport!
what suits one person doesn’t necessarily suit another but once you get around the mechanics you can sort most things. Occasionally it all goes off the rails for no reason and those are the times you can get quite frustrated with it especially if you feel you have ‘stuck’ to the rules! There are no rules with diabetes!!
I had a 149 staring point and I have managed to get my BG levels down to something reasonable so I am hoping my next round of bloods get below 100!! But like others have said I think this is helped or hindered by the ‘honeymoon’ phase although it’s nothing like my fortnight in Torremilonos in the 1980’s I can assure you!! 
Keep going you are doing well but just be kind to yourself with it.
Off for a cup of tea and a Soreen malt loaf snack who needs a Hob nob anymore!!!!


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## trophywench

Bearing in mind the human body needs insulin constantly - if the body can no longer make it - ie Type 1 diabetes - then the only way that body can continue to function is by someone injecting insulin.  So no - once the so called honeymoon period (why honeymoon?  I enjoyed my honeymoon, well obviously must have done, so much that I had another one a few decades later) is over, it's not physically possible.


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## Gwynn

Thank you so much for your replies. It is hydrocortisone induced diabetes. 

The reading this evening is 5.5. So, for now, things are generally settling a bit. 

I am on just 2 units of insulin in the morning to be reduced further to zero. However, I take your points that once the honeymoon period is over I will have to inject insulin again. 

I think the comment about things going off the rails for no particular reason was very helpful to me. I like things to be done properly including my internal hormones, enzymes, and stuff which is normally looked after by the liver and pancreas plus a whole raft of other organs. So now I have a bit of fear that it all may go haywire at any moment. I must get to grips with that. 

For now I am on top of things. Tomorrow is a new story.... 

It is all a bit tiring


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## rebrascora

If it gives you some perspective, a non diabetic person's BG levels will vary quite a bit too. They can go lower than 4 on occasion and higher than 8, so expecting your levels to stay about 5 or even trying to keep them in the 5s all the time would probably be abnormal, even for a normal person with a fully functioning pancreas.


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## helli

rebrascora said:


> If it gives you some perspective, a non diabetic person's BG levels will vary quite a bit too. They can go lower than 4 on occasion and higher than 8, so expecting your levels to stay about 5 or even trying to keep them in the 5s all the time would probably be abnormal, even for a normal person with a fully functioning pancreas.


Coincidently, I have just found this article https://www.diabetes.co.uk/forum/th...ic-far-more-variable-than-youd-expect.178437/
Blood sugars of someone (a marathon runner) without diabetes.


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## rebrascora

That was really interesting @helli. Thanks for posting. It even makes you wonder whether the closed loop systems might be aiming for something which is not natural and if perhaps some variation in BG levels might be important to other systems within the body.... a bit like the immune system is better for being challenged occasionally.
Gosh, imagine 100 corrections a day to stay in range. Makes you feel pretty good about yourself to think that you manage it with just one or two much larger clumsier doses on MDI than the tiny adjustments a pump dispenses... if that makes sense.
Really interesting to see all those sub 4 readings through the night, especially as I am struggling with solving my night time hypo problems.


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## Gwynn

If you are wondering why I am obsessing about keeping my BG to between 5 and 6 it is because the one thing they did say to me in the hospital was that that was what I had to aim for. Mind you they didn't say how I was to attain or keep or correct my BG. 

So I came away with the one thought....   5.5 or die. It is hardly surprising that I was a bit on edge and when my BG initially kept getting lower and lower. I was freaking out. 

I feel somewhat better now that it seems a bit more settled and that you have mentioned that it can vary quite a bit in 'normal' people. So I will try not to panic if it goes up or down, but work out what to do to take corrective action if necessary. 

Mind you a BG result  between 5 and 6 makes me feel good. As if I have passed yet another exam or won the lottery for the day.


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## nonethewiser

Gwynn said:


> Yes, thanks... A honeymoon period. Makes sense. I wonder how long that will last.



How long is piece of string, who can predict.


Gwynn said:


> Did you have one and if so, how long did yours last?



Certainly did, mine was about year before things settled.


Gwynn said:


> If you are wondering why I am obsessing about keeping my BG to between 5 and 6 it is because the one thing they did say to me in the hospital was that that was what I had to aim for.



Impossible in real world, own is 4.5 - 8.5, only get that about 70-75% of time, sometimes hit 80% in target but 70's is usual figure.


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## rebrascora

Gwynn said:


> Mind you a BG result between 5 and 6 makes me feel good. As if I have passed yet another exam or won the lottery for the day.


Yes, I totally get that, but it is almost certainly unsustainable long term (since a normally functioning pancreas can't manage it) and the concern is that you get so involved in trying to keep it there that it becomes obsessive and you lose sight of the fact that diabetes has to fit in with your life not the other way around. 
I got into a similar sort of mentality over the summer and was "over the moon" when I got a really great HbA1c result in October having put a lot of effort in to get it. Now I am putting the same amount of effort or even more perhaps but things have gone totally haywire and my stats are rubbish and I am having hypos through the night or I have to take my levels up to 12 before bed to prevent a hypo in the night and I am experimenting with all sorts of different strategies to try to fix it and I've discussed it with a DSN but we are both baffled. The thing that is keeping me afloat mentally is that I have had good control before and therefore I will do again but at the moment all I can do is my best and accept whatever results I get. There is a spanner in the works and it is taking some figuring out where it is and how to get it out. I am only in my second year with this so there is every likelihood that these spells of good control and poor control will ebb and flow with life and whatever it throws at me and I have to learn to accept that control will not be perfect all the time. 
I think many diabetics go through this thought process and it can easily lead to anxiety and depression or feelings of failure.... In reality the only time we fail is when we don't try. 

Did you click on the link posted by @helli and see the graph of the 24hr readings of a fit healthy non diabetic person. That really demonstrates that you are shooting for the moon trying to maintain readings between 5 and 6 and any medical professional who suggested as much deserves to get diabetes so that they see just how impossible that is. Putting unrealistic expectations on us has to be one of the major causes of burn out.


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## trophywench

Gwynn - the Abbott Libre system - a Flash glucose monitor gizmo a fair number of us use, has a central range between 3.9 and 10.0, and they like us to stay within that range for 70+% of the time!

Mike (@everydayupsanddowns) manually set his tighter than that and got a bit of a telling off from his Diabetes clinic, for setting himself unrealistic targets!


