Talking type 1 is proudly supported by a Bronze Sponsorship from Animas Insulin Pumps 

The aim of these pages is to provide a "talking" place about all sorts of issues and experiences relating to living with type 1 diabetes. We will continue to add to these pages and we encourage you to contribute to them as well.

Questions to ponder

In thinking about what you read at these pages, it might be helpful to consider the following questions.

• What stood out to you in the story and comments?
• Did you connect with something in particular?
• Why did this stand out to you, what did it connect with in your own story?
• Did reading this bring up any images or pictures for you? Maybe you have an image about someone else, the person whose story you read, or perhaps a memory or image of your own experiences.
• What difference has it made to read other people's stories and comments? Will it make any difference to the way you go about your life and your diabetes?

Please share your comments and thoughts! Drop us a line This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you have a story or comment to share about what you read here and we will post these at the "Talking type 1" page for others to share.

Type 1 diabetes - the basics

Diabetes is a condition where there is too much glucose circulating in the bloodstream. This is the same for all types of diabetes, your garden variety type, or wild and wonderful types!

Glucose is the main source of energy for our bodies and comes from the food we eat. Insulin is released by the pancreas, to transport the glucose out to all the cells of the body The cells, such as the muscles, brain and organs need this glucose to obtain their energy and work.. Without insulin the glucose simply builds up in the blood stream and the body is unable to access enough energy to function properly.

Type 1 diabetes used to be called insulin dependent diabetes or juvenile diabetes. Over the years this has become confusing as many people with Type 2 diabetes eventually need insulin to manage their diabetes as well and adults can also get type 1 diabetes.

In Type 1 diabetes, the pancreas cannot produce insulin because the cells that actually make the insulin have been destroyed by the body’s own immune system. The Islets of Langerhans is the area in which the endocrine,( hormone-producing) cells of the pancreas are grouped. Discovered in 1869 by the famous German pathological anatomist Paul Langerhans, the islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas. There are about one million islets in a healthy adult human pancreas, which are distributed evenly throughout the organ; their combined mass is 1 to 1.5 grams.

Hormones produced in the Islets of Langerhans are secreted directly into the blood flow by (at least) five different types of cells:

• Alpha cells producing glucagon (15-20% of total islet cells)
• Beta cells producing insulin and amylin (65-80%)
• Delta cells producing somatostatin (3-10%)
• PP cells producing pancreatic polypeptide (3-5%)
• Epsilon cells producing ghrelin. (<1%)

Interestingly the rest of the pancreas remains intact - it is like the islet cells are seen as the "bad guys". This insulin must be replaced. People with Type 1 diabetes must have insulin every day to live. At this stage that means insulin injection via an insulin syringe or pen, or an insulin pump. While Type 1 diabetes can and does occur at any age, it usually starts in childhood, the teen years and in young adults, with the peak age being 11 years old. It is most common under 40 years of age. People diagnosed as adults can find it tough going as it can be assumed they have type 2 diabetes due to their age. There is also an adult onset autoimmune diabetes (LADA) which is basically type 1 diabetes in adults - it has a slow onset, not quick like the usual type 1 diabetes and is also often misdiganosed initially, as type 2 diabetes. A simple blood test can tell you have type 1 or autoimmune diabetes.

Type 1 diabetes is the least common form of diabetes, with just 10-15% of all people with diabetes having Type 1 diabetes. Some people with type 1 diabetes feel this makes them unique and special! Others feel that there is not enough focus on type 1 diabetes and it is certainly the case that confusion reigns when it comes to the types of diabetes, causes and consequences. The media often fails to differentiate between types of diabetes and many young people with diabetes become sick of being asked "did you eat too much sugar" or " but you don't look overweight"! There is some argument for type 1 and type 2 diabetes needing separate names to overcome this confusion. But for now we are stuck with the current labels. While things are changing, this is still a common issue for people with type 1 diabetes.

