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aaronjunited

aaronjunited

Member
Relationship to Diabetes
Type 1
I am Aaron from Northern Ireland. I have been type 1 for 14 years now and I have never really had good management.
I am 34 and starting to see my health deteriorating so I have come on board the forums to try and get my management under control through asking questions and learning a bit more. My diet has been poor over the years and mainly simple carbs is the culprit. My mental health hasn't been great all my life up until recently I have learned to control it much better and now the diabetes damage must be reversed as much as possible. Hope to gain some better understanding of certain aspects of this illness. Look forward to chatting with you all and see you in the comments.
 
Hey Aaron and welcome to the forum. If you have any questions then please ask away. Are you on a pump or MDI?
 
Welcome to the forum @aaronjunited. I am glad that you have found the forum.

Good to read that you are wanting to get to grips with your diabetes. If you tell us a bit about how you manage it will help us tailor our replies. Are you on pens or a pump? Which insulin(s) do you use?
Have you been given access to a Libre Sensor

When looking to do a ‘restart’ it can be helpful to focus on one job at a time. In general getting your basal (background) insulin sorted first helps, since if you know that is okay you can then work on other things such as carb ratios, correction ratios and also look at the timing of your bolus (I learnt about that from others on here and it had a big impact on my levels)

Fire away with any questions that you have. Nothing is considered silly on here. Just ask.
 
Hi and welcome from me too.

Sorry to hear that you are starting to see a deterioration in aspects of your health as a result of your diabetes but It is great that you have found the forum as it is a wealth of knowledge on how to improve things. I'm just 2.5 years down the road with my diabetes diagnosis but this forum has been instrumental in helping me understand how to manage it better.

The Freestyle Libre sensor system is a game changer, so if you don't have that, then ask about it as it is available on prescription if you fit the criteria. You might also benefit from an education course like DAFNE or whatever your local equivalent is. It is an intensive course but it is about so much more than just carb counting and teaches you how to spot when your basal insulin dose needs adjusting as well as how to keep yourself as safe as possible during exercise or illness or with alcohol etc. One of the big benefits of the course is spending a week with other Type 1 diabetics because you learn so much from each other and it is refreshing just to be "normal" in a group of people.

As @SB2015 mentioned, getting your basal insulin dose (and maybe even type of insulin) correct for you is key to good diabetes management. I think many people who have been diagnosed a while assume that once your basal insulin dose is set, that is it for life or at least years, when in actual fact it can need adjusting on a much more regular basis. I have a split dose basal insulin (Levemir) which I absolutely love because I can adjust it very easily to cope with my varied lifestyle and I need much less insulin during the night than the daytime, so a long acting basal insulin like Tresiba would not work for me (it would make me hypo at night and/or high during the day) but it might be great for people who have a very regular routine. Understanding how these different insulins work and looking at your own BG patterns and lifestyle will help you to get the best basal insulin for your particular body's needs. So if you can't manage to find the right dose to keep your levels steady on the basal insulin you currently use, then trying a different one might make all the difference..... this of course is assuming you are on Multiple Daily Injections (MDI) rather than a pump.

The more information you can give us about your situation, the better we can tailor our suggestions to your individual needs.
 
Thank you for the welcome guys. I am on MDI and I tried to get the Libre a few years back but they made it so difficult for me to obtain. I guess I wasn't taking my diabetes very seriously then and they wanted to see how and why I should get access to it. I haven't worked with my team very much over the last 5 years as my mental health problems where more prominent and there just wasn't any understanding or support that worked for me so I lost hope with them all and decided to stick it out alone without their beating around the bush.

My Insulin is Novorapid and Lantus and has been since diagnosis and I believe these are suitable for the good old basic diet of CARBS CARBS CARBS. Since I am going lower carb this last week I have noticed I may need a change. It's getting hooked up with the diabetes team again that will be my main hurdle I believe. I have started to record my blood sugars over the last week which is another thing i wasn't good at. The finger pricking gets me down and I have a hard time getting blood if I don't do it in the middle of the finger, so it can be frustrating. Needs must though.

