Type 1 & low carb

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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.

You’ll be able to think about it less once you get things roughly right. Each part of the process takes time. It is annoying and frustrating, but taking time to get things roughly right, will pay dividends. Once you’ve got things roughly right, it should be easier.

Regarding the Levemir, “they” don’t control you or have power over your diabetes. People on insulin are entitled to the insulin that they want. Tell don’t ask!
 
And I wouldn’t bother too much with working out the ratios when you’re at the hospital. They might change when you’re on Levemir. There’s no working out with diabetes, it’s estimates and trial and error. This was one of the first things I learnt when I asked the consultant how she worked out my insulin dose. Her answer: “We don’t. We use the data we have to make an estimate, but it’s just that - an estimate”.
 
Sorry all, after lunch I’ve got another question! So sorry about taking up your time!

So lunch I had a similar lunch to yesterday (meal deal sandwich basically), same amount of carbs. Yesterday I took 4u and today 4.5u. The result is exactly the same. I’m seemingly stuck at 12.5 mmol after 2.5 hours. Is this a timing issue or still just not enough insulin?

I know basal is probably not quite right, but that shouldn’t cause this difference from yesterday to today would it?
 
Don't keep apologizing for using the forum for what it is here for... ie. to ask questions. We would be sad and disappointed if we thought that you felt you couldn't ask whatever you needed to. Feel free to ask away as much as you like.

Anyway, can you talk us through your whole lunch situation.... ie What was your premeal level? How many carbs in the sandwich? Did you have crisps and a drink with it and what were those ie How many carbs in total?
What is the ratio you are currently using for lunch?
How long in advance of lunch did you prebolus and what was your reading when you started eating?

Have you been told how to do corrections and if so, what is your correction factor. ie. How many mmols will 1 unit of bolus insulin drop your levels? If you can tell us all that info, then we will have a much better idea of what is going on.
 
Sorry all, after lunch I’ve got another question! So sorry about taking up your time!

So lunch I had a similar lunch to yesterday (meal deal sandwich basically), same amount of carbs. Yesterday I took 4u and today 4.5u. The result is exactly the same. I’m seemingly stuck at 12.5 mmol after 2.5 hours. Is this a timing issue or still just not enough insulin?

I know basal is probably not quite right, but that shouldn’t cause this difference from yesterday to today would it?

I’d also add that the carbs on the sandwich packet are only an average estimation. I’ve ‘under-bolused’ for sandwiches before because I’ve looked at them and been a bit suspicious about the carbs, and my blood sugar has been fine, so the carbs were obviously not very accurate.

I think it’s partly a timing issue and a basal issue, but what I’d like to know is what your blood sugar comes down to before your next meal. Again, eating too few carbs causes physiological insulin resistance and that will gradually ease over time. 12.5 isn’t awful and you never have to apologise for asking questions 🙂
 
Don't keep apologizing for using the forum for what it is here for... ie. to ask questions. We would be sad and disappointed if we thought that you felt you couldn't ask whatever you needed to. Feel free to ask away as much as you like.

Anyway, can you talk us through your whole lunch situation.... ie What was your premeal level? How many carbs in the sandwich? Did you have crisps and a drink with it and what were those ie How many carbs in total?
What is the ratio you are currently using for lunch?
How long in advance of lunch did you prebolus and what was your reading when you started eating?

Have you been told how to do corrections and if so, what is your correction factor. ie. How many mmols will 1 unit of bolus insulin drop your levels? If you can tell us all that info, then we will have a much better idea of what is going on.
Thank you so much! I suppose I’m just feeling I’m currently quite heavily relying on other peoples support but so happy you are here.

Premeal level today was 8.5, 41 carbs in the sandwich, only drank water with it. Yesterday was similar (41 grams carbs, but fat content yesterday 7 grams and today 15 grams), premeal levels yesterday 7 mmol.

I took 4u yesterday and 4.5 units today. Pre-bolus yesterday 10 mins, today 15 mins. 2 hours after eating levels were: 12.5 yesterday, 12.5 today.

I’ve never been officially told how to do corrections (or any bolus at all to be honest), but I’ve taken 0.5u today and yesterday which have brought levels down to ‘green’. 0.5u seem to bring my levels down anywhere between 1 and 3 mmol.

Hope that helps!
 
I’d also add that the carbs on the sandwich packet are only an average estimation. I’ve ‘under-bolused’ for sandwiches before because I’ve looked at them and been a bit suspicious about the carbs, and my blood sugar has been fine, so the carbs were obviously not very accurate.

