UCAN/Livesteady products - any advice for bolusing?

I’m wondering how many among us have tried UCAN products with the Livesteady slow release carbs for preventing hypoglycemia? My doctor recommended it to me and I just purchased some protein powder and energy bars to try, but I’m a little confused about how to bolus for them.

Background: I’ve been struggling with blood sugar management, particularly while at work, for a few years now. My days are usually physically demanding (walking up to 20,000 steps a day, in all weather; lots of heavy lifting as well), but otherwise unpredictable. Sometimes all the hard work is before lunch, sometimes it’s after. Sometimes my work day starts at 7 am, other days it starts at 10:30 am. Sometimes lunch is at noon, sometimes at 3:30 pm. Not having a routine is making it hard for me to see patterns and make adjustments to my insulin doses. And I’m on MDI (taking Lantus 2x/day and Humalog), so my options are somewhat limited. No extended blousing for me. No computer algorithms to help. (I tried a pump in 2020; it was painful, so I quit in 2021.)

Anyway, a couple things I have noticed recently… My blood sugar’s almost always high when I have breakfast (due to dawn phenomenon/feet on the floor syndrome. I’ve been dealing with it for decades and I have bigger fish to fry right now.) Then it drops slowly until lunchtime. Usually it’s on target at noon, but sometimes it goes low between 10 and noon. Then it often plummets shortly after noon. It often roller coasters throughout the afternoon. Yesterday it stayed low for several hours despite multiple packets of skittles and a bottle of lemonade. Occasionally it sky-rockets in late evening and then my blood sugar’s high at dinner.

So my doctor recommended UCAN to prevent the midday and afternoon lows. I’m thinking I’ll have an energy bar with lunch and maybe try making smoothies for breakfast with the protein powder. I’m concerned about the “slow-release” carbohydrates, though. I’m worried that if the carbs in UCAN take longer to digest than normal, then all I’m going to accomplish is shifting the timing of the lows. The last time I tried smoothies and parfaits for breakfast (no unique ingredients just nuts and/or beans, fruit, and Icelandic yogurt), my morning blood sugars went on a crazy roller coaster ride. So does anyone have any experience with UCAN? How should I expect these products to digest and interact with my Humalog?

Thank you!

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I got nothing @bsteingard I just wanted to say that the only saving grace for a unpredictable schedule, in my experience, is the ability to adjust basal rates on my pump. I’m sorry I don’t have anything useful or practical. Also in my opinion, if I were to eat some slow release carbs I would do so when my activity levels increase. Similar to reducing basal, if I could absorb 12 grams per hour for 4 hours I would do so when my activity spiked and I’d keep it up until I knew my activity was going to be closer to my baseline. Sorry I can’t help.

@bsteingard, I can see your dilemma but I too can’t provide much help. My initial thought, after you have experienced this new product for a while and find it hasn’t provided a solution, drop it and congratulate yourself for making the attempt. IMO, managing diabetes is a balancing act and not easy - why bring in a ‘new player’ that throws curveballs you cant see.

Two thoughts which I didn’t see in your post. Do you keep a “usual” sleep and meal schedule even during shifts of time in your workday? And, if you have a CGM, use the data provided for timing your bolus after you have watched for a couple of days and see the delay in when the new food begins to increase your BGL.

I don’t know of any “law” that says you need to inject a bolus exactly when you eat. This thought is kind of a twist to Dr. Stephen Porter’s “Sugar Surfing” management program. He has had T1D for 55 years and practiced as pediatric endocrinologist - I’ve adopted some of his teaching into my management. I’m not advertising for him, but I found him quite helpful when I encountered him at a TypeOneNation Summit.

Thank you, both. It’s been a rough few years. When I originally applied for the job, 8 years ago, the hours were really stable. Start at 7:30, leave at 4:30, lunch at noon. I was thrilled that I wouldn’t need any accommodations because I’ve not had good experiences with that in the past. But in 2020 my bosses introduced this “split shift” thing. From April to Oct we work either 7:00 am to 3:30 pm or 10:30 am to 7:00 pm (then back to 7:30-4:30 in winter). And since they took our regular staff and split us in half, we don’t actually have enough people to cover all those shifts and we’re all getting really worn down. Ideally I get two weeks on one shift and two weeks on the other every month, but we often have to switch around to cover people on vacation and such. Admittedly my blood sugar wasn’t the most stable before, but my peaks and valleys were predictable at least and I could cope with them. These new hours just made everything harder. My doctors suggested I ask for accommodations - to be put on only one shift or the other - but we’re so short staffed all the time that I’m certain my employer will come back to me and say that my request is unreasonable. And I don’t want to start a fight I can’t win. Like I said, I’ve had some really unpleasant experiences with HR.

@joe, I did really appreciate the flexibility that the pump offered, and I miss it a lot, but the pump also malfunctioned often (manual labor with a blood sugar over 500 isn’t much better than manual labor while hypoglycemic) and my skin reacted so badly to the catheter that I was often in severe pain. I tried to stick it out and problem solve but I was so miserable I had to stop.

