Struggling to balance carbs and insulin

[rebrascora]

Hi
Diagnosed with Diabetes mid Feb (Hba1c 112 after a normal reading the previous year) and initially assumed type 2. After 6 weeks of low sugar, low fat, low complex (wholemeal) carbs, low salt diet and metformin and Gliclazide and nearly 2 stone lighter and normal BMI my HBa1c had gone up to 114. Started on insulin 3 weeks ago and have Levemir (now up to 8 units at night) and NovoRapid at 4 units before I have a meal containing carbs. I have already had a hypo and a hyper, both of which I was able to figure out a reason for. If I keep my carbs low and take very little NR I can keep my readings reasonably steady but sooner or later I get cravings and the temptation is to have a binge .... leading to a hyper. I am still taking Metformin but not Gliclazide
My nurse and the dietician are keen for me to follow a "normal" diet and I recently got a place on a carb counting course, so I am working on 10g carbs requiring 1 unit of NR. I bought a pack of "Sugared Out" Apricot Flapjacks last weekend and each bar has 27.6g carbs. I have had a couple through the week for breakfast and used 3 units of NR which has been quite successful.

Yesterday I was going away for the day and had to get up and breakfast much earlier (6am). My fasting reading was 14.4 and I was having one of these flapjack for breakfast along with a cup of hot chocolate, so I decided that 4 units of NR would be appropriate to counter the flapjack and hot choc and perhaps lower my reading a little. The needle and insulin stung going in which was a first and there was a little bead of fluid (insulin) at the injection site after I removed the needle. I mention this because it was unusual. Anyway, by 8.30am I was feeling pretty unwell (thankfully I had elected not to drive) and my reading had plummeted to 6.6 and half an hour later, it had further dropped to 5.5, where it stabilised and then started to come up (without resorting to glucose tablets). I felt yuk the whole day and spent most of it resting in the car whilst my partner attended the auction we had gone for. I took 2 units of NR (didn't dare take more) and ate sausage, veg and a little mash at lunchtime, but still had bad shakes and needed to rest all afternoon. I was back up to 14.0 by 2.30pm but back down to 10 by 8pm. Took 3 units of NR with my evening meal..... sea bass with 3 pieces of potato, aubergine, broccoli and cabbage and yoghurt with a few blueberries. Only took 6 units of Levemir as my earlier dip gave me a fright and started the day on 12.1 this morning. I'm back to omelette and salad for breakfast with no NR and have had a low carb lunch of tomato, mozzarella and cucumber salad with balsamic vinegar and one square of dark choc and a few nuts for lunch, again with no NR. Current reading is 14.6.
I will be having carbs with my meal tonight.... probably some wholemeal pasta and taking either 3 or 4 units of NR plus I might do better to take 8 units of Levemir tonight to hopefully get my fasting reading down a bit but just do not understand why I dropped off that cliff edge yesterday morning and how I am supposed to eat "normally" and keep things balanced. I am back to being frightened to eat carbs and use the insulin.

Also, how do people get away with treats like a piece of cake or an ice cream or a scone or a piece of pie. I haven't had such a treat since my diagnosis in Feb and it is becoming more difficult when people are eating them around me. My one square of dark chocolate every once in a while is just not doing it for me. I have bought Sula or Riccola boiled sweets which are OK but not like a piece of cake or an ice cream or a nice pudding like a crumble. Plain yoghurt and berries are becoming a bit boring as my dessert option.

I don't see the consultant until the 30th April to get further testing for possible type 1 and the nurse is reluctant to change my medication until I have seen the consultant..... I was wondering if Levemir twice a day and no NR might be better for me. I feel less anxious keeping my BGs in the 8-15 range than risking things plummeting by eating carbs and taking NR several times a day but I know that having those higher readings consistently is also putting my long term health at risk.

Both times I have had a hypo it has been in the morning a couple of hours after breakfast (8.30am yesterday and 11am the previous time) which may be a coincidence or may not.

I'm open to any thoughts or suggestions or comments. Do other people have the same problems when they first start using insulin? I am very conscious that too many hypos put my driving licence at risk, so really wanting to avoid them for that reason too.

 

[Docb]

Hi Rebascora, can't really help with your basic query cos I'm not on insulin and do not want to be if I can help it but something in the middle of your post caught my eye. That is the idea of "treats". I don't see the things you list as "treats". I see them as things that are going to create problems I don't want and so I'll keep away from them.

 

[everydayupsanddowns]

These sound like ‘false hypos’ to me @rebrascora. Where your body has become used to elevated BG levels and is giving you full-in hypo warning signs as you get into the normal BG range.l (5.5 and 6.6 are great levels!)

Sounds like the insulin is working well for you, and you seem to understand the basics well, but these alarming symptoms are putting you off.

But don’t worry, just gradually reduce your BG into single figures and your internal glucose ‘thermostat’ will reset.

 

[rebrascora]

Thanks to you both for responding.
I know that this whole diagnosis means a new way of life and I have very radically altered my diet and I know it is now a life long dietary change, but I am being told to eat "normally" and I cannot seem to manage to do this and balance my blood sugars with the insulin I have been given at the moment. I felt like I was managing to bring them down to a reasonable level of 8 ish and keep it stable by avoiding carbs as much as possible prior to being prescribed insulin but introducing that and eating small portion carbs just seems to have set me yo-yoing and what seems to work one day has a dramatically different effect the next, even without bringing exercise into the equation. I know 5.5 and 6 are good readings in themselves and what I am striving for and don't constitute a true "hypo" but coming down from 14.4 to 5.5 in 3 hours was a significant shock for my body and surely that one extra unit of NR should not have caused such a dramatic drop, particularly when I was sat immobile in the passenger seat of a car for most of that 3 hours.

