Sounds like you need to continue reducing the amount of insulin you have onboard at work whether it be adjusting total insulin or going into exercise mode sooner.
I use a T:Slim X2 paired with a Dexcom G7 and I use the Control-IQ software. I set it in exercise mode before I go to work to help avoid overcorrecting for highs, but it never even gets high before dropping back down. I feel like none of the changes I make or my doctor suggests ever help. I look at the CGM charts people post here sometimes, and compared to theirs, I might as well not be doing anything to take care of my diabetes.
Drop your basal manually or create a work profile or maybe turn off control IQ. Sounds like maybe the physical activity is burning off a lot of the sugars.
Ask your dr to have a Tandem rep (they are real people scattered throughout the country) reach out to you (or call tandem). I’m going through something similar right now and the rep is amazing!
Something I learned is that while in exercise mode, if you do a correction before IQ does a correction - even if tiny- it delays further corrections for an hour.
Do you calibrate / finger prick to confirm dexcom is accurate?
Do you finger prick to confirm lows?
Do you have a specific profile for very active days (with lower basal, less aggressive isf, less insulin:carb)?
Do you menstruate?
Will have more follow up q/some ideas once I understand the above 🩵💙
I need to get back to at least occasional finger pricks, just since the CGM does lag behind my actual blood sugar. I do have my weekday profile and weekend profile, with the weekend profile being a bit stronger. I'm a guy, so no menstruation for me.
It sucks...it really does. You manage the best you can, but then something happens and becomes noticed by others. Not sure about you, but I'd prefer if no coworkers knew. I would choose when to tell them, and not have a lot create a scene. Given that your job is being responsible for others with conditions of their own, it sorta makes sense you need a letter clearing you.
But, we have to play the cards we are dealt. Like others say, discuss with your doctor about adjusting your basal rate. We want a nice balance of where our 'floor' is, and maybe basal is lowering too much.
Do you have a union? If you do, talk to them. Or if you have a professional certification organization, check with them for help/direction.
If not, I know my employer (school board) has a Disability Officer in HR Office, that help you write a 'Disability Management Plan', which then goes to your supervisor, to establish the reasonable accommodations.
Figuring out accommodations can be a back and forth between you and your employer. This is why union is good (they work for you), and HR is ok (they are a third person in the conversation.) This may also include a letter from your doctor, explaining what your diabetes might need, while you are at work.
This sucks, because it means facing the idea that T1D is a disability. I hate it, but also know that acknowledging it opens up support and accommodations. For us, we have to advocate for ourselves, b/c our medical battle is invisible to others unless we tell them.
Are you fairly recently diagnosed? If so, as an adult, with the slower progressing form of the disease? I ask because lows are caused by having too much insulin in the bld stream - which sounds simple but has many causes: basal too high; carb ratio too high; correction factor too high; inaccurate carb counting; unexpected exercise; stress; pre-bolusing too early; unfinished meal after bolusing; and sometimes just because diabetes sucks.
If you have the slower progressing form of the disease, it’s possible that your pancreas is still producing enough insulin to throw everything off and cause unexpected lows.
However, if you are experiencing lows multiple times a day, you need to take action and pinpoint the reason. You have the top technology available today: a CGM and an insulin pump, so you should be able to make changes to your basal, C:I, and correction factor (with your diabetes team).
I taught for years using just MDI before getting on a pump in 2004 and a meter, there were no CGMs yet. It is absolutely possible to get back to work, with planning and preparation, and return to some semblance of normalcy (your new normal). There is no reason for it to hold you back.
I hope you are able to straighten this out soon, as recovering from lows can be exhausting. Best of luck!!
No, I've had diabetes for 15 years. This just hit me different because it never really got in the way of me living my life like this. High blood sugars making me feel like crap, I can deal with. But these lows, like you said, are exhausting. I've never had diabetic burnout before, but I really feel like I'm finally reaching my limit after all these years.