Peer Support Program - JDRF

The Juvenile Diabetes Research Foundation Peer Support program is seeking adults who have been living with type 1 diabetes, and parents who have children with type 1 diabetes, who understand the trials and tribulations, and who would like to support other adults and families who have been recently diagnosed. Sharing experiences prevents feelings of isolation and helps overcome the trauma of diagnosis.

The JDRF Peer Support Program provides:

> free access to a volunteer-based support network for newly diagnosed adults and families across the country
> trained, local volunteers giving personal, non-medical, support through shared experiences.

For more information on getting Peer Support or becoming a Peer Supporter please contact:

SA: Carmen Bishop: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 08 8338 3677

NSW: Helen Farrer: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 02 9966 0400 ext 209

VIC & TAS: Emily Werner: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 09 9696 3866 ext 204

WA: Anna Coneglan: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 08 9444 9137

QLD & NT: Georgina Duncan: This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 07 3831 0544

ACT: Jessica Fredin This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 02 6249 8555

Who is most likely to get Type 1 diabetes?

We still don’t know what actually causes Type 1 diabetes in the first place. We are getting closer to understanding more each day as researchers invest a lot of time seeking answers. It seems that new type 1 diabetes cases are increasing in developed countries and Australia is high on the list. We do know it has a family link, but this is not as strongly linked as it is in type 2 diabetes. We also know there are some envrionmental factors involved in the "tipping" over or trigger, which starts the process of autoimmunity in type 1 diabetes - and there are a range of ideas here such as exposure to wheat or cow's milk.

In addition it gets more confusing as some people say that they got type 1 diabetes and nobody else in the family had it, others can pinpoint relatives scattered throughout their family trees. We do know that some people are born with the predispositon to develop type 1 diabetes and research is looking at the markers for type 1 diabetes in those at higher risk and then seeking possible ways to prevent it developing.

Research shows that a trigger is needed for the immune system to start damaging the pancreas. These triggers are thought to be factors in the environment, which are still not fully understood and it is suggested that the trigger might be different for different people.

We know Type 1 diabetes occurs when something triggers the immune system to destroy the insulin-making cells in the pancreas, such as a virus. This is called an autoimmune reaction. While the cause of Type 1 diabetes has nothing to do with lifestyle, a healthy lifestyle is very important in managing the condition. In reality this sort of lifestyle is one that all people would benefit from and orms the basis of a healthy and long life.

Once the body’s immune system, whose job it is to protect us from infection, starts to attack the insulin producing cells (beta cells) of the pancreas, it can take from a few weeks to many years for all of the beta cells to be destroyed. The pancreas has many beta cells to spare, so symptoms of diabetes do not occur until more than 90% of the cells have been destroyed. In adults diagnosed with the slower form of type 1 diabetes (Lada), this can take many years. In children the process is usually quicker and onset of diabetes symptoms are acute and significant.

Signs and symptoms

When type 1 diabetes develops blood glucose levels may rise up to five to ten times the normal level! Normal levels sit about 3.5 mmol - 8 mmol. This can be a pretty horrible trip on the way up. Anyone who has experienced the overwhelming thirst of undiagnosed type 1 diabetes knows what we are talking about - if you have never experienced this, we can not help you to fully understand. Imagine putting your mouth under a fast running tap for a week and still not quenching your thirst and you might get some idea!

Excess glucose then spills over into the urine, taking water with it which leads to frequent urination and dehydration. Thirst increases as the body tries to compensate and that unquenchable thirst results. Excessive tiredness, infections and mood changes are also common.

The body is unable to use glucose from food for energy and starts to break down fat and muscle leading to weight loss over weeks or months. The breakdown of fat causes chemicals, known as ketones, to accumulate in the blood, resulting in abdominal pain, nausea and vomiting. If undetected, glucose and ketone levels become very high in the blood stream with severe dehydration and loss of salts from the body. This is called diabetic ketoacidosis (DKA) and coma may occur.

Common Signs and Symptoms of type 1 diabetes

Going to the toilet frequently to pass urine

Excessive thirst and drinking a lot of fluids

Weight Loss

Tiredness

Mood changes

Other Signs and Symptoms

***In babies and young infants, signs and symptoms may be less easily detected.

Can Type 1 diabetes be prevented or cured?

