Switched to low carb! Not sure what is happening.

[rebrascora]

I too eat low carb because I would be a carb monster otherwise (bread tatties and anything sweet.... yes a sugar addict here and very much an all or nothing person) and it does help a lot in controlling the cravings and feeling sated and there have been other health benefits like no more acute and debilitating migraines (which I had suffered from for over 20 years) and significantly reduced joint pain and my diabetes control is now really good, but I had to invest time and experimentation into learning what worked for me with my digestion and the insulins I have.

Personally I love split dose Levemir but I do have to adjust it very regularly, sometimes on a daily basis.... I have developed an element of intuition about this, but I factor in exercise and ambient temp and what my dose was the day before and what results it gave me.
I also have to be very proactive with my bolus insulin. I swapped to Fiasp as it is faster than Novo-not so-Rapid and that was really hard work for the first 3 months both times I tried it. By the 4th month of the second trial I cracked it and I currently have 93% TIR over the past 90 days with Fiasp and Levemir. I don't love Fiasp like I do Levemir but I have found ways to make it work. Someone recently suggested that "regular insulin" would suit my low carb diet better but personally I am not convinced it would and I am not sure I could improve much, if at all, on the TIR I have now with Fiasp, so I am not prepared to try it. I have to break the rules with Fiasp to get the results I want, so I stack corrections on a daily basis to cope wit the protein release. In my opinion, the rules about not stacking insulin are based on a diet where glucose is released quickly from carbs. With protein releasing slowly over a much longer period, stacking seems to be necessary and with modern technology like L:ibre/CGM the risk from stacking insulin is dramatically reduced because you can keep a close eye on your levels and slow the drop with a prune or an apricot or whatever if levels are dropping too low and too quickly.
I have heard about Dr Bernstein of course and he is quite remarkable but he seems to be just a little too extreme for my comfort, although I admit I have not read or watched much. I have found my own way, that works for me and I would encourage you, not to be frightened of your insulin because being more proactive with it (I do corrections once my levels hit 8mmols most days and my high alarm is set at 9.2. When the high alarm goes off I inject a correction, even if I only injected an hour before, but I keep a close eye on it after that and I ensure I have a small high carb snack like a fig or a prune if my Libre shows my levels in the low 5s and dropping fast. If I get to 4.5 and still dropping fast, I eat a Jelly Baby. Just one though. You have to be very disciplined and not overdo it. Small corrections of 1.5-2units is usually enough and 1 or occasionally 2 prunes (about 5g each) are enough to level it out in the 5s. Gone are the days when I could happily eat a whole packet of prunes or dried apricots! 🙄 .... and lets not talk about a multipack of snickers😱

 

[aaronjunited]

I too eat low carb because I would be a carb monster otherwise (bread tatties and anything sweet.... yes a sugar addict here and very much an all or nothing person) and it does help a lot in controlling the cravings and feeling sated and there have been other health benefits like no more acute and debilitating migraines (which I had suffered from for over 20 years) and significantly reduced joint pain and my diabetes control is now really good, but I had to invest time and experimentation into learning what worked for me with my digestion and the insulins I have.

Personally I love split dose Levemir but I do have to adjust it very regularly, sometimes on a daily basis.... I have developed an element of intuition about this, but I factor in exercise and ambient temp and what my dose was the day before and what results it gave me.
I also have to be very proactive with my bolus insulin. I swapped to Fiasp as it is faster than Novo-not so-Rapid and that was really hard work for the first 3 months both times I tried it. By the 4th month of the second trial I cracked it and I currently have 93% TIR over the past 90 days with Fiasp and Levemir. I don't love Fiasp like I do Levemir but I have found ways to make it work. Someone recently suggested that "regular insulin" would suit my low carb diet better but personally I am not convinced it would and I am not sure I could improve much, if at all, on the TIR I have now with Fiasp, so I am not prepared to try it. I have to break the rules with Fiasp to get the results I want, so I stack corrections on a daily basis to cope wit the protein release. In my opinion, the rules about not stacking insulin are based on a diet where glucose is released quickly from carbs. With protein releasing slowly over a much longer period, stacking seems to be necessary and with modern technology like L:ibre/CGM the risk from stacking insulin is dramatically reduced because you can keep a close eye on your levels and slow the drop with a prune or an apricot or whatever if levels are dropping too low and too quickly.
I have heard about Dr Bernstein of course and he is quite remarkable but he seems to be just a little too extreme for my comfort, although I admit I have not read or watched much. I have found my own way, that works for me and I would encourage you, not to be frightened of your insulin because being more proactive with it (I do corrections once my levels hit 8mmols most days and my high alarm is set at 9.2. When the high alarm goes off I inject a correction, even if I only injected an hour before, but I keep a close eye on it after that and I ensure I have a small high carb snack like a fig or a prune if my Libre shows my levels in the low 5s and dropping fast. If I get to 4.5 and still dropping fast, I eat a Jelly Baby. Just one though. You have to be very disciplined and not overdo it. Small corrections of 1.5-2units is usually enough and 1 or occasionally 2 prunes (about 5g each) are enough to level it out in the 5s. Gone are the days when I could happily eat a whole packet of prunes or dried apricots! 🙄 .... and lets not talk about a multipack of snickers😱