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## Gwynn

5.6 this morning. Elated for the day. 

All the house electricity died first thing this morning, not so elated. 

Life!!!


----------



## Gwynn

I did go to the link. What scared me was the fact that diabetes is an unstable condition. Oh dear that did not fill me with hope. 

However it was mentioned on here that the only failure is to stop trying and I AM a tryer. So I have hope in that. 

I use an app that details exactly what I am eating and eat 7 small balanced meals a day. Whether it is working to help me or not as much as I think it is is moot but I do feel overall really well. I have never felt really well, all my life! 

Just waiting for the hidden trap door to spring open....


----------



## trophywench

Oh Lor Gwynn - the fridge!!!!!!


----------



## Gwynn

I have just been reading the support and advice you all give to many on this forum and I must say that this is one of the most helpful and positive forums I have ever encountered.

My own BG reading yesterday evening was a tad higher than I had aimed for. I discovered after looking at the days data, that I had mis-weighed things.

So this is a chance to see if lowering the evening carbs will have produced a reduction in line with my calculated guess, this morning, or will I find that my body has a mind of its own. Ummm

Electricity sorted. The muppet who installed new wiring when I had the kitchen rewired and installed a new consumer unit too, had done a bad/dangerous/careless job. There could have been a fire anytime. Several circuit breakers replaced. One with burn marks on it. Wiring sorted to make the whole thing secure and safe. The stress of the whole thing (which was significant) has now gone. Perhaps that also had a bearing on my BG levels. 

Up at 2am this morning. Bright as a button. Does anyone else find that they sleep less but feel good? Mind you I have always been an early riser. This is a bit earlier than usual (5am) though.


----------



## Gwynn

My fridge is full of fruit and skimmed milk. It used to be full of jelly and full fat milk. Ho hum. 

I am finding that fruit tastes really good - and sweet too. I used to put sugar on everything! Now sugar is banned. A bit extreme but I have to get a firm grip on myself and never allow any bad (for me) eating habits to creep back in.


----------



## Gwynn

I had a very long assessment with the extensive care unit this afternoon. They advised that my aim of BG being between 5 and 6 is too low. Completely opposite to the hospital. However his reasoning was sound. Too low at night where i could unwittingly get into trouble whilst asleep if the BG varied for some reason. I have decided to try to get my BG to between 6 and 7. This evening redult was 6 (coincidental). 

They also said that the reason they don't firmly understand what is wrong is because they are still waiting for confirmatory blood test results. 

Their feeling is that the most probable diagnosis is latent adult autoimmune diabetes (i think that is what he said). LADA. 

I am pesently on zero insulin but carefully adjusting my meals. They were happy with that for now as long as I keep testing (as if I would dare to stop). 

I may be jumping the gun but does anyone here have LADA and did it have more or less complications than type 1 or 2.


----------



## Inka

Yes, there are a number of people here with LADA. It’s like a slow-onset Type 1. It has just the same complications if your blood sugar isn’t well-controlled. That’s the main thing, not so much what ‘type’ you have.

Give yourself some leeway with your blood test results. If you do have LADA/Type 1, then you’ll have to live with it for a long while so you want to ‘keep it in its place’ and not let it take over. I try to be between 4 and 8, but accept sometimes I might go higher after a big meal or a site absorption issue. My consultant says to stay below 10 and above 3.8. The worry about nocturnal hypos is very justified. They’re frightening and best avoided.


----------



## Gwynn

This monings reading at 6am is 5.3. This was after I increased my evening carbs to 140g.

How do you increase your carbs without breaking the bank of calories and gaining weight?


----------



## Lucyr

Given you aren’t taking any insulin, I don’t think you need to be concerned about readings in the 5s, since the main reason to be cautious about waking at 5 seems to be overnight lows. A normal morning reading after a high carb dinner looks like your pancreas did a decent job.

if you want to increase carbs without adding calories you would need to reduce something else, since all carbs have calories.


----------



## everydayupsanddowns

Gwynn said:


> I am pesently on zero insulin but carefully adjusting my meals. They were happy with that for now as long as I keep testing (as if I would dare to stop



Have I understood that right? Are you not taking any insulin now?

If you are on no insulin at all (either background or mealtime) then there is far less need to be worried about an overnight hypo which would be caused by the wrong insulin dose. Did the extensive care team know you weren’t taking insulin?

I would suggest you aren’t going to have much success getting your waking reading to particular levels by eating more in the evening, because your body has hours and hours to try to get BG back into the normal range, which is likely be lower than the 6-7 you are aiming for.

The thing to keep an eye onis of your pancreas starts to flag again (it seems to be feeling pretty perky at the moment, but obviously had a bit of a wobble earlier for you to get your diagnosis.

LADA is a slower onset form of T1, where the autoimmune destruction of beta cells happens over a longer period of time. it may be that after the support of insulin therapy your beta cells have had a bit of a breather, and are able to produce more insulin for a while. Over time though (months or perhaps years) the autoimmune attack is likely to destroy more of them, and eventually a tipping point will be reached where you will need insulin again.


----------



## Gwynn

Yes you understand that correctly. Zero insulin of any kind. 

I will keep monitoring things because my pancrease may decide to go south again. Besides, they still don't have a confirmed diagnosis.


----------



## Drummer

It doesn't seem to make sense - if you do not need extra insulin, that you are eating fruit and having 7 meals a day, and the skimmed milk - why hammer in the carbs?
I would have thought that eating twice a day and low carb would be the way to go, a minimum insulin requirement diet so your pancreas gets a rest rather than being constantly stimulated.


----------



## Gwynn

Now that is an interesting thought. 

My take is that many small meals would give the pancreas less overall stress rather than fewer larger meals. 

I shall think on this some more.


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## rebrascora

The pancreas only needs to produce high quantities of insulin if you eat a lot of carbs, so you only put it under stress if those 2 larger meals (or 6 smaller meals) are carb rich. A low carb diet, means that the pancreas needs to produce very little extra insulin for food and can then hopefully continue to tick over producing the bit of insulin needed to meet your basal needs for longer ie the glucose trickled out by the liver to supply your vital organs.

Since you are now no longer injecting insulin, there is no risk in reducing your daily carb intake to see if you can preserve the insulin producing Beta cells you have left.