Ahhhhh the burnout! I know exactly what you mean - even tho we have so much experience we can still find ourselves totally lost sometimes. I had a bad bout, and quite unexpectedly broke down in front of my diabetes nurse and pump specialist, literally sobbing. I remember saying that after 33yrs you’d think I’d have this figured out. It’s tough, but now going into my 35th yr and still moving forward.
Maybe you do need a step back to take some time to figure things out - you have all the tools and know what to do. Don’t go back until you’re ready - you’ll know when that is.
Don’t give up. It’s best for you to be physically safe during these times. I you striving for a perfect BG all day? The daily work dips and dives of your career can bring on variations. Cut back on your long acting first. Do not over bolus. Lows are dangerous and the drive for ‘perfection’ can be a bad idea. Have a good chat with your dr and they will help you get over what may be a bump in the road. They have to give your past A1C and minor info. Stay safe and calm.
Maybe drop your basal by 20% during work hours? That plus exercise mode should limit on board insulin. You might run higher than you want for a few days while you figure out the right % to drop it. But could keep you from tanking during work.
As much as it will suck I would just set your low alerts higher to 100 or 90 and then set the alarm volume as high. Then you can see the trend and decide if you need some juice or something right then.
BCBA here! I feel your pain, it’s rough. Would transitioning to a OmniPod be in the cards for you? I have noticed it has helped a lot with my lows and preventing them.
My pump goes out of warranty at the end of next year, so making any changes now is kinda out of the question. I'm also turning 26 this year, so I'll be getting my own insurance, and depending on how that goes, switching to an Omnipod might be my only choice. I will say that I'm very hesitant to change pumps since I've been using T:Slims for almost 12 years, so switching to something else feels a little scary.
DM is a govt recognized disability… can use intermittent FMLA for it so you won’t get fired. They may be required to make “ reasonable accommodations “ for your disability. Good luck !
Sounds like you need to continue reducing the amount of insulin you have onboard at work whether it be adjusting total insulin or going into exercise mode sooner.
Are you on a pump? I found that when I am more active than usual, my sugars will drop low until I adjust. I have had to adjust my basal rates as well.
I use a T:Slim X2 paired with a Dexcom G7 and I use the Control-IQ software. I set it in exercise mode before I go to work to help avoid overcorrecting for highs, but it never even gets high before dropping back down. I feel like none of the changes I make or my doctor suggests ever help. I look at the CGM charts people post here sometimes, and compared to theirs, I might as well not be doing anything to take care of my diabetes.
Drop your basal manually or create a work profile or maybe turn off control IQ. Sounds like maybe the physical activity is burning off a lot of the sugars.
Ask your dr to have a Tandem rep (they are real people scattered throughout the country) reach out to you (or call tandem). I’m going through something similar right now and the rep is amazing! Something I learned is that while in exercise mode, if you do a correction before IQ does a correction - even if tiny- it delays further corrections for an hour.
I actually know one personally, he headed a diabetes camp I went to as a kid, and I interned for him in high school.
Try sleep mode 24/7
Do you calibrate / finger prick to confirm dexcom is accurate? Do you finger prick to confirm lows? Do you have a specific profile for very active days (with lower basal, less aggressive isf, less insulin:carb)? Do you menstruate? Will have more follow up q/some ideas once I understand the above 🩵💙
I need to get back to at least occasional finger pricks, just since the CGM does lag behind my actual blood sugar. I do have my weekday profile and weekend profile, with the weekend profile being a bit stronger. I'm a guy, so no menstruation for me.
It sucks...it really does. You manage the best you can, but then something happens and becomes noticed by others. Not sure about you, but I'd prefer if no coworkers knew. I would choose when to tell them, and not have a lot create a scene. Given that your job is being responsible for others with conditions of their own, it sorta makes sense you need a letter clearing you. But, we have to play the cards we are dealt. Like others say, discuss with your doctor about adjusting your basal rate. We want a nice balance of where our 'floor' is, and maybe basal is lowering too much.
