Getting levels down when newly diagnosed type 1

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Mango

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, I am newly diagnosed with Type 1 Diabetes. It’s my first week monitoring my blood glucose levels and taking insulin. I am a bit unsure how cautious I should be in these first few weeks before I have my appointment with the diabetes specialist nurse and learn about carb counting.
My blood glucose levels are often between 15 and 20 and I am aiming for 10. I have been given a set dose for my insulin pen to get me started so I am trying to be careful with food. I am a vegetarian and generally eat quite healthy food and am following all the tips from Diabetes UK (). I must admit I have not been very active since being in hospital last week and feeling tired from the hyperglycaemia but am back at work (a desk job) working from home. Despite being careful with my diet my levels are still high and I am feeling a bit helpless! Do I need to just relax and let it settle in it’s own time or is there more I can do to get it closer to 10 whilst I can’t change the insulin dose? Appreciate any tips for a newbie!
 
It’s normal for them to want to reduce your levels slowly because you may feel unwell at a ‘good’ glucose level when your body has been so used to highs. The first few weeks are a lot about data gathering so eat what you would normally eat and be as active as you would normally be and they will adjust your dose to suit that.

They need a few weeks of data to be able to determine your bolus ratios so that you can accurately match your dose to your carbs. If you want to start carb counting now that’s useful info but there’s no rush.
 
Thebearcametoo said:
It’s normal for them to want to reduce your levels slowly because you may feel unwell at a ‘good’ glucose level when your body has been so used to highs. The first few weeks are a lot about data gathering so eat what you would normally eat and be as active as you would normally be and they will adjust your dose to suit that.

They need a few weeks of data to be able to determine your bolus ratios so that you can accurately match your dose to your carbs. If you want to start carb counting now that’s useful info but there’s no rush.
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This is so helpful and makes loads of sense. Thank you!
 
What insulins are you taking @Mango ? You mention “pen” singular so I was wondering if you’ve been given both types of insulin - ie basal/slow and bolus/fast/meal insulin?

Although your blood sugar will be brought down gradually, you still need to keep an eye on things. If you’re regularly between 15-20 I’d give your nurse a call for advice.

The recommended diet for Type 1s is the and healthy diet recommended for everyone, by the way. We don’t need to follow a strict diet like many Type 2s have to. Once you get your insulins sorted, you’ll be able to eat pretty normally. The only thing I was told to avoid were full sugar soft drinks unless I was treating a hypo or about to exercise.
 
Thanks Inka, I have been given the two types of pen. I am speaking with the nurse tomorrow morning on the phone, so I can let them know and see about adjusting the dose. Yes I was also given the same advice for eating and drinking…I think I have been being extra careful avoiding bread and biscuits etc subconsciously!
 
Mango said:
Thanks Inka, I have been given the two types of pen. I am speaking with the nurse tomorrow morning on the phone, so I can let them know and see about adjusting the dose. Yes I was also given the same advice for eating and drinking…I think I have been being extra careful avoiding bread and biscuits etc subconsciously!
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That’s good. You could remind the nurse that you’re vegetarian. If you eat things like lentil lasagne or chickpea curry and rice, etc, you’ll probably be eating more carbs than a carnivore. That is not a bad thing! When I was diagnosed almost 30 years ago, they tweaked my insulin/carbs as I found they were subconsciously thinking of meat-eaters in their reckonings. It’s definitely worth a reminder.

Carb counting isn’t hard. It used to be taught at diagnosis. There are online courses you can do if you want a head start or you could just start looking at packets and boxes and getting used to checking the carbs. You should be given meal ratios - ie how many carbs 1 unit of insulin will cover. That allows you to calculate your dose according to what you’re about to eat eg if your ratio is 1:10g and you’re about to eat 50g carbs you’d take 5 units.

