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Basal Insulin Testing – Why, How & When?

Do you have frequent low blood sugars? Or high? And they all seem to come out of nowhere?

It could be something wrong with your basal insulin, dose or timing! Learn all about basal insulin testing in today’s Type 1 Thursday!

When was the last time you checked you basal insulin settings?

Type 1 Thursday – Basal Insulin Testing – Hanna Boëthius

Transcription

If you prefer to read all about basal insulin testing, you can do so below. Enjoy!

Basal Insulin Testing

‘I want to ask you this first, do you perhaps experience frequent hypos or frequent highs that seem to come out of nowhere? They are not really connected to when you’re eating and your bolus insulin, and it’s not really connected to anything else either. So maybe it is something else, could it be? (As we all know, with diabetes, chances are it could be…)

Butt first, hypos, or low blood sugars, never, ever happen because you’re not eating enough food! Hypos always, always, always happen because you’re taking too much insulin for that particular circumstance. That actually leads us back to today’s topic, basal insulin settings and how to check that your basal insulin settings, like your long acting insulin, or basal settings on your pump, are correct for you. Not for anyone else, never ever compare insulin dosages with anyone else. It is what it is for you and if it is correct.

Basal insulin is really key, either is dose or the timing. If you are on MDI, timing of the basal insulin could be a problem. So let’s figure out what it is, how we do it and all this stuff when it comes to basal insulin testing. It’s not necessarily fun, but hey, you know, it needs to be done if you want as good of a control as you can have on your Type 1 Diabetes. Having your basal set properly also helps you bolus correctly for your food or it makes it a lot easier to calculate.

What is a basal insulin test?

The point of basal insulin is to keep your blood sugar stable when you’re not eating, when you’re exercising when you’re not doing anything. It works the same in healthy people, the ones that don’t need to add insulin from the outside. Basal insulin is there to keep your blood sugar very stable during the whole day when you’re not eating, not exercising, not doing anything of the few things that actually help lowering your blood sugar, or any of the 42 or 45, or whatever things that can increase your blood sugar.

What is a basal test? Well, it’s basically to determine what your proper basal setting is, whether you are on a pump or taking long acting insulin. Without the influence of food and without bolus insulin, without exercise.

How to basal insulin test?

How do you do it? Well, trick number 1 is to start at a normal blood sugar level. Don’t start if you’re too high, don’t start if you’re too low, start at a normal that is the baseline of basal insulin testing.

You can either do it in two ways. Either you fast the full 24 hours and get it all out of your system and you have done in one go or you divide it up on 4 days and divide the 24 hours into 6 hour increments, where you fast for 6 hours and then check your blood sugar’s hourly to see what happens to them.

This is also where a CGM is very helpful, although I would not trust it to be exact for all of that, I would also prick my finger a couple of times in those 6 hours or those 24 hours, just so you can actually see what is doing what. If you choose to do it in four days, then you do overnight in one go and then you do a morning session, followed by a day session and then an evening session, so that you get those 24 hours all checked.A suggestion is that you basal insulin test one week and then the next week you do the same, to just double check and fine tune and really tweak your basal insulin (because this is really key for good blood sugar management)

Do & Don’t when Basal Insulin Testing

Don’t eat or take insulin (bolus) 4 hours before you start the test.

You can have water and herbal tea during your fasting hours, anything that’s not caffeinated and nothing that will do a number on your blood sugar. Anything that is neutral is fine.

Don’t eat unless you go too low, if you’re having a hypo. Also, don’t correct unless you go too high. (If you go too low during your your basal insulin testing, it means that you’re taking you’re taking too much basal insulin, whether it isn’t a pump or injections. If you go too high, your basal insulin is sett too low.)

Make sure you’re not sick or on your period or have something going on that you know influences your blood sugars.

It is completely okay to break the test if you have to! If you have a hypo, you have to correct it. It’s fine to break the basal insulin test, you just do it another day instead. And the same if you go too high, it’s fine to break the test, you have a bolus and get on with your day. The main point is that you take care of yourself! The basal insulin test can be done another day instead.

Also, one, one very important tip, is to write down the results, so you have them on paper. It makes it a lot more easy to overview instead of having it in some app and you have go back and forth between resources. Good old pen and paper works the best in this case, I would say.

What are the results of basal insulin testing?

If your blood sugar drops too much, you’re taking too much insulin. You’re taking too much basal for your needs. If your blood sugar goes up too high during the basal insulin test, you’re taking too little basal insulin, and you need to increase it.

If you are an MDI and notice something could be better during these 24 hours, perhaps you need to split to your dose? This is something you can discuss with your doctor. And if you’re on a pump, remember that it’s usually the basal setting that is about an hour to 2 hours before that impacts your blood sugar’s right now, so you have to be a little bit flexible in adjusting this, if you need to.

That was my very short run through on how to basal test your insulin properly.

I want to know from you, when was the last time you basal tested your settings or your dose or timing for that matter?

Let me know in a comment below. I’ll be so happy to chat with you there.

Ps. Want to learn more about basal insulin testing? Check out Dr. Richard Bernstein’s video here!

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High or low blood sugars?

How often do I have high/low blood sugars that need treatment? 🤔 A question from the audience!

Learn how I attempt to avoid the high and low blood glucose readings (that are, more or less, a part of life as a Type 1 Diabetic).

Type 1 Thursday with Hanna Boëthius

What about you? How often do you have highs or lows that require treatment? Let me know in a comment!

Transcription

If you prefer to read the information in the video above, please find a written version right here:

High or Low Blood Sugars?

This week, I have another question from the audience. And it’s a personal one-ish. Well, I don’t want to get your hopes up, it’s not that bad. Actually a normal question, but it is more personal natured one. So I’m looking forward to answering it. Because this person writes:

How often do you have a real low or high blood sugar that you need to correct? Is it rare, or is it part of everyday life?

I thought this question was very, very interesting. And I guess I’m not that open, perhaps, with my blood sugar levels online, because I frankly don’t think it’s very interesting to share them. If you want me to, I could share more of my day to day values. (If you do, please leave me a comment so that I know because I cannot read your thoughts out there! 😃)

High and low blood sugars are of course part of living with Type 1 Diabetes and no one can deny that. The frequency of them, however, can greatly and amazingly be influenced by different lifestyle factors, for example. For me, for example, a low carb lifestyle has really helped to eliminate most highs and lows. I no longer get those extreme highs followed by extreme lows, because I simply follow the law of small numbers so I don’t have that much insulin in my body. And also not that much insulin required, that I get those quick drops. Furthermore, I don’t eat that much sugar and carbs so that I get the high highs. You can do a lot with lifestyle factors!

It’s also a question of definition. For me is low is below 3.2-3.5 mmol/l, which is about 65 mg/dl, and my highs are already around 6.5 mmol/l or 117 mg/dl. It’s really a question of definition. Do you mean those super-highs of 400 mg/dl and then down to 20 (22 mmol/l to 1.3)? Or, do you mean this sort of gradual, just on the verge kind of sugar surfing highs and lows? It differs from person to person.

