Dear Dani, Grace and Jude,
Note: This page is advice for Grace, Jude and John. For any other reader, it’s information only. No therapeutic relationship is formed – read this.
Type 1 diabetes is bursting with rules and guidelines that serve as a good starting point.
- 15g of fast carbs to treat or prevent hypos.
- Give insulin 15-20 minutes before meals.
- Only correct high glucose levels after two hours.
- All you need to do is count carbs, apply the carb ratio, deliver the insulin, and the glucose will stay in target.
Unfortunately, the rules are usually taught as dogmatic absolutes with no wriggle room. When the glucose does not behave the way the textbook predicts, the health care professional holds steadfast. Even when faced with undisputable contradictory evidence from the glucose results.
I know this very well!
I used to cling to these rules as a Dietitian before I was diagnosed with type 1 Diabetes in 2008. I could often be heard saying.
“You must not have counted your carbs correctly for that pizza!”
It was not until I got direct feedback from CGM that I realised just how individual type 1 diabetes is.
I discovered solid foundations must be laid first, then real learning is only acquired through experimentation. It cannot be taught in a classroom, you have to earn it.
Lessons taught by my glucose on the journey to creating Dynamic Glucose Management include:
- Change hypo treatment based on glucose value and arrow.
- Alter before meal insulin timing based on glucose value and arrow.
- Use short bursts of exercise, not correction doses, to drop glucose between meals.
- Add extra insulin for high-fat meals and spread it out.
- Always use glucose to prevent or treat hypos, never sugar.
Using CGM taught me the most essential principle of diabetes management.
The Glucose Never Lies
If the glucose level stays in target, the strategy is a keeper. If the glucose goes too high or low, make adjustments next time, no matter what the textbook or health professional says.
Let the glucose be thy guide, it never lies!
Any other principles?
Pizza causes so many issues. I eat three slices, give insulin, and go to sleep in range. The glucose sets off to climb Everest overnight. I wake up very angry!
It nearly sent me mad. I tried hundreds of insulin dosing experiments. These experiments taught me the value of trial and error with continual tinkering.
You cannot expect to get it right the first time or even the tenth time. However, you are getting closer with every failure! Hence my second principle.
Use trial and error with continual tinkering
Following the meal insulin dosing experiments, I dug into the research. At least three years lost in the weeds of how insulin works, how nutrients get digested, metabolised and assimilated, and insulin resistance mechanisms. The led to creating a Masters (Msc) module called.
A super deep dive with all the bells and whistles.
This deep dive taught me another valuable lesson. When you do not know why a strategy works, find out. Get your head in the books to understand the mechanisms.
The final principle was set.
When something works, find out the mechanisms
After the disaster of Christmas day 2018, I needed to re-learn type 1 diabetes management. I demolished my set of diabetes rules based on slow movers of glucose.
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