Adults Living with Type 1

[Pam01]

I love that we are getting some new people posting, and encourage everyone to continue writing their own personal questions. But I thought maybe we could have a thread (stickied at the top, if possible?? Trish?) with some of the basic terms, abbreviations, and tips  that we use here all the time.

I'll start, but hope others contribute. (I know I can't control how a thread turns out, but I'm imagining something easy to read without tangents, if possible?) I know some variation of our old message board had this from members and I found it so helpful!

BASAL INSULIN: 
also sometimes  called "background" insulin, keeping your blood sugar steady without food.  Basal insulin may be covered with slow acting Lantus or Levemir insulin (via shots), or in some cases, intermediate acting insulin like NPH.  In an insulin pump, it is the steady continuous infusion of fasting acting insulin on an hourly basis.

BOLUS INSULIN:
refers to the dose you take to cover food you've eaten with short/fast acting insulin like humalog, novolog, or Apidra.  The bolus is usually carbohydrate based (ex. 1 unit per 10 grams of carbs) and so it varies.

CORRECTION BOLUS (CB):
A bolus of fast acting insulin taken to correct a high blood sugar, sometimes taken in conjunction with a food bolus.  People on a sliding scale are in effect taking a correction bolus before eating, but not necessarily accounting for the carbohydrates in the meal they are about to eat.

Sensitivity Factor:
The amount that 1 unit of fast acting insulin will bring down blood sugar, over the duration of that insulin,  used when determining a correction bolus.  The amount varies per individual.
. 
For example, a person determines that 1 unit of humalog will bring their blood sugar down 50 points (without food). If the blood glucose reading 4 hours after a meal is 200, and the target is 100, they would take a CB of 2 units.  If the duration of humalog for that person is 4 hours, the blood sugar would come down slowly over that time period.

MULTIPLE DAILY INJECTIONS (MDI)
Term or abbreviation used for people managing their diabetes through multiple injections.  While there is no set number that makes someone able to say "multiple" injections, generally the term refers to someone maintaining tight control, 
adjusting insulin based on carbohydrate consumption, and correction boluses when needed.
   

[trisha01 Diabetes Brain Trust]

Pam,

I fully agree with this. Before we changed to this new format in 2009, we did have a sticky at the top. I had started one on tips for T1's, where we all included all kinds of great information Matter of fact, I think it was you, that asked whomever mod it was at the time, to make it a sticky. (Thanks again for that!) They did, and we had over 200 posts in that thread, if I recall correctly.

However, when the forum format changed over, we lost every bit of it. I then tried to get a new one going, and very few T1 members contributed. Everyone was fed up with trying to figure this new format out, and as you know, we then had many members go awol on us.

Time has passed, maybe now is the time to get going on this again, starting with this thread of yours. It is a much needed sticky. I'll email Matt and see if he will do this. That is one function that I think he can do, and not have to depend on thePort to do it.

We have another option as well, but requires more work on our part. You and I both, could each do one in our blogs, and include the link to it in our sigs, directly to that portion of the blog (we'd have to figure out how to do that). If we had similar definitions, etc., that would be ok too, since not everyone reads every blog. And we can stay on Matt to make this a sticky, where it is needed the most.

I know you don't do the pm's stuff, but check yours later.

Thanks for starting this discussion. It's time has come.

P.S. I'll work on some abbreviations, and add them sometime before the day is over.

P.S. again...I reported my post, so Matt will see it sooner.

Trisha

[Pam01]

BASAL TESTING:
If your basal insulin (whether long acting through injection or fast acting background insulin in a pump) is set correctly, a type 1 diabetic should be able to maintain a steady blood sugar level without needing to eat.