----------



## helli

I ha


rebrascora said:


> Since you are now no longer injecting insulin, there is no risk in reducing your daily carb intake to see if you can preserve the insulin producing Beta cells you have left.


I have seen people discussing this approach to "save their beta cells". 
Is there any research to show that you can, effectively, extend your honeymoon period by eating low carb?


----------



## rebrascora

helli said:


> I ha
> 
> I have seen people discussing this approach to "save their beta cells".
> Is there any research to show that you can, effectively, extend your honeymoon period by eating low carb?


Don't know but it is surely worth a go. 
Logically it ties in with people finding that they need less insulin after their initial diagnosis where the pancreas gets a bit of a break from insulin being injected. But there is sadly so little research on low carb diet, mostly just anecdotal from those of us who find it helpful.


----------



## helli

rebrascora said:


> Don't know but it is surely worth a go.
> Logically it ties in with people finding that they need less insulin after their initial diagnosis where the pancreas gets a bit of a break from insulin being injected. But there is sadly so little research on low carb diet, mostly just anecdotal from those of us who find it helpful.


It makes sense to me with type 2 but for an auto-immune disease, such as Type 1 or LADA, I can't fathom the logic that would lead the body to stop killing off cells that it does not like. Type 1 and LADA are not caused by the pancreas being stressed due to a specific diet.
As you suggest there is no harm in trying. My scientific mind is trying to work out why it would work. But there is so much about the way our bodies work that is a mystery so why not?


----------



## Drummer

Gwynn said:


> Now that is an interesting thought.
> 
> My take is that many small meals would give the pancreas less overall stress rather than fewer larger meals.
> 
> I shall think on this some more.


Your food choices are not the best - by eating foods with higher nutrition AND which do not require insulin, you could be doing yourself some good.
I visualise my pancreas snoozing away the day once breakfast is done with, as I eat at 12 hour intervals.


----------



## Inka

helli said:


> I ha
> 
> I have seen people discussing this approach to "save their beta cells".
> Is there any research to show that you can, effectively, extend your honeymoon period by eating low carb?



The only research I’ve seen about extending the honeymoon, particularly in LADA, said that early introduction of insulin preserved the remaining beta cells longer.

Eating very low carb causes insulin resistance and makes the beta cells work harder. If it was me, I’d go for moderate carbs and insulin if/when needed.

As @Gwynn is still waiting for a diagnosis he’s short of the final information he needs to know precisely what’s happening anyway.


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## Gwynn

The extensive care team and diabetic nurse do know that I am zero insulin and have no concerns hsving looked at all the readings. They know that I am checking things and very alert to any unusual changes that may occur. 

I am very open and honest with them so that they can offer the best advice to me. 

I have been online to see which is less stressful on a body system and most beneficial in regard to the quantity of meals eaten in a day. Unfortunately many sites contradict each other whilst claiming theirs is a scientific study. So no conclusions could be drawn. 

My take on it all is that the results may vary depending on the people being tested and the type of foods they eat, but I don't actually know. It feels right that smaller more frequent meals would be less stressful on the body, but that could be completely wrong. The carbs I am eating in any day are roughly the NHS recommended daily quantity, divided as evenly as I can across several meals. The balancing across the meals seems to have stopped my hunger.  Is that carb heavy? 

I will ask the extensive care team about it all when they next visit. By then there may be a diagnosis too. 

Reading this evening is 5.8. Quite happy with that. What ever I or my pancreas are doing, we are getting the right sort of results. I hope that it will continue.


----------



## Gwynn

Now this is scary for me. 

In an attempt to increase my fasting BS from 5 to 6....

I increased my carbs yesterday evening  (that one meal to 147g) and ate later for my last meal at 10:30pm. At 6am this morning I got my lowest reading so far of 4.2.

So what am I doing wrong do you think?

I will ring the diabetic nurse today to ask for some advice.


----------



## Gwynn

Oh I can't. It is a Saturday. Now what?


----------



## pm133

Inka said:


> The only research I’ve seen about extending the honeymoon, particularly in LADA, said that early introduction of insulin preserved the remaining beta cells longer.


Yes that's what my diabetes nurse and GP both said when they stopped me taking Gliclazide on the second day of my diagnosis and concluded I had type 1 not type 2. They said that taking Glic would stress my beta cells and kill them off faster. Hence the immediate move to me using insulin.

The idea that your diet can save your beta cells for type 1s doesnt make sense to me at all and I also think that the "it can't do any harm" idea is potentially dangerous.

The low carb thing for type 1s just confuses me. Type 1 is fundamentally not about carbs (leaving spikes aside for a second). It's about insulin. For me, I genuinely don't understand why anyone would do anything other than give the body the insulin it needs. It seems odd to avoid that.


----------



## Gwynn

Whoops. Panicking. I meant 61g of carbs in the last meal of the day at 10:30pm.

It was 147 for the whole afternoon and evening. 

Sorry.


----------



## Gwynn

Well we don't know what it is. Type 1, type 2, LADA, yet


----------



## pm133

Gwynn said:


> Now this is scary for me.
> 
> In an attempt to increase my fasting BS from 5 to 6....
> 
> I increased my carbs yesterday evening  (that one meal to 147g) and ate later for my last meal at 10:30pm. At 6am this morning I got my lowest reading so far of 4.2.
> 
> So what am I doing wrong do you think?
> 
> I will ring the diabetic nurse today to ask for some advice.


I'm not sure what you are worried about here.
Personally, I would go back to eating 3 normal meals per day and split the carbs reasonably evenly across the day and continue with that until your body starts to show signs of beta cell failure.
You might be in danger of making unwise dietary decisions here based on over analysing numbers which seem OK to me within the random fluctuations you would expect.


----------



## pm133

Gwynn said:


> Well we don't know what it is. Type 1, type 2, LADA, yet


Hence, it's probably most important you don't do anything drastic diet-wise until you find out.


----------



## Gwynn

Now this has me a bit confused. 

Worried., I took a calibration reading of the BG test meter. All ok, within calibration range. 

I then did a second BG reading 30 minutes ater having eaten nothing and the BG reading was 5.2.

Could the meter be faulty. Or could I need to do the test 30 minutes after waking up in the morning rather that straight away. 

Any advice on this please. 

5.2 was lower than I expected too. Almost as if my pancreas is behaving well (for now). If so, what went wrong for me to end up in hospital I wonder.


----------



## pm133

The meter isn't faulty but it is innaccurate.
Individual readings are less important than observing the general trend in your readings.