Exceptional! Love how much we have in common here. I've suffered with addictions of many kinds over the years and definitely the all or nothing kind of person, and still am when it comes to anything i do.

Are you a Libra by any chance? Born in October?

I hear you when it comes to the not so novorapid lol I feel this is the case with myself and been looking at something else. R insulin works slower and in line with protein digestion rates much closer so stacking would be out the window with this insulin.

Most low carb people I have spoken to swear by it as it rules out the need to stack and extend boluses based on its slow release action. I'm definitely going to try it. Think it's called humulin here in UK?

With my Lantus u don't think I'm getting past 8 hours with it as it wears off too quick and comes online just after 2 hours for me which does fit my low pattern around 6-8am. Upping and downing my basal has been a constant battle but i think that is down to what reading I go to sleep at. levemir sounds like it could help me and Dr Bernstein does advocate it also over Lantus.

He can be a little too extreme but this comes from his early days when he had to sharpen his own needle and work everything out without any basic knowledge. Keeping in mind look at his condition at 89 having type 1 since he was 12. It's remarkable what he has achieved. His book is a must read for those serious about lowering blood sugars and who want the benefits of clean eating rather than the poison all over the supermarkets these days.

Thanks for your tips on control also for going low and high. I love your drive and dedication and it's a must if we want to stay as healthy as can be. As they say once we are diagnosed the ticking time bomb begins and the fight against the numbers begins.

 

[aaronjunited]

Well perhaps myself & @Bloden & other forum members here are exception to the rule.

Anyway stick to what your drs told you as they know you best, was just pointing out that lantus lasts much longer than 8 hours in my experience of using it over many many years.

With all due respect my doctors have never known me better than I do myself. They have made some terrible decisions in my 16 years as a type 1. But I don't paint them all with the same brush. I do appreciate those who want to listen to my own experience instead of trying to label me as the diabetic they think they know better.

This may be the same disease we all have but it's wildly different in how it manifests for us all in so many unique ways. It's best for us to take the lead in this game because that clock is ticking and we only have one life to love and live.

 

[helli]

Please do not aim for "tight control". There are too many things that affect our BG that you will be disappointed and risk diabetes burnout.
It may only be words but I consider "better management".
I too tried low carb and, as well as finding it did not suit my life style, I found it incredibly difficult to correctly dose as every different type of protein had a different insulin to protein ratio and timing. I needed split doses for every meal and complex calculations for the amount.
I used to use Lantus. I took it as I went to bed and found I needed to dose extra for my evening meal to account for the Lantus running out after about 21 hours.
As for Dr Bernstein, I am not a fan. Like many doctors, especially historically, he found women's hormones too challenging. His advice was that all women with Type 1 should take the pill to avoid the complexity of menstruations. In other words, he ignored half the population. And no idea what he thought of pregnancy. This may not affect you but it shows how ill considered his approach was for real life beyond his own. Life moves on and do does diabetes management including CGMs and newer insulins.

 

[Inka]

There are a few regular insulins available in the U.K. @aaronjunited not just Humulin. There’s also Hypurin Porcine Neutral and Actrapid, I believe.

