New to insulin

[rigsby]

Hi I am a 69 year old man who has been prediabetic for two years but whose blood sugar suddenly went up dramatically, despite having lost weight and started to eat more healthily. I started to get blurred vision and reduced vision, so the doctor ordered a blood test and the results were so high I was called into hospital and started on insulin immediately.

I am still losing weight and eating carefully but my teatime and bedtime blood sugars are too high still (anything from 15 to 29 on my tester) despite an increase in insulin and further changes to my diet. I had a CT scan on my pancreas today. I was diagnosed on 30th October 2019, so still struggling with the routine.

Any advice and support please?

 

[TheClockworkDodo]

Hello @rigsby and welcome to the forum - sorry to hear what you're going through at the moment.

I'm not a medical professional, but if you've been told you're type 2, it sounds to me from what you've said as though you may have been misdiagnosed and that you may have either slow onset type 1 or type 3c (depending on the result of the CT scan - type 3c is a rare type caused by pancreatitis). The treatment for both of these is insulin, so if you do have one or the other of them, you are at least already receiving the right treatment. If the scan comes back negative, it would be worth asking to be tested for type 1 - ideally you'd want a C-Peptide test and a GAD antibody test (both blood tests).

Can you tell us which insulins they have put you on (if you don't know the type, what are the names of them)? - as this may effect any advice we can give. Have they given you fixed doses, or have they taught you how to increase your own doses according to what you eat?

What sort of things are you eating before you get the high readings? It may be you are eating what would be a healthy diet for a non-diabetic, but haven't cut out a few things which are bad for diabetics (a lot of people continue to eat fruit or drink fruit juice after diagnosis, for instance, not realising that a lot of diabetics can't tolerate much fruit, and fruit juice is an absolute no-no unless your blood sugar is too low).

 

[rebrascora]

Hi and welcome from me too.

I agree with Juliet. It sounds like you were misdiagnosed originally and you are actually slow onset Type 1. Good to hear that you were despatched to hospital and started on the correct treatment (ie insulin) and further testing arranged. I too would suggest you ask if they will do C-peptide and GAD antibody tests as well as the CT scan to clarify which Type you really are. The Type 2 diagnosis is just an assumption based on a high HbA1c which denotes you are diabetic and your age as it had previously been thought that Type 1 only affected children and young adults, so anyone older with a high HbA1c was assumed to be Type 2. More and more older people are now being properly tested for Type 1 and diagnosed and the consultants in my area now compete with each other for the oldest newly diagnosed patient. At 55years and 1 day, I was not in the running.

It is pretty overwhelming when you are first told that you will need insulin and learning to inject and work out how much to give yourself etc but you will get the hang of it with time.... I am just 7 months into it and whilst I don't always get it right still, it is not nearly so daunting. Just be prepared to make mistakes sometimes (it happens despite your best efforts) and always carry some hypo treatment with you wherever you go as hypos often hit you when you least expect it.

I would guess that your high readings might be down to bread and pasta and potatoes etc. Those were the things that spiked my levels really high for many hours on end. People who are diagnosed with diabetes or prediabetes often assume that they just need to cut down on the sugar and cakes and biscuits but the body breaks starchy carbs like bread and pasta down into glucose just the same. A spoon of sugar or a piece of fruit might spike me for an hour or two at most but a slice of bread would spike my BG for 8-10 hours so they have a significantly worse effect. I no longer eat bread and pasta now (even though I can inject insulin for it) unless in exceptional circumstances where I am hosted and it would be rude to refuse. I prefer my low carb diet as there is less chance of injecting too much insulin and going hypo and I enjoy what I eat without those heavy stodgy carbs.

 

[rigsby]

Thanks to you both for your advice. I do eat bread, potatoes and cereals and 2 pieces of fruit a day. I so miss having a piece of cake or fruit pie or a biscuit, but have not eaten them for ages but will cut the bread and potatoes out, fruit if I have to. I don't drink fruit juice.

I take novarapide 10 at breakfast, 14 lunch and 14 teatime and Toujeo 15 at night. The night time dose works and morning readings are perfect, the glucose levels just go up as the day goes on so it must be food related or the pancreas function is worse than anyone thought. It will be at least a week before I get the results of the CT scan. I will ask for type 1 testing if this doesn't settle. The diabetic nurses ring me once a week for readings and advise a change of insulin where necessary but the doses are going up.

Can anyone suggest something filling instead of bread and potatoes as I have a very good appetite and am really struggling being hungry all the time, although I am losing weight gradually anyway?