----------



## Gwynn

Now that surprises me for something so important, with calibration too and the manufaturer guaranteeing that the readings are accurate to within 0.87 in 97.7% of test cases (sorry lost the link). Perhaps the meter is a faulty one. 

So do I ignore it if the reading is, lets say 3, but I feel fine. But the diabetic nurse said that with such a low reading eat first and get emergency help second. Do I go into panic mode or not? 

Sounds like I may have to do things based on how I ferl, unfortunately I do not feel any different if the meter reads 4, 5, 6, or even 12. So I don't think that judging things by how I feel will be a good way forward. But then again, if I feel fine then I feel fine, what could be better. 

Am i missing something.


----------



## Robin

Meters usually claim great accuracy, but the legal specifications are quite lax, they only have to be within 15%, and 10% at the lower end.
Secondly, blood is not homogenous, I usually get a higher reading from my right hand than I do from my left. 
Thirdly, your liver starts trickling out glucose the moment you wake up (and sometimes from the early hours), so a rising blood glucose level is quite common first thing in the morning.
If your pancreas, for whatever reason, is working well at the moment, there’s nothing you can do the night before to increase your morning readings, and if you are not on any medication, I’m not sure why your diabetes team would want you to try. However many carbs you eat, a working pancreas will deal with them and bring your levels down to what it considered normal for you. Which is usually between 4 and 5 in most people without diabetes.


----------



## silentsquirrel

4.2 to 5.2 in 30 minutes without eating first thing in the morning is perfectly normal (for any type) - dawn phenomenon or foot on the floor syndrome. 

The 1 decimal place reading on the meters misleads one into thinking they are more accurate than they really are.  All readings are "ish".  Given the allowable +/- 15%, 4.2 could be 3.6 to 4.8, and 5.2 could be 4.42 to 6.0.
Also blood is not homogeneous - readings taken at the same time from different fingers can vary a bit.

As you are not at the moment taking any insulin 4.2 and 5.2 are both very acceptable readings!  No need at all to panic.  Even if the reading is only 3, while you are NOT on insulin you do not need emergency help.


----------



## Inka

If you get a 3 on your meter, you treat it as a 3 and as a hypo. However, the glucose meters have a 15% margin of error. They’re not supposed to be giving you an exact figure, just a ball-park one eg you test before a meal and get a 4.9. You test again immediately after and get a 5.6 - “Oh no - what’s going on??” you might ask yourself. The answer is nothing. All you need to worry about is you have a good blood sugar there whether it’s a 4.9 or a 5.6.

If you’re on zero insulin now, you don’t need to worry about hypos. You don’t need to worry about a 4.2 (which might be a 5 anyway). That’s a normal blood sugar.


----------



## silentsquirrel

Robin types faster!!


----------



## Inka

silentsquirrel said:


> Robin types faster!!



So do you


----------



## grovesy

Well this morning I was 6.4 on waking getting up and going to bathroom and back  it was 7.4


----------



## Robin

silentsquirrel said:


> Robin types faster!!





Inka said:


> So do you


Well, we are all singing from the same hymn sheet, at least!


----------



## Lucyr

I was going to say the same thing as others. You don’t need to worry about hypos since not on insulin, you may even go slightly below 4, non diabetics do that, and it isn’t an emergency unless it goes really low. The reason readings under 4 are an emergency for diabetics is that the medication we give to reduce blood sugar will still be reducing us further, it doesn’t stop working just because we are 4 like a pancreas does.

your blood sugar increasing without eating in the morning is normal too. Your body saw you woke up, thought you might need a bit more sugar than 4.2 and provided it, increasing you to 5.2 which is also a perfectly great number whilst not on insulin.


----------



## Gwynn

Now all those replies are very helpful and reassuring. Thank you.


----------



## Gwynn

I am learning as I go. But I don't know what I need to know until I hit some brick wall of confusion or panic. I am so glad that this forum is here to help.


----------



## Lucyr

Gwynn said:


> I am learning as I go. But I don't know what I need to know until I hit some brick wall of confusion or panic. I am so glad that this forum is here to help.


Keep posting,  glad you’re feeling better about things.


----------



## trophywench

The ONE thing about diabetes it is essential for healthy survival to know - is never stop asking questions about it, Gwynn !

None of us knows everything!!


----------



## pm133

Gwynn said:


> I am learning as I go. But I don't know what I need to know until I hit some brick wall of confusion or panic. I am so glad that this forum is here to help.


I think that's probably true for all of us, from those who are newly diagnosed to those who've been living with this for decades. There isn't a single person on here with all the answers.


----------



## trophywench

pm133 said:


> I think that's probably true for all of us, from those who are newly diagnosed to those who've been living with this for decades. There isn't a single person on here with all the answers.


Nor anywhere else.


----------



## Gwynn

I realise that I know so little. Very humbling. 
I realise that the human body is incredible. Very humbling. 
I realise that there are kind lovely people out there. Very humbling. 
I realise that I am just one lone tiny person in one huge World. Very humbling. 
I realise that in reality I am not really in control. Very humbling. 

I will certainly keep asking questions and posting what is going on and I will certainly let you know when they finally come to a diagnosis. It has been over 2 months now since I was admitted to hospital. Surely they must have the blood test work back by now. 

I had no idea, but should have realised that my body would need time to 'wake up' in the morning. By sheer chance I had been waking up quite early and testing at least one hour later. Except, yesterday when I got up late at 5:45 am and tested before 6am. I was very shocked and worried by the first very low reading. Several of you helped me understand and the next two readings at 6:30am and 7:am were fine. But the initial panic that I felt was horrible. 

I have been obsessing and worrying about everything, trying to control everything whilst knowing nothing and learning fast. It seemed to work and maybe it will going forwards, to some extent. It has all made me feel very fragile amd very alone.  This is where your forum has helped me so much. I no longer feel completely alone and you are there with your own experiences and understandings to help me where you can. 

Good on you all   ! 

Very humbling.


----------



## Gwynn

Reading this morning 5.1.

What did I do differently? Nothing except waiting 1 hr after waking before taking the reading.


----------



## everydayupsanddowns

Gwynn said:


> This is where your forum has helped me so much. I no longer feel completely alone and you are there with your own experiences and understandings to help me where you can.



