Type 1 & low carb

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Evergreen said:
I’m feeling pretty frustrated about it if I’m honest and like I’ll never get it right. It’s also making me pretty anxious, which I’ve never experienced before getting this diagnosis.
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I think you have to find a level of acceptance that you won't always get it right ever (there are people here with 50+ years, still not getting perfect results) and if you do, it is usually a fluke. 🙄 Not saying you will get it wrong all the time by any means, but you have to come to terms with near enough being good enough. That can be quite a tough concept and is one of the reasons why I love CGM and the Time in Range feature. For most of us, 70% time in range (3.9-10) is achievable and more importantly means we are doing really well, but it takes time and practice and experience. I think most of us were impatient to do well in the first few months and even first few years. Libre certainly speeds up the learning process, but there are days and weeks when it goes awry for no apparent reason and then other times when it feels more like plain sailing. This ebb and flow is a feature of life not just diabetes. Nothing goes smoothly all the time and you have to weather the storms to enjoy the calmer waters, but there will always be another storm sooner or later and there is nothing I can do about that other than hang in there until it passes.... and it does. You learn little strategies to help here and there but a lot of it is just acceptance that you do your best and the rest is in the lap of the Gods.

Evergreen said:
I’ve been aiming for 30-40 grams of carbs per meal. It’s useful to hear that 60 grams seems to be a number where you don’t need to wrestle with the insulin resistance and protein! I actually have that book, might need to read again!
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By the way, the magic number of carbs is about 30g per meal, not 60g, regarding preventing protein break down.
 
Evergreen said:
Thank you again everyone!

I’ve been aiming for 30-40 grams of carbs per meal. It’s useful to hear that 60 grams seems to be a number where you don’t need to wrestle with the insulin resistance and protein! I actually have that book, might need to read again!
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To clarify - the 60 gms is not a magic number. It is a minimum of 30 gms with any main meal that means that there are sufficient carbs to prevent your metabolism from seeking extra carbs from proteins and fats. You still need to bolus for those carbs; and if 2 main meals you'd need to bolus twice likewise for 3 main meals bolus three times. Even with 3 x main meals, each hitting that nominal 30 gms of carbs a 90gm daily carb intake is still low carb in the wider understood considerations of staying low carb.
Evergreen said:
I’m not going to lie though, it’s been tough doing this! I clearly have a lot of learning to do (and I’m probably a little too impatient..)

For most meals I’ve not given myself enough insulin, even though I’ve gone from 1:15 ratio to 1:10 and I’ve only been back in ‘green’ just before my next meal which has been frustrating. This might be a silly question, but does this put me at a higher risk for DKA?

Randomly I thought I got my ratio perfectly for dinner yesterday but nearly went low overnight (I’ve got a young child who woke up so I noticed before it went low),
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This catches my attention; my CGM alerts (rather than alarms needing urgent action) are set a lot higher. For Libre 2 I used the highest setting of 5.6, most of the time. Then I'd get due notice that my BG was dropping, even if the trend arrow was still showing level. From that alert I can make a deliberate decision about what to do next. From an alarm close to 4, I have little choice but to react quickly and sometimes it could be a bit too late.
Evergreen said:
I ate at 6.30pm though so I’m making an assumption that that was my basal (even though I’m currently only on 7u!)
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I'm not sure I understand your point. Did you mean bolus rather than basal? Or are you inferring your basal is, to some extent, catering for your meals - from which I'd suggest a basal test would be appropriate. We don't live in a perfect world and from my relatively short experience there is no perfect way for any one person to perfectly manage their D. But I would place the principle of getting one's basal as correct as possible as an important principle - otherwise one's shorter life bolus is constantly needing to be "right" against a background longer lasting basal that already isn't right. Chasing it's tail, so to speak.
Evergreen said:
I’m feeling pretty frustrated about it if I’m honest and like I’ll never get it right. It’s also making me pretty anxious, which I’ve never experienced before getting this diagnosis.
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I never was anxious before my surgery and consequent diagnosis. I am finally starting to look beyond those anxious moments:
1. Because I increasingly feel happy to deal with a change that I wasn't anticipating and emerge broadly OK.
2. Because there are far too many factors that affect our BG that make the management of D an art as well as a science. My maths is OK, but I can't mathematically solve art issues. Also, from time to time I just seem to have put on the wrong colour socks and the rules aren't being obeyed.