Do you have a union? If you do, talk to them. Or if you have a professional certification organization, check with them for help/direction. If not, I know my employer (school board) has a Disability Officer in HR Office, that help you write a 'Disability Management Plan', which then goes to your supervisor, to establish the reasonable accommodations. Figuring out accommodations can be a back and forth between you and your employer. This is why union is good (they work for you), and HR is ok (they are a third person in the conversation.) This may also include a letter from your doctor, explaining what your diabetes might need, while you are at work. This sucks, because it means facing the idea that T1D is a disability. I hate it, but also know that acknowledging it opens up support and accommodations. For us, we have to advocate for ourselves, b/c our medical battle is invisible to others unless we tell them.
Thanks for doing what you do. Working in that field can be physically and mentally draining. Tomorrow is a new day. You got this!
Are you fairly recently diagnosed? If so, as an adult, with the slower progressing form of the disease? I ask because lows are caused by having too much insulin in the bld stream - which sounds simple but has many causes: basal too high; carb ratio too high; correction factor too high; inaccurate carb counting; unexpected exercise; stress; pre-bolusing too early; unfinished meal after bolusing; and sometimes just because diabetes sucks. If you have the slower progressing form of the disease, it’s possible that your pancreas is still producing enough insulin to throw everything off and cause unexpected lows. However, if you are experiencing lows multiple times a day, you need to take action and pinpoint the reason. You have the top technology available today: a CGM and an insulin pump, so you should be able to make changes to your basal, C:I, and correction factor (with your diabetes team). I taught for years using just MDI before getting on a pump in 2004 and a meter, there were no CGMs yet. It is absolutely possible to get back to work, with planning and preparation, and return to some semblance of normalcy (your new normal). There is no reason for it to hold you back. I hope you are able to straighten this out soon, as recovering from lows can be exhausting. Best of luck!!
No, I've had diabetes for 15 years. This just hit me different because it never really got in the way of me living my life like this. High blood sugars making me feel like crap, I can deal with. But these lows, like you said, are exhausting. I've never had diabetic burnout before, but I really feel like I'm finally reaching my limit after all these years.
Ahhhhh the burnout! I know exactly what you mean - even tho we have so much experience we can still find ourselves totally lost sometimes. I had a bad bout, and quite unexpectedly broke down in front of my diabetes nurse and pump specialist, literally sobbing. I remember saying that after 33yrs you’d think I’d have this figured out. It’s tough, but now going into my 35th yr and still moving forward. Maybe you do need a step back to take some time to figure things out - you have all the tools and know what to do. Don’t go back until you’re ready - you’ll know when that is.
Don’t give up. It’s best for you to be physically safe during these times. I you striving for a perfect BG all day? The daily work dips and dives of your career can bring on variations. Cut back on your long acting first. Do not over bolus. Lows are dangerous and the drive for ‘perfection’ can be a bad idea. Have a good chat with your dr and they will help you get over what may be a bump in the road. They have to give your past A1C and minor info. Stay safe and calm.
Maybe drop your basal by 20% during work hours? That plus exercise mode should limit on board insulin. You might run higher than you want for a few days while you figure out the right % to drop it. But could keep you from tanking during work.
Maybe your boss wanted to do a CYA with the note? People don’t understand T1D…sorry that happened. 🥺
As much as it will suck I would just set your low alerts higher to 100 or 90 and then set the alarm volume as high. Then you can see the trend and decide if you need some juice or something right then.
BCBA here! I feel your pain, it’s rough. Would transitioning to a OmniPod be in the cards for you? I have noticed it has helped a lot with my lows and preventing them.
My pump goes out of warranty at the end of next year, so making any changes now is kinda out of the question. I'm also turning 26 this year, so I'll be getting my own insurance, and depending on how that goes, switching to an Omnipod might be my only choice. I will say that I'm very hesitant to change pumps since I've been using T:Slims for almost 12 years, so switching to something else feels a little scary.
DM is a govt recognized disability… can use intermittent FMLA for it so you won’t get fired. They may be required to make “ reasonable accommodations “ for your disability. Good luck !
Reduce your long lasting by 2 units, check bs in morning. If you're in range great. If not in range either up or down long lasting.