How do I keep REGULAR.......now I dont eat porridge , bran and jacket potatoes ?

[Deleted member 21371]

To my utmost despair, I am still not told which type I am, 5+ months since diagnosed. The first treatment offered to me was insulin. I was rushed to HSP with raised ketones. Possible DKA. All symptoms pointing to Type 1. The experts keep changing their opinion.

I ended up in A&E yesterday with high ketones (type 1?). But the doctor also thought that I am T2DM.

Who should I ask?

I am the first to admit my complete lack of knowledge on this, but there are many way better qualified to answer this.
Hopefully they will be along soon.

 

[rebrascora]

I am afraid not. Allow me to give you an example. I calculated carbs for lunch. Added 2u as correction. BG levels were 14.3 mmol/L. Fast forward an hour and half, sensor reads 15.7 mmol/L been out and about meanwhile. Returned home to 19.2. I ve not eaten a crumb during this period.
Can any one pls explain? Cos I can't. Ta!

Sounds like your basal insulin dose may not be holding you steady.... but it also depends if you gave your bolus insulin plenty of time to bring your levels down before you ate and your correction dose may not have been large enough.

If my levels are above 8 when I eat then they will just go higher, so I always inject my bolus and correction and wait until they come down below 8 before eating, even if it takes 2-3 hours. I may eat something low carb in the meantime like a boiled egg if I am hungry but nothing is going in my mouth that will send my levels higher until I come down into range.

For me 2 units would be nowhere near enough of a correction dose to bring me down from 14 and clearly it wasn't for you either. Correction factors like 2 or 3 (where a unit of insulin drops you 2 mmols or 3 mmols) often only work if your levels are within a reasonable range and if levels are higher then many of us need a larger correction dose. For me 1 unit will drop me 3 mmols if I am in range, but if my levels are above 8 then 1 unit will only drop me 2mmols and if I am above 10 it will probably only drop me 1.5 units. That is because we become more insulin resistant when our BG levels are higher. That said, if I do some exercise with my normal correction factor of 3 then it will be more effective, so I have to factor in whether I am likely to be able to do some exercise whilst I am waiting for that correction to be effective, when I inject it. There is a lot to think about. It is not a simple and straight forward ratio or correction factor that works every time, you have to take into account, the starting BG and your activity levels and how long you can reasonably wait to eat. If I am in a hurry, I sometimes give a much bigger correction that I think I will need and then keep an eye on my levels afterwards and top up with a little few carbs later if I need to. This wasn't possible pre Libre but with the advantage of being able to monitor levels more quickly and easily whenever we want, we don't need to be quite so cautious with corrections because we can monitor how they are working and just correct with a few carbs if we were a bit heavy handed with the insulin earlier.

I think your situation may be a combination of not enough basal insulin and not enough correction insulin was probably the cause of your levels going upwards instead of coming down, but prebolus time is also twice as important when levels are high and the rule of not eating when levels are above 8 is a really helpful one for regaining control when levels are high. I appreciate it isn't always possible to delay a meal by 2 or 3 hours but it is well worth doing if you can because it enables you to get your BG back on track rather than fighting a losing battle with high levels. I often remark that you would think my insulin turned to water when I inject it with my levels above 10 for all the good it does. I have to be really heavy handed (generous) with it to bring high levels down.

 

[nonethewiser]

... and how do the T1 respond? Not that I am any wiser as regards to my diagnosis. Lol not.

Sounds like you need proffesional input but ain't getting it, type 1s like myself manage just fine when we have skills & tech to hand, most of what we know is from experience & in many ways that can't be taught as our bodies are all different.

Just this minute finished delicious & nutritious bowl of porridge with greek yogurt & berries, with right treatment & knowledge you should be able to eat similar meals in time.

 

[Wannie]

I had to take some fybogel two days ago !

Prunes ? ?

I have 40g of Asdas version of Allbran (19g carb) plus either 40g of blueberries, raspberries or strawberries, with either semi skimmed milk or Alpro no sugar yogurt or greek yogurt. Tested BG before and after breakfast for a while, until sure I could cope with it without a big rise, plus plenty of fluids, lots of veg and salad!

 

[Purls of Wisdom]

I got hammered when I went low fat.
I was told the only way to go was to cut carbs, and that was all I had to focus on as well.

I chose to step back, assess what I needed for me overall, not just fixate on BG.
It took a while, but I sorted a solution that fixed everything.
In my case my focus was mainly on weight.
I put exercise into the mix, then decided on a diet to comment my lifestyle, and the diabetes just fell into line after that.

All I could say is focus on what you want, take small steps, and look at overall quality of life.

