March 24, 2023 How 2 Type 1

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If you’ve recently been diagnosed with Type 1 diabetes, or if you’ve had it for a while

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and want to step up your management, or if someone you care about has Type 1 diabetes

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-- a friend, or family, or a friend who’s become family -- then this series is for you.

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This series is for me, too.

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I'm Conrad Pow.

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I'm a Senior Project Manager at Diabetes Action Canada.

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My daughter was diagnosed with Type 1 diabetes when she was four years old, so -- as you

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might imagine -- there has been a lot of worry, and learning, and work.

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These videos would've helped my family a lot.

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Type 1 diabetes is a condition where your immune system attacks your pancreatic cells,

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so they can't make the insulin needed to regulate your blood sugar automatically.

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It can feel like your body has betrayed you, which it kind of has.

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And that can feel isolating, defeating, and like you're broken.

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But the thing about humans is: we're incredibly resilient.

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Things break all the time, like when you drop your cell phone in the toilet.

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There's that moment of panic, or sadness, or rage, like, "ugh, my phone is dead and

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I have to find a way to let everyone know, but that's embarrassing, and also somehow

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I have to find the time and money to buy a new one!?"

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All those feelings can seem overwhelming in the moment.

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And, in a similar way, living with Type 1 diabetes may have overwhelming moments or

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days or weeks.

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That's normal.

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But, like I said, humans are resilient.

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Managing Type 1 means gathering tools to help your body, practicing skills, and getting

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better at dealing with the hard stuff that comes your way.

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Type 1 diabetes doesn’t need to hold anyone back from living a full and healthy life.

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In this bite-sized video series, we’ll help you solve the most common problems related

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to diabetes, and learn how diabetes, insulin, food, and activity all work together.

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We'll also share guidelines to help you customize your treatment to different situations and

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live the life you want -- whether that involves running marathons, reading on the couch with

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your dog, or becoming a locally famous foodie.

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We're not here to judge your dreams.

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We're here to encourage them, and help you reduce any unwelcome diabetes-related surprises.

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This series will also help you set and reach your own goals by understanding exactly how

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your body works with diabetes.

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Remember, though: the goal isn’t perfection.

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One small change each week or each month can make a huge difference in your life.

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Most importantly, there are so many other people with Type 1 who are somewhere along

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their journeys.

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That's where all this information comes from: collective scientific study, collective mistakes,

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and collective hope of making it easier for current and future Type 1s to deal with this

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major life shift.

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Now, let’s go.

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Accept You Have Diabetes

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Accepting that you have diabetes is often the most  difficult hurdle to overcome. The more you fight  

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it, the more everything feels like a struggle. The  more you embrace it, the easier it is to live your  

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life. I know, easy to say -- hard to do. But the  most important part is a shift in perspective.

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In frustration, you might think of Type 1 diabetes  as a monster inside of you that you have to slay.  

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Instead, try to think of it as something to be  managed with skills that are learned, practiced,  

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and eventually mastered. Living a healthy  and full life with diabetes is achievable.

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Mindfulness is a great tool that can help get  you started on the path to acceptance. Lots of  

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healthcare professionals recommend mindfulness –  and not just for diabetes patients. The goal is to  

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be more aware of your thoughts, feelings, and body  through a judgment-free lens. Mindfulness can keep  

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you from dwelling on negative feelings, which  leaves more energy to focus on how to improve.

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You can try mindfulness out with  guided meditations on YouTube,  

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or apps like Calm and Headspace. It'll  probably be tough at first! Nowadays,  

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it's so easy to put on music or Netflix  in the background, so just sitting with  

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your thoughts can be challenging. But  I promise, it's worth it. Even a little  

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mindfulness practice can be very powerful  in starting to accept your diabetes.

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Check Your Blood Sugar

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Having Type 1 diabetes means that your body  no longer regulates your blood sugar level.  

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It's on you to actively check your  blood glucose and respond to it.

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No matter how long you’ve had diabetes, here's  our biggest piece of advice: try not to worry  

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about getting perfect blood sugar numbers. In  fact, the number you see when you check can  

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never be "perfect," because it isn't inherently  good, bad, or a measure of your self-worth!

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Checking blood glucose levels can help you  learn how many things affect your blood sugar,  

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and get data to decide what you can or should  do next. In some ways, managing diabetes is  

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like getting haircuts or picking clothes. You  need to know your body well so you make choices  

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that help you feel good in it -- whether  that's bright pink hair or chunky sneakers.

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And just like we've all had regrettable fashion  choices, no-one gets diabetes “right’ all of the  

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time. Checking blood sugar is a learning  process, and every skill takes time to acquire.

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Make checking blood glucose levels a habit.  By doing it regularly before meals and at key  

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times it will become second nature. You’ll then  always have up-to-date information about your body  

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and be more in control. Specifically,  you'll start to notice how different factors  

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affect blood sugar levels, like eating a ham  sandwich compared to eating a hot fudge sundae.

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Take Your Insulin

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The most important part of managing Type 1  diabetes is making sure you’re taking your  

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insulin consistently. This is the only way your  body can lower blood sugar since your pancreas  

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isn’t making it! As taking insulin becomes a  habit, you won’t think twice about doing it.

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As with checking blood sugar, it’s totally  normal to worry about your numbers.  

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If you feel nervous about going too  low, take a smaller dose of insulin.  

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You can always correct later. Don’t  forget the golden rule: safety first.

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Diabetes may initially feel like a huge weight,  

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but it's only a small part  of you and can be managed.  

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One day at a time, you’ll understand your body  better. And before you know it, you’ll be a pro!

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Accepting that you have diabetes,  checking your blood sugar,  

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and getting skilled with taking insulin will  build the foundation for a full and healthy life,  

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if this seems like a lot, but feel free to pick two to  start with, as long as one is taking your insulin.

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Accepting your diagnosis and learning the  basics of how to manage your Type 1 diabetes  

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are the first steps in this journey. Now, for  some key tips so you can feel more confident in  

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your management. If you’re doing these next 10  things regularly, you are well on your way!

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Be Proactive

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Be proactive, rather than reactive.  Learn to understand your body  

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and recognize situations ahead of time  that may challenge glucose levels.

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Surprises are inevitable, but health  surprises are never fun, in my experience. By  

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practicing paying close attention to your body,  

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you can try to prevent major highs or lows, and  be prepared to handle them when they happen.