While a great deal of research is being done, at this stage nothing can be done to prevent or cure Type 1 diabetes. There is a lot of work being done on prevention trials.

One such trial is the Intranasal Insulin trial. This is for relatives of people with type 1 diabetes. Enrollment of people into the type 1 diabetes prevention trial, the Intransal Insulin Trial, continues with over 1700 people now taking part. The trial is looking to recruit more people who are at risk of developing type 1 diabetes - that is those who are aged 4 - 30 years old and have a relative with type 1 diabetes

Call 1300 138 712 or visit www.stopdiabetes.com.au

There is also a lot of work being done on development of a "closed loop" system of management, essentialy an "artificial pancreas". You can read more about this here

http://www.jdrf.org/index.cfm?fuseaction=home.viewPage&page_id=4FE619DE-1321-C834-03EA38F133249485

You can find out about some of the current advances in the prevention, detection and management of type 1 diabetes at:

• JDRF http://www.jdrf.org.au
• Diabetes Australia http://diabetesaustralia.com.au/Research/National/
• International Diabetes Federation http://www.idf.org/
• http://www.stopdiabetes.com.au/

Is there any risk of other family members developing type 1 diabetes?

Although other family members may carry the same ‘at risk’ genes for developing type 1 diabetes, the overall risk is generally low. The risks for family members are estimated as follows:

• Mother who has type 1 diabetes – 1-2% risk for child
• Father who has type 1 diabetes – 4-6% risk for child
• Identical twin who has type 1 diabetes – at least 35%
• Brother or sister who has type 1 diabetes – 3-6%

Living with it

There are many issues that can arise when living with type 1 diabetes.

We would like to present some of those here, with personal stories, FAQ, comments from our Ambassadors and "experts" with the main "experts" being you - your thoughts and comments. Please drop us a line in regards to anything on this page at This e-mail address is being protected from spambots. You need JavaScript enabled to view it and we will add to the page.

The food police

Now here is one that many people with all types of diabetes might identify with!

It used to be that when you got type 1 diabetes sugar was the "bad guy". Foods were restricted and even "forbidden". For a child, this equated to all the "good" foods! It also included being unable to eat foods which could lead to feeling isolated and left out. Many people we talk to say that it just made them want these foods even more. The really down side many years ago was that non carbohydrate, fatty foods - such as meats, cheeses and so on were called "free" foods - foods that you could eat as much as you liked! We know now that fat and salt are just as important in a healthy diet and management of diabetes.

We have moved on from this thankfully and we now know a lot more about food and how it works in the body in conjunction with insulin and a range of other systems. We know that people with diabetes CAN eat sugar, in moderate amounts, can eat really any foods, in a healthy and measured way. It is important to avoid fatty, salty, high sugar, high processed foods - but this is the case for EVERYONE - regardless of whether they have diabetes or not. However there is a lot of misunderstanding in the community and many people find others asking them "Can you eat that"? "Doesn't that have sugar in it?" " You are being very naughty eating that"! Like they know more than the person with diabetes does! This can be a very frustrating situation. Here is a blog we wrote about this topic: http://diabetescounsellingonline.wordpress.com/2010/03/16/can-you-eat-that-and-other-guilt-laden-moments/

Interestingly people with type 1 diabetes used to have to measure carbohydrates into "portions" - 10 grams of carbohydrate and later "exchanges" - 15 grams of carbohydrate. We have now come back to this in management of type 1 diabetes. People often use the amount of carbohydrate at each meal to work out how many units of insulin to take with the meal - this is often called the bolus dose. It allows more flexibility in eating and one very structured way of doing this is a programme calle DAFNE (dose adjustment for normal eating). You can read more about this here DAFNE: Dose Adjustment for Normal Eating

There are some diabetes centres in Australia who offer this programme which involves attending a group for quite intensive training in the methods of this management tool. Speak to your diabetes educator about accessing a DAFNE programme.