Many of us mention this frequently because it is not often something taught by doctors (even endocrinologists) and should be the starting point for all  insulin therapies. THe instructions pasted below are  linked at the bottom of every post from Trish01, and are in the Type 1 archives:

Rules for performing basal tests:

1. No Food Being Digested
• You may not eat for at least 4 hours preceding the basal test.
• The meal/snack preceding the basal test should be low in fat.
• Do not eat during the basal test, unless your blood glucose is below 70*.
• You may have water or diet beverages during the test (note: I also include other carb free foods like sugar free jello, celery, eggs)
• No caffeinated beverages during the basal test.

2. No Bolus Insulin Working During the Basal Test
• Do not bolus for at least 4 hours preceding the basal test.
• Do not bolus during the test, unless your blood glucose is above 250**.

3. No Changes in the Body's Normal Glucose Output
• No hypoglycemic episodes for at least 6 hours preceding the basal test.
• No illnesses during the testing (fever, infection, virus)
• No steroid medications being used
• Avoid testing during major stages of menstrual cycle if blood glucose changes are usually noted

4. Allow Basal Insulin to be Delivered Uninterrupted
• Do not put the pump into suspend
• Do not disconnect from the pump.

5. Maintain low-moderate activity level
• Do not exercise starting 4 hours after last meal/snack.
• You may perform light/moderate exercise soon after last meal/snack if it is your normal time to do so.
• Perform usual daily activities during basal test.

6. Monitor blood glucose levels
• Start testing at least 4 hours after last meal/snack/bolus.
• Use the same blood glucose meter throughout the testing.
• Check blood glucose level every 2 hours. (or more frequently)
• Testing may be performed for 4-12 hours.(up to 24 hours)
* For readings below 70, take carbohydrate and stop the basal test.
** For any readings above 250, stop the basal test and check for ketones.

Note: I want to start basal testing only when I'm at a decent number, and test more frequently than every 2 hours. If I see it going down, I want to catch it before it gets too low. Personally, I would stop the test before 250 to take a correction bolus, although the information is useful to know that is a time of day that you will need to increase your basal insulin. THe standard guideline is your basal is set correctly if blood sugar does not fluctuate more than 30 points.  (pam)

Here's how it might look in a personal example:
I eat a low fat  dinner at 6 pm (fat slows down digestion and may screw up results). I choose yogurt, toast, fruit. Take bolus to cover the carbs. I have estimated that for me, my bolus insulin lasts 4 hours.

At 10 pm, I can start testing. My blood sugar is at 100 which is perfect for me before bed and before a basal test.

12 midnight - 95
2 am - 90
4 am - 110
6 am - 150 (This would signal dawn phenomenon to me. Since it is a rise of more than 30 points from my starting blood sugar, I would want to increase my basal rate just prior to this hour. On a pump, this is easy to do on an hourly basis. On injections, this might mean splitting your dose of long acting,  increasing the pm dose. Some counteract DP in other ways)

I would likely stop the test at this point, and start again another day to figure out my basal for the time from 6 am through at least 6 pm.

[trisha01 Diabetes Brain Trust]

Part one: Typical abbreviations (and their definitions), used on the Type 1 forum, and in no particular order.
**************

Autoimmune = the body attacking itself. Autoimmune can be system or organ specific. In Type 1 Diabetes, the "Beta cells in the Islets of Langerhans", located in the pancreas, are attacked by "Killer T cells".

T1 = Type 1 Diabetes, 'betes (the way I write it sometimes)

Type 1.5 / LADA = A slow forming Type 1 Diabetes. It is not "Double Diabetes" nor is it related to Type 2 Diabetes.

Bg = BG, blood glucose, blood sugar

S.D. = Standard Deviation ... the lower the standard deviation, the less swing between low and high numbers. The higher the standard deviation, the greater the swing between numbers, indicating many hypos and hypers. Standard deviation can usually be found on your reports, if you upload your meter, cgm, etc. to software on your computer, or on to secure websites of the meter, cgm companies.

I:C Ratio = Insulin to Carbohydrate grams...matching the number of units of insulin to the carb grams that you will be eating.

Sliding scale = Very outdated way of covering the carbs with insulin. A set amount of insulin for a set amount of carb grams, and is determined by what your Bg is, prior to the meal.