I think it’s partly a timing issue and a basal issue, but what I’d like to know is what your blood sugar comes down to before your next meal. Again, eating too few carbs causes physiological insulin resistance and that will gradually ease over time. 12.5 isn’t awful and you never have to apologise for asking questions 🙂
I have to take some extra insulin to bring levels down which is fine albeit a little annoying. The thing I just don’t understand is that I seem to take more insulin each day with the same result as the day prior, which is why I thought that maybe the insulin resistance was getting worse
 
@Evergreen it seems that you have been left alone without much information about how to manage your diabetes.
Diabetes can be frustrating at the best of times but when you don't have much knowledge to had (I was going to say "all knowledge" but I am not sure everyone knows everything about diabetes).
One thing that stands out to me is that you seem to be relying only on how much insulin and what you eat to effect your blood sugars but there is much more to it. This article explains it better than I can: https://diatribe.org/42-factors-affect-blood-glucose-surprising-update
Many of these things cannot be measured so it becomes a bit of a gut feel. For example, I have a tough meeting so I expect my BG to rise and will need more insulin with my lunch. Or I ran to the shops before lunch (yeah, for me that will mean "run") so I will need less insulin.
Basically, we could eat exactly the same meal and take the same amount of insulin for 5 days and get different results. Or take different amounts of insulin on two days and get the same results. Diabetes is fickle that way.
 
@Evergreen it seems that you have been left alone without much information about how to manage your diabetes.
Diabetes can be frustrating at the best of times but when you don't have much knowledge to had (I was going to say "all knowledge" but I am not sure everyone knows everything about diabetes).
One thing that stands out to me is that you seem to be relying only on how much insulin and what you eat to effect your blood sugars but there is much more to it. This article explains it better than I can: https://diatribe.org/42-factors-affect-blood-glucose-surprising-update
Many of these things cannot be measured so it becomes a bit of a gut feel. For example, I have a tough meeting so I expect my BG to rise and will need more insulin with my lunch. Or I ran to the shops before lunch (yeah, for me that will mean "run") so I will need less insulin.
Basically, we could eat exactly the same meal and take the same amount of insulin for 5 days and get different results. Or take different amounts of insulin on two days and get the same results. Diabetes is fickle that way.
This is probably very true and one of the main reasons I’m switching teams. I feel I’ve been given this life changing diagnosis at a time of major change (Covid and a newborn baby) with some insulin pens and an off you go! I can ring the diabetes team and even though they are lovely, I don’t have a choice in who I see (meaning differing opinions and advice) and I have never seen a consultant (until I paid privately).

No one has ever in dept spoken to me about carb counting, ratios, correction factors or the impact of different foods. Most of my knowledge comes from here and from reading, but I feel so overwhelmed with it all and pretty alone.

This article is useful. I think I’m wanting an easy ratio that’s correct most of the time but I might need to let that go. I’m not wanting my levels to be perfect, I’m ok with 70 TIR, but I’m hoping for a way to give this a little less space in my brain.
 
Do you have time for the bertie course?
This is the free online version of the DAFNE (Dosing For Normal Eating) course.
I have read good things about it to walk you through things like carb counting, correction factors, ratios, different foods, sick day rules and more in a structured way.
 
Oh I haven’t heard of that! I can certainly try and make time! I’ll look it up now, thank you!
 
Another thing I’ve found @Evergreen is that, for me, there’s an optimum time to have lunch. If I eat at 12.30pm, I do my usual ratio and all’s fine, but if I eat later my blood sugar is prone to go high and/or be more stubborn in coming down. Just another thought and something else to consider. (I think my body pumps out a bit of glucose if lunch is late).

But basically, it’s impossible to have precise ratios, etc, as we’re human beings not machines. There’s no magic formula you’ll find, like you might for a machine. We aim to do the best we can, while understanding that perfection is impossible.
 
Yes, I understand. I suppose it’s about getting to a point of acceptance which I have found hard as it’s ever changing. I’m going to try and work on this.

I still think that I must be able to get to a place of slightly better control (def in the 70% range), but alongside I’m going to have to accept that life has radically changed and that the constant changes are part of life.
 
As others have said, you can't duplicate results day after day, even with the same food and the same insulin. If you are within 2mmols of the previous day's result, that is a reasonable outcome.

Don't worry yourself about insulin resistance. It is not something you need to consider at this stage, if at all, unless you get significantly overweight and your insulin needs become very high... and I am talking about 15-20 units for every meal and 50+ units of basal. Any increase in insulin needs for you, particularly at the moment, is much more likely to be due to your beta cells dying off, so just accept that you will gradually need to increase your insulin doses during the honeymoon period although some people find they need to reduce them first and then increase them. It really is not something that you should concern yourself with at all, so please put it out of your head. You need however much insulin you need and it will change over time, sometimes up and sometimes down and you just have to learn to go with the flow.

