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Eating too little?

A

Abner55

Well-Known Member
Relationship to Diabetes
Carer/Partner
Morning all
My Wife was diagnosed with Type 1 just over a year ago
Other than finding the Libre 2 sensors being extremely frustrating when they are giving readings that are much higher than the blood finger tests, she is coping very well
My main concern at the moment is that, to keep herself in range, she eats very little, and is now noticeably losing weight
She has been told to continue using 1unit of Novorapid before meals, and 5 units of Abasaglar in the evening
She has not been told how to use correction doses and carb counting as yet, and as, (I assume) she must be nearing the end of her “Honeymoon period”, this may now be required
As a guide she eats 14 grams of porridge for breakfast, 4 crackers for lunch, and has no more than 2 potatoes with her evening meal
This keeps her, on average, at 92% TIR, which is great, but at what cost to her wellbeing in general?
As always, any comments/advice would be gratefully received
 
Hi @Abner55 . I am not a type 1 so I expect others with more knowledge of insulin dosage and diet will be along to help.
I was underweight when diagnosed and upped my protein and fat intake to compensate for the carbs reduction to reduce my blood glucose levels.
It sounds like your wife is reducing carbs but maybe not adjusting her diet to keep calorie intake enough to maintain her normal weight.
 
Welcome to the forum, @Abner55
It is great that you are supporting your wife.
I am very surprised that she is not able to do carb counting as Type 1 diabetes is managed with insulin not diet - she should not be cutting down on food to match her insulin. I would encourage her to push for carb counting as it gives so much more flexibility.
While 92% TIR is great, as you suggest, she needs to be aware of her complete body (and mind) rather than just her diabetes. I believe the target is 70% TIR so she can relax a little to provide more balance.

Regarding the Honeymoon phase, this varies from person to person. Some people find it very challenging as their dying insulin producing cells can occasionally, temporarily burst into life and then cause hypos whereas others find it is a slow decline. My case was the latter which took 8 years.

Finally, you mentioned Libre accuracy. (Sorry I am responding to your message ia completely different order).
Are you aware of the limitations in CGM technology. Once this is understood, the frustrations tend to be less.
Sadly, DSNs tend not to explain these so they are often repeated on the forum.
This is one of those threads: https://forum.diabetes.org.uk/boards/threads/cgm-limitations-and-precautions.108188/
 
helli said:
I am very surprised that she is not able to do carb counting as Type 1 diabetes is managed with insulin not diet - she should not be cutting down on food to match her insulin. I would encourage her to push for carb counting as it gives so much more flexibility.
Click to expand...
I suspect there may be an element of age discrimination, but it's also possible the service is just overstretched and they're unable to supply the necessary support.

There are online resources, https://www.mytype1diabetes.nhs.uk/ and https://bertiediabetes.com/
 
Also, @Abner55, for some people their bodies don't manage Libre 2 particularly well. I was one of those. I totally understand the frustration of getting Libre readings which are well adrift ao finger prick results. These things might seem trivial to complete outsiders, but I know they aten't; yes, we can mentally adjust hour by hour day by day - but it's all adding to the stress of managing our BG and stress affects our BG, sometimes a lot. Congratulations to your wife for her TIR, I can only wish ..... But I know the price of achieving that can be a big intrusion to one's daily living.

Today, there is an extremely good alternative CGM at the same NHS tariff and thus wholly interchangeable with Libre 2/2+. It just needs your GP to amend the prescription. This CGM is Dexcom One+. It needs replacing every 10 days, which is a small downside, and the phone app is a similar, but slightly different experience; however thus all easily manageable. You can get a hand held Receiver which works totally independently of the phone app to provide those readings and sometimes that is extremely convenient. I interchange both, happily. I would recommend your wife trying Dexcom One+ for at least a couple of months and seeing if that helps her to reduce one frustration.
 
That’s shockingly little @Abner55 It sounds like her team are unaware of how little she’s eating. I’ve seen that a fair bit here - Type 1 keeps in range by eating hardly anything, team simply looks at numbers, screens out any comments and says person is doing fine and should carry on with what they’re doing.

Your wife is not doing fine! She’s starving herself and not getting enough nutrition. She needs to understand that Type 1 is all about the insulin. If a Type 1 eats a meal and gets higher than desired numbers afterwards, it’s NOT because the food was ‘bad’ for them! It’s nothing to do with the food and everything to do with the insulin. Your wife isn’t taking enough insulin to allow her to eat what her body needs.

Look at the links @Bruce Stephens posted about carb counting and get her to understand that carb counting isn’t some mysterious black art that only the higher echelons are able to access after 15 interviews with their DSN and a 5 year wait for a Very Special Course. Carb counting is easy and logical. She can teach herself. All she needs to work out is the right dose of insulin for that meal/carbs.

Take her porridge as an example. For a few days, get her to eat 30g of porridge instead. The first day I’d either keep her insulin the same (so she can see the effect of those extra carbs) or increase it only very slightly. The next day, she eats the same again and sees the result. After a few days of that, she should have an idea of how much insulin she needs for 30g porridge. That’s a very brief description, just to give you the idea. She should always err on the side of caution and take less insulin than she thinks she’ll need to start with. She should also get a half unit pen.

She should be eating normal foods and learning how to use her insulin and be her own pancreas.
 
