Type 3c need advice

[Rafferty]

It depends on the severity of the hypo and the fact that you are probably over treating it due to the timing and going high afterwards, so the combination of dropping rapidly and then rising sharply to a higher that ideal level is likely what makes you feel rough.
You really could do with an education course but you can pick up a lot of info here on the forum.
Balancing insulin with carbs is a lot more than carb counting and calculating insulin dose. Timing of the dose and then when you eat (referred to as pre-bolusing or pre-bolus timing) is almost equally important. If you inject too far in advance the insulin will drop your BG levels before the glucose from the food reaches your blood stream. If you don't inject soon enough, your levels will spike quite high and then come rattling back down but you are much less likely to hypo in that second situation so it is most certainly preferable, which is why I suggest you inject your Apidra just 5 mins before you eat your porridge and see how you manage with that. It might even be that you need to inject just as you start to eat or even after eating, depending on the slowness of your digestion.

Thank you thank you... I did ask DN about taking after I've eaten so I could see which way I was going but got told only on "sick day rules"... Its same as I carb count some food, inject for it then sometimes I can't eat it all.. Don't know if its right or wrong but I'm sometimes taking half the units then if I think I can eat more inject during the meal...
Gastro had referred me to dietician so I'm hoping I get some help from there...

 

[rebrascora]

Thank you, I will try that from tomorrow morning, is it the same with other meals of the day? Take 15/20 minutes beforehand please?

It depends on the individual and how quick or slow their digestive system is and the food they are eating. It sounds like your digestive system may be slow and that may be normal for a Type 3c using creon, I don't know, or perhaps due to surgery you have had. It also depends on the type of food you are eating, so if you were eating mashed potato that usually hits the blood stream pretty quickly but pizza can be very slow and many people split their quick acting insulin into 2 doses and take some just before eating and the rest afterwards. I had that problem with chilli the other day. Had it with a baked potato and the potato released quite quickly but the kidney beans were much slower so having taken the full dose at one go, I hypoed about 2 hours later because the kidney beans hadn't digested when the insulin peaked and then I went high 4-5 hours after eating when the kidney beans broke down and hit my blood stream.... I will know for next time and split the dose!!

 

[Rafferty]

It depends on the individual and how quick or slow their digestive system is and the food they are eating. It sounds like your digestive system may be slow and that may be normal for a Type 3c using creon, I don't know, or perhaps due to surgery you have had. It also depends on the type of food you are eating, so if you were eating mashed potato that usually hits the blood stream pretty quickly but pizza can be very slow and many people split their quick acting insulin into 2 doses and take some just before eating and the rest afterwards. I had that problem with chilli the other day. Had it with a baked potato and the potato released quite quickly but the kidney beans were much slower so having taken the full dose at one go, I hypoed about 2 hours later because the kidney beans hadn't digested when the insulin peaked and then I went high 4-5 hours after eating when the kidney beans broke down and hit my blood stream.... I will know for next time and split the dose!!

You are a wealth of information, did you do a course? Or experience... Do to one thing and another my diet is very very bland, every so often they put me on nutritional drinks which are 66 carbs per bottle as they say I'm malnourished, ( I'm a size 18) but apparently size is not indicative!! I think by you saying about split the dose is what I've been doing but not knowing it!! I have written down multi points and will ask DN for help... Once again thank you...

 

[rebrascora]

If you are hypoing through the night more than very, very occasionally then I would say that your basal insulin dose (Toujeo) is too high and should be reduced or try a different basal insulin like Levemir which can be split into 2 separate doses (Toujeo can't be split as it is too long acting).
Reducing your Toujeo may mean that your daytime levels go too high and then you would need to use your Apidra to correct them and bring you back down into range. Again this is something you should be taught to do.

Yes, it sounds like you have already intuitively discovered split dose bolusing and it is very wise to do so if you sometimes struggle to eat all the food on your plate. Once that insulin is injected you can't get it out again so you need to eat (or drink) enough carbs to counteract it.

Fat and fibre usually slow down the release of glucose from food so having your hypo treatment and then a slice of wholemeal toast straight after might compromise your ability to absorb the carbs from the hypo treatment due to the fibre in the wholemeal toast. Better to take as much fast acting carbs as it takes to bring your levels out of the red (in 15g doses) and then eat the slower acting carbs to stabilize it once you have come up, but if you had already eaten your porridge this morning then those carbs from the porridge would probably act as the slow release without the need for toast, hence why you went too high.

I learned a lot on the DAFNE course but I also learned most of what I know about diabetes from the wonderful people on this forum and applying it to my own experience. We are all different so what works for me will most likely not work for you but understanding how things work enables you to figure out what may be going wrong and how to correct it. The DAFNE course and this forum are both great for sharing experiences and learning from each other.

 

[rebrascora]

Just to clarify, I would say not to take your Apidra any more than 15 mins before eating for the moment since you have had at least one incident of hypoing from it but if I was you I would maybe just make it 5-10 mins in advance and definitely split it if you think you might not be able to eat it all or it is something fatty like pizza or high fibre like lentils or pulses.

 

[Rafferty]

If you are hypoing through the night more than very, very occasionally then I would say that your basal insulin dose (Toujeo) is too high and should be reduced or try a different basal insulin like Levemir which can be split into 2 separate doses (Toujeo can't be split as it is too long acting).
Reducing your Toujeo may mean that your daytime levels go too high and then you would need to use your Apidra to correct them and bring you back down into range. Again this is something you should be taught to do.

Yes, it sounds like you have already intuitively discovered split dose bolusing and it is very wise to do so if you sometimes struggle to eat all the food on your plate. Once that insulin is injected you can't get it out again so you need to eat (or drink) enough carbs to counteract it.

Fat and fibre usually slow down the release of glucose from food so having your hypo treatment and then a slice of wholemeal toast straight after might compromise your ability to absorb the carbs from the hypo treatment due to the fibre in the wholemeal toast. Better to take as much fast acting carbs as it takes to bring your levels out of the red (in 15g doses) and then eat the slower acting carbs to stabilize it once you have come up, but if you had already eaten your porridge this morning then those carbs from the porridge would probably act as the slow release without the need for toast, hence why you went too high.

I learned a lot on the DAFNE course but I also learned most of what I know about diabetes from the wonderful people on this forum and applying it to my own experience. We are all different so what works for me will most likely not work for you but understanding how things work enables you to figure out what may be going wrong and how to correct it. The DAFNE course and this forum are both great for sharing experiences and learning from each other.

Thank you, that does make sense.. I will ask about the course, because I was mis diagnosed, way back, the course I done was basically don't over eat!! I'm guessing due to pandemic maybe why not been suggested but armed with my list of questions I shall see what I can do... Plus read advice on forums..

 

[Rafferty]

Just to clarify, I would say not to take your Apidra any more than 15 mins before eating for the moment since you have had at least one incident of hypoing from it but if I was you I would maybe just make it 5-10 mins in advance and definitely split it if you think you might not be able to eat it all or it is something fatty like pizza or high fibre like lentils or pulses.

Thank you...

 

[Rafferty]

Thank you...

Hello, thought I would give an update as just got off phone to diabetes nurse...
No 1...reduce Toujeo by 10% await 2 days, if still having early hypo, reduce again 10%..
No 2... Referred to DAFNE course, but only on line, await when...
No 3... Does not want to change medications as yet...
So thank you yesterday for all the advice..