Basal Testing

The number 1 thing that I would advise people in this situation is to check your basal settings. Whether you have your long acting insulin or an insulin pump with a basal setting, make sure that those dosages are correct. That can save you a lot of trouble! This is something that I do on myself, as well, I make sure that my basal settings are correct (or as correct as they can be because life happens and things go up the wall sometimes) If you want me to do a video about how to basal test properly, then also let me know in a comment!

If your basal dose is correctly set, you also need less corrections to get the results you need. If you’re too low or borderline too low, for example, and your basal isn’t too high so your blood sugar won’t keep going down much further. With the right settings for you, you only need very little carbs to get you back up into a healthy safe range. Same with highs, if you are borderline high, you don’t need that much insulin to get yourself into a nice, safe healthy range again, because your basal insulin is correctly set.

My Trick

I correct before there is a high or a low. Of course when I can, things like sleep, illness, travel, stress and things like this too much work (guilty as charged!) can of course make this a little bit trickier and hinder me from keeping that level of control. But whenever I can, I do react before it the low blood sugar or the high one is a fact.

Managing this before they’re a fact, I cannot say enough that a CGM, a continuous glucose monitoring system, really is worth its weight (well, really is worth its value) in gold, because they’re quite expensive. They’re small, but expensive things. Anyway, they are worth absolute gold so that you can react before there’s a high or there’s a low blood sugar.

CGM’s are of course not exact. I don’t know of any CGM system that is absolutely exact. Especially when my goal range is so small, it is very, very annoying that it is more most often 1-3 mmol/l (18-60 mg/dl) off. It’s not really exact, but it is invaluable to see the trends! Where is your blood sugar trending? If your blood sugar is steady and starts to trend downwards, then you can already treat so that you need a lot less and the the hypo doesn’t become a fact. Or, if you see that you’re trending upwards, you can play with either temporary basal if you are in a pump, or wait it out and see what happens ,or correct with insulin. For the trends, and the CGM is fantastic and I could not recommend any more!

Timing

Reacting in time actually also helps the Standard Deviation of your blood sugar, as well as your Time In Range, which is what reacting in time will help. This will also help your HbA1c. That little trifecta is a fantastic measurement of health for diabetes. And that also is helped by reacting in time so that you don’t go high and don’t go low, but you can react before it is a thing.

Doing it this way, reacting before a high becomes a high or low becomes a low, makes them very rare. It actually makes them more rare than then it would be, if I, for example, added a ton of sugar, or the recommended amount of carbs for example. This is true for me, and I’m not going to talk about anyone else. But for me if I added that, I would have many more highs and I would have many more lows, because I would have to fight the carbs as well as my body with the stress, work, illnesses, and all of the other 45 things that always influence our blood sugar.

This is my Dexcom G6 24 hour curve from 20th February, and I’ve marked where I used my method and reacted before a high was a high and a low was a low:

I want to hear from you:

Do you have highs and lows often and that you need to react to? Or are they rather rare for you? Let me know in a comment. I’d be happy to chat with you there.

Ps! Join me live next time, Thursday’s at 6pm CET on my Facebook or Instagram for another episode of Type 1 Thursday!

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Why No Protein Shakes?

Why no protein shakes? 🤔

Type 1 Thursday is here with another question from the audience:

“Hello, I notice that you don’t drink any protein drinks or shakes? Do you think they are unhealthy?”

Hanane

As a short answer, no, I don’t think they’re unhealthy. But I do think there needs to be a need for them, as protein needs are individual. Check out the whole explanation here!

Type 1 Thursday – Hanna Boëthius

I want to hear from you, do you drink protein shakes? Or do you get your protein from other sources? Let me know in the comments! 🙌

Transcription

If you prefer to read my views on whether protein shakes are good or not, you can find a written version here:

I am so excited, because there is another question from the audience today that I will be answering. If you have any questions that you think that I should be answering on these live chats (that we have every Thursday 6pm on Instagram, and Facebook), please do let me know in a comment somewhere on the interwebs and I’ll be happy to answer them.

To today’s question, it reads like this: “Hello. I noticed that you don’t drink any protein drinks or shakes is that because you think that they are unhealthy?”

Protein is a very individual

Protein threshold is very individual, especially on low carb, but also generally. Maybe on low carb you give a little bit more of a damn about the protein amount, especially if you have read #*#. Richard Bernstein’s book and checked out his Diabetes University. Protein needs are very individual and it can range from anything, for very sedentary people something like 0.8 grams of protein/kilogram body weight, which doesn’t mean 0.8 grams of meat but 0.8 grams of protein, to something more normal, if you are a little bit more active, maybe something like 1.2 grams per kilogram, or maybe 1.3, 1.5. But it can also go as high as something like 2.4 grams per kilogram, up to five grams per kilogram, if you are a super active athlete.

If your main fuel is protein and amino acids, then it is very individual how much you should be eating. This is why I personally don’t need to drink any protein shakes. I am not a very active athlete, well, I try to keep active but not that active. I’m also not a growing child. So I don’t need as much, and I can cover my protein needs with real food. You have to determine for yourself how much protein you need in your individual case.

Protein in Meat

All meat generally contains about 20 grams of protein per 100 grams of meat. Not all meat is protein, and not all protein is meat. Only one-fifth of the meat is actual protein and amino acids. If I eat 400 grams of meat a day, which is possible, not in one sitting, but if I have two sittings, lunch and dinner, which is normal for me. I don’t really have breakfast so I don’t have to pay attention there. If I have two sittings, and I have 200 grams of meat or protein filled food per sitting, that gives me 80 grams of protein for a day. And that would mean that that is 1.3 grams per kilo of body weight that I have (now you can count how much I actually weigh) Personally, I just prefer to get my protein from real foods because I can. And because I don’t have that extra need for protein shakes that you may have, as I said, if you’re a growing child or a very active athlete.

Need for protein shakes?

The short answer to your question is; I don’t think that protein shakes or drinks are unhealthy, per se. I just think that there needs to be a need for it. And in my case, I don’t have that need. Perhaps, in your case, because you are asking, there is a need for it and then you have to determine if that’s true or not for you.

If you do need a protein drink or a shake, I would recommend something that is clean without any sugars and any added stuff. Flavours is one thing, but you can also flavour it with other things like natural cacao powder or something. You don’t have to buy the ready mixed flavoured stuff, but something that is clean without sweeteners and without dextrose, please, because that will mess with your blood sugar, all the ways till Sunday. If I had the need for protein shakes, I would go for something like an egg white protein or a whey protein.

So, in conclusion, no, protein shakes and drinks are not inherently unhealthy. But there needs to be a use for them and a need for them. Thank you so much for your question!

I would love to hear from you – what are your experiences with protein and with protein shakes? Do you drink them? Or do you get the protein that you need from real food? Let me know in a comment below, and I’ll be happy to chat with you there.

