Old age and diabetic

Hey there! Your A1c sounds very good. I do understand your interest in TIR. When you say Type 1.5, do you mean type 1 diagnosed as an adult? Are you taking long acting and short acting insulin?

Type 1.5 is what my doctor calls it. I have lots of antibodies so that leans it toward type 1. I am 5'7" and 116 lbs. and was diagnosed at age 78. I never had an issue before that. I am taking a 70/30 insulin (long and short) with a fast-acting sidekick if I think I need it. My GP said if I had any questions, she could answer them, but with the 15 minutes we are allowed together, it's not enough time for my questions. I was never really educated on how to work all of this. I've been to 3 diabetes classes and 2 dieticians, but no one seems to know how to deal with the 70/30 insulin. I am going to be seeing an endo in June, so maybe she can straighten me out! Meanwhile, my A1C isn't off the wall so perhaps I'll be ok until then. Thank you!

@ksdm welcome to Mayo Clinic Connect. As @celia16 pointed out your A1C is very good. From the height and weight you listed, you sound like you are taking very good care of yourself. That is to be commended.

In my opinion the type of diabetes you have doesn’t matter so much. I had an endocrinologist at Mayo tell me “Diabetes is high blood sugar regardless of the type”. You are correct to be concerned about “time in range”. You mentioned feeling like being “on a roller coaster” with too many highs and lows. Ideally the highs and lows can be reduced to achieve a time in range that more closely resembles a flat line.

Three things come to mind that might be helpful to you. 1) your monitoring system & devices. I saw in another discussion where you referred to the Libre Freestyle system. I came to that discussion and responded to it first. The Libre Freestyle is a continuous glucose monitoring system (CGM). Do you have one? You also need a glucometer. I talked about the difference between the two devices and how they compare. I actually used the term “rollercoaster”. That is a different kind of roller coaster than what you are concerned about in this discussion. In addition to these devices a good record keeping system can help you and your provider identify patterns and trends you are experiencing (the highs and lows). This can help to make better informed decisions about your treatment.

2) Your insulin. At Mayo Clinic Connect we don’t diagnose or prescribe. I’ve got to say I’m going on nearly 50+ years of diabetes (all types plus experiencing every treatment I know of). There are lots of types of insulin. They have different lengths of effectiveness and times of onsets. This can cause peaks and waning valleys. They are often referred to as long acting and fast acting. Some are a combination. 70/30 insulin is a rare one. I’m glad to know that you will be seeing an endocrinologist. The endocrinologist at Mayo that I mentioned above also told me that it is best to find the simplest treatment plan. Something that is too complicated can be overwhelming and too daunting to follow. Perhaps the endocrinologist you see in June can help you establish a treatment plan with easy to use monitoring devices & recording systems and appropriate insulin.

3) last but not least is diet and exercise. You said that you are following a “low carb (under 60 a day)” diet. I’m not sure what you mean by this. Again in the 50+ years I’ve been dealing with this I’ve encountered lots of dietary plans. In general low carb, low fat, low sodium etc. is a good idea but people are individual and there is no such thing as one size fits all. Perhaps your endocrinologist can refer you to a nutritionist that can help you customize a plan to best meet your needs.

I’m so sorry that you have not gotten the training and information needed to make your best diabetic journey possible. A 15 minutes appointment with a GP, 3 diabetes classes & 2 dieticians hasn’t been near enough. You will probably be ok until June but you could inquire about being on a call list in the event that something sooner opens up. Could you also clarify that this appointment is your first consult? It should be long enough to include time to review your history and labs (an hour?). Find out if there’s anything you can do ahead of time get the records of your history and labs sent ahead. I will keep you thoughts and prayers. I hope to hear from you again that you are making progress.

Okay. So, with antibodies, that says Type 1. My earliest endocrinologists were also teachers, so I read a lot of their work and attended seminars where they spoke. They never differentiated in categories of type 1. They always said it comes at any age. It can also come on gradually, but it’s still type 1. That’s my understanding.

I have never taken 70/30 insulin. And, I’ve never known a type 1 who did, but there must be a reason they prescribed it. I just don’t understand it enough to say much. It contains both slow acting AND regular insulin. I’ve never taken Regular insulin. I was placed on long acting like Levemir or Lantus twice a day, morning and night. With fast acting, Novolog for before meals and corrections. Five years ago, I went on pump therapy, so I only take fast acting insulin Novolog through my pump. It gives small doses to keep BG in range.

