These few pointers may not only help the newly diagnosed but also help the experienced people in managing diabetes to revisit and make changes as required.
Background:
Type 1 Diabetes / T1D is an autoimmune condition where the pancreas stops producing insulin due to the destruction of insulin-producing beta cells by the immune system, thereby people with type 1 diabetes have to inject insulin multiple times a day and ensure blood sugars are in the normal range by frequent monitoring of sugars using glucometer/glucose sensor.
Author info:
I’m Lakshminarayana Varimadugu, Certified Diabetes Educator from Hyderabad. I’m a person with vision impairment (100% blindness) by birth and was diagnosed with Type 1 diabetes at the age of 17. No connection between the 2 of my challenges. I wrote this blog based on my experience as a person with T1D as well as Diabetes Educator. Hope you’ll love this blog and benefit from it.
Thanks to Sirisha Mantha, Certified Diabetes Educator, mother of a child with type one diabetes, from Hyderabad, for reviewing and providing valuable suggestions and comments to the blog.
Introduction:
Glucose fluctuations are common in people living with type 1 diabetes and our job is to minimize the fluctuations through better diabetes management. Maintaining normal HBA1C is crucial. Many diabetes-related complications can be reversed/managed well by concentrating on the root cause i.e. Normalizing blood sugars.
“The higher the HBA1C and fluctuations, the higher the chance of getting complications.”
‘Time in range’ is another achievable standard for people with type one diabetes. Good Standard Deviation (minimizing the fluctuations) is important too, even while having a good A1C and good Time in Range.
Confused where to start learning diabetes management? Follow these 10 steps to kick start the art of diabetes management.
1. Acceptance:
Understand diabetes management by debunking the myths and understanding the facts about type 1 diabetes. Acceptance is the key to starting learning DSME (diabetes self-management education). Compliance with diabetes management will only be possible after one accepts multiple BG checks, multiple injections, etc. Are you or your child newly diagnosed with type 1 diabetes? Click here to know more tips for newly diagnosed. Are you still feeling hopeless and worried about life? You can see the video “victory over diabetes awards 2021” in which there are people with T1D who lived 60+ years with type 1 diabetes and their lives are an inspiration for all of us.
“Accept and understand the autoimmune condition, its requirements, stay away from fake cure suggestions. These often do not understand the autoimmunity part of type one diabetes. Never replace insulin”
2. Multiple Blood Glucose checks:
The more you check your BG levels the more you understand the condition. Your diabetes management is highly linked to BG monitoring. Most of the severe hospitalizations due to severe low sugars and severe high sugars can be prevented through frequent BG monitoring. Not just BG checking but Understanding, analyzing and interpreting glucose levels is equally important in achieving good BG readings. Daily normal BG readings are key steps towards good HBA1C. Want to know the factors which can impact glucose fluctuations? click here.
“As a person with T1D I feel confident that I can predict my BG levels wherever I’m in this world and I won’t feel disturbed because of my diabetes if I have to check and correct my blood sugars when needed”.
3. Basal insulin setting:
Whether you are on pump or injections, basal insulin setting is the key to kick start learning diabetes management. Even though you start Having a healthy diet, good activity, frequent BG monitoring, food and correction bolus, etc, it feels meaningless and all the efforts go wasted Without proper basal insulin setting.
The purpose of a proper Basal insulin setting is to maintain consistent normal BG ranges throughout the day. To put it simply: it maintains constant normal BG ranges in the fasting stages of the day by preventing BG fluctuations. It is important to note that the purpose of basal is not to drop blood sugars during fasting and do not expect basal to act like food bolus. The basal needs may keep changing during growth, puberty, sickness and other instances. Take help from your health care providers such as doctors and diabetes educators in setting the basal insulin You can read more on basal insulin setting by clicking here.
“Basal insulin can not be skipped and should be injected every day at the decided time. It is independent of the meals”.
4. Food bolus:
Understanding your short-acting/rapid-acting insulin is very important to analyze BG fluctuations. Understanding the food along with its components helps to bolus properly and prevents severe highs and lows. You have to adjust your bolus insulin according to the food components like carbs, protein, fats, fiber, etc. One should know approximately how many carbs a 1 unit of their short-acting insulin covers. Pls, take the help of your doctor and diabetes educator in understanding the food bolus. To understand nutrition information of different foods, you can read the book “Diet In “Diabetes Simplified: Your Personal Diabetes Nutrition Coach”
Insulin carb ratio/carbohydrate coverage ratio = 500 ÷ Total Daily Insulin Dose = 1 unit insulin covers so many grams of carbohydrate. It is also important to eat a similar amount of carbs at a similar time, have a check before eating and 2 hours after eating and not do anything that can impact the bolus dose, for a few days to estimate the IC ratio better rather than just relying on the formula.
“This formula is only for rough estimation to calculate the bolus dose and usually your doctor sets it. This is to know where to start and slowly you will estimate the doses for particular meals of your choice. “
“Consistency in meals and moderation without the feeling of deprivation is the key towards successful diabetes management.”