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Low Blood Sugar and Weight Loss?

How does Low Blood Sugar Affect Weight Loss? 🤔Does it have to? What factors do you have to look out for?

Type 1 Thursday is here!

Do you have experiences with how blood sugars impact weight loss? Share them in a comment!

Type 1 Thursday with Hanna Boëthius

Thank you so much for watching. Please let me know if you have any questions!

Transcription

If you prefer to read my thoughts on this, here’s a text version on low blood sugar and weight loss:

Blood Sugar and Weight Loss?

This week I’m excited about the new audience question! (If you have any questions that you want to hear my answer to, then please let me know!)

This week’s question comes from Joe, and Joe writes, “how do low blood sugars affect weight loss?” Thank you for the question!

Are you insulin dependent?

A lot of it depends on if you are taking external insulin or not. Because weight loss happens when a) the blood sugar is stable and b) there’s no excess insulin in the body. There are different theories of weight loss, two main ones as I see it, which I’ve talked about before here on Type 1 Thursday. One is the good old calories in vs calories out which we know is maybe not as applicable as they thought that it was. The other one is that it is actually hormone regulated, mainly with insulin as it is the master hormone in the body. If you don’t have excess insulin, and your blood sugar’s are stable, weight loss will occur.

In diabulimia, which is a very, very serious condition to have, which is when you take no insulin to lose weight. But that is not the point of this. This is about healthy, happy weight loss, if that is necessary. This is not an eating disorder thing that I’m talking about. Just to clarify that, and I find that very important because it is a terrible, terrible condition to live with. So, none of that, just healthy healing, healthy weight loss if necessary.

What is a low blood sugar due to?

A low blood sugar is because you took too much insulin for that particular circumstance. For that particular food, for that particular mood, for that particular weather, whatever it is that is influencing your blood sugar, you took too much insulin for that. That’s why you ended up with a low blood sugar, because nothing else lowers blood sugar like insulin does, and nothing else can lower blood sugar lower than it should be in a normal human being than insulin. So, if you are treating diabetes with insulin, does that mean lows are equal to excess insulin? Which then means that it will be a slower weight loss?

Well, actually, not necessarily. It depends on how stable your blood sugars are. If they are jumping like a roller coaster, so that it’s super high and then goes super low (which means that you then have to treat it and then go super high and super low. Again.) That’s a completely different thing than if your blood sugar is really stable. And then sometimes it trends downwards and dips minimally and you can correct it very easily. I’s a completely different thing than if you are all over the place in terms of blood sugar, and are struggling with it. Balanced blood sugar is the key, not a jumpy blood sugar. That’s what we should aim for. And that usually also aids weight goals.

Low Blood Sugar anyway?

You know, we all end up there no matter how good (or whatever) we are as people with diabetes, no matter how well we take care of ourselves, circumstances do change in the body. And lows do happen. They happen to me, they happen to everyone I know who are normally quite well controlled.

The key here is how do you treat it? Do you choose to eat the whole kitchen? So you grab anything from grapes, to peanut butter, to that sugary candy you have in the back somewhere, to snacks, to yoghurt, to honey, to you know the whole nine yards which will end up on this rollercoaster blood sugar ride, which is quite detrimental for your health. And it feels, first and foremost, really, really frickin terrible. So try to avoid it for that reason alone! Or, number two, do you treat low blood sugars targeted with an exact measurement of glucose? Because that doesn’t create the rollercoaster rides. It creates an even curve, even if you do dip a little bit you take a gram, or two grams or three or four, depending on how much you need (and that you need to do a trial and error with). You just come up a little bit again, and then you’re fine. Again, you don’t get those big swings. So that is really important how you treat the low when it does happen.

Correcting a low is of course, necessary, it can and definitely does save your life. So don’t skip it, even if it would potentially kick you out of ketosis, if that is your goal. I’m not saying that ketosis and keto and low carb is everyone’s goal, but if that is what you’re worried about in this question that treating a hypo will kick you out of ketosis or something, don’t be! You really need to save your own life in that case. It doesn’t matter if you get kicked out of ketosis or not. If you are fat-fueled in that way, or you can burn both fat and sugar, you will get back into ketosis very fast afterwards, so don’t worry about it. It really is key that you do take care of this.

The short version of my answer to your question, Joe, is that low blood sugars do not have to affect weight loss at all. It depends on how you treat the low and depends on how stable you are blood glucose is normally and that you don’t have excess insulin in your body.

Hope that helps!

If you have any questions, do let me know. And also do let me know your experiences of blood sugar and weight loss? Have you managed to lose weight, or maybe you don’t manage to lose weight although your blood sugar’s as good as perfect? Let me know in a comment, and I’ll be happy to chat with you there.

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Type 1 Thursday – Bolus Gone Wrong?

Type 1 Thursday is BACK – and it’s all about the bolus!

Today, I’ll be answering a question from the audience about mealtime bolus gone wrong… How do you handle first high blood sugars, then low? Or high and steady after meals? Or low 3-4 hours after a meal? So confusing!

Do you have any experiences with mealtime bolus? How did you solve it? Let me know in the comments!

Type 1 Thursday with Hanna Boëthius

Also, do you have any questions for me to answer? I’d love to answer your question in a future Type 1 Thursday.

The bolus infographic from Diaverge.com that I mention in the video is this one:

Transcription

If you prefer a written version of the video above, here you go:

Type 1 Thursday – Bolus Gone Wrong?

I have a really interesting question today actually, because this is something that I’ve struggled with myself quite a lot. I got a question from the audience this time to answer.

“So, how do I time insulin for different meals? I’m struggling despite eating low carb, and I still spike sometimes dosing at the start of the meal and then go low one hour after. And if I dose at the end of the meal, I go high and then low three hours later? This is so confusing!”

Rachel

I do agree with Rachel, it is very, very confusing. It is difficult to figure this out. But I do have some rules of thumb that may help Rachel (may actually be a good reminder for myself, too) and maybe it will help one or two of you guys as well.

Dosing vs Timing?

As I see it, this can be both a dosing issue, but it can also be a timing issue.

This really comes down to first of all, what kind of mealtime insulin are you using? Are you using regular insulin as many people do on low carb? Are using some of the faster ones like Humalog or Novolog or Novorapid? Or are using the even faster ones like Alfrezza or Fiasp? It’s very difficult, as these insulins have different working time until they actually hit your system. Until you figure that out, it can be clue number one!

