Hypo s shopping

[Clarelryxx]

Hi I coming up to week 4 of been on insulin I’m finding that every time I go into a supermarket my sugars drop I start to shake panicking I check my sugars before I enter shops and tonight they were 9.0 after 15 mins I had to have glucose tablets as My legs were shaking and they had gone down to 4 .1 I had had some cheese and apple about hour before I went in and as level was 9.0 thought I’d be fine can anyone offer any advice as I feel helpless if this is going to happen each time I try and go shopping

 

[Thebearcametoo]

Do you do the shopping at the same time of day each time? A drop like that is more likely to be related to your previous insulin dose or a basal issue so you may be able to reverse engineer which dose needs lowering. If that doesn’t work then think about having something to snack on as you’re going round the supermarket or a drink with some carbs in like people do sometimes when exercising.

 

[Inka]

I often get unexpected drops shopping too @Clarelryxx I now have Dextro tablets before I start and/or part way through. However, it sounds like you had quite a big drop so it would be worth looking at your insulin doses to make sure they’re ok.

If they are, you could try the Dextro tablets and maybe something like a piece of flapjack (nice mix of fast and slow carbs) to help keep you going when you’re shopping.

 

[nonethewiser]

Many years ago this topic was discussed on here, it seems hypos in shops is more common than first thought, few thought it was modern day lighting to blame, can't see how but who knows.

 

[rebrascora]

Yes, the supermarket used to do that to me too and I would get stranded in the carb park with my chilled produce melting in the middle of summer waiting an hour for me to be able to drive home. I wonder if part of the problem for yourself, may be down to your own insulin production kicking in since you are quite newly diagnosed and getting quite a dramatic drop (ie honeymoon period) but it doesn't really explain why so many of us experience hypos at the supermarket particularly. I have just learned to be extra vigilant and top up on carbs, usually a single JB will keep me above 5, but having to top up when you are already on 9 to prevent a crash is a bit much!!

 

[Clarelryxx]

Thanks everyone I’m at my wits end I’ve spoken to my consultant via telephone and he has got me on 8 units of lantus (background)and fixed dose of 5 units of novo rapid breakfast lunch and evening meal I haven’t seen my diabetic nurse and have a telephone appointment on 9th Dec so until then i can’t tweak my dose as I haven’t been taught how to yet so im just muddling on through myself with only the likes of this forum to help me

 

[Leadinglights]

Have you been given a fixed amount of carbs to have to balance the 5 units of rapid insulin, you may need to tweek it a bit.
I should ask for an earlier appointment or at least a telephone call for some input as you are clearly having a problem and they should be there to support you in this early stage.

 

[rebrascora]

That really is shocking that a newly diagnosed Type 1 doesn't have more support in the first couple of months which is really when you need it most. My practice nurse at the surgery was my support during that time but she was in regular contact with the consultant at the clinic if she needed advice. I know the diabetes clinics are really stretched now but leaving a patient without support when they are regularly hypoing is not acceptable.

 

[Clarelryxx]

I haven’t got a clue how many carbs I should be eating for 5 units I’m also waiting for a dietitian appointment also my practice nurse was great but as soon as I’ve spoken to consultant I’ve not heard anything from her since so I’m constantly checking my sugar s to make sure I don’t go too low I was a type 2 but am now a lada diabetic it all feels a bit daunting at the moment I’m not sure what carbs are best for me

 

[Inka]

You don’t need special training to tweak your insulin/carbs as long as you’re careful and cautious. Start with one meal at a time and see how the fixed insulin dose is working for that meal, eg if you’re always going low after breakfast, either reduce your insulin dose or eat more carbs. If you eat the same breakfast each day while you’re doing this experiment, you’ll learn what works. That’s how many (most?) Type 1s learn.

You should be able to eat a pretty normal diet once you’ve got the hang of things.

 

[Inka]

You might also find this course helpful:

https://www.bertieonline.org.uk/

Always be cautious - better to be a little high than to risk a hypo.

 

[Leadinglights]

Without some guidance about how many carbs you should be having you are 'flying blind'. It is usual to give people a guide on insulin to carb ratio and then they need to test to see how that works for them and adjust by a small amount until it feels right.

 

[Clarelryxx]

You don’t need special training to tweak your insulin/carbs as long as you’re careful and cautious. Start with one meal at a time and see how the fixed insulin dose is working for that meal, eg if you’re always going low after breakfast, either reduce your insulin dose or eat more carbs. If you eat the same breakfast each day while you’re doing this experiment, you’ll learn what works. That’s how many (most?) Type 1s learn.

You should be able to eat a pretty normal diet once you’ve got the hang of things.

Hi I do eat the same breakfast and lunch it’s only evening meals where it changes I do try to stick to regular meals breakfast8.15am and lunch1pm but I do have to have a snack to keep me going till I eat evening meal around 7 pm so just wondering what a good snack to have to keep me going till eve meal I do nibble on nuts through out the day as I’m not sure what I should be eating in between meals or if I should be snacking

 

[Inka]

It depends on what you need @Clarelryxx If your blood sugar is dropping or you’re about to exercise (or shop!) then you could have a carby snack like an apple, a digestive or two, etc, but if your blood sugar is fine, you could go for a snack with minimal carbs eg cheese, nuts, cold meat, veg and hummus dip, etc etc. You might find you can eat a snack with some carbs without an injection anyway eg a couple of oatcakes (approx 10g carbs in total) and cheese.