Glad you have been finding the forum helpful @Gwynn 

Keep us updated with how things are going and keep asking questions 

Part of learning to live with diabetes, for me, is learning to strike the balance between being kind to yourself when things don’t work as expected, and learning when to try to apply more focus and experimentation to improve results in a certain situation. 

‘control’ is a tricky word, because there are so many things that can affect BG that we don’t directly influence, but we can gradually learn how to work around many of those, and just roll with it where our diabetes throws a spanner in the works


----------



## Gwynn

This becomming even more confusing to me. If any of you can shed some light on things then I will be very grateful. 

Test at     3:45pm    right hand. Result 8.0  surprise as carbs were well controlled. 
Retest at 3:50 left   hand.          Result 7.3
Retest at 4:00 right hand.         Result 6.3
Retest at 4:10 left hand.            Result E-3
Retest at 4:12 left hand.            Result 6.1

Is my pancreas suddenly intermittently playing up/working ok? 
Is my test machine suddenly intermittently playing up/working ok. 
Is there some new factor I am unaware of. 

I believe that testing is very important but the result just minutes apart are very different. I decided to do several retests just to gather more data and to see if there was any trend or consistent error. 

Help I feel like a pin cushion


----------



## Inka

Those are all normal @Gwynn The first two are just variations of the same thing (the meter has a margin of error) and the ones in the 6s are most probably your blood sugar decreasing slightly naturally just as it’s supposed to.

Blood sugar naturally goes up and down throughout the day. Meters have a margin of error, and you’ll rarely get exactly the same result with multiple tests in a few minutes.


----------



## Gwynn

Is a variation of 1.7 within 30 minutes normal? If so, it wouldn't take very long to get into trouble without realising it. 

I am not sure what this tells me. Had I taken some insulin because my BG was higher than expected (advice was given to do so in this situation) then I might have got into difficult waters quite quickly. 

So do I sort of ignore the meter readings or rely on them but take multiple readings each time. 

I cannot rely on how I feel because I feel fine all the time. Best not to leave it until a hypo appears too. 

Today was like all the other days. No extra carbs. No less carbs. Well balanced. All consumed at precise times. So there was no expectation of any significant variance. And a 1.7 difference is significant. 

Rats, I am back in panic mode again.


----------



## trophywench

Well all meters have a plus or minus margin of error of 15% anyway - so what actually is/was your correct BG?

Truth is - none of us know!!  We all have to live with that.  If the meter suddenly tells you after eating carbs that you are in double figures when you've been around 4 or 5 for hours previously - then yes, looks like you needed some insulin for that - so have some now.

One sole occasion of double figures seriously cannot kill you anytime soon.

If it's 20+ and stays there for long it can - but still slowly.


----------



## Lucyr

As people have mentioned, blood glucose meters are only accurate to within 15%. So if your blood sugar is 7, the meter can show anything between 6 and 8 and be accurate. Add on top of that, different fingers are different samples, and blood sugar is constantly changing so even testing 5-10 mins later can give a different number (I’m told to test after 10-15 mins if I’m low to see if my blood sugar is fixed). All that means that a change of 1.7 in 30 minutes is completely normal.


----------



## Gwynn

And yet I had not eaten or drunk anything in the 30 minutes of testing or the two hours before. 

I wasn't worried that the higher reading would kill me but the effects of too much insulin incorrectly taken based on one higher reading. 

In the end I decided that 6.1 to 6.3 is probably right and did nothing. A variance of 1.7 is higher than %15 (I think). 

Looking things up online suggests that the blood glucose level is unlikely to change significantly rapidly with no input of food or drink. 

So was a change of 1.7 in 30 minutes with no food or recent food significant? It dropped 1 point in 5 minutes according to the meter. 

I am still confused. Things will always vary but surely not by such a large amount in such a small time frame? 

Sorry if I sound a bit off I am a panicked and concerned


----------



## Lucyr

Gwynn said:


> And yet I had not eaten or drunk anything in the 30 minutes of testing or the two hours before.
> 
> I wasn't worried that the higher reading would kill me but the effects of too much insulin incorrectly taken based on one higher reading.
> 
> In the end I decided that 6.1 to 6.3 is probably right and did nothing. A variance of 1.7 is higher than %15 (I think).
> 
> Looking things up online suggests that the blood glucose level is unlikely to change significantly rapidly with no input of food or drink.
> 
> So was a change of 1.7 in 30 minutes with no food or recent food significant? It dropped 1 point in 5 minutes according to the meter.
> 
> I am still confused. Things will always vary but surely not by such a large amount in such a small time frame?
> 
> Sorry if I sound a bit off I am a panicked and concerned


It’s 15% either way, so 30% pretty much. Your blood sugar looks to have been naturally dropping in that time too.


----------



## silentsquirrel

Every single one of those readings is within 15% of 7.  Nothing to be alarmed about or unexpected!  Remember readings are ISH, so they are all 7ish.

Readings are not just affected by food, lots of other factors involved, including stress! - and stress can put people up or down......


----------



## grovesy

Gwynn said:


> And yet I had not eaten or drunk anything in the 30 minutes of testing or the two hours before.
> 
> I wasn't worried that the higher reading would kill me but the effects of too much insulin incorrectly taken based on one higher reading.
> 
> In the end I decided that 6.1 to 6.3 is probably right and did nothing. A variance of 1.7 is higher than %15 (I think).
> 
> Looking things up online suggests that the blood glucose level is unlikely to change significantly rapidly with no input of food or drink.
> 
> So was a change of 1.7 in 30 minutes with no food or recent food significant? It dropped 1 point in 5 minutes according to the meter.
> 
> I am still confused. Things will always vary but surely not by such a large amount in such a small time frame?
> 
> Sorry if I sound a bit off I am a panicked and concerned


Was your last meal fatty by any chance as, fatty meals can sometimes make blood sugar rise over a longer period.


----------



## Inka

Gwynn said:


> And yet I had not eaten or drunk anything in the 30 minutes of testing or the two hours before.
> 
> I wasn't worried that the higher reading would kill me but the effects of too much insulin incorrectly taken based on one higher reading.
> 
> In the end I decided that 6.1 to 6.3 is probably right and did nothing. A variance of 1.7 is higher than %15 (I think).
> 
> Looking things up online suggests that the blood glucose level is unlikely to change significantly rapidly with no input of food or drink.
> 
> So was a change of 1.7 in 30 minutes with no food or recent food significant? It dropped 1 point in 5 minutes according to the meter.
> 
> I am still confused. Things will always vary but surely not by such a large amount in such a small time frame?
> 
> Sorry if I sound a bit off I am a panicked and concerned



@Gwynn There is honestly no need to panic about those readings. I’ve often tested my non-diabetic friends. They have 4.8s, 6.9s, 7.8s - anything within the normal range. Their blood sugar goes up and down within the normal range. That is.....normal.