Clue number two is that it definitely can be a timing issue, but also a dosing issue. So let me go through this very, very carefully, point by point so that we don’t lose any details because that could be devastating!
– if you first spike blood sugar after your meal, and then you go low, that means that you took too much insulin. It was also too late, hence the spike first and then the drop. So, play around with that, maybe you need to dose a little bit less, or maybe you need to do the same dose but earlier.? So that can be one of the clues if that is your problem, which it was in the question.
– if you go low within the first hour, the amount of insulin you took was just too early because it hit your system before the food hit the system. So be careful and dose a little bit later.
– if your blood sugar goes high and remains high after food, your bolus or the amount of insulin that you took was just simply too small. You need more bolus for that particular food or that particular situation or that particular anything-that-you-know influences blood sugar (which we all know is about a gazillion things).
– Number four, which was also part of Rachel’s question, you go low two to three hours after food, that means that the bolus was too late. And definitely too much because your blood sugar dropped afterwards.

Those are the four different scenarios that I can figure out that may help. I shared this in a wonderful infographic from the beautiful ladies at diverge.com recently on my Facebook page, and it’s also above here in this post.

If you’re not recognising the patterns that you’re that you have. If you notice, for example, when you have certain foods, does the one or the other happen? If you have different timings of insulin, of course, this or the other happen? Or perhaps something completely new? Or, for example, if it’s the time of day – some people are more insulin resistant in the mornings than they are in the afternoons! So it can also be a timing issue, not just because of the insulin and when you took insulin and how much, but it can also be, depending on how or what time of day it is, because it just doesn’t always add up. It’s not always the same for people and especially not Type 1’s that are handling a lot of things at once.

I’m very, very happy to hear your experiences with mealtime bolus? Do you have any problems? How did you solve them? Have you maybe not solved them yet? Let me know in a comment below and I’ll be so happy to chat with you there.

Type 1 Thursday – Medication

Are you taking the right medication, or medications, to manage your diabetes?

We often just “take what we’re prescribed” in terms of medications. But is this always the best strategy? Is there anything you can do as a patient to influence your medication?

In this week’s Type 1 Thursday, this is exactly what I’m talking about, how we as patients can get more of an insight and clue into what we’re actually given, and should be taking.

Type 1 Thursday – Medication – Hanna Boëthius

Are you taking the medication you need to manage your diabetes as well as you can? Is there anything you should perhaps check with your health care professional? Let us know in a comment below!

Transcription

If you prefer to read this information, please find a text version below:

I can’t wait to discuss today’s very important, but this may be my shortest Thursday ever. The topic today is medication and although this is a super important thing when managing your diabetes, I am unfortunately not a medical professional. Ergo I am not allowed to give you any advice on this. (This is why this might be my shortest type on Thursday, ever.) But what I will give you are some general tips and tricks of what you can do and what you should look out for and when it comes to medication and your diabetes management, whether this is Type 1 or Type 2, it doesn’t really matter. Most of us need to, unfortunately, be on medication anyway, Type 1’s, of course, forever and ever until the day we die, we need to be on insulin, at least, if not other medications. Type 2’s can get away with not being medicated, in some cases. But in case you are, then this could be something for you as well.

The first thing to really make sure that you have is a great cooperation with your healthcare professional, because they, in comparison to me, can give you advice on medication, and medical issues in your management. I can only give you results, tell you things that I’ve done and that has worked for myself and that I know from other people’s experience, nothing else (glad we got that covered!) With your healthcare professional, you need to find out whether or not your medications are actually what you need. In many cases that I know of, are actually not given the correct medication, which they find out in hindsight. This is where you really have to speak up as a patient and tell your health care provider, whether that’s an endocrinologist, or CDE, or nurse or nurse practitioner – whatever you prefer to go to. You have to have an open conversation with them in terms of how you feel, how it’s affecting you, how it’s affecting your lifestyle, your energy and what your blood glucose values are, if you live with diabetes. This can both relate to the amount of a medicine that you’re already taking, or a type of medication that you’re taking. Do have someone that you can really trust on your team so that you can get the help that you need in terms of medication.

This medication, as I touched upon a little bit before, needs to fit into your lifestyle, as well. If it doesn’t fit you to feel sluggish, not energetic slow and just generally crappy, then definitely speak up, do something about it! There’s always, always, always something that you can do to feel better, as I usually say. And there’s most often another medication that you can try instead. Make sure that you get what is right for you for your lifestyle, for your body type, for everything that can have a an influence.

Let’s go more into insulin. Have you been given the correct types of insulin, for example? There are many types of insulin, of different efficacies, and how long they last in the body. How long insulin works in your body is very individual. For me, for example, my short acting insulin, that I’m on all the time through my insulin pump, last quite short in my body, it’s only two hours. That being said, the same insulin can last a lot longer in someone else’s body, even up to four or five hours. That’s something that you have to find out. Do you have the right type of long acting insulin, for example, for your life, for your diabetes, for the way that you want to feel? There are many different types of long acting insulin, and they have different aspects and attributions to them. Check out if you may be need to change yours or try another one for a while. In most cases you can try if you want and then go back to your normal routine if it doesn’t work out for you. I think, as patients, it’s very important that we have that choice. There are also different types of short acting insulins, rapid acting ones, which you need to find out which one works the best for you. We also have, for example, regular insulin, which covers, for example, protein very well. It can be a great tool to use if you are willing to try it. It doesn’t act like the other insulins, so don’t expect it. But it can be very helpful in certain cases, especially with a more protein rich way of eating.

When was the last time you did some basal testing? When was the last time you did a proper basal test to check your basal insulin? Whether that comes from a pump, or long acting insulin is accurately dosed for you, your life, and your diabetes. For example, someone maybe more insulin sensitive at times of the day or more insulin resistant at other points of the day. We have to make sure that the basal insulin is the correct amount for you. This is best done with through fasting and you check your blood sugar every hour throughout a 24 hour time period, this can be split up in different days, as well. Anyway, I’ll get to that in a different chapter in a couple of weeks time. Basal testing is very important to figure out if you’re doing the right thing with the insulin.

Another thing is to pre bolus. Do you need to pre bolus for your meals? Maybe check it out, if you feel comfortable with it, you can try around a little bit with pre bolusing before meals, and see if you get better blood sugar results through that.

Other, not directly diabetes related medications, that you may or may not be prescribed. Again, you have to work with your healthcare provider and see what can be maybe improved, maybe added, maybe taken away. Being diabetic, one of the milder complications can be high blood pressure. Maybe you are on blood pressure medication already, maybe you need to be on one? Maybe you need to be an ACE inhibitor, which has been shown to sometimes protect the kidneys from damage, for example. And it’s a statin really necessary in your specific case? Discuss with your doctor, and bring papers, bring your research along and they usually try to accommodate, or, rather, should try to accommodate you. But it doesn’t mean that everyone does, of course. A medication like Metformin, for example, maybe it could be beneficial for you? Maybe you don’t need it anymore?

Again, you have to have an open dialogue with your healthcare provider. That’s my main point when it comes to medications. I can give you ideas of things to think of and bring forward to your doctor, but I cannot give you advice on exactly how to do it.

Are you taking the medication you need to manage your diabetes as well as you can? Is there anything you should perhaps check with your health care professional? Let us know in a comment below!

