I’d read about somebody taking 60+ units of basal and how they had to use a longer tip and I guess assumed it was related, but as Dorie said, it may have been more of a body fat thing. I guess it also made sense because the idea of a larger injection leading to more skin bubbles or leaking (both of which I see sometimes with my smaller doses) made sense to me (and a deeper site might mitigate those).
Glad you’re okay. And, yeah. A lot of learning experiences ahead.
You know, when I was diagnosed, I spent a week in the hospital. Not because I was that badly off. I was caught really early and barely needed any insulin to stay on track. But it was standard at the time (at least at that hospital) to keep newly-diagnosed diabetics in the hospital so we could get the training we needed while also under supervision in case anything went wrong. They taught us about portion sizes and how different foods affect us and how best to manage and what technologies were available and how they compared. And then, after we went back home, we stayed in touch with each other and the medical team with a support group run by the nurses, so we could learn from each other and stay up to date on new options. I really wish that kind of orientation was still possible and standard. (A decade later I was talking to a newly-diagnosed diabetic in a chat room and he’d just tested 300 and was about to go eat some carbs because he knew that reading was way out of range but didn’t understand which direction it was supposed to go…)
clinicaltrials.gov is a central location to search for trials in the US. You can input keywords like “diabetes” and filter results by other metrics like age and location, and it’ll show you what’s out there. You can also let your medical team know you’re interested. Part of their job is to keep informed about studies and developments. And, yes, you can also call the companies and ask.
Ah. Depends on delivery method. Back when I started, there were no insulin pens. You had to draw the insulin you were taking into a syringe and inject it. Although pens are more convenient for many people and have become less expensive, there are many patients who still use syringes.
Syringes come in different capacities as well as needle sizes. Standard capacities are 30 units, 50 units, and 100 units. That’s that maximum that can be safely drawn into the syringe.
Needle size is likewise variable. Looking at what BD has to offer right now, you can see that the 30 unit syringe has a 6mm needle, while the larger capacity syringes are 8mm. Other companies might offer different sizes (and I think BD offers a few more options than are shown on that page), but that’s a good start. (And BD is, in my opinion, the gold standard for syringes, lancets, and alcohol swabs.)
They also offer 30 and 31 gauge needles. (The higher the gauge number, the thinner the needle.) Longer needles are harder to find at high gauge numbers.
So, if you’re using a syringe to deliver your basal and you’re taking 60 units, you’d need to use a 100 unit syringe (unless you were willing to split it into two shots), and that’s very likely going to come with a longer and thicker needle.
Of course, back when I started, 6mm needles didn’t exist on the market. The smallest you could get was a 50 unit syringe with a 12mm needle, and I don’t think even 30 gauge was available. Improvements in manufacturing allowed for shorter needles and higher gauge sizes, and that’s when the 30 unit syringe was introduced. That was a lot nicer, and much less likely to cause pain or bruising.
That said, you can put any size needle on the end of any insulin pen. The pens have a standard screw thread on the end. So no matter the dose size you’re taking, as long as your doctor approves, you can use whatever needle you want. It’s just, as I said, a thinner needle will take longer to deliver the same amount of insulin.
As you say, a shorter needle does come with more of a risk of bubbling or leakage, but experience and technique help with those. You learn how to find a good spot by tapping the site with a finger to check for bruising or sensitivity. You also learn which little patches on your body are most likely to cause problems. How to come in at a good angle. Holding the needle in place for a few seconds to give the site a chance to close up a bit and form clots if necessary. That sort of thing.
None of that applies when you’re using a pump. You just have the cannula (which also comes in different sizes - I use a 6mm) in your skin continuously. The bolus can be delivered gradually instead of pushed through in a matter of seconds. A regular bolus can take a minute or so. But you can also program the pump to split it, delivering, say, half the bolus immediately and the other half as effectively an addition to your basal over the next hour or two.
I know I am late to the party, but if you are using an INpen you can have more info at your fingertips by connecting to your Dexcom. InPen Support - How to connect InPen to Dexcom | Medtronic
There are also other really good apps for tracking glucose and seeing trends.
It’s hard to comment on your post meal responses or your profession of units required without knowing what you eat.
But your stats sound great, I was diagnosed in April and I am still experimenting, but my stats are comparable at the moment.
After reading the book at Xmas, I am now finally making more effort to implement the regime from “Mastering Diabetes” book.
I still have some pancreatic function and I’d like to keep it that way (as long as possible).
That plus the random lows because of light exercise, yeah that’s definitely part of what I feel.
I get the pain thing. I think January was the worst month since my diagnosis and it was way more despair about my wrist pain (causing concern for both my livelihood and my hobby) than the diabetes. And the tests for that came back nominal, so I’m back to being a mystery. A mystery with a bruised thumb.
How do you manage day-to-day variation? Can you tell or is it just dealing with the consequences?
