How I manage my T1D: an overview

Over the coming weeks I intend to publish a number of posts focusing in detail on each aspect of my diabetes management, which I hope will be useful and of interest to others with Type 1 Diabetes, and also to those who support people with T1D. This post is an overview, intended as an introduction.

Measuring my blood glucose:

Central to the life of someone with T1D is an efficient means to measure blood glucose levels. In order to do this I use a FreeStyle Libre 2, which I regard as a tremendous bit of kit. I apply (or, to be more accurate, my wife Claire applies!) a new sensor to the back of my arm every two weeks, using the supplied applicator. These sensors, in other guises (Zoe and Lingo to name just two), are advertised all over the internet these days, and the accompanying videos always stress that applying the sensor doesn’t hurt. I can attest that (most of the time at least!) the application does not hurt. The applicator simply shoots a tiny filament into my arm, which then measures the glucose levels in my interstitial fluid which is, apparently, the fluid that surrounds my body’s cells. The sensor then transmits this data to the LibreLink app on my iPhone, which gives me a real time reading of my blood glucose levels. The app has many other features, which I will cover in more detail in a later post. One that I will mention here, however, is the alarm, which is really useful for letting me know when my blood sugar is very low (particularly important overnight).

Having begun my diabetic journey relying on finger prick checks, I cannot stress enough just how significant the Freestyle Libre is. It is truly a revolutionary tool, and I cannot imagine life without it. A friend once said to me:

Measuring your blood sugar with a traditional meter is like driving a car at nighttime with the headlights off. Every so often you turn your headlights on and see how you’re doing, but then you’re thrust back into the darkness and have no idea how you are getting on. Using a Freestyle Libre is like driving at night with the headlights on. You can see exactly where you are, how your journey is progressing and foresee any action that you may need to take.

I cannot recommend the FreeStyle Libre more highly.

Monitoring my blood glucose:

Whilst the LibreLink app is great, I monitor my blood glucose using XDrip4iOS. This is an unreleased app for iPhone which takes data from the FreeStyle Libre, via the official LibreLinkUp system, and makes it even more useful for me. I particularly value the following features of this app:

• Live Activities: this is a very recent, but massively significant, addition to the app. XDrip4iOS enables me to have my blood sugar constantly displayed in the Dynamic Island of my phone. It also displays a reading, plus a graph, on the “always on” locked display of my phone. This means that when my phone is on my desk in front of me, I can see at a glance my blood sugar. This is incredibly helpful for managing my diabetes.
• Nightstand widget: this is another recent addition to the app, and allows me to add a widget to my phone when it is charging overnight which displays my blood sugar really clearly. This is really useful when I wake up at night and wonder how my blood sugar is doing.
• Fast rise/fast fall notifications: whilst I use the very low alarm in the original LibreLink app (but not the low or high alarms), XDrip4iOS gives me silent notifications when my blood sugar is rising or falling quickly. I find these very helpful.
• Feed to Nightscout: Nightscout is another brilliant tool which I barely scrape the surface of. At its most basic, it is an online tool and graph for displaying blood sugar levels. It is, of course, far more than that – much, much more, in fact. XDrip4iOS has the facility to feed data directly into Nightscout, simply by filling in the relevant fields in the settings.

XDrip4iOS is not the easiest app to get hold of. It’s not available through the App Store. The only way to get hold of it is to build it yourself from the code (which is not actually that difficult, and described in detail here) or to hang around on the official Facebook page and wait for a generous person to start a private beta to which they are happy to invite others. I build the app myself, and aim to release a private beta to visitors to my site in the coming weeks. Keep an eye on the blog if that might be of interest to you.

Monitoring my blood glucose on my watch:

One of the advantages of feeding my blood glucose from XDrip4iOS to Nightscout is that this makes the data accessible from other tools. I use Nightscout to feed my blood glucose to my watch. For this I use a Garmin Epix 2 with the GearMin V3 watch face. I have customised the watch face to show my current (up to ten minutes ago) blood glucose, two trend arrows, the change since the last reading, and how many minutes ago the data was updated, plus a graph across the full width of the display. I can also see the key data on the screensaver of my watch. All very useful!

I have also added the Xrip+/Spike/Nightscout Datafield to the activity screens which enable me to see my blood glucose when I am running, which is really valuable tool when I am exercising. I have tried using Nightscout to feed this field, but have found this pretty unreliable. In the same way that I build XDrip4iOS from code, I also build a similar app, Spike, to feed the data field, which is probably overkill, but does seem to work. Spike doesn’t seem to be being developed anymore, however, so I’m not sure if this is a long term solution.

Controlling my blood glucose:

In common with all people with Type 1 Diabetes, I am insulin dependent. My body does not produce its own insulin, which is needed to unlock the cells in my body to absorb insulin. I therefore need to inject myself with insulin.

I use two types of insulin:

• Levemir: this is a slow release insulin which I take twice a day to keep my background blood glucose steady. My regular dose is around 7 units at 8am and the same at 8pm, dependent on my activity levels. I find that Levemir works well, but is not particularly stable: should it get a little warm it can be destroyed and is therefore useless. Since I take a relatively small dose it can go off before I finish a cartridge.
• Fiasp: this is a very fast acting insulin which I take when I consume carbohydrates, at a ratio of between 10 and 15 units for every 10 grams of carbs I have, depending on the time of day. Since Fiascp acts so quickly I find it to be an excellent way to control my blood glucose.

I dose my insulin using Novopen Echo pens (I believe that these have been superseded). I opted for these pens since I believe they are better for the environment, since there is less plastic waste than a standard insulin pen, and they also allow me to give 0.5 unit doses, which is really effective in controlling my levels.

If I need to increase my blood sugar, because I am having a hypo or am close to having a hypo, I use three products to assist:

• Jelly Babies: my preferred product, since they are easy to buy, easy to portion (each Bassett’s Jelly Baby contains about 7g of carbs), and taste nice!
• Dextro Energy: I always carry several packets of these with me, and always have a pack in my pocket. They’re great because each tablet contains about 3g of carbs, and are very fast acting (more so than Jelly Babies). The disadvantage is that they taste pretty horrible!
• Coca-Cola: I have a stash of 150 ml cans of Coke at home (each containing 16 grams of carbs). I use these either in emergencies, when my blood sugar is falling dramatically and I need an urgent hit, or if my blood sugar crashes when I am running on the treadmill. The benefit is that the sugar hits very quickly, but the disadvantage is that it can cause a rapid crash, which means that my levels will need careful monitoring after drinking a can, and probably a further carb boost.

Conclusion:

This, then, is pretty much my entire diabetes management regimen. I wouldn’t claim that it is perfect, but it works for me. It has resulted in an A1C of 5.7% (39 mml/mol) which I understand is pretty much that of a non-diabetic.

I publish this here in the hope that the information might be helpful and interesting to others, but as ever, this is most definitely not to be construed as medical advice or guidance.

If you have any thoughts or would like to share your own diabetes management strategy, please do comment below.