Adult Onset Type 1 Diabetes

I am 68 years old. Due to a severe case of pancreatitus in November 2016 I no longer produce insulin. I am on Lantus and Novalog. I have reduced my A1C from 12.8 to 6.2. But, I have dramatic swings in blood sugar readings, from 60 fasting to 250 at the end of the day. I am a serious carb counter and try to keep it below 60 g per day.

I have some questions:
How do adults incorporate exercise without a big drop in blood sugar?
Are my blood sugar swings normal or should they be more constant?
I am taking 3-7 units Novalog before meals and snacks. Is this too much?

Most of you at my age have had T1D for many years and probably have moved way beyond my concerns. But, any help would be greatly appreciated.

Hi Carol @cpeitersen,
Diabetes and diabetes management doesn’t really change much as the years go on, I was diagnosed with diabetes when you were 7 and I’m still learning “new” techniques and management skills. Yes, insulin [I began using poorly refined insulin from animals] and our tools and gadgets make our living so much simpler - back then it took blood was drawn from a vein and poured over yeast to get a blood sugar reading in a couple of days.

I’ve lived with BG swings like yours and now I’ve eliminated many, but not always. The “trick” is to study your own body - you are your primary doctor - and observe how various foods, activities and insulin affect you. Work on one adjustment at a time and monitor heavily… A couple of examples:

A. Eat a breakfast that is NORMAL FOR YOU, count the carbs and apply a particular carb/insulin ratio that you and maybe your doctor have determined is right for you. After insulin and eating “live” a normal day with usual activities for you; check {I don’t say test] your BG after two hours and again after three hours - write it all down and graph it if possible. If your BG is exactly what it was before you ate three hours later, you took the correct amount of insulin - congratulations. If BG is dropping sharply 2 hours after eating you took way too much insulin - eat something and change your carb ratio and try again the next day. If your BG is more than 60 mg/dl after a meal than before the meal, you may need a spec more insulin for that amount of food. Do this meal by meal.

B. After you are fairly comfortable that you meal carb ratios are close, add exercise and see how that affects you. For me, aerobic exercise will decrease my BG so I will always have a carbohydrate beverage and snack with me [Gatorade and granola bar]. Anaerobic exercise initially pushes my BG higher and hours later [5-10 hours] I sometimes drop to hypoglycemic range if I fail to monitor.

C. Your body is different than mine, all of us react differently to food, activity and insulin so you probably shouldn’t try to gauge how much insulin by comparing. I eat over 200 grams of carbohydrate every day and my total daily insulin is in the low 20’s units - high metabolism rate or something, BMI of 20.0. If I took 7 units of insulin with my 18 gram carb snack I’d be on the floor - my snack time insulin is usual 1 unit or less, often 0.

Sorry for being so wordy; much too long for me. But please continue to ask questions. Continue this string, message or email - there are many people here who want to help to adjust to T1 and for you to live a full, active life.

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@cpeitersen HI Carol,

@Dennis put a lot of good stuff so I’ll just tag on… blood sugar goes up with carbohydrates and goes down with exercise and insulin. if you look how insulin and exercise work together there’s your answer - if you are going to be more active… then less insulin and vice-versa if you are going to be less active. Now don’t get carried away, if your body doesn’t make any insulin then you will always need a little insulin no matter how much you exercise.

figuring out how much insulin is a little bit of math and a little bit of trial-and-error. My favorite doctor says “you can always take more insulin”.

If you like to read please get a book called “Think Like a Pancreas” and it explains a lot.

Good luck to you and please let us know how you are doing.

Hi Dennis,

Thank you so much for the advice and direction in my new jouney. I
appreciate your thoughtful insight and the time you took to respond to my
concerns. I look forward to implementing you suggestions. My first
lesson; take one step at a time. My first step; dial in my carb/insulin
ratio. Right now that seems to be 1 unit of insulin for every 15 g of
carbs. My second step; start introducing regular exercise. This is the
tricky one.

Happy Holidays,


Hi Joe,

Thank you for your sensible input. I am definitely getting the book as my
pancreas in non-functional. I have to take 8 pills of Creon ($12.50 per
pill) each day as a replacement for digestive enzymes that I no longer
produce. NOT CHEAP!! But, I have found a foundation to help me with the

As I told Dennis, my first step is to dial in the carb/insulin ratio. I
think I was trying to solve all problems at once and I became overwhelmed.

Your insight is greatly appreciated.

Happy Holidays,


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