Try, try again

Welcome back where this time round in the "Andy quits being a lazy slob and starts to get active" I will be looking ot how things went the second time round with lessons I applied from last time.

So let's do a quick recap on what I learned last time, first off the good:

• Delaying my morning basal shot until after the run and then doing a stepped reduction in basal based on time seemed to work well.
• Sugars were nice and stable during the run

Well that was great and to be honest I was thrilled at the time that I didn't hypo but then it all went wrong after that, so here is the bad:

• Correcting at lunch to bring my sugars down caused a bunch of hypos.
• My dinner time ratio was clearly a bad idea as that too caused hypos
• Night time basal was way out caused me to hypo all night, so not a lot of sleep there.

Well nuts, so I got it more wrong than I got it right. Well that's one view though I will choose to see it a different way and basically see the second list as lessons or wonderings.

What needs to change?

Before I started in the morning I had a really good look through the previous weeks data to try and work out what I would do, I will try to run you through it so you can see my thinking though I should put the caveat on the front of this that you should NOT treat this as a guide as your diabetes may vary.

As I said, it kind of went wrong from lunch time so lets look at that.
BG before lunch was 12 and I was eating 24g of carbs. So I went with my normal 1:1 ratio to give me 2.5UI and then I did a "gentle correction" of 2.5UI aiming to bring me down to around 7mmol/l (1UI drops my bloods 2mmol/l approx)

As you can see that dropped me to 5.7 an hour or so later which seems amazing, for me this is too good since it takes more than 2.5 hours for me to return after a meal. Then at around 17:30 I had an early dinner as was hypo. So clearly my lunch ratio was off or maybe I should NOT have corrected.. okay thats 1 point.

So dinner was fairly carb heavy at 100g, normally evening ratio is 2UI:1CP but due to hypo and the guess that I was still dropping (No Libre or CGM so I have a scalal value not a vector... it's a pain!)

A couple hours later I am hypo AGAIN!
Then we see a pattern where I keep throwing carbs on top but pretty much remain hypo the whole time.
I should mention that I do not really follow the standard guidelines of 15g carbs and then more. I calculate what I need to eat and it usually serves me well... usually.

What makes this a little complicated to work out is that I did not return to a "good" number before bed so it is difficult to tell the difference between where the bolus ended and the basal becomes the dominant factor in all of this.

Bolus first

Since this is all one big experiment I will simplify things and make some assumptions to test.
BG between dinner and 21:30 (when I take basal) remains about the same so lets say that I had 120gC and that 17UI kept me stable. That means my ratio was about 1.4UI:1CP for that... so we will take that forward for next time.

Basal baby

To show you the whole story I need to add an extra view of last times overnight BG's and they are not

pretty... I'm fairly sure that my specialist will have a fit tomorrow at my annual review but I'm still here so clearly not totally unsafe!

Between 21:30 and 8am I was up to deal with hypos a few times. Total additional carbs before breakfast was 25g. Going with on the assumption of 1:10 I will say that I needed at least 3 units less than I took. So I took 16 which means 13UI basal. To complicate matters my night time basal is changing anyway (reducing) so that makes it trickier.

Looking back at my logs from last year it seems to be a year on year trend that as the days get lighter my night time basal drops off, recent night time hypos or low morning seem to back this up so I will go with 12UI next time I think.

And again

I've gone on an aweful lot looking at last time however since I cannot see the future I have to look at the past and try to build a predicitive model from previous data (look at me sounding all sciencey) so this is what I intend to try this time around:

• Back off morning basal and inject after the run since it worked last time
• Make a judgement call about lunch of either reducing ratio (currently 1UI : 1CP so not sure) or do not correct.
• Reduce dinner time bolus ratio from 2UI:1 to 1.5UI:1.
• Reduce evening basal to 12UI

That is a hell of a lot of changes which is going to make it hard to understand what is doing what. Yes that's true however given the number and duration of hypos last time I decided that for safety sake being quite aggressive in backing off my insulin intake is probably the best thing.

How did it all work out then?

To be honest, better that I expected. I had thought that I would spend a lot more time hyper and have

to correct at some point.
Morning started off a little high so I did a small correction since I didn't want to start too high as I figured that would make me feel rubbish.

Levels during the run remained pretty stable again with the small correction I put on (3.5 Units, aiming for about 7mmol) meant I was on target when I finished by 9:48 with 7.8.

Something which did surprise me (even though I didn't notice it last week and it was there) was the rise an hour and a bit afterwards... that's the 17.1 here.
Lunch time came around and I was 12.3, again I was really missing the vector value since I had no idea how fast my sugars were dropping.
Lunch was something yummy (and spicy) from Nandos as we had to go run some errands. I decided that I would dose normally and just ignore the correction since I guessed it was dropping on its own.


