How to increase time InRange, part 1

Before reading, please remember, this blog is in no way medical advice, rather, my own musings and experiences in living with Type 1 Diabetes. Please talk with your GP or Diabetes Specialist team before making any changes with your management.

Everybody wonders how to best manage their diabetes and what I have found is that it comes down to two simple things, and if these things are managed well then blood glucose levels are more likely to be InRange. If you have a think about it, you can come to this conclusion too! The two main things are Insulin and Timing. Amazing isn’t it? Let me explain this further. The two main things that affect the blood glucose (BG) levels of a person with type 1 diabetes are the Insulin dose and the timing of said insulin dose.

Insulin dose – If your blood glucose level is high, you need more insulin. I know, it sounds super simple. And I know, there is a question of active insulin and numerous other things but if you think about it, when you go high after eating does it just come down on its own or do you need to do extra insulin for your BG level to come down? If it just comes down on its own, that is fab, but you could still benefit from this advice as it is the rapid changes in blood glucose levels that cause the most damage. In your case, changing the timing of your insulin dose will prevent the spike in BG level and make your glucose profile less wavy, therefor reducing the chance of complications. A person with type 1 diabetes should ideally aim for steady blood glucose levels. And yes, I know, fat lot of chance that happening but if we have tools to prevent the spikes and drops, we can help to prevent those complications and help prolong good quality of life WITH Type 1 Diabetes.

Refer back to my blog where my husband wore a CGM to see what a BG levels do all day for someone who does not have diabetes (‘A working pancreas with CGM). Take into consideration that he was not watching what he ate and he was occasionally trying to test the CGM, I assure you, it does not show! In short, the answer is that it is certainly less spikey and resembles more an ebb and flow type situation, generally hovering around the 5mmol/L mark, I know, frustrating, but there are ways to make this happen that don’t ruin your life, I promise and I will do some more blogs about these ways over the next little while. This is just one aspect, or two as the case may be that may help get you closer to a higher percentage of InRange levels.

I don’t know if anybody else finds this but if I am high (say above 12mmol/L) my blood glucose needs a lot more of a correction to bring it down into Range. Putting this into techni speak, if my blood glucose level is high, my insulin sensitivity decreases meaning that I need more insulin to bring that down than I would normally need to correct a more InRange level. I find it best in terms of management, to just not get to these levels, because once I am there I end up chasing it for a while. By chasing it I mean I do the normal correction my pump would suggest and my BG level goes nowhere, then I wait, test again, give it a little extra etc etc. I know you’ve been there! I know this sounds like loading insulin, but it is also listening to your body and what you need, as well as being aware of what you have been doing and what you are going to be doing and making an educated decision about what you need to do. Because I know that I need more insulin to correct those high levels I now add a little extra comfortably knowing that this is not usually going to make me low. Other times, I will go for a run and that will correct it without any insulin. That is completely the best course of action, but preventing that high in the first place is by far superior!

How do I do it you ask? This is a matter of talking to your health professional and doing some monitoring and self-experimenting of your own. Does your insulin sensitivity decrease when you are high? Do you need more insulin than you normally give to correct that high? Are you spiking high with meals? Does the insulin that you do work well with meals? Do you do numerous corrections on your insulin pump after a meal? Do you get a high then a low after eating?

Timing – this is in relation to food and this is really important. Despite what a lot of us have been educated about when first diagnosed or when going on to an insulin pump, we can’t just do insulin at the same time as we are eating food and hope for this to have a positive result. When insulin is done in this way it is always chasing the food and it is always lagging behind. It may catch up and your numbers may level out or drop but chances are, you may require a correction dose. How many times has this happened to you or your loved one with diabetes? It has happened to me a lot, it still happens, even though I know this information because some days, admittidetly I am too busy and pre blousing is not even a thing because I don’t have time, or because I have no idea how long it Is going to take us to get the kids to sleep or for a meal to be in front of me. When days are more predictable, this is a top tip for getting your BG levels InRange for a longer time.

Ideally, we should do our insulin dose prior to our meal, a pre bolus or pre meal injection. In some cases this is difficult or unachievable but if you are doing it sometimes that is also great. With the awesome success you have on these times, you will be more motivated to do it at other times. So, what does this actually look like? Unfortunately, the answer is that it can be different for everyone. This difference occurs for a number of reasons including achievability for different people, Insulin sensitivity, Insulin resistance, varying time requirement and BG level. Obviously using continuous glucose monitoring (CGM) helps a lot with this and really helps to reduce the fear and the guessing related to when is enough time. If you are not using CGM full time and wanting to experiment with this I would suggest getting a CGM trial or doing a week on if you already use CGM occasionally.

As I said, timing is different for everyone because the activity of insulin and that person’s insulin resistance or insulin sensitivity is different but generally everyone could benefit from a 15 minute to 45 minute pre bolus. This is relevant for both people using insulin pumps and multiple daily injections, the same theory applies. For people that express frustration with this option I often ask them to check their BG level when they get up in the morning, before a shower (now I don’t shower in the morning but I do go to the toilet and test then continue to get the two kids up and dressed and I generally don’t have breakfast before about 20 – 30 minutes after that first test). If their BG level is above 5 mmol/L and they know what they are going to have for breakfast, try doing an insulin dose then, before their shower! If they are concerned, I suggest to do half of the insulin dose then and half when they start to eat and note what difference this has made. If it hasn’t made them low, they might like to try the full dose the next day. Once this is working appropriately, a person might find that they need less insulin to counteract the same amount of carbs because the insulin has had the head start this time and the food is going in, but now it is working in time with the insulin so there should, in theory, be less of a spike.

This is the information at its most basic level obviously, there are so many things that come in to play when using insulin for type 1 diabetes management. I am going to do some more blogs on these different aspects over the next little while; some include Dual and Square wave blousing or combo blousing and the use of temporary basal rates to increase and decrease insulin levels. Please let me know if you have found this helpful or interesting or if you have any blog suggestions for me to do in the future, I would love your input!

Once again, please also remember that this information is in no way medical advice, rather my own musings and experiences in living with Type 1 Diabetes. Please talk with your GP or Diabetes Specialist team before making any changes with your type 1 diabetes management.