Thoughts on Blood Sugar Control with Age

Comments from SF East Bay Type 1 Women’s Group starting 5/16/2013

On Thu, May 16, 2013 at 6:27 AM PST, F1 wrote:

Wondering about blood sugar control with age .. Had it 36 years and harder to control .. More brittle..anyone else having the same problem? Thx

On Thu, May 16, 2013 6:42 AM PST, F2 wrote:

As for blood glucose control and age, yes, I flow in and out of brittle diabetes.  It makes things harder to, control and I’ll admit it’s thrown me off of exercise.  I usually pump to manage it. (Right now I’m taking an extended break from the pump just to use up a bottle of Lantus though.)

I’d love to hear any tips any of you might have.

On Thu, May 16, 2013 at 8:25 AM, F3 wrote:

I am also interested in hearing what you all have to say, as always.  I have not had diabetes that long (about 15 years now) but I feel like I will have my basals set and all is good for a few months then I am back to having to readjust my basals (sometimes up and sometimes, like now, down).  Anyone else experience that?

I’ve had it for about 17 years and have found the same thing – sometimes will have to adjust basals up and down.  I usually find there’s a reason though – a fluctuation in stress, exercise, etc.  It’s rarely just random for me.

On Thu, May 16, 2013 at 9:36 AM, F4 wrote:

For you ladies who’ve had it longer, do you think it just slowly gets more and more brittle?  Or also fluctuates?  I wonder if there’s research on this.  Anyone know of anything?  I’d be curious to know what’s in store. :)

On Thu, May 16, 2013 at 9:42 AM, F5 wrote:

yes, between perimenopause for years and 20 years of pumping, I’ve had plenty of inexplicable ups and downs, what you could call brittle. Then throw thyroid issues into the mix and it’s even worse.

For years I would alternate between two basal profiles, a lower one for a couple of weeks before my period and then a higher one for a couple of weeks during and after. Then, starting around age 46 that was all out of whack with the advent of perimenopause. For about 9 years until just this past year, I was all over the place, day by day. I eat the exact same breakfast every day and bolus the same (with any adjustment for starting blood sugar), yet I’d range anywhere from low to 300 afterwards. No rhyme nor reason. I was constantly adjusting my basals and whatever I did was usually only good for two or three days before I’d have to adjust again. My explanation was hormone fluctuations due to perimenopause. Now for the past year that I’ve been in true menopause (no more periods for over a year), that has gotten much better and I pretty much can stay on one basal pattern.

However I’ve had another wrinkle at different times during my pumping life. First, about ten years ago after being really bad about site rotation for the first ten years on the pump, I completely overused my stomach area and had to give it a break for 8 months. I started using other areas of my body and in conjunction with that switched from Quicksets to Silhouettes (Quicksets just weren’t working in those areas). After 8 months I added my stomach back into the rotation plus started being really strict about rotating and tracking how I was doing it. I also started changing my sites every 2 to 2 1/2 days faithfully. That worked great for about 9 years until last fall. Then all of my old sites basically stopped working and I’d be in the 300′s all the time even with frequent change of sites and about a 30% increase in my basals.

So I stopped using all of my regular sites and for four months started completely different sites mostly on my upper back and along the sides of my ribs. You need someone else to insert for you in those areas. Plus I have no fat there at all so I could only use the 13mm Silhouettes and the insertion had to be done just right to get it into the miniscule amount of skin that could be pinched up. I also faithfully changed sites every 2 days. However, voila, that worked beautifully! My blood sugars were constantly around 90-120 even with a drastic lowering of my basals! So that confirms my theory about overused sites, scar tissue, etc. Now just a couple of weeks ago I started adding my old sites back into the mix because I was afraid of overusing the new back sites. I found that one area (love handles) did not work at all. My stomach seems to be okay, but had to raise my basals again and it’s inconsistent again depending on the specific site. So even though a four month rest definitely helped, I think a longer rest would be better. I’m now considering trying my arms or lower butt (the part I sit on) as sites on the word of my endo’s office who says some people use those areas successfully.

To summarize, I think a lot of the problems people are having the longer they have diabetes could be related to either hormonal issues with perimenopause and menopause  as well as overuse of pumping or injection sites. It’s very frustrating and the more time that passes the more of these problems we’ll all face.

On Thu, May 16, 2013 at 10:00 AM, F6 wrote:

I’ve had diabetes for 48 years and have been in menopause for 3 years. I don’t really have any more trouble now than I ever did (just less enthusiasm to give #$&t). My basal is almost perfect (it’s eating I have trouble with). I find the best way to really check basal rates is to fast. And I’m talking a 24 hour fast. In the night you have to wake yourself every 1.5 to 2 hours to see what’s happening and in the day you have to test every 1-2 hours. It’s really the only way to get your basal correct; eating during the day will just mess things up. It’s hard to do, but it works. You’d be surprised how an incorrect basal rate at 1:00am can mess you up 8 hours later. BTW, if you find you just can’t fast for that long, eating a few nuts goes a long way and doesn’t affect your blood sugar.

On Thu, May 16, 2013 at 10:15 AM, F7 wrote:

Wow, F5, thank you for your long, detailed response!  I learn so much from all of you!

I am still new to this, diagnosed 3 ½ years ago, and on the pump 3 years.  I find my best site functionally, where it is not in the way and getting knocked out, is on my upper abdomen, above any waistbands.  Thanks to weight gain from the insulin, I have plenty (too much) of real estate there, but I do wonder if/when I will be wearing out that region.  I have not tried the back, but I do not like the lower abdomen, hips, thighs, etc, because I always end up knocking it too much.