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Check with a Purpose

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Check, check, check. I know,  you’ve heard it a million times,  

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but checking blood glucose levels  is now a big part of your life.

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If you feel off, check your blood sugar levels  and please don’t drive. Seriously, even a go-kart!

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Even when you don't feel off, remember to check  with a purpose. You need this information to  

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understand your body, learn what actions to take  with specific numbers, and understand how your  

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body reacts to new meals and activities.  Especially if you switch up your routine.

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As you get more data and learn  how to make more adjustments,  

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you’ll gain confidence in your body. It'll get  easier as you start to recognize patterns.  

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Basal and Bolus Balance

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For most people, long-acting  insulin -- also called basal  

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insulin -- makes up about half  of their total daily insulin.  

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The other half is made up of mealtime doses of  fast or short-acting insulin -- bolus insulin.

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It’s super common for people to rely on basal  insulin, but that isn’t ideal. Think of it like  

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eating a steak with just a fork, or rowing with  one oar -- using one tool can only get you so far.  

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Getting the balance between  basal and bolus is important.

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If your blood sugar is going low  often and you can’t figure out why,  

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try paying close attention to how you're  balancing different kinds of insulin.

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Bolus Before Eating with All Meals

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Bolus with every meal. That is  what a healthy pancreas would do,  

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and whether you like it or not, you're a  substitute pancreas now. It may be tempting  

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to skip doses but preventing high glucose levels  is better than having to deal with them later.  

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Building this habit can actually  save you from extra diabetes-work.

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Taking a bolus before eating is the best habit  to build, since it takes time for the body to  

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absorb insulin into the bloodstream. If  you take it after meals, you may forget.  

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And that could lead to one of two extremes:  high glucose levels that you have to deal with,  

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or playing catch-up and overdoing the  insulin, which can cause hypoglycemia.

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Be Consistent with Carbs

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Carbs are delicious, no question! And they’re in  lots of different foods, from staples like pasta,  

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rice, potatoes and bread to cookies  and the honey you put in your tea.

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You don't need to cut carbs out of your  diet -- they're a great source of energy!  

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However, the fewer carbs you eat in a  meal, the less insulin you’ll need to take,  

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which means there’s less of a chance  that your blood sugar will swing. So

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be thoughtful about how and when you eat carbs,  like by spreading them out throughout the day and  

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eating them in smaller quantities. Make a Plan for Hypoglycemia

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Like I mentioned earlier, preparing for surprises  is key. Hypoglycemia, which is low blood sugar,  

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triggers a primal drive to eat. And if you  don't have a plan, you might find you’re  

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consuming way too many carbs all at once, which  can throw off your body in many different ways.

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Carrying rapid-acting carbohydrates like  Dex tabs can help you treat hypoglycemia  

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quickly, and in a controlled way… 

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and without eating the whole fridge.

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Treat Highs Carefully

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On the other end of the spectrum, you also need  to take care when treating highs. Start off gently  

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and be patient. It takes time for insulin to be  absorbed before it starts lowering blood sugars.

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Some people give large doses of fast-acting  insulin to correct high blood sugars,  

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which can lead to low blood sugars later. Others  

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jump in with a second correction dose too soon,  which can also cause blood sugars to crash  

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later. You don’t want to rage bolus;  it can have unwelcome consequences!

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Adjust for Exercise

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Exercise is a big part of good  physical and mental health.  

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It can also help improve your body’s  insulin sensitivity which is great.  

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Exercise, insulin and carbs are like the three  legs of a stool. It’s important to balance them.

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Different types of exercise can have  different effects on your blood sugar,  

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some may raise it, like pumping iron,  while others may lower it, like birding.  

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Check your blood sugar before during and after  and you’ll find the patterns. Listen to your  

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body and be careful to avoid hypoglycemia. It may  be tricky to learn at the beginning but trust me  

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the benefits are worth it! Switch Up Your Spot

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When building these routines, don’t forget to  switch up where you inject insulin on your body.  

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Sticking with one spot can cause lipohypertrophy,  which means insulin won’t absorb as well in those  

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areas, causing unpredictable highs and lows.  But it's an easily avoidable problem if you  

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just change your injection sites. Be Patient and Kind with Yourself

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My last piece of advice is to be patient and kind  with yourself. Managing your diabetes will take  

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time and practice, especially if it's a brand-new  diagnosis. It’s okay to make mistakes. You are  

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learning new skills -- after all, nobody was born  ready to consciously perform the job of a pancreas  

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or aspired to be one when they grew up,  usually children want to be something  

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like a veterinarian or astronaut. Anyway, we won’t pretend all this is easy,  

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even if advice can be boiled  down to concise videos and tips.  

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You may be frustrated with your progress  day-to-day, but you’ll be amazed at how  

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far you’ve come in a few weeks or months if you  keep learning about your body. You’ve got this!

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[Applause]

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[Music]

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learning that you have type 1 diabetes

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can make your life suddenly feel as far

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from normal as possible

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living well with diabetes means new

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routines and keeping track of things

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like insulin and blood sugar that you

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didn't really have to think about before

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but the thing is everyone's body is a

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little abnormal the fact that some

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people feel invigorated by a brisk 6 a.m

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run is completely bonkers to others

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living with type 1 diabetes means

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figuring out what normal now looks like

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for you

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a lot of people will have suggestions

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for what you should do to manage type 1

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but understanding your new normal means

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understanding what's going inside of

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your body specifically it helps to know

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about a little sugar molecule called

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glucose

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almost every cell in the human body

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needs glucose to survive

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your brain needs glucose to run your

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nervous system and keep everything

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working

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your muscles need glucose to move

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especially when you're doing intense

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exercise

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and your skin cells need glucose to do

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well what skin does protect you from

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germs and stuff like that

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you get glucose from digesting different

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kinds of food not just sugary things but

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also from foods that don't taste sweet

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like bread pasta and rice

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you can even get some glucose from

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protein-rich foods like chicken or steak

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all kinds of chemical building blocks

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from food get absorbed into your

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intestine

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go into your bloodstream and get

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shuttled to the cells that need them

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even though you're not constantly eating

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your body constantly needs energy and

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glucose is a major currency

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whenever you have some extra glucose in

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your bloodstream

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your body has to figure out ways to save

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that energy for later

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the liver stores glucose to be used in

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the short term and the fat cells store

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excess glucose for the long term

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whether it's from your intestines or

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your liver after the glucose had made

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its way into your bloodstream it needs

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to get into your cells

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to make this happen you need a molecule