I have been reading a little about people using a Freestyle Libre to track their BG more effectively so that they have a better idea of how the food and insulin interact over a more specific period and wonder if that might help me to balance things better. I went onto their website, but it seems they are not supplying new customers at the present time..... Have I understood that correct and if so, are there other devices which are available to buy which do a similar job and can people recommend one?

 

[grovesy]

I have been on the waiting list since September for the Libre. Some have managed to purchase in some pharmacies.

 

[nonethewiser]

I have been reading a little about people using a Freestyle Libre to track their BG more effectively so that they have a better idea of how the food and insulin interact over a more specific period and wonder if that might help me to balance things better. I went onto their website, but it seems they are not supplying new customers at the present time..... Have I understood that correct and if so, are there other devices which are available to buy which do a similar job and can people recommend one?

Abbott have done this before, closed the website to new customers as they can't keep pace with the demand for the sensors. Some pharmacies will have them, Asda being one and Boots.

There is another device available, the Dexcom G5 G6 is a CGM and don't think there's any issues with supply, costs considerably more than the libre but probably worth it, funds being available the Dexcom would be my choice.

 

[rebrascora]

Thanks for that info. Will research the Dexcom and see if funds can be stretched to one. I know it is a big financial commitment either way but if it improves my ability to manage things better and get less stressed about eating, which used to be my main pleasure but is now almost something to be dreaded, it is worth going without other things. Even if it just gets me over this initial bumpy patch, so I have a bit more idea what I'm doing and how my body is responding, although I have a feeling that once you have a piece of kit like that, you don't want to give it up lightly.

 

[everydayupsanddowns]

Thanks for that info. Will research the Dexcom and see if funds can be stretched to one. I know it is a big financial commitment either way but if it improves my ability to manage things better and get less stressed about eating, which used to be my main pleasure but is now almost something to be dreaded, it is worth going without other things. Even if it just gets me over this initial bumpy patch, so I have a bit more idea what I'm doing and how my body is responding, although I have a feeling that once you have a piece of kit like that, you don't want to give it up lightly.

I think there is a starter pack for the Dexcom G6 which is relatively affordable (in the context of horrendously expensive CGMs). Alternatively as @nonethewiser suggests - you may be able to get a reader/sensors from a pharmacy (or use your phone and the LibreLink app to scan the sensor if you have a smart enough one)

 

[trophywench]

1u of Novo wouldn't do that - UNLESS you already had other insulin circulating in your body, either your own or the Levemir. You can only predict what the Levemir can do - you cannot predict what your pancreas might or might not. If you are T1 and you cannot produce any insulin yourself - it's far easier to calculate. It's always tricky anyway at first since the cessation of insulin production is not instant.

 

[rebrascora]

Thanks for your reply.
The dietician is adamant that I must be Type 1 but until I get testing we just don't know. Hopefully that will happen on Tues 30th April when I attend the hospital to see the consultant. The thing that suggests that I am not producing any insulin is that during my 6 weeks of treatment with Metformin and Gliclazide and very strict dieting and weight loss, (prior to commencing injecting insulin), we saw a rise in an already very high HbA1c reading from 112 to 114, so it looked pretty likely that my pancreas had run dry. I did wonder if it was possible for it to have produced some on Saturday. I was however very late taking the Levemir the night before and in fact it was probably after midnight and then woke up less than 6 hrs later to start the day, so perhaps the Levemir was at it's peak then.... I'm not sure what the time/action profile of Levemir is other than obviously slow acting.
Anyway, I have reverted to minimal carbs at breakfast (loving my mushroom, aubergine and bacon omelette and salad) and just have low carb snacks if I feel hungry during the day,(some nuts or a chunk of cheese or some raspberries today... yum), and a small portion of carbs with my evening meal and thankfully things have settled down a lot and I feel so much better for it. I bottled out of taking the full 8 units of Levemir last night (I took 6) and just 3 of NR with my meal, but I started the day on 10.0 went up to 12.6 after breakfast but have been steadily declining since then and last reading was 8.0 at 6pm, so I am getting closer to the normal range again now without too much variation. Hopefully tomorrow I will start the day nearer 8 and be around 6 or 7 by tomorrow afternoon and maybe get a fasting reading in the normal range by Thursday fingers crossed.
The nurse feels that I might just be very sensitive to insulin and just a little too much is causing a huge reaction. I wonder if a half unit NR pen might be beneficial for me or using the Levemir twice a day and no NR, but the nurse doesn't want to change anything until I have seen the consultant, so for the time being I am just trying to minimize using the NR apart from on an evening and that is working much better and having a protein breakfast and no insulin means I am not feeling hungry or craving anything naughty through the day..... I do find that the insulin (or perhaps the carbs) make me want to eat sweet stuff. The last 2 days of being back to my 3 egg omelette and salad for breakfast with no bread or NR and I am not suffering any real cravings and physically and mentally I feel so much better.