Do ask for a half unit pen for your bolus/fast/meal insulin. It makes things much easier and allows you to take more accurate doses. If they’ve given you disposable insulin pens, ask for the proper re-useable ones. I think the half unit pens are only available in those anyway. They’re better quality and more robust (as well as being better for the environment).
 
Inka said:
That’s good. You could remind the nurse that you’re vegetarian. If you eat things like lentil lasagne or chickpea curry and rice, etc, you’ll probably be eating more carbs than a carnivore. That is not a bad thing! When I was diagnosed almost 30 years ago, they tweaked my insulin/carbs as I found they were subconsciously thinking of meat-eaters in their reckonings. It’s definitely worth a reminder.

Carb counting isn’t hard. It used to be taught at diagnosis. There are online courses you can do if you want a head start or you could just start looking at packets and boxes and getting used to checking the carbs. You should be given meal ratios - ie how many carbs 1 unit of insulin will cover. That allows you to calculate your dose according to what you’re about to eat eg if your ratio is 1:10g and you’re about to eat 50g carbs you’d take 5 units.

Do ask for a half unit pen for your bolus/fast/meal insulin. It makes things much easier and allows you to take more accurate doses. If they’ve given you disposable insulin pens, ask for the proper re-useable ones. I think the half unit pens are only available in those anyway. They’re better quality and more robust (as well as being better for the environment).
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That’s a great tip on being a vegetarian. Thank you, I will let them know. Thanks as well for the information on carb counting, really useful to get an idea of what it entails. And grateful to learn about the half unit re-useable pens. I’m definitely cringing at how much plastic waste there is from this!
 
Mango said:
, I am newly diagnosed with Type 1 Diabetes. It’s my first week monitoring my blood glucose levels and taking insulin. I am a bit unsure how cautious I should be in these first few weeks before I have my appointment with the diabetes specialist nurse and learn about carb counting.
My blood glucose levels are often between 15 and 20 and I am aiming for 10. I have been given a set dose for my insulin pen to get me started so I am trying to be careful with food. I am a vegetarian and generally eat quite healthy food and am following all the tips from Diabetes UK (). I must admit I have not been very active since being in hospital last week and feeling tired from the hyperglycaemia but am back at work (a desk job) working from home. Despite being careful with my diet my levels are still high and I am feeling a bit helpless! Do I need to just relax and let it settle in it’s own time or is there more I can do to get it closer to 10 whilst I can’t change the insulin dose? Appreciate any tips for a newbie!
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Collect as much data as possible for diabetes team, they will advise on adjusting doses further to reduce bg levels.

Everyone is in same position at start so your not alone, keep positive all will come right.
 
You will be tired with high levels, so don’t beat yourself up about that.

There’s no stupid questions so please ask away.

Water (loads of it) and walking are great natural ways to get your levels done if you’ve not been taught about corrections yet.
If mine are sneaking up I have a pint of water and go for a quick walk.

As others have said once you have data and can see patterns that will help you understand how to change things
 
Also I can’t remember what level they say don’t exercise at all at, might be 13?

My nurse said ideal for exercise is 7-8 but that’s a tight window for me
 
Mango said:
That’s a great tip on being a vegetarian. Thank you, I will let them know. Thanks as well for the information on carb counting, really useful to get an idea of what it entails. And grateful to learn about the half unit re-useable pens. I’m definitely cringing at how much plastic waste there is from this!
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Similar to my situation! Diagnosed six weeks ago.

I'm not a complete vegetarian but have always eaten very little meat; as Inka points out, that means far more carbs than a habitual carnivore. And I've always eaten little for breakfast or lunch and then huge dinners. Very healthy, loads of veg and wholegrains etc, but masses of carbs.

When I was diagnosed, they wanted firstly to get the basal right and only then start me on mealtime, 'bolus' insulin. I had to press them really hard to put me on bolus insulin asap-- I was worried about the high blood-glucose levels, and also worried about how low my weight was.

