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New and feeling like I’m never gonna get there.

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Chris04

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Relationship to Diabetes
Type 1
Hi everyone. I was rushed into hospital at the end of March, seriously ill. I don’t actually remember much about it. I had had a bad cough for three weeks, which needed antibiotics but didn’t seem to improve. I started being really sick and couldn’t keep anything down. When I got to the stage where I was slurring my speech and rambling, my husband and daughter sent for an ambulance. I think they thought I had Covid. The hospital told them they would phone them every hour but it didn’t look good.
All I remember is a doctor, in PPE coming to me and telling me I had tested negative for Coronavirus.
It was only when I was on the main ward, I was told I had diabetes and one of my kidneys had stopped working.
I also had fluid in my lungs. To cut a long story short. after a week I was sent home ”for my own safety” as we had Covid patients
on the ward.
The hospital consultant diagnosed me as type 2. Firstly saying I would be on tablets but at the last minute that was changed to insulin.
In the last couple of weeks that has been changed to type 1...not definite but that’s what they think.
No matter how much I count carbs, I can’t seem to get my levels stable.
I thought I was beginning to see some hope last week but then I took a bad UTI. The gp prescribed antibiotics but my levels just kept rising. Then Sat they were at 27 and my ketones were 2.7. I didn’t know what to do. I took the extra 2 that the booklet I got said to do but still it wouldn’t come down. There was no one to ring. I tried the helpline the nurse had given me but it said it was no longer available. In desperation I phoned dalriada.. The doctor was very concerned and told me to go to the hospital right away which I did. Luckily I brought my testing kits with me as the doctor wanted to admit me right away....I honestly did not want to go back into hospital....so I asked her if I could test them again before she would ring the ward. When I did...they were down..both glucose and ketone...so she said she was relieved and let me go home with a promise to ring them before bed...or earlier if things started to go wrong again. I decided to just keep taking 2 extra units every 2 hours and I have thankfully reached today. Unfortunately I finished the antibiotics today and I’m still stinging, thankfully it’s nowhere near as bad as it was but it’s not away and levels are still quite high. Ketones are down though so I’m not as worried.
Thing is...I take recurrent UTI’s. Will this happen every time? What are the safest antibiotics to take. I am feeling totally overwhelmed at the minute. My life is revolving around this. I haven’t started back to work yet as I work with special needs kids but when we do...I don’t know if I will be able to do it. I’m sorry for the long winded post. Just feeling a bit down today.
 
Hello @Chris04 and welcome to the forum!

My goodness! what a story you have been living through. It sounds extremely stressful and worrying for you.

I suspect the sequence of illnesses you have had have made things extremely difficult to get any kind of stability. Illness, and even simply recovering from illness or injury typically requires increased insulin doses. But insulin is a tricksy beast and needs treating with caution, and increases need to be made carefully to avoid potentially disastrous hypos.

This can mean a bit of fire fighting and corrections from time to time. And it can be very useful to have a ‘sick day rules’ framework to help you.

Sickday rules pdf

Sick day rules flowchart from Leicester diabetes centre. Particularly useful for people with Type 1 Diabetes during the Coronavirus outbreak.
www.t1resources.uk www.t1resources.uk

Hopefully your UTIs (which are more common when BG is elevated, and elevate BG in turn... vicious circle!) will settle down and leave you alone soon.
 
Two things that help when you have very high ketones are 1. Extra insulin, and you need as much as you need, there are no rules almost as to how much more - you just need to keep testing your BG at least every 2 hours and 2. drinking as much plain unadulterated tap water as you can stomach, interspersed with the odd cup of freshly brewed tea but best to stay off coffee with a UTI as that alone can irritate the bladder. You will absolutely spend a lot more time weeing and will be uncomfy for a while until the UTI subsides a bit BUT ketones can kill us though UTIs can't generally - so afraid that's just tough.

