I was diagnosed with high blood sugar a few years back and prescribed metformin but I made me extremely sick whenever I took it, and I tried a different medication which I can't remember the name and that made me very sick also. The nurses have since said that I was misdiagnosed.
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Newly diagnosed After food blood levels
- Thread starter StephenB
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Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Absolutely true! I eat pretty much what I would eat if I didn’t have diabetes.
I normally aim for 15 minutes, but if my levels are lower like 6 then I'll maybe do 10 minutes as it seems to work fast and I see it going down to 3.8 before the carbs kick in.
Well that is brilliant to know/hear from another diabetic. Thank you.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
15 mins is a reasonable time in advance 🙂 I’m on Humalog, which, as I said, is a slightly different insulin but in the same family as Novorapid and used in the same way. Before my evening meal, I can often inject just before I eat; before lunch I need 10-15 mins in advance, but before breakfast I need to inject 20- 30 mins in advance.
Breakfast is usually when we’re least sensitive to insulin and it’s quite common to have to inject further in advance then and to have a different ratio. It’s also common to need different ratios for different meals (ie breakfast, lunch, evening meal). Your ratio works out as approx 1 unit to 12g. Using that rather than deducting a unit should give you a more accurate dose.
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
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- She/Her
Hi and welcome.
Really sorry to hear you had such a rough DKA to start your diabetes journey and that you are feeling a bit lost with managing your diabetes with insulin at the moment. It is a slow, complicated process of trial and improvement in learning how your particular body responds to the insulins you have and the food you eat and the exercise you do and a whole host of other factors, so don't expect to get great results in a matter of a few months. Really pleased you have come to the forum though as it is a goldmine of knowledge and practical experience so I am sure we can help you improve things.
It sounds like you are on fixed doses of insulin at the moment rather than carb counting and adjusting your own doses according to what you want to eat. Am I right in that assumption? If so then you have quite a big step to come. Have you had no input at all from the diabetes clinic since you were discharged from hospital. Generally there is follow up phone calls for a few weeks to check on your progress and an appointment at the clinic at some point in the first few months and then probably 6 monthly, but you should have a means of contacting a nurse or the clinic if you need help.
The rises you mention are not out of the ordinary after meals in the early stages. I can remember I used to spike up to 15 most mornings after breakfast and then come crashing back down to 5 about 2-3 hours later. It wasn't very pleasant, but it took time to work out the right timing for injecting my insulin in advance of breakfast. The trick is to carefully adjust the timing of the meal time insulin (NovoRapid in your case) by a few minutes each day prior to the meal until your levels stop spiking so high but not so far in advance that you hypo whilst you are eating or not long after. For me with NovoRapid this turned out to be a whopping 75 mins before I ate breakfast, which is very extreme and why I eventually changed to a faster insulin. Basically I digest food quite quickly and absorb insulin quite slowly, so I need to give the insulin a bigger head start to hit the blood stream the same time as the glucose from the food I have eaten gets there. Most people find about 30 mins prebolus time is enough at breakfast and less at other times of day, but some people only need to inject 5 mins before they eat and some need to inject after they eat. It really is very individual which is why you need to start where you are now and gradually increase the time by a few mins each day, until you find your sweet spot timing and it can be quite different for different meal times. Evening meal usually needs the least time and breakfast the longest, but everyone is different, so you have to find what works for you. How long before meals do you currently inject your NovoRapid?
You have added more info whilst I have been typing, but the prebolus timing is almost certainly what you need to adjust to prevent levels spiking so high, if you are coming back down into range before your next meal.
I imaging the 1 :10 insulin units to g carbs ratio minus 1unit is just a simple rule to keep you safe from hypos without having complex ratios and if it is working well for you then great. I think if you are restricting your carbs a bit and sticking to about 50g carbs per meal then it will continue to work for a while, but nothing stays the same for long with diabetes so it will likely eventually change.
