Hi There

[Sally T]

Hi, I was diagnosed with type one diabetes in 1990 and have been jogging along ever since. I guess I'm not alone in the determination not to let diabetes determine me and the changing attitude experienced over the last few years has been refreshing.
In 2019 I joined the libre sensor fraternity which was extremely liberating in conjunction with carb counting.
Unfortunately I still can't match what actually happens to my blood sugars with any degree of carb counting and have really joined the forum to try and shed some light?
Also - any one else find that blood sugar good control almost always leads to weight gain?

 

[Bruce Stephens]

In 2019 I joined the libre sensor fraternity which was extremely liberating in conjunction with carb counting.
Unfortunately I still can't match what actually happens to my blood sugars with any degree of carb counting and have really joined the forum to try and shed some light?

First of all, welcome.

I think you'll need to give us some hints as to how it's not working. There's lots of variables, so it may just be that some of them aren't quite right yet.

(It's also possible that the usual twice a day basal insulin dose doesn't quite work for you (works fine for me, but some people find a pump is required that allows adjusting the basal dosing).)

Also - any one else find that blood sugar good control almost always leads to weight gain?

No, but I understand what you mean: you need a bit more insulin to cover your food, but then need to eat a bit more because you're going low so you end up with ~10% of your calorie intake over a day being jelly babies (which is surely not recommended 🙂).

I think it's not such a problem if you can better judge how much insulin you really need (which needs carb counting to work). (It's never going to be perfect, obviously.)

 

[Sally T]

Hi , Thanks for your reply.
I use Toujou 30 units as daily dose and Novo Rapid fast acting.
At the moment I have joined weight watchers as weight gain has always been a frustration for me. I am currently a generous 14st, 8lb (really, the largest I have ever been and well unacceptable for a 5'5'' woman.

I'm choosing to cut out carbs to the best of my abilities but have had a couple of hypos this week leading to a binge on sultanas and bananas (probably the only two foods that rhyme).

As an example of my dilemma this morning on waking my BG was 7.4 (very good for me) after my usual cup of tea with milk in bed I had reached 9.1 and climbing.

I've just had a virtually carb free breakfast of boiled eggs, fat free bacon, cherry toms and lettuce along with (a guessed at) 6 mols of novorapid and my current reading is 10.4.

Regularly my BG climbs during the early part of the day and it is only after lunch that it begins to look even slightly reasonable.

Any thoughts would be great. (I had noticed an earlier post re insulin more effective during the active part of the day e.g. lunchtime) so will bear that in mind.

 

[trophywench]

Where were the carbs in that brekkie, did you actually need any Novorapid?

I don't find I need any for carb free meal like that - my body would only convert either protein of fat to carbs if it had been starved of carbs for a lot longer than just since yesterday - and then it needs FAR less insulin to do so.

Please tell us what happened and that you are OK !!

 

[Bruce Stephens]

I've just had a virtually carb free breakfast of boiled eggs, fat free bacon, cherry toms and lettuce along with (a guessed at) 6 mols of novorapid and my current reading is 10.4.

Regularly my BG climbs during the early part of the day and it is only after lunch that it begins to look even slightly reasonable.

Any thoughts would be great. (I had noticed an earlier post re insulin more effective during the active part of the day e.g. lunchtime) so will bear that in mind.

You might want to try treating mornings as special, and just accept that you need some Novorapid to cover the rise that many of us get (and call either the dawn phenomenon or foot on the floor, caused by stress hormones).

As an example of my dilemma this morning on waking my BG was 7.4 (very good for me) after my usual cup of tea with milk in bed I had reached 9.1 and climbing.

Which very much suggests your liver is releasing glucose because you're waking up, so maybe a few units of Novorapid as soon as you wake up might be appropriate? And maybe if you can cover that morning jump (that many of us get) then the rest of the day might become easier? (It always seems quite a bit harder to handle things once I'm over 10, though being under 4 is also not fun.)

Might also be that Novorapid just needs more time, so injecting it some time sooner would help. (I find half an hour before eating works OK, but some people find they need an hour or more, especially for breakfast.) That kind of approach works if you're getting back to level after ~4 hours (so the dose is right but you're just having a bit of a spike).

If your levels are rising when you're not really easting much, that suggests an increase in your basal dose rather than with Novorapid.

 

[rebrascora]

Hi and welcome.