You can also ask your doctor or educator about how you can simply manage your insulin doses to carbohydrates and activity levels. Many people work out how much insulin they generally need to bring their blood glucose down when high and how much they need with various foods. Often there is still some "guesstimation" as it is very hard to work out carbohydrates all the time, especially when eating out, but this usually works quite well.

We now tend to take the "everything in moderation" approach and look at the glycemic index of foods, the balance of your diet and so on. The insulin pump and fast acting insulins have both made life a lot easier for those of us with type 1 - we can work out the amounts of carbohydrates in our food and how much insulin we need to match this, rather than the other way around - where we used to inject insulin and then have to "feed" the insulin so as not to hypo.

A story from From Sarah - one of our members....

"It’s great to know that the food police are not unique to my life! My mother-in-law thinks that she is an expert when it comes to diabetes. She was a pharmacy assistant for 20 years or so and this is where her education on diabetes has come from. Her husband was recently diagnosed with pre-diabetes (and a lot of fuss was made about that!) and they have gone on to a strict diet (the cardboard diet), which is based on the old ideas of no sugar, no sugar, no sugar. I was only diagnosed with type 1 diabetes recently and have done as much research as possible on a healthy diet and have found that by eating low GI foods that I can control my diabetes quite well. Initially, I thought my mother-in-law’s ignorance around sugar etc was quite reasonable and I did my best to educate her by sending her articles, recommending books etc… She seems to have some trouble accepting this information though and continues to watch what I eat and offer lots of advice. Luckily, we live in different states, but we recently visited them over the Christmas break. I was shopping for presents for family and was in Adelaide’s best chocolate shop, when she passed by, snuck in and announced loudly that I had been ‘busted’! I wasn’t actually buying chocolate for myself, but hey, I think it would have been fine if I was! To round it off, she brought around a couple of baked goods for us (she doesn’t enjoy cooking and isn’t particularly good at it), which included thick pastry, potatoes and parsnips!

There have been so many other occasions where she has done this sort of thing and I know that it’ll keep happening, despite our best attempts to explain things clearly (but kindly) to her. It’s rather maddening, as I’m doing my best to work with the diabetes without an ill-informed ‘expert’ ‘helping’ out! I’d love to know how to ask her to back off without offending her, but I’m not sure it is possible."

Hypos and hypers - the daily rollercoaster that can happen with type 1...

The thing most people assume about diabetes is you have too much "sugar" in your blood. Most people have seen a movie or two where a person with diabetes passes out and then is given an insulin injection. Thing is, often times the person was probably low (hypo) not high (hyper) and did not need insulin! Most people also know someone with diabetes, often someone with type 2 diabetes and they judge type 1 diabetes by this experience. However it is very different to type 2 diabetes. This is another misunderstood area - another "oh when will they get it?" - of type 1 diabetes.

If you have type 1 you know that on a regular basis your blood glucose levels can go up, down, up, down - yes just like a yoyo on a string you can feel at the mercy of your diabetes and the blood glucose monitor at times.........

This up and down is a normal pattern - all people's blood glucose goes up and down over a 24 hour period and is affected by hormones, stress, food, sleep and so on. However without diabetes, this up and down is within a normal range and does not often affect the person. For those with type 1 diabetes, these ups and downs might range from 2.0 mmol to 21 mmol (or less/more) and it can be a frustrating and disheartening ride if this happens. Once you start to feel out of control with your diabetes it can really impact on your wellbeing and sense of hope. It is important to regain this control, so that you can move on and continue your life in a happy way.

We are all different, our management regimes are different, each day is different and injecting insulin can never totally mimic what the body does when not having to cope with diabetes. Add to this the fact that every aspect of life affects blood glucose, from the injection site, to the time of day, to the time of month, to what you eat, how active you are, your mood, stress levels and the day of the week - and it can be a recipe for a rollercoaster ride.