I remember the nurses trying to encourage me to "eat normally" after my diagnosis as Type 1 (I was initially diagnosed as Type 2 and went low carb and have remained so, but do have the odd treat now and then). I think when you are seeing levels spike with relatively low carb meals, it can be scary to consider eating more, but gradually as your confidence grows you will learn how to dose for more, it really does just take time to build up that confidence, although I think some Type 1s find that there are foods which are just not worth the BG upheaval except perhaps for special occasions. It is all about finding what you are happy and comfortable with and it takes time to find that balance both in terms of managing BG levels but also balancing that with living life and enjoying yourself. In my opinion it is better to gain confidence and learn to walk really well with your diabetes before you start to run, so do what you are comfortable with food wise but know that it is up to you to push those self set boundaries when you are ready to and perhaps find ways to experiment in a safe environment..... so for instance. before going out for a night on the down with your mates, have a practice run with alcohol in the safety of your own home, so you learn how you respond to alcohol with insulin and how best to manage it. Same with higher carb foods. Do it when you feel confident to take that next step, not just because the nurse says to do it.
Eventually you will be offered an intensive education course like DAFNE which will give you a framework of how to manage all these everyday situations, like meals out and alcohol and illness and exercise, but mostly you will learn from experimenting on yourself. Libre is a wonderful tool in allowing you to see what is happening and stay safer, so we are all really lucky to have this and other technology to help us, although it is not perfect, so don't take everything it shows as gospel. It has a tendency to exaggerate the highs and lows a bit, so do bear that in mind.
Really sorry to hear you had such a rough DKA to start your diabetes journey and that you are feeling a bit lost with managing your diabetes with insulin at the moment. It is a slow, complicated process of trial and improvement in learning how your particular body responds to the insulins you have and the food you eat and the exercise you do and a whole host of other factors, so don't expect to get great results in a matter of a few months. Really pleased you have come to the forum though as it is a goldmine of knowledge and practical experience so I am sure we can help you improve things.
It sounds like you are on fixed doses of insulin at the moment rather than carb counting and adjusting your own doses according to what you want to eat. Am I right in that assumption? If so then you have quite a big step to come. Have you had no input at all from the diabetes clinic since you were discharged from hospital. Generally there is follow up phone calls for a few weeks to check on your progress and an appointment at the clinic at some point in the first few months and then probably 6 monthly, but you should have a means of contacting a nurse or the clinic if you need help.
The rises you mention are not out of the ordinary after meals in the early stages. I can remember I used to spike up to 15 most mornings after breakfast and then come crashing back down to 5 about 2-3 hours later. It wasn't very pleasant, but it took time to work out the right timing for injecting my insulin in advance of breakfast. The trick is to carefully adjust the timing of the meal time insulin (NovoRapid in your case) by a few minutes each day prior to the meal until your levels stop spiking so high but not so far in advance that you hypo whilst you are eating or not long after. For me with NovoRapid this turned out to be a whopping 75 mins before I ate breakfast, which is very extreme and why I eventually changed to a faster insulin. Basically I digest food quite quickly and absorb insulin quite slowly, so I need to give the insulin a bigger head start to hit the blood stream the same time as the glucose from the food I have eaten gets there. Most people find about 30 mins prebolus time is enough at breakfast and less at other times of day, but some people only need to inject 5 mins before they eat and some need to inject after they eat. It really is very individual which is why you need to start where you are now and gradually increase the time by a few mins each day, until you find your sweet spot timing and it can be quite different for different meal times. Evening meal usually needs the least time and breakfast the longest, but everyone is different, so you have to find what works for you. How long before meals do you currently inject your NovoRapid?
You have added more info whilst I have been typing, but the prebolus timing is almost certainly what you need to adjust to prevent levels spiking so high, if you are coming back down into range before your next meal.
I imaging the 1 :10 insulin units to g carbs ratio minus 1unit is just a simple rule to keep you safe from hypos without having complex ratios and if it is working well for you then great. I think if you are restricting your carbs a bit and sticking to about 50g carbs per meal then it will continue to work for a while, but nothing stays the same for long with diabetes so it will likely eventually change.
