Hi my name is Shelly and this my first message. I've had type 1 diabetes for 43 years. My reason for joining is my son was also diagnosed with type 1 in February and we are really struggling with his blood sugars. He also has a pelvic kidney and is 14 so obviously hormones are a big factor. I was hoping for some advice, or suggestions and support as the hospital aren't listening
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Hello
- Thread starter ShellyG
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Hi he's mainly struggling with Hi's uv been reading up on teenage hormone insulin resistance and am thinking this could be why. But also Benhas had a pelvic kidney since birth that only works at 28% and iv read that this can also cause high blood sugars.
He was on Novorapid but has recently moved to Fiasp and this seemed to work short term its now not. Resulting in trips to the hospital because he's had ketones and constant headaches snd fatigue.
We've had very little help from the hospital and ben can't really afford to loose anymore weight as he's 5ft 6 and weighs 7 st.
He was on Novorapid but has recently moved to Fiasp and this seemed to work short term its now not. Resulting in trips to the hospital because he's had ketones and constant headaches snd fatigue.
We've had very little help from the hospital and ben can't really afford to loose anymore weight as he's 5ft 6 and weighs 7 st.
Inka
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Let me tag @stephknits for you as she has a teen with Type 1. I can’t comment on the kidney issues but I’d suggest changing back to Novorapid or to an older bolus insulin like Humalog. Lots of people have had issues with Fiasp ‘not working’ after a while.
As I’m sure you know, getting his basal right is the first step. If he does have hormonal insulin resistance, he might need a basal increase. If he can get that right, then getting the mealtime ratios correct will be a lot easier. I’d also consider a half unit pen for his bolus insulin if he hasn’t got one already, as then he can have more precise doses, but also it will make it easier to correct any highs early on - eg if he spikes too high after a meal then he could correct cautiously so he’s not staying high for too long.
As I’m sure you know, getting his basal right is the first step. If he does have hormonal insulin resistance, he might need a basal increase. If he can get that right, then getting the mealtime ratios correct will be a lot easier. I’d also consider a half unit pen for his bolus insulin if he hasn’t got one already, as then he can have more precise doses, but also it will make it easier to correct any highs early on - eg if he spikes too high after a meal then he could correct cautiously so he’s not staying high for too long.
Thank you for getting back to me do quickly. He's currently on Levemir of an evening 17 units this however seems to kick in around 4am and only lasts until lunchtime.
He's currently eating very little carbs as he's got it in his head it makes his blood sugars worse so his diet is very limited ATM. And when he does have carbs he does numerous injections it just won't come down with a miminum correction of at least 5 units. What are the general views on Humalog ? As Novorapid had very little if any affect on him.
Inka
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Firstly, I’d split his Levemir into two doses, a.m and p.m. The split doesn’t have to be equal amounts. That would stop it ‘running out’. Just doing that could make a difference. Yes, it’s an extra injection but so worth it if he can get more flexibility and improve control.
I use Humalog and find it very good. It has never ‘stopped working’ even after many years.
The other thing to say is that avoiding carbs and eating a very low carb diet actually increases insulin resistance - just what he doesn’t want! He’d be better off eating a normal amount of carbs. That would help his insulin sensitivity.
I use Humalog and find it very good. It has never ‘stopped working’ even after many years.
The other thing to say is that avoiding carbs and eating a very low carb diet actually increases insulin resistance - just what he doesn’t want! He’d be better off eating a normal amount of carbs. That would help his insulin sensitivity.
Trying to argue with a 14 is a loosing battle but I will show him what you've suggested. What carbs would you suggest I try and encourage him to eat?
I will speak to the hospital about trying Humalog they are just so unhelpful.
In terms of splitting the levemir I was thinking of trying maybe 10 before bed and 10 in the morning ?
I really am so grateful for all your support and help.
I will speak to the hospital about trying Humalog they are just so unhelpful.