Going down to two meals would definitely be an adjustment for me. I used to snack frequently, but between carbs and fat concerns, I’ve mostly run out of ideas for low-fuss snacks.
When I was diagnosed with T2, my PCP told me over a video call and really didn’t tell me much else. “You’re diabetic, good luck” as a summary of our conversation is only slightly uncharitable. I spent three days in the hospital (two in the ICU) and saw the dietician once for like 10m. I saw the diabetes educator a couple times probably totaling an hour. They gave me a bunch of literature and the educator gave me my first sensors… most everything else I’ve learned has been from the internet, especially since it took almost 3mo for an endo to see me.
I get that. But I’ve got other disabilities. And I’ve had to learn some hard lessons. It sounds trite, but…
Life is what it is. Everyone has problems. Everyone eventually has something they can point to in their lives to say “No one should have to live with this.” It’s how you deal with it that matters. I get resenting your body for not working right. I get being jealous of those who don’t have to worry about such things. But it’s not your fault or your choice that you’re diabetic, it’s not their fault or choice that they aren’t, you have no idea what they’re struggling against, and getting mad about it is ultimately just a needless self-inflicted wound. There’s no sense getting upset over things you can’t control.
On the flip side:
In my grandfather’s generation, there were no adults with T1D. If you had T1D, your family was doomed to watch you waste away and die in a matter of months and there was basically nothing anyone could do about it.
In my mother’s generation (and as some of our regulars here can attest), you managed by guesswork. No BG meters. You ate your food, you took what you hoped was the right amount of insulin, you waited to see how you felt, you peed on a stick to see how much excess sugar your kidneys were flushing out of your system, you used that to guess how much more insulin you should take, and you hoped you got it right. You could live, but every day was stumbling around in the dark with medication your life depended on, and odds were you were going to develop complications.
When I was diagnosed in 1990, I was taught to be grateful for the technology we had. A BG meter you could keep in your pocket! And it was reasonably accurate. Give or take 20%, anyway. And they’d just developed a way for the meter to read blood droplets on the outside of the test strip instead of having to insert the blood into the meter itself and then clean and disinfect it after every test. I had the tools to not just survive, but to keep in fairly good control.
In the time since then, meters have gotten more accurate and need approximately 1% the amount of blood. We now have accurate CGMs that can give you not just a few painful tests per day but readings every 5 minutes so you can see how you’re trending and what’s going on between meals and be alerted before you get too high or too low. I’ve switched from purified pork insulin (literally harvested from pigs sent to the meat packing plants) to cloned human insulin. It’s faster, more reliable, and less likely to cause insulin resistance. I’ve gone from NPH basal (which lasted 12 hours or so if you were lucky, but still peaked after about 4-6 hours and then became less effective) to Lantus (which, for most people, lasts 24 hours and works steadily the entire time). And now I’ve got a pump that works with my CGM readings to adjust my basal on the fly. And it allows me to bolus whenever I want without having to stick myself with another needle. Speaking of needles, they’ve gotten much smaller and more comfortable.
So… when you’re looking at seemingly healthy people and getting upset that you have it harder than they do, don’t forget to take a look back and be grateful that you’ve got it easier than the diabetics who came before you.
Sorry to hear that. Is the wrist feeling any better? Could it have been the diabetes that caused the problem? Reduced blood flow due to buildup of sugar in the capillaries can cause muscle cramps, nerve pain, etc. And buildup of sugar in the cartilage can cause joint stiffness.
That said, I’ve been a medical mystery for my whole adult life. Going to neurologists and immunologists and cardiologists and rheumatologists and endocrinologists and pulmonologists and more. Getting poked and prodded and scanned. Spending years wondering what was wrong and whether we’d ever be able to fix it. While trying to learn how to live with it. And not being able to do the things I used to excel and and had planned to make a career of. So… I hear you. It really sucks. Not only do you have the pain of the thing, you’ve got the frustration of hitting the same wall where you know a wall shouldn’t be, and the grief of losing the future you’d thought you’d had. And it’s all exacerbated by the not knowing. The uncertainty. The lack of grounding. Being lost in the dark. It just really sucks. I’m sorry you’re going through that, and I hope you get answers soon. And that you make a full recovery.
Some of both. You get the hang of it as you go. You learn what works and what doesn’t. You still slip up and have emergencies. Life throws weird situations at you, and you have to improvise solutions. (“I’m supposed to take this Lantus every 12 hours, but I’m on a plane skipping 3 time zones and I had to move breakfast to make the flight but I won’t get dinner until we land…”) And then sometimes you just get a cold and it throws everything into chaos because being sick messes with your blood sugar and your ability to keep food down.
It gets easier with practice. You learn. You develop systems. You have fewer problems because you’ve figured out how to head them off and where you can be flexible to have some fun. And when things do go awry, you have a better handle on how to fix them and get back on track. But it still takes constant vigilance.