Well that sort of worked. By dinner time I have been running high but still in single figures though I think the reduced basal is running low either that or I need more basal and less at lunch... not sure which to go on that one, will have to mull it over some more.

So dinner time and I go with the reduced ratio and add a correction to bring me towards 5 before evening basal.
So basal time and I am running at 4.5 (again... no clue which way it's going) so go with basal of 12UI (last week was 18UI) an almost straight away I hypo to 3.8.
Working on the assumption that this was left over bolus I did a small correction of 5g which should kick me to around 5mmol/l by morning.

It's no morning and I woke up after a nights sleep uninterrupted by hypos and my test came back at 5.7mmol, I will take that as a morning reading any day you care to name thank you.

Where do I stand now?

Well I improved my parkrun time by 7 minutes which sounds amazing, well I guess sit is since I only expected to gain 2-3 but I have now gone from bloody slow to just merely slow now however that's the bonus and I still have more to do.

The key thing I have achieved is that I can now say that with the changes this week I can now do this exercise safely, only 1 hypo this time compared to 6 last time around. I haven't got this dialled in fully by any measure but I am defininitely further forward than I was before and I now have more datapoints to work from.

What next?

I think for now I want to do a few more weeks following this exactly pattern to build up more data. The big reason for making a load of changes compared to last week is that it just was not safe to leave things that way. Now that I am safer I can let things settle a little so I have more information to inform decisions for the further adjustments.

I have ordered up a Libre sensor to give me a little more data even though I know my skin will react but I just need the data. So let's build a bigger dataset to work from and move from there.

Get moving

Okay so I finally did it. After many years of being a lazy git I made the decision to start getting more active and try to be a bit fitter and healthier.

It seemed to me that it is relatively straightforward on the surface of things, you need to:

• Eat healthily and sensible portions
• Get more physical activity in
• Keep doing the above forever

The food side was fairly straightforward, as a T1 I am already very aware of anything that goes down my throat, to the point of it technically being an eating disorder if you go by the letter of the description, that making a few small adjustments was no major thing. The keeping on doing something forever, uhm... T1, I know how to do stuff forever even if I don't really like it.

So I'm already more than half way there... this stuff is easy! Well.....no!

The last time I hit the gym was probably 7 years ago and one of the reasons I stopped was that I just could not get around the crash of blood sugars, combine that with the fact that when I exercise I pretty much lose ALL hypo symptoms. Well, not completely true. While active I cannot feel anything coming on, when I pause between activities then I feel like I am having most of the symptoms so my body is being very unhelpful at both times.

My kingdom for a flat line

Well that's the crux of the problem identified and the thing is again on the surface it should be easy to manage. Test sugars lots and deal with it.
You could I suppose, though you would spend all your time chasing your BG's and likely feel like rubbish a lot of the time, call me strange but that doesn't seem like a sensible approach to keep you motivated enough to do step 3 above!

So what can you do? Well I pulled my logs from years ago when I was still going to the gym (yes I still have them stored on my computer and backed up online) so that was easy for me.
It seems that the way I used to handle activity back then was one of a few ways:

• Eat before the gym, short bolus and then go.
• Take plenty of snacks with me and eat between activities
• Short bolus at lunch (gym after work) and run high all afternoon.

Obviously this didn't work out or I would still be going to the gym today. Based on my notes some of the things that went wrong include (but not limited to).

• Massive hypo after coming off the treadmill (1st activity) and had to scrub the rest of the session
• Activity made me bring dinner up (my notes were a bit more course) so then had panic about not having enough carb in me anymore and so ditched the rest of the session.
• Felt so rotten all afternoon that I didn't feel well enough for the gym.
• Everything went well and gym was fine

Oddly enough based on the notes it seems that the last outcome there was actually in the majority, though it didn't feel like that at the time. Funny how you see things differently when you actually go and look at the data after the fact.

My plans weren't great, what next.

So clearly my original methods were not a great success, obviously more than I thought at the time, so a different approach is needed.
It's completely obvious that this not a completely insurmountable challange since others are managing it, however there is the little issue of #YDMV (Your Diabetes May Vary). What works for one might not for another and all... this T1 thing is complicated, annoying and completely inconsistent.... it's a wonder any of us are still sane. Errr... moving on!

Trying to see what others were doing was obviously a sensible idea, fortunately my diabuddy @Type1Bri started doing exactly this and since he has such a wonder set of links and experience on his site I started there bounced around reading a bunch there and stuff he linked to in order to work out a strategy.

It's basically a navigation exercise

What is the idiot on about now you are probably wondering. I thought we were talking T1 and exercise. Well yes but the principal is similar, please bear with me here. For navigation you need to know a few things:

• Where am I now?
• Where do I want to get to?
• What routes can I take to get there?
• Do I need anything special to travel any of the chosen paths?