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called insulin

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in people without diabetes insulin is

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automatically released by the pancreas

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to regulate blood glucose

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kind of like how your heart beats

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automatically or cruise control saves

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you the work of pushing the gas pedal

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these things don't just happen

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themselves but they can feel a little

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like magic

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when you have type 1 diabetes your

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pancreas doesn't make the insulin needed

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to automatically regulate blood glucose

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anymore

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but your cells don't know that they

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still need glucose and your body still

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needs insulin to get the glucose to the

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right cells at the right time

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so now you

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have to supply the right amount of

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insulin

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at the right time to allow your cells to

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take in the glucose

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figuring out how much insulin is tricky

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it depends on what you're eating and how

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much energy you're using throughout a

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day

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just like you don't know if you're

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following the speed limit without a

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speedometer in your car

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you don't know if you took the right

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amount of insulin if you don't monitor

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your blood glucose levels

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like hopping behind of the wheel of a

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stick shift when you're used to an

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automatic this can feel frustrating at

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first

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you're already busy enough living your

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life and it would be much easier if your

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body would just take care of itself

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it's gonna be an imperfect journey as

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you learn what your body needs on a

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cellular level and that's okay

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but what feels impossible at first can

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become totally natural with practice

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here are the top three takeaways

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number one

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blood glucose levels rise when we eat

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and when glucose is released from the

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short-term stores in the liver

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number two

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insulin opens the cells to let energy in

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to use now or to store for later causing

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blood glucose levels to drop

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number three without enough insulin

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blood glucose levels will rise even if

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you don't eat

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i'm conrad a senior project manager at

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diabetes action canada and a father of a

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child with type 1 diabetes

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thanks for watching hope you found this

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episode helpful

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[Music]

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[Applause]

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[Music]

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[Music]

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you've been listening to signals from

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your body since the day you were born

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like how you drink water when you're

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thirsty wear warm clothes when you're

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cold or sleep when you're tired

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and we all make mistakes along the way

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maybe you've been sunburned from staying

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in the sun too long or get hangry when

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you forget to eat

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when you're living with type 1 diabetes

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though you have to pay attention to a

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few more signals

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understanding how and when the amount of

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glucose in your blood goes up and down

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and how insulin plays a role in keeping

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your body running smoothly

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think of managing diabetes as a skill

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that you can learn kind of like learning

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to drive a car

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you have to start with the basics how to

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accelerate and brake use your turn

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signals and change gears

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but there are also a lot of

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unpredictable things about driving

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like a reckless driver cutting you off a

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snowstorm that makes it hard to see

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or a big pothole that might blow up your

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tire

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you're not going to be perfect at

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handling all these things right away in

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fact they can be downright annoying or

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scary

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nobody wants to pull over to the side of

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a road and change a flat

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by gaining confidence in what you can do

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like staying alert and steering your car

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you can get past a lot of these

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different obstacles

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in type 1 diabetes there are two

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fundamental skills to steering your body

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this isn't a perfect metaphor but it can

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help to think of them like basic driving

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skills

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the first skill is measuring your blood

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glucose regularly

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this is like paying attention to your

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speed the weather or traffic while

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you're driving

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knowing how much glucose is in your

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system and what you're planning on doing

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in a day will help you make decisions

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about how you take care of yourself and

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prevent any huge surprises

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the second is balancing your food intake

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and insulin doses

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you need both in your system just like

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you need gas and brake pedals to drive

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your car safely

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since glucose is the energy source for

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your cells you can think of it like fuel

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that keeps your car moving

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some of it is stored in your gas tank

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your liver

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but you also need to stop at gas

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stations every so often which is like

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eating

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on the other hand insulin is sort of

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like keeping a foot on the brake pedal

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to make small adjustments or slow down

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when you're going downhill

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braking too hard could cause you to skid

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but it would be really dangerous to

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drive without any breaks

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too much or too little insulin isn't

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great for your body either

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and just like knowing what's down the

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road will help you plan out how much you

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want to accelerate or break

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knowing whether you're going to run a

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half marathon or sit at a desk all day

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helps you plan your food and insulin

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so it's important to pay attention to

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how activities like exercise affect your

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blood glucose levels

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nobody starts out as a perfect driver or

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a perfect caretaker of their body and

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that's okay

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but practicing this kind of steering and

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always keeping your eyes on the road

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will help you get better at handling

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those unexpected bumps in your type 1

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journey

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here are the top three

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takeaways number one

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steering your body with type 1 diabetes

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means balancing your food exercise and

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insulin

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number two

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avoid too high or too low insulin doses

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to keep your blood glucose levels from

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spiking or crashing dangerously

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and number three

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monitoring your blood glucose levels can

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help you learn how different foods and

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exercise affect how much insulin you

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need

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thank you for watching hope you found

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this episode helpful

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[Music]

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[Applause]

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[Music]

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when you have type 1 diabetes you

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basically get a new job so

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congratulations

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you are now a pancreas

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because your body isn't built to live

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without insulin you have to consistently

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give yourself doses

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but it's not as simple as doing the same

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thing every day without thinking like

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sleepily brushing your teeth

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there are actually a couple kinds of

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insulin and ways to take it

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plus your daily needs can change

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depending on what you're doing

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how you're eating and your unique body

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this is where having diabetes gets a

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little messy your goal is to gently

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steer your blood glucose levels to avoid

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dangerous spikes or crashes so your

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cells aren't stressed out by too little

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or too much sugar floating around

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for most people the target range is four

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to ten millimoles of glucose per liter

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of blood

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as they say

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whole body is nerfed

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so it's great if you can stay in that

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zone around 70 of the time

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now most people don't think of

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themselves as bags of four and a half to

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five and a half liters of blood but you

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probably know how tall you are or how

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much you weigh

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so you can use that information to

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calculate how much insulin you might

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need in a day to steer your body towards

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the target blood glucose range

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on average

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adults with type 1 diabetes take 0.6

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units of insulin per kilogram of body

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weight per day

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while nobody's exactly average this is a

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good place to start

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you might need less than average if

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you're relatively small or thin

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if you don't eat too much foods with

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carbohydrates or if you're burning

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energy quickly like if you're exercising

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a lot

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or you might need more than average if

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the opposite is true if you're

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relatively big if you eat lots of foods

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with carbohydrates or if your blood

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doesn't pump as efficiently for whatever

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reason

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you might also want to check where

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you're injecting insulin because if you

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reuse one of your favorite spots over