In a way, it’s like learning to drive. When I was first starting out, I was so nervous that I had to keep pulling over to check my BG because the tingling anxiety felt just like going low. But I learned. How to control the car. How to take turns at the right speed and angle. How to safely change lanes. I still have to be alert. To know where I’m going, keep an eye on the dashboard gauges, look out for unexpected obstacles and dangers from all angles. But I’m comfortable doing it all now. I’m practiced enough that it’s second nature. I still have to do all the work, but it’s much easier and less scary.
Be careful with that. I tried cutting lunch out of my diet and it screwed up my whole body. I got terrible acid reflux. Bad breath. Sullen moods. I got to a supposedly healthier weight, but the cost was too high. The doc said I’d put my body in “starvation mode.” Even though I was getting enough calories from dinner, my body thought that the rarity of the meals meant food was scarce, and it took emergency survival measures that caused all sorts of problems.
It may be different for you. Depends on how much you’re eating and when and what your body needs. But keep an eye out for changes.
Salads can make good snacks. Popcorn is fairly satisfying and low enough in density that you can eat a fair amount without too much carb intake. There are some good sugar-free cookies out there. You can try Jell-o. Reddi-wip has almost no calories and makes the Jell-o better. Their sugar-free pudding is nice, too. Sometimes just a piece of sugar-free chocolate can give me the boost I need. But I also just try not to eat between meals. If you can get into the habit, your body will get used to it and will stop expecting so many snacks.
That is… horrifying. Unconscionable. It should be a violation of all medical ethics to turn a diabetic loose without the tools to control a life-threatening disorder. I’m really sorry that’s the experience you had. I’m glad you found better resources, but you shouldn’t have to go looking for them. Especially because on the open internet it’s so easy to find terrible or misleading advice. I’m glad you have an endo now. But if you can find a diabetes education class or something of the sort, it might help a lot. And an hour or so with a dietician.
I know I’ve said a lot here. I hope it wasn’t too much. I hope that at least some of it has been helpful. I’m glad you found us. I hope you can find a good daily routine and just get a handle on things. We’re here if you have questions.
This is all great info and advice, and much of it really resonated with me (except for the eating jell-o part - you know what that’s made of?? ech! and think of the animals…). Anyway, thank you for the taking the time to post and share - it’s so nice to have this bit of space to commune w/ others going through similar experiences, and with thoughtful advice on taking a good perspective.
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I hear you. When I was diagnosed I got NPH (that’s it), was just told, “take enough so that your blood sugar gets down to 130 in the morning”, and then was just handed what seemed like a boat-load of intimidating and unfamiliar diabetic supplies from the pharmacist, with absolutely no instruction on what to do, for anything. I got home, took out the supplies, put them on the counter, took out the products’ instruction books, looked down in confusion and dismay, and started crying. Then I got to figuring out what the products even were, what they even did, and how to use them. And while I did get to an endo a couple of weeks later, yes, for me as well, pretty much all of my diabetes management info and skills have been self-taught from the Internet and experience. But really, experience is the main teacher anyway, and there’s no sub for it, so in the end things worked out.
I personally manage the day-to-day variation by keeping a log (handwritten - I’m a Luddite) of the carbs I eat at each meal, along with my game-plan for insulin dosing for the day, and then notes on what I actually end up doing and what my glucose readings are (I’m on MDI, no pump. Did a Dex for 6 months, but it was so inaccurate I had to finger stick 8-10 times a day anyway just to know whether I was going to make a mistake in treatment by following just the CGM. Also the overnight false low alerts were just awful). Anyway, so now I do about 7 sticks per day (+/- 3, depending) and about 6 bolus shots, + Lantus in morn. (8-9 units) and night (1-2 units). The night Lantus helps w/ dawn phenomenon.
So anyway, then b/c I keep track of my carbs and how my strategy worked for that food-type (and any other notes that may be relevant), I then use those notes to figure out what I should do for a given day’s meals that have the same/similar foods, and try to correct for mistakes from last time and/or do what worked last time. So like, a small amount of apple (e.g. 80 grams) might need a 10 carb ratio, but a larger amount (e.g. 160 grams) might need an 8 carb ratio with a more extended bolus. Or a low-carb bread might need an extra 0.75 units and a more extended bolus due to a lot of fiber (or whatever causes a late rise for that, for my body, who knows). And I kind of strategize a game plan for what I’m eating that day based on these (seeming) patterns.
I should clarify that the ordeals of managing T1D prior to the era of better monitors, CGMs, and pumps (for those who use the latter), is not part of my own experience. So your own experience and thoughts on that were part of what I meant by my appreciating your advice on how to take a better, broader perspective, and so thanks again for that! It is important keep these things in mind…
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