When they did give me bolus insulin, after about 10 days, it was simply with instructions to 'start by trying two units with each meal'. No instruction in carb counting! When Inka says "It used to be taught at diagnosis", I'm thinking-- why isn't it still?? Instead, they've booked me in for a carb-counting course in mid-October ...

Fortunately, within a couple of days of being diagnosed, I had come across carb counting in stuff on the internet and started implementing it. Initially, before they allowed me to have bolus insulin, this meant eating meat much more often than usual, in order to avoid having too many carbs. Also, snacking on cheese-- 0 or practically 0 carbs-- and almonds-- only 4.8g carbs per 100g, and very filling.

Then, when I first got the bolus insulin (initially Fiasp, recently changed to Novorapid), I was at first afraid to use 'too much'-- and I was given no guidance as to what sort of insulin-to-carbohydrate ratio I might try.

Then I did the online BERTIE course, https://www.bertieonline.org.uk -- which I think I discovered via mentions in this forum!-- and only there did I find the suggestion that one might start with 1 unit of insulin to 10 grams of carbs, see what happened, and modify accordingly.

So for the past two weeks I've been playing with that. Still a lot of ups and downs, but at least I've been able to have what for me are more normal meals, like a huge bowl of lentil bolognese on wholewheat spaghetti.

And, regarding reusable half-unit pens, snap!

Finally: You don't mention whether you've got a Libre 2? They gave me one at the same time they started me on bolus, and I feel it makes a huge difference, primarily due to the low-glucose alert. Yes, it sometimes gives a false alarm, but it makes me feel much more confident in experimenting: rather than thinking 'if I get it wrong I COULD DIE!!!', I'm getting used to thinking 'the worst that can happen is the alarm goes off and I have to drink some juice'.

Anyway, best of luck, and let us know how you get on!
 
PhoebeC said:
Also I can’t remember what level they say don’t exercise at all at, might be 13?

My nurse said ideal for exercise is 7-8 but that’s a tight window for me
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Regarding exercise, I put this in another post on this forum: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702152/pdf/PEDI-21-1375.pdf . "Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)" ...

Not the snappiest of titles, but the tables are great-- reassuringly research/evidence-based.

First you work out which category you are (Figure 2, p 1381). If you never or hardly ever exercise for 45 mins or more and/or are high risk for hypoglycaemia, you're "Ex 0". If you exercise for 45 mins or more once or twice a week and/or are moderate risk of hypoglycaemia, you're "Ex 1". If you exercise for 45 mins or more three or more times a week and/or are low risk of hypoglycaemia, you're "Ex 2".

And then Table 1 (p 1379) tells you what to do just before exercise, depending on what your glucose monitor is saying; Table 2 (p 1380) tells you what to do during exercise, depending on what your monitor is saying; and Table 3 (p 1381) tells you what to do post-exercise, including overnight if you were exercising in the late afternoon or evening.

According to this: Nobody should start exercise if BG over 15 and blood ketones over 1.5; you should have a correction dose of insulin first and wait. And nobody should start exercise if BG under 3.9; take your hypo remedy and wait. But, between 9 and 15, everybody's good to go.
 
rebrascora said:
I am guessing that should read 3.9 and 15, not 9 and 15
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Between 3.9 and 9, you have to look at Table 1 and see what it says, which will depend on which category you're in, what your BG level is, how the trend arrow is pointing, and whether you expect your BG to be rising or falling. (What I said in the previous post was simply what applies to everybody, no matter what their category with regard to exercise experience and hypo risk.)

For example: Say you're in the "Ex 1" category, and you've recently had a snack-- in anticipation of your exercise, with reduced or no insulin-- so you expect your BG will be rising.

According to Table 1, you're good to go with your sensor reading anywhere from 8 to 15.