5. Correction bolus:
The short-acting / rapid-acting insulin also does another important work i.e. can bring your BG ranges down when they are on the higher side. One has to take a correction bolus according to one’s insulin sensitivity factor. Maintaining normal pre-meal BG can only give good post-meal BG levels. Take the help of your health care provider in knowing your insulin sensitivity factor before taking correction bolus.
We use the “1500 rule” to calculate the insulin sensitivity factors for people who use Regular (short-acting) insulin. The 1500 rule works as follows: Divide 1500 by the total daily dose of Regular insulin, in units.
We use the “1800 rule” to calculate the insulin sensitivity factor for people who use the rapid-acting insulin analogs lispro (brand name Humalog), aspart (NovoLog), and glulisine (Apidra). This is done by dividing 1800 by the total daily dose of rapid-acting insulin.
“In some instances, food bolus and correction bolus have to be added and joined with a specific waiting time before eating after injecting the short-acting insulin, to ensure that the postprandial bgs are in target ranges”
6. Healthy balanced diet:
Balanced diet includes proportionate protein and fiber along with carbs. Vegetables are a source of good fiber in your diet. Examples of protein sources are eggs, soybeans, paneer, chicken, fish, etc. Having carbs alone can shoot up the BG levels rapidly as carbs get digested faster. Insulin may not catch the carb-related BG spike immediately. Having proportionate protein and fiber along with carbs can slow down digestion and maintain consistent post-meal BG levels. Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels: Read more on food orders to manage post-meal blood sugars.
“Diet for type one diabetes is designed to provide maximum nutrition while monitoring the intake of carbs, proteins and fats”
7. Handling hypos and hypers:
One should be able to handle high and low BGs effectively only through frequent BG monitoring. To effectively handle a hypo, one needs to know approximately by how much mg/dl, 1 g of glucose raises. This is often determined by the weight of the person. To manage the hyper, one needs to know how much mg/dl one unit of their short-acting insulin drops
Choosing food with lower carbs helps to bring down the high sugars effectively in a short time. Having more fluids such as water, buttermilk, lemon juice with salt, etc. is very important to prevent dehydration on higher sugars.
“Low sugars should be treated with sufficient simple carbs. Treating hypo either more than sufficient or lesser can result in a roller coaster. High sugars have to be treated with insulin according to ISF Or correction factor.”
When the basal is set properly, the bolus is correctly calculated and given at the right time for healthy meals consisting of measured carbs, proteins and fats, also when the minor hypos and hypers are handled well, normal blood sugars without much roller coasters can be achieved, similar to the graphs below. Frequent checking can give enough information to make suitable decisions and can help one to be proactive to handle hypos and hypers much ahead of time before they turn out to be dangerous. Please note that we cannot be perfect all the time as there are about 40-50 factors affecting blood glucose.
8. Reliable sources of diabetes management:
Right diabetes education should happen from authorized institutions and online sources. Every person with T1D should have scientific knowledge and should be able to differentiate facts from unsolicited advice. Some examples for authorized sources are “American diabetes association”, “diabetes.co.uk”, “Dr. Mohan’s diabetes specialty center”, “JDRF ”, etc. In India, we have information from experienced T1Ds through Blue Circle diabetes foundation blogs.
“I hope every person with T1D and parent having T1D child becomes certified diabetes educator.”
9. Joining the T1D support groups:
I strongly encourage people with Type 1 Diabetes to join T1D support groups and participate in the events. T1D is a living condition and it is a way of life. Support groups address not only physical health but also social, cultural, emotional aspects. Being part of the group, you can find similar people and share your feelings comfortably. You can learn practical experiences from experienced T1D adults and parents having children with T1D. Examples for the support groups are Type 1 diabetes foundation of India, Sweet Souls, Type One Thriving, BlueCircle Diabetes Foundation, DIABETES INDIA YOUTH IN ACTION, THE DIABETES FOUNDATION, Juvenile Diabetes Foundation, Diabetes Awareness and You, etc. Following pages, channels, groups, etc. of the support groups on social media feels connected with the T1D community and fosters the learning and coping with T1D. Excited to know about the T1D support group in your area? You can click here to find a support group in your local area.
Image of the first sweet souls meeting with T1 warriors in Hyderabad.
Type one Thriving (Tot) conducts virtual meets for T1D Tots and engages them in interesting activities while teaching them about diabetes management and encouraging them to be bold and to open up, and to make online T1D friends from different places.
The picture below shows some of their events conducted virtually:
“Salute to all the leaders who are running support groups.”
10. Regular tests:
Regular tests are important for people with T1D for a lifetime. Regular tests include HBA1C, kidney tests such as ACR, Microalbuminuria, retinal tests such as fundus, etc. Your health care provider advises different tests based on your health condition. The HBA1C test gives average blood sugars in a span of 3 months and it is a mandatory test for all people with diabetes every 3 months.
“Regular tests prevent severe complications by providing the timely status of your health .”
Disclaimer: This blog is only for educational purposes; It should not be considered as a replacement for your doctor’s advice.
Conclusion: Diabetes management is an art and science. Start learning and normalizing your blood sugars from today.
“Love your diabetes; it loves you back.”