@Dennis, no, I don’t keep the same sleep & food schedule for each shift. If they were only an hour or two different I would, but 4 hours is a big chunk of time. I get home from the late shift when I would need to go to sleep to get ready for the morning shift (if I want a full 8 hours, which I do). So I shift my entire day by 4 hours every time my work shift changes. Within that, I try to keep as much routine as I can. Breakfast is the same thing almost every day. So is lunch. The way I cook, dinner will be the same thing every day for a week at a time. I do play around with insulin dose timing a little bit. I sometimes take my lunchtime insulin after I’ve finished eating, instead of before. Since my blood sugar does often drop right after lunch I figure it can’t hurt to give the carbs more time to break down before the insulin peaks. It’s hard to get back to my office to take my insulin outside of lunchtime, though. I carry my Libre scanner and some snacks in my cargo pockets, but I’m not eager to carry around insulin and syringes like that.

I take every opportunity I can to express to management the effect that this schedule is having on morale (I’m 100% not the only one struggling) and I’m actively applying for new jobs, but in the meantime I’m desperate for coping mechanisms. Yesterday wasn’t any different with the fancy carbs on board. First low alarm was in the middle of a meeting, around 1:30. I had lunch at 2. Then 3 packets of skittles and 2 popsicles through the afternoon/evening and my blood sugar was only 93 when I got home at 9. I’d be thrilled about 93 if it hadn’t taken 65 g worth of extra sugar to get me there. I’m wondering if I should just not bolus for the UCAN products at all. I’ll try that when I go back to work next week and see how it goes.

I’m going to a workshop most of next week, so for now I need to shift gears to tackle traveling with diabetes and celiac disease… The pandemic has me out of practice. I have a feeling I’m going to wind up with 3 suitcases: medical supplies, food, clothes. :woman_facepalming: Good thing I’m driving there.

Hi @bsteingard . I recognize your name from the forum and you might recognize me as a member who likes to chime in her and there. I’m afraid I don’t have anything to offer about the product you’re using but a couple of things you said stuck out. I may not be offering anything new but again, if you knew me from the forum you know that’s not going to stop me so I ask your forgiveness if I’m preaching to the choir.
A pump could be the closest thing to an ideal solution given the unpredictability of your work (do you mind if I ask what you do?). You’ve tried one before but found the cannulas painful: some people truly can’t wear them but it may be a different type might work better for you. I alternate between the Autosoft 30 and the XC on my TSLIM - if one angle doesn’t work for you the other may be better. And there are different depths - the longer ones are recommended for people who are less lean, but it could be that a different one would be more comfortable while just as effective. And there is a steel cannula which people say is not as unpleasant as it sounds - if you’re allergic to the other type it could be worth a try.
You could see if the pump trainer could give you a variety to try in advance, especially considering your past experience. When I first started pumping I just picked one and hoped for the best. Thankfully it worked out but it would be nice to try before you commit - especially for a 4 year investment!
I love cargo pants. There are carriers you use for your supplies - many of them insulated, and there are ones for bottles as well as pens. Can you use pens rather than drawing from a bottle? It took me a little getting used to but now I prefer pens if I go off pump. I find them quicker, more discrete, and more convenient, but if course it’s a matter of of personal preference.
All the best to you in your job search. It sounds like the environment isn’t good for anyone. Keep us posted on how you’re doing, and have a good trip.

Hi Dorie,
I do recognize you from the forum. I’m hardly a newbie, either; my 29th diaversary is this month. But I’m clearly struggling right now and I appreciate everyone’s desire to help.

To answer your questions, I’m a zookeeper. I deal with lots of tight spaces, uneven terrain, crawling through bushes… My glasses fall off, my shirts get torn, my hair gets tangled… And I carry so much stuff in those cargo pockets already. Utility knives, flashlight, sharpie, glucose tablets, almonds, skittles, protein bar, Libre scanner, phone, radio/walkie talkie… Once upon a time there was a PDM, too. I don’t really want to add a bulky insulin case to the mix and I really worry about tubing and cannulas falling out during the day.

On top of that, I’m terrified of needles. I can’t even watch other people take insulin. It took me years to learn to give myself my insulin and I have to use assistive devices to do it. Without my inject-ease I freeze up. I did try a Novolog pen once in college but the assistive device was so bulky that it was difficult to use it on myself. As far as I know, most pens don’t come with assistive devices at all. I like the sound of the InPen, for example, but there’s no auto-inject feature and I don’t think I could stab myself with it. I’m relatively new to CGM’s for the same reason. I like the pump-action thing the Libre uses, but if I accidentally look at the needle inside I have to do a breathing exercise to clear my mind before I can move forward.

My doctor has been suggesting a pump for years and I fought it for years. First we tried adjusting my doses, talking with multiple nutritionists, and eventually switching from Lantus to Tressiba. When the Tressiba didn’t help I opted to try the Omnipod. It injects the canula for me and there’s no tubing involved. During the year I was using them, in addition to the pain I was experiencing, they malfunctioned so often that my A1c increased and my time in range decreased. I often couldn’t tell why they were malfunctioning, either. Sometimes I’d take it off early because my blood sugar was over 500 and there’d be no evidence of a leak. Other times my blood sugar would be fine but there’d be insulin all over my skin and the bandage. Deciding to stop was an incredibly difficult decision with a lot of mixed emotions. The most intense relief I’ve ever felt, followed by at least 4 stages of grief. I’ve been in therapy since and I’m not keen to repeat the experience. Not yet, anyway.