With all my years diabetic - I was pretty gobsmacked to say the least when I had to increase my long acting insulin up to 300% when I broke a kneecap - ketones of 4 to begin with then quite a few days over 3, and it took nearly 3 months to get it back down to what it was before I fell over.

So yeah - you certainly are firefighting and if it was hard for me with 45 years experience under my belt - it's going to be far harder for you. Don't try to fight it - please try to just go with the flow of what you need to do when you need to do it.

Now - which insulins and what doses of them are you on?
 
You are to be congratulated - you did rvery thing right, Increased the insulin, frequent testing, got help by phone, went to A&E.

With more experience and much more nerve you might have increased the insulin even more, but basically what you did worked.

Well done.
 
Hello and welcome to the forum @Chris04 🙂
 
Thank you everyone for your help. I haven’t replied before because my daughter broke her toes? going upstairs. She didn’t want to go to A & E so she strapped them together and has been trying to manage. Then last night her husband broke his foot...don’t ask...he simple fell off the bottom stair. What is it with them and stairs lol. The have a four year old son so it’s pretty difficult at the minute. He went to hospital and has to go back Friday. I wanted to go round to help but she won’t hear tell of it. She’s more concerned about me. Anyway enough...i am on Novorapid (counting carbs) and Toujeo 9 units plus Metaformin at night. I originally came out of hospital with Novomix but no matter how I tried, I couldn’t stabilise my BS. I either was sky high or having a hypo. To be honest the Toujeo seems to do nothing...usually increases levels. Unfortunately, with the Covid 19 stilL out there, I can’t attend any clinics or training sessions. I so appreciate your help. Thank you.
 
The Toujeu insulin is not supposed to bring your levels down. Ir is used to replace or supplonent the trickle of insulin that is needed all the time to allow all the cells of the body ro use glucose as a fuel so that they can do what ever it is that they are supposed to do.

If the dosage is correct BG should not go up or down by very much when there is no food (carbs) being digested and no Novorapid insulin active.

The Novorapid should take care of meals and can also be used to adjust BG levels. You need some numbers:

How much Toujeu to inject each day.

Carb to insulin factor; for each ten gms of carb inject X units of insulin.

Correction factor: one unit of insulin will change BG by X mmol/L.

These numbers are provided as pure guess work by your HCT and WILL need adjustment, a log of food, insulin, and BG tests will be needed to allow this to be done
 
Goodness it’s so overwhelming. I have so much to learn. I know I was told to take 1 unit of insulin for every 10 carbs, also to correct by 1 for every 3 over 10. That’s it. I have been doing this to the best of my ability. I have never been told how to bring BG levels down if they are very high...only to eat 4 jelly babies if I have a hypo. This worries me because I take frequent hypos and just before I took the UTI I took one which wouldn’t come up, so I had to take 3 lots of jelly babies. If i keep that up I’ll end up the size of a house. Of course then it shoots upl. How on earth do you do it? I feel so inadequate.
 
Actually you do know, sort of, how to bring your high levels down. They are saying one extra unit of insulin will bring the level down by 3 mmol/L. They are also saying do not bother to correct unless your BG is over 10 mmol/L. So if you test before a meal and the result was 13 just add one extra unit to the pre-meal dose to correct this high. You can correct a low too; subtracting one unit from the dose will cause a rise of 3 mmol/L.

A good number to know is your jelly baby to BG convertion factor. ie one JB will raise the BG by X mmol/L. This will allow you to know how many JBs ro eat. Remember JBs take time to work so I set the kitchen timer for 15 (or 20) mins and only test when it rings. If it's more than 4, fine, just test again in half an hour. It is easy to panic and eat like a demented Billy Bunter. How do you find this factor? - suck one and see!

Complicated? Yes, but in a few weeks you will wonder what the problem was.
 
Ah - and I will say - CHEW the JBs, don't try and swallow them mega fast - because the glucose in them (or anything else) starts being absorbed via the insides of the cheeks when the teeth and saliva get going. Some people on here didn't know that, hence why I'm repeating it.