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and over again the insulin might not

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absorb as well

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there if you're just learning how to

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manage type 1 diabetes or you're really

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struggling to stay in that target range

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that's okay

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it's not easy to be a pancreas

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you can try starting from that

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calculation of how much daily insulin

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you might need and adjust it from there

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but like i said before

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there isn't just one kind of insulin

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there's two

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basal insulin and bolus insulin

2:31

basal insulin is also known as

2:34

long-acting insulin you always need some

2:37

insulin in your body and basal insulin

2:39

helps you steer your blood glucose

2:41

levels throughout the day and night

2:44

without any basal insulin your glucose

2:47

levels may skyrocket

2:49

it's kind of like keeping gentle steady

2:52

pressure on the brake when you're

2:53

driving downhill so you don't speed out

2:55

of control

2:56

some people rely on basal insulin almost

2:59

completely even through meal times but

3:02

this isn't the safest strategy

3:04

you might get in trouble with low blood

3:06

sugar in the middle of the night if you

3:08

miss a meal or exercise a bunch during

3:10

the day

3:12

it's healthier if about half of your

3:14

daily insulin is basil

3:17

the other half of this dynamic duo is

3:19

bolas insulin also known as short-acting

3:22

insulin

3:23

a working pancreas will squirt out some

3:25

insulin with every snack or meal

3:28

so

3:28

now that you're a substitute pancreas

3:30

you should too making this a habit is a

3:33

game changer

3:35

when you're eating bolus insulin helps

3:37

your body move glucose into the cells

3:39

for energy or storage instead of leaving

3:41

it to float around in your bloodstream

3:44

after taking your basal dose the

3:46

remaining half of your daily insulin

3:49

should ideally be bolus

3:51

to get mathy again it's helpful if your

3:53

total basal dose is about the sum of all

3:56

of your bolus doses across the day

3:59

these basic ratios will take you far in

4:01

your type 1 journey

4:03

if they seem way off from what you've

4:05

been doing make sure to chat with your

4:07

diabetes care team and make adjustments

4:09

gradually to learn how your body

4:11

responds

4:12

and in the next few videos we'll talk

4:15

about how to fine-tune your basal and

4:16

bolus doses even more

4:19

here are the three key takeaways from

4:21

this episode

4:22

number one

4:23

the average adult with type 1 diabetes

4:26

needs 0.6 units of insulin per kilogram

4:29

of body weight per day though needs will

4:31

vary from person to person

4:34

number two

4:35

around half of your daily insulin should

4:37

be long-acting basal insulin and the

4:39

other half should be made up of short

4:41

acting bolus insulin with meals and

4:44

snacks

4:45

and finally three

4:47

making a habit of taking some bolus

4:48

insulin every time you eat is a game

4:51

changer

4:52

unless you're treating a low or about to

4:54

exercise thanks for watching hope you

4:57

found this episode

5:00

[Music]

0:00

[Applause]

0:00

[Music]

0:00

[Applause]