Last edited:
Abner55 said:
Morning all
My Wife was diagnosed with Type 1 just over a year ago
Other than finding the Libre 2 sensors being extremely frustrating when they are giving readings that are much higher than the blood finger tests, she is coping very well
My main concern at the moment is that, to keep herself in range, she eats very little, and is now noticeably losing weight
She has been told to continue using 1unit of Novorapid before meals, and 5 units of Abasaglar in the evening
She has not been told how to use correction doses and carb counting as yet, and as, (I assume) she must be nearing the end of her “Honeymoon period”, this may now be required
As a guide she eats 14 grams of porridge for breakfast, 4 crackers for lunch, and has no more than 2 potatoes with her evening meal
This keeps her, on average, at 92% TIR, which is great, but at what cost to her wellbeing in general?
As always, any comments/advice would be gratefully received
Click to expand...
Hi I was diagnosed last April, been doing carb counting after a couple off weeks off diagnosis. I lost 3 stone as misdiagnosed type 2, I wasn’t putting any weight on. Asked at hospital why, they said I wasn’t eating enough carbs, they told me to put weight on should be having 200 carbs a day. Everyone is different with activity etc. I’m in the honeymoon period, doctor said can last 2-3 years, again everyone will be different
 
silver minion said:
Hi @Abner55 . I am not a type 1 so I expect others with more knowledge of insulin dosage and diet will be along to help.
I was underweight when diagnosed and upped my protein and fat intake to compensate for the carbs reduction to reduce my blood glucose levels.
It sounds like your wife is reducing carbs but maybe not adjusting her diet to keep calorie intake enough to maintain her normal weight.
Click to expand...
Thank you
 
helli said:
Welcome to the forum, @Abner55
It is great that you are supporting your wife.
I am very surprised that she is not able to do carb counting as Type 1 diabetes is managed with insulin not diet - she should not be cutting down on food to match her insulin. I would encourage her to push for carb counting as it gives so much more flexibility.
While 92% TIR is great, as you suggest, she needs to be aware of her complete body (and mind) rather than just her diabetes. I believe the target is 70% TIR so she can relax a little to provide more balance.

Regarding the Honeymoon phase, this varies from person to person. Some people find it very challenging as their dying insulin producing cells can occasionally, temporarily burst into life and then cause hypos whereas others find it is a slow decline. My case was the latter which took 8 years.

Finally, you mentioned Libre accuracy. (Sorry I am responding to your message ia completely different order).
Are you aware of the limitations in CGM technology. Once this is understood, the frustrations tend to be less.
Sadly, DSNs tend not to explain these so they are often repeated on the forum.
This is one of those threads: https://forum.diabetes.org.uk/boards/threads/cgm-limitations-and-precautions.108188/
Click to expand...
Thank you
 
Proud to be erratic said:
Also, @Abner55, for some people their bodies don't manage Libre 2 particularly well. I was one of those. I totally understand the frustration of getting Libre readings which are well adrift ao finger prick results. These things might seem trivial to complete outsiders, but I know they aten't; yes, we can mentally adjust hour by hour day by day - but it's all adding to the stress of managing our BG and stress affects our BG, sometimes a lot. Congratulations to your wife for her TIR, I can only wish ..... But I know the price of achieving that can be a big intrusion to one's daily living.

Today, there is an extremely good alternative CGM at the same NHS tariff and thus wholly interchangeable with Libre 2/2+. It just needs your GP to amend the prescription. This CGM is Dexcom One+. It needs replacing every 10 days, which is a small downside, and the phone app is a similar, but slightly different experience; however thus all easily manageable. You can get a hand held Receiver which works totally independently of the phone app to provide those readings and sometimes that is extremely convenient. I interchange both, happily. I would recommend your wife trying Dexcom One+ for at least a couple of months and seeing if that helps her to reduce one frustration.
Click to expand...
Thank you
 
Inka said:
That’s shockingly little @Abner55 It sounds like her team are unaware of how little she’s eating. I’ve seen that a fair bit here - Type 1 keeps in range by eating hardly anything, team simply looks at numbers, screens out any comments and says person is doing fine and should carry on with what they’re doing.

Your wife is not doing fine! She’s starving herself and not getting enough nutrition. She needs to understand that Type 1 is all about the insulin. If a Type 1 eats a meal and gets higher than desired numbers afterwards, it’s NOT because the food was ‘bad’ for them! It’s nothing to do with the food and everything to do with the insulin. Your wife isn’t taking enough insulin to allow her to eat what her body needs.

Look at the links @Bruce Stephens posted about carb counting and get her to understand that carb counting isn’t some mysterious black art that only the higher echelons are able to access after 15 interviews with their DSN and a 5 year wait for a Very Special Course. Carb counting is easy and logical. She can teach herself. All she needs to work out is the right dose of insulin for that meal/carbs.

Take her porridge as an example. For a few days, get her to eat 30g of porridge instead. The first day I’d either keep her insulin the same (so she can see the effect of those extra carbs) or increase it only very slightly. The next day, she eats the same again and sees the result. After a few days of that, she should have an idea of how much insulin she needs for 30g porridge. That’s a very brief description, just to give you the idea. She should always err on the side of caution and take less insulin than she thinks she’ll need to start with. She should also get a half unit pen.

She should be eating normal foods and learning how to use her insulin and be her own pancreas.
Click to expand...
Thank you
 
Woodywoodpecker said:
Hi I was diagnosed last April, been doing carb counting after a couple off weeks off diagnosis. I lost 3 stone as misdiagnosed type 2, I wasn’t putting any weight on. Asked at hospital why, they said I wasn’t eating enough carbs, they told me to put weight on should be having 200 carbs a day. Everyone is different with activity etc. I’m in the honeymoon period, doctor said can last 2-3 years, again everyone will be different
Click to expand...
Than you
 
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