Struggling with any carbohydrates in diet

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Nell83

Nell83

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Type 2
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Hi all,
Since starting insulin in March I've cut out all refined sugars from my diet but I'm now finding if I eat anything with carbohydrates in I have a massive spike usually 5-8mmol from pre-meal reading. I'm using a libre 2 (self funded) to try and help with educating myself about what has an impact and what doesn't.
I have to travel a lot for work and occasionally have to grab a sandwich to eat on the run and these have caused massive spikes of up to 10mmol after 2 hours.

As a picky eater I have relied on beige food all my life - cutting carbs has been really difficult for me.

Am I better looking at time in range which is around 80% between 4-10mmol? at the moment I feel like I'm on a rollercoaster! I'm also exhausted all the time - is this likely to be because my sugars are up and down so much?
 
Which insulin(s) do you have and when do you take it/them?
 
I'm on Novo30 and I'm up to 52 units before breakfast and dinner (around 6pm) I have an appointment with the nurse tomorrow but all they keep saying is increase the dose by 2 units every 3 days if I'm still over 8mmol when injection is due. I'll soon be at the max 60units injection.
 
For example today pre lunch BG 5.8 Sensor 5.1 - I had a cheese sandwich with wholemeal bread from a small bakers fresh loaf and an apple. Two hours later my BG 11.6 Sensor 11.5
Last week I had this exact same lunch and the rise was only 3mmol and I was on less insulin so I had put it on my "safe" list.
 
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How long before breakfast and dinner do you inject?
Spiking up to 10 isn't too bad.... I used to spike up to 15 every morning after breakfast, but I found that if I injected a bit earlier before I ate my meals, the height of the spike reduced..... basically the insulin we inject takes time to get from the subcutaneous fat that we inject into, to the blood stream to deal with the glucose from the carbs we eat. Our home produced insulin is secreted straight into the blood supply from the pancreas. We can't do that with the insulin we inject, nor would we want to, but it means we have to give the injected insulin a bit longer before we eat. If you currently inject 10 mins before your meal. try 15 mins before you eat. If that still isn't enough, try 20 mins, until levels don't spike so high. You will likely find that you need longer before breakfast than you do with your evening meal. I tend to inject my morning insulin as soon as I wake up as I need quite a long time before injecting and eating at breakfast.

You do have to be careful with adjusting this timing gradually as if you inject too far in advance you can end up hypo whilst you are eating or just after, so increasing the length of time by just a few mins each day is important. Once our levels get above 10 we become more insulin resistant and we need more insulin than normal to bring it down, so if you can keep it below 10 you should need less insulin overall.... so you may need to reduce your doses slightly. Timing of insulin is almost as important as the actual dose.
 
Thanks - I noticed quite early on that I needed to inject 20mins or so before eating so that's what I'm doing. My levels seem to be ok in the morning - it seems to go up mid afternoon and then just keep climbing until the middle of the night when it starts to come down!
 
The problem at lunchtime is that you don't have any meal time insulin in your system, so there is nothing to cover the carbs in your sandwich and apple. Having a low carb lunch like an omelette with salad and coleslaw or a salad and some nuts rather than fruit would help to prevent the lunchtime spike.

You posted that graph whilst I was typing my first reply so my coment above is not really relevant. That graph suggests that your timing of insulin at breakfast is fine but it is just the carbs at lunchtime which are the problem, because you have no insulin to cover them. The mixed insulin that you have doesn't allow you to inject at lunchtime, because it contains a twice a day basal as well as meal time insulin and if you inject that for lunch as well you will have too much basal insulin at night and will hypo.
The other option if having a low carb lunch isn't possible is to ask your nurse for separate basal (long acting) and bolus (quick acting) mealtime insulin. It means 4-5 separate injections instead of just 2 but it will allow you to inject insulin to cover your sandwich or whatever carbs you have at lunchtime.
 
Thank you - I'm finding that at the moment I feel like I'm really restricting myself food wise and trying to be so careful and getting frustrated with myself!

What you have said helps immensely - I'll try the low carb lunches or ask tomorrow about the change in insulin.
 
Hi, I empathise. I’ve been type 2 for 20 years but only on insulin since the end of December. I’m on a single daily dose of basal insulin and went up and down till I found the right dose for me. I also self funded a CGM which was invaluable in showing me which foods spike my glucose. I cut carbs to 60-80gms daily. So no sandwiches, potatoes, oats and lentils etc. Adjusting to a different eating pattern wasn’t easy. I eat keto nut bars for breakfast. Eggs or cheese or other proteins for lunch and fish/ chicken/ meat and above ground veg at night. I’m not a saint and have the odd shortbread finger but I’ve spent the last few months convincing my body that carbs are bad for it. I’ve eaten more butter, cheese, bacon etc than ever before in my life. Last bloods were a couple of weeks ago and A1c was 41 (down from 67) and cholesterol 3.6.
I find now I can eat a small amount of pasta or rice with my evening meal and not be spiked. It’s hard adjusting. Sandwiches were so easy to grab on the run but egg and salad bowl/ cold meat platter work too.
Good luck adjusting. I found my insulin needs reduced as I lowered my carbs.
 
rebrascora said:
The problem at lunchtime is that you don't have any meal time insulin in your system, so there is nothing to cover the carbs in your sandwich and apple. Having a low carb lunch like an omelette with salad and coleslaw or a salad and some nuts rather than fruit would help to prevent the lunchtime spike.