So let's apply this to my situation now.

Where am I now?

Ignoring the unfit part, I T1 on MDI taking Levemir for Basal Morning and Night with varying bolus ratios throughout the day wth blood testing done with old fashioned finger prick testing since I get a sever reaction to the FreeSyle Libre. This is a shame since I loved the Libre and wish I could use it. For now I hold out hope that the SugarBeat drops in the next couple of months.
I generally do not eat breakfast (whole other story from even longer ago than T1) and am only a little bit over weight.

Where do I want to get to?

I would like to get rid of the excess weight and be able to happily run 10k in something approaching on hour without feeling like I am about to die.

What routes can I take to get there?

Well this is where the hard work starts since there no short cuts unfortunately my maps are all a bit faded. What this means is I will need to do a LOT of experimenting and take things fairly slow to start with.
ParkRun seemed like a good way to start all this since it's all well organised and I can make the organisers aware of any issues I may have so from that point of view it's all pretty safe.

How did it go?

Yes I know I missed point 4... Well I didn't but it got crazy long and wildly off topic so I cut that and will maybe push it into a different post in future.

Being on MDI makes changing your basal almost impossible, note I say ALMOST. Once it's in it's in so then it IS impossible. However, parkrun takes place in the morning a couple hours after I would normally get up and finishes around an hour later so call it 3 hours.

My first thought was this:

• Don't take my basal when I get up
• Do parkrun
• Calculate an equivalent hourly rate and deduct that from a basal shot to be taken AFTER the run.

So how did that work out? Easy if you take a look -->

So the day did not start well with a 2.8 at waking but no worry I can still work with this and I am determined to do so.

Before leaving the house I am up to 6.7, so getting better and this is mostly expected as I tend to see a rise not long after getting up.

By the time I am about to start at 08:43 things are looking better and I know that I have no basal onboard so for the next two hours I should, if I do nothing, see a rise of 4-5mmol, this is what I am giving myself.

I should point out that I did NOT run this course but did a very brisk walk and then ran a good chunk of the final lap.

at 9:32 I am half way and stopped to do a test (annoyingly this added at least 30 seconds to me time) but 6.3, I can work with that.
Remember, no real hypo awareness when exercising.

09:56, all finished an wandered off to grab a brew and sitting nicely at 7.5. Not too shabby, this is where I took my basal and reduced it down by 4 units (usually 18).

Peer support.

This is something that I have blogged about before, it really is all about the people that get you so I want to send a huge thank you for the messages of encouragement from the #GBDOC. Thank you also for the advice and warnings of what to look out for over the rest of the day.

The support and advice were huge for me and did make me adjust what I was going to do for the rest of the day, though as you will see probably not enough. But it's all a giant experiment and the key thing is I got DATA! I do still want to say a big thank you to Thank you also to @Type1Bri, @Fractis, @PlatinumB2 and @flipper1 for the encouragement.. much appreciated ladies and gents!

So the eagle eyed amoung you will have spotted the graph at the top of the picture which shows me going hypo around 6pm, it didn't get a lot better after that. I was high for lunch so was planning a correction. @Type1Bri helpfully warned me that I would need to likely back off my ratio. What I did was half a unit of my calculated bolus and then took an extra unit out of the correction. Wouldn't you know it that was not far off, around 4pm I was at 5.7.

Then it all went to the gutter for the next 16 hours or so:

I dropped to just below 3 and was fighting it until around 8am the following morning so it was not the most restful nights sleep ever.

During that time I had to take about another 60g of carbs to try and deal with the hypos, so clearly I did something wrong!

Here is the important thing:
NONE OF THIS IS BAD! IT'S ALL NUMBERS AND I INTEND TO DO SOMETHING GOOD WITH EM!

What next?

Well clearly I need to do something about the drop ~ 10 hours after the event and also over night. I guess my liver is sucking up the sugars overnight so I am looking at something like this moving forward.

Drop evening bolus ratio to 1.5UI to 10GC.

Drop my night time basal by 4UI to 14U.

Will this work? I have no idea, I doubt it will make things worse but the point is that it is all an experiment. Everything right now is successful (no bad numbers) for a few important reasons:

• I didn't hypo so bad I needed any help
• I got a ton of data from it all.
• I have a plan for what I will do next week.
• I actually did something!

If you are considering trying to get more active then to be honest I would say just make a start at it. Obviously your diabetes situation may be different but if you take the time to do the navigation work then you might be surprised at where you can get to.

As always, the cool thing about the online diabetes community is there are a load of people out there who will just get you. Many will be going through or will have experienced something similar and will always be happy to help and offer encouragement. So take that first step, it doesn't need to be fast but it still puts you one step closer to where you want to be than you were yesterday!