 

[rebrascora]

Hi again Rigsby

Because you are now on fixed doses of insulin you will need to be careful about reducing your carbohydrate intake otherwise you could go too low which can be worse than being too high so in some respects it may be best to continue eating the bread and potatoes etc and the nurse will help you to adjust your NovoRapid over the coming weeks to match what you eat and bring those BG levels down. They like to start with low doses and slowly increase the insulin to match your food so if you start cutting out the starchy carbs now it may lead to you going hypo and make it more difficult for the nurse to work out how much insulin you need for meals. Eventually you should get a course like DAFNE (Dose Adjustment For Normal Eating) which will help you to calculate the carbs yourself in whatever you eat and work out how much insulin you need to inject to cover it.

I was a bit different because I started eating very low carb in order to try to control my diabetes (initially diagnosed Type2) by diet and oral meds. I was 6 weeks into it and off bread, pasta, rice, potatoes, breakfast cereals and porridge as well as cakes biscuits and sweets before they realised that something was amiss and insisted that I start on insulin and I was started on very low doses as a result... just 6 units of long acting insulin a day and 4 units of NovoRapid with food. Even then it was causing me to hypo. They told me to eat normally, but I was no longer sure what that was for me. I tried increasing my carbs but it just seemed to make me go too high or too low so I went back to low carb eating and I much prefer that now and feel healthier for it. I probably only eat half of what I used to eat but I feel satisfied and don't get the hunger pangs or cravings for food that I did when I was eating carbs. I attribute this to eating more fat which takes longer to digest and therefore keeps you feeling fuller for longer. I have a nice chunk of cheese (I have developed a love for blue cheese, having hated it all my life before this) with breakfast and cream in my coffee and creamy natural yoghurt with my low sugar Nutty Granola. I have a few olives or nuts at lunchtime and lots of veggies like spinach, leeks, cauliflower and cabbage or kale all cooked with a knob of butter or a dollop of cream cheese with my evening meal of meat or fish. I sometimes have a couple of small potatoes but once you get used to eating low carb you don't miss them. I experiment once in a while with wholemeal pasta or bread with a sandwich but I almost always regret it even though I weigh them very precisely and calculate the carb content accurately because my BG levels become much more erratic and I feel hungry the next day.

I hope your team at the diabetes clinic help you to find a good balance with your insulin soon. If you do decide to cut down on starchy carbs, just make very small changes like one less potato or half a slice of bread less. You will however most likely feel hungry doing this because your body will crave those carbs.
What amazes me now is that people can now eat cakes or sweets in front of me and I don't feel deprived or crave them. This is a total revelation for me as I had such a sweet tooth prior to my diagnosis it would be fair to say I was not just an addict but a "heavy user". I think it was necessary to go cold turkey for me to cure that and then the introduction of more fat into my diet made it filling and enjoyable and therefore sustainable.

 

[silentsquirrel]

If your diagnosis is changed to T1 or T3c then DAFNE should be an option, but if it remains as T2 then it will be whatever local course is provided for T2 insulin users, which is unlikely to be as detailed as DAFNE, sadly.

 

[trophywench]

Protein is filling - I find eggs especially so.

 

[TheClockworkDodo]

I'd increase things like full-fat cheese, meat, fish, and eggs to fill you up, and cut things like bread and potatoes a bit (but not too much - as Barbara says you don't want your blood sugar to go the other way and get too low). If you are currently eating white bread, then switching to brown or granary might help as you will take longer to digest them. Boiled or baked potatoes are better than mashed potatoes for the same reason.

If you can eat something like porridge instead of packet cereals that will be less sugary (Weetabix is also not too bad) and will fill you up more too.

If you are eating exotic fruits (including bananas and grapes) these are likely to spike your blood sugar up, so it might help to switch to fruits like apples, pears, and berries, at least for the time being until you've got your blood sugar more stable.

It's good that the diabetes nurses are ringing you once a week and increasing your doses, and not leaving you to manage this on your own. It will take a while to get the doses right, so don't worry that things don't change instantly (people often say on here that diabetes is a marathon, not a sprint). The doses they put you on at first are a "best guess", and it's better to make small adjustments gradually than to make a big change and have your blood sugar plummet dangerously.

 

[Drummer]

If you are used to a bulky low nutrition diet - which high carb can be - it might take a while for your body to realise it is not lacking anything.
In the mean time you could try such things as eating a small serving of berries with sugar free jelly and cream - sometimes I make up the jelly with less water than required and then make it up to a pint once it has cooled using full fat Greek yoghurt. It can be whipped up to make it frothy, so it is well over a pint in volume, and it keeps in the fridge.
Another dish which many like is cauliflower cheese. I steam some frozen cauliflower until almost done, then take a warm dish from the oven, put in the cauliflower, cover it with cream cheese, add a pinch of dried herb or ground spice - whatever you fancy, then cover with grated cheese - I favour Red Leicester. Put the dish back in the oven - not too hot, just enough to get the cheese to start to melt and get a golden top. As those are both low carb it should make it less problematic with serving sizes, a little or a lot makes not a great deal of difference to total carb intake for a meal.

 

[rigsby]

Thank you for all your support and wonderful advice. It's really appreciated.