FUDiabetes

Winds of change

Have been learning a lot about how different dynamics add so many variables to managing diabetes…

I’ve started a new job, in addition to my old one… and with the new job, for several years, I’m no longer the star of the show but am always riding someone else’s shirt tails, at the mercy of someone else’s schedule and other circumstances I have very little if any control over… which is just very foreign to me and makes diabetes quite a bit harder…

I did pick up a trial pen of fiasp at my last apt… I think it’s going to be more adaptable than novolog for this, and I think I’m going to end up refocusing on Afrezza as well… the ability to prebolus 20-30 minutes is just not reality in this current world… so options that allow me to dose more in real time or even after the fact can make all the difference

I even think when the omnipod horizon or tandem sport come out it might even be time to give that a try for basal management, at least until I’m not playing the second fiddle anymore…

Change sucks with diabetes…

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Hang in there! Change keeps us on our toes. Change sounds pretty good to me right now… the pandemic caused me to create a daily routine that is starting to feel like a rut. I’ve been jumping on every opportunity that comes along to inject a little change in the routine.

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And stress doesn’t improve things any. Sorry about the stress and change, but excited for you. We see the effects of stress on my son’s CGM any time a high stakes test or finals roll around.

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Can you elaborate a bit more on what changes you see and how you manage them (or try to). We’ve been at high elevation for some downhill skiing (distanced and Covid safe of course). My son had odd highs at random times. We thought it might be the altitude, adrenalin, endorphins, or just his “dying” pancreas sputtering (he’s only 9 months into T1D and still honeymooning). Thanks, ~A

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I think Fiasp has the potential to really help when you can’t properly plan for meals, etc.
I am a driver/truck manager, and also do sales, so there is NO SCHEDULE while I am at work.
I have a hard time managing myself on Novolog, but having Fiasp in my pump has made a world of difference!
To note, I take full advantage of the Control-IQ algorithm on the Tandem X2 pump. I have tweaked the settings to work best for me, and that, in conjunction with Fiasp/Loomjev have made the world of difference to how I can manage this hectic job/life.

That being said, both Fiasp and LoomJev (Lyumjev) are so much better at controlling spikes without having the downward freighttrain I get with Novolog.

Also, what about Afrezza? I am going to try this out as well (mainly for stubborn highs, or large meals, unexpected meals, etc.

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Afrezza is a real game changer… I don’t use it much as I used to for a primary bolus just because I’ve gotten to the point where my bolus doses are relatively large and that makes it a little less appealing—- but the stuff is magic… hopefully if I get back into a little better physical shape I can increase my sensitivity again to the point where it’s a more perfect fit for me.

I’m using a loomjev trial pen right now… pretty good stuff it seems. And I just took my first delivery of fiasp pens… there will of course be a learning curve but hopefully they will all help… I’ve turned up my nose at pumping all along, and it’d be difficult to manage in my current job I think, not having regular access to mail/ supplies/ having to carry multiple backups for everything… but I have to admit I am starting to see the appeal if not for those things

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Even if you never use the pump to bolus, having full control over your basals (and being able to STOP them,) is a massive advantage to the pump.
And with the new logic in these pumps that can adjust the basals on their own, it really is a life/game changer!

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Sure @Andre, when finals rolls around the weekend before you can see his baseline blood sugar begins climbing. On test day his track will look like a roller coaster, and he will be much more insulin resistant than when he is relaxed.

Skiiing for us, was fairly easy to manage, but if he was taking on challenging runs, and using more big muscle power for those runs they could easily raise his blood sugar quickly. My son has also run cross country (easy to manage), baseball catcher (Hard to manage because game effort isn’t predictable), backpacking (10-20 mile days 1000-6000 feet of elevation gain/loss) Hard to manage because of all the variables, swimming (medium).

How hard were the highs to bring down? Growth hormone highs have been in our experience the most difficult and hard to manage due to variable insulin resistance. Exercise highs are easier than that in our experience.

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Thanks for the details. Very helpful. Sounds like our children are similar in that ours does a fair amount of cross country and track, mountain biking, and just movement around the neighborhood on a scooter, the bike, skateboard, on foot. Most days it’s easy to manage.

As for the highs at skiing, it was hard to get down. Then it went way down during the night so that we had to give him some juice. Overall rather unpredictable. I guess growth hormones would be a good explanation. He is still growing after all. Thanks again for the input.

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Hi @Andre ,
At higher altitudes, your body has to adjust to the lower oxygen levels. So yes, this can cause the body to release stress hormones which help your body cope with the lower oxygen levels. These hormones cause spikes. So that might be what you were seeing.

Then at night, when everything is calm and he is asleep, the high level of activity from the day would cause a drop.

When I was a kid, vacation always meant a big basal drop. And lots of snacks.

Also, is he using a pump?

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The worst of the growth hormone highs occur 2 hours after he fell asleep. However, during high growth phases there were some really odd highs that were very stubborn as well.

Lot’s of snacks won’t necessarily be a bad thing for him :slight_smile: . He doesn’t use a pump and with an A1C of 6.0, we’re not pushing it. His Dr. said we (as a family) are a very good pancreas. He is so skinny that we have a hard time finding places for G6, and injections. He doesn’t want another device yet. His G6 keeps failing a bit more often we think, because his skin is so thin that the sensor ends up hitting blood or muscle and it apparently doesn’t like it.

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Thanks @Chris , that’s helpful to know others are experiencing that too. It coincides with what we’re seeing.

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Once his pancreas finally gives out completely, you will likely gravitate towards a pump for the additional control over dosing options (tenths of units rather than 1/2 units) and the ability to tweak his basal profiles and deal with sports. My son uses Lantus for half of his basal and the pump for the other half. Then he removes his pump prior to sports or intense activities and has the approximate amount of basal needed, which is much much easier than remembering to dose basal differently the day before. But these things will come in time, and learning to be an expert with shots is a great skill to have, and this is a marathon not a sprint anyway.

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The reason I asked about the pump is that there are some reports of high elevation changing the insulin delivery in pumps, because of the dissolved air in the insulin expanding at higher elevations.

This is not relevant to your situation, but I wanted to pass it along as general information.

BTW, I think it is mostly irrelevant in an airplane, because the pressure difference is not too extreme. But in the mountains it could have more of an impact.

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Yes, we know it and our son knows it too. Just want to live in the transition world for as along as possible. I can support him with that :slight_smile:

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… not yet, but that is a good thing to know. We’ll have a pump eventually. Makes a lot of sense from a physics perspective, but that’s not one’s first thought when going on the trip to the mountains. Thanks again.

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I went without a pump for 44 years!

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