I have been looking at my basal over the last few days and with eating more fat than carbs my levels have been higher or not coming down when taking my normal amounts of novorapid. I understand this is because the fat releases slower and sometimes up to 6/8 hours later so its been giving me lots of highs and I'm using more insulin than ever. I have looked at the extended bolus methods but I'm still confused on doses as I'm not eating lots of carbs with my meals.

I think my basal needs to be upped a bit more. I have brought it up to 28 from 24 over the last 5 days but went to bed with 7.7 and woke with 11.8 this morning. I am a good carb counter just the protein and fats and how they effect my levels is all new to me so it's definitely like starting from the beginning and learning how these effect me without so much carbs in my diet.
 
Hi and thanks for providing more info.
Low carb works well for me but it isn't for everyone and it can make calculating insulin doses more complex. I generally inject for the few carbs I eat in advance (usually 1-3 units) and then watch for the protein kicking in later..... fat rarely has enough impact to make a difference but the body breaks down about 40% of the protein you eat in the absence of enough carbs (and approx. 10% of fat) into glucose. I find that starts to kick in about 1.5-2 hours after my meal and I have to inject more quick acting insulin then to correct my levels. Having Libre sensors makes this so much easier to keep track of, learn how your body responds and develop a successful strategy. You can self fund Libre (many of us did until we managed to get them on prescription.... not cheap but even on low income, it was worth every penny for me). Abbott are currently doing a 2 week free trial of the Libre 2 if you fit the criteria, so it might be worth you investigating that on their website.
The system isn't perfect and doesn't negate finger pricks .... just reduces them, but the additional information you get from them makes a huge difference to understanding how your body, food and insulin respond.

As regards NovoRapid, there is no reason why you shouldn't be able to manage a low carb diet using that. I did for quite a while and went back to it after trying Fiasp the first time and I would go back to it again. The problem for me was that it was taking a really long time to kick in on a morning and if I didn't prebolus over an hour in advance of eating breakfast I would spike up to 15 and then come crashing down to 5 each morning which didn't make me feel too great or I would get distracted after injecting and forget to have breakfast until I was suddenly hypo. Fiasp for me is not much quicker at 40-45 mins but I have a morning regime worked out now and rarely get distracted in that time. With the Libre I can keep scanning every 5 mins until I see the insulin start to kick in and then eat, but before I got it, I was testing up to 16 times a day by finger prick to help manage things. Thankfully I don't have a problem getting blood. Have you tried the old tricks of running your hands under warm water or holding a cuppa to encourage the blood flow or wriggling your fingers like you are playing a piano or swinging your arm around in a circle from your shoulder a few times, being careful not to catch anyone or thing in the process?

I think you need to contact your diabetes clinic and explain that you want to re-engage and manage your diabetes more proactively and need some help. There should be a helpline number for the clinic and the hospital switchboard should be able to put you through to it if you don't have the number. It is just an answering machine at my clinic but a nurse usually rings back in a day or two. I know they will be quite busy at the moment as Covid has created quite a lot of new cases of diabetes, but do keep ringing until you get help.

Keeping a food diary along with your readings will help you to understand how your body is responding. I did that for well over a year before I got Libre, which I can now record some stuff on.

As regards your basal, it looks like another slight increase may be needed if you are rising overnight, but it might be worth setting an alarm for 2am to see if levels are dropping and then rising due to Dawn Phenomenon (DP) or possibly dropping low and rebounding or just steadily rising throughout the night. If the latter, then a basal increase is probably needed. If you dip and then rise, it would not be recommended unless you went to bed with a slow release snack on board. Changing the time you inject your basal can have a significant impact too, so that may be something else tp consider. Possibly swapping from evening to morning or vice versa depending upon when your body needs the peak of insulin activity.

When go you take your morning reading? If you wait until you are out of bed and showered and dressed and just about to have breakfast your reading will usually be higher due to DP or Foot on the Floor (FOTF) syndrome where your liver dumps glucose into your blood stream to help give you energy for the day ahead. Most of us test the moment we wake up and before we set foot out of bed to get a better picture of what is happening overnight. My BG will rise by 4-6 mmols due to FOTF and I tend to inject 1.5-2 units of quick acting insulin before I get out of bed to deal with it..... usually with my breakfast bolus... so that I have 40 mins from then until I eat breakfast. Of course this is just how my body works and you need to work out the correct timing and insulin amount for your body.

