New type 1

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Rory Delap's Long Throw

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Type 1
Hi all, Newly diagnosed type 1 after admission to a&e a couple of weeks ago. Shock as no family history and in my 40s, but at least caught and a relief from awful symptoms like endless thirst and tiredness. I was given the libre 2 sensor in hospital and cant believe how helpful it is as soneone new to all this. A huge credit to the NHS team that looked after me as well and the diabetic team who have bombarded me with useful info!
My insulin has been set at 20 solostar and 10/8/8 novirapid for breakfast lunch and dinner, but have started to try and reduce carb intake over time. Only now im a releasing just how big my pasta and rice portions were. Also hope to get back to exercise as would normally spend a good few hours on the bike in a normal week.
I've been reading the forum over the last week or more and already have some really useful tips, hopefully I can help others over time as I get to grips with it.
 
Welcome, sounds like you’re doing well just be careful about reducing those carbs because you’re on fixed doses of insulin and those novorapid doses will have been calculated assuming you eat a certain amount of carbohydrates at each meal
 
Hi @Rory Delap's Long Throw and welcome. Sorry to hear about your diagnosis. There’s quite a few of us here diagnosed as adults and with no family history. I was 41, eg.

As a Type 1 there’s no need to reduce your carbs, just make sure you cover the carbs you eat with an adequate amount of insulin.

Fire away with any questions... :D
 
Welcome @Rory Delap's Long Throw 🙂 Interestingly, approx 9 out of 10 people who develop Type 1 don’t have a family history of it.

As said, you shouldn’t reduce your carbs on fixed doses of mealtime insulin. The best thing you can do is learn to carb count so you can adjust your mealtime insulin according to the carbs you’re about to eat. In the meantime, try to establish the appropriate amount of carbs for each meal to ‘fit’ your insulin dose. That way you’ll find it easier to reduce both highs and lows.

Solostar is the name of an insulin pen. Is your basal/long-acting insulin Lantus?
 
Thank you both, I am under the impression that although the NHS advice is to continue with carbs as part of a healthy diet, other advice outside the UK points towards a lower carb intake, in order to help keep glucose in range more easily. I can see the benefit of lowering carb intake over time and gradually reducing insulin intake as needed. Honestly I would normally eat twice the normal portion size of carbs with a meal which just wasn't ideal anyway.
I've had a few dips close to hypo so far even after a moderate walk, I'm more aware of symptoms of lower blood sugar (which I've had for months thinking I was just hungry after exercise), so guess I need to see how I deal with exercise over time.
 
Inka said:
Welcome @Rory Delap's Long Throw 🙂 Interestingly, approx 9 out of 10 people who develop Type 1 don’t have a family history of it.

As said, you shouldn’t reduce your carbs on fixed doses of mealtime insulin. The best thing you can do is learn to carb count so you can adjust your mealtime insulin according to the carbs you’re about to eat. In the meantime, try to establish the appropriate amount of carbs for each meal to ‘fit’ your insulin dose. That way you’ll find it easier to reduce both highs and lows.

Solostar is the name of an insulin pen. Is your basal/long-acting insulin Lantus?
Click to expand...
Thanks, oh yes I take lantus as the long acting in the morning - I take my breakfast novirapid along with it just to get 2 injections out of the way.
I'm on the waiting list for the dafne course and using the carbs and cals app which has been useful. I am still eating plenty of carbs but afraid to alter my rapid dosage, but do have a follow up meeting with the diabetic team in a month or so.
 
Rory Delap's Long Throw said:
I am under the impression that although the NHS advice is to continue with carbs as part of a healthy diet, other advice outside the UK points towards a lower carb intake, in order to help keep glucose in range more easily. I can see the benefit of lowering carb intake over time and gradually reducing insulin intake as needed.
Click to expand...
Eating low carb can either cause hypos with your fixed doses or can actually increase your insulin requirements as it can make you more insulin resistant.
 
Rory Delap's Long Throw said:
Thank you both, I am under the impression that although the NHS advice is to continue with carbs as part of a healthy diet, other advice outside the UK points towards a lower carb intake, in order to help keep glucose in range more easily. I can see the benefit of lowering carb intake over time and gradually reducing insulin intake as needed. Honestly I would normally eat twice the normal portion size of carbs with a meal which just wasn't ideal anyway.
I've had a few dips close to hypo so far even after a moderate walk, I'm more aware of symptoms of lower blood sugar (which I've had for months thinking I was just hungry after exercise), so guess I need to see how I deal with exercise over time.
Click to expand...