My body weight has never been an issue. I have lost too much weight as it is. My only positive point, if there is such a thing.

I ve spent past few weeks feeling sorry for myself. Definitely fixated on BG levels. Not thinking for myself, taking extra actions, risks, control and wondering why things are not working for me?

I have decided to take things in my own hands as you had suggested. I know I am not an outdoor-ish person, lack self discipline and motivation but I made conscious effort to get off the couch, move around. I was pleasantly surprised to discover how well it works. It has only been 2 days and I see difference in my readings. Surely being little generous with the insulin has a big hand to play in it.

I tend to worry about one particular hyper episode until it dawned on me, it is not a matter of one reading; it is an issue for the rest of my days now. What I need to do is to experiment, take risks, and keep trying until the desired levels are achieved. A light bulb moment indeed.

All I can say here is, thank you for all the support. Do not know where would I be w/o this Forum.

 

[Purls of Wisdom]

Sounds like you need proffesional input but ain't getting it, type 1s like myself manage just fine when we have skills & tech to hand, most of what we know is from experience & in many ways that can't be taught as our bodies are all different.

My experiences were nothing but negative. The support I get is too little and far in-between. I certainly do not know enough for me to feel confident.

Just this minute finished delicious & nutritious bowl of porridge with greek yogurt & berries, with right treatment & knowledge you should be able to eat similar meals in time.

When you say 'time', roughly how long did it take you to work out the right ratio of insulin to carbs? In 5+ months, I've understood very little and retained even less.

Living in hope ...

 

[Purls of Wisdom]

Sounds like your basal insulin dose may not be holding you steady.... but it also depends if you gave your bolus insulin plenty of time to bring your levels down before you ate and your correction dose may not have been large enough.

You are so right. The DSN said the same but suggested nothing to remedy it. I have not even touched the finer points of manipulating the hyper readings. For your amusement, my time in range is 56% and average glucose is 10mmol/L, which in my view is too high. I should be guided towards bringing it lower. I am barely at the baby steps stage in regards to correction doses.

If my levels are above 8 when I eat then they will just go higher, so I always inject my bolus and correction and wait until they come down below 8 before eating, even if it takes 2-3 hours. I may eat something low carb in the meantime like a boiled egg if I am hungry but nothing is going in my mouth that will send my levels higher until I come down into range.

With my average levels, how low should I be before eating? I have not been told but I picked this up from here only.

For me 2 units would be nowhere near enough of a correction dose to bring me down from 14 and clearly it wasn't for you either. Correction factors like 2 or 3 (where a unit of insulin drops you 2 mmols or 3 mmols) often only work if your levels are within a reasonable range and if levels are higher then many of us need a larger correction dose.

Don't i know it. I have only been advised to take 1 or 2units as correction. No mention of the longer waiting time. At times my BG levels are fairly high. 1 or 2units do nothing.
Am i expected to take charge w/o any formal education?

For me 1 unit will drop me 3 mmols if I am in range, but if my levels are above 8 then 1 unit will only drop me 2mmols and if I am above 10 it will probably only drop me 1.5 units. That is because we become more insulin resistant when our BG levels are higher. That said, if I do some exercise with my normal correction factor of 3 then it will be more effective, so I have to factor in whether I am likely to be able to do some exercise whilst I am waiting for that correction to be effective, when I inject it. There is a lot to think about. It is not a simple and straight forward ratio or correction factor that works every time, you have to take into account, the starting BG and your activity levels and how long you can reasonably wait to eat. If I am in a hurry, I sometimes give a much bigger correction that I think I will need and then keep an eye on my levels afterwards and top up with a little few carbs later if I need to. This wasn't possible pre Libre but with the advantage of being able to monitor levels more quickly and easily whenever we want, we don't need to be quite so cautious with corrections because we can monitor how they are working and just correct with a few carbs if we were a bit heavy handed with the insulin earlier.

I think your situation may be a combination of not enough basal insulin and not enough correction insulin was probably the cause of your levels going upwards instead of coming down, but prebolus time is also twice as important when levels are high and the rule of not eating when levels are above 8 is a really helpful one for regaining control when levels are high. I appreciate it isn't always possible to delay a meal by 2 or 3 hours but it is well worth doing if you can because it enables you to get your BG back on track rather than fighting a losing battle with high levels. I often remark that you would think my insulin turned to water when I inject it with my levels above 10 for all the good it does. I have to be really heavy handed (generous) with it to bring high levels down.

 

[nonethewiser]

My experiences were nothing but negative. The support I get is too little and far in-between. I certainly do not know enough for me to feel confident.