I guess it's back to my earlier point that perfection is not attainable - so accept the glitch, learn a lesson IF there is an obvious lesson, and move on. Tomorrow will definitely be another day. Talking of which you've had a roller coaster 2 days since starting this thread, had masses of dialogue and I would be pretty confused by now trying to sort out what's going to help in the very short term and what needs a more measured approach. Good luck and akin to Strictly "Keep Asking"!
 
Inka said:
Getting your basal changed should help a lot @Evergreen You won’t believe how much a wrong basal throws everything off. Remember too that this is a gradual process. You’re not going to switch your diet just like that and have everything work immediately. As you’re sensibly doing, you have to be cautious to avoid hypos, and you have to inch your way to the correct ratios for meals.
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Yes I know you’re right, I just wish I could be in a place where things are a little bit more predictable! I know I have to be patient and thank you for reminding me.

Do you know whether having my blood sugars higher than usual puts me at greater risk of dka? I’m obviously still taking my basal and do give corrections when needed to get blood sugars down
 
rebrascora said:
I think you have to find a level of acceptance that you won't always get it right ever (there are people here with 50+ years, still not getting perfect results) and if you do, it is usually a fluke. 🙄 Not saying you will get it wrong all the time by any means, but you have to come to terms with near enough being good enough. That can be quite a tough concept and is one of the reasons why I love CGM and the Time in Range feature. For most of us, 70% time in range (3.9-10) is achievable and more importantly means we are doing really well, but it takes time and practice and experience. I think most of us were impatient to do well in the first few months and even first few years. Libre certainly speeds up the learning process, but there are days and weeks when it goes awry for no apparent reason and then other times when it feels more like plain sailing. This ebb and flow is a feature of life not just diabetes. Nothing goes smoothly all the time and you have to weather the storms to enjoy the calmer waters, but there will always be another storm sooner or later and there is nothing I can do about that other than hang in there until it passes.... and it does. You learn little strategies to help here and there but a lot of it is just acceptance that you do your best and the rest is in the lap of the Gods.



By the way, the magic number of carbs is about 30g per meal, not 60g, regarding preventing protein break down.
Click to expand...
Yes I’m trying to get to a level of acceptance. I know I need to, but I’m finding it hard. I’m a perfectionist by nature and this obviously isn’t helping. I will try and keep this all in mind, thank you.

I didn’t mean 60g per meal sorry. More 60g in total a day on some days might be enough to not get back to insulin resistance hopefully!
 
Evergreen said:
So mostly up around 13, then only back down to below 10 just before the next meal. But yesterday my blood sugar went up to 15
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Brief excursions to higher numbers won’t cause DKA. Ideally, you wouldn’t go up to 15 but sometimes sh*t happens. I had a 17 the other day after a cannula issue. It’s prolonged highs and ketones that cause DKA.
 
Proud to be erratic said:
To clarify - the 60 gms is not a magic number. It is a minimum of 30 gms with any main meal that means that there are sufficient carbs to prevent your metabolism from seeking extra carbs from proteins and fats. You still need to bolus for those carbs; and if 2 main meals you'd need to bolus twice likewise for 3 main meals bolus three times. Even with 3 x main meals, each hitting that nominal 30 gms of carbs a 90gm daily carb intake is still low carb in the wider understood considerations of staying low carb.

This catches my attention; my CGM alerts (rather than alarms needing urgent action) are set a lot higher. For Libre 2 I used the highest setting of 5.6, most of the time. Then I'd get due notice that my BG was dropping, even if the trend arrow was still showing level. From that alert I can make a deliberate decision about what to do next. From an alarm close to 4, I have little choice but to react quickly and sometimes it could be a bit too late.

I'm not sure I understand your point. Did you mean bolus rather than basal? Or are you inferring your basal is, to some extent, catering for your meals - from which I'd suggest a basal test would be appropriate. We don't live in a perfect world and from my relatively short experience there is no perfect way for any one person to perfectly manage their D. But I would place the principle of getting one's basal as correct as possible as an important principle - otherwise one's shorter life bolus is constantly needing to be "right" against a background longer lasting basal that already isn't right. Chasing it's tail, so to speak.