Those JBs are intelligent, they know why diabetics ae eating them - yet some of our 'gang' have been biting their heads straight off and swallowing them whole and thus never heard the JBs shouting 'Eat me slower!' or 'Chew me!'

They laugh and giggle like we're tickling them, when we eat them properly.

As Michael Caine (never) used to say, 'Not a lot of people know that'.
 
Lol no I do chew them....I like jelly babies lol. But thank you for making sure... and I will work out how much 1 of them raises my BG. It feels so good to be able to talk to people who know what they are doing. I still have the infection and have a few more days of antibiotics ahead. If my levels are over 15 but my ketones are ok, should I take extra insulin between meals to bring BG down or just leave it and correct at next meal. I’m sorry..I know no body expects the Spanish Inquisition lol ..but I’ve a million questions...as you can see lol.
 
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Chris04 said:
Lol no I do chew them....I like jelly babies lol. But thank you for making sure... and I will work out how much 1 of them raises my BG. It feels so good to be able to talk to people who know what they are doing. I still have the infection and have a few more days of antibiotics ahead. If my levels are over 15 but my ketones are ok, should I take extra insulin between meals to bring BG down or just leave it and correct at next meal. I’m sorry..I know no body expects the Spanish Inquisition lol ..but I’ve a million questions...as you can see lol.
Click to expand...

It will be interesting for you to take a look at how they work for you. The ‘baseline’ suggestions you have been given

1u = 10g carbs
1u = 3mmol/L drop in BG

also generally have an expectation that

10g carbs = 3mmol/L rise in BG

But these are just general guides, and part of improving your diabetes management involves a bit of experimentation and seeing how those are actually working for you in practice.

For instance... you may discover that at breakfast for you

1u = 8g carbs or...
1u = 12g carbs

Which is not quite so easy to work out in your head! But if you generally eat the same breakfast each day you can do the sums on a calculator and just use that dose 🙂

If you would like some help and support with this style of diabetes management thereis a free online course you can do called BERTIE

Bertie Diabetes

www.bertieonline.org.uk www.bertieonline.org.uk
 
Do I correct now of wait 'till the next pre-meal injection is due?
It depends. First on the clock, if the meal is due soon then add. If it is a long way off extra dose. If it is bedtime the extra dose, but be careful that you do not over treat.

Did you test too soon and have some short acting insulin still working? - better perhaps not to treat at all in this case. Did you miss a dose or get the dose wrong? - perhaps better to inject a correction sooner rather than later. You will need to test again later.

Do NOT expect perfection and under treat both highs and lows rather than over treating them, until you get more knowldge
pf how things work for YOU - if it works for YOU most of the time then it is right.
 
@Chris04 - I reckon 1 JB ought to increase the BG by 1.0, as it is generally reckoned that a menage a trois of em is 10g carb. (which is exactly the same as 3 from a tube of Rowntree's fruit pastilles)
 
Hi @Chris04 Welcome to the forum. Sorry you have needed to join but it is a good place for help, advice and support.

One thing I do is have a 15 min alarm after treating a hypo. I get very impatient with them, especially if I am busy. The alarm makes me wait and avoids me testing too early and then over treating the hypo and shooting up after. It still seems like an age, but really helps.
 
Yes, but what 10 gms does is a personal thing, according to my SDN it raises the BG by between 3 and 7 mmol/L.
 
leonS said:
Yes, but what 10 gms does is a personal thing, according to my SDN it raises the BG by between 3 and 7 mmol/L.
Click to expand...

Yes, like everything else, it depends. The general advice for a hypo is 15g, wait 15 minutes, and test again. (Testing with a test strip, since Libre or similar won't show anything for another 15 minutes or so.)

But someone following a low carb diet (and taking very little bolus insulin) might reasonably do something radically different. (One person I met treated her hypos with a handful of nuts.)
 
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