In terms of splitting the levemir I was thinking of trying maybe 10 before bed and 10 in the morning ?
I really am so grateful for all your support and help.
rebrascora
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I love split dose Levemir as a basal insulin because it is so flexible but I find I do need to be prepared to tweak it quite often to keep the dose in line with my needs.
If your son is not eating many carbs he may need to bolus for protein which takes a bit more thought and often extra injections after a meal because the protein doesn't start to release it's glucose until about 2 hours after eating it. If you eat enough carbs then your body doesn't convert the protein into glucose so that might be another reason for your son to consider eating more carbs. For example if I have a 2 egg omelette with salad (no appreciable carbs) I usually have to inject 2 units 1-2 hours after eating to cope with the glucose release from the eggs, so this may be why it looks like your bolus insulin isn't working, as well as perhaps not having the correct dose and timing for his basal insulin.
Definitely worth doing some basal testing and increasing the carbs a bit even if it is just for a short period to test it out and see what happens. I follow a low carb way of eating but it is more complicated to bolus for and involves more between meal corrections. Increased protein in his diet to offset the lack of carbs may also put more strain on his limited kidney function, I believe. If he doesn't eat more protein and/or more fat, he will simply not have enough energy to grow and be healthy and it sounds like he is already significantly underweight so he needs more calories and there are only 3 sources of them, carbs, protein and fat. I hope you are able to help him find a balance with his diet and BG levels. Please let us know how you get on.
If your son is not eating many carbs he may need to bolus for protein which takes a bit more thought and often extra injections after a meal because the protein doesn't start to release it's glucose until about 2 hours after eating it. If you eat enough carbs then your body doesn't convert the protein into glucose so that might be another reason for your son to consider eating more carbs. For example if I have a 2 egg omelette with salad (no appreciable carbs) I usually have to inject 2 units 1-2 hours after eating to cope with the glucose release from the eggs, so this may be why it looks like your bolus insulin isn't working, as well as perhaps not having the correct dose and timing for his basal insulin.
Definitely worth doing some basal testing and increasing the carbs a bit even if it is just for a short period to test it out and see what happens. I follow a low carb way of eating but it is more complicated to bolus for and involves more between meal corrections. Increased protein in his diet to offset the lack of carbs may also put more strain on his limited kidney function, I believe. If he doesn't eat more protein and/or more fat, he will simply not have enough energy to grow and be healthy and it sounds like he is already significantly underweight so he needs more calories and there are only 3 sources of them, carbs, protein and fat. I hope you are able to help him find a balance with his diet and BG levels. Please let us know how you get on.
Right ok alot to take on board and my brain just went to overload. But a massive thank you. I'm gonna make some notes and digest your recommendations aswell as try to encourage my son to increase his carb intake. Trouble is he's very stubborn just like me lol. Many thanks
rebrascora
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Experimenting is key with diabetes in my opinion. You need to become your own expert, so do your best to encourage your son to try different strategies and see what works for him, particularly if what he is doing now ie low carb is not working. I don't think health care professionals encourage enough experimentation when it comes to diabetes and if you have the Libre, that enables you to keep yourself much safer whilst you try different things out.
If he decides to stick with low carb then approx 40% of protein is broken down into glucose, so he needs to know the protein content of eggs and cheese and meat and fish and nuts etc, then work out what 40% of his portion size is and then inject for it an hour or two after eating as well as possibly prebolus for the few carbs that he does eat in the meal.
You can sometimes increase your Levemir to cover the protein but it is more tricky and I would certainly not recommend it until your son has got to grips with how the protein releases.
I am not convinced by the theory that low carb makes you more insulin resistant. I think it is more to do with the protein releasing glucose much later and raising your BG levels making it look like insulin resistance.
If he decides to stick with low carb then approx 40% of protein is broken down into glucose, so he needs to know the protein content of eggs and cheese and meat and fish and nuts etc, then work out what 40% of his portion size is and then inject for it an hour or two after eating as well as possibly prebolus for the few carbs that he does eat in the meal.
