Newly diagnosed with T1

Status
Not open for further replies.

jaijones_1997

New Member
Relationship to Diabetes
Type 1
Hi everyone, I got diagnosed with T1 a couple of weeks ago after being admitted to the hospital and having ketoacidosis with my blood sugar levels at 28.4 and ketone at 6.4. I feel physically good now but mentally I am struggling. I am scared to eat as my numbers have been quite high. It has only started to drop to a normal-ish range of 7.9 - 10 in the last couple of days. Before that, it was sitting around the 10-17 range. The diabetes team has put my lantis up to 20 and my NovoRapid to 5/6 with meals. But they have told me to use trial and error with having a snack. I generally do eat more than 40-50g of carbs per meal and when I do snack I try and go for snacks usually 1g. Has anyone got any advice? Sorry for the long post
 
Welcome to the forum that no one wants to need to join.

When you are first diagnosed, your team will want to bring your levels down slowly. You started rather high, so your levels over the last fortnight sound very normal post diagnosis, and you are now in normal range. Don’t be surprised if your levels jump around as you start to learn how to manage them. none of us can get them perfect all the time, we just do the best that we can.

You are in fixed doses at present with some flexibility around meals, and your team will work with you to hand the responsibility of mealtime doses, so that you can eventually eat what you want when you want.

For snacks:
- if going low/hypo I use Jelly babies for a quick rise
- if I am about to go for a stroll perhaps an apple
- for low carb options nuts.

Have you started to look at carb counting? This is the basis of our management, so start looking at the labels on your foods. We are looking for a best estimate at each meal and then we learn, by trial and improvement how much insulin to give to balance the carbs we eat. Lots to learn but take things step by step.

It is a steep learning curve at the start, a bit like learning to drive, where things seem really complicated at the start, then things become more automatic, and we just watch for obstacles and changes along the way.

There is a wealth of experience to tap into on here, and I have learnt most of what I use day by day from the practical advice on here. Ask any questions that arise. Nothing is considered silly on here. Just ask.
 
Hi, thanks for that. I would love to start carb counting but I was told until they have figured out my base insulin and figured out what my insulin to carbs ratio is then I can start carb counting. I do keep on remembering myself it has only been 2 weeks since I have been diagnosed and I need to be less hard on myself
 
Hi, thanks for that. I would love to start carb counting but I was told until they have figured out my base insulin and figured out what my insulin to carbs ratio is then I can start carb counting. I do keep on remembering myself it has only been 2 weeks since I have been diagnosed and I need to be less hard on myself
Even if they don't want you to be 'carb counting' just yet it is still a good idea to start to become familiar with what to look for on packets and the internet for the carb content of foods.
To use @SB2015 's analogy a bit like looking at the highway code before starting the driving lessons.
 
Yeah definitely, I fully get the concept of carb counting and I have always been very good at reading packaging and understanding generally what carbs are in what. It’s just knowing what my insulin-to-carbs ratio is but I know I will take time to get to a time where I can control it properly
 
Yeah definitely, I fully get the concept of carb counting and I have always been very good at reading packaging and understanding generally what carbs are in what. It’s just knowing what my insulin-to-carbs ratio is but I know I will take time to get to a time where I can control it properly
It is very hard to be patient at the start, but work with your team. They will get you onto the carb counting as soon as they can But it is important to take things slowly at the start.

If you work out your carbs for each meal, and record this alongside your BG and insulin dose this will help your team to hit on the correct ratios more quickly. The more data they have the better. It will also help you to see the progress you will be making as things settle.

It sounds like you are in safe hands, and they are protecting your eyes and kidneys by bringing levels down steadily. Keep reading and get yourself ready by learning as much as you can.
 
Welcome @jaijones_1997 Sorry you’ve had to join us. My advice is to pace yourself both physically and mentally. It takes months to get the hang of practical things and even longer to get your head round the emotional side. But things do gradually get easier.

I was just going to say the same @SB2015 above about recording your carbs, but she beat me to it! Don’t stress about your levels. It’s still very early days. It takes time to get things more balanced. Slow and steady is the way.
 
Welcome to the forum @jaijones_1997

Sorry to hear about your diagnosis, but good to hear your levels are coming down gradually and steadily.

It’s perfectly natural to feel a bit knocked sideways by a diagnosis with diabetes, so be kind to yourself, and give yourself time to adjust and adapt. Some liken it to a form of grieving, with all the intensity of emotion and psychological impact that can involve.

It’s also perfectly understandable to want to be given the right doses (or ratios / correction factors) so that you can just crack on and get things sorted. But diabetes is a fickle so and so, and what you will probably find is that your doses and sensitivity to insulin flex and change over the months and weeks. Sometimes changing with the seasons, other times seemingly changing on a whim!

Some of the most important skills to learn are the resilience and flexibility to go with the flow, and adjust and adapt your strategies as your diabetes flounces about changing the rules.