Ps. Do you want to learn from amazing medical professionals at Europe’s healthiest event? Join us in Mallorca, Spain in November at The Low Carb Universe 2019!

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Type 1 Thursday – Hydration, why so important?

How important is hydration for diabetes? What can it cause if you’re not hydrated?

I’ve noticed it myself. Sometimes, if I have a particularly stubborn high (or event borderline high) blood sugar that won’t come down with my usual line of care, it may very well be that I’m a bit dehydrated.

But is that the whole story? In this weeks episode of Type 1 Thursday, I go over the main factors why hydration is important, what signs of dehydration is, the causes, and how all this can impact your blood sugar management.

Type 1 Thursday with Hanna – Hydration, why so important?

Do you consider hydration an important part of your diabetes management? Why, or why not? Let me know in the comments!

Transcription

If you prefer to read about hydration instead of watching the video, here is a transcribed text version for you:

We all do it every day, hopefully. And we may not be paying enough attention to it though, which is why I wanted to make a point of it today: hydration, and how important hydration is to a diabetic or person with diabetes, depending on which you prefer.

What causes dehydration, and what can it cause if you’re dehydrated? Dehydration is a higher risk for people with diabetes, because of high blood blood sugars being dehydrating for the body. Even if you don’t have super high blood sugars, or maybe you are someone who is up in the 70 to 90% it time in range of blood sugar. But even then we do have those few circumstances when the blood sugar does go up so that we have to pay attention to our hydration.

High blood sugars don’t just cause dehydration, dehydration can also cause high blood sugars. I know this for myself, for example, if I have a more stubborn, higher blood sugar than I would like insulin is not really taking as it should, movement doesn’t help, insulin neither, all my normal strategies of trying to get my blood sugar down. Sometimes, it can actually be that you are a bit dehydrated! In that case, that’s why your blood sugar has gone up as well, because the body doesn’t have enough liquid to actually keep that blood sugar moving in the body. One doesn’t necessarily cause the other, they can both cause each other. It can be a vicious loop, unless you pay attention to it.

What are the symptoms of being dehydrated? The obvious thing is thirst. If you’re thirsty, you’re probably quite dehydrated and you should fuel up with some water. You can have a headache, often a creeping on headache can also be a sign of dehydration. Dry eyes and dry mouth, I know for myself when I have a higher than normal blood sugar, I can definitely feel my eyes being like a little bit sandy, and my mouth feels like it’s been swiped with about 15 cotton balls! You can become dizzy, especially in hot weather, for example if you’re dehydrated. You can become tired and sluggish. And, if you when you go to the bathroom and your urine is dark, that can also be a sign of dehydration.

What causes dehydration? One I already mentioned was high blood sugars. But as you remember, high blood sugars can cause dehydration, but the dehydration can also cause high blood sugars. Yhe jury’s still out on which one is which! Other things are you simply drink too little water, that is very likely one of the causes. Hot weather or strenuous exercise, so if you’re sweating more than normal, can be a contributing factor. It can be alcohol, for example, that dehydrates your body. Diarrhoea or that you’ve been vomiting can also dehydrate your body.

Why does dehydration happen? And why in relation to high blood sugars? When our blood sugars are high, the kidneys try to filter as well as much of it out as possible. This means that you actually filter a little bit more of blood through your kidneys at that point, which also brings with it water. In a simplified explanation, that’s why we get dehydrated and can feel dehydrated when our blood sugars are higher. Actually, the main point in diabetic ketoacidosis is not necessarily the ketones, for example. Ketones are not bad in limited amounts. It’s also not necessarily the high blood sugar, but it is the dehydration. The really dangerous part of a DKA, and especially if it has come to vomiting and other symptoms of DKA can bring with it, it is the dehydration that makes it dangerous. Please watch out so that you don’t become too dehydrated, as it can also be a contributing factor to the diabetic ketoacidosis. And, I can’t forget, every time I talk about DKA, I cannot miss the fact that it can only be caused by a lack of insulin in the body! This can be a relative lack of insulin in the body, when the body is simply not getting the insulin that it needs and requires to work properly. That is why DKAs happen – it’s not necessarily just because of the high blood sugar – the root cause is always too little insulin. Diabetic ketosis is not the same as ketosis, they are two completely different things. You can see and read my further thoughts on DKA av ketosis here!

Anyway, back to the topic! Dehydration can also cause a lack of electrolytes. If you’re severely dehydrated, you should and may have to go to the hospital to get IV fluids with electrolytes.

How much to drink is another question I often get and that is a little bit of a tricky one, because it is very individual. It entirely depends on how active you are, on what you do and depends on what shape your body’s in. It depends on so many factors! As a rule of thumb, I personally try to drink about two litres of water a day. This also helps me flush out any things that aren’t supposed to be there and also help to stabilise my blood sugar.

Thank you so much for watching. I can’t wait to chat with you more in the comments! If you have any questions, comments or experiences that you want to share with me, please leave them in a comment below, and I’ll happily chat further on over there.

Just remember kids and sweet friends, drink your water and keep hydrated!

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Type 1 Thursday – Weight Loss & Type 1 Diabetes

Today’s topic is T1D & weight loss, a hot topic!

I asked on Instagram what topics you wanted me to cover on Type 1 Thursday, and a good amount of people said WEIGHT LOSS!

So I took the opportunity to gather my thoughts on weight loss and Type 1 Diabetes in a short video for you! If you prefer to read about weight loss and T1D, I’ve transcribed it for you below.

Hanna Boëthius – Weight loss & Type 1 Diabetes

What are your experiences with Type 1 Diabetes and weight loss? What worked for you, or what didn’t work for you? Let me know in a comment!

Transcription

If you prefer to read this, please go ahead:

Weight Loss & Type 1 Diabetes

This is the moving party of a Type 1 Thursday! I have been doing Type 1 Thursday for 17 episodes over on The Low Carb Universe (my other project). I’m very, very happy to welcome Type 1 Thursday back to where it belongs – on the diabetes page (that would make more sense, right?!)

I am a Type 1 Diabetic since 34 years, and I am very, very happy that you are here with me, because today’s topic is super interesting. And it turned out to be a really hot topic! When I asked on Instagram a couple of days ago what I should talk about, a good few people said this topic. I am very happy that I have the chance to cover that for you today. And the topic is, not maybe completely unexpectedly, Type 1 Diabetes and weight loss and how that works together.

It can be really tricky when you are taking a lot of the fat storing hormone, insulin. The more insulin you take, the more weight you gain. It’s not always easy to lose weight with T1D. I wanted to try to describe a little bit what is going on in your body and how it could work for you as well. (And please, please, please do share your experiences with T1D and weight loss, or weight loss at all in the comments! I am very, very happy to talk to you more there!)