A1c = The test that is done every 3 - 4 months, to determine past history, of how your numbers were doing. Red blood cells live for 120 days (for the most part), so new ones are forming each and every day. The latter month before the A1c test, holds the most weight, as the red blood cells are newer.

YDMV = Your Diabetes May Vary. Many folks use YMMV = Your Mileage May Vary. I prefer YDMV.

Endocrinologist = Specialized physician that treats many endocrine problems, such as Diabetes and Thyroid issues.; Endork, coined by a member = acidrock aka AR, and one to which many of us agree with.

DKA = Diabetic Ketoacidosis. DKA is a VERY SERIOUS issue, and can cause coma and death, sometimes very quickly. It is nothing to fool around with. DKA, in simple terms, is very sustained high blood glucose numbers and with the presence of Ketones. This is a medical emergency and needs to be treated at once, with no delay whatsoever. Your breath may smell fruity (like alcohol), vomiting, upper stomach pain, lethargic, etc., and there will be ketones in the urine. Many times, the ketones will show in the urine, before the sustained high blood glucose numbers come about.

STAT = Immediately; Right now with no delay.

Ketones = A body of different chemical compounds that break down within the body. People that are dieting, will sometimes show ketones in the urine. This is NOT the same as ketones in the urine from DKA. Ketone strips can be purchased at all pharmacies over the counter, and are usually about $8.00 per bottle of 50, not in foil covering. One should also check for ketones when sick.
***********
More abbreviations and definitions will be added to this list.

Trisha

[trisha01 Diabetes Brain Trust]

A couple of tips for starters:

1.) Do not inject within a 2" circle around the belly button. Your physician may or may not have told you this.

2.) When doing finger pokes, if you get blood on your shirt or other clothing.....use your own saliva to get the blood off. Do it before the blood dries. This is an old quilting tip from long ago. Someone had told me about it, when I started quilting in the 1970's.

Trisha

[jpg391]

Tip #2 about getting blood out of clothing is good for us type 2s to know also.

[Pam01]

Books -

There are 3 we are most likely to recommend on here.  I'm providing the Amazon links so you can read the reviews and descriptions.  The 4th one on the list is sometimes debated as the author advocates a very low carb diet - take what you like and leave the rest.  

"Think Like a Pancreas" by Gary Scheiner
http://www.sample.comhttp://www.amazon.com/Think-Like-Pancreas-Practical-Managing/dp/1569244367/ref=...

"Using Insulin" by John Walsh
http://www.amazon.com/Using-Insulin-Everything-Need-Success/dp/1884804853/ref=sr_1_1?s=books&ie=UTF8...

"Pumping Insulin" by John Walsh
http://www.amazon.com/Pumping-Insulin-Everything-Success-Smart/dp/1884804861/ref=pd_bxgy_b_img_b

"Dr. Bernstein's Diabetic Solution" by Dr. Bernstein
http://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316167169/ref=sr_1_1?s=books&ie=...

[trisha01 Diabetes Brain Trust]

Part two: Typical abbreviations and their definitions used on the Type 1 forum, and in no particular order.
**************

OP = Original Poster...the one that started a discussion

Discussion = Most folks call them *threads*, I prefer discussions

OT or OT / whatever = Off Topic or Off Topic / let's party!

Stacking Insulin = Taking extra insulin for a correction shot, before the last injection has worn off, without the benefit of carbs. This will get you in trouble in a couple or so hours. Do not stack insulin.

Inserts = 1.) The paperwork inside a new box of insulin. It tells you most everything you ever wanted to know about insulin
                   2.) The orthotics that many folks wear inside of their shoes

OTC = Over the counter as in meds / etc. that can be purchased without a prescription

Target Range = The highest and lowest numbers that you would like for your Bg to stay in. It doesn't always happen, but we can sure strive for it. Example... my target range is 100 to 140, and for bedtime I prefer at least 150. My bedtime number is because of  my damaged kidneys.

