Newly diagnosed Type 1 and now going on a P&O cruise - advice please

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Anne C

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Type 1
Hi everyone,

Looking for some advice. I was diagnosed 3 months ago with Type 1 out of nowhere! I am 40. Its all been a bit of a rollercoaster since then. I currently take no long-acting and just Novarapid with meals. My time in range is currently in the high 60s but only with a ban on all fun - no eating out, no takeaways, no cake, no dessert :( Any eating out or takeaways knocks it out for days. I did a 4 night cruise in March and had spikes frequently into the 20s despite being armed with the carbs and cals book - it was very difficult to judge the components of the food and every meal was different in the main dining room. By day 4 my eyes were going blurred. I am now facing 7 days of this and wondered what the strategy should be? Does anyone have any experience of requesting simple meals in the main dining room? According to the website, they cater for diabetic but I'm assuming this is keto.

Also, my diabetes nurse team used to phone me every week in the first month then just stopped phoning altogether. Is this normal? I have no follow up appointments or anything.
 
Is there a reason you're not taking long acting insulin?
 
Have you asked for an appointment? I’d speak to your team for more help on adjusting doses if you’re not confident with that yet. Also discuss a basal insulin. You shouldn’t need to restrict what you eat, so a bit more learning before you go and then eat what you like. Have you done the free online Bertie course?
 
Welcome @Anne C 🙂 Type 1 is a bit like the Monty Python sketch about the Spanish Inquistion - nobody expects it! Rest assured there are plenty of Type 1s diagnosed in adult, many older than you, so you’re not alone🙂

Why aren’t you on a long-acting insulin? Are you carb-counting and adjusting your Novorapid doses accordingly? Do you know how to do correction doses? The recommended diet for Type 1 is the same healthy diet recommended for people without diabetes. When you’re on your cruise, I’d go for meals with easy to count carbs but also know how to correct any highs if necessary.
 
Hi. Yes, you should surely have a Basal insulin as well - do ask for this to be added. I believe NICE guidelines say this for T1. It you go to the buffet for breakfast and lunch as we do on a cruise you can select the right foods. There are usually low-sugar options on the dinner menu but may still be high'ish carbs. Many of us even on Basal/Bolus need to control our carbs to avoid high BS spikes but the buffet helps the choice. I would avoid asking for a diabetic meal as few understand what that means and you will end up with a low-fat meal.
 
Welcome to the forum @Anne C from another late starter (aged 53) with T1.

It is indeed a roller coaster at the start but it does get easier. More so if you have the right tools and it looks like you are missing one by not having a background (basal) insulin to deal with the glucose that your body is trickling out all the time to keep you going even if you don’t eat. Well worth asking for that to be included now, especially with the levels that you have mentioned.

For meals you will need to gradually find what the right ratio of cabs to insulin is for you. This will also change over time. The Diabetes Specialist Nurse (DSN) will have started you off on a ratio (often 1 unit of insulin to 10g of carbs) but this will need to be tweaked. Have they talked to you about how to make these adjustments yourself. If not ask them to help you with this.

You mention spikes after meals. I suspect that cruise meals may be very high in carbs. If I eat a big meal (more than 60 g of carbs) I find that I need more insulin than my ratio would suggest. More trial and improvement to find out what works for each of us.

If your levels are back down to where they were before the meal after four hours then you have the right amount of insulin, and you might find that you can reduce your spikes by injecting your insulin earlier. I only do this at home where I know what I will be eating and when I will be eating. When away I can do this at breakfast as it is often self service, so after the first day Ican set myself a target for carbs, inject for that before I eat. The insulin is then active by the time the glucose hits my blood stream. Another thing to talk to the DSN about.

We deal with a lot of variables every day, but it does get to be just a ‘new normal’.
There is a wealth of experience to tap into on here so ask any questions that arise. Nothing is considered silly on here. Just ask.
 
SB2015 said:
You mention spikes after meals. I suspect that cruise meals may be very high in carbs.
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Not really, the portions are usually tiny and there’s plenty of choice
 
Re the calls from the diabetic nurse...its normal for these to trail off as you become more confident. You should expect appointments with your hospital team though - i am on one a year now as all well. I would expect you to have a number to contact the nurses should you need it. Also yearly eye and feet check
Have you been offered the Daphne course? It goes into carb counting etc. That may help.
Also, unless there is a good reason, i'd expect you to have a basal (long acting) insulin. I don't need a basal all the time, but thats farly unusual, and for most its an essential part of an insulin routine.
Do you have a way to check for ketones?
As for post meal spikes, excercise is a great help for those
 
Wow, thanks for all the advice everyone. So I started with a basal as well but due to overnight lows was told by DB nurse to keep lowering the dose and then eventually told to just stop it altogether as I was down to 3 units by this point and wasn't worth it. My overnights are in line between bed and waking up so I think this is correct. I have a carb ratio of 1 unit to 15g which was advised by the DB nurse but I have adjusted that from time to time as required. I am enrolled on a DAFNE but not until July as they advised it wasn't a good idea during the honeymoon period. The BERTIE is a good shout so I'll get that done before we go. Have been reading the book written by David Cavan who recommends meals with carbs < 30gs which I've been trying to follow. I guess this is partly why the eating out is causing such issues - because I go from one extreme to another (and also it being very hard to judge the carb content with unfamiliar sauces etc...and then resisting the dessert....). A full 3 course meal has got to be well over 100g of carbs. I struggle a bit with correction doses not knowing how much to put in when the levels still seem to be rising and am nervous about injecting large quantities just before bedtime. I will phone the nurse next week. Sounds like the buffet is the safest bet anyway 🙂
 
You can have dessert @Anne C It’s not necessary to eat such a strict diet and sometimes it can make things harder. I eat around double the carbs you do and have very good control and a TIR between 85 and 95+ %. It’s all about the insulin with Type 1. Learning to manipulate that as well as you can is the way to succeed.