Weight loss has many reasons, there can be a gazillion reasons as to why you want to lose weight. There are two main ones, with the first one being you want to improve your health. And that can be of course a reason to lose weight, which is good, that’s great. Secondly, it can also be vanity. So I think, first of all, anyone who wants to lose weight needs to be honest with themselves as to why they want to lose the weight. Is it because of health reasons? Or is it simply because it would feel great to have those last 5 kg/10 pounds, or whatever else off the body and feel accomplished? It’s definitely an important thing to consider.

There are also two main weight loss theories. The first one is the hormone theory, which is that weight gain and weight loss is all about the hormones. It’s all about insulin, and it’s all about how insulin is the master hormone, and how that then impacts the other hormones. The other theory is the the old one, to eat less and move more, the kcal theory, which I feel like we’ve disproven this one? In my humble opinion, I feel that it is actually a combination of the two. Yes, your hormones have to do with weight loss, absolutely. But so do calories, I don’t believe that you can eat 15,000 calories in a day and still be losing weight. Unless that helps to regulate your hormones in some way. Your hormones need to be balanced for you to lose weight. And that actually requires a certain amount of calories, and a certain amount of the right macronutrients. Enough amino acids, enough fatty acids, because those are both essential for the body, there’s no essential sugar for the body. There is essential protein, and there is essential fat so that the hormones can become regulated. Those two for me (not saying anyone else!) but for me really go hand in hand. So it does require both of them to work to get there!

The old saying “abs are made in the kitchen” is true! I’ve heard several numbers on this, but there is an 80/20 thing going on, that 80% is the food and 20% is the exercise. So there you have this again: both go together for weight loss. And if you’re really overweight, if you just start eating the right things, you perhaps don’t even have to exercise in the beginning. That’s great, right? Generally, if abs are made in the kitchen, movement does also play a part in regulating your hormones.

What do I eat if abs are made in the kitchen? Well, there are, like I said, essential protein to the body, amino acids are essential. Focus on that. That is also what, for example, Dr. Bernstein talks about in his “Diabetes Solution” – to focus on the protein. And if you see someone really ripped, there’s a good chance that they are eating a good amount of protein. That’s also because protein is thermogenic. It actually it burns calories when the protein is processed in the body, shortly explained. Also have some fat for good measure, and to regulate your hormones. It may be difficult to get up to an OK calorie count in terms of protein only. So do have some fat. But when you get to stable hormones, and become a fat burner, you will use the fat that you already have on your body, which is actually a very simple way of weight loss, right? Then, of course, carbs; keep them to a minimum, mainly leafy greens. This also really helps your blood sugar, which does help in weight loss, as well. It’s incredible how much goes hand in hand in this!

What does this kind of eating, focused on protein, some fat, a little bit of carbs, what effects does this have? Well, it’s clearly that if you lower the amount of carbs, you lower the amount of insulin that you’re taking. And because insulin is the fat storing hormone, and the master hormone, if you use less of it, there’s a good chance that you will store less fat, as well. And, like this, you won’t really add too many calories on to your diet, which is also goes back to one of the two theories that the calorie, “eat less and move more”, (the 80s called and they wanted their nutrition advice, or weight loss advice back!). I do think it does play a role, I just don’t think that is the only thing that plays a role. Protein does repair your body and it helps to build muscle, which really does help you in losing weight, as well.

In order to lose weight, you also have to be motivated, and you have to find your WHY? Why do you want to lose weight? This is where my background as a coach comes in quite handy! Ask yourself why in three levels; why do you want to lose weight? And the answer to that ask why again? And then the answer to that as why again, so that you really know what is behind your choice of losing weight.

But could it be something else? Why did you gain the weight in the first place? And did you gain it overnight? Or did it take a while to accumulate? Because there is no overnight solution to losing weight. It is hard work! And it is a lot of trial and error, just as getting a grip of diabetes is, so is the weight loss process. Could it be something else than just “random” weight gain? Could it maybe be your thyroid? That also has a lot to do with hormones! Could it be stress, which is the hormones cortisol, adrenaline, and can really drive weight gain. Can be fluid retention? Are you retaining fluid for some reason? Maybe not enough salt? And could you be pregnant? Could it be some sort of medication that you’re on? For example, antidepressants are usually causing weight gain, so it’s corticosteroids. Antipsychotic medications and birth control pills can really, really make you gain weight because that also goes back to the hormone theory.

Please do share your weight loss success or questions in the comments, and I’ll be happy to chat with you there.

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Type 1 Thursday – Unexpected high blood sugars? 🤔

…it could be THIS!

When you’ve done everything you normally do to keep your blood sugar healthy and stable, and your blood sugars all of a sudden rise to the point that you have to drastically increase your basal dose or rate.

You’ve eaten low carb, taken insulin & other meds you may be prescribed, hydrated, moved, supplemented, not stressed too much, changed insulin vials, stuck to your routine – all to no avail. Your blood sugar is stubbornly and unexpectedly high anyway!

In thisType 1 Thursday, I will discuss a possible reason why, based on my own very recent experience.

Watch the video or read the transcription below:

https://youtu.be/qafwdTm4tqQ
Type 1 Thursday – Hanna Boëthius

Have you experienced something like this? Leave a comment and tell us more!

Transcription

If you prefer reading the information, here it is:

Today’s topic is actually a bit of a personal note, because this is something that I’ve recently experienced. If I’ve experienced it, there may be others out there who experienced the same and may need help with similar situations or at least help figuring out what it can be.

If you live with Type 1 Diabetes, you know that some days are just weird, blood sugar-wise. It doesn’t matter what you do, your blood sugar’s either high or it’s low, or it’s whatever where it shouldn’t be. Usually it is a little bit on the higher side, and if you have frequent lows, you just think that you’re cured for a split second!

When you have those stubborn high blood sugars, to the point where you do a basal test to find out how much basal you should be taking. And that actually shows that you’re taking too little basal all of a sudden! It’s not due to hormones, if you’re growing or a woman or anything hormone related. It is not due to the seasons, because whether can involve insulin resistance, too. It’s not because you’ve changed your diet, you’re eating the same thing. Basically, you keep everything the same. Just all of a sudden, your blood sugar’s up, and you need more insulin overall.

“Oh, okay. Have I not exercised enough? Yes, I’ve done that.” Check off the list. “Am I coming down with something? Am I getting a cold or a fever? Is there something like that going on? Nope.” You feel fine as a little baby bird, just maybe apart from the high blood sugar situation? Hmm, what else? “Am I injured somewhere? No, not that I know. And have I been drinking enough water and I’ve been taking my supplements? Have I been eating low carb enough?” It can also of course, be stress, it could have been stress in my case, definitely. And it could have been a bad insulin vial. But as this kept going throughout insulin vials and stressful periods and stuff, I figured out it wasn’t that. All these things that will checklist of lifestyle factors that do influence blood sugar. Everything is in check. What the *bleep* is going on?

Well, this, as I mentioned, did happen to me quite recently. In the past few months, all of a sudden, my basal requirements increased with, I kid you not, 30%! This is, of course, it’s just a number and you have to use the insulin that your body needs. But to me, it felt very weird. Wait, what could this possibly be that is going on? I didn’t think more about it. My blood sugar was then back to their stable, wonderful self, with the 30% extra basal insulin requirement.