A couple of things occur to me....
Firstly Toujeo is a very long acting insulin. It gives you a steady trickle of basal insulin day and night in quite a uniform pattern. Basal insulin is there to deal with the glucose our liver trickles out day and night to keep our vital organs fueled when we are not eating/digesting food. Most people's bodies are not uniform and do not need a uniform amount of basal insulin throughout the day and night. Most of us need quite a bit more in the morning to deal with Dawn Phenomenon (DP) or Foot on the Floor syndrome (FOTF) as we often refer to it here on the forum because our BG levels start to rise as soon as we get out of bed. This is believed to be a prehistoric function from the days when we had to go out and forage or hunt for our first meal of the day rather than plod into the kitchen and open the fridge and grab some food. I believe thet pretty much everyone experiences it but people with fully functioning pancreases obviously don't get much of a BG rise because their pancreas releases insulin to deal with it. I inject quick acting (bolus) insulin before I get out of bed to deal along with the bolus for my breakfast. Usually 1.5-2 units in my case for FOTF. If I was having a low carb breakfast like you describe, I might need a couple of units of bolus insulin 2 hours later to cover the breakdown of protein from the eggs and bacon but that is another matter... Anyway, the other thing is that most people need a lot less basal insulin between 2am and 5am when they are in the deepest part of their sleep. With a basal insulin like Toujeo, you may need to have a biscuit of two at bedtime to push your levels high enough so that you don't dip too low through the night from it releasing too much insulin during that "dead of night" period. So what you end up doing is feeding that insulin rather than just taking enough to balance your liver output.
An insulin pump is the current best solution to this problem where it injects very small and variable amounts of quick acting insulin throughout the day or night which can be adjusted to balance the glucose your releases. There is however a basal insulin which gives you a bit more flexibility to manage things better via MDI and that is Levemir which is a shorter acting basal insulin and lasts usually about 12-20 hours which you take as 2 injections morning and evening and you can adjust each dose both timing and amount according to what your body needs. So for me, I am currently using 24 units in the morning which I inject before I get out of bed and last night just 1.5 units. For me my daytime dose is fairly static but my evening dose varies a lot particularly if I have had a very active day and can be anywhere between 7 units and none. Because it is short acting, it also means that any adjustment I need to make have a real time impact rather than waiting the usual 3 days beffore seeing the full impact of the change and if I need to adjust it again the next night, I can. I absolutely love my Levemir for the flexibility it gives me in managing my basal insulin needs and I love, love LOVE my Libre for showing me when I need to adjust it.
If I was in your shoes, I would be requesting a change of basal insulin to Levemir to enable you to balance your basal needs more closely.

As regards a low carb diet, this is what I follow, but not for weight loss. For me, it helps to control my disordered eating. I do however feel fitter and healthier eating this way than I have in 20-30 years but it does take some understanding of the fact that 40% of protein (and 10% of fat) will break down into glucose in the absence of enough carbs and you also have to consider the lower carb components of your meal like onions and tomatoes and pulses etc rather than just counting the carb rich foods that DAFNE recommends. Protein (and fat) typically breaks down much slower than carbs so firstly it keeps you feeling full for longer so you are less likely to suffer the munchies between meals but it also raises your BG levels much more slowly once it does start releasing. This means more injections as most meals need a small upfront dose to deal with the small amount of carbs and then a back up or correction dose 2 hours later to stop the gentle rise created by the protein release. I sometimes need 2 small corrections (stacked 😱) after a meal to deal with the protein as it sometimes just keeps giving. I tend not to carb count or "protein count" but just respond to my Libre these days and if my levels are in the 8s and drifting upwards I stick 1-2 units in and check again in an hour and if they are still drifting upwards then I stick another unit in. This works for me and I am currently 95% Time in Range on my Libre for the past 7 days but it takes time to get your head around it all and you need to monitor you levels pretty closely. It is not an easy option by any means.

For me, reducing my fat intake (I eat a lot of fat on my Low Carb, Higher Fat (LCHF) way of eating and exercising more.... just brisk walks usually.... is they key to weight loss but with the increased exercise, reducing my evening Levemir (basal) insulin dose is very important.

I would also like to mention that there are 42 known factors which affect BG levels some pushing them higher, some lower and some like exercise can do both. Many of those factors are beyond your control so don't feel like you are failing when things don't pan out as you expect. Perfection is impossible with managing BG levels and if I can achieve a personal best time in range once in a blue moon, that makes me very happy, even though I know that my results will drop a bit in between times. I find by BG management ebbs and flows. Sometimes the harder I try the worse it gets and the thing then is to check your basal doses are as right as they can be but otherwise just accept you are going through a bad patch and usually for no obvious reason, it just comes right again and then othertimes like now I will be on a real roll and a new PB will be just tantalizingly within reach (97% with just 1% below is my current PB) and then I really focus and try to outdo myself...... but I mostly just treat it like a game. As long as I hit the 70% Time in Range with less than 5% below target I tell myself that I am doing OK.

Anyway, those are my thoughts and an idea of my approach with low carb eating to Type 1 management. Libre makes it much easier than finger pricking that is for sure!! Hope it is of some help to you.

 

[everydayupsanddowns]

Welcome to the forum @Sally T !

Glad you have joined us, and hope that sharing experiences with others here gives you some new strategies to try, and some little pieces of the diabetes puzzle slot into place.

I’m a relative newcomer compared to you (I was diagnosed a year later 😛) and yes it can be a frazzling and frustrating old business when your diabetes doesn’t seem to have read the instruction book and is making things up as it goes along!

Have you ever been offered a structured education course (eg DAFNE) to give yourself a refresher? There’s a free online version called BERTIE which you could sign up to.

You might also find some nuggets of information in Think Like a Pancreas by Gary Scheiner or Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas - both frequently recommended on the forum.

One other tip and technique I discovered through forums about 10 years ago was basal testing. If you’ve never systematically examined your basal insulin and tried to get your dose as right as it can be, it might be a real turning point. When my basal is ‘off’, even just a little bit, everything else just seems to stop working properly.

https://www.mysugr.com/en/blog/basal-rate-testing/

Glad to have you here, and look forward to hearing how you get on 🙂