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[Purls of Wisdom]

Re the hypos, sometimes your own insulin-producing cells recover a bit temporarily and you find your injected insulin needs decrease.

The consultant cleared the fact that looking at my CGM readings it is pretty obvious that my pancreas is not making any insulin.

If you’re having lots of hypos, reduce your insulin and/or eat more carbs.

Which insulin - Levemir or NovoRapid?
I work in the primary education sector, on my feet all day long. The Consultant suggested to reduce morning Levemir by 1u on working days. How many carbs should I be eating in a day? Some unknown person wrote that it should be 20g and no more. I ve also read that it should be somewhere between 120g to 130g. Who to believe and which advice to follow? The DSN refuses to comment on this topic.

Snacks - carby snacks are a digestive biscuit (10g carbs) or two (20g carbs), an average apple (15g approx) 3 oatcakes plus cheese (15g approx),

How many digestive biscuits in a day one can eat or in a week? I do eat eggs, cheese, oatcakes and nuts. Still looking for other suitable alternatives.

a flapjack bar 18-20g check the label.

is there a particular brand of flapjack bars which i can eat guiltfree?

If you’re going low you might be able to eat these without insulin.

I have always wondered which insulin covers the snacks - Levemir or NovoRapid? Never known of injecting insulin for snacks.

If you don’t retain information (and I agree that that seems the case, as I mentioned before), write things down in a way that works for you in bullet points eg “Snacks - digestive biscuit (10g carbs), etc”

Thanks.

Consistency - not possible. Forget it. There are multiple things that can affect our blood sugar.

I am well aware of this fact.

Learn what your normal/average result is and then if you get a different result, adjust your actions eg if you’re normallly 8 two hours after breakfast and that works fine for you, but tomorrow you test and you’re 5, then you need a few carbs to push you up towards your normal 8.

You got to be kidding me. My time in range is set at 56% and average at 10mmol/L. The BG levels are set between 4.5 to 14mmol/L, which to me are fairly high. I will be doing somersaults if the post meal reading is below 8. The readings jump up high after breakfast of Weetabix or Oats porridge. The current 14 days average is 10.2mmol/L.

If you’d find a twice daily insulin easier, then go with that, but you’d still have to carb count to make sure you were eating the right amount for your dose. It would reduce your flexibility. It also demands regular meal times because the insulin kicks in and you need to eat lunch.

Not sure how I feel about it just yet. My time keeping is not so great.

 

[Purls of Wisdom]

How high are your high levels going and do they come down into range or are they always high?
You should not ignore or accept your levels being high? Who is telling you that?

My target range is still between 3.9 and 10.0. The DSN admits that 10.0 is high but suggests nothing to rectify that. Most annoyingly she keeps saying that I am doing very well. I beg to differ.

You also have to realize that having 100% in range readings is not sustainable, so an acceptance of going above range occasionally

I know that as long as the hypers are occasional occurrences. In my case in range readings are occasional.

Have you been offered a DAFNE course or other equivalent intensive education course?

No such thing has been mentioned to me. In fact I ve asked if there is any possibility of diabetes education available to me?

Good to hear that you have a confirmed diagnosis of Type 1 now. It might be helpful to go into your profile here on the forum and change it to show you as Type 1 instead of Type 2 as it currently shows.
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Purls of Wisdom​

Well-Known Member​

Relationship to DiabetesType 2

Could you pls guide me how to access my profile and how to edit it? Thanks.

Are you on just one injection of Levemir a day or two?

I am on 13u of Levemir twice a day and Novorapid thrice before meal times.

 

[Leadinglights]

The consultant cleared the fact that looking at my CGM readings it is pretty obvious that my pancreas is not making any insulin.

Which insulin - Levemir or NovoRapid?
I work in the primary education sector, on my feet all day long. The Consultant suggested to reduce morning Levemir by 1u on working days. How many carbs should I be eating in a day? Some unknown person wrote that it should be 20g and no more. I ve also read that it should be somewhere between 120g to 130g. Who to believe and which advice to follow? The DSN refuses to comment on this topic.

How many digestive biscuits in a day one can eat or in a week? I do eat eggs, cheese, oatcakes and nuts. Still looking for other suitable alternatives.

is there a particular brand of flapjack bars which i can eat guiltfree?

I have always wondered which insulin covers the snacks - Levemir or NovoRapid? Never known of injecting insulin for snacks.

Thanks.

I am well aware of this fact.

You got to be kidding me. My time in range is set at 56% and average at 10mmol/L. The BG levels are set between 4.5 to 14mmol/L, which to me are fairly high. I will be doing somersaults if the post meal reading is below 8. The readings jump up high after breakfast of Weetabix or Oats porridge. The current 14 days average is 10.2mmol/L.