I remember the nurses trying to encourage me to "eat normally" after my diagnosis as Type 1 (I was initially diagnosed as Type 2 and went low carb and have remained so, but do have the odd treat now and then). I think when you are seeing levels spike with relatively low carb meals, it can be scary to consider eating more, but gradually as your confidence grows you will learn how to dose for more, it really does just take time to build up that confidence, although I think some Type 1s find that there are foods which are just not worth the BG upheaval except perhaps for special occasions. It is all about finding what you are happy and comfortable with and it takes time to find that balance both in terms of managing BG levels but also balancing that with living life and enjoying yourself. In my opinion it is better to gain confidence and learn to walk really well with your diabetes before you start to run, so do what you are comfortable with food wise but know that it is up to you to push those self set boundaries when you are ready to and perhaps find ways to experiment in a safe environment..... so for instance. before going out for a night on the down with your mates, have a practice run with alcohol in the safety of your own home, so you learn how you respond to alcohol with insulin and how best to manage it. Same with higher carb foods. Do it when you feel confident to take that next step, not just because the nurse says to do it.
Eventually you will be offered an intensive education course like DAFNE which will give you a framework of how to manage all these everyday situations, like meals out and alcohol and illness and exercise, but mostly you will learn from experimenting on yourself. Libre is a wonderful tool in allowing you to see what is happening and stay safer, so we are all really lucky to have this and other technology to help us, although it is not perfect, so don't take everything it shows as gospel. It has a tendency to exaggerate the highs and lows a bit, so do bear that in mind.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Here’s an online course which covers carb-counting @StephenB :
I can’t stress enough how overwhelming Type 1 can be to start with because you feel you’re doing an impossible job, but you’ll gradually start fitting diabetes into your life rather than the other way round. It might not seem like it, but every week you’re gaining experience and knowledge. Again, it really will get easier. Type 1 will always be a pain in the bum, but it will stop being such a pressure as you learn more and get used to things.
I can’t stress enough how overwhelming Type 1 can be to start with because you feel you’re doing an impossible job, but you’ll gradually start fitting diabetes into your life rather than the other way round. It might not seem like it, but every week you’re gaining experience and knowledge. Again, it really will get easier. Type 1 will always be a pain in the bum, but it will stop being such a pressure as you learn more and get used to things.
That is very helpful to know, thank you
Yes, I asked my nurse if she could get me on some diabetic courses and she recommended bertie, I'm definetly going to do that. Yes my partner keeps telling me that eventually I will be able to just have a meal and carry on but for the last3 months I am constantly checking the libre for my levels, and panicking and laying down to try to not let it go high, even though that just seems to mask it because the moment I stand up my levels shoot up.
Hi, Thank you for your message, yes it's been so tough since the dka, and everything is making me worry, I never expected to take on this much with a diabetes diagnosis, I never realised how much it takes over your life.
What would you say is a "normal" amount of carbs for a meal? I try to stick to 50 because it's what I know but would like to mess about with it a bit.
Yes the eating normal idea just seems insane to me only because when I've heard of diabetes before it was always seen to me as cut this out and don't eat that.
I have an appointment on the 15th with a consultant, my first one so I will ask about the dafne course, the nurse recommended the bertie course which I will give a go. Libre is excellent, but it also makes me very paranoid.
Thank you for all your information.
How many carbs per meal do you try to aim for? As I normally do 50, but I worry its not enough.
Leadinglights
Well-Known Member
- Relationship to Diabetes
- Type 2
- Pronouns
- She/Her
The reason you will have heard that about diabetes is the majority of people are Type 2 which is treated differently mostly by diet plus for some people oral medication though some then do need insulin.
So the diet requirement is to reduce carbohydrates to a level that their body can cope with.
Type 1 is treated very differently but still needs insulin to be tailored to the individuals carb intake and that can be different for each individual.*
So the diet requirement is to reduce carbohydrates to a level that their body can cope with.
Type 1 is treated very differently but still needs insulin to be tailored to the individuals carb intake and that can be different for each individual.*
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
There is no "normal" carb intake. It depends on your tastes and your body size and your age and the amount of exercise you do and what you fancy and the occasion....there is no normal, just what you are happy with.