You say you were told to use insulin if you were high? 6 or 7 is *not* high. 8 isn’t high. 15 would be high but you’re well away from that. You’re eating carbs and your body is behaving normally at the moment.

You seem to be thinking that blood sugar should remain basically the same figure - but it _doesn’t_.

My advice if you’re not taking any insulin is to test less. It’s clearly stressing you unnecessarily.


----------



## Inka

@Gwynn Also, have a look at this blood sugar graph:

https://diabetespsychologymatters.com/2020/06/22/flat-lining/

That is from a person without diabetes. Check out the rises and the falls. All perfectly normal.


----------



## Gwynn

I eat little fat. Today it was same, very little. 

8 was an abberation. It eorried because I am now doubting the validity of any of the readings.


----------



## silentsquirrel

Gwynn said:


> I eat little fat. Today it was same, very little.
> 
> 8 was an abberation. It eorried because I am now doubting the validity of any of the readings.


If you had eaten 2 hours before the 8, it was perfectly in range   Guidelines for a T2 are 4 - 7 before meals, but up to 8.5 after a meal.  I may be misremembering, but I think for T1s the post-meal target is up to 9.  Not an aberration at all.
I agree with @Inka , perhaps give your fingers a bit of a rest while you are not on insulin.


----------



## everydayupsanddowns

Here's a helpful table that shows the permitted variation of home BG monitors from a lab test result at various BGs. The higher the BG the greater the permitted variation. But you can see that even mid-range there's quite a spread. As has been said, for all their illusion of decimal points home BG meters are showing 5ish, 6ish, 7ish readings


----------



## Gwynn

Thanks for that. Some variation!!


----------



## Gwynn

Forgive me for asking but, considering accuracy, wbich meters do you use? 

I thought that all meters would be accurate as it is so important. But apparently I am wrong. 

Any recommendations?


----------



## silentsquirrel

Better accuracy would be the ideal, but wishing for something does not make it happen.  It isn't that long ago that there were no meters at all, and Type 1s had to go through elaborate routines to get the vaguest idea of what their glucose levels were some hours earlier.  I'm sure @trophywench or another of our long term T1s can give you the detail!


----------



## trophywench

It wasn't that difficult TBH - just boiled 10 drops of water plus 5 drops of wee up in a miniature test tube every single morning when you went for your fist wee, by adding a Clinitest tablet to it, wait till it stopped boiling then shook the test tube (without touching the bottom of it where the liquid was, unsurprisingly it was boiling hot LOL) - and checking what colour that liquid was now.  You wanted it to be Royal Blue, not green, khaki or Burnt Orange.

Ah well, Hey ho!  - orange went far better with a primrose bathroom suite than dark blue, didn't it?


----------



## Bruce Stephens

trophywench said:


> It wasn't that difficult TBH - just boiled 10 drops of water plus 5 drops of wee up in a miniature test tube every single morning when you went for your fist wee, by adding a Clinitest tablet to it, wait till it stopped boiling then shook the test tube (without touching the bottom of it where the liquid was, unsurprisingly it was boiling hot LOL) - and checking what colour that liquid was now.


And that (or the rather simpler test tape that I used at first) could tell you whether your BG was above (and to some extent how far above) or below some individual threshold. So of marginal value for actual management. (On the other hand the insulins were also fairly iffy, so knowing precisely what your BG was probably wouldn't have been _that_ valuable anyway.)


----------



## everydayupsanddowns

Gwynn said:


> Forgive me for asking but, considering accuracy, wbich meters do you use?
> 
> I thought that all meters would be accurate as it is so important. But apparently I am wrong.
> 
> Any recommendations?



Ascensia Contour Next Link was a bit of a step-change for me. Previously if I didn’t ‘like’ a result I could recheck and pretty much guarantee a different result, but i find the Next strips to be very consistent and reliable from drop to drop and sample to sample.

Accu-Chek usually come out well in bench tests too.


----------



## Gwynn

This morning... 
5:55am 4.5
5:57am 4.7 sounds consistent

+/-15% gives an accuracy range of 3.99 to 5.04

Retest at 5:58am 5.4  outside the boundary for error. 

So what is going on. My body will surely not change so quickly. Is the machine inaccurate. Should I even care. I am well. All readings are ok. 4.5 is edging towards concern but a way off. 

Do I just see if I am below 4 or above 10 and only take action if that is the case? 

How do you ensure better accuracy?


----------



## Docb

Hi Gwynn, there is another factor which has yet to figure in this discussion and that is sampling error.  The thing is that blood wanders around the body picking up glucose here and loosing it there and quite what reading you get from a tiny drop of blood at the end of your finger will depend on where it has been as it has been travelling around.  General experience suggests that the sampling error is not too wild but it will be there.

Add the sampling error to the meter reproducibility and your 5.4 is best considered no different to the earlier readings. 

I think you are trying to read far too much into your readings than is merited.  In my mind, a better way of looking at things is to, as you suggest, have ranges in mind and be content if you are within them.  I tend to have three ranges to keep an eye on. 

There is the overall range which for me is 4 to 10.  I would like to see any reading I take at any time during the day somewhere in that range.  Anything much over 10 suggests I have eaten something which I should think about avoiding.

My waking and bedtime rangesI would like to see somewhere between 4 and 6.  For me that means I am starting and ending the day in a good place.  Interestingly this morning I got a 6.8.  I'm not worrying about it but I will do a post breakfast check to see what that is.  If that is in range, then I will put the 6.8 down to being one of those things.  If it isn't, then I will do a bit more testing over a few days to see whether I am running higher than historical or not.

By way of background I spent most of my working life measuring things and then trying to make sense of the measurements and so I am quite comfortable with handling error.  If you are not used to it, then it is all to easy to assume a precision in a measurement which is not justified and then worry about it.  It is part of the reason why the NICE guidelines do not recommend providing meters to "run of the mill" T2's.