I never was anxious before my surgery and consequent diagnosis. I am finally starting to look beyond those anxious moments:
1. Because I increasingly feel happy to deal with a change that I wasn't anticipating and emerge broadly OK.
2. Because there are far too many factors that affect our BG that make the management of D an art as well as a science. My maths is OK, but I can't mathematically solve art issues. Also, from time to time I just seem to have put on the wrong colour socks and the rules aren't being obeyed.

I guess it's back to my earlier point that perfection is not attainable - so accept the glitch, learn a lesson IF there is an obvious lesson, and move on. Tomorrow will definitely be another day. Talking of which you've had a roller coaster 2 days since starting this thread, had masses of dialogue and I would be pretty confused by now trying to sort out what's going to help in the very short term and what needs a more measured approach. Good luck and akin to Strictly "Keep Asking"!
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Sorry I don’t know how to quote!

I’m using Suggah with my Libre at the moment and have my alarms set for 4.5. I also get quick drop alerts though and this seems to work alright.

I think what I meant by assuming it was my basal is that I took a bolus injection with my food and that should have finished working when I went to bed. So I can only think that the drop overnight would have been due to my basal. Does that makes sense?

I like how you view your diabetes and I’m working on wanting to be less perfect so to speak haha. It’s a battle and I think the anxiety that I feel just wants to get to a place of not even perfection, but a little more predictability. I’m hoping I can achieve that at some point.
 
Evergreen said:
Sorry I don’t know how to quote!

I’m using Suggah with my Libre at the moment and have my alarms set for 4.5. I also get quick drop alerts though and this seems to work alright.

I think what I meant by assuming it was my basal is that I took a bolus injection with my food and that should have finished working when I went to bed. So I can only think that the drop overnight would have been due to my basal. Does that makes sense?
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Yes total sense, thanks. Any one bolus insulin, or indeed any one insulin regardless of bolus or basal, has a manufacturer's performance profile - which will generally be what users actually experience. But not always - some can find the bolus is faster or slower. But another relevant feature is the pre-bolus timing. I find my body needs a shorter prebolus for the evening than the day. Also my natural insulin resistance changes through the day such that my bolus is noticeably more efficient in the evenings. So lots of variables that can bring modest variations - even before I've established if it's wrong colour socks day. Even so the drop overnight probably was your basal. Personally I like to see some repetition with these sorts of things before making biggish decisions - BUT in waiting for that repition I'd need to have similar repeat criteria PLUS safeguards against that possible repeating of a low scenario. This all adds to more time being given by me to managing my D and eventually all that time "lost" gets to me, creating different angst etc. So finding that "balance" is very personal and only you can judge which way to go. But I do hear and heed quiet observations from my wife which, if I'm very truthful, gives me the excuse to relax and roll with the possible short term outcome.
Evergreen said:
I like how you view your diabetes and I’m working on wanting to be less perfect so to speak haha. It’s a battle and I think the anxiety that I feel just wants to get to a place of not even perfection, but a little more predictability. I’m hoping I can achieve that at some point.
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More predictability will come. Steadily, you will remember those meals (days) that didn't work so well and try a different approach whether it's in different prebolus timings or different quantity or bolus ratios for that meal. Each small success will give you a great smugness (until you do this on a wrong socks day!) and a great feeling of gradually making progress. Those moments will show up in improved Time in Range stats.

One useful bit of advice given to me some 45 years ago was to "Apply the Test of Reasonability". A test that can be applied to almost any scenario. When one encounters something that seems contrary to what I might do, ask yourself "Is this Reasonable?" If it is, go with it; if not be clear why not and able to defend my position to myself as well as others. I use that test a lot and definitely whenever I'm trying too hard and straining the patience of my wife (and recently losing valuable time with my 10 yr old grandson - now we are temporarily house sharing). That need to be safe is still important but not as important as enjoying family time. Its a great help in my internal debates about accepting some imperfection.
 
Evergreen said:
Yes I’m trying to get to a level of acceptance. I know I need to, but I’m finding it hard. I’m a perfectionist by nature and this obviously isn’t helping. I will try and keep this all in mind, thank you.
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It is not easy to accept the vagaries of diabetes. Like you I am a perfectionist and also a Mthematician, so I was certain I could ‘sort this out’ . It took me a good while to accept that with the number of variables that we are dealing with it is definitely IMPOSSIBLE to get things perfect. In the early days when people on here encouraged me to be more realistic, I just thought they weren’t trying as hard as I was !!! Eventually they got the reality of life with D through to me. This takes time to get used to.
 