If you are currently getting comfortable with managing 50g in a meal, then start trying 60 or 70g and see how you get on. Build your confidence up with more as you feel ready to.
I follow a low carb way of eating as I said, so normal for me is about 30g and often less but if there is a special occasion like a birthday to celebrate at the local Chinese restaurant where we have a banquet, then I might have 80 or 90, maybe even more, although generally on these occasions, I still eat less carbs than I would have done pre diagnosis and to be honest I feel better for eating less, but maybe that is because my stomach has shrunk, because I have got used to eating smaller meals..... no bad thing in my opinion. I used to hate that horrible feeling of having over eaten when I got home after a big meal out.
TYpe 1 and Type 2 diabetes can be very different in the approach and generally Type 2 need to restrict calories or carbs or both, especially if they are managing it with tablets or just diet, whereas with Type 1 it is simply about you injecting the insulin that your pancreas can no longer supply for the food you eat. Before you developed diabetes, you didn't worry about how many carbs you ate and your body produced insulin to cover what you ate. Now you have to inject that insulin instead. With Type 2 you have insulin resistance so need very large amounts of insulin to overcome that resistance and the more carbs you eat the more insulin you need and the more resistant you become. Your doses are relatively small so you don't have insulin resistance, so you don't have to worry about that. If you were needing 100 units of Lantus a day and 30-60 units of NR per meal, it would be different, but you don't.
It is likely that your insulin doses will increase a bit in the next few years but that is normal as your own pancreas may still be producing a little insulin itself at the moment, but this will gradually dwindle as your immune system slowly kills off your remaining insulin producing beta cells, so don't worry if you start to need a bit more or perhaps a bit less for a while as the injected insulin gives your remaining beta cells a bit of a breather. The honeymoon period can last several years where your own insulin production limps along in the background contributing a little bit here and there. It was about 2 years from diagnosis when mine seemed to fizzle out and I needed to nearly double my dose over a period of a few months and it has been reasonably stable since then, give or take a few units up or down for more or less exercise or hot weather and a couple of bouts of illness when things went a bit haywire for a week or two. If it helps to give you an idea, I need about 20-25 units of basal a day and I still use a 1:10 carb ratio. Other people here need less and some need more. It depends on your body weight and exercise/activity levels and metabolism.
I think what can be difficult to get your head around is that there is a very broad spectrum of normal and you are not necessarily striving to be in the middle of that range, but just what works for your body. Like I said in my previous post, I needed to inject NovoRapid 75 mins before I ate breakfast to prevent spiking up to mid teens. That is crazy and pretty much the longest I have heard anyone else need to prebolus, 20 mins is about the norm, but I can't change my body and that was what it needed. Thankfully I could change my insulin to a slightly faster one and now I just need 30-45 mins at breakfast sometimes less and just 10-20 mins at other times of day. This is what my body needs. You have to find out what your body needs, so don't try to aim for "normal", because there is no such thing, just what is right for you and your body.
If you are currently getting comfortable with managing 50g in a meal, then start trying 60 or 70g and see how you get on. Build your confidence up with more as you feel ready to.
I follow a low carb way of eating as I said, so normal for me is about 30g and often less but if there is a special occasion like a birthday to celebrate at the local Chinese restaurant where we have a banquet, then I might have 80 or 90, maybe even more, although generally on these occasions, I still eat less carbs than I would have done pre diagnosis and to be honest I feel better for eating less, but maybe that is because my stomach has shrunk, because I have got used to eating smaller meals..... no bad thing in my opinion. I used to hate that horrible feeling of having over eaten when I got home after a big meal out.
TYpe 1 and Type 2 diabetes can be very different in the approach and generally Type 2 need to restrict calories or carbs or both, especially if they are managing it with tablets or just diet, whereas with Type 1 it is simply about you injecting the insulin that your pancreas can no longer supply for the food you eat. Before you developed diabetes, you didn't worry about how many carbs you ate and your body produced insulin to cover what you ate. Now you have to inject that insulin instead. With Type 2 you have insulin resistance so need very large amounts of insulin to overcome that resistance and the more carbs you eat the more insulin you need and the more resistant you become. Your doses are relatively small so you don't have insulin resistance, so you don't have to worry about that. If you were needing 100 units of Lantus a day and 30-60 units of NR per meal, it would be different, but you don't.