There is no answer to your final question, "How do you ensure better accuracy?"  All you can do is stick to best practice, use a meter that meets a recognised standard with in date test strips and make sure your finger is clean before testing. The reproducibility (a better term than accuracy) you then get is what it is.


----------



## Gwynn

It all sounds like a game for two with one of the players using their own invisible rules. 

Thanks for that reply. Helpful.


----------



## Docb

Gwynn said:


> It all sounds like a game for two with one of the players using their own invisible rules.


Lol, a brilliant way of putting it.  Most of science is like that!

By the way, one hour after my breakfast (when my BG usually peaks) I got an 8.9.  That's within range so can forget about the 6.9 waking for the time being.  See what happens over the next few days and think again if my waking reading does not return to the normal "somewhere between 4.5 and 6"


----------



## Inka

@Gwynn Did you see my reply and my post showing the glucose trace of someone without diabetes? (the last two posts on page 7 of this thread)


----------



## rebrascora

Gwynn said:


> It all sounds like a game for two with one of the players using their own invisible rules.
> 
> Thanks for that reply. Helpful.


I see my BG levels as very much like a game. Not sure if you remember the early computer games that you played on the TV and involved a slow moving game of tennis where you had a player at each side of the screen and the cursor or paddle at each side stopped the ball going off screen if you got it in the right place and the ball bounced off it and back to your opponent. I see my diabetes like that.... the screen is my range and I am constantly trying to keep it on the screen by one cursor being my Jelly babies or glucose tabs and the other being my insulin. My range is 3.9-10 as these are roughly normal range for a Non diabetic person. So if I drop below 4 I have glucose and if I get up to 10 I have insulin and if I can do that the ball stays nicely on the screen bouncing back and forth and the game continues. If I misjudge it and the ball goes off screen I am disappointed but the game isn't over... It's just that we start a new service and hopefully I learn from the mistake I made in the previous point, but there will also be times when I get distracted or don't focus enough and the ball will go out of play as well as me actually making a mistake.... and that is OK too. We are all human and can't concentrate fully all the time, but the more we practice the less genuine errors we should make.... then it is just about life sometimes getting in the way of our focus on the game and finding a balance which is acceptable is important.

And yes, BG levels can certainly change that quickly even without food. For instance on a morning, if I didn't take insulin straight away, by BG levels could easily rise by 3mmols in half an hour before breakfast. Similarly, my levels dropped by over 6 mmols in an hour yesterday from 10 to 3.1 because I injected just 1 correction unit and then did some exercise. I knew it was a risk but exercising when my levels are at 10 is hard work and they had been stuck up at 10 for over an hour.... probably because I am stressed at the moment. Getting the balance right isn't always easy or within our ability.

This was why I was trying to warn you that you are being too rigid with your expectations of control.... it isn't natural to have control that tight even for a non diabetic person with a fully functioning pancreas....

Edited to add..... There are two different modes for my game. This is my "correction" game mode but there is also the "bolus" game mode for meals and sometimes there might be a little bit of overlap, when you are playing both modes at the same time.... which is trickier and more expert level.


----------



## rebrascora

Inka said:


> @Gwynn Did you see my reply and my post showing the glucose trace of someone without diabetes? (the last two posts on page 7 of this thread)


@Inka... I have also posted that link earlier on this thread for Gwynn's consideration


----------



## rebrascora

Someone used an analogy of herding kittens for managing their BG levels the other day which I thought was really apt..... it is just not a precise science.


----------



## Eddy Edson

Gwynn said:


> This morning...
> 5:55am 4.5
> 5:57am 4.7 sounds consistent
> 
> +/-15% gives an accuracy range of 3.99 to 5.04
> 
> Retest at 5:58am 5.4  outside the boundary for error.
> 
> So what is going on. My body will surely not change so quickly. Is the machine inaccurate. Should I even care. I am well. All readings are ok. 4.5 is edging towards concern but a way off.
> 
> Do I just see if I am below 4 or above 10 and only take action if that is the case?
> 
> How do you ensure better accuracy?


I'd echo all the "don't sweat the decimal points" comments, but I'd also point out that the ISO standards given by Mike upthread say "+/- 0.83 when the reading is below 5.6".  So yr 4.7 then 5.4 readings are consistent with that standard.


----------



## Inka

rebrascora said:


> Someone used an analogy of herding kittens for managing their BG levels the other day which I thought was really apt..... it is just not a precise science.



And it doesn’t need to be. To continue that analogy, we’re trying to ‘herd our kittens’ _into a pen (_ideal blood sugar range)_. _We understand that our kittens will walk around a bit in that pen but that doesn’t matter. What we’re _not_ trying to do is ensure our kittens stand in the same place all day because that’s not necessarily and simply doesn’t happen.


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## adrian1der

Gwynn said:


> This morning...
> 5:55am 4.5
> 5:57am 4.7 sounds consistent
> 
> +/-15% gives an accuracy range of 3.99 to 5.04
> 
> Retest at 5:58am 5.4  outside the boundary for error.
> 
> So what is going on. My body will surely not change so quickly. Is the machine inaccurate. Should I even care. I am well. All readings are ok. 4.5 is edging towards concern but a way off.


But if the true reading was, say, 5.2 then +/- 15% gives a variation of 0.78 so all readings are identical


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## rebrascora

Inka said:


> And it doesn’t need to be. To continue that analogy, we’re trying to ‘herd our kittens’ _into a pen (_ideal blood sugar range)_. _We understand that our kittens will walk around a bit in that pen but that doesn’t matter. What we’re _not_ trying to do is ensure our kittens stand in the same place all day because that’s not necessarily and simply doesn’t happen.


I really like that thought. If you also consider that some of the kittens will climb out occasionally when your back is turned and need putting back, it also fits quite nicely.


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## trophywench

You'd hate it if the kittens did stay in the same place - that's not natural you'd say - what's wrong with them?


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## Gwynn

An interesting thought. What if the true reading wasn't 5.2. What if it was 4 or 12. Or pretty much anything once you get the idea in your head that the meter may not be telling the truth or anything near it. Of course as you mention it could be and the readings are fine. How do I know? 

I am speaking to the doctor this afternoon (to see what he thinks) as THE diabetic nurse does not work on Mondays. Only one diabetic nurse? 

It is all very scary to me.


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## Lucyr

The true reading can’t have been 12 because all three readings were similar and within allowed error. They were all in range so whether your true reading was 4.7 or 5.4 really makes no difference whatsoever to your treatment.