But then I started getting a tooth ache. We were traveling at the time, and I was like, “Oh, no, I have to like find a dentist!” I’m not too fond of dentist, as it is. I contemplated finding an emergency dentist where I wasn’t notat home, and didn’t really speak the language. And I don’t know what I’m doing. I don’t know where I am and all the stuff. I’m like, oh, what am I gonna do?

But I made it. I could soothe the symptoms until I got back to my normal dental hygienist, who happily took an X ray of my lower jaw on the left side and noticed, “oh, you have an abscess underneath that tooth that was hurting.” I’m like, “oh, okay, so it was an inflammation. I just couldn’t feel it at the time!” I had walked around with an inflammation, which is known to cause high blood sugars and insulin resistance (or both, which is probably the case here). I was very jolted when she said that it has to be surgically removed.

Now, I’ve had a fair amount of dental work done. Especially when I was still in my high sugar eating days, my teeth started crumbling a little bit. I didn’t know why, because I was eating the way I was supposed to. Since going low carb, I haven’t had any problems at all. So for a long time, I haven’t had to go to the dentist, I’ve only gone to the dental hygienist to get my teeth cleaned and and she checks my teeth. If everything is good, I don’t have to go to dentist. Yay. Happy me. But this time, she’s like, “well, you know, you can’t really remove this on your own, it won’t go away. So we have to actually surgically open up your gums on the lower left side.” This sounded lovely. (If you’re sensitive, please just fast forward!)

“We have to open up your gums on the lower left jaw and we have to dig out the inflammation by hand because it won’t go away.” And I’m like, “No, this is terrible!”, feeling my stress regarding dentists as it is, my blood sugar immediately went up a little bit. I wasn’t very happy about that (but that wasn’t the point of the story.) The point of the story is, that when I finally managed to get the courage to make that appointment, and the dentist was allowed to cut up my gums (and ended up doing a lot of other work that I just don’t even want to remember, because it was terrible.) Then, when the inflammation was out, and I had started healing, look at that, hey, presto – there went my 30% basal rate that I had added on top! My basal rate went back to normal. It was that inflammation.

The moral of my terrible experience and story is that if you do have unexpected highs and your basal rate does go up, it doesn’t have to be anything that you’ve done or that you’re doing wrong, or that you’re not being “compliant”. That’s a terrible word! It can also be something that is going on in your body that you don’t even know about, as in my case, it was a dental inflammation, a dental abscess.

I don’t recommend it to anyone. But if it does happen to you, make sure that you get it taken care of, and go check it out. And this is why it’s actually quite good as a diabetic to get your teeth cleaned quite regularly so that someone can see the differences going on.

Have you ever experienced anything similar to this? Anything that all of a sudden raise your blood glucose values or all of a sudden raise your basal rates?

Let me know and let me know how you sold that in the comments and we’ll be happy. I’ll be happy to do chat with you there.

I hope this story hasn’t put you off! It did me for a good while, but I’m happy that it’s now over and I can look forward again.

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Type 1 Thursday – Injections vs Insulin Pump?

Today’s topic is MDI (multiple daily injections) vs insulin pump – which is better?

This comes after a question I got on an Instagram post, where I was asked if it’s necessary to use a pump as a Type 1 Diabetic?

My short answer is DEFINITELY NO! If you achieve great results and reach your goals, it doesn’t matter what kind of insulin delivery system you use. The main point is that you have normal, healthy, happy blood sugars.

Watch the video (or read the transcription below, if that’s more your thing) to find out my pros and cons of MDI and insulin pumps.

I want this to be a conversation starter, so why don’t you let me know YOUR pros and cons in a comment below? And, what do you use to deliver insulin? Let me know!

Transcription

The age old question for most people living with insulin dependent diabetes, is the question I recently got on my Instagram post.

The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic?

This is very difficult to answer straight off the bat, because this is a highly individual topic. In my opinion, the short answer is that it doesn’t really matter what you use to deliver the insulin, that you do need as a Type 1 Diabetic, as long as you do. If your diabetes is well managed with maybe a completely crazy version of either MDI or insulin pump or whatever, then hey, that’s fantastic. You found what works for you, and that is great.

Today, I wanted to have a conversation starter with you, which we can happily continue in the comments below. I wanted to outline my pros and cons for both MDI, which is multiple daily injections, you deliver your insulin by injecting yourself every so often with both basal and bolus insolence. And also pros and cons for the insulin pump that I’ve noticed for the past couple of years. Maybe this can help you make up your mind, maybe there you find out something that you want to try, and if you do, please let me know in a comment.

My own story in regards to my insulin delivery method has been a little bit jumpy. Well, I was actually flat out refusing to have an insulin pump for so many years. I had had diabetes for 27 years before I finally agreed with my diabetes nurse that now I was ready to try. And this despite health care professionals suggesting an insulin pump to me, for the majority of my upbringing, (well, maybe not in the 80s. They weren’t super common back then.) since they have become more common, they have been suggest to me every once in a while, and I’ve always refused. Because, and this was the biggest con for me the insulin pump back then, was that there’s something always attached to me. I was afraid that I would feel sicker than I have to be. And I was afraid that I’d be constantly reminded of that I am maybe not as chronically healthy as I would like myself to be or as other people may be. (I am, however, chronically awesome!)

So I was very, very hesitant and very afraid of getting myself my first insulin pump. I opted for a tubeless patch pump, which then changed into a tubed pump, about one and a half years ago, I took the step towards a tubed pump for a variety of reasons, which we can happily discuss, and maybe a little bit later. I’ve done multiple daily injections for a lot longer than I have lived with an insulin pump constantly attached to my body.

I wanted to outline few pros and cons of them each.

So let’s start with MDI, as that’s where I actually have most of my personal experience. I want to start with the pros. This is a biggie for me, and for very many other people who live with diabetes, the freedom factor you have with multiple daily injections. You don’t have anything attached to your body, unless you’re wearing a CGM, but they are a lot smaller and maybe you don’t want two things connected to your body at all times.

Hand with this goes also that it makes the illness more invisible. Because you don’t have a pager looking thing stuck to your hip or your clothes somewhere. It becomes a very much more visible illness to live with, with an insulin pump.

If you do multiple daily injections, you can also take a lot more different types of insulin, because different insulins act in differently during different times. For example, as Dr. Bernstein always recommends, is that you take regular insulin, or R insulin, to cover protein, and the protein spike that comes a few hours after you eat a lot of protein. This is easier to do if you are on MDI then having to remember to also have another shot when you’re on an insulin pump. You can also then take fast acting insulin, to which you have to correct high blood sugar or for covering for carbs. Finally, you can choose which long acting insulin that you combine this with in a way more flexible way. When it comes to types of insulin that you take, you can find a routine and a regime that works for you. And for your diabetes, to manage it properly.