Not sure how I feel about it just yet. My time keeping is not so great.

The Levemir is your basal insulin which you take once or twice a day depending, the NovoRapid is the insulin you take for covering the food you eat, meals and snacks if they are carbs which you are not having to treat hypos.
I think you need a better understanding of what the different insulins are doing and about adjusting for the carbs you are having.
Some of the information that had been suggested to you before would have been when your diagnosis was Type 2 so may not be applicable now.

 

[Bruce Stephens]

Which insulin - Levemir or NovoRapid?

Yes. (Whichever is appropriate. If you lower Levemir that'll tend to raise your BG for the whole day; if you lower Novorapid that'll change the next 4-5 hours. So choose which one seems a better fit for the hypos you're seeing.)

I work in the primary education sector, on my feet all day long. The Consultant suggested to reduce morning Levemir by 1u on working days. How many carbs should I be eating in a day? Some unknown person wrote that it should be 20g and no more. I ve also read that it should be somewhere between 120g to 130g. Who to believe and which advice to follow? The DSN refuses to comment on this topic.

You're type 1, so you choose what you want to eat. More carbs tends to be a bit more complex since you'll go up higher and then (with the insulin) down again. With lower carbs rises and falls will tend to be smaller so it's all spread out in time. But both are doable with training and practice. (Lots and lots of practice.)

 

[Bruce Stephens]

Could you pls guide me how to access my profile and how to edit it?

Click on your name at the top right, select Preferences then Account Details and scroll down a bit to Relationship to Diabetes.

 

[Bruce Stephens]

But both are doable with training and practice.

Having said that, while you're not confident in changing insulin doses try to eat roughly the same carbs day to do. If you take the same doses of insulin and that works one day and you eat much less carbs the next day you can expect to have hypos.

In fact I ve asked if there is any possibility of diabetes education available to me?

I'm sure they'll try to. It's recommended by NICE: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations#education-and-information

There's online information, https://www.mytype1diabetes.nhs.uk/ https://www.bertieonline.org.uk/home https://www.diabetes.org.uk/guide-t...-and-diabetes/nuts-and-bolts-of-carb-counting

 

[rebrascora]

Could you pls guide me how to access my profile and how to edit it? Thanks.

At the top right of this page you will see your profile name in a box. It is next to the box with an envelope and the bell symbol which shows your message alerts. Click on the box with your name in it and a drop down box will appear. Click on "Account details" and a new page will open up. Scroll down until you see a box with all the options like Type 1. Type 1.5 LADA, Type 2, MODY etc. There will currently be a tick in the Type 2 circle, so select Type 1 instead and then click save at the bottom of the screen and that should sort it.

 

[rebrascora]

A sensible approach would be to aim for about 40-50g of carbs per meal. You absolutely do not need to restrict your carb intake to 20g a day and if you do that you will hypo a lot more. I think whoever told you that was looking at your profile showing you as Type 2. As a Type 1 diabetic, you can eat whatever you want and adjust your insulin to match once you learn how BUT at the moment whilst you are on fixed doses, then you need to be a bit careful and aim for fixed amounts of carbs. Once you have had an education course and get more confident in carb counting and adjusting your doses, then you can experiment more with bigger meals or more carbs if you wish, but just try to keep it simple at the moment.

Do you understand about which foods contain carbs and how to estimate them? So things like a medium slice of wholemeal bread is about 15g carbs, so a sandwich made with 2 slices is about 30g carbs. Add in a bowl of soup (10-20g carbs) or an apple (15g carbs) or a couple of digestive biscuits (2x10g carbs) and you are up to about 40-50g carbs.

Does that make sense. It becomes more difficult with curries made with lentils...dahl etc as some people seem to be able to extract more carbs from them than they are supposed to contain and the carb info is given as cooked weight I believe which when it is in a curry is very difficult to estimate , so you would need to experiment with different portions and see how you manage. Obviously naans and rice are quite high carb as are chupatis. I think the "Carbs and Cals" book or app will be able to give you carb values for those, so you can choose a portion that will fit into that 50g carb limit for the meal.

Do you know how many carbs are in your Weetabix breakfast or the porridge? Maybe start with calculating that if you haven't already...

 

[Inka]

How many carbs should I be eating in a day? Some unknown person wrote that it should be 20g and no more. I ve also read that it should be somewhere between 120g to 130g. Who to believe and which advice to follow? The DSN refuses to comment on this topic.

If you’re on fixed doses of Novorapid, you need to find how many carbs that covers for each meal. But generally Type 1s just eat a pretty normal diet and adjust their bolus/meal insulin as necessary. Think what you’d eat before diagnosis and go from there. Get a half unit pen if you haven’t got one already (more flexibility).