I appreciate that some(maybe a lot) of the above may not make sense to you now, but there are so many things you can try to get better control and the members of the forum here have the experience to suggest things if/when you hit problems. It is a big learning curve and Libre helps to fill in a lot of the blanks more quickly. A couple of years ago it was really difficult to get it n prescription and if you weren't engaged with your diabetes management then you can see why they might be reluctant as they would want to give it to people who will make the most of it. It is easier now to get it on prescription and if you show that you are keen to improve your diabetes management and learn and perhaps have done the Libre trial they may be more open to changing their previous decision. For me, attending a DAFNE course seemed to improve my eligibility, although it is not supposed to directly, I felt it opened doors. Maybe that was because I showed better management and more confidence as a result of attending the course and was able to show very clearly through the records that I had kept, how Libre would help me. Showing that you are taking an active interest in improving your self management should really help though so don't be put off that you were turned down the first time you asked. That happened to most of us. You have to keep asking and build a case of evidence where they eventually can't refuse.
 
I would second what @rebrascora has said about reengaging with your team. I am pretty certain that if you show that you want to take a more proactive approach they are very likely to want to help you. If one of the DSNs was particularly difficult for you ask to see a different one. You can also ask to be a referred to a different clinic if there is another one near enough to you.

With regard to accessing the Libre, there were many hoops to jump through on the original set of criteria, but this is a lot simpler now and many more have been able to get this. Again as you are being more proactive this couod help, as well as if you are honest with them about your mental health.

The impact of protein should be minimal if there are carbs around for your body to use, but if you go very low carb then you would start to need to take account of this in your insulin doses. I find that with 30 g carbs at each meal I can safely ignore proteins.

I do find that with a fatty meal the release of carbs is slower, so when on MDI I used to avoid the big fatty meals such as Pizza or pre-prepared curries or I would split my dose, injecting half before the meal, and the other half a couple of hours later (but I often forgot to do the second half!!). With a pump this is a lot easier as you can tell it how You want it to deliver the insulin and let it get on with it.

Keep in touch and keep the questions coming, and we will help where we can. I get the impressions from what you have said that you know what you need to do and are now starting to get things sorted. Well done.
 
I've done the DAFNE course years ago so my carb counting isn't an issue thankfully. It's the complete switch from high carbs to very low carbs and higher fat that is causing most of issues now as I have stopped the binge eating carbs and addictive behaviours I find I have most problems with on a high carb diet. I don't find the protein amounts I have effect me that much either. I need to get my basal correct before anymore testing on the dosage for higher fat content is successful I guess.

I always check bloods as soon as I wake as I am aware of the foot on the floor. I don't think it's Somogyi effect happening as the bloods have been staying high all week with the diet change and higher fat content. I take my lantus at around 12 midnight and usually in bed for 3am then up around 11am/12pm. I've tried splitting lantus in the past and didn't see much improvement. I haven't ruled out DP mind you. I would say its more likely DP with the liver dumping glucose while I sleep as I usually feel all heavy and groggy.

Most of my fat content is coming from meats, mayo, coleslaw and cheese at the moment. Pizza I don't entertain at all these days. I would have Hovis nimble wholegrain bread which is really low carb, 30g serving of tesco extra mature cheddar, lettuce and cucumber and mayo. I sometimes eat tesco shortbread biscuits around 7g carb each. Easy to bolus for these. I'm not sure whether 28 units of lantus is enough to counter everything. But I guess this is my mission at the minute. 24 units wasn't causing these issues on HIGH CARB foods with much less fat in my diet which is strange.

Thank you for the replies once again and all the advice and guidance!
 
T2 here so not able to chip in with advice but wanted to welcome you to the forum and to say you're in a good place for solid advice and for support.
 