If the sensor reading is 5.0-7.9, depends on what the trend arrow says:

- If the trend arrow is pointing straight up or diagonally up, just set off.
- If it's horizontal, go ahead and start exercise-- but, just before you do, have 10g of fast-acting carbs.
- If it's diagonally down-- 15g fast-acting carbs and wait.
- If it's straight down-- 20g fast-acting carbs and wait.

Hours of fun! ; )

I haven't actually road-tested it myself yet; waiting until I've regained a bit of weight. Looking forward, though!
 
I hate trying to exercise when my levels are above 8. It makes me feel like I have lead weights on my ankles. Anywhere between 4 and 8 is good for me. If in the 4s I have about 10g carbs and keep an eye on it unless I am doing high intensity muscle burn exercise which will push levels up, so then I don't have carbs beforehand but have them later.
It always amazes me just how far I can go on one jelly baby!! My body claws back glucose whilst I sleep so adjusting my overnight basal is the key part of my diabetes strategy with exercise. I seem to have pretty good glucose stores to sustain me during exercise but once I go to sleep they drain my system of glucose to replenish their stores 😱
 
rebrascora said:
I hate trying to exercise when my levels are above 8. It makes me feel like I have lead weights on my ankles. Anywhere between 4 and 8 is good for me. If in the 4s I have about 10g carbs and keep an eye on it unless I am doing high intensity muscle burn exercise which will push levels up, so then I don't have carbs beforehand but have them later.
It always amazes me just how far I can go on one jelly baby!! My body claws back glucose whilst I sleep so adjusting my overnight basal is the key part of my diabetes strategy with exercise. I seem to have pretty good glucose stores to sustain me during exercise but once I go to sleep they drain my system of glucose to replenish their stores 😱
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Yes, I was depressed to read that exercise greatly increases the risk of nocturnal hypoglycaemia! And of course you're right that moderate-intensity aerobic, high-intensity, and resistance training all have slightly different effects (noted in the tables).

This is another thing that peeves me about this Type 1 nonsense. ; ) Here we are, doing the right things to stay healthy-- and one of the most important things for staying healthy, physically and mentally, is exercise-- but exercise creates particular problems in managing Type 1.

Last week I actually seriously found myself thinking: 'Ok, the novelty has worn off; can we go back to Planet Pre-Diagnosis, please??' ... I just keep telling myself this is all very recent, and with any luck I will eventually get the hang of it!
 
rebrascora said:
I hate trying to exercise when my levels are above 8. It makes me feel like I have lead weights on my ankles.
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I'm fine at levels over that, though only if I have some insulin on board. So when I'm uncomfortably high (so over 15 according to Libre (which tends to read higher than test strips when high)) often I'll inject a small amount and go for a walk.
 
Spathiphyllum said:
Yes, I was depressed to read that exercise greatly increases the risk of nocturnal hypoglycaemia!
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Yes! That's an advantage of Levemir (or a pump): you can reduce the basal dose just for that night. I find I don't usually need to do that, but now and again I'm much more active than usual and so do.
 
Mango said:
, I am newly diagnosed with Type 1 Diabetes. It’s my first week monitoring my blood glucose levels and taking insulin. I am a bit unsure how cautious I should be in these first few weeks before I have my appointment with the diabetes specialist nurse and learn about carb counting.
My blood glucose levels are often between 15 and 20 and I am aiming for 10. I have been given a set dose for my insulin pen to get me started so I am trying to be careful with food. I am a vegetarian and generally eat quite healthy food and am following all the tips from Diabetes UK (). I must admit I have not been very active since being in hospital last week and feeling tired from the hyperglycaemia but am back at work (a desk job) working from home. Despite being careful with my diet my levels are still high and I am feeling a bit helpless! Do I need to just relax and let it settle in it’s own time or is there more I can do to get it closer to 10 whilst I can’t change the insulin dose? Appreciate any tips for a newbie!
Click to expand...
 
Hi Mango I've been a diabetic on insulin for 69 years. Found using a Flash meter for the last few years helped me. As your doctor to proscribe you one.
 
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