You posted that graph whilst I was typing my first reply so my coment above is not really relevant. That graph suggests that your timing of insulin at breakfast is fine but it is just the carbs at lunchtime which are the problem, because you have no insulin to cover them. The mixed insulin that you have doesn't allow you to inject at lunchtime, because it contains a twice a day basal as well as meal time insulin and if you inject that for lunch as well you will have too much basal insulin at night and will hypo.
The other option if having a low carb lunch isn't possible is to ask your nurse for separate basal (long acting) and bolus (quick acting) mealtime insulin. It means 4-5 separate injections instead of just 2 but it will allow you to inject insulin to cover your sandwich or whatever carbs you have at lunchtime.
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The slow part of the Novo30 is supposed to cover lunch. That’s why you need to eat to a schedule on mixed insulin: you inject the mix before breakfast and the fast bit deals with your breakfast, the slow bit kicks in a few hours later and is supposed to cover your lunch. The problem is that mixes don’t always suit people because the proportions don’t suit their needs.

Don’t cut your lunch carbs at once @Nell83 Gradually reduce them.
 
Thanks for the advice
 
Nell83 said:
I'll soon be at the max 60units injection.
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You have some great advice above and I only wanted to add a little bit.
That is there is no maximum dose. You need as much insulin as your body needs.
60 units may be the highest that you can dial up for a single injection but, if you need more, you can give yourself two injections one after the other. Some people will split smaller doses in this way.
 
helli said:
You have some great advice above and I only wanted to add a little bit.
That is there is no maximum dose. You need as much insulin as your body needs.
60 units may be the highest that you can dial up for a single injection but, if you need more, you can give yourself two injections one after the other. Some people will split smaller doses in this way.
Click to expand...
Very good point and in some respects splitting your current dose might be more effective than injecting it in one shot as you can get better absorption from two different sites with half in each. For instance my morning basal dose is 22 units and I inject 11 into each buttock. All of my other doses are under 10units so I don't bother about splitting them as there is nothing to gain with smaller doses.

Also, do be aware that you don't have to increase both morning and evening doses to keep them the same. I can see from your graph that your overnight levels drop. If this is a regular trend, then it would be wise not to increase your evening dose anymore and maybe even dial it back a bit but increase your morning dose a bit. I need a lot more basal insulin during the day than at night, so I need 22 units in the morning and anywhere from 0-4u at night. I appreciate that this is just basal insulin, not mixed, but it is just an example of how our bodies don't always need the same dose day and night.
 
So I can inject twice splitting the dose? I hadn't been told that - in fact the nurse expressly said I was only to do two injections a day....but maybe I've misunderstood what she meant? I'm now dropping back down from over 11mmol and down to 6.7 I've been shivery, shakey and dizzy for the last hour or so. Now I'm having to inject again so I can have dinner.

I'm still concerned about how restrictive I'm having to be on my diet and the fact that it's still going up and down like a seesaw!!

And why is it when you know you can't eat it cake becomes the only thing you want!
 
It is just one dose morning and evening still but you are splitting it between 2 sites. So you inject half of each dose into one site and then the other half straight after but into a different area. Smaller doses into 2 different areas is less likely to damage the tissue than one large dose into one area.

Nurses try to keep things as simple as possible and they seem to think that extra injections are more intrusive, but getting a better result, perhaps without needing more insulin is better in my opinion even if it means more jabs.
Also, you are clearly worrying about what happens when you get to the maximum dose of 60u that the pen will dispense and the simple answer is to inject more with a second jab if you need more. There are people on over 100units. Obviously it is better to need less because the more you inject, the more insulin resistant you can become, but the important thing is to inject as much as you need and get the most efficiency from the insulin you inject and for me, that means splitting the dose and jabbing it into two different areas. You can use the same needle to do the two jabs. I certainly do, so I do my air shot and then I dial up my first 11units and jab it in my bot and then dial up another 11units (to make a total of 22u) and jab it in my other buttock.
 
the nurse expressly said I was only to do two injections a day....

I guess she meant not to take more than your set doses. As @rebrascora says, injecting the same dose but simply splitting it between two injection sites is still the same dose.

On mixed insulin, you ideally eat your meals at the same time each day. Also, you need to stick to the same amount of carbs for each meal. If you total up the carbs you’re having for each meal, ie breakfast, lunch, etc, then you can see how the amounts are working with your insulin. Regularity and routine is the way with mixed insulin.
 
Warburtons do a bread with no added sugar it’s a small brown loaf. BUT it’s only 9 carbs per slice. We have this for sandwiches ok it’s small but can have 4 slices with a bit of chicken and balances fine. Asda sell it and B and M stores bigger ones stock it. Hope that helps
 
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