0:04

figuring out how to balance your insulin

0:06

every day is a puzzle it's like a math

0:09

problem a science experiment and how

0:12

well do you know yourself quiz all in

0:14

one

0:14

but whether you're newly diagnosed or

0:17

you're re-evaluating your daily routine

0:19

it's good to start with basal insulin or

0:21

long-acting insulin it's a staple in

0:24

type 1 diabetes management

0:26

basal insulin helps you gently steer

0:28

your blood sugar levels letting glucose

0:30

into your cells as you need it

0:32

throughout the day

0:34

without any basal insulin it's like

0:36

you're driving a car without any breaks

0:38

you might speed out of control

0:41

biologically your liver will keep

0:43

pumping out glucose but nothing's around

0:45

to let that glucose into your cells

0:48

so your blood sugar levels can skyrocket

0:50

dangerously leading to even more severe

0:53

hyperglycemia also known as high blood

0:55

sugar or even diabetic ketoacidosis a

0:58

high blood sugar condition that i'll

1:00

talk about more in an upcoming video

1:03

too much basal insulin can be dangerous

1:05

as well

1:06

after all you don't want to be

1:08

constantly slamming on the brakes of

1:10

your car either with too much basal

1:12

insulin floating around your cells will

1:15

absorb too much glucose and there won't

1:17

be enough left in your bloodstream to

1:19

fuel important things like your brain

1:21

which could get you into hypoglycemia

1:23

territory

1:24

so to find that safely driving in your

1:27

car zone you can adjust your basal

1:30

insulin a little bit at a time

1:32

if you're feeling good about how you're

1:34

managing type 1 and your blood glucose

1:36

levels are pretty stable throughout the

1:38

day and night it's perfectly fine to

1:40

stay where you are

1:42

but if you feel like your blood glucose

1:43

levels creep up and down too much for

1:45

comfort right now it can be helpful to

1:47

start with a simple basal level

1:49

calculation

1:50

around 0.3 units of basal insulin per

1:54

kilogram of your body weight per day

1:56

this might not feel like enough but

1:58

remember you need to leave room for your

2:01

bolus insulin when you eat

2:03

more on that in the next video

2:05

sticking with basal insulin for now if

2:07

you're taking injections one thing to

2:09

consider is when to take your daily dose

2:12

or doses to set you up for a smooth

2:14

24-hour journey

2:16

this smooth journey is especially

2:18

important overnight when you can't check

2:20

your blood sugar or adjust because

2:22

you're asleep so the risk of a low can

2:25

be a problem

2:26

the first thing to ask yourself is

2:29

when will you remember to take your

2:30

basal insulin

2:32

it might be easiest to add it into a

2:34

consistent time in your daily routine

2:37

so if your bedtime is all over the place

2:39

it's not a great idea to use that as a

2:41

benchmark for your basal dose

2:44

but if you walk your dog at 8am every

2:46

day that might be a reliable easy

2:48

reminder for your injection

2:51

certain kinds of basal insulin may

2:53

require a specific routine because the

2:55

chemicals are just different

2:58

for example lantis and levomere are

3:01

types of basal insulin that sometimes

3:03

need to be taken twice per day instead

3:05

of once it's all part of your unique

3:07

journey

3:08

to make adjustments to your basal dose

3:11

it's helpful to compare your blood

3:12

glucose when you go to bed and when you

3:15

wake up

3:16

if in the morning you're more than three

3:18

millimoles higher than the night before

3:21

you'll want to increase your daily basal

3:23

insulin by around five to ten percent

3:26

remember to check again in a couple days

3:28

to see if you need to adjust some

3:30

more on the other hand if you're more

3:33

than three millimoles lower than the

3:35

night before you'll want to decrease

3:37

your daily insulin by around five to ten

3:39

percent and do the same sort of check-in

3:42

in a couple days later

3:43

and if you're using a pump rather than

3:45

injections you're probably working with

3:47

around three different basal insulin

3:49

rates for example most people will need

3:53

a lower rate when they go to bed with a

3:55

higher rate for a few hours before they

3:57

wake up

3:58

now if all these calculations sound a

4:00

little overwhelming

4:02

thankfully you're not on this journey

4:05

alone

4:06

your diabetes care team is always there

4:08

to help as are research-based trusted

4:11

resources like this video series

4:14

here are three key takeaways from this

4:16

episode

4:17

number one the average adult with type 1

4:20

diabetes needs 0.3 units of long-acting

4:23

basal insulin per kilogram of body

4:26

weight per day though needs vary from

4:28

person to person

4:30

number two

4:31

take your daily dose or doses of basal

4:33

insulin at a time of day that works for

4:36

your routine and the type of basal

4:38

insulin you're taking

4:40

and three when adjusting your basal

4:42

insulin dose do it gradually try

4:45

increasing or decreasing your dose by

4:47

five to ten percent and then

4:49

re-evaluating in two to three days

4:50

before making any additional changes

4:54

i understand that this episode was a

4:56

little math heavy so for further

4:58

information please just click the link

5:00

below

0:00

[Applause]

0:00

[Music]

0:00

[Applause]

0:04

a lot of daily insulin management isn't

0:06

exact because our lives aren't 100

0:08

predictable

0:10

we plan some things like celebrating a

0:12

holiday with a big meal but you don't

0:14

wake up knowing what breakfast lunch and

0:15

dinner you're going to have every single

0:17

day or whether you're going to need to

0:19

run to catch a bus

0:21

this unpredictability is why it's so

0:23

important to build a habit of adjusting

0:25

your blood glucose levels with fullest

0:27

insulin or short acting insulin

0:30

it's like when you're driving a car you

0:32

can't just use cruise control all the

0:34

time

0:35

you need to balance the brakes and the

0:37

gas as you go especially in case of

0:39

surprises

0:41

in general your bolus insulin should

0:43

make up around half of your daily

0:45

insulin but it's split up into small

0:47

doses every time you eat to prevent a

0:49

spike and if you want to correct a high

0:51

blood glucose level

0:53

these doses won't be perfect all the

0:54

time even a superhuman amount of math

0:57

can't predict exactly how your body is

0:59

going to react but you can try your best

1:02

to adjust each dose to roughly match the

1:05

food you're about to eat

1:06

it's especially important to pay

1:08

attention to the carbohydrates in your

1:10

food

1:11

most of the carbs we eat are longer

1:13

molecule chains that your body breaks

1:14

down into simple sugars like glucose

1:17

a lot of staple foods even if they don't

1:20

taste super sweet are packed with carbs

1:22

yes candy contains carbs but so do

1:25

grains potatoes kidney beans you get the

1:28

idea

1:29

and not all carbs are equal some get

1:32

broken down faster like a slice of cake

1:34

while others get broken down slower like

1:37

oatmeal

1:38

the rest of the non-carbs in your meal

1:40

such as proteins and fats make a

1:42

difference too for instance

1:44

all the ingredients in a slice of pizza

1:46

can collectively contribute to higher

1:48

blood glucose levels sometimes for hours

1:52

knowing all that it's easy to see why

1:54

some people would try to skip bolus

1:56

insulin altogether it just seems so

1:58

complicated but building the habit and

2:00

making small corrections is the best way

2:03

to steer safety

2:05

if you're not used to estimating bolus

2:07

doses for different size meals it can

2:09

help to start simply

2:11

let's say you eat three times a day for

2:13

breakfast lunch and dinner

2:16

to make sure your total bolus dose

2:18

equals your total basal dose your bolus

2:21

insulin before each meal should be

2:23

around one-third of your basal insulin

2:25

dose

2:27

since you're not eating the exact same

2:29

food three times a day you can adjust

2:31

your bolus doses by measuring your blood

2:34

glucose before each meal and around two

2:36

hours after each meal these measurements

2:39

will help you decide if the amount of

2:41

bolans you took was a good match for the

2:43

amount of food you ate and help you

2:45

build that intuition

2:47

for most people the target blood glucose

2:49

range before each meal is between four

2:51

to seven millimoles per liter

2:53

if your blood glucose is too high before

2:56

you start eating you can add in a

2:58

correction dose of bolus insulin as well

3:00

inevitably your blood glucose will go up

3:03

when you eat

3:04

but the goal of bolus insulin is to

3:06

counteract that spike so when you check

3:09

your blood glucose levels two hours

3:10

after eating you don't want to be much

3:13

higher than 10 millimoles and ideally

3:16

you'll drop back into that target range

3:18

of four to seven millimoles before you

3:20

eat again

3:20

[Music]

3:21

if you're not hitting these ranges don't

3:24

beat yourself up take it as an

3:26

opportunity to learn about how your body

3:28

reacts to the different amounts of foods

3:30

or daily routines

3:32

there are a lot of things that can

3:34

adjust like how much you're eating at

3:36

different meals or when you exercise

3:39

maybe you misjudged how many carbs a

3:41

meal contained or underestimated the

3:43

impact of proteins and fats or maybe you

3:46

didn't take your bolus dose early enough

3:48

before eating one day taking bolus doses

3:51

will become second nature but first it's

3:54

going to take some careful

3:56

experimentation and that is okay if you

4:00

want to dive in deeper we've included

4:02

some more resources in the video

4:04

description about precise calculations

4:06

like carb counting or corrections

4:09

here are three helpful takeaways from

4:11

this episode number one build a habit of

4:14

taking a dose of bolus insulin before

4:17

every snack or meal and to correct a

4:19

high blood glucose level number two the

4:22

total amount of bolus insulin you take

4:24

in a day should match the total amount

4:26

of basal insulin and number three adjust

4:29

the amount of bolus based on how much

4:31

food especially carbs you're eating

4:33

measure your blood glucose levels before

4:35

eating and around two hours after

4:38

aim for four to seven millimoles per

4:40

liter before and try to make sure you're

4:42

not far above 10 millimoles per liter

4:44

after

4:45

thanks for watching hope you found this

4:47

episode helpful

0:00

[Applause]

