Achieving good blood sugar control with type 1 diabetes

I’ve been a type 1 diabetic since I was 29. I can pinpoint the exact point in time when my pancreas decided to give up the ghost.

As a child I was generally healthy and sporty — a competitive swimmer, volleyball player, netball and hockey player and generally absorbed into every sport I could fit into my life to varying levels of success. I was rarely ill and came from an upbringing where you didn’t have a day off school unless you physically couldn’t drag yourself from bed. This approach to fortitude has stuck with me most of my life and I am a strong believer in never giving up. I do however remember taking a day off work when I could barely lift my head off the pillow. I know understand this to have been the flu and it stopped me for just 1 day before I got up and went back to work. Over the next few weeks I took a holiday to Portugal and I went for a round of golf on one of the most incredible golf courses I have ever played, with orange trees lining the fairways and clear blue skies overhead. After teeing off at one hole I couldn’t track my ball to see where it landed. I decided that my new pair of contact lenses may have been the wrong prescription for me and I pushed on with blurred vision which I subsequently blamed for every bad shot. When I got back to the apartment I changed into my glasses and it was then that I realised I still had less than perfect vision. It became apparent that it wasn’t my contact lenses but instead my eyes that were the problem. I remember drinking a can of Fanta as I was thirsty. I never drink fizzy drinks which is probably why it stands out in my memory.

On arriving home from holiday I started the process of getting myself checked over. First was a trip to the opticians who checked my eyes and told me that they looked fine but that diabetes was a common reason for vision loss. They suggested I visit my GP which I did (after a 3 week period of not being able to book an appointment). During this time I lost a stone and a half in weight and was regularly visiting the toilet and had a constant gripping thirst. My GP didn’t know how to use a blood sugar testing kit so she sent me for a urine sample to test my sugar levels. She quickly ascertained that they were high and suggested diabetes may be the cause, sending me straight over to the Royal Berkshire Hospital to get tested.

Whilst in the high dependency unit at the Royal Berks hospital they ran a few tests and came back to tell me that I indeed had type 1 diabetes. I would need to go to the diabetes and endocrinology centre to receive immediate insulin treatment and begin my new life as a Type 1 diabetic.

What has followed over the years has been a lifetime of adjusting to the constant regime of control. Control over my food, control over my insulin and trying to micromanage the fluctuations of my blood sugars in line with these, and other, variables in life. I have read a lot, followed many other type 1 diabetics and learned from the experts on how to best control my sugar levels and these are the key takeaways that I have learned, and where I suggest other type 1 diabetics start when they are new to the disease.

1. It is possible to keep your blood sugar levels within a normal healthy range (by this I meant between 4 and 7) but it requires ongoing discipline.
2. Carbohydrates are our enemy — apart from when correcting a hypo. Carbohydrates are also not an essential part of your diet as we can sustain ourselves without them. I have proven this by embracing a no carb diet and felt better than ever and had the best blood sugar control in my life.
3. You need a continuous glucose monitor like the Libre or Dexcom to really understand the impact of food, exercise, insulin and other external factors like illness, stress and temperature on your own sugar levels. You can’t rely on what impact these have to others.
4. Exercise really does help maintain good blood sugar control.

I’ll start by telling everyone that I am not the best example of a tightly controlled Type 1 diabetic. I admire so many disciplined Type 1’s who follow the strict Dr Bernstein methodology of carb free diets. I absolutely agree that this is the best way to be the healthiest you can be, but to me this is sometimes at a cost to my freedom and agility. I work in the events industry with my mobile coffee business, Camper Cafe. I can be out all day at big events and then be preparing for the following day in the evening. Sometimes this means I eat less and it has a positive effect, sometimes though I succumb to a burger from the burger van next door. Yes, I know I could make a healthy salad every night but I’d rather see my kids, get some rest and cope with the blood sugar spike as best I can with insulin. In summary I refuse to be a slave to my diabetes and take the decision to lead a balanced life. Everyone should find their own balance between life and diabetes.

Carb free

I was always under the impression that going carb free would be an impossible feat. I generally led a life of HBA1Cs of around 7.5 and I was slightly in awe when I was told by my consultant that people managed to get this under 7. I have since discovered diabetics can get this down int eh range of 4’s and 5’s which is truly amazing and demonstrates that it can be done.,When I was pregnant my consultants asked me to get my HBA1C under 7 throughout the course of my term, something I had never before managed to achieve with injections and finger pricking. I now thankfully have 2 healthy children but even my diabetic nurses said that my sugar levels very difficult to manage during both pregnancies. I was put on the pump during my second pregnancy but this didn’t make a massive amount of difference to me. I struggled to even go carb free for 12 hours to identify where my basal levels should be, and during pregnancy I just craved carbs — the worst thing for me!