Can you just remind us how long you have been diagnosed and been on insulin. I am wondering if you are just trying to do too much too soon. I know the feeling because I was really chomping at the bit to get it right straight away but it's like expecting to go and play in the Wimbledon final against Serena Williams when you normally play club level once a week. You have to set yourself reasonable expectations. It takes time and experience and practice and knowledge and you don't get that overnight. Be patient with yourself until things slowly click into place both with you getting the hang of it but also your body slowly stabilizing, because the honeymoon period can be pretty challenging.

One thing I do which helps with the timing of insulin and meals is to watch my Libre and not eat until I see the insulin starting to kick in and drop my levels. I have a rule were I don't eat if my levels are above 8 unless I really can't help it. So I inject for my food and then I keep a close eye on my Libre until I see my levels start to drop. Generally I like to be mid 5s when I eat but I would aim for mid 6s for yourself and that should still give you plenty of time for whatever you eat to hit your blood stream. So, if your levels are 8.5 when you inject for lunch, wait until they reach 6.5 before you start eating. If my levels are above 10 I can be waiting 2 hours to eat sometimes because high BG levels cause temporary insulin resistance. I know it isn't possible for everyone to wait 2 hours to eat a meal, but once you start keeping your levels mostly in range it becomes less of an issue.

I would also like to say that I learned almost everything I know from this forum and experimenting on myself, so don't expect too much from your clinic staff. As @Inka said, they can only ever make a best guess, so ultimately you need to learn how your particular body works in any given set of circumstances and adjust things accordingly. Gradually it takes up less head space and becomes more intuitive and I see it as more of a challenge and a game now rather than a serious health issue. Libre takes a lot of the strain out of managing my diabetes compared to finger pricking, but I wonder at this stage if it is giving you too much info and you seem to be applying Type 2 mentality to your results. If you were only finger pricking before your next meal, you would not know what your levels were 2 hours after your meal and therefore not be getting frustrated about them. If you were high at your next meal then you would just add a correction to bring you down into range. If you were consistently high at the next meal over a period of days then that might suggest that your basal insulin needed adjusting or that your ratio was wrong. You would look at the basal first and do a test by skipping lunch to see what happened in the absence of food and bolus insulin.

Just to give you an idea of the realities of diabetes and I am probably towards one extreme of the range, I often need 2 or 3 insulin corrections a day on top of my bolus for meals (although this is mostly for protein because I eat low carb) plus I need to adjust my Levemir (particularly my evening dose) on an almost daily basis sometimes. So last night I got a lovely flat line in the 5s with 2.5 units of Levemir, down from 3.5u the previous night. This afternoon for the second day in a row, I have been hedge cutting in my field and I will need to reduce it by another unit or perhaps1.5 units tonight. If I don't I will hypo. By contrast I need 22 units in the morning which is pretty consistent, unless I do lots of exercise on consecutive days and my basal dose is down to 0 at night and I am still hypoing overnight, so I have to start reducing the morning dose. When I am exercising less, the doses will go back up.
 
This talk about low carb diet piqued my curiosity, so I decided to give it a go. I bought an OXO manual spiraliser to make veggie noodles as a pasta substitute.

Monday I had courgette noodles with basil pesto - 40g carbs.

Yesterday I had cucumber noodles with bolognaise sauce - 34g carbs.

The results are encouraging (see attached), yesterday in particular. I had the flattest evening and night blood sugar readings in quite some time.

Monday, blood sugar rose more markedly later in the evening but that was most likely due to a high fat/protein count for dinner (4.8).

I will definitely be exploring this further.
 

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Spiraliser is a big bonus. It speeds up cooking time for some more solid veg and reduces the portion size as it all bulks up, and courgette is so easy as a replacement for pasta. I look forward to reading your further progress @littlevoice359
 
Experiment continues. Yesterday I had shredded cabbage, instead of cucumber noodles, with the same bolognaise sauce as the day before. 40g carbs total for dinner. No real spike after eating and steady blood sugar throughout the evening and night. So far, this low carb strategy is looking like a winner!
 

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Experiment continues. Yesterday I had shredded cabbage, instead of cucumber noodles, with the same bolognaise sauce as the day before. 40g carbs total for dinner. No real spike after eating and steady blood sugar throughout the evening and night. So far, this low carb strategy is looking like a winner!
Glad this is working for you. Less carbs, smaller rise in BG makes sense, and I found around 30 g per meal is enough for me not to have to think about protein.
 
Glad this is working for you. Less carbs, smaller rise in BG makes sense, and I found around 30 g per meal is enough for me not to have to think about protein.
Cheers. My experience so far is similar, as long as I keep between 30g and 40g carbs and adjust insulin accordingly.

Results from yesterday (attached) are in line with what I reported in this earlier post.

I am happily surprised at the difference this change has made.
 

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