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I have additional thoughts that will likely be of no use! first - did you ever try I-Port? you wear it like an infusion set (it resembles the size of of the Libre sensor) and it lets you do a pen-like injection into it. Just a thought. I too have a very big problem with needles. Imaging after 40+ years, I still can’t do it well. I just put a new infusion set in and I prefer “quickset” because the “clicker” is so compact. But I can’t for the life of me, push the button without an anxiety attack. Today the infusion set hit a nerve (once in a while, smacking direct hit) and I leaped off the chair. The only clicker that DOESNT scare me is the G6 applicator. I did okay on short needles, but I “drilled” them and only into an area that I was certain wouldn’t hurt. The way i figure it is like this: the self-preservation instinct that does NOT want me to stab myself cannot be overwritten.

so maybe i-port and inhaled insulin would be the “least possible” way to do MDI making the least number of holes? good luck @bsteingard

Thank you for sharing. Your career sounds fascinating although from what you describe it comes with its share of challenges. I’m getting ready to try the Omnipod 5. Which one were you using? From what I’ve read about “podding” it either works very well or very badly so time will tell. I hope the i-port @joe mentioned can help you.

@joe my diabetes educator and I talked a little bit about I-ports when we talked about the In-Pen. The instructional videos make me cringe and I’m nervous my skin’ll react the same way it did to the pods.

@wadawabbit That was exactly my experience. I was using Omnipod Dash. When the pods worked well, they worked really well. And when they didn’t, they really didn’t. There wasn’t much in between. I do miss the dose calculator and food library on the PDM, though. That was really handy. I hope the Omnipod 5 works well for you.

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When you say you’re high at breakfast, what counts as high? People keeping tight control might say it’s 150 while others may say it’s anything over 180 (I’m giving random numbers here).

I’ve read that some people split their basal insulin dose and/or adjust the time so it works for them, and or the other might help with the 10-12 low. I’m not sure how to work in Lantus’s 24 hour lifespan though, since your schedule is irregular🤔. I hope counseling helps you manage your fear. Confession: developing diabetes as early as I did, I adjusted to needles very early and thought that was the case for all of us who have been doing this a long time. I was profoundly mistaken so please forgive me. Keep working hard on your counseling - maybe someday you will be able to look into pumping again. It’s possible to be creative with tubing so you can keep your pump inside your clothing do it doesn’t snag.
Later!

For me “high” is anything over 200. My CGM alarms at 300. My target is 120 at breakfast and lunch, 150 at dinner/before bed.

When I was taking Lantus once per day, I took it before bed because that’s when I could take it most consistently. I knew that it peaked around 4 in the morning and wore off after about 20-22 hours. So I had peaks and valleys and tactics for working around them. That worked fine in college but got less fine the older I got. And my new doctor (when I left pediatrics) wasn’t a huge fan of my coping mechanisms.

Taking it twice a day presents its own challenges because there are now conflicting peaks and valleys that I have a hard time wrapping my head around. For example, morning Lantus peaks a few hours before evening Lantus wears off. I’m sure that has a lot to do with the afternoon lows and dinner-time highs I often experience, I just don’t know how to adjust the doses. If I back off on morning Lantus to avoid the afternoon lows, then my evening blood sugar will probably go even higher. And then split shifts make it even more complicated because I’m not taking it at the same times every day. I try to stick to breakfast and shortly after dinner, so they’re about 12 hours apart, but then when my schedule shifts a couple of doses get either stretched out or scrunched together. But, back to the original topic, my doctor thought the UCan bars might to help ward off those afternoon lows without sending my evening blood sugar through the roof. I just need to figure out how they work, first.

@bsteingard, I strongly suggest that you validate how Lantus actually works in your body - just the Lantus and your usual activity level. This means, no food and no bolus insulin, while staying properly hydrated and restricting munching to vegetable greens. Look at the graphs developed by the CGM. The “fasting” should last for at least 12 hours.

Lantus is for most people a “background” insulin formulation with minimum peak if it has any about 6 hours after injecting; Lantus begins its action within 2 hours after injection. You will need to also experiment with Lantus action times in your body when on a split-dose regimen, keeping in mind that each Lantus dose will cause an “overlap of action” for up to 12 hours.

I did that when I first started taking Lantus. It peaked about 7 hours after I took it and it wore off at least 2 hours early. I know it’s supposed to last 24 hours without a peak, but it doesn’t actually work as advertised.

Frankly, I’m not willing to fast while I’m at work. I’m already sleep deprived and struggling with unpredictable blood sugars. Trying to fast seems like adding fuel to the fire. There’s no way I can get the energy I need from greens and the last thing I need right now is another reason to feel lightheaded. Part of why I eat the same thing almost every day is because that’s the next best thing to fasting when it comes to controlling my carb intake variable.