I like the idea of the cgm. It can provide you with a good idea of your needs and trends. You can do finger sticks with a meter too. Logging the numbers all throughout the day. I hope the endocrinologist and/or CDE are able to help sort it out for you. I hope you’ll get input from others who take 70/30. I’d log your numbers, times, carbs, protein, fats, insulin injections so your endo can review it, Mine have always been able to offer suggestions.

Good luck with everything! Please post what you find out.

Wow, thank you for all of the info! I have CGM and a glucometer. I am always checking. Good idea about getting a sooner appointment and that it will be my first appointment. I think if I got off the 70/30 insulin I might have an easier time of it. With this type of insulin, no dietician can guide me. (this has been a problem before) I do eat a low-carb diet but low fat and low salt. At my age, I am not ready to sacrifice butter and salt!! I have no complications from diabetes yet and I am 82......Thanks for your guidance! PS I also had an endocrinologist tell me "Some people just have high blood sugar, and you will be fine".

I admire your confidence, motivation and success so far. That’s really impressive for any age.

What I could not find -- and Cheryl has properly identified -- is the role of physical activity, given that it seems your BMI is on the Underweight category which may still be ok if you have adequate muscle mass. I, at 80, though have never bothered with numbers, I do make sure I eat right (and tasty) food and do enough physical activity to maintain:strength, endurance, flexibility, balance.

What's Also very important is socially invigorating and enjoyable social connection. Frankly I was taken aback by a health academic from Harvard U, Jeremy Nobel who has also written a book, Project Unlonely, claims lack of such social connection raises one's risk of Diabetes by 50%. I still find it hard to believe but perhaps humans are social animals and lack of mutually rewarding friends do help us heal in ways we can't imagine.

This is one are we can't do alone; I reach out for every opportunities everyday.
Good luck!
https://www.cbc.ca/radio/thecurrent/who-loneliness-health-stigma-1.7035081

I am 69 and have been a type 1 diabetic for over 50 years. There is not much for me to add to the excellent advice above--but I was wondering if you are taking any oral agents. Around 20 years ago, when I started experiencing transitory insulin resistance with peri-menopause, I began taking metformin along with insulin. I found that 500mg in the morning evened out the "roller coaster" considerably. This isn't for everyone--since some people have unpleasant gastric side-effects (though they often resolve in a couple of weeks), but I found that my diabetic gastric complications actually improved significantly. An added benefit for me (I don't know your gender) is that metformin is known to mitigate the risk of gynecologic cancers.
I've always been a little annoyed at the current dogma that an AIC of 7 is more than fine for elderly people. The reasoning is that low blood sugars are more dangerous--given the few years left to us--than any complications that might develop in that time. This reasoning is sound if the diabetic is unable or unwilling (certainly not you!!) to try some simple measures to tighten things up. However-even if complications don't result--and they can in a couple of years with a 7 AIC- a blood sugar roller coaster can affect QOL and can actually result in more hypoglycemic episodes. Currently, (after a misspent youth with AICs over 18) mine is below 6 and I rarely have low blood sugars. Rather late in the game I started using an insulin pump which is linked to my CGM. That has helped immeasurably. I also eat a low carb diet and exercise--and my CGM readings make a beautiful flat line.

Thank you for that! I tried metformin when I was first diagnosed and got to the point of not being able to eat! I wish I could take it. I've had a few low blood sugars that have been really scary like 33 at 4AM. I am 82 and I live alone, so I try to not risk it which means I err on the side of not enough insulin and wake up high. I don't think I want to get involved with an insulin pump right now. That's a little scary. I don't believe I need a flat line given I have no symptoms and never have, but I would like to avoid the real highs and real lows. I am glad you've got it under control, you've done a good job!

The main reason I first got a cgm was fear of dropping BG during my sleep. I now have a pump with integrated cgm, but my first was just a cgm. Over the years, I would awaken to low BG. Fortunately, I was able to get myself some juice. My lowest that I’m aware of was 25, It scared me. With a pump, if my cgm is not working properly, I set an alarm and get up to do finger sticks every couple of hours.

I have taken Invokana off label for a short time. Too many infections.