3 years ago I decided to have a serious go at the carb free diet when a friend was embarking on it to lose some weight. A group of 4 of us went on a 12 week carb free diet together and so I finally had some support and motivation to keep it up. After a challenging first few days, I settled into the lifestyle remarkably well and got used to a lack of sugar in my diet. I didn’t even crave it. To cut a long story short, over the 12 weeks I lost close to a stone in weight and my HBA1C went down to 6.3. I really noticed the effects on my blood sugars. No longer was I experiencing big spikes or crashing lows and I became more sensitive to insulin. I exercised at least 3 days a week with gym classes and did 1 long walk of at least 15km a week. This combination with a mainly carb free diet (taking into account the odd slip-up and weekly treat) left me feeling great, looking great and more healthy than ever. I have to say, it left me in no doubt that it is the way forward.

Carbs — the enemy

I now maintain an effort to make every meal a carb free meal; for me it’s a meal by meal challenge. What I do notice though is that when I fail in my goals and eat some cake, cookies, chocolate or anything that contains quick release sugar I see a big and immediate spike in my blood sugars. Combine this with no exercise (as is often the case when in an office environment) and my spike can be drawn out for 2 hours or more. Often I take a top-up injection to counteract the high which then leads me into a downward crash that ultimately ends in a hypo. This results in me eating more glucose and hence begins the sugar roller coaster, swinging from high to low, a vicious circle that is really difficult to get out of. The simple answer to combat this is to not eat those carbs. I agree that this is easier said than done for most of us though!

Continuous Glucose Monitors

Until these became available on the market, I really didn’t have much of an insight into how food, exercise and insulin affected my blood sugar levels. How quickly would they rise after food and how would different foods alter the severity and speed of the peaks? With exercise, how would the intensity and duration impact my levels? And how quickly does insulin really work on me? Having now been a Freestyle Libre user for over 2 years I an in a much stronger position to take control of my diabetes as I have information at my fingertips. My view is that if I can get my sugar levels within range overnight then this is one third of the day that I can live like a normal individual. This to me is key, as we don’t have the impact of food or exercise over night so there are 2 less variables to consider. Having managed to get my overnight basal levels right with the aid of the Libre, I am only effectively diabetic between around 7am and 11pm — much easier to work with. As per the picture below, it is a comforting graph when you get your night time basal levels correct.

The Libre has been so powerful to me and although I still struggle to stay within range, at least I can determine that I need to inject around 30 minutes before I eat, and that even carb free, protein based meals mean that I need to take insulin, but only a little spread over the course of 2 hours. I know now that I should ideally exercise (a walk is generally best) after any carbs to reduce the likelihood of a spike.

As the Libre becomes prescribed by the NHS, diabetic consultants are now measuring diabetic control by “time in target” rather than HBA1C as this is a much more accurate reflection of control, and with this comes better outcomes for us all with less invasive blood tests.

The future non-invasive continuous glucose monitoring through sweat and tears, research that is already underway and due to be available in 10 years.

Exercise

I am someone who needs variety in life, which includes my exercise regime. I love walking and have a great group of walking friends who I recently completed a 100K ultra challenge with. I also enjoy the gym and do weights and HIIT classes. All of these have a very different affect on my sugar levels. By far the best I feel for my own control is walking. My sugar levels always decline slowly when I walk and as long as I either reduce my basal for long walks (4+ hours) or snack during shorter walks (1–2 hours) then my sugar levels remain nicely within target.

At the gym, I find that if I am doing high intensity training then I can experience a sugar peak. This is generally only if I am returning to classes after a break from the gym (and not as fit) After a few classes back in, my body seems to be prepared for the intensity and I no longer get the spike. I believe this spike to be a reaction from the liver to provide emergency glucose, but as the body adjusts with fitness levels then the liver doesn’t react in such a way.

Summary

With diabetes, everyone responds differently and it is good to understand the main influences in your own lifestyle to blood sugar levels. To some this may be stress, underlying illnesses or lifestyle. For me it is food and exercise. If you can get to grips with how your body reacts to these external influences, combined with how you respond to insulin then you can get very good blood sugar control. There are so many good resources to read — I find Dr Bernstein and Patrick Holford the best approaches with Holford providing a slightly more sustainable methodology. As with any illness ,you have to listen to your own body but by taking away every external stimulus (food, exercise, stress, illness etc) and measuring jut one at a time you can start to get powerful insights into how they affect you.

This is a continual journey, but we should all aim for continual improvements within ourselves in line with the technological advancements and resources available.