You don’t need a guilt-free flapjack - jettison the guilt. Type 1 is an auto-immune condition. It’s not your fault and it doesn’t need a restrictive diet. It’s the insulin that’s the answer for Type 1 not the diet. The flapjack bars I mentioned are sold in packs of 5 usually by most supermarkets. They make a handy snack.

If busy days at work are the cause of your hypos, then reduce your insulin as suggested and/or top up with extra carbs (without insulin) as needed.

Yes, making all these decisions every day is wearing and annoying, but that’s the nature of it. We have to do the job of a pancreas. A pancreas reacts to blood sugar multiple times a day, adjusting its insulin output. We have to approximate that by balancing our insulin/food/activity. Sadly, there’s no insulin regime that allows us to forget that.

 

[Purls of Wisdom]

Now you have officially been diagnosed as Type 1 you should be able to get more support from your diabetic clinic about your insulin doses.

If only. I was curtly told that after 7 months from diagnosis, there shouldn‘t be much support expected from them.

I am not clear about exactly what your insulin regime is now and what doses you are having.

13u of Levemir twice a day. NovoRapic depending on carbs.

ģ Are you adjusting your dose now to take account of the carbs you have in your meal

Correct.

and are you just using finger pricks or do you have a Libre, if not you should ask your clinic.

I have a Libre2.

Have you been given a carb to insulin ratio for your bolus insulin and given information about correction doses.

yes. 1:5 for breakfast and 1:10 for lunch and dinner. Correction doses are somewhat tricky. 1 or 2 units at a time.

What sort of blood glucose levels are you getting.

At midnight last night, it went beyond 18.0.
Woken up to 12.0mmol/L.

If you could share some of that infromation people may be able to help.
Have you tried the protein yoghurts or Kvarg deserts or the protein nut bars like Nature Valley, shop own or similar.

Kvarg is tasty. I did not think about trying Nut bars for their sugar content.

 

[Purls of Wisdom]

A sensible approach would be to aim for about 40-50g of carbs per meal. You absolutely do not need to restrict your carb intake to 20g a day and if you do that you will hypo a lot more. I think whoever told you that was looking at your profile showing you as Type 2. As a Type 1 diabetic, you can eat whatever you want and adjust your insulin to match once you learn how BUT at the moment whilst you are on fixed doses, then you need to be a bit careful and aim for fixed amounts of carbs. Once you have had an education course and get more confident in carb counting and adjusting your doses, then you can experiment more with bigger meals or more carbs if you wish, but just try to keep it simple at the moment.

Do you understand about which foods contain carbs and how to estimate them? So things like a medium slice of wholemeal bread is about 15g carbs, so a sandwich made with 2 slices is about 30g carbs. Add in a bowl of soup (10-20g carbs) or an apple (15g carbs) or a couple of digestive biscuits (2x10g carbs) and you are up to about 40-50g carbs.

Does that make sense. It becomes more difficult with curries made with lentils...dahl etc as some people seem to be able to extract more carbs from them than they are supposed to contain and the carb info is given as cooked weight I believe which when it is in a curry is very difficult to estimate , so you would need to experiment with different portions and see how you manage. Obviously naans and rice are quite high carb as are chupatis. I think the "Carbs and Cals" book or app will be able to give you carb values for those, so you can choose a portion that will fit into that 50g carb limit for the meal.

Do you know how many carbs are in your Weetabix breakfast or the porridge? Maybe start with calculating that if you haven't already...

I can proudly say yes to all the above. Thanks.

 

[42istheanswer]

If you want a hot drink for the evening that isn't likely to affect your blood sugar much or need any insulin calculations, then I would suggest herbal tea.

But if you are looking for something that will be more substantial then milk based drinks will be more helpful, though may need an insulin bolus depending on what your blood glucose is doing at the time and when you last had fast acting insulin (so whether you need to be careful not to overload and trigger a hypo).

It depends on the nut bars, but most of the Kind ones are only 10g carbs or so, so if your blood glucose isn't too high then you may be able to have one without extra insulin.

 

[Leadinglights]

With the high glucose levels you mention it sounds as if the insulin isn't sufficient to cover the carbs you are having for your meals. You should be contacting your DSN about those to see if they can suggest anything.

 

[Deleted member 21371]

A sensible approach would be to aim for about 40-50g of carbs per meal. You absolutely do not need to restrict your carb intake to 20g a day and if you do that you will hypo a lot more. I think whoever told you that was looking at your profile showing you as Type 2. As a Type 1 diabetic, you can eat whatever you want and adjust your insulin to match once you learn how BUT at the moment whilst you are on fixed doses, then you need to be a bit careful and aim for fixed amounts of carbs. Once you have had an education course and get more confident in carb counting and adjusting your doses, then you can experiment more with bigger meals or more carbs if you wish, but just try to keep it simple at the moment.