When you say 'time', roughly how long did it take you to work out the right ratio of insulin to carbs? In 5+ months, I've understood very little and retained even less.

Living in hope ...

Time as in whole shebang, meaning not just radio of insulin for food but getting basal dose right, that is fundamental before anything else.

As well as ratios its timing of bolys dose for different meals, so there's no set time it's just something you learn as you go along.

 

[Leadinglights]

You are so right. The DSN said the same but suggested nothing to remedy it. I have not even touched the finer points of manipulating the hyper readings. For your amusement, my time in range is 56% and average glucose is 10mmol/L, which in my view is too high. I should be guided towards bringing it lower. I am barely at the baby steps stage in regards to correction doses.

With my average levels, how low should I be before eating? I have not been told but I picked this up from here only.

Don't i know it. I have only been advised to take 1 or 2units as correction. No mention of the longer waiting time. At times my BG levels are fairly high. 1 or 2units do nothing.
Am i expected to take charge w/o any formal education?

People have mentioned an on- line BERTIE course which people can register for, have you done that or thought of looking at that, as you say you have had no education. Or ask for referral to the DAFNE or your area equivalent.

 

[Poppy460]

Really interested about the comments on porridge. I love the stuff. Think I might be eating a little too much, anyone know the grams per serving I should be having?

 

[everydayupsanddowns]

Really interested about the comments on porridge. I love the stuff. Think I might be eating a little too much, anyone know the grams per serving I should be having?

It’s a very individual thing, and people will have different tolerances.

There will probably be a suggested serving size on the pack, which might help with calorie estimation if you find that helpful.

Many members here would simply check BG immediately before, and again 2hrs after the first bite, and see if the rise from the meal was 2-3mmol/L or less. If higher than that try a tweaked recipe or smaller portion?

 

[NotWorriedAtAll]

I make a keto version of 'overnight oats'

for one portion

1 teaspoon of psyllium husk
1 teaspoon of oat fibre (it is oats with all the carbs removed)
1 teaspoon of chia seeds
some nutmeg
some cinammon
some zero carb milk (either almond or pea protein) to cover the dry ingredients
sweetener to taste

Into a jar and keep in the refrigerator overnight.
Serve it with double cream or greek yoghurt and some berries or chia seed jam.

You can also do this hot - by microwaving the mixture and having it as hot porridge.
It is delicious and it is full of fibre and I have no issues with keeping regular because at the smallest hint of it - I have this for breakfast with a big cup of decaf coffee.

 

[Deleted member 21371]

It’s a very individual thing, and people will have different tolerances.

There will probably be a suggested serving size on the pack, which might help with calorie estimation if you find that helpful.

Many members here would simply check BG immediately before, and again 2hrs after the first bite, and see if the rise from the meal was 2-3mmol/L or less. If higher than that try a tweaked recipe or smaller portion?

What's your feeling if you start from somewhere low, say 4?
I used to be more than happy with a rise of 4 or 5, targeting 8.5, with a bit of leeway for the meter accuracy.

 

[everydayupsanddowns]

What's your feeling if you start from somewhere low, say 4?
I used to be more than happy with a rise of 4 or 5, targeting 8.5, with a bit of leeway for the meter accuracy.

It’s an interesting question - and I think it’s different for me because I will always need to check on an ongoing basis. Personally with insulin involved I would treat a 4.0 with something high glucose to guard against a dip, on top of the meal itself.

I generally give myself leeway with all these things. So while recognising 2-3 as ideal I would be happy-ish with 4, or thereabouts.

If I were looking for knowledge about which sources / portion sizes of carb which suited me best that I could use on an ongoing basis with less frequent ‘maintenance’ BG monitoring, then 2-3 seems a good limit. That way, if I were mid-range to start with I’d still only get to 9ish. Still fine by me.

Additionally, in the beginning it would mean I could still gather useful data. A rise of 10-11.5 still makes it a ‘good’ meal, even though 11.5 is higher than ideal.

Just my own thoughts. Glad you’ve found an approach that works for you. 🙂

 

[Deleted member 21371]

It’s an interesting question - and I think it’s different for me because I will always need to check on an ongoing basis. Personally with insulin involved I would treat a 4.0 with something high glucose to guard against a dip, on top of the meal itself.

I generally give myself leeway with all these things. So while recognising 2-3 as ideal I would be happy-ish with 4, or thereabouts.

If I were looking for knowledge about which sources / portion sizes of carb which suited me best that I could use on an ongoing basis with less frequent ‘maintenance’ BG monitoring, then 2-3 seems a good limit. That way, if I were mid-range to start with I’d still only get to 9ish. Still fine by me.