Stick at it. It sounds like you are off to a great start, and you’ll soon begin to piece together a picture of what your diabetes needs right now to be kept in its box. 🙂
 
Yeah definitely, I fully get the concept of carb counting and I have always been very good at reading packaging and understanding generally what carbs are in what. It’s just knowing what my insulin-to-carbs ratio is but I know I will take time to get to a time where I can control it properly
Hello Jai! I was diagnosed 3 months ago.

Like Inka, I agree with SB2015 about starting now with counting and recording your carbs; that is information both you and your team need. (Don't just record the carbs, though; also make a little note of what the meal was, so you can start to see whether your body reacts differently to different types of meals.)

Also agree with the general view of 'don't stress too much about it'. But-- for some of us, it is far less stressful to be *doing* something, rather than simply waiting.

You might find it helpful to do the BERTIE Online course straightaway: https://www.bertieonline.org.uk . I did!

Fortunately, I discovered this forum not long after my diagnosis, and on one thread or another discovered a mention of BERTIE Online, and then did the course (which is free)-- I think actually about two weeks after my diagnosis, so around the same point you're at. My basal had been set and they'd started me on fixed mealtime doses; they weren't going to give me the carb-counting course for another 6 weeks. I found this very frustrating and worrying.

For me, one of the most helpful thing about the BERTIE course was that it mentions using 1 unit of insulin to every 10g of carbs as a starting point for figuring out your ICR. Obviously, once you have even a rough idea of a starting point-- and once you're recording your BG readings, your insulin doses, and the carbs you eat-- you can tinker with your mealtime dosage yourself and work out your personal insulin-to-carbs ratio yourself.

As for low-carb snacks, to fill in those little gaps when you don't want to inject more insulin: cheese! cheese! and more cheese! And almonds-- the lowest carb nuts I know.

Finally, you don't mention whether they've given you a CGM yet? If not, press them for it! All best wishes.
 
Hi,
Thanks for the reassurance. I know it will take time and I appreciate the support. Lucky I love Cheese and almonds and I do snack on them. I also love almond butter!
 
As for low-carb snacks, to fill in those little gaps when you don't want to inject more insulin: cheese! cheese! and more cheese! And almonds-- the lowest carb nuts I know.
The usual advise is that you can snack on up to 10g carbs without taking insulin.
The problem with eating low carb food is that our body will convert this to glucose and may still impact blood sugars. I find a large bowl of nuts (I struggle to eat a few) will need insulin due to this.
It is definitely no where near as easy as eating carb free to avoid raising blood sugars.
 
The usual advise is that you can snack on up to 10g carbs without taking insulin.
The problem with eating low carb food is that our body will convert this to glucose and may still impact blood sugars. I find a large bowl of nuts (I struggle to eat a few) will need insulin due to this.
It is definitely no where near as easy as eating carb free to avoid raising blood sugars.
My understanding is that the fats and the proteins in food are not converted into glucose.

Most cheeses have 0 or near-0 carbs, and I find I can eat quite a bit of cheese with no apparent effect on my BG, even though, for me, even 5g carbs can have a significant effect on my BG.

As for nuts: Some nuts have quite a few carbs per 100g; cashews, for example, have 16.8g carbs per 100g. Almonds, though, have only 4.8g carbs per 100g. I find that 50g of almonds is very filling and has no apparent effect on my BG.
 
My understanding is that the fats and the proteins in food are not converted into glucose.
In the absence of carbs, these are converted to glucose. This is glucogenesis and the reason why many of us find we need insulin when we eat something carb free like a cheese omelette.
 
Hello @jaijones_1997, I'm Type 3c (no pancreas) but my treatment is as if T1, plus some quirks.

Very early on I got Gary Scheiner's book "Think Like a Pancreas" and found that very useful as part of getting some understanding about insulin dependency. One of the things he covers is conversion of carbs, proteins and fats into blood glucose. All foods can get converted into glucose, but our bodies find the carbs easiest and so convert those first. Gary Scheiner suggests a 30gm 'rule', whereby if any main meal has more than 30gms of carbs then the body generally won't bother with converting proteins or fats. This seems to be supported by other specialists as well as people with D. This also is not difficult, since a low carb diet might be be anything below 130 gms daily, so 3 meals at 30gms is well short of that sort of level.

Generally carbs have a predictable conversion rate into glucose, for any one person and sometimes at different rates for the time of day - so one adds up the carbs, apply a conversion rate for that meal time and take a bolus accordingly. But proteins have different rates of conversion for different types, so the 'sums' get a bit more messy and the conversion into glucose takes a fair bit longer; so juggling timing needs even more consideration. Fats are worse for the sums and time juggling! So the 30gm carb rule keeps things simpler, without being at all excessive - unless you are intent on going keto with an ultra low carb diet, when the 30gm rule can't be used as guidance and glucose estimating becomes more hit and miss until you find how ultra low works for you. I favour keeping things simpler, whenever possible and I have a healthy appetite, with good cholesterol levels and a good BMI; so I eat what I want and take my insulin accordingly.

Gary Scheiner also says:
"Diabetes is complicated, confusing and contradictory". I think that is so true. I don't try to control my D, the unpredictable moments make that a vain aspiration. But I do aspire to managing it, accepting that sometimes there are glitches; then see if there is a reason (so lesson to be learnt) and move on without over-analysing it all.