Type 1 isn’t really about diet. We can eat normally once we sort the insulin. So, for example, if you went out for coffee mid-afternoon and wanted a toasted tea-cake with it, you’d calculate the carbs and inject the correct amount of insulin. We have to learn to be our own pancreas. It’s not easy but you gradually learn what works for you.

You don’t have to stick to regular meal times on MDI (multiple daily injections) It’s a flexible regime that will allow you to live pretty normally. In the old days, when I was first diagnosed, we only had two injections a day and we did have to follow a schedule. Now, we have much more freedom.

 

[Clarelryxx]

That’s what I need to learn how much insulin to give and would I just increase it accordingly when I inject as normal at meal times or each time I eat something

 

[Bruce Stephens]

would I just increase it accordingly when I inject as normal at meal times or each time I eat something

It depends. If you're having a meal and expect to hang around and have a coffee and mince pie an hour or so later then maybe just count it as part of the meal.

If you're walking in the middle of the afternoon and fancy an ice cream, consider injecting separately for that. Though it's also possible you don't need to because you can see your level is OK and you can just correct it for your evening meal. (Or even that your level is falling so an ice cream makes sense to stop that.)

 

[Inka]

That’s what I need to learn how much insulin to give and would I just increase it accordingly when I inject as normal at meal times or each time I eat something

Part of that learning is experience, which only time will give you, but you can also do courses like BERTIE that I linked to above, and read books. They’ll give you the background knowledge you need, and then you’ll have a better idea about what to try.

Don’t be afraid to experiment eg try a biscuit mid-afternoon without insulin. See what happens to your blood sugar. If you don’t already have them, you’ll find half unit pens very helpful as you can then tailor your insulin doses more accurately.

 

[Inka]

Here are a couple of books about Type 1 that are popular here:

Think Like a Pancreas’ by Gary Scheiner.

And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too).

 

[rebrascora]

I think the place to start is learning to count carbs because it seems like you don't have any understanding of that yet. So for instance if you have toast for breakfast every morning, then look at the packet that your bread comes in and it will have a nutritional information box in small print, usually on the side or bottom. It will tell you the amount of carbs in 100g of the bread and also per slice if it is a sliced loaf. Your average medium sliced wholemeal loaf is about 15g carbs per slice, so if you have 2 slices then that is 30g carbs. If you have it with butter and jam/marmalade, there are no carbs in the butter but you can guess about 5g carbs per rounded teaspoon of jam. So if you say a spoon of jam on each slice then you are looking at about 40g carbs for that breakfast. The carbs in a splash of milk in your tea or coffee are negligible so unless you have a latte or very milky tea or you have more than one cup, then you wouldn't count that.

If you have cereal, then again the box will have the nutritional information and will tell you how many g of carbs per 100g of cereal. If you weigh out 50g of cereal then it will have half that figure.... so say it is 66g carbs per 100g and you weigh out a 50g portion, then you will have about 33g carbs. If you have that with 100mls of milk you can add another 5g carbs from the milk, so in total that is 38g carbs. If you have a few sultanas or some fresh or frozen berries like rasps or blueberries or strawberries you can add another 5-10g carbs. You will then have a total number of carbs in the meal once you have totted them all up. What happens then is that you are usually given an insulin to carb ratio, which is usually 1:10 as a starting point, so you use a unit of insulin for every 10g carbs in the meal. So if it was the 2 slices of toast and jam at 40g carbs a 1:10 ratio would mean you needed 4 units of insulin.
Most foods have this nutritional info on them other than fresh fruit and veg and meat etc and you can do a Google search to find the content of these foods or invest in a Carbs and Cals book which has the information both in figures and a pictorial guide in the form of photos of different portion sizes to help you learn to guestimate.

If you look at the BERTIE online course mentioned I am sure it will go through all this information and give you lots of examples to work through, so that you get the hang of it.

I should say that some people are more sensitive to insulin than others and particularly if you are quite slim and fit, then you might just need a 1:20 meal ratio, so you just use 1 unit of insulin for every 20g carbs, so that 40g breakfast would just need 2 units. And ratios are not always the same throughout the day. Most people are less responsive to insulin in the morning so they might need a 1:10 ratio foir breakfast but a 1:15 for lunch and evening meal ie they need less insulin for the carbs they eat later in the day.

If you start out by calculating the carbs you are having now for your meals and making a note of them and what your BG readings are premeal then you should be able to see if the insulin you injected brought you back to about the same level before your next meal (assuming you didn't eat any snacks in between. Not saying you can't have snacks but if you are trying to work out your insulin:carb ratio then you need to keep things simple for a while so that you see how your meal time doses are working out. Hopefully that makes a little sense, but if you slowly start to work your way through the BERTIE online course it will gradually start to click into place.

 

[everydayupsanddowns]

Sorry to hear you’ve been left a little adrift with only fixed doses, but no information as to how many carbs you need to be aiming for to balance those doses.

One of the tricky things about managing diabetes is how individual it is, and how much doses can vary from person to person.

Some clinics use basic ‘rules of thumb’ to give an initial guide, sometimes taking bodyweight to establish a likely average daily requirement for insulin (TDD or total daily dose), then splittng that into background and meal doses using various ‘rules’ to suggest insulin sensitivity, and insulin:carbohydrate ratios.

Other courses like DAFNE seem to start everyone on the same basis (1u of insulin for every 10g of carbs, and 1u of insulin expected to reduce BG by 3mmol/L) and then let people adjust from there.

It would have been helpful for you to have been given at least some guidance though. At the moment with the information you’ve been given you could take the same dose for a burger and large fries, or an omelette and green salad - which is clearly madness!