Bolus, Basal, pre-bolus, honeymoon, Carbs, …
You are already doing brilliantly and got your head round so much. Well done.
Take things step by step. Keep the questions coming.
 
Evergreen said:
For most meals I’ve not given myself enough insulin, even though I’ve gone from 1:15 ratio to 1:10 and I’ve only been back in ‘green’ just before my next meal which has been frustrating. This might be a silly question, but does this put me at a higher risk for DKA?
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If you are returning to "green" before your next meal (and assuming your basal is correct), your issue maybe more around timing than quantity of your bolus.
If you drew a graph of your carb digestion/absorption after eat and took the insulin profile (this is available online and is easy to find with Google but varies per insulin), in an ideal world, the peak of both would line up.
We can't change the shape of the graphs (apart from eating a different meal) but we can change the relative timings between them.
If your levels are returning to "normal" but after too long, your food spike is happening before your insulin spike and you need to pre-bolus earlier.
If your levels are not retuning the "normal", you need more insulin.
 
They aren’t returning to ‘green’ unless I give myself an extra 0.5 unit. Very much clinging on to levels of 13 whatever I seem to eat/do! I haven’t waited longer than 2-2.5 hours so not sure if levels would come after that.

I’ve been pretty frustrated overall but really trying to be more mindful about it all. My team have been able to squeeze me in for an appt in 2 weeks and there’s talk of changing me over to levemir so fingers crossed!

I’ve had the same breakfast for the last 3 days (bagel thin with peanut butter - 25 grams of carbs). I started with 2.5 units of insulin, then 3 units yesterday and 3.5 units today. Literally no difference at all. Could I be getting more resistant?!
 
Evergreen said:
I’ve had the same breakfast for the last 3 days (bagel thin with peanut butter - 25 grams of carbs). I started with 2.5 units of insulin, then 3 units yesterday and 3.5 units today. Literally no difference at all. Could I be getting more resistant?!
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Breakfast can be a bit more of a challenge due to the morning liver dump.
Some people find they need a fixed bolus for the liver dump and then the calculated bolus based on carb ratios for their meal.
It is also common to need an earlier pre-bolus.
 
It’s just so bizar that the more insulin I take in the morning it doesn’t seem to be making a difference? Or maybe it is that I need to pre-bolus earlier.

Gosh what a nightmare!
 
No, I doubt you’re getting more resistant @Evergreen Remember, it can take time to get your sensitivity back - sometimes as much as 3 weeks. In addition,I still think your basal is a big part of the problem. Once you get the Levemir, you’ll be able to build on that. In the meantime, before increasing your breakfast bolus again, try moving the time of the bolus more in advance. Move it gradually, 5 mins earlier each day.

Think about this as gently nudging a ball to get it back on track as it’s moving down a path. If you give it a massive great whack, it’s all going to go haywire. You need to take things slowly and gently. You’ll get better control but you’ll do that by being patient. It is frustrating and I don’t pretend to be the most patient person myself, but honestly, getting your head round the idea that slow and steady is the way and that it will benefit you, is important.
 
Inka said:
No, I doubt you’re getting more resistant @Evergreen Remember, it can take time to get your sensitivity back - sometimes as much as 3 weeks. In addition,I still think your basal is a big part of the problem. Once you get the Levemir, you’ll be able to build on that. In the meantime, before increasing your breakfast bolus again, try moving the time of the bolus more in advance. Move it gradually, 5 mins earlier each day.

Think about this as gently nudging a ball to get it back on track as it’s moving down a path. If you give it a massive great whack, it’s all going to go haywire. You need to take things slowly and gently. You’ll get better control but you’ll do that by being patient. It is frustrating and I don’t pretend to be the most patient person myself, but honestly, getting your head round the idea that slow and steady is the way and that it will benefit you, is important.
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Thank you, this is helpful. I think I’m just so ready to get to a place where I can start to think about this less that it’s making me more frustrated.
 
I have an hour long appointment at the hospital in 2 weeks time. I’m keeping a diary on paper and I’m logging everything meticulously in the Libre app so that the nurses have as much data as possible. I reckon they’ll change me over to levemir and they will analyse my levels to help me work out some ratios. I’ll just muddle through in the meantime
 
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