There are a couple of books often recommended for Type 1s on this forum:

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).

Think Like A Pancreas is American but I liked the chatty style and it contains some great information, as does the Ragnar Hanas book.
 
Anne C said:
Wow, thanks for all the advice everyone. So I started with a basal as well but due to overnight lows was told by DB nurse to keep lowering the dose and then eventually told to just stop it altogether as I was down to 3 units by this point and wasn't worth it. My overnights are in line between bed and waking up so I think this is correct. I have a carb ratio of 1 unit to 15g which was advised by the DB nurse but I have adjusted that from time to time as required. I am enrolled on a DAFNE but not until July as they advised it wasn't a good idea during the honeymoon period. The BERTIE is a good shout so I'll get that done before we go. Have been reading the book written by David Cavan who recommends meals with carbs < 30gs which I've been trying to follow. I guess this is partly why the eating out is causing such issues - because I go from one extreme to another (and also it being very hard to judge the carb content with unfamiliar sauces etc...and then resisting the dessert....). A full 3 course meal has got to be well over 100g of carbs. I struggle a bit with correction doses not knowing how much to put in when the levels still seem to be rising and am nervous about injecting large quantities just before bedtime. I will phone the nurse next week. Sounds like the buffet is the safest bet anyway 🙂
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Anne you are doing brilliantly considering how recently you have been diagnosed. Well done. You have already got your head round much of this. It is a lot to learn and there are lots of adjustments we need to make, and this will get easier.

I tend to avoid meals out which have sauces as they can have a lot of hidden carbs, but sometimes things are just exactly what I fancy and I just do my best.

Keep the questions coming.
 
I am not Type I but I have been on cruises with Celebrity and Cunard. I find they give a variety of choices. I normally just ask for fish, meat, poultry and just vegetables which do not include potatoes. The buffets also have a wide variety of food including high glycaemic and lower.

They are usually very happy to oblige wherever they can even if you have no medical problems.
 
Anne C said:
I struggle a bit with correction doses not knowing how much to put in when the levels still seem to be rising and am nervous about injecting large quantities just before bedtime. I will phone the nurse next week. Sounds like the buffet is the safest bet anyway 🙂
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Hope you get some useful info from your call with the nurse, and some advice on how to negotiate the unknowns of cruise food, plus strategies for corrections if needed!
 
I have only done one 14 day cruise it was with Celebrity Cruise and I came back a slightly lower weight than at the start , They offered a very varied range of meals so I just chose what I know to be similar to my regular size of portion / type of meal .I was diagnosed at aged 42 , and we were going to Florida in two weeks after being diagnosed , it wasn't an option to not go on holiday, it had been arranged twelve months in advance and my children would not have been happy. Your diabetes is with you for the rest of your life, I took the view we would have to learn to rub along together , it is trial & error and you will soon find what works for you.
 
Hi @Anne C welcome. Like you I was diagnosed type 1 recently at 40, and like you was initially drawn to a low carb diet - you mentioned 30g at a meal, but I wouldn’t be too restrictive even if it means more rapid insulin, so you can enjoy a meal with higher carbs or that 3 course meal. I’m finding 70 - 90g of carbs per meal means I can still enjoy pasta and rice etc, but making sure it’s wholewheat or brown helps after some experimenting. Ultimately I might reduce this over time after the “honeymoon” you’d also mentioned, but hopefully you have a relaxing cruise and fully enjoy it.
The book @Inka recommended, think like a pancreas, is excellent as a novice to all this.
 
Wotisname said:
I have only done one 14 day cruise it was with Celebrity Cruise and I came back a slightly lower weight than at the start , They offered a very varied range of meals so I just chose what I know to be similar to my regular size of portion / type of meal .I was diagnosed at aged 42 , and we were going to Florida in two weeks after being diagnosed , it wasn't an option to not go on holiday, it had been arranged twelve months in advance and my children would not have been happy. Your diabetes is with you for the rest of your life, I took the view we would have to learn to rub along together , it is trial & error and you will soon find what works for you.
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I lost weight on a Celebrity Cruise too. People were amazed. I explained to them there was so much variety of food and also lots of healthy options. Also I don't eat myself stupid just because it is there!! I would end up being sick anyway and what is the point of that🙂
 
Thanks everyone. I phoned the nurse team on Monday but still waiting for my call back from the nurse. I have the Think Like a Pancreas book and I've just purchased the Type 1 Diabetes in Children & adolescents - going on Saturday so I'll take that one with me. I also did the Eating out section of BERTIE. Still not sure on the correction doses but feel more informed all round 🙂
 
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