0:01

[Music]

0:04

even the most careful driver can get

0:06

into an accident so it's important to

0:08

look out for warning signs to prevent

0:10

them when you can

0:11

and with type 1 diabetes those warning

0:13

signs usually mean that something's a

0:15

little off with your blood glucose

0:18

i've said a couple times in this series

0:20

that ideally an average person's blood

0:22

glucose should run between four to ten

0:24

millimoles most of the time though that

0:26

can vary

0:27

the goal of using insulin is to help you

0:29

stay in your safe range if you swerve

0:32

below or above that range there's a

0:33

mismatch between how much insulin you're

0:35

taking and how much your body needs and

0:38

that can get into dangerous territory

0:40

either hypoglycemia meaning too little

0:42

blood glucose or hyperglycemia meaning

0:45

too much blood glucose in either case

0:48

your body will tell you that something's

0:50

off

0:51

when you have low blood glucose like if

0:53

you take too much insulin you may

0:55

experience scary symptoms like being

0:57

shaky sweaty or hungry

1:00

they're all caused by your body

1:01

releasing the hormone adrenaline to try

1:04

and fix blood glucose levels in an

1:05

emergency and to tell you to eat some

1:07

freaking carbs

1:09

hypoglycemia is dangerous because your

1:11

brain needs glucose to work properly and

1:14

at levels around and below 3 millimoles

1:16

there's not enough energy to go around

1:18

so other symptoms include feeling tired

1:20

weak or confused signs that your brain

1:23

isn't in tip-top shape

1:25

when you have high blood glucose like if

1:27

you don't take enough insulin you may

1:29

experience some other not so fun

1:32

symptoms like being nauseated feeling

1:34

sluggish or really thirsty you usually

1:36

start feeling bad above about 12

1:39

millimoles higher blood glucose levels

1:41

after eating is expected but

1:43

hyperglycemia without food is dangerous

1:46

because it's a sign of other biological

1:48

things going wrong

1:49

without enough insulin to let glucose

1:51

into your cells your body starts looking

1:53

for other ways to fuel itself like

1:55

breaking down fats

1:57

that's not inherently a bad thing but

1:59

breaking down fats too fast creates a

2:01

bunch of byproducts called ketones which

2:03

build up in your blood and throw off the

2:05

chemical balance of your body

2:07

this can make you very sick very quickly

2:10

because of a condition called diabetic

2:12

ketoacidosis which almost always needs

2:15

to be treated in the hospital

2:17

it's important to look out for these

2:18

unpleasant symptoms but the best case

2:21

scenario is avoiding these extremes

2:24

just like you look out for potholes

2:26

traffic or dangerous weather when you're

2:28

driving try to pay attention to

2:29

situations where you're at risk of

2:31

dipping too low or too high

2:34

for example you might be at risk of low

2:36

blood glucose after some heavy exercise

2:38

or when you're stressed or tired

2:41

you can confirm any suspicions by

2:43

testing and lift yourself out of a slump

2:45

by eating some fast-acting carbohydrates

2:48

on the other hand you might be at risk

2:50

of high blood glucose after eating a

2:52

huge meal or if you forgot an insulin

2:55

dose if this is the case you can balance

2:57

out your system by calculating and

2:59

taking a corrective dose of fast-acting

3:02

bonus insulin

3:03

that being said knowing these dangers

3:05

exist doesn't mean that you should pen

3:08

just like driving accidents happen but

3:10

most people need to use a vehicle at

3:12

some point to get where they need to go

3:14

the more comfortable you are behind the

3:16

wheel the more relaxed you would be

3:18

i'm not saying this is easy being too

3:20

high or too low can be scary

3:22

the more you know what to look out for

3:24

and how to avoid them or to fix them

3:26

quickly and safely the more confident

3:29

you'll be so remember you have the power

3:32

to correct mistakes test often and

3:35

adjust as soon as you feel something's

3:36

wrong

3:37

three key takeaways

3:39

hypoglycemia happens below four

3:41

millimoles per liter and when your body

3:44

and brain don't have enough glucose to

3:45

function

3:46

so you might get shaky sweaty and hungry

3:49

or might find it hard to concentrate

3:52

rising blood glucose levels even when

3:54

you're not eating suggests you don't

3:56

have enough insulin on board and may be

3:58

an early warning for diabetic

4:00

ketoacidosis

4:01

the best way to prevent these conditions

4:04

is building good self-care habits and

4:06

checking blood glucose often

4:08

we hope you found this episode helpful

4:10

stay tuned for more

4:16

you

0:00

[Applause]

0:00

[Music]

0:00

[Applause]