Regarding carbs, it’s perfectly possible to choose non-junk carbs rather than processed rubbish. Yes, the supermarkets are full of rubbish, but there are plenty of wholesome foods there too. Sadly, there’s no magic diet for Type 1. Each diet brings its issues. Eating very few carbs can really mess you round when you get ill as you can need massive correction doses and are more at risk of DKA. Low carb can be anything up to 130g carbs per day. That or moderate carbs is easier IMO.

Dr B is very knowledgable but very extreme. I don’t fancy injecting into a muscle in an attempt to stop the highs of illness! He also lost his hypo awareness completely. Take the good things from him, and good things from other regimes and find a combination that suits you as an individual.

Re the Novorapid, try Humalog. Most people find it faster than NR. You’ll also see that Dr B rates its strength/speed too.

 

[nonethewiser]

With all due respect my doctors have never known me better than I do myself. They have made some terrible decisions in my 16 years as a type 1. But I don't paint them all with the same brush. I do appreciate those who want to listen to my own experience instead of trying to label me as the diabetic they think they know better.

Absolutely agree my friend, we are ones who live with condition 24/7 so know our own bodies best so would guess that hcps imput is less than 1%, that said if you have a good team behind you that 1% can make all the difference to your wellbeing.

This may be the same disease we all have but it's wildly different in how it manifests for us all in so many unique ways. It's best for us to take the lead in this game because that clock is ticking and we only have one life to love and live.

Often gets said on forum that we are all different & no one approach suits all, I totally agree with this statement so again what you've said is so true my friend.


Mistakenly thought you were across the pond & a patient of this Dr B, hence comment about listening to your Dr about lantus profile, but looking back at your posts can see that your from beautiful NI.

As this issue with lantus has been ongoing for 2 years it probably isn't for you so time for change, suggestion would be to switch to insulin pump so you can have multiple basal rates over 24hr period, don't know if you open to that idea but something to discuss with your diabetes team.

Stay positive & sure you'll cracked all this pretty soon with help from likes of @rebrascora who has loads of experience in following a low carb diet. Good luck.

 

[Leadinglights]

Please do not aim for "tight control". There are too many things that affect our BG that you will be disappointed and risk diabetes burnout.
It may only be words but I consider "better management".
I too tried low carb and, as well as finding it did not suit my life style, I found it incredibly difficult to correctly dose as every different type of protein had a different insulin to protein ratio and timing. I needed split doses for every meal and complex calculations for the amount.
I used to use Lantus. I took it as I went to bed and found I needed to dose extra for my evening meal to account for the Lantus running out after about 21 hours.
As for Dr Bernstein, I am not a fan. Like many doctors, especially historically, he found women's hormones too challenging. His advice was that all women with Type 1 should take the pill to avoid the complexity of menstruations. In other words, he ignored half the population. And no idea what he thought of pregnancy. This may not affect you but it shows how ill considered his approach was for real life beyond his own. Life moves on and do does diabetes management including CGMs and newer insulins.

In the days when much of the research was done on animals, rats and rabbits particularly then male animals were always used to reduce the issue of fluctuating hormones.

 

[Pumper_Sue]

Are you on low carb? What type of long acting do you use and how often? And same question for your food insulin?

I tried low carb and found my numbers just went up as did my insulin needs (by a considerable amount) I use a pump so can split/extend my bolus as I need.
I tend to make sure that I do not go over a limit for carbs per meal (75) and all is fine. It's not often I reach that limit these days though.
Eating a well balanced meal is the way to go. 🙂

 

[rebrascora]

No, I am an Aquarian, not that I put any store on such stuff. We do seem to have a lot of similar traits, so I understand your situation and I totally agree with your comment about the doctors and nurses. I get a 10 min phone call twice a year if I am lucky and I don't believe the consultant views my Libre stats prior to that, so apart from anything that the Libre AGP data throws up, he really has no idea how I am doing. I get on well with him and I respect him but I tend to use him as a sounding board to make sure I am not getting too polarized in my approach rather than seeking advice about my day to day diabetes management and obviously, if I feel I need something to help with my management I need to get him onboard, but I would not take advice from him on changing my doses or anything like that.... or accept any criticism from him.