My other question is about the feet.  My feet are already showing changes.  They are much more dry, and get slightly swollen if they are down for very long periods.  The skin on my feet and lower legs looks reddish, and of course, if I scrape my leg, it takes way longer to heal than before Diabetes.  If I get any aches or pains in my feet now, I do not know if these are the usual symptoms of Type 1 Diabetes, or if there is actually something else going on like, Arthritis, Gout, a pulled muscle or ligament, etc.  I don’t want some problem to be missed because it is assumed that it is a Diabetic Neuropathy.

Any input from any of you is welcome!

On Thu, May 16, 2013 at 11:27 AM, F6 wrote:

One more thing regarding fasting. My blood sugars love a day off from eating. It’s very mentally satisfying to test often when the results are in the normal range (it makes me happy) and often times my blood sugars remain in the normal range for 4-5 days after.

On Thu, May 16, 2013 at 11:57 AM, F8 wrote:

Hi, all. I never get to the meetings anymore and I love to hear people’s experience and tips on this chain. I know there is the tudiabetes site and stuff but haven’t waded in there yet.

A colleague recently recommended Dr Bernstein’s Diabetes Solution book to me (he is a long-living type I diabetic with a very interesting history who advocates a very low carb diet, basically lots of green veggies and protein and fat) to keep blood sugars in the 80-90s range at all time. He says that there is so much variability in how carbs and insulin are absorbed every day that the only way to deal with that is to have few carbs. I have been grappling with trying it, but not really ready yet to try it even for 24 hrs! It’s like the fasting basals. I know i should be it’s very hard for me to do it. I have cut way down on my carbs and it has helped somewhat. It also brought down my cholesterol and LDL and Hgb A1c, all of which had risen recenly. Interesting to me, that at least a few long term folks with type I who have NOT read his book came to the same conclusion on their own that they had better control if they did not eat bread, rice or fruit.

Anyhow the point of this, F7, is that I met a guy with diabetes at a berkeley beer and basals group who had started to develop peripheral neuropathy and went on Dr. Bernstein’s eating advice for a year and a half and reversed it completely. He said it’s hard but not impossible and was totally worth it to him.

all the best to all of you!

On Thu, May 16, 2013 at 12:27 PM, F9 wrote:

hi all

this message board is great.
okay, i have had diabetes 26 years and i study a lot about new drugs and technology for diaTribe. here are a few newer things we have heard:
- I know there’s been a lot of talk online about CGM - anyone trying to figure out better mgmt (for those on pumps – basal rates; for everyone, sensitivity factors, insulin to carb ratios etc), definitely get your hands on one. I would be really curious how many in our population have CGM – if you are willing to let me know, email me directly (not the group) and let me know what pump and CGM you wear and i’ll report back
- Why I really wanted to write – I’ve taken some type 2 drugs “off label” that my insurance (Aetna) pays for and I’ve had a lot of help from these drugs. Obviously only do this working with your healthcare team and only if you and the team think it might work for you and only obviously if you know these are not approved for type 1 (yet).
#1: GLP-1 – here is what my experience has been on GLP-1 – I’m on Victoza and have had some good success with it since 2010. I wrote a letter to Novo Nordisk the maker, asking them to test it in type 1. Many people wanted them to do this and now it is in phase 3 testing with thousands of type 1 people – but it will still most likely be some years off (maybe 2 or slightly longer) before approval. Here is the updated letter that includes a piece from NN.

#2: INVOKANA – this is a new drug class called SGLT-2 that got approved for type 2 diabetes in late March. Here is the background on the Invokana approval, what happened at FDA, and some info on how this class works. I have taken this for one month and again, this is completely “off label” – but my doctor said he thought it was a good idea to try it. It is a pill you take once a day and I’ve had a really good experience with it – it lowers my BG about 25-50 points or so and seems like I have fewer spikes. I do not have great data (I don’t download my CGM) but it feels much better and I put my basal rates down twice. You can read more about it but the researchers I’ve heard like it because it’s a “unique mechanism” – that means it should work to supplement what insulin is doing. Not promoting this at all (!) but I heard about it from other type 1s taking it and wanted to give the anecdotal info I’ve had.
#3: Artificial Pancreas: i’m doing a Closed Loop trial with a group in Boston to see about the artificial pancreas. In this trial, you get to wear the artificial pancreas for five days. It’s very cool. We haven’t written about it yet but you can see a great piece on DiabetesMine and here is a video of the head researcher. I just mention this because it seems like it is moving faster now and this is a very exciting sytem. You wear two pumps (kind of a pain granted) that have insulin and glucagon, a CGM, and then they have algorithms that run it all – let me know if you are interested and i can tell you more after the trial ends in early June. If you are interested in being in the trial, you have to be able to spend a few days in Boston – if you want more info write to Courtney here.
Take good care and thank you again for this wonderful list. My apologies on talking about the stuff not approved yet for type 1 for anyone who is not comfortable with it – definitely am not promoting any of it, but for a long time I had a dr who would not have recommended any of this and now I see someone who is up for looking at newer things that might help type 1 but are not yet approved.

On Thu, May 16, 2013 at 12:40 PM, F5 wrote:

FYI – I’ve been using a CGMS for years and Symlin at breakfast for 8.

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