I also, after about a year, got Dr Ragnar Hanas' book "Type 1 Diabetes in children, adolescents and young adults"; the title misleads, its fine for 73 yr olds as well!

Arguably there is comprehensive information just within this forum and a book on D isn't really necessary. But authors tend to present their guidance in a structured format and sometimes it's easier to research within that structure. This forum is brilliant, a huge amount in here, but sometimes a search here is not successful because the exactly correct word isn't being asked; and also sometimes there is too much information within any one thread.

That's my hint to myself to stop rambling and wish you well.
 
Hello @jaijones_1997, I'm Type 3c (no pancreas) but my treatment is as if T1, plus some quirks.

Very early on I got Gary Scheiner's book "Think Like a Pancreas" and found that very useful as part of getting some understanding about insulin dependency. One of the things he covers is conversion of carbs, proteins and fats into blood glucose. All foods can get converted into glucose, but our bodies find the carbs easiest and so convert those first. Gary Scheiner suggests a 30gm 'rule', whereby if any main meal has more than 30gms of carbs then the body generally won't bother with converting proteins or fats. This seems to be supported by other specialists as well as people with D. This also is not difficult, since a low carb diet might be be anything below 130 gms daily, so 3 meals at 30gms is well short of that sort of level.

Generally carbs have a predictable conversion rate into glucose, for any one person and sometimes at different rates for the time of day - so one adds up the carbs, apply a conversion rate for that meal time and take a bolus accordingly. But proteins have different rates of conversion for different types, so the 'sums' get a bit more messy and the conversion into glucose takes a fair bit longer; so juggling timing needs even more consideration. Fats are worse for the sums and time juggling! So the 30gm carb rule keeps things simpler, without being at all excessive - unless you are intent on going keto with an ultra low carb diet, when the 30gm rule can't be used as guidance and glucose estimating becomes more hit and miss until you find how ultra low works for you. I favour keeping things simpler, whenever possible and I have a healthy appetite, with good cholesterol levels and a good BMI; so I eat what I want and take my insulin accordingly.

Gary Scheiner also says:
"Diabetes is complicated, confusing and contradictory". I think that is so true. I don't try to control my D, the unpredictable moments make that a vain aspiration. But I do aspire to managing it, accepting that sometimes there are glitches; then see if there is a reason (so lesson to be learnt) and move on without over-analysing it all.

I also, after about a year, got Dr Ragnar Hanas' book "Type 1 Diabetes in children, adolescents and young adults"; the title misleads, its fine for 73 yr olds as well!

Arguably there is comprehensive information just within this forum and a book on D isn't really necessary. But authors tend to present their guidance in a structured format and sometimes it's easier to research within that structure. This forum is brilliant, a huge amount in here, but sometimes a search here is not successful because the exactly correct word isn't being asked; and also sometimes there is too much information within any one thread.

That's my hint to myself to stop rambling and wish you well.
Thanks, Proud! I 'spoke' too soon and far too sloppily: proteins and fats can be converted into glucose-- but not by your digestive system on its own, and the body "won't bother" unless it's necessary.

This is good on the basics of digestion: https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works . Your digestive system turns carbs into glucose, protein into amino acids, and fats into fatty acids and glycerol. All of these are then pumped into your blood-- so it's the glucose from the carbs you've eaten that hits your blood first.

Then-- your liver and your kidneys can, if they so desire, take some of the amino acids or glycerol out of your blood, turn these into glucose, and pump this newly made glucose into your blood; this is called 'glucogenesis' or 'gluconeogenesis'. But normally the liver and kidneys will only start doing this when your blood glucose levels are low.

Finally, a key point for us T1Ds is: Insulin inhibits gluconeogenesis. So for those of us who have long-acting basal insulin in our bodies all the time, your basal will probably prevent your liver and kidneys from making much glucose-- even when you wish they would, like when you're going hypo! T2Ds have the opposite problem: their insulin resistance means that their livers and kidneys go on merrily synthesising glucose and pumping it into their blood even when their blood glucose levels, and insulin levels, are high. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927596/ )

Well, I think it's all fascinating! As somebody I know said, what's astonishing is not that this amazingly complex system sometimes goes wrong; what's astonishing is that it ever works in the first place. ; )
 
My understanding is that the fats and the proteins in food are not converted into glucose.

Most cheeses have 0 or near-0 carbs, and I find I can eat quite a bit of cheese with no apparent effect on my BG, even though, for me, even 5g carbs can have a significant effect on my BG.

As for nuts: Some nuts have quite a few carbs per 100g; cashews, for example, have 16.8g carbs per 100g. Almonds, though, have only 4.8g carbs per 100g. I find that 50g of almonds is very filling and has no apparent effect on my BG.
I briefly started some carb free meals. The proteins then got converted to glucose, in the absence of carbs. I decided that my head was full of Carb counts and had no space to worry about the ratios for protein, and grams of protein. I now just include some carbs, so it is not an issue
 
Status
Not open for further replies.
Back
Top