I am a believer in listening to all the different approaches people have but then finding what works for me as an individual. One of the things I discovered myself was a technique called "sugar surfing" (absolutely hate the terminology... as the use of the word "sugar" leads into the whole misinformation about diabetes) I see it more like flying a plane and trying to maintain my altitude with either a little bit of insulin or a little bit of glucose. JBs are my emergency nose lift when I am heading for the red line too fast or I break through it and insutin keeps me from heading into orbit. A little here and there as needed keeps me on an even-ish flight path and with the help of my Libre, it just becomes a long running computer game rather than a health condition. Yes, I hit turbulence sometimes, but the more experience I get, the better I manage the turbulence.
Whilst it has many quirks and frustrations, the great thing about Fiasp is that it is faster and it is gone in 3 hours for me with the main activity in the first 1.5 hours..... provided I can keep my levels below 10, so even when stacking small corrections I know I can never go too far wrong and the protein (and fat) release buffers it, plus there is no sting in the tail with it to catch you out. If I go above 10 it's like it turns to water and I have to stack bigger doses to get back down, which is why I make a point of saying I need to be proactive with it and correct at lower levels like 8.

It would take me completely rehashing my management to use a slower bolus insulin and I found NR too challenging/frustrating particularly on a morning when it needed 75mins prebolus time and I am not sure I would want to juggle 3 different insulins by including a "regular insulin" for protein release but keep the Fiasp for breakfast and carbs when I can manage it well by stacking Fiasp. I think people see stacking as something bad, because we have been taught not to do it, but I am quite happy stacking and I would be quite happy explaining to my consultant why I do it, if he challenged me about it. In many respects, it is no different to using Levemir where the 2 doses overlap. You just get used to managing the overlap and using it to best advantage. ie adjusting the time you take it to create the overlap when you need it most. Did I mention.... I love Levemir

 

[rebrascora]

PS. Will be really interested to hear how you get on with regular insulin if you try it. Fiasp has been really hard work but now that I have cracked it, it would have to be very exceptional circumstances for me to want to change now.

 

[aaronjunited]

PS. Will be really interested to hear how you get on with regular insulin if you try it. Fiasp has been really hard work but now that I have cracked it, it would have to be very exceptional circumstances for me to want to change now.

I would certainly let you know if I was to get R Insulin!

The Fiasp sounds interesting in how it works. You say 1.5/2 hours for peaking? I am finding this Novorapid a little slow since moving away from high carb. And taking it before eating also is a pain which I have never really done all these years. I have always taken as I eat and this has I guess been the reason for my rollercoaster with blood sugars. Plus the fact I never understood my basal correctly until I was told basal only acts on your liver and stops the livers action from sending us too high.

I had also been injecting my lantus into my thighs up until last night I injected 16units into my butt cheek and I ended up hypoing this morning around 5am staying steady low for a few hours until i eat some chocolate to bring me up again. I believe injecting into the butt cheek has given me the full effect of the insulin as it should have been and doing it in the thigh has actually not helped as I've never had a low like that for that long in the early hours.

So you say your Fiasp works better when you are below 10? And you only stack like 1 unit when you go above 10? So does this happen because the insulin you took for meal isn't enough to stay below 10 and you find another unit (stacking) helps you manage this?

 

[aaronjunited]

There are a few regular insulins available in the U.K. @aaronjunited not just Humulin. There’s also Hypurin Porcine Neutral and Actrapid, I believe.

Regarding carbs, it’s perfectly possible to choose non-junk carbs rather than processed rubbish. Yes, the supermarkets are full of rubbish, but there are plenty of wholesome foods there too. Sadly, there’s no magic diet for Type 1. Each diet brings its issues. Eating very few carbs can really mess you round when you get ill as you can need massive correction doses and are more at risk of DKA. Low carb can be anything up to 130g carbs per day. That or moderate carbs is easier IMO.

Dr B is very knowledgable but very extreme. I don’t fancy injecting into a muscle in an attempt to stop the highs of illness! He also lost his hypo awareness completely. Take the good things from him, and good things from other regimes and find a combination that suits you as an individual.

Re the Novorapid, try Humalog. Most people find it faster than NR. You’ll also see that Dr B rates its strength/speed too.

Have you tried any of the regular insulins?

