Type 1 / limiting carbs / large doses of insulin / beyond help

[mum2westiesGill]

This morning I sent an email and also spoke with my DSN
- I asked about limiting carbs and she said we all should be limiting our carb intake - I reminded her that I'm type 1 diabetic and since 1992 out of all my DSN's over the years she's the only one who has said I should be limiting carbs to around 150g per day! I have never done this and looking back some days have gone quite a bit over.
- I asked about large doses of insulin and having to split the injection into 2 separate doses on 2 separate sites (this was mentioned on another thread of mine - 'meal out already its a disaster')and she said doses such as 12u, 13u, 14u etc are ok to take in one dose but if it was a dose such as 40u (which luckily I've never had) then it would have to be split into the separate doses.
Back to the carbs - you just think you're doing well and my DSN was happy with my levels the other day then bang this hits you! After all these years I now have my certain foods & meals which I love..........

 

[Sally71]

Your DSN can only advise you, it’s still up to you whether to take her advice or not.
There are reasons why it would be a good idea to limit your carb intake, but if you never have done in nearly 30 years why start now? Your numbers seem pretty good most days.
I’ve heard it said that doses over 7u should be split, never heard what your DSN is saying before. People do get information from different sources, which is why if you ask too many people the same question you can sometimes end up getting more confused than finding it helpful! So again, it’s up to you. We are pumping though, all the insulin goes through a cannula which is changed every 3 days. Whatever size doses we do within those 3 days all goes through the same cannula, they are expensive and we aren’t going to start putting two at a time in and swapping the tube around if the dose goes over a certain amount! So whether that particular information is true or not we don’t take any notice 🙂

 

[silentsquirrel]

As a T2 on relatively high doses of insulin, I have never been told to do more than one injection at the same time. Before I switched to Levemir, I was taking 52U of Lantus in one go - so no more than 7U at a time would have meant 8 injections, not one!!!! Not going to happen. If I need to start a new pen to complete a dose, then I would use 2 different sites, but otherwise I would not consider doing more than one injection.

Gill, focus on your DSN was pleased with your levels, you do not have to take every comment as something you MUST do, just advice that you can choose to follow - or not.

 

[Thebearcametoo]

How do you feel with the carbs and insulin doses you’re currently having? Are you managing to stay mostly in target or getting lots of issues with matching carbs to insulin? The biggest problem with larger carb loads and bigger insulin doses is the margin of error - your body may absorb the glucose faster than the insulin can combat or vice versa and so you can end up with more highs or lows. It can help to keep a detailed diary of what you eat (so you can look if some foods cause a fast spike or have a later burst of glucose) and what your insulin dose is. Foods that are high fat may give a second spike later and may benefit from a split dose so it’s not just about the amount of insulin for the carbs but how your meals play out in your body. Our dietician has said that doses above 10 units can be split even if it’s not because of the particular food eaten so we sometimes do a split bolus on the pump but you could do that by taking part of the dose before food then the rest after you eat. If it means you might forget the second dose though it’s better to do it all at once. The point of splitting the dose it to match the insulin to the glucose absorption not to change the site per se.

Dieticians are pretty down on lots of carbs so you would likely be told that there’s benefit to limiting them but everyone has different needs. My daughter generally gets around 80g carbs per meal (when she was first diagnosed it was more like 60 but she’s grown a lot since then) and the dietician has been fine about that. 150g a day seems aimed more at type 2s IMO (and even then their carb tolerance varies). Some people choose to go low carb with type 1 to reduce the amount of insulin they need to take and if it works for them great but you need to find what works for you.

 

[Drummer]

As a type 2, my intake of carbs is 40 gm a day max to keep in normal numbers.
I just deleted a post advising go with what works - thinking it a bit presumptive as I need no medication eating as I do, but, what else can you do really?

 

[silentsquirrel]

I thought the context here for "splitting doses" was in terms of sites, not time? I may be mistaken.

 

[pm133]

Gill, I don't think her comment that "we should all limit our carbs" was a helpful comment. It sounds very vague.
For example, who does she mean by "we"?
All diabetics or everyone?

Also, I'd like to know what research she is relying on for that.
Why 150g?

I know there are many opinions on this stuff but I'm not aware of a consensus amongst credible researchers and doctors that limiting carbs to 150g is something that we should all be doing.

To make it worse, she appears to have caused you confusion and a bit of worry.

 

[Deleted member 25429]

I was told by a consultant you can go down the low carb route , less insulin less risk . I chose that option as it works for me . I was 52 on diagnosis and have completely changed what I eat . It also helps me maintain my weight easily. I would rather have tight control for example my levels rarely are above 6 normally in the 4’s and 5’s if I’m going to walk the dogs and low 4’s only takes 5G of carbs and I’m fine to walk for a good hour without any change to my levels. This works for me and my lifestyle . It’s all about choices we all have to make our own .

 

[Inka]

I wouldn’t worry about it @mum2westiesGill The important thing is get and maintain good control. Your numbers always look pretty good and you’re obviously really working hard to keep in range. If it ain’t broke, why fix it?

 

[nonethewiser]

150g isn't bad, can eat this amount some days others more .

Dont be fooled by less carbs less insulin malarky as it not strictly true, spent few months doing 50g & insulin usage remained same, only difference was had to double amount of injections to keep bg under control, so loads of corrections involved.