You can sometimes increase your Levemir to cover the protein but it is more tricky and I would certainly not recommend it until your son has got to grips with how the protein releases.
I am not convinced by the theory that low carb makes you more insulin resistant. I think it is more to do with the protein releasing glucose much later and raising your BG levels making it look like insulin resistance.
Inka
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I don’t have any foolproof method for arguing with a teenager
However, he might listen if you give him the facts and allow him to deduce a sensible way forward re diet himself. Firstly, carbs are not the enemy. They put blood sugar up, yes, but that’s nothing to do with carbs being bad, it’s to do with the lack of endogenous insulin. Too few carbs leads your body to believe there is a famine and it could starve - so it ‘helps’ by cranking up its insulin resistance.He might also like to know about Robby Barbaro who has worked to get great insulin sensitivity and now takes around 26 units of insulin for 600-700g carbs per day! No, that’s not a typo. Maintaining insulin sensitivity is really important. He might think that if he eats more carbs his numbers will be even worse - they won’t. It will take some days to undo any insulin resistance from his diet, but it will happen.
So, he could eat cereal, sandwiches, fruit, potatoes, rice, pasta - not vast platefuls just moderate normal portions.
As for the Levemir split, it depends if/when he’s prone to hypos. Most people take slightly less at night because insulin needs usually decrease then. It’s a case of cautious experimentation.
Inka
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I am not convinced by the theory that low carb makes you more insulin resistant. I think it is more to do with the protein releasing glucose much later and raising your BG levels making it look like insulin resistance.
It’s not a theory @rebrascora Its a fact - a biological adaptation to famine. I mention it not because I don’t like very low carb, but as one big reason why I don’t like very low carb diets.
The protein does cause a later rise but that’s a separate issue (and another reason I don’t like too few carbs).
It’s not a theory @rebrascora Its a fact - a biological adaptation to famine. I mention it not because I don’t like very low carb, but as one big reason why I don’t like very low carb diets.
The protein does cause a later rise but that’s a separate issue (and another reason I don’t like too few carbs).
PattiEvans
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Inka, if you follow that reasoning i.e. that restricting carbs makes you more insulin resistant, then how do you explain that a low carb diet works well for Type 2s in reducing their insulin resistance? In fact if the body perceives a lack of carbs it will easily switch to making energy from protein and fat. I respect your way of managing your diabetes, but it doesn't necessarily work for everyone. I do not go to Bernstein levels, but I do know that moderating my carbohydrate intake works best for me to avoid spikes and stay in target. I prefer to stay in the region of >70g per day. I don't feel ill done by at that level, I eat very well and have never actually been a person who eats a lot of carb. I normally have plenty of energy too. My Hba1c has been no higher than 45 in the last 18 years, with the exception of the last one, which covered a period during which I was very ill. Having said that, everyone has to find their own way to manage their diabetes, but what works for one may not work for another.
Inka
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It’s not the low carb diet @Pattidevans it’s largely the weight loss IMO. It’s not ‘restricting carbs’ that causes IR, it’s going too low.
PattiEvans
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It depends what you call low carb doesn't it? Bernstein recommends very low carb and there is also a group of T1 very low carbers I belong to on Facebook. The people there go lower carb than I do but none of those people are losing weight hand over fist. Low carb doesn't have to mean low calorie!
Inka
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No, very low carb doesn’t have to mean low calorie - I totally agree - but it does increase IR and, having tried it, along with so many other diets, especially early after diagnosis, it’s not one I’d choose personally because it increases IR and just swaps one set of problems for another. I also would never recommend it to a growing child, and would be quite hesitant to recommend it to adults actually, although, of course, they’re free, like yourself, to choose it. I suspect levels of carbs that work for people change over life stages whether somebody has diabetes or not.
PattiEvans
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