MDI can also be seen as being a bit simpler, you take an injection and you’re done. Instead of having to care about every time you remove a piece of clothing or something that the tubing gets stuck or you snag the the infusion set… If you get the benefits and reach your goals with MDI, then why not stay with that?

I think it can also be argued that MDI is cheaper than being on the pump. With the pump comes very many things that you have to pay for, such as rent of the pump, for example. I have to pay rent every month for having my pump. All the supplies for it also cost a lot. It’s not just the insulin that costs! With MDI, either you use syringes that are reasonably cheap, or you have insulin pens that most people with diabetes actually get for free.

Also, from a very, from very superficial point of view, because sometimes you need to be that, too. On MDI, you can wear anything, and you won’t see any devices poking or sticking out, or being in the way, or there’s a seam or there’s something that is just obstructing either the pump or the tubing. With MDI, you are freer in that way too.

I would conclude that with the main point of the pros of MDI is freedom.

The cons of MDI! I find it in hindsight, it is quite inconvenient to be on MDI for myself. I can only speak for myself here! But every time I had to correct, every time it’s time for the the basal shot, I had to pull up my shirt, or pull down my pants… For me, it became quite inconvenient, because I had to inject myself about 10 times a day, before I swapped to the pump. That was a big sales argument for me, to be honest, not having to pierce myself with a needle 10 times a day, only do it once every three days, that sounded like heaven! That’s why I went for it, actually. You also have to remember to take your basal insulin at the right time. It became a huge effort for me to try to remember when and how and how much, which dose at this time of day…

What else I see as a con for MDI, in my opinion, is that you have a lot more to carry along with you when you leave the house. An insulin pump is always on you. So that’s it for the insulin thing. Then you need a blood sugar meter, maybe some glucose tabs and that’s fine. That’s a lot easier to carry then two types of pens and the pen needles and blah, blah, blah, for me it becomes a lot more carrying along. That being said, for most people is not a problem.

Another, slightly inconvenient part of MDI, is that you have to expose body parts. Usually this is not a problem at all, whether you’re female, male, whatever. But – imagine what is it really, really cold, and you have to like take up your shirt, and you feel that icy wind against your skin. Then you also have to inject yourself. I don’t miss that at all. I really do enjoy the fact that for example, if I am out and about around town or something, I can just take up my insulin pump, I can look like I’m texting (or whatever ignorant people choose to believe). That’s how easily I’ve saved my life with more insulin if that’s what I need, or turned down the basal if that’s what I need. But it becomes a little bit inconvenient for me to expose body parts here and there, especially when I’m out and about.

The importance of rotating sites becomes very, very big on MDI, because we all have those favorite spots that we like to inject ourselves in. And that’s fine. But you do have to rotate your sites! I noticed for myself, that it is a lot easier for me to rotate pump sites than it was to rotate injection sites. It even got so bad that no one could touch my upper thighs for a while because I had just injected so much long acting insulin into them.

For the MDI cons, in conclusion, inconvenient to me.

Let’s move over to the pros of the insulin pump. So the absolute highlight for being on an insulin pump for me is that it is very, very flexible. I can be very flexible with my basal rate, for example. If I notice that I’m trending upwards, I can change it, I can add on a bit of temporary basal to see if that’s the problem. And also with the bolus, you have the different bolus profiles. Instead of, as I was talking about in MDI, you can use different insulins for this, you use the same insulin the whole time, just in different profiles, so to speak. For me, it’s a lot easier to just remember that I have one tool to work with and I can do different things with this same one thing.

My second favorite pump benefit, it is micro-bolusing. I can take bolus’ in the size of 0.1 unit, for example. If I really want to, I can do a 0.05 bolus on some pumps, making it much more precise. This is not possible on MDI, because there you have the minimum is half a unit. So it depends a little bit on how tight you want to steer your diabetes ship. I really like the fact that I can really micro manage my blood sugars, to a certain extent, not overly so of course, because that becomes ridiculous on all other levels. But it is very nice that I can do a micro bolus every now and then. When I see the CGM trending up, I’m like, oh, let’s try with 0.X units and see if it comes a little bit down. If not, then I have to redo and recalculate. But it is a good check for me to see what’s wrong.

As I mentioned before, it is very easy to handle when you are on the go. You can even take care of your health and blood sugar during a business meeting (I have done that many times before), and when you’re out with friends, if you are in a busy street. Or imagine, for example, it’s rush hour at the farmers market and you feel or you get a notification for your CGM that your blood sugar is a little bit high, you would like to correct but you can’t really find a quiet corner. With an insulin pump, it’s a lot easier because you just click a few buttons and you’re done. You’ve taken care of the situation and you can move on with your day.

To a certain extent, I also find that it’s more efficient for me to treat and manage my diabetes with an insulin pump. I don’t use nearly half of the insulin as I do before. I also don’t spend as much time managing my diabetes as I did with MDI. Also, of course, if you are a data nerd, you have a lot of data to take care of and see and have insights and analyze and see trends. And the ever so important tech integration, more and more pumps now do integrate with a CGM, so that you can get both things at in the same device. And also, the looping possibilities that are coming up now that are very, very exciting to everyone who lives with diabetes.

The cons of insulin pumps (yes, yes, they are. There are cons with these ones too, it’s not all just roses and happy flower dances.)

I already mentioned one of them, which is that this is something that you always have attached to your body. And that can be very draining, both emotionally and physically and mentally, for some. It’s not always easy to always be connected in that way.

The tubing does, if you have a tubed pump, get caught on stuff like door handles, and other things, clothing, everything. It’s not really the most maybe smooth thing in the world to live with, you do have to watch out and make sure that your tubing is inside of your clothing, preferably, so that you don’t snag it somewhere.

I find that using an insulin pump produces a lot more trash than MDI. I’m not really happy about that, but as it is a lot easier for me to manage my diabetes with the help of an insulin pump, I keep with it, and I hope that the insulin pump provider companies will at some point really reconsider their recycling policies, so that you can maybe even send that stuff back so that they can take care of it. And not to mention Dexcom, please get your act together! But that’s another video. 😉

One problem with insulin pumps is that if it for some reason, malfunctions, and that can be the site malfunctions, the battery runs out, or the insulin goes bad or the machine get some sort of hiccup. If it somehow malfunctions, you don’t get any insulin at all and that can become dangerous quite quickly. That is one of the bigger cons for an insulin pump.

For me, airport security, or generally when you travel, insulin pumps can sometimes get a little bit interesting. They will want to swipe them for explosives. For certain airports, I do have to take more time into consideration when I travel through there because they just don’t know really what it is yet. It is unfortunately becoming more and more common, meaning it is less of a problem. But sometimes I could happily maybe be on MDI for a trip!

What do you have to add in terms of pros and cons for MDI and pros and cons for insulin pump? What do you use it to deliver insulin?

Please let me know in a comment below. I will be happy to chat with you there.