It is likely that your insulin doses will increase a bit in the next few years but that is normal as your own pancreas may still be producing a little insulin itself at the moment, but this will gradually dwindle as your immune system slowly kills off your remaining insulin producing beta cells, so don't worry if you start to need a bit more or perhaps a bit less for a while as the injected insulin gives your remaining beta cells a bit of a breather. The honeymoon period can last several years where your own insulin production limps along in the background contributing a little bit here and there. It was about 2 years from diagnosis when mine seemed to fizzle out and I needed to nearly double my dose over a period of a few months and it has been reasonably stable since then, give or take a few units up or down for more or less exercise or hot weather and a couple of bouts of illness when things went a bit haywire for a week or two. If it helps to give you an idea, I need about 20-25 units of basal a day and I still use a 1:10 carb ratio. Other people here need less and some need more. It depends on your body weight and exercise/activity levels and metabolism.
I think what can be difficult to get your head around is that there is a very broad spectrum of normal and you are not necessarily striving to be in the middle of that range, but just what works for your body. Like I said in my previous post, I needed to inject NovoRapid 75 mins before I ate breakfast to prevent spiking up to mid teens. That is crazy and pretty much the longest I have heard anyone else need to prebolus, 20 mins is about the norm, but I can't change my body and that was what it needed. Thankfully I could change my insulin to a slightly faster one and now I just need 30-45 mins at breakfast sometimes less and just 10-20 mins at other times of day. This is what my body needs. You have to find out what your body needs, so don't try to aim for "normal", because there is no such thing, just what is right for you and your body.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
I don’t aim for a certain amount of carbs @StephenB . I choose what I’m going to eat, then work out the carbs. If you were a normal weight before you got diabetes, then I’d aim to carry on with how you were eating before, unless it was badly.
I’m female, very slim and petite so your carb average will probably be higher than mine. Presuming you’re male, then you’ll probably be having more carbs than me once you’ve got things worked out as the weeks pass. I eat anything from approx 150g to 220g carbs per day, occasionally higher than 220g. I don’t aim for anything - I just choose my meals and tot up the carbs beforehand so I know how much insulin to have.
“Yes the eating normal idea just seems insane to me only because when I've heard of diabetes before it was always seen to me as cut this out and don't eat that.”
This bit is really important: almost everything you read and hear about diabetes is about Type 2. Type 2 is a very different condition to Type 1 (in fact, there are periodic campaigns to change the name of it). Type 2s have to watch their diet because they have metabolic issues and insulin resistance. Often these issues cause them to be overweight. Type 1 is nothing like that. It’s an auto-immune condition where our immune system wrongly attacks and kills the insulin-producing beta cells in our pancreas. ‘All’ we have to do is take over the job of those beta cells by injecting insulin. We’ll never do as good a job as our own pancreas, of course, but we should be able to lead a normal life while doing so. Normal diet, normal exercise, normal job, normal travel, etc etc.
The reason I put the ‘all’ in inverted commas above is because ‘being a pancreas’ isn’t always easy. We have to count carbs, work out insulin, pre-plan meals, pre-plan exercise - a lot more thinking!
So, looking at your meals, think about what you’d have eaten pre-diagnosis and gradually increase your carbs if necessary (ie adding a few more grams, trying that for some days until you get your insulin pretty ok, then adding a few more grams if needed and repeating). As you refine your control, you might find that you need different ratios for different meals ie breakfast, lunch, etc). You might also find that different meals (ie different foods) like pizza and fish and chips require you to inject slightly differently. This is because they’re high fat and that can cause a later rise in blood sugar, so some people need to split their mealtime injection (split = have some of the insulin before the meal and some after). All these things are tiny tweaks and refinements you’ll learn over time. Don’t worry about them now. I only mention them in case you eat fish and chips and are worried that ‘something went wrong’.