Do you understand about which foods contain carbs and how to estimate them? So things like a medium slice of wholemeal bread is about 15g carbs, so a sandwich made with 2 slices is about 30g carbs. Add in a bowl of soup (10-20g carbs) or an apple (15g carbs) or a couple of digestive biscuits (2x10g carbs) and you are up to about 40-50g carbs.

Does that make sense. It becomes more difficult with curries made with lentils...dahl etc as some people seem to be able to extract more carbs from them than they are supposed to contain and the carb info is given as cooked weight I believe which when it is in a curry is very difficult to estimate , so you would need to experiment with different portions and see how you manage. Obviously naans and rice are quite high carb as are chupatis. I think the "Carbs and Cals" book or app will be able to give you carb values for those, so you can choose a portion that will fit into that 50g carb limit for the meal.

Do you know how many carbs are in your Weetabix breakfast or the porridge? Maybe start with calculating that if you haven't already...

To be fair, that's nonsense advice for type 2's as well.

 

[Deleted member 21371]

I am looking for a hot nourishing drink which can replace the need to eat a supper to keep me afloat all night such as Horlicks light, Ensure, Glucerna etc. etc.

I am a vegetarian. Eat home cooked Soups, vegetables, lentils, pulses and legumes. I find that all those considered good food items come high in carbs. I do not get enough proteins in order to keep me full for longer and I can only eat so many eggs, nuts or cheese. I stay away from potatoes and refined grains.

Please suggest suitable alternatives. Thanks.

Have you tried making cheese soup?
I know you said you can get fed up of it, but it a different way of having it.

 

[helli]

@Purls of Wisdom it sounds as if you got caught in the type 2 advice to minimise carbs. This is not necessary with Type 1.
Some find it is easy to calculate their insulin dose when they eat less carbs. However, I have found this can add to more complexity because, with little carbs, our body will convert protein to sugar which can affect our blood sugars. Therefore, I had to calculate insulin for protein at different ratios.
I have chosen to eat the same diet as I did before I had diabetes. I am happy to eat bread, potatoes, rice, pasta (although the sauces can make this more challenging) and pizza. I do not eat all of these all the time - I can go for months between pizzas, for example.
I eat a mainly vegetarian diet which is very varied. For example, this week my dinner has included pie and mash, coconut, peanut and aubergine curry, shakshuka, mixed roasted root vegetables with feta and tonight it will probably be beetroot and covolo nero risotto.
I never get bored with my food but my blood sugars are "only" 85% in range. I am happy with this because my CGM allows me to keep a close eye on my levels and correct when necessary whilst not allowing diabetes to take over my life.

Sorry, I didn't mean this to be all about me but I wanted to highlight
1. Type 1 diabetes does not need to limit your diet
2. You are more than a diabetic. Remember to look after all of your mind and body which may mean compromising a little on diabetes targets at times.

 

[Inka]

At midnight last night, it went beyond 18.0.
Woken up to 12.0mmol/L.

What was your blood sugar when you went to bed? What time do you take your evening Levemir? Do you know why you went high? Eg evening meal, illness, etc etc. What would your blood sugar normally be overnight? Are you sure your basal (Levemir) is at the right doses - have you done a basal test?

 

[rebrascora]

If levels dropped from 18 to 12 overnight then it looks like evening Levemir is possibly a bit too high to me, but that there was perhaps a problem with the evening bolus.

@Purls of Wisdom What time did you eat and what was your meal and what were your levels before the meal?

Can you take a photo of your Libre graph and post it so that we can see what is happening?

 

[Purls of Wisdom]

But if you are looking for something that will be more substantial then milk based drinks will be more helpful, though may need an insulin bolus

Yes please. Horlicks or ground Almonds are definitely my first choice. I have added Vanilla extract to milk to make it more appealing. I would also try powdered green cardamoms.

depending on what your blood glucose is doing at the time and when you last had fast acting insulin (so whether you need to be careful not to overload and trigger a hypo).

I understand that it takes roughly 4 hours for NR to do what it supposed to do. When I mentioned topping up NR after eating to DSN, she said no.

It depends on the nut bars, but most of the Kind ones are only 10g carbs

Thanks for clearing the mystery around the nut bars. A very welcome addition.

or so, so if your blood glucose isn't too high then you may be able to have one without extra insulin.

What BG would you say is not too high?

 

[Purls of Wisdom]

With the high glucose levels you mention it sounds as if the insulin isn't sufficient to cover the carbs you are having for your meals. You should be contacting your DSN about those to see if they can suggest anything.

The DSN has already expressed her frustration and annoyance with me for still needing support. My GP won't entertain anything which is remotely related to Insulin. Who do I have to turn to?