Mystery of the Varying Overnight Basals

Last week was an exhausting week for many reasons that had absolutely nothing to do with diabetes.

Yet surprisingly, my blood sugars have been cruising along at the best they’ve been in weeks.

I’ve been struggling with my overnight basal rates in recent weeks. There have been some uncomfortable overnight lows, and then there have been other mornings where I’ve woken up frustratingly high. Alarms have been going off 2 or 3 times each night, instead of the usual one.

Things have felt rather inconsistent of late, so I decided to slap on a new FreeStyle Libre sensor last week to try and nut things out. I think I have finally cracked the mystery of the varying overnight basal needs.

If I go to bed sitting in the 7s or 8s, my overnights look something like this.


Looking at the gradual rise from around 4am, I’d be ready to make a basal change.

But when I go to bed sitting in the 5s or 6s on the same basal rate, my nights end up looking like this.

So it seems that my insulin sensitivity is far better when I go to bed in the 5s and 6s. I cruise along much more smoothly during the night, and my blood sugars get off to a much better start when my day begins in range.

So I’m now trying to be a little more bolder with my corrections at bedtime, in the hopes that I can replicate these levels and a decent night’s sleep more often.

Diabetes has so many little intricacies. It always keeps me on my toes, and I’m still learning new things about it after seven years.

Type 1 Event: Relationships, Partying and Life

I don’t know about you, but I’ve always felt that there’s a bit of a gap in terms of the support available when you’re a young adult living with diabetes.

Here in Perth, kids and families are really well catered for by the Telethon Type 1 Diabetes Family Centre, Diabetes WA and Princess Margaret Children’s Hospital. Diabetes WA run a cycle of programs for adults, but they seem to skew towards an older crowd. And I can only watch on with envy at some of the awesome things happening in the diabetes space in other parts of the world.

Earlier this year I met with a group of young adults with diabetes, and from there the Perth Diabetes Care Youth Advisory Committee came to life. Basically, we’re a group of young adults with diabetes, trying to fill the unmet needs of young adults living with diabetes in Perth.

If you’re in Perth and have type 1 diabetes, we are holding the second in a series of type 1 themed events on Thursday June 22.

The theme of this event is Relationships, Partying and Life. Nikki, a member of our committee, will be our personal speaker for the night. Dr Martin DeBock, an endocrinologist and researcher at the Telethon Institute, will also be speaking about his latest research in the areas of relationships, intimacy and diabetes.

Events like these are simply a great opportunity to hear other perspectives on living with type 1 and mix with other people who have diabetes.

All the details are below, and if you have any questions feel free to leave a comment or get in touch through my contact page.

Hope to see you there!

Review: My Dario Smartphone Glucose Meter

I was recently given a Dario Smartphone Glucose Meter and some test strips to try from my friends at Perth Diabetes Care. I squealed with excitement at the prospect of taking that little orange device home with me, because I tend to get pretty excited about integrating my diabetes tasks with my screentime. There was no expectation that I would blog about the Dario, and all opinions expressed here are my own.

The Dario is a really nifty little device. I was surprised at Dario’s relatively low key launch into Australia, considering that many bloggers in the UK were given meters to try some time ago. If it weren’t for the odd sponsored post on Facebook or my perusing the Diabetes WA online shop, I wouldn’t have known it had hit our shores.

So, it’s an all in one glucose meter. Lancing device at one end, test strip vials stored on the opposite end.

For some crazy reason, I thought the whole device clipped onto the bottom of my smartphone. So there I was on the first night I brought it home, trying to attach the whole damn thing to my phone! Until I realised that only the little test strip port connects via the headphone jack.

You also need to download the Dario app to your phone, and register to get started. I was able to register with my Facebook account, which is a big plus in my book – one less password to remember! Once you’ve opened the app and connected the little test strip port, you can insert a strip and receive a glucose reading on your phone screen.

The Dario app also had features like a bolus calculator, food databases, data sharing and an estimated hba1c. The data entry screen shown below gave me plenty of time after testing to input carbs and calculate an insulin dose, so long as I didn’t press the tick to exit.

I didn’t really make too much use of the app because I use my insulin pump for calculations, but I imagine that if I were on injections this would be really useful.

How accurate are the strips? Although I felt extremely wasteful doing unnecessary tests for the purposes of answering this question, the Dario quickly proved to me that it was a reliable competitor. It held up extremely well against my FreeStyle Libre, my FreeStyle Insulinx, high blood sugar levels and in target blood sugar levels. From memory, most of my comparisons were within 0.5mmol – with the exception of my One Touch Verio, which tends to read slightly higher than my other meters.

I really wanted to like this device.