HOWEVER - with the tools we have now, it is entirely possible to have a more balanced ride with your type 1 diabetes. Regular blood glucose checks, keeping informed about the latest technology, tools and insulins - enable you to take control of your diabetes as much as you can. Sometimes there will be unexplained swings, but it is possible to maintain things on a smoother level as much as possible. Getting good support is vital. You also need to practise regular relaxation, find time out from diabetes, learn how to manage the more tricky aspects of type 1 and connect with other people who understand.

Some people we have spoken to worry about the long term impact of high blood glucose levels and work very hard to keep the levels in a "normal" range. This often means more hypos, as when you run your levels at a "normal" rate with type 1 diabetes, there are going to be times when there is a little too much insulin floating around. Pumps make this easier for many people and the new long acting insulins such as Lantus and Levemir also help reduce hypos. Often times this means an unforgiving regime of many blood glucose checks each day and close monitoring of food intake, exercise etc - people can end up worn out, burnt out and giving up.

It is important to find a balance of what suits you, so that you can stay healthy without burning out. We have more information about stress management and burn out at our website here Diabetes Counselling - Chill Out - Mental Health

Other people develop a real fear and even anxiety about hypoglycemia. This can result in them keeping their blood glucose levels high, to prevent a hypo happening. This is particularly the case for people in positions of control, such as a new parent, a person who cares for others in their work, or who has to make regular public presentations, for example.

Once you have had a hypo, you understand what it feels like - the loss of control, mood swings, physical sensations and sometimes even a feeling of anxiety and panic - can in themselves bring on anxiety and panic. This can then become entwined with the hypo and lead to people not being sure if they are suffering with a hypo or a panic attack. In the end it can seem easier to stay at a higher level, so that a hypo can not eventuate.

We speak with many people dealing with this problem in counselling and have personally experienced this as well so drop us a line at This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you would like some help with this.

What can help is to make sure you check your levels when you feel "funny" so you can see if you are low or not - you can record this and see how accurate you are at picking up a hypo. In fact there is a programme called "Blood Glucose Awareness Training" (BGAT) which is currently being adapted in Australia. This is a formal programme which teaches you to learn the signs and symptoms of high and low blood glucose more accurately. We will post more about the Australian version as it comes to hand.

Along with the rollercoaster can come a sense of "why can't I get it right?" "What is wrong with me?" And this can equal "I am a hopeless loser". No matter how long you have had diabetes and how much you know, this can still happen. The "should's" can creep in - I should have had less insulin, I should have known this would happen etc etc

This way of thinking is unhelpful and whilst we are not always able to do this, it is important to try and be aware of this thinking and stop it. A trick is to start to recognise this thinking and when you notice it, turn it around to saying something like "I did the best I could at the time, I made the decision I thought would be ok - it is just a high/low reading and now I will deal with it". In this way you are being rational about the reading on the blood glucose monitor and doing something about it, rather than beating yourself up.

Pregnancy and parenthood

As the writer of this page, I am going to share some of my own "talking type 1" on this topic. Here is a blog about pregnancy and type 1: How do you have babies when your pancreas is missing in action? « Diabetes Counselling Online's Blog

Healthy pregnancy and parenthood is VERY possible for women with type 1 diabetes.

However we still talk with women every day who have heard horror stories about pregnancy and diabetes.... We hope to change this so that women with type 1 feel confident and informed about pregnancy and their choices around this.

Here is a great resource: Can I have a healthy baby?

The answer is - Yes you can have a healthy and enjoyable pregnancy and a very healthy baby! This is especially so in 2009 and onwards, as we develop better insulin and better ways of delivering this.

We know now that meticulous control prior to and during the pregnancy is best for Mum and baby. Most recommendations are that women planning a baby get really tight control at least 3 months prior to conception.

Of course pregnancy is not always planned, whether you have diabetes or not. What is important if this happens to you, is to go see your diabetes specialist as soon as possible and an Obstetrician who knows about managing diabetes. If you have any pre exisiting complications, such as retinopathy or kidney disease, these need to be closely monitored as well, as the stress of pregnancy can make these worsen. Any medications you are on must be reviewed as well.