0:04

food might be a great source of joy and

0:06

connection with your family and friends

0:08

or

0:09

it might feel like a daily struggle

0:11

no matter what your relationship with

0:12

food is though everyone can benefit from

0:15

learning about nutrition especially

0:17

people with type 1 diabetes

0:19

in fact

0:20

understanding how the food you eat

0:22

affects your body and blood sugar can

0:24

help you make choices about what when

0:26

and how much you eat that leave you

0:28

feeling free rather than restricted

0:31

because food is a major source of

0:32

glucose managing diabetes involves

0:34

balancing what you eat with bolus

0:36

insulin whenever you eat to keep your

0:38

glucose in range and to strike a healthy

0:41

nutritional balance it's helpful to know

0:43

what major nutrients or macronutrients

0:46

are in the food that fuels your body

0:49

you've probably heard macronutrient

0:51

words thrown around in grocery stores on

0:53

restaurant menus or even in this video

0:56

series even if you didn't know they were

0:58

macronutrients

1:00

there are three main categories proteins

1:03

fats and carbohydrates

1:06

protein found in foods like animal

1:08

products lentils and tofu gets broken

1:11

down into building blocks called amino

1:13

acids which your body can use to do

1:15

things like build new muscle tissue

1:18

but if you eat a lot of protein at once

1:20

the extra amino acids floating around

1:22

can get converted into glucose

1:24

protein just takes longer to digest than

1:27

carbs so you may see an uptick in your

1:29

blood glucose level a few hours later

1:31

this might be surprising if you were

1:33

taught that only carbs affect your blood

1:35

sugar

1:37

fats

1:38

fats have gotten a bad rap over the

1:40

years that they don't deserve they're

1:42

not inherently good or bad for you

1:45

eating healthy fats can be a great way

1:47

to keep your blood glucose steady while

1:49

enjoying yourself

1:51

fats are found in creamy foods like oils

1:54

butter avocados and nuts

1:56

in your body fats are a source of energy

1:59

are necessary to make important hormones

2:01

and help absorb vitamins and move

2:03

nutrients around on their own eating

2:06

fats in small amounts will have little

2:07

to no effect on your blood glucose but

2:09

after a large rich fatty meal even

2:12

without many carbs you'll notice your

2:14

blood glucose starts to rise a few hours

2:16

later like proteins fats take longer to

2:19

digest

2:21

that brings us to carbohydrates all

2:23

carbs which includes sweet things but

2:25

also savory foods often staples like

2:28

bread rice potatoes or grains that can

2:30

broken down into glucose some faster

2:33

than others

2:34

the key to understanding how carbs

2:36

affect your blood glucose is often how

2:38

many you eat at one time not how sweet

2:41

they taste

2:42

so a good basic strategy is to match the

2:44

bolus doses to the amount of carbs

2:46

you're going to eat

2:48

another strategy to keep your blood

2:50

glucose balanced is aiming for lower

2:52

carb meals especially in the morning

2:54

thanks to changes in hormone levels

2:56

so for meals with no carbs try starting

2:59

with a small dose of one or two units

3:01

measure your blood glucose and adjust

3:03

next time

3:05

you might be familiar with carb counting

3:07

which is a useful skill for type 1

3:09

management

3:10

but carb counting can also be tricky to

3:12

do precisely or suck the joy out of

3:14

eating for some people

3:16

you can use an insulin carb ratio to

3:18

calculate a dose of bolus insulin that

3:21

should roughly match what your body

3:22

needs for the amount of carbs you're

3:24

eating

3:24

if you know that number

3:26

we've included some resources in the

3:28

video description to help you on your

3:30

journey that being said it's super

3:33

important not to get carried away with

3:34

carb counting

3:36

a simpler way to start might be to

3:38

estimate how many carbs are in a meal

3:40

and decide if you need a small medium or

3:42

large dose of insulin

3:44

trial and error is the way to go here

3:47

your blood glucose levels will tell you

3:48

how close you were and whether you need

3:50

to fine-tune your estimate

3:52

different combinations of macronutrients

3:54

can also have a big effect on your blood

3:56

glucose levels for example if you eat

3:59

some mashed potatoes with steak that's a

4:01

balance of some carbs from the potatoes

4:03

with protein and fat from the steak

4:06

combining these macronutrients can delay

4:08

digestion and slow the release of

4:10

glucose into your bloodstream preventing

4:12

big swings this is especially true for

4:14

fats

4:15

lots of carbs combined with lots of fats

4:18

may raise your blood sugars for hours

4:20

i'm looking at you pizza

4:22

whether you love meal prepping or

4:24

struggle to find food enjoyable being

4:26

thoughtful about nutrition can make a

4:28

huge difference managing type 1. by

4:31

balancing your macronutrients especially

4:33

carbs with your bolus insulin doses you

4:36

can better understand changes in your

4:37

blood glucose and avoid some unexpected

4:40

swings and besides feeling empowered in

4:42

your body maybe just maybe eating might

4:45

become a little more fun

4:48

three key takeaways

4:50

foods contain different amounts of

4:51

protein fat and carbohydrates eating

4:54

carbs has the biggest impact on your

4:56

blood glucose levels where protein and

4:58

fats contribute to

5:00

one strategy to balance your blood

5:02

glucose and bolus insulin is by carb

5:04

counting and figuring out how much bolus

5:06

you need for the amount of carbs you

5:08

plan to eat

5:09

eating meals with smaller amounts of

5:11

carbohydrates and eating carbs in

5:12

combination with other macronutrients

5:15

especially fats can help prevent big

5:17

swings

5:18

thanks for watching hope you found this

5:20

video helpful

5:21

see you next time

5:24

[Music]

0:00

[Applause]

0:00

[Music]

0:00

[Applause]