Unfortunately I just found it really tiresome to have to pull out my phone, open the app, eject the test strip port from the Dario, connect it to my phone, pull out a test strip and prick my finger for a result.

After a week I still felt kind of clunky using it. I couldn’t remember how to eject the little test strip port from the Dario, or which end was for lancing and which end was for test strips.

Although I had a box of test strips to play with, I didn’t use it as much as I thought I would. While I was out and about, using my meter was simply more convenient.

While I loved the idea of an all in one glucose meter, the reality is that I have to be prepared for my diabetes every time I leave the house. I already carry skittles, insulin and spare supplies to deal with a pump failure, that carrying a meter, test strips and a lancing device isn’t exactly a big deal.

That being said, I have only used this device for a week. It is a big change from using a traditional glucose meter for the last seven years, and perhaps I just needed some more time with it.

The Dario Smartphone Glucose Meter can be purchased online at mydario.net.au, and is also available through selected Pharmacies. The test strips are subsidised through the NDSS, and are sold through the Diabetes WA Shop here in Perth.

Foggy

I stirred in the darkness. I felt sticky. I could feel the dampness building around my neck and my thighs. I could feel heat emitting from the pillow where my stuffy head had been resting. Leaving the quilt on my bed last night was probably a bad idea.

I felt shaky. I could feel my entire upper body vibrating, as I lay there under the covers. Could I be?

But I didn’t want to open my eyes. I didn’t want move a muscle. I couldn’t gauge exactly why this was, but my brain couldn’t overpower my body that morning as I lay paralysed in bed.

BLEH BLEH BLEH BLEH…

No sooner than I had closed my eyes again, my alarm began to sound. It startled me. I couldn’t believe it was morning. I couldn’t believe I hadn’t registered the time on my clock radio when i stirred only moments ago.

I fumbled hurriedly for my phone, desperate to silence the blaring alarm. I felt disoriented. I felt weak. I switched on my bedside lamp, and reached for my meter.

2.6. My blood sugar was sitting at lowly 2.6.

I frantically got out of bed, pulled my retainers out of my mouth and fumbled around on my dresser for the ancient yellow-rimmed coffee cup where I could dunk them into.

I could still feel those shakes as I walked into the kitchen, like someone had frightened me. I poured milk into my coffee cup, and placed it into the microwave to heat up. Once the 45 seconds were up, I placed it under the coffee machine, watching the sweet brown liquid drip slowly into my cup.

I felt thirsty. I washed that coffee down my throat in big gulps, as a way to quench my thirst. I reached for biscuits. One of Nonna’s amaretti topped with a glace cherry, followed by a choc chunk cookie.

I wondered how long I had been low. I knew I had gone to bed sitting on a 4.9. I had eaten 3 skittles as well, which should have brought my blood sugar closer to 6. I hoped I hadn’t been sitting low for too much of the night.

As the shakes subsided, the brain fog began to set in.

As I went about my morning moving pallets and pushing trolleys, I could feel aches in my very weak arms and legs.

Those aches were a lasting reminder of that hypo.

Those aches left me feeling riddled with guilt.

Some added science from my friend Matt: Apparently your muscles are repairing overnight, and if there isn’t enough sugar for them to slurp on…ouch is incurred.

T1 Talk: Managing the Unmanageable

Welcome back to T1 Talk, a series of conversations between myself and Bec of Sweet and Sour Diabetes. We’ve started these conversations with the aim of highlighting how type 1 diabetes impacts two people of a similar age, who were diagnosed at slightly different stages of life. You can learn more about us in our first post here.

This T1 Talk is titled Managing the Unmanageable, and tackles the more technical side of management – from diabetes healthcare professionals to pens, pumps, fingersticks and CGMs. There are two parts to this T1 Talk. The first part is here, and the second part follows over on Bec’s blog at Sweet and Sour Diabetes.

The Australian health system is split into public healthcare and private healthcare. What do you use and why?

Frank: I began seeing a diabetes educator privately last year because I needed someone who had more time for me. The public system pushed me towards self management as soon as I was able, and diabetes education is something I genuinely missed for a few years there in the middle. I wanted someone consistent, someone who I could get to know and who I was able to contact inbetween appointments. I didn’t feel like the diabetes education I received in the hospital was personalised to my needs towards the end.

I see my allied healthcare professionals privately too, simply because it’s more convenient than going to the hospital.

I still see the endocrinologist publicly at the hospital. I feel like the endo is more strictly business. She refers me for all of my important check ups, reviews my hba1c and other pathology reports. I only tend to flag the more “medical” concerns with her. I’m happy seeing my endo publicly, and I don’t feel I could justify the cost of going private based on my experience here.

Bec: Your relationship with your CDE sounds brilliant!