Hypos - It is common in the first trimester to experience more sudden hypos as your insulin needs can decrease and this needs to be closely monitored by the mum to be. As you progress the insulin needs will then climb. This may mean more blood glucose checks than usual and fine tuning of insulin and dietary needs throughout the pregnancy . I personally found the pump made a huge difference. We are all different and it is important that you find the best management tools for YOU. It is important to work with your health care team to plan the best way of managing for you and your particular circumstances.

During pregnancy your insulin needs will then gradually increase from the second trimester onwards and you will end up on perhaps 2 - 3 times more than you were on before. I found again, that the pump enabled me to increase the basal rate ( or background rate) of insulin in small increments at the time of day/night that I noticed levels creeping up. At one stage of the pregnancy this was every few days. I was also able to have increased boluses with food, which I noticed was about double the dose I would usually need.

At the end of the pregnancy this changes again and there is a need to reduce the insulin back to pre pregnancy levels. The placenta and the hormones it produces in pregnancy block the action of insulin and thus the increasing needs during the pregnancy. When the placenta is delivered, the body will suddenly have lower insulin needs and in fact might not require much at all for a day or so.

Breastfeeding

Breastfeeding also impacts on diabetes, as we use so much energy in feeding our babies and a range of hormones are at work, as well as factoring in sleep deprivation!. Really it is a case of experimenting with it all and taking it step at a time, with the close support of your health care team and those around you. Some women find that their breast milk takes a couple more days to "come in", so more likely around day 5 than day 3. Being proactive and letting the doctor and ward nurses know how you want to manage is vital. If your baby is well and you are up to it, it is important to room in with the baby and feed as often as possible in those first few days - this helps the milk to come in and helps prevent the need for supplementary feeding. It also helps you to recover from the birth and sets up a bonding process. If you or bub are not up to it or your baby needs some nursery care - don't stress as this is not helpful for either of you. You may be able to express milk if bub is in the nursery and this is great as she/he gets your vital colostrum and also stimulates your milk to come in. Many people go on to feed despite less than optimum starts - so set up your plan but always have a plan B and someone to support you with this. You will get a vast array of opinions from nurses on the ward!

More to come on this soon - we are aiming to add a page on sexual health and pregnancy soon so stay tuned

Type 1 AND Type 2 combination - a less common mix - From Danny - a member and person who describes himself as having a "type 1 and type 2 combination"

Danny writes:

"I haven’t seen any mention of people with BOTH Type 1 and Type 2 diabetes, that is the pancreas produces no insulin AND the body is resistant to insulin. My Endo describes me as a Type 1 with a Type 2 body.

I’m male, 55, have had type 1 diabetes (late onset – suddenly on to insulin) since 30, and I have this combination (as do a number of diabetics to some degree – and some don’t even know it) and find that quick acting insulin can take from 15 minutes to 5 HOURS to work. This can catch me out because when I measure my BSL 2-3 hours after a meal and find it’s higher than I expected I have to work out whether the high reading is because I underestimated my food (carbs) value, or because my body hasn’t processed the insulin yet.

If I inject a corrective bolus, and my carb calculation was actually correct, I will have a hypo a couple of hours later when both boluses finally work (this is fun – not!). I read my BSL around 10 times a day, because a reading on it’s own isn’t reliable enough, I need to see the trend over the last several readings to know if resistance is causing me problems.

(Editors comment) - some people have this experience also if they have gastroparesis, so the food does not catch up with the insulin and they have a hypo and later a spike in BGL when the food does kick in.

My degree of insulin resistance varies depending on amount of exercise, general health, stress, pain and illness. It’s always worse when I’m in hospital after an operation and / or when I’m in pain. ( Editors comment) - this is normal for all people, diabetes or not and in particular for those of us with diabetes!

As a background I have the following medical problems and operations: A lifelong battle of being overweight (Evening grazing, family history), Liver problems, lots of allergies, high blood pressure, high cholesterol, non-union (split) sternum, Sleep apnoea, severe Restless Leg Syndrome, Insomnia . Just in the last few years I’ve had a heart triple bypass, heart aortic valve replacement, three sternotomy operations including the first in Australia to have Sternal Talons installed, cataract surgery, eye Vitrectomy, two types of eye laser treatment (both eyes). (I think I’ll stop now but you get the idea).