You mention lying down because your blood sugar goes up when you stand up? You could try a little exercise after a meal - simply doing some household chores rather than sitting down can help reduce the spike after meals.
**An important thing that occurred to me is to tell you that the Libre is not as accurate at the extremes of the range. It’s best in the middle. So, your 16 after a meal might not actually be a 16 at all. If you check with a finger prick, you might find it’s a 12.9. So do try finger-pricking to get an idea of whether your higher numbers are accurate.
Bruce Stephens
Well-Known Member
- Relationship to Diabetes
- Type 1
I think it's important to be generous to yourself, particularly early on. This is an extra 24/7 job that's just been imposed on you.
Something Libre (and other CGMs) gives is Time In Range. So don't try to always be under 10.0 (or whatever). Try to get to a place where you're between 4 and 10 over 70% of the time (the Libre software will show you where you are with that). And less than 25% of the time over 10 but especially less than 5% under 4. With any luck you'll find you can do better than that, but if you just get there you'll be doing rather better than most people with Type 1 in England.
Hi, thank you for all that information, this is all very useful for me and much appreciate your information im grafeful for any help i can get right now.
I have been avoiding activity because it seems to make my levels go high, if I sit still or lay down I find it seems to keep it leveled out after the initial rise, in my mind I feel like if I was active it would go high and stay high and potentially go higher than what I normally see. That part of it has really affected my life because I'm not going out or doing any excersize, I don't work at the moment and it makes me think how do people get on if they're eating at work and see their levels rise and see it staying high all day. I haven't tested it properly as in where I've done stuff for the day to see where it will go, fear always gets the better of me and end up thinking I should stay still or lay down because that is what I see making it stay at bay. So I guess really what I wanted to ask is in your experience of this what do you typically see with your own levels if you eat and go out and do stuff, does it come down just the same or stay higher or go lower quicker.
Leadinglights
Well-Known Member
- Relationship to Diabetes
- Type 2
- Pronouns
- She/Her
From a not Type 1 perspective, you are in early days of trying to get an insulin regime that is going to work for you, eating normal things, doing the activity that would be normal for you otherwise diabetes will be controlling your life.
Working it all out will take time but experimenting with different things but keeping safe by always having your testing kit and hypo treatment to hand.
It can be a bit of trial and hopefully not too much error but be a learning process if things go awry.
Working it all out will take time but experimenting with different things but keeping safe by always having your testing kit and hypo treatment to hand.
It can be a bit of trial and hopefully not too much error but be a learning process if things go awry.
Hi, thanks do much for your message. I have taken a lot from what you have said. If possible would I be able to ask your advice on a few more questions?? It would help me a great deal. If that's ok I'll message tomorrow or Tuesday. Many thanks
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
If I sit down after a meal, eg eat my meal then just move to the sofa and sit there watching TV for two or three hours, my blood sugar will go higher than if I’m active after the meal. Sometimes I’ll need more insulin (called a correction dose) if it goes really high. Conversely, if I eat my meal, pick in the washing, put the bins out and/or take the dog for a 15 or 20 minute walk, my blood sugar will come down. I find it easier to control my blood sugar after a meal if I’m a little bit active. Some days I just go up and down the stairs putting things away, and even that helps.
It’s unusual for your blood sugar to go up unless you lie/sit after a meal - very unusual. It could be that lying/sitting makes you feel more relaxed whereas being active makes you anxious and stressed, so the stress is pushing your blood sugar up. It could also be that your insulin doses aren’t quite right yet. If you want, you could experiment by eating the same easily countable evening meal a few nights in a row and try various activities to see what happens to your blood sugar. If you go out for a brief walk, remember to take hypo treatments with you.
Generally, exercise will lower blood sugar (eg a walk or a swim). However, some people find very vigorous activity will raise it (eg sprinting). Don’t let the Type 1 stop you exercising. Build it up gradually and cautiously week after week @StephenB
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