People with Type 1 generally eat normally. Obviously some people’s normal is excessive or full of junk foods, which isn’t a good idea, but the recommended diet for Type 1s is the same healthy diet recommended for everyone else. Eating too few carbs can cause insulin resistance as @Lucyr said.

You don’t need to eat low carb to get good results. As an example, one successful way of eating for diabetes is a very low fat plant-based diet (see Mastering Diabetes). This improves insulin sensitivity and Time in Range. One proponent of this diet takes around 26 units of insulin a day in total and eats 600g carbs per day (because his insulin sensitivity is excellent).

There are a couple of books often recommended for Type 1s 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).

Both are very helpful, as is this forum.
 
There’s some basic information about carb-counting here @Rory Delap's Long Throw :

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...
www.diabetes.org.uk www.diabetes.org.uk

And an online course:


Carb counting is often over-complicated and made out to be some kind of complex dark art to newbies, but it used to be taught at diagnosis and still is in some areas. You’ll pick it up 🙂
 
Inka said:
People with Type 1 generally eat normally. Obviously some people’s normal is excessive or full of junk foods, which isn’t a good idea, but the recommended diet for Type 1s is the same healthy diet recommended for everyone else. Eating too few carbs can cause insulin resistance as @Lucyr said.

You don’t need to eat low carb to get good results. As an example, one successful way of eating for diabetes is a very low fat plant-based diet (see Mastering Diabetes). This improves insulin sensitivity and Time in Range. One proponent of this diet takes around 26 units of insulin a day in total and eats 600g carbs per day (because his insulin sensitivity is excellent).

There are a couple of books often recommended for Type 1s 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).

Both are very helpful, as is this forum.
Click to expand...
Thanks for this, I'll have a look at those books, I had bought Vickie de Beer's recipe book and ordering Dr Bernstien's Diabetes book (hence my thoughts on lower carb approach over time).
 
Inka said:
There’s some basic information about carb-counting here @Rory Delap's Long Throw :

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...
www.diabetes.org.uk www.diabetes.org.uk

And an online course:


Carb counting is often over-complicated and made out to be some kind of complex dark art to newbies, but it used to be taught at diagnosis and still is in some areas. You’ll pick it up 🙂
Click to expand...
True, I've never used a kitchen scale before now
 
Dr Bernstein eats an extremely strict diet and has total hypo unawareness. Be careful. Although Dr B himself is a knowledgable man, some of his followers are totally bonkers. There’s a lot of cr*p out there on the internet and a lot of it is centred round those followers and similar groups. Some of those followers are on massive doses of insulin - because their extreme diet messed up their sensitivity to the very drug they need to keep them alive.
 
Rory Delap's Long Throw said:
Thanks for this, I'll have a look at those books, I had bought Vickie de Beer's recipe book and ordering Dr Bernstien's Diabetes book (hence my thoughts on lower carb approach over time).
Click to expand...
I second/third the “no need to eat low carb” approach.
My philosophy on diabetes management is looking after all of me, not just the diabetes part. This means not letting diabetes control my life.
For me, this is eating what I want which is lots of fresh fruit, vegetables, fish and home baking. I do not eat a low carb diet or go for a walk immediately after every meal or watching my CGM like a hawk or limiting my exercise or … as Dr Bernstein suggests going on the pill because women’s hormones are too difficult. Ok, so the latter may not be relevant fir you but it is an idea of the kind of control some people put on their lives due to diabetes and the lack of balance from some low carb evangelists like Dr Bernstein.
I do not mean that I do not manage my diabetes. It is part of me that I take care in as much as work/life balance, regular exercise, not drinking too much, etc.
This approach works for me, my lifestyle and my body - 20 years after diagnosis, I have no complications due to diabetes, hypo awareness, relatively low insulin and a HbA1C below the type 2 threshold.

Sorry, I did not mean to get onto my soapbox.
I should have started by welcoming to the forum and reassuring you that your life does not need to change unless you want it to.
 