Sounds like you are already pretty "genned up" on a lot of stuff, so apologies if it sounded like I was "teaching my granny to suck eggs" so to speak. It is difficult to know how much people "know"!
Great to hear that the lower carb diet, higher fat diet has helped you to control your disordered eating. That has been the big plus for me with it and why I stick with it as it isn't always easier to manage BG levels eating that way. Bolusing for protein has been a lot of trial and error, but just using the Libre to do corrections after meals has taken the guess work out of it and I don't try to calculate it anymore I just respond to the Libre readings. So I just watch my Libre and know when levels get to 8 and are rising, I need to inject a couple of units to bring it down.
I often skip meals, so it is easy with the LIbre to see when my basal is holding me steady.
I don't think it is relevant that you aren't eating more protein but just that the protein now gets broken down once you cut the carbs.... and yes the fat contributes too, but only about 10% of fat by weight, so you would have to be eating really huge amounts to need to bolus for it compared to 40% of protein and you have to remember that there is protein in cheese and eggs and mayonnaise as well as fat, so those things are contributing to increased protein and fat, not just fat.

I have been low carb since I was diagnosed 2.5 years ago so I don't really know any different with diabetes but I had a dramatic step up in basal needs in the early part of this year when my total basal dose almost doubled over a period of a few weeks. It has been steady for several months give or take a couple of units reduction when I have been out for a run or long walk but last night I felt totally washed out and went to bed without taking my evening dose of basal and I hypoed overnight and today my levels have been right on the bottom edge of my range most of the day with my normal morning dose of basal (I take split dose Levemir) despite very little activity, so it looks like things are changing again. My basal needs have reduced by -7 units in one night which is a pretty dramatic drop and I fully expected to see levels rise today not keep dropping, so no idea what is going on, but just have to go with the flow and see what tomorrow brings.

Some people here on the forum believe that low carb higher fat causes insulin resistance. I was starting to think maybe they were right a few months ago. Today I am not so sure. All I know is that we need however much basal insulin we need and you have to be prepared to adjust that when it is needed, both up and down and that is the basis of good diabetes management. Once you get your basal insulin right everything else makes so much more sense and Libre really helps you to see that so much more easily than the odd finger prick here and there, so do keep pressing for the Libre system and if you get the chance to do the free trial, go for it!
 
Welcome to the forum @aaronjunited

Great to hear you are trying to re-engage with your diabetes management, and with your diabetes clinic. And it’s good that you’ve found some approaches that help you to manage your disordered eating.

Sorry to hear that your BGs are still giving you the runaround a little. Hopefully once you’ve got your basal insulin tweaked (or as tweaked as you can manage) you will have a more stable base to work from. I never found splitting Lantus worked for me either, but experimenting with the timing of the single dose worked well (I ended up taking it at breakfast). My other option was to try Levemir, which seems to be more flexible and responsive than Lantus. But in the end I switched to a pump instead, and have been pumping for 10 years now.
 
I highly recommend Levemir too. (with MDI)

Has anyone suggested to you that if you wash your hands in hot water, and vigorously wash them, maybe even scrub the ends of your fingers with a nailbrush then dry them and test - it should help because you've got the circulation there going and if you scrub them like that once a day every day - eventually it gets rid of hard skin. Also don't bodge holes in the pads of them - use the rounded bits at the sides of the fingernails instead.
 
Hi Aaron just to say Hello as I am also from Northern Ireland. I am newly diagnosed and like you finding the mental health aspect of it overwhelming. I hope you are doing better these days. Managing can be tough but I am finding chatting with others on here is really helping. The support is really good.
 
Welcome to the forum @aaronjunited

I have been reading through your comments and have a few comments which may help.
You mention that you struggle to get blood out of your fingers. I do too as I have Reynaud's. I find cuddling a hot cuppa before pricking helps to bring the blood to the surface. A few years ago I bought some USB charges handwarmers which do the same thing when I am out.
In the absence of a diabetes team to prescribe Libre, you could sign up for the free trial from their website. This only gives you one sensor but over that two weeks you will get a better idea of what is happening at night to be able to determine whether the high morning is Somogyi, DP, delayed carb absorption or not enough basal and may help with split bolusing.
 
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