re: Insatiable thirst, more than just summer heat UPDATE 12/29

I've been yo-yo'ing the last 24 hours or so, so I'll be happy to get things regulated.

I injected my long acting, ate like normal because I was in range and my chart didn't recommend a shot of fast acting before a meal. Then went dizzying low before bed, so I had a spoonful of honey to snap out of it. Was in range at night, then was under 70 when I woke up. And now I'm high again after having breakfast. My graph looks like the Aggie football hopes rollercoaster right now

Of course, I let my doctor know all of this

Your lantus dose is likely too high. You need to bolus humalog before any meal that contains carbs, but your GP doesn’t know how to help find your ratio, so he is only prescribing humalog to correct a high BG. The endo will help you learn how to use humalog to help your BG stay relatively stable rather than just as a correction after it becomes too high.

Being in the 60’s isn’t a critical low. Just eat five to ten grams of carbs and you will be fine. Between 70-90 is ideal imo.

If you want to try to dial in your carb ratio, when your BG is stable after you have fasted 4 hrs or more…then give yourself 2 units of humalog and then wait a few minutes (5 to 10) and eat 30 grams of carbs. This is a 15 carbs to 1 unit of insulin ratio. Measure your BG every hour for the next 4 hours (more often if you can stand it) and chart your BG. The goal is to not spike Your BG too high and return to an ideal range within a couple of hours of eating without your BG dropping below 70.

If you spike high and it takes more than 2 hours to return to your ideal BG range, then you adjust the ratio down a couple of grams per unit of insulin until you find the right balance.

If you go low, the you adjust the ratio up a couple of grams per unit.


All of this, however, is somewhat dependent on dialing in your basal dosing of Lantus just right, because the Lantus is always working in the background so to speak. Juice Box should have some episodes on basal testing that you might find helpful.

Your GP just doesn’t have the tools for this. That’s why working with the endo is key.

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I've been yo-yo'ing the last 24 hours or so, so I'll be happy to get things regulated.

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Also, this is going to happen for a while as you go through this and figure out your needs and how different variables (exercise, stress, sleep, hydration, fats, sex, alcohol, etc) affect your body and BG. It’s a process and once you get it dialed in, something will change.

I don’t say that to discourage you, but to let you know it’s normal and don’t let it get you down.

Doctors, including endos, start off relatively conservative and work from there to get your ratios dialed in for safety reasons obviously. As learn more and become more comfortable with insulin, you can begin to be a little more aggressive to keep your BG in range more strictly.

Stay conservative at first though. JuiceBox can be controversial among endos because it challenges you to be “Bold with Insulin.” A good thing for someone who really understands it, has experience with it, and knows how to protect against lows properly. It can be dangerous for people still learning.

Also, while A1C has long been the gold standard number in medical research and practice, a better number for you to focus on now that you have your dexcom, is time in range (TIR). Do some research on time in range, but don’t stress too much about your numbers initially. Use numbers as a tool and not a grade.

I've been in range for nearly 6 hours. It's taken a little bit of snacking (I think my basal is still a little high but I'm recording everything for the endo) but I'm in range. I'm gonna make diabetes my bitch

I’m happy to offer any advice you may need. I’ve been Type 1 since the age of 11 and I’m 52 now. I have no detectable damage from the disease and my A1Cs run in the mid four range. Be very careful about your endo. Most doctors seem to be paranoid of low blood sugar and they steer their recommendations towards higher blood sugars. My advice, avoid hyperglycemia like the plague. Be scared of higher blood sugars.

Happy to offer any help I can up to including a phone call or two should you wish. Feel like I’ve achieved a level of expertise that far surpasses and doctor I’ve ever had, but I’ll disclaim that I am NOT a doctor.

I saw the endo today and my mind is much more at ease. Like I said previously, I started messing around with carb ratios and 1:15 seems to be working for me. I shared that with my doctor and he said I can continue that. He also cleared me to start running again and advised me on how it can affect my insulin dosing. He generally recommended lowering carbs but I was honest and said if i'm running 40-50 miles per week that I'm not cutting back carbs. The advice was then to make sure my food is as unprocessed as possible, and cook at home when I can so I know what's going into it. Those are things we already do, so that's no big deal.

He told me he likes to be relatively aggressive with insulin and that it's very possible we will "flirt with lows" with that strategy, but I told him I'm fine with that. I know my body and can adjust things. He did have me split up my Lantus dose to take half of it twice daily rather than all at once.

He also brought up pumps and said I can discuss getting one at my follow-up in 6 weeks. He prefers the Medtronic but it's ultimately up to me on which one I get. He mentioned the InPen as an option too. His philosophy is that, in the long-term, people are going to manage it better if they have less to think about and pumps are allowing for that because they're rapidly improving the tech they use. I'm not sure if I want a pump yet, and I'm not sure which one I'd want if I do get one.

Oh and I woke up farsighted this morning. I tried to read the nutrition label for my breakfast and couldn't see shite when I held it close. I let him know that and he said "that's because your glucose isn't 300 anymore" I expect my vision to get back to normal as I stay in range. The body does some weird stuff.

WDE, Lakeboy, StreamsOfWhiskey: if y'all have input on pumps, I'm all ears. I have no issue doing daily injections but if a pump simplifies things, especially with running, I like that too.

Hey man good update!

Agree on the carbs if running. You will have to play with the math as much as you run just set your CGM to alert for lows. I’d scale back mileage initially to be safe.

DIL went with Omnipod. Wearable and water resistant (can take a shower).. Good for 3 days then you move it.

She was very diligent with eating, monitoring and dosing. Her goal was under 150 (I think) and after a month on the pump with no change in routine she is down 12-15% which is great AND less work, less anxiety at meal time.

Now you start the tweaking process. Reading labels, portions, how your body react to carbs, exercise. Going out to eat, travel, what low carb beer taste best (Flight by Yeungling).

I’ll share with you my thoughts on what the ideal blood sugars are. If you want to live a life of longevity similar to a person without Diabetes, you must run your sugars like a non-diabetic. Non diabetics typically do not see blood sugars of 150. Aim higher. I try and keep my blood sugars in a nice tight range where 80 percent of my week is spent between 60 and 110 bs levels. Don’t let a doctor lull you into thinking that because you’re diabetic your standards should be different.

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I’ll share with you my thoughts on what the ideal blood sugars are. If you want to live a life of longevity similar to a person without Diabetes, you must run your sugars like a non-diabetic. Non diabetics typically do not see blood sugars of 150. Aim higher. I try and keep my blood sugars in a nice tight range where 80 percent of my week is spent between 60 and 110 bs levels. Don’t let a doctor lull you into thinking that because you’re diabetic your standards should be different.

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I 100% agree with this. Your endo sounds like he supports this, which is good. We used to “get in trouble” on our endo visits because they were concerned my son was too low fora diabetic. After a while, they realized we knew what we were doing and we get support. Now my son is at an age where his compliance is less than perfect. We are trying to give him a little room To work through it and own his management, but it’s difficult with the foresight and emotional swings of a hormonal 13 year old.

Understand that other medical professionals you deal with will prefer higher BG numbers because they fear emergency lows and won’t be around in 30 years when the chronic high blood sugar effects could ravage your body.

Aim for normal BG numbers for a non-diabetic and use those parameters to set your time in range limits. Then try to keep improving your time in range without beating yourself up about misses.

Ran 5 miles this morning before breakfast and my BG stayed remarkably consistent. Here's hoping that continues. I'll play around with time of day since usually my workouts are in the afternoon