For insulin control, I use a basal daily Lantus dose, a bolus whenever I eat, and an overnight insulin pump profiled to counter the ‘Dawn phenomenon’.

Exercise

The biggest thing I’ve found is that I require daily exercise. I find that an hour’s exercise (at a rate to make me puff) makes my BSL levels controllable for the next day, and reduces the insulin resistance. This means the insulin that I inject will work faster.

Two days of consecutive exercise gives me better control for the following two days (an extra day).

I can’t stress enough the importance of exercise to a person with diabetes– I’m lucky in that being a type 1 also I get to see the benefit in two ways; less insulin resistance the next day and lower insulin requirements the next day. On the occasions where I’ve been ill, I have trouble controlling my BSL and I often put on weight (because I can’t exercise and I eat ‘comfort food’). I find walking at night after my dinner is the best – I get a four way benefit – Better BSL control next day, Better mood as a result of the activity, No comfort eating in the evening, and no hypo because I’ve just eaten (but I must be careful with my meal bolus or I’ll have a hypo late evening). (Editor comment) - exercise is helpful in all cases of type 1 if you can get the carb ratio right to prevent hypos, it does have an ongoing impact on insulin needs; weight training can impact on BGL for even a couple of days, so close BGL monitoring is important. It is also a brilliant stress management tool.

Dawn Phenomenon

I also suffer from ‘Dawn Phenomenon’ – that is at around 2 – 3 am when I’m in REM sleep, the adrenalin released causes my liver to release glucose – meaning that if it’s untreated I wake with an excessively high BSL (up to somewhere between 12 to 18 mmol or 216 to 324 mg/dL). This causes me to have poor control for most of the day – a corrective dose takes hours to work in this case. (Editor comment) - it is normal for all human beings to release stored glucose and a range of growth hormones in the early hours of the morning. In a person without diabetes, their body also releases just the right amount of insulin - in people with diabetes this does not happen. Many people with type 1 find over time that this becomes more of an issue. Changes to overnight insulin and use of insulin pumps can help. It is important however to work out the cause of high morning levels as sometimes it can actually be due to having a hypo overnight and the response by the body - leading to a rebound high. If you were to assume it was dawn phenomenon and increase evening insulin you risk a dangerous low. Checking BGL at 2 - 3 am for a week or two can give you a good picture and/or using a continuous blood glucose monitor for a few days to see what is happening before making changes.

I proved my ‘Dawn phenomenon’ by using my pump’s continuous glucose monitoring sensor – a 2 to 3 am sharp rise in BSL is clearly evident.  Previously I couldn’t work out why I had to go to sleep with a high BSL to stop 1 am hypos, when I was trying to adjust my insulin to give low morning readings. When in hospital one time before I’d worked this out, one nurse berated me saying “You should be ashamed of yourself, you have bad control and you should be doing better than that” (I was so upset, I checked myself out next morning to recover at home).

To overcome this I wear an insulin pump at night to give me a bolus between 2 – 4 am, tapering off until my normal waking time (I use Lantus for a daily basal cover, but I find I get 21 hours cover, not 24 so the extra three hours are covered by the pump). By giving a bolus, I mean I set the basal rate at a high value for an hour, at a rate per hour equal to the bolus I need.

Of course if I don’t go into full REM sleep, I have a hypo – such is life!

By the way, how did I work out my basal rate? Using an insulin pump instead of the Lantus, I set a ‘guestimate’ basal rate on my pump. I waited until I had a ‘good’ day (i.e. my control was good and no noticeable insulin resistance), then I delayed a meal by some hours and tracked my BSL levels every hour (nowadays I would use a continuous monitoring sensor). The target is to maintain steady in BSL readings over this period (assuming ‘normal’ or sedentary physical activity) – this means the basal rate is correct.

Danny

We will be adding to this page so check back regularly and don't forget to send us your thoughts and comments!