 

[mum2westiesGill]

Your DSN can only advise you, it’s still up to you whether to take her advice or not.
There are reasons why it would be a good idea to limit your carb intake, but if you never have done in nearly 30 years why start now? Your numbers seem pretty good most days.
I’ve heard it said that doses over 7u should be split, never heard what your DSN is saying before. People do get information from different sources, which is why if you ask too many people the same question you can sometimes end up getting more confused than finding it helpful! So again, it’s up to you. We are pumping though, all the insulin goes through a cannula which is changed every 3 days. Whatever size doses we do within those 3 days all goes through the same cannula, they are expensive and we aren’t going to start putting two at a time in and swapping the tube around if the dose goes over a certain amount! So whether that particular information is true or not we don’t take any notice 🙂

Thank you for your kind reply @Sally71 🙂

 

[mum2westiesGill]

As a T2 on relatively high doses of insulin, I have never been told to do more than one injection at the same time. Before I switched to Levemir, I was taking 52U of Lantus in one go - so no more than 7U at a time would have meant 8 injections, not one!!!! Not going to happen. If I need to start a new pen to complete a dose, then I would use 2 different sites, but otherwise I would not consider doing more than one injection.

Gill, focus on your DSN was pleased with your levels, you do not have to take every comment as something you MUST do, just advice that you can choose to follow - or not.

@silentsquirrel thank you for your kind reply 🙂

 

[mum2westiesGill]

How do you feel with the carbs and insulin doses you’re currently having? Are you managing to stay mostly in target or getting lots of issues with matching carbs to insulin? The biggest problem with larger carb loads and bigger insulin doses is the margin of error - your body may absorb the glucose faster than the insulin can combat or vice versa and so you can end up with more highs or lows. It can help to keep a detailed diary of what you eat (so you can look if some foods cause a fast spike or have a later burst of glucose) and what your insulin dose is. Foods that are high fat may give a second spike later and may benefit from a split dose so it’s not just about the amount of insulin for the carbs but how your meals play out in your body. Our dietician has said that doses above 10 units can be split even if it’s not because of the particular food eaten so we sometimes do a split bolus on the pump but you could do that by taking part of the dose before food then the rest after you eat. If it means you might forget the second dose though it’s better to do it all at once. The point of splitting the dose it to match the insulin to the glucose absorption not to change the site per se.

Dieticians are pretty down on lots of carbs so you would likely be told that there’s benefit to limiting them but everyone has different needs. My daughter generally gets around 80g carbs per meal (when she was first diagnosed it was more like 60 but she’s grown a lot since then) and the dietician has been fine about that. 150g a day seems aimed more at type 2s IMO (and even then their carb tolerance varies). Some people choose to go low carb with type 1 to reduce the amount of insulin they need to take and if it works for them great but you need to find what works for you.

Hi @Thebearcametoo I guess I feel happy with the carbs and insulin I'm currently having - my tresiba insulin dose remains the same unless it needs changing because of bgl's changing. My humalog doses change at each meal because I match insulin to carb amounts which with me can vary with each meal - the humalog dose also depends on my bgl. At the moment my bgl's are staying more or less in target. I try and make a note of all foods eaten and enter it into my MySugr diary. I've never really paid attention to what foods do what - I just eat and get on with it - I only really focus on why I'm high or why I'm hypo. What I find what works for me is what I've been doing for the last 30 years. The one time I did mess up was when I ended up with DKA (not nice at all!) and leading up to it I was really messing around ie mostly skipping injections and meals.

 

[mum2westiesGill]

I thought the context here for "splitting doses" was in terms of sites, not time? I may be mistaken.

You're correct about the context for splitting doses it's in terms of sites.

 

[mum2westiesGill]

Gill, I don't think her comment that "we should all limit our carbs" was a helpful comment. It sounds very vague.
For example, who does she mean by "we"?
All diabetics or everyone?

Also, I'd like to know what research she is relying on for that.
Why 150g?

I know there are many opinions on this stuff but I'm not aware of a consensus amongst credible researchers and doctors that limiting carbs to 150g is something that we should all be doing.

To make it worse, she appears to have caused you confusion and a bit of worry.

Thanks for your reply @pm133 - I definitely don't think her "we should all limit carbs" was helpful at all!

I've no idea where she gets her research about the 150g from but I wish I knew!

Yes all this has certainly caused me some worry - after 30 years of doing things my way then suddenly this but as everyone has virtually said to me don't let it worry you"!

 

[mum2westiesGill]

I wouldn’t worry about it @mum2westiesGill The important thing is get and maintain good control. Your numbers always look pretty good and you’re obviously really working hard to keep in range. If it ain’t broke, why fix it?

Thank you so much for your lovely reply @Inka especially "if it ain't broke, why fix it"?

 

[Deleted member 25429]

Maybe your DSN was just trying to say we should all eat healthily

 

[mum2westiesGill]

Maybe your DSN was just trying to say we should all eat healthily

I'm thinking that too - but I eat the things that I like and enjoy not what she's saying I need to like and don't enjoy

 

[Deleted member 25429]

I'm thinking that too - but I eat the things that I like and enjoy not what she's saying I need to like and don't enjoying

 

[Deleted member 25429]

I used to be a really fussy eater , since marrying my husband he has got me to try lots of new foods and I’ve become far more adventurous and healthier. If I try something and don’t like it I move on don’t eat it again