Help: New TD1 & Blood Sugar Consistently >9.0mmol/L

[james27]

Hi, all. I'm a very recently diagnosed 21-year-old T1D who, since leaving the hospital with a mild case of DKA, has been struggling to get a handle on a persistently elevated blood sugar level; my average across the past six days has been 10.9mmol/L. I haven't experienced a single low, and my level, though high, is fairly stable. I have administered 4-5 units of Fiasp before each breakfast, which has been a very low-carb omelette. My personal insulin-to-carb ratio eludes me, especially when the Internet suggests 1 unit per 10g of carbs and I bolus, say, 6 units for around 35g of carbs. This marginally reduces my level by two or so mmol/L, but I will remain between 7 and 11mmol/L afterwards. I take 16 units of Lantus in the morning. If I am stable but high, is the Lantus dosage insufficient? Am I expected to increase it (for example, by one or two) without seeking medical counsel?

Huge thanks in advance to anyone willing to advise on this. I'm a healthy weight and have been increasingly diet-conscious (no alcohol, confectionery, hefty carb portions, etc.) since the diagnosis, and I really want to get things right--or as right as possible--at this early stage.

Thanks again. 🙂

 

[Robin]

Hi and welcome to the forum. We could all bombard you with tips and advice on managing your insulin, and you’d probably end up overwhelmed. At this early stage, you really should have been given a contact at the hospital, a specialist nurse, who will guide you through these early days and discuss changes to your Lantus and Fiasp if necessary. Were you seen at a hospital diabetes clinic? If so, contact them and ask to speak to a DSN.
Also, a lot of people recommend the book 'Type 1 diabetes in children, adolescents and young people' by Ragnar Hanas, which is useful for people of any age, or my go-to bible in the early days was 'Think like a Pancreas' by Gary Schneider.

 

[rebrascora]

Hi James

I think you are probably a bit too keen to bring your levels down. When you are newly diagnosed, your levels are high and the chances are they have been like that for a while and the body adjusts to those higher levels. Getting insulin doses right is a very complicated business and so the doctors and nurses start with lower doses than they thing you will need and gradually increase them over a period of weeks to bring your levels down slowly. This enables them to see how your body is responding to the insulin so that they don't increase the dose too much and you experience a nasty hypo but also because the fine blood vessels in the eyes and feet are quite vulnerable to changes in BG levels and so it is safer, particularly for your sight, to bring your levels down slowly into range.

So at this stage, no you should not be adjusting the Lantus until they tell you to do so and to be honest eating low carb can confuse the issue because those units of Fiasp that you are taking and then eating an omelette are actually propping up the Lantus rather than dealing with a more carby breakfast they are supposed to be working on. I am an advocate of low carb but Unless your team are aware that you are doing this and you are keeping a detailed food diary it may be best to eat "normally" for now. That way your health care professionals have a better idea of how much Lantus you actually need rather than that being "disguised" by the Fiasp you are taking. Not sure if that will make sense to you at this stage but getting your basal insulin (Lantus) dose correct is the basis of good diabetes management and if that isn't right, nothing else makes sense... ie ratios with Fiasp will be wrong and unpredictable etc.

When do you next speak to your diabetes nurse? They will gradually adjust the Lantus to bring you down. I totally understand you wanting to be on top of this but it is very complicated and takes time and ideally an intensive education course like DAFNE so just be a bit patient. 9s, 10s and 11s are all good readings for this early stage in your diagnosis.

 

[james27]

Thank you, Robin and rebrascora. These are useful comments. I suspected that I shouldn't tamper with the basal insulin independently of a DSN, so I'll wait for the follow-up appointment in little over a week from now.

I think my eagerness to reduce my blood sugar levels comes from a place of fear; the associated complications and possibility of an abbreviated lifespan are concerns difficult to keep at bay.

Thanks again.

 

[rebrascora]

A week or two of readings at that raised level or even a month or two are not a great concern in the scheme of things and as I mentioned, bringing levels down quickly can slightly increase the risk of damage to your sight so best to follow the doses you have been given and wait for further guidance from your health care professionals at your next appointment. If your levels were up in the 20s every day then I would be more concerned and suggesting you contact your nurse for further advice, but those levels are probably about perfect for the length of time you have been diagnosed.

 

[helli]

HI @james27 Welcome to the forum.
I second the comments above about not bringing your levels down too fast.
The "advantage" of Type 1 over type 2 is that, typically, it comes on faster so the undetected higher levels are not likely to have been around for long enough to have long last effects.

I also second the comments about "eating normally" so that your DSN has the data to work out your insulin to carb ratios. I have dabbled with low carb and found it more complex for me as, in the absence of "enough" carbs, your body will break down the protein you eat. This is at a different rate and different ratio to carbs and often a different ratio to each other (I found I needed a different insulin to protein ratio for nuts, salmon, eggs, prawns, cheese, ...) so it may easily skew the insulin to carb ratios.

Eagerness is good but it is often said that managing diabetes is a marathon not a sprint - I think we can continue to learn along the whole marathon (I am still learning after more than 15 years).