Also I agree with what you are saying in regards to Bernstein. I just use him as a marker for low carb. I don't follow everything he says. But he is a very good marker for management of type 1 even with his extreme ways. I guess we are all different. He did use old fashioned needles so I guess he's not scared of injecting into muscle. I agree though I couldn't do that, im scared of needles enough lol.

 

[aaronjunited]

Absolutely agree my friend, we are ones who live with condition 24/7 so know our own bodies best so would guess that hcps imput is less than 1%, that said if you have a good team behind you that 1% can make all the difference to your wellbeing.



Often gets said on forum that we are all different & no one approach suits all, I totally agree with this statement so again what you've said is so true my friend.


Mistakenly thought you were across the pond & a patient of this Dr B, hence comment about listening to your Dr about lantus profile, but looking back at your posts can see that your from beautiful NI.

As this issue with lantus has been ongoing for 2 years it probably isn't for you so time for change, suggestion would be to switch to insulin pump so you can have multiple basal rates over 24hr period, don't know if you open to that idea but something to discuss with your diabetes team.

Stay positive & sure you'll cracked all this pretty soon with help from likes of @rebrascora who has loads of experience in following a low carb diet. Good luck.

Thani you sir! I hope I can crack this soon. It's been a roller coater.

 

[Inka]

Have you tried any of the regular insulins?

Also I agree with what you are saying in regards to Bernstein. I just use him as a marker for low carb. I don't follow everything he says. But he is a very good marker for management of type 1 even with his extreme ways. I guess we are all different. He did use old fashioned needles so I guess he's not scared of injecting into muscle. I agree though I couldn't do that, im scared of needles enough lol.

I have indeed @aaronjunited 🙂 I used Actrapid for a number of years following diagnosis, and I now use Hypurin. It’s ideal for non-carby meals like, say, salmon and salad. I also use it for low carb higher fat treats, and a few other things.

 

[aaronjunited]

I have indeed @aaronjunited 🙂 I used Actrapid for a number of years following diagnosis, and I now use Hypurin. It’s ideal for non-carby meals like, say, salmon and salad. I also use it for low carb higher fat treats, and a few other things.

Interesting! I shall see what my team has available for me then. So Hypurin is good for protein and veg/salad meals where it gets the slower release from the protein? At the moment I'm injecting 2 units of novo-rapid half hour before eating chicken and veg

 

[Inka]

Interesting! I shall see what my team has available for me then. So Hypurin is good for protein and veg/salad meals where it gets the slower release from the protein? At the moment I'm injecting 2 units of novo-rapid half hour before eating chicken and veg

Yes, Hypurin is regular insulin, so its profile of action is different from the analogue insulins like Humalog and Novorapid. It takes longer to kick in and more closely matches the protein rise. I’ve just used it for a low carb meal tonight and actually injected it after eating so it can tick along and keep my blood sugar level. It takes a little experimentation. The best way is to basically eat the same meal a few times and see what works for you.

You’ll probably have a bit of a fight to get Regular insulin. Some HCPs can’t get it into their head that newer isn’t always better and disparage the older insulins. Hypurin they’ll probably have a double go at because it’s porcine insulin, but it works great for me. You’re entitled to have the insulins that suit you, so read up, make your case and don’t be dissuaded by them trying to push you on to an ever more engineered analogue insulin.

 

[Pumper_Sue]

Interesting! I shall see what my team has available for me then. So Hypurin is good for protein and veg/salad meals where it gets the slower release from the protein? At the moment I'm injecting 2 units of novo-rapid half hour before eating chicken and veg

Have you tried injecting half an hour after eating?

 

[aaronjunited]

Yes, Hypurin is regular insulin, so its profile of action is different from the analogue insulins like Humalog and Novorapid. It takes longer to kick in and more closely matches the protein rise. I’ve just used it for a low carb meal tonight and actually injected it after eating so it can tick along and keep my blood sugar level. It takes a little experimentation. The best way is to basically eat the same meal a few times and see what works for you.

You’ll probably have a bit of a fight to get Regular insulin. Some HCPs can’t get it into their head that newer isn’t always better and disparage the older insulins. Hypurin they’ll probably have a double go at because it’s porcine insulin, but it works great for me. You’re entitled to have the insulins that suit you, so read up, make your case and don’t be dissuaded by them trying to push you on to an ever more engineered analogue insulin.