Additionally, in the beginning it would mean I could still gather useful data. A rise of 10-11.5 still makes it a ‘good’ meal, even though 11.5 is higher than ideal.

Just my own thoughts. Glad you’ve found an approach that works for you. 🙂

I think there is possibly a difference in the types of diabetes that affects the rise in BG.
Even between type 2's to the amount of carbs and insulin response.
For type 2, I found insulin resistance, and insulin response varies, at diagnosis, I could produce insulin, no idea on initial response, but definitely ok on the slower response.
Insulin resistance varied depending on what I had been doing.
So rises were fairly unpredictable.
But, I could probably have a slow graze, on a slow rise food, and my body would still be trying to keep to 8.5 ish, and even with a slow insulin response, succeeded sometimes.
A fast glucose source, it wouldn't keep up.
Now I've got it under control, my body's feedback maintains the ceiling at which it'll switch off insulin response.
Say 8.5.
I can't actually change that.
But I don't know that bringing it down a lower level would have benefitted me, apart from stopping me eating food my body could naturally still cope with.
I agree if you are starting higher, and a rise would take you over 8.5 it's not ideal, then I'd be looking for a lower rise, but still expecting my body to be targeting the drop to 8.5 if I had to eat.
And to be honest, even if I didn't eat, a liver dump would probably happen, and take over anyway, depending on insulin resistance.

 

[DiabeetusDad]

I would love to have porridge oats or toast but my BS accelerates rapidly if I do despite onboarding insulin 20 minutes earlier. This throws my day out. I generally have a small portion of scrambled eggs and bacon and my levels are amazingly stable. I also take some Psyllium husk. I have recently started intermittent fasting 20 - 24 for 48 hr so don’t eat breakfast on these days.

 

[rebrascora]

I would love to have porridge oats or toast but my BS accelerates rapidly if I do despite onboarding insulin 20 minutes earlier.

Have you experimented with pre-bolusing longer for your breakfast. I need 45 mins with Fiasp and 75 mins with Novo (notso)Rapid which is quite extreme, but I am not the only one. If you love porridge then it might be worth some more experimentation with prebolus timing. I now inject for breakfast as soon as I wake up and before I get out of bed and then go through my morning routine until Libre shows the insulin is kicking in and I usually start eating mid 5s and even with creamy Greek natural yoghurt with berries and seeds there is still time for my levels to come up before I hit the red line.
I don't time it anymore but just keep an eye on my Libre and the 45 mins advance insulin is remarkable consistent for me.

Not suggesting you (or anyone else) should prebolus so far in advance without careful experimentation or close monitoring of Libre but just saying that 20 mins at breakfast is not long enough for many people so maybe try increasing it by a few mins each day until you find the sweet spot timing for your body, but don't feel limited by the 20 min advice from health care professionals or pharmaceutical advice. Other meals need much less prebolus time but we can be quite insulin resistant in the morning due to Foot on the Floor/Dawn Phenomenon so the insulin often needs a bigger head start.

Of course eggs are a great way to start the day but just thought, if you love porridge, you might want to find a way to make it work for you. Best to experiment on a non-work day so you have time to keep a close eye on things.

 

[Lucyr]

Porridge for breakfast is a 40-45 minute prebolus for me too, with apidra. If you’ve only tried 20 minutes then don’t rule porridge out, just try longer preboluses first.

 

[rebrascora]

Porridge for breakfast is a 40-45 minute prebolus for me too, with apidra. If you’ve only tried 20 minutes then don’t rule porridge out, just try longer preboluses first.

Thanks Lucy. I already need 45 mins prebolus time with Fiasp even for my yoghurt breakfast and I enjoy that so at the moment I can't be bothered to experiment further with porridge. I also feel more in control of my eating when I keep grains to a minimum and eat low carb. I get horrible cravings and want to comfort eat when I start to eat more carbs ..... and I enjoy low carb eating in general now that I have got my head around it. I would also rather have a big bowl of low carb foods as a small bowl of high carb.

 

[Lucyr]

Thanks Lucy. I already need 45 mins prebolus time with Fiasp even for my yoghurt breakfast and I enjoy that so at the moment I can't be bothered to experiment further with porridge. I also feel more in control of my eating when I keep grains to a minimum and eat low carb. I get horrible cravings and want to comfort eat when I start to eat more carbs ..... and I enjoy low carb eating in general now that I have got my head around it. I would also rather have a big bowl of low carb foods as a small bowl of high carb.

@DiabeetusDad does want porridge though. As do I.