Hi and welcome from me too.... another late starter with Type 1 at 55yrs old. That was 5 years ago now and it is just my new normal.

I follow a low carb, higher fat way of eating and it suits me well because it has helped me gain control of my disordered/comfort eating and sugar addiction. I am not desperately strict with it but most days I stick to about 70-80g carbs. I was initially thought to be Type 2 so that was why I started low carbing but by the time I started on insulin 6 weeks later, I was starting to see health benefits to reducing the carbs plus most of my cravings stopped, so I continued with it. I would not say it is easier as I have to inject before meals for the carbs in the meal and then 2 hours later for the protein release (about 40% of protein breaks down into glucose in the absence of enough carbs), but digestio of protein is much slower, so it doesn't start to release it's glucose until 2 hours after eating and then it is a steady release for about 4-6 hours. In the early days my own insulin was still enough to deal with the glucose but gradually I found that I had to start injecting for it. I don't calculate how much insulin I will need for protein, I just inject a unit or two when my levels get to 8 and start drifting upwards. Libre is brilliant for allowing me to see it happening and I basically just inject insulin when I see my levels slowing increasing. I have my alar set at 9.2 and if that goes off I inject 2 units, although I may need another unit or two later as well. This only works because the carbs in my meals don't generally take me up to 8. For anyone following a normal diet I would imagine their levels would regularly go above 8 or 9.2 due to carbs and you would certainly not inject insulin in that situation because you will already have bolused for the carbs before the meal and that insulin will bring them back down, so I am not recommending you try this, especially on fixed doses, because you put yourself at a high risk of serious hypos, but just illustrating that low carb is not as easy/straightforward as you might expect. I personally have not seen any obvious insulin resistance in the 5 years I have been low carb and I still use a 1:10 insulin to carb ratio when I can be bothered to carb count. 🙄 I do find the protein release can be useful for exercise if I time it right as it is a slow steady release over several hours, but planning and timing are not my strong subjects, so mostly I have to inject for the protein. I probably average about 7-8 injections a day, instead of the usual 5 (I have a twice daily basal, so that is 2) so low carbing does require several more injections, but for me it means more stability in my levels and less mental band width thanks to Libre, because I basically just calculate my insulin based on my Libre readings/graph.

Anyway, many congrats on your 80% TIR so far as that is really great going for someone who is relatively newly diagnosed..... and indeed for anyone who has been diagnosed a long time for that matter. 70% is the target, so you are overachieving at the moment! Well done!
 
Quite a lot to digest (forgive the pun) in terms of approach, appreciate the advice and caution. Realistically I’ll not be changing anything soon if at all, the one challenge I want to get over is exercise and understanding a couple of sudden dips in blood sugar after an hour walk, roughly an hour after dinner on a couple of occasions. Also had a day gradually falling down to 3.8 a few times even with similar carb intake across meals, so trying to read up on post prandial hypos.
 
Your own pancreas will probably still be making small amounts of insulin on a bit of a random basis @Rory Delap's Long Throw That can cause unexpected lows.

For exercise, either eat extra carbs at your preceding meal or top up with carbs as you walk and as needed. That’s a simple way to do things at this stage.
 
Exercising with a decent amount of bolus insulin on board is risky. NovoRapid lasts about 5 hours but the first 2 hours are when it is most active so exercising within that time after injecting will be the cause of your hypo. Many people learn to reduce their bolus by a few units if they plan to exercise after a meal, or take on more carbs. Exercise affects your levels (generally lowers them) for up to 48 hours afterwards and for me it is my evening levels which are most responsive to exercise, so I have to reduce my evening basal dose after exercise otherwise I will hypo through the night. Obviously you can't do that with taking a single dose of basal in the morning, so maybe push your levels a bit higher than normal at bedtime if you start to notice nocturnal levels dropping due to exercise earlier in the day.

What do you have your low Libre alarm set at? Mine is 4.5 which usually gives me plenty of time to prevent a hypo but some people have their low alarm set higher at 5 or even 5.6. You are missing a trick in my opinion if you set your low alarm at 3.9 as by then you have no opportunity to prevent a hypo, just to treat it, so it might be worth considering raising your low alarm if it is currently 4 or below.
 
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