Medical ID = Bracelet, necklace, tattoos, that show that we are Type 1 DM. This is what we want Law Enforcement and EMT's to see, if we are in insulin shock (hypo), sick or injured. Otherwise, they may think that we are under the influence of booze, drugs, etc., and otherwise would not know that we need immediate help. Wear Medical ID!

Cal Factor = This is for MiniMed users for calibrating the cgm...Meter Bg divided by ISIG = Cal factor. If the resulting number is between 1.5 and 20, it is ok to calibrate.

Peeabetes = Just a fun term that I coined for Type 1 DM aka IDDM aka just plain old DM, for those of us that were DX'd with pee strips - aka urine strips, before glucose meters were available. The vial of urine glucose strips had a color chart on the side. This was how we tested for glucose. If you think this was ancient, before our time even, there were tablets or a liquid (don't remember which one) that was dropped into a test tube of urine. The color it became, told them what they needed to know, for their daily insulin. And before that, physicians poked their finger into a cup of urine  - if it tasted sweet, the patient had Type 1 DM, and usually died fairly soon after. This was before insulin.

DKA = Diabetic Ketoacidosis. DKA is a VERY SERIOUS issue, and can cause coma and death, sometimes very quickly. It is nothing to fool around with. DKA, in simple terms, is very sustained high blood glucose numbers and with the presence of Ketones. This is a medical emergency and needs to be treated at once, with no delay whatsoever. Your breath may smell fruity (like alcohol), vomiting, upper stomach pain, lethargic, and there will be ketones in the urine. Many times, the ketones will show in the urine before the sustained high blood glucose numbers.

Other Factors = Anything that messes with our control...ie:....gremlins, weather changes, misleading nutrition labels, female version of menses, male version of menses, stress, shopping, activities aka exercise, miscounting carb grams, other medical conditions, medications, pregnancy, you name it - it does it.

Splitting the dose = Many of us have learned, that splitting our basal dose (long acting insulin) works best for us. Example, for myself, for part of the year is two long acting injections and not necessarily 12 hours apart. The rest of the year is three long acting injections, and not necessarily 8 hours apart. One HAS to be somewhat expereinced with the use of insulin, before doing this, and also needs to know how to do a basal test. See Pam's instructions up above, and also the archived linky within my signature area. Usual disclaimer...check with your physician first.

TDD = Total Daily Dose ... the total amount of long acting and rapid acting insulin used daily. This can and does vary.

Meter Variance....the + - 20% that is allowable by FDA law. Most meters are within + - 5% to 10%.

If any of these are repeated from my definitions in the further up post, it's because someone, somewhere, needed to see it / them again. 
***********
More abbreviations and definitions will be added to this list as needed or thought of.

Trisha

[trisha01 Diabetes Brain Trust]

more Tips for Type 1's...

1.) + or - insulin dose for + - weight change

2.) Different numbers by testing different fingers in a few minutes time....does not mean that your meter is off....does not mean that your fingers are automatically all at once dirty...it does mean that you are a normal diabetic, as numbers change almost constantly.

3.) I:C ratios can and do vary, by time of day, type of carbs, just because, and see Other Factors in definitions post

4.) Some newly diagnosed folks, seem to think that when Type 2's start using insulin for control of their numbers, that this automatically makes them a Type 1. Not true. Type 1 is an autoimmune disease, whereas Type 2 is an Insulin Resistance disease. Some Type 1's can also have insulin resistance.

5.) Some folks also believe that Type 2's using insulin to control their numbers - makes them insulin dependent. Not true. The Type 2's using insulin for control of numbers - will not die if they do not have insulin. There are, however, some Type 2's that are insulin dependent type 2 - because their pancreas' have become exhausted.

6.) Insulin Dependent means a person will die if they do not have insulin. Insulin keeps us alive. Respect insulin, as it can also kill us.

More tips will be added as needed or when thought of. Anything that has been repeated, is because someone, somewhere, needed to see it / them again.

Trisha