When it comes to health system, I’ve sampled most of it. Currently my diabetes management primarily falls on two people, both private practitioners. My private endocrinologist is basically a whole healthcare team in one. She manages everything a diabetes educator would, as well as her usual endo role. This suits me really well and I feel very well supported in the private system. However, this was hard for me. I strongly believe in public health care being the best quality care. I believe you shouldn’t be able to pay more for better health care, it should just be a given. Unfortunately, the public system (whilst amazing as an early teen) was not the best fit for me as an adult. I see my allied health professionals in the public system, and everyone else privately.

Frank: Wow, the all in one sounds awesome. It sounds similar to endos I’ve read about in American blogs. It does sound expensive, though. 

Bec: It’s not too bad price wise considering it’s only once every 3 months. She’s very supportive by helping out between appointments via email, but I often feel guilty for asking for help when I’m not paying for it.

Describe the relationship you have with your Diabetes Educator and/or endocrinologist.

Frank: I see my diabetes educator once every three months. I’m pretty proactive with my management, so at the moment it’s more than enough. I’ve got her card and I know I’m welcome to call or email inbetween appointments if need be, which is comforting. It’s so good to have someone who dedicates that whole hour to you. She lets me steer the conversation, and I don’t feel pressured into anything I don’t agree with. I love that my educator also explores things like how I feel with my current level of management, or how I handle my diabetes around others. The price I pay is absolutely worth it.

Bec: I’ve always thought your educator sounded amazing. I remember mine at the kids hospital were brilliant. She sounds like she takes a real interest in your health overall, rather than focusing on just one part of diabetes.

My endocrinologist is quite business like and direct, but I like that about her. She understands my approach to my t1 and supports that, but she also tells me when to dial it back and give myself credit for what I AM doing for my management. She’s very contactable outside of the quarterly appointments via email which is very helpful for my management. I find that I’m not as self sufficient as you are Frank, and I need a bit of help working out what to do with my insulin rates. I think this might be because you’re not very self sufficient in the paediatric setting. I understand how everything works but still feel some hesitation making my own rate changes without confirming it with an endo. Plus, with work and uni and constant fluctuations in my sugars I need a helping hand to sort through the mess. So just like your educator, my endo is certainly worth paying for. I just don’t have the brain space to do it alone.

Frank: That’s fantastic. We’re under all this pressure as type 1s to constantly manage well, that along the way I think we lose sight of what an achievement this is in itself. So, I think it’s great that your endo gives you credit where it’s due. Basal rates are really tricky to work out, and obviously you need to allow time for them to kick in and sometimes it takes a lot of trial and error before you get them right. If you feel more comfortable making basal changes under the guidance of your endo, then I say good for you. I’m glad you feel supported in it.

What would you change about the system of healthcare in Australia?

Frank: Stop cutting resources in diabetes clinics! Stop pushing patients away! The number of patients in my diabetes clinic keeps growing, but over the years it seems the resources continue to be stretched thin. The wait time to see a diabetes educator is at least a month, and although I’m supposed to see the endo in 9 months, it will likely be closer to a year. Once upon a time, diabetes clinic was the only resource I relied upon to manage my diabetes. I couldn’t imagine where I would be today if I hadn’t diversified my investment chips into peers, websites, books, social media, private education and allied health professionals.

Bec: Excellent points there. So you see your endo less than once every 3 months? That makes sense considering the role your educator plays in your management. I agree that adult care needs to improve, which is something transition services such as Trapeze (a company I work for) is working toward. I left public health care because it just didn’t fit me or my needs.

The thing I would change is the idea that CGM is a luxury. It certainly is not. I can’t feel my hypos very much, and I tend to drop in my sleep. How anyone can consider an alarm system that keeps you alive a luxury is beyond me. Yes, it’s subsidised for those under 21 upon recommendation from their endo, but t1 has no age cut off. I’ve spent a lot of time contacting politicians to make a change. Just last week I sent a letter to my local member to bring the issue up again. Probably not effective, but at least I’m trying to do something about it.

Frank: I feel so guilty to whinge about CGM considering how lucky we are here in Australia, but yes I wish they were more accessible to me. While I’m so happy for the kids who will get one subsidised, I feel like our government has simply forgotten about the rest of us with type 1. I worry so much about going hypo unaware. I go through tonnes of test strips. I usually set an alarm midway through the night, just to make sure things are sitting steady. Good on you for doing something about it, I still haven’t gotten around to contacting my local MP.

Head on over to Bec’s blog at Sweet and Sour Diabetes to read the second part of this T1 Talk. We delve into pens versus pumps, fingersticks versus CGMs, and the challenges of making changes in our management. Catch you there!