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## rebrascora

Gwynn, you are really not hearing what we are all saying and showing you. 

*BG LEVELS VARY A LOT ALL THE TIME .*..... It is not natural for them to be consistent and stable.... unless you are dead! You are trying to achieve the impossible! 

Please don't panic about this.  It has been going on in your body (and everyone else's) like this since we were born, you just didn't have a meter to see it until now.

We would be the first to tell you if there was something wrong with the readings you are getting or if we suspected your meter was faulty, but that is absolutely not the case. 
We are trying to tell you that your expectation is way too high and you need to be more relaxed about your readings and accept some variation and error margin... 
.... maybe as much as a whole mmol each side of a reading for now would be a good thing for you to learn to accept. 
So if you get a 5 it might actually be anywhere between 4 or 6 but it is still within the normal range so don't worry. Even if we say you get a meter reading of 4.2....  so following my suggestion it could be between 3.2 or 5.2  It would still be nothing to worry about because it can't go too low without a huge amount of exercise or insulin and you will know that you haven't done either of those things, so the reality is that that 4.2 reading will still reflect a BG level in the normal range.


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## Inka

Gwynn said:


> An interesting thought. What if the true reading wasn't 5.2. What if it was 4 or 12. Or pretty much anything once you get the idea in your head that the meter may not be telling the truth or anything near it. Of course as you mention it could be and the readings are fine. How do I know?
> 
> I am speaking to the doctor this afternoon (to see what he thinks) as THE diabetic nurse does not work on Mondays. Only one diabetic nurse?
> 
> It is all very scary to me.



It’s perfectly reasonable to be anxious about the diabetes. Of course it’s scary - particularly in the early days after diagnosis.

But - it’s *not* reasonable to wonder if your blood glucose meter is lying to you. All meters are tested and have an approved margin of error. Your blood sugar might not be 4.8 it might be 6, and then it might go up to 6.2 then down to 5.3. This is all *normal*. It’s also normal if it goes up to 8. You don’t need a new meter because that will present you with different numbers too. The problem isn’t the meter.

You’re allowing your natural fear about the diabetes to become all-consuming and cloud your judgement. You’re not answering posts that seek to reassure you or show you that blood sugar goes up and down in people without diabetes. You think ‘something is going on’, but it really *isn’t*. It is utterly irrelevant whether your blood sugar is 5 or 6.1 or 4.2. It’s irrelevant that you can get three different readings in 3 minutes - utterly irrelevant because that’s what your body is _supposed_ to do and the meter isn’t trying to tell you your precise blood sugar anyway.

Buy an oximeter or a BP machine or anything similar. You’ll see natural variation. Your heart rate will be 68, then 72, then 74, then 58. Unless you’re seeing results outside of the normal range, then all those different numbers are all fine.

You can’t control the systems of your body that work automatically. You can’t make them present you with the same number on repeated tests. And why would you want to?

Reduce your blood tests as I suggested early and try to relax. That can only be beneficial for your wellbeing.


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## Gwynn

Yes, ok. I think you are all correct. I have been obsessing about the numbers ever since I came out of hospital and the readings were quite chaotic and variable. I will try to take a more rational, calm view of these slight variations going forwards. 

Thanks for all of your help.


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## Docb

@Gwynn, if it is any consolation, I spent the first few months after my HbA1c went wonk taking measurements and looking to make sense in the details of the numbers.  It's what I used to do for a living so I just had to go at it.  Fiddled around with all sorts of stats and even did some Fast Fourier Analysis at one point.  Should have known better.

Took me a couple of months to come to terms with defeat in my quest and accept the reality as being exactly as I and others have suggested.  What you get from a meter is very broad brush but it is absolutely invaluable when as a T1 you are checking to make sure you have got your insulin calculations about right or as a T2 you are working to eliminate foodstuffs that your system can't cope with.  

The rapid feedback you get from the meter allows you to react quickly and accurately when things are going really awry and you are heading into hypo or hyper territory and for that may we all be truly grateful. 

PS... have you come across the diabetes fairy concept yet?  Many of us are convinced that this mischievous being flits around the country casting her mischievous spells over blood glucose levels, and she is the root cause of those minor variations which do not seem to make sense.  Fanciful I know, but it's as good as explanation of what goes on as any.


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## helli

Gwynn said:


> How do you ensure better accuracy?


Whilst there is so much that can affect our blood sugars (bad night's sleep, good night's sleep, more exercise, less exercise, stress, illness, alcohol, hotter, colder, ...) and every day is different, I think accuracy is over rated. Even the carb content of food is an estimate (who knows whether you will get the slice of cake with more or less sultanas in or the over or under ripe apple or a rise due to protein rather than carbs for a low/no carb meal?)

Take care not to obsess. I say this as someone who has done so in the past and ended up with diabetes burn out.
Plus, as stress causes our blood sugars to rise, the more chilled you are the better it is for your diabetes.

You are more than a diabetes diagnosis. Please look after all of yourself not just your "accurate" blood sugar readings.


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## Gwynn

You will not believe this... 

The doctor rang me just now so we had a chat. 

The results of the extended blood tests have finally been returned after two months and... I am not diabetic. It is thought that the hydrocortisone and my terrible lfestyle had temporarily 'blown' the system. My new lifestyle and temporary insulin seems to have slotted things into place again. Not sure how long for but any reprieve is to be welcomed. 

No way will I let it run away again if I can. The good diet stays. And the monitoring of BG. 

We also briefly discussed the varying results from my BG meter. He immediately said that they would supply a different type of meter and to continue the testing. 

Amazing.

Is that the creak of a trap door opening???


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## Inka

Yes, I do believe it - it makes sense  Nothing you said sounded like Type 1 and your regime suggested you were being treated as steroid/Type 2. It’s sad that extra anxiety was caused with the mention of Type 1.

Good news then as steroid-induced diabetes can often be reversed as I said or can resolve itself. A “terrible lifestyle” can, of course, also be altered for the better and have good effects on blood sugar.


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## trophywench

Good!


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## Gwynn

Just to let you know my last 10 readings are... 

6.1, 5.4, 5.6, 5.6, 5.2, 5.1, 5.4, 5.6, 5.9, 5.4

My weight (which was 90.4Kg) is now 76.6Kg and falling gradually (controlled diet) 

The best Christmas present ever!!


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