New to Diabetes Type 1

[marina winter]

Hello everyone,
My son is newly diagnosed and is struggling with snacks in between mealtimes. Could really do with some help please?

 

[Thebearcametoo]

Hi and welcome

Can you give us some more info please so we can help

How old is he and what are the issues you’re having?

 

[marina winter]

He’s 24, fit and healthy, was diagnosed a few days ago, is on 3 injections a day before mealtimes and then a further injection at night.

 

[everydayupsanddowns]

Welcome to the forum @marina winter

Sorry to hear about your son’s diagnosis

But good to hear he is on a flexible insulin regime, that in time he will learn to adjust and adapt to allow him to eat pretty much whatever he wants, whenever he wants.

Snacking can be a bit of a conundrum for sure, but there are a number if strategies that different people try…

One of the old-school approaches was to not worry about snacks of less than 10g carbs, and certainly I find I can grab a handful of nuts without having to faff about with extra insulin. So opting for low carb snacks can certainly work.

However, 10g of carbs does have the potential to raise glucose levels by 3-4mmol/L, which could be enough to cause a frustratingly high level after a well-managed meal.

Some people opt for a strategy of adding a little extra insulin to meals to account for a snack taken in the hours after the meal - but this always feels a bit high risk to me, as the insulin is already ‘on board’, so the clock is ticking, and you can’t get distracted or forget to have the extra carbs without risking BG levels dipping.

You can snack simply be adding another insulin dose for the carbs involved. But the tricky thing about adding extra insulin is that the previous meal dose will still be active, and you’ll be stacking extra insulin (with its own onset/peak/tail) on top of what is already acting, which can make things behave slghtly unpredictably.

Some people find that the increased insulin sensitivity that comes with physical activity is enough to give them sufficient wiggle room for a snack if they are going to be more physically active (eg taking extra snack carbs without insulin when going for a walk, or doing physical work).

Most likely your son will end up using a combination of all of those techniques at different times. Including one of the most important… which is aiming to reduce the habit of regular snacking - simply because the faff and uncertainty involved takes some of the enjoyment out of the snacks themselves 😉

 

[marina winter]

Thank you. The nurses did mention an extra injection if he smacked more than 10g carbs but he’s then worrying about leaving 4 hours between injections and his night injection which he has to take at 9. If he snacked after his evening meal would he have to have his bedtime injection later?

 

[SB2015]

Welcome to the forum @marina winter . I am sorry to hear of your son’s diagnosis but pleased that you have found the forum.

Just to clarify regarding the bedtime insulin. This is a basal insulin also called background insulin. This deals with the glucose that our bodies dribble out all the time to keep us ticking over. It is nothing to do with our quick acting insulin (bolus) which we use to cover the carbs in our meals. So the short answer is Yes your son still needs to take his bedtime insulin. This is long acting and will take home through to his next basal insulin the following evening.

There is a lot to learn at the start but it definitely gets easier. Keep the questions coming. Nothing is considered silly on here. Just ask.

 

[Inka]

Hi @marina winter I guess by nighttime injection you mean his basal/long-acting insulin? That’s separate from his bolus/meal/fast injections. So - just as an example - somebody could eat their evening meal at 6pm with a bolus/meal/fast injection beforehand, and then inject their basal/slow insulin at 8pm.

In addition, the advice about leaving 4 hours between injections is only a precaution, especially for those newly diagnosed. Once your son knows what’s what and has enough experience, he can inject his fast insulin as needed and won’t have to leave a 4 hour gap. That’s something for the future though - best and safest to keep things simple now.

You mention snacks and, if he’s anything like most newly diagnosed Type 1s, he’s probably very hungry and has lost weight. That hunger is completely normal. If he wants snacks below 10g carbs, he can have cheese, raw veg, nuts, cold meat, etc

 

[rebrascora]

Hi and welcome.

His long acting insulin does not impact the meal time insulin, so he can inject that and his meal time insulin at the same time if he fancies a snack at 9pm when his basal insulin injection is due. The two act completely separately.

If he is going to inject for a snack, he needs to be aware of how many carbs are in the snack and adjust the dose accordingly, particularly if he is currently on fixed insulin doses for his meals.
Personally, I think it is easier and safer (particularly at this early stage, to have low carb snacks like eggs or cheese or veggie sticks with dips or cooked meat maybe with coleslaw, particularly near bed time because going to bed with active mealtime insulin on board is always a bit risky in case you miscalculated and you have a hypo during the night. It isn't so much of a concern during the day when you can monitor things more closely.

 

[marina winter]

Thank you everyone for your help and support. Been really helpful for us. Thank you again

 

[marina winter]

Hello everyone. It’s only 5 days on insulin, we’re seeing the diabetic team tomorrow but he’s just tested and he’s at 28.9!! Ketones are 0.1. Should we be worried? He was admitted with DKA in the first instance but Keyones then we’re at 6.9

 

[Inka]

Hello everyone. It’s only 5 days on insulin, we’re seeing the diabetic team tomorrow but he’s just tested and he’s at 28.9!! Ketones are 0.1. Should we be worried? He was admitted with DKA in the first instance but Keyones then we’re at 6.9

Get him to wash his hands and re-test. If he’s still 28.9 he is at risk of DKA and should seek some medical input despite the low ketones.

 

[marina winter]

Ok. Will do it again now.

 

[Inka]

If he is that high, try to work out why. Has he missed an injection, for example? Could he be ill?

 

[marina winter]

He’s not unwell but wasn’t when he had DKA. His glucose levels were 37 with ketones of 6.9. He felt fine!! The hospital couldn’t believe it.
He’s going to re test at 10 giving it an hour between tests.

 

[marina winter]

He hasn’t missed his injection.

 

[Inka]

He’s not unwell but wasn’t when he had DKA. His glucose levels were 37 with ketones of 6.9. He felt fine!! The hospital couldn’t believe it.
He’s going to re test at 10 giving it an hour between tests.

So when he re-tested just now, was he 28.9 or so?

 

[marina winter]

He’s going to re test at 10pm. I’ll let you know the result. Thank you for your help and support so far.

 

[Inka]

He’s going to re test at 10pm. I’ll let you know the result. Thank you for your help and support so far.

When you get a high blood sugar result that you weren’t expecting, it’s important to verify it’s correct. You do this by washing your hands well and re-testing immediately. Either you find you must have had something on your finger messing up the test (even an invisible smear of food can do that) or you realise you are truly high and something has gone wrong and then you can attempt to get things back into range or seek prompt medical input.

 

[marina winter]

It’s now 27.3 it’s going down

 

[rebrascora]

Does he know why it has gone that high? What was his premeal reading tonight and what did he have for his evening meal?
Those sort of levels are really not good and it is always good practice to try to figure out what happened so that he can hopefully prevent them going that high again. In the meantime, drinking plenty of water will help to flush some of it out of his system.