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Dr. Steve Edelman, a type 1 diabetic and endocrinologist, shares strategies for spending less time and increasing your range on the blood sugar roller coaster.
There are some everyday things you can do to keep your blood sugar levels between 70 and 180 mg/dl (time within range). Some things I've already done, some things I have fond memories of, and some new ideas.
He is the Director of the Endocrine Fellowship Training Program at the University of California, San Diego. control diabetes (TCOYD) outlined its top 10 recommendations for staying within range at the recent ATTD conference in Florence, Italy.
With these tips, insulin-dependent diabetics can spend more time on the range and less on the roller coaster of highs and lows.
“I truly believe, without question, that this is the most important advance since the discovery of insulin,” Edelman said of continuous glucose monitoring (CGM). The use of continuous glucose monitoring technology is rapidly increasing, but more needs to be done to increase access and adoption. “I'm very happy about the fact that everyone is working on it, but there's still a vast majority of Type 1 people in the world who don't have CGM.”
Maintaining blood sugar levels in the 70-180 mg/dl range for at least 70% of the day means the goal is to stay within that range for most of the day and avoid hypoglycemia as much as possible, he says. He said that. TIR guidelines call for approximately 17 hours in this range, if above 250 or below 70 he should not exceed 1 hour, and below 54 he should not exceed 15 minutes.
“Diabetes is hard,” Edelman said, adding that it's important for people to know that “you don't have to be perfect all the time” to stay healthy.
“Alerts and alarms are your friends,” Edelman said, encouraging people to choose sounds that are less annoying. (Don't choose a baby crying alarm sound, he joked.) The settings are meant to help you, not drive you crazy. He also suggested lowering the upper limit on daytime alert settings.
“One way to improve range without changing anything with insulin is to lower the high alarm,” he says. “If your goal is 70 to 180 mg/dl, why would you set the limit at 180? Once you hear the sound, you're out of range.”
Edelman recommends lowering the daytime high alarm setting to 150 or 160 mg/dl. “At night, it's a good idea to keep your settings high to avoid waking up too often. This simple setting change will improve your time on range and reduce your time out of range. It will be shorter and your A1C will be improved.”
“Most health care providers don't teach their patients how to deal with trend arrows,” he says. “When you go over a ceiling, you want to react to it.”
He recalled a study from several years ago. They asked people marked with an upward diagonal arrow to add 50 points to their current blood sugar level and correct the increased number.
“This probably underestimates their true needs, but we wanted them to understand that when the arrow goes up, they need more.” said Edelman. “When the arrow is down, [to do] Whatever you do, just wait until it stabilizes. ”
The base dose and rate settings are the basis for all other settings on the CGM. If these are not correct, nothing else will work properly. These settings are especially important for people who use multiple daily insulin injections, users of pumps that are not connected to a CGM, and certain automatic insulin delivery systems.
“Make sure you get training on how to test basic abilities,” Edelman cautioned. Most endocrinologists will suggest a starting basal rate, but to be sure, it's also helpful to perform your own basal rate test.
Edelman acknowledged that the biggest frustration for insulin-dependent diabetics is probably figuring out how to avoid postprandial spikes and staying away from the roller coaster of highs and lows.
“We've found that taking insulin 20 to 30 minutes before a meal makes a big difference in postprandial blood sugar levels,” he says. Taking insulin 20 minutes before meals, rather than at mealtimes or 20 minutes after meals, can significantly improve your running time.
“The problem is remembering,” he added. He said requesting a prescription for fast-acting, quick-disappearing inhaled insulin could be a solution.
Eating is supposed to be fun. Edelman warns that trying a diet full of foods you don't like or one that's unenjoyably low in carbohydrates won't work, Edelman warns.
For example, he said he was making something he called “.Taco time within rangeUse iceberg lettuce for the wrap instead of tortillas. “You have to choose what you like,” he told a room full of ATTD health care workers. “You can't force them to eat food they've never tried. They have to choose what they like.”
Learn more about choosing the right foods. “I love peanut butter, ice cream, cupcakes, and cookies. Unfortunately, when I'm feeling down, I can be quick to eat them,” Edelman said. “Then you rebound and have to give a bolus and it’s another roller coaster ride.”
Instead, choose a small amount of candy or fruit juice, he said. He said he likes to treat his complaints with candy corn, but the limit should be around 18 (which equates to 20 to 30 grams of carbohydrates, depending on the brand). As I warned you, it's not always easy to stop eating.
There are now easy-to-use glucagon options on the market. Edelman emphasized that everyone should carry an unexpired ticket. “We have glucagon in our noses,” he said, referring to Baksmi. “We have Gvoke Hypopen, which is very easy to administer, like an EpiPen.”
Edelman points to Tandem's t:slim Highly recommended for diabetics. Currently available in the US.
“You have to find a system that fits your needs,” Edelman said, noting that he himself uses an Omnipod DASH. “I encourage people to look at each one and not make a decision until they've seen them all,” he said, noting that what they choose is usually the right one for them.
Edelman praised the technology of the automated insulin dosing system, which has dramatically improved delivery times. “Before hybrid closed-loop, since when was it possible for a patient to get his A1C below 7 without hypotension?” he asked. That was just not possible. ”
“Exercise makes up for mistakes,” Edelman says.
Exercise for people with diabetes is essential, but it can have a big impact on blood sugar levels in people with type 1, so it requires education and preparation. “That's important, and I tell my patients they can exercise at any age,” he said.
Edelman ended with three additional notes on how to “keep your mental time within bounds,” as he calls it.
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you are your best advocate
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Be smart and persistent.knowledge is power
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Celebrate your victories, no matter how small, and find your dear buddy!
Photo credit: Tsukoid