0:04

exercise can do a bunch of great things

0:06

for your body and brain like improve

0:08

your mood boost your energy and help you

0:10

sleep better in fact it can even help

0:13

you manage type 1 diabetes but exercise

0:16

is a double-edged sword

0:17

worrying about hypoglycemia may make you

0:20

nervous and that's totally normal

0:22

just like running a marathon or lifting

0:24

heavy weights without proper training

0:26

can be dangerous you have to learn how

0:29

exercise affects your blood glucose

0:31

levels to make sure you don't put

0:32

yourself at risk in general any sort of

0:35

muscle movement takes energy so any

0:38

exercise will increase the demand for

0:39

glucose and your cells will use up

0:41

glucose as you work out if you exercise

0:44

regularly your blood glucose levels will

0:47

swing a lot less dramatically because

0:49

your body adapts to the ebbs and flows

0:52

now it's important to remember that

0:54

exercise means a lot of different things

0:56

to a lot of different people from light

0:58

stretching to triathlons so to really

1:01

understand how exercise affects a body

1:04

with type 1 diabetes we need to break it

1:06

down into different categories

1:08

high intensity exercise is anything that

1:11

involves explosive bursts of effort like

1:13

sprinting weight lifting or many team

1:15

sports you may not be doing these things

1:17

for hours on end but your muscles will

1:20

be working hard while you are and

1:22

they'll let your body know that they

1:23

need fuel for that energy

1:25

as your heart gets pumping thanks to a

1:27

hormone called adrenaline your body will

1:29

release the extra glucose it needs from

1:31

energy stories this means that you may

1:33

find your blood glucose levels are high

1:36

after high intensity activities

1:38

often your blood glucose levels will

1:40

settle down as the adrenaline wears off

1:42

but some people might need to steer them

1:44

off slightly with the small correction

1:46

dose of bolus insulin

1:47

be careful with any corrections though

1:50

exercise that really works your muscles

1:52

makes them super sensitive to insulin

1:54

your muscles will be sucking up glucose

1:56

with even small doses

1:58

basically this means that for around 6

2:01

to 12 hours afterwards you may need

2:03

around half the bolus insulin you

2:05

normally take

2:06

it's easy to overdo it and your blood

2:08

glucose may swing low so small

2:10

adjustments are the safest bet

2:13

you'll need to experiment to figure out

2:15

what works best for you start small you

2:17

can always add more insulin next time if

2:19

it wasn't enough

2:21

on the other end of the spectrum low

2:23

intensity exercise is anything that gets

2:26

your blood pumping but doesn't

2:27

necessarily lead to burning muscles like

2:30

going on a walk or hike cleaning your

2:32

house or even a long day shopping

2:35

with these low-intensity activities your

2:37

muscles often need fuel for longer

2:39

periods of time so your blood glucose

2:41

levels will gradually fall as your cells

2:44

use it up

2:45

even for low-intensity exercise planning

2:47

ahead is important to avoid hypoglycemia

2:50

for example you might take slightly less

2:52

insulin before the preceding meal or eat

2:55

some carbs right before the activity

2:57

try 20 grams to start

2:59

for longer workouts you might need to

3:02

top up the gas tank by having a snack

3:04

during exercise as well or if you have

3:06

an insulin pump you might temporarily

3:08

reduce the basal rate by around 20 to 50

3:11

percent

3:12

your workouts may fall somewhere in the

3:14

middle of high intensity and low

3:16

intensity exercise because these aren't

3:19

perfect categories but you can use them

3:21

as guidelines whenever you're learning

3:22

about your body

3:24

the key to balancing your blood glucose

3:26

levels is experimentation and not giving

3:29

up

3:30

just like exercising gets easier as you

3:32

make a habit of it building healthy type

3:34

1 habits into your routine gets easier

3:36

with time plus

3:38

as you exercise regularly your blood

3:41

sugar levels will be steadier a win-win

3:45

three key takeaways

3:47

all exercise requires energy and your

3:49

cells will demand glucose so pay

3:51

attention to your blood glucose levels

3:53

before and after exercise and more

3:55

regular exercise means more regular

3:57

glucose

3:59

vigorous high intensity exercise can

4:01

cause blood glucose levels to spike but

4:04

it's good practice to not adjust during

4:06

your workout and be careful with any

4:08

correction insulin doses as you may go

4:10

lower

4:11

cardio and low intensity exercise can

4:14

cause low blood glucose levels during or

4:16

afterwards so it's good to plan ahead

4:18

and make sure your body has some extra

4:20

fuel before or during your workout we

4:22

hope you found this episode helpful

4:24

thanks for watching

4:28

[Music]

4:30

you

0:00

[Applause]

0:00

[Music]

0:00

[Applause]

0:04

type 1 diabetes clearly affects your

0:06

physical health like how your body uses

0:09

insulin or how your organs function

0:12

but it's just as important to notice the

0:14

complicated feelings that come with

0:15

being human

0:17

or how diabetes affects your mental

0:18

health mental and physical health are

0:21

deeply intertwined because emotions

0:23

often correspond to hormones floating

0:25

around your body

0:27

for example if you're feeling nervous or

0:29

afraid those stress hormones will also

0:32

tell your liver to release glucose so

0:34

your blood glucose levels might

0:36

fluctuate even without exercise or a big

0:38

meal

0:39

no matter how many healthy habits you've

0:41

learned

0:42

there will still be unpredictable

0:44

moments

0:45

and it's not like you can just take a

0:46

break when living with diabetes feels

0:49

overwhelming

0:50

taking care of your mental health often

0:52

boils down to three things

0:55

accepting you have

0:56

diabetes accepting the treatment of it

0:59

and following through on self-management

1:02

behaviors

1:03

these three keys are rooted in

1:05

acceptance

1:06

not rigid routines and aiming for

1:09

perfection

1:10

that's a recipe for frustration

1:12

which causes the release of stress

1:14

hormones which causes the release of

1:16

glucose and well it becomes a vicious

1:19

circle

1:20

so when you're struggling you might try

1:22

identifying the stress and then let

1:24

yourself feel the emotions fully instead

1:27

of suppressing them

1:28

seek support and problem solve from

1:30

there

1:32

having setbacks is common and normal

1:35

coping is about not falling too far

1:38

behind and trying to get back onto your

1:39

routine quickly

1:41

most people figure out different ways to

1:43

cope as they live their lives and

1:45

finding the path that works for you is

1:47

important

1:48

taking care of your body when you have

1:50

type 1 involves learning about yourself

1:52

and a lot of careful thought about

1:54

eating exercising monitoring blood

1:56

glucose and administering insulin

1:59

and motivation to do anything especially

2:02

all that work is easier if you connect

2:04

with what you value the most

2:06

stick with me here say you value

2:08

knowledge

2:10

after all you're watching a video series

2:12

about type 1 diabetes instead of saying

2:14

how do i stick with good management

2:16

habits a more motivating question might

2:19

be how can i use knowledge about type 1

2:21

to learn more about the natural patterns

2:24

of my body or say you value something

2:26

else like plain old fun

2:28

instead of saying carb counting sucks

2:30

the fun out of eating but how do i force

2:32

myself to do it

2:34

you might try reframing your motivation

2:36

as how can i plan my meals my blood

2:38

sugars fluctuate less so i enjoy eating

2:42

of course any change is hard changing

2:44

how you live every day of your life

2:46

thanks to something like diabetes can be

2:48

incredibly hard and full of setbacks

2:51

but it's worth putting in the effort to

2:53

remember that you are not alone

2:56

diabetes like any major life change can

2:58

be incredibly tough to do alone

3:01

leaning on your care team or loved ones

3:03

when you need a little extra help can

3:05

make all the difference in your mental

3:06

and physical health

3:08

and just like it's never too late to

3:10

start learning a new hobby whether

3:12

you're playing the drums or learning a

3:13

new sport it's never too late to start

3:16

fresh with safe type 1 management habits

3:19

no matter what your last choice was your

3:22

next choice can be made with diabetes in

3:24

mind

3:25

so recheck your basal and bolus doses

3:28

pay attention to nutrition or exercise

3:30

or whatever in your life might be making

3:33

you anxious

3:34

life is one big experiment anyway where

3:37

we're all learning about ourselves and

3:38

each other and type 1 diabetes is just

3:41

part of the journey

3:42

here are four key takeaways

3:44

good mental health involves accepting

3:46

your diabetes accepting the treatment of

3:48

it and being ready to follow through on

3:50

self-management behaviors

3:52

your mental health can directly affect

3:54

your physical health

3:56

focus on your core values to help stay

3:58

motivated diabetes management is

4:00

imperfect and ups and downs are part of

4:02

the journey

4:03

it's never too late to start fresh with

4:05

basal and boneless doses and build

4:07

healthier habits

4:08

sometimes you need a reset to dig

4:10

yourself out of the frustration

4:12

we hope you found this episode helpful

4:14

thanks for watching

4:18

[Music]