Thank you for clearing all that up for me. I will be seeing them next month and putting them straight.

 

[aaronjunited]

Have you tried injecting half an hour after eating?

I take another 2units about an hour later

 

[rebrascora]

Didn't you say that you have started injecting Lantus in the morning as well as at night. If so, it will likely be the overlap which caused your low. I know you might think it doesn't last more than 8 hours but the majority of people find it lasts much longer, it is just that it has a peak between 5 and 8 hours and then tails off, much like my Levemir, but I believe Levemir is more predictable.

I would say that Fiasp peaks between 45mins-90 mins and by 2 hours there will maybe only be a third left so if I injected 3 units, there is probably only one unit worth of insulin left at the 2 hour point and all done by 3 hours.

Prebolusing is still very necessary for me even with Fiasp particularly in the morning when it needs 45 mins head start on my yoghurt, berries and seeds breakfast, mostly because it also has a very strong tidal current of Foot on the Floor (liver dump) to overcome as well as have something left to deal with breakfast. I always inject both basal and bolus before I get out of bed to give it as much head start as possible and I add between 1.5 and 2 units to deal with FOTF on top of my breakfast bolus. I don't use a different ratio for breakfast, just these extra couple of units because if I skip breakfast I still need those units to deal with FOTF.

If I am having something like gammon and ratatouille I inject Fiasp about 10-15 mins before I eat to deal with the sugars in the tomatoes and peppers and onions etc and then a couple of units around the 2 hour post meal mark when levels start to drift upwards as the protein releases. This is why a regular insulin would have to be on top of my Fiasp because I still need that up front insulin to deal with the carbs. I then usually wait until my levels hit 8 before I inject the 2 unit correction and then I monitor closely and sometimes I might need another unit an hour later if levels continue to rise and sometimes those 2 post meal units will be enough to cover the protein.. It will also depend if I had some cheese after my meal (I very rarely do dessert as that is a slippery slope but I do enjoy nice cheeses), or nuts which will also will release glucose from protein so if I have more than a handful, I may have to bolus for those. If you eat low carb you have to become quite aware of the protein you eat and watch for it releasing and take action before it gets to high. On a normal diet, you could probably eat that cheese or nuts without needing any insulin for them but if you are low carb, your body will break it down and you will need to use insulin to deal with it. At least that is how my body works. You could of course go out for a run or cycle ride 2 hours after your meal and burn off the protein release as it is releasing and not need insulin or carbs to sustain you because you are getting the steady trickle from the protein.

The key things for me is that I prebolus for the carbs and most low carb meals will still get 2 units up front and then I pay close attention to my Libre after the meal. If I have timed the prebolus right my levels shouldn't go above 7 from the carbs usually about 6 and then there will be a slow steady creep upwards after the carbs have gone, when the protein starts to release and if I notice in the 8s I will inject then, if it gets to 9.2 and my high alarm goes off, I inject then and if I have an upward sloping arrow I might give it 2.5 units. Fiasp is fast enough to bring it down from 9.2 without hitting double figures most of the time.

I should also say that I almost never eat when my levels are above 8 (and if I do I only eat protein because I have 2 hours for my insulin to work before it starts releasing. I almost always inject my bolus and correction and then wait for it to come down to mid 5s before I eat. If I wake up and my levels are in double figures which very rarely happens, I can be waiting 2 hours to eat breakfast but if I don't wait, I will be battling high levels all day and I don't need that frustration and I will use far more insulin for the same amount of food because I am quite resistant above 10, so I inject and wait and when Libre shows mid 5s, I eat and that gets my levels back on an even keel again. I no longer worry about how much insulin it takes to bring levels down, but I do record every injection in my Libre log so that I can see when my last one was and how much and have a rough idea of how much of it is left. This may seem complicated but it has become intuitive and I don't calculate anything really with my diabetes. I don't really carb count and I certainly don't calculate protein release, I just inject a token amount up front and then be guided by my Libre after that. I am generally a very disorganized person but I have found that being discipled with my diabetes makes a huge difference to managing it well, so if I want it to behave nicely, I have to be firm and patient.