Type1 or Type 2

[Inka]

Hi @JillFearn - just picking up on this bit:

…he is on Novomix 20 in the morning and 18 after dinner…

Why is he injecting his Novomix after dinner rather than before? Does he have additional medical problems affecting his ability to eat, or do you just mean that he can’t decide what to eat? Novomix should usually be injected before a meal to reduce the risk of highs and lows.

 

[JillFearn]

If he is found to have Type 1, there is nothing he cannot eat - Type 1 is managed with insulin, not diet.
Many people with type 2 reduce the carbs that they eat. However, doing so whilst they are still confirming type may hide any Type 1 symptoms and risk hypos whilst he is on a fixed dose.

Thank you so much that makes sense now, especially with the hypos, thank you

 

[JillFearn]

Hi @JillFearn - just picking up on this bit:

…he is on Novomix 20 in the morning and 18 after dinner…

Why is he injecting his Novomix after dinner rather than before? Does he have additional medical problems affecting his ability to eat, or do you just mean that he can’t decide what to eat? Novomix should usually be injected before a meal to reduce the risk of highs and lows.

Sorry I meant before dinner. Yes he can’t decide what to eat as he wants to limit his carbs

 

[JillFearn]

In his book 'Man Food' Ian Marber, a nutritionist, recommends basing every meal on 1/3 plate protein, 1/3 veg and 1/3 carbs. He adds you can always replace (some or all) the carbs with more veg - which is probably a good thing for many diabetics.

As a specific guide to what to eat you could have a look at this meal planner and its red, amber, green food lists from Dr Kim Andrews at the Freshwell surgery. This is a healthy low carb diet for T2Ds to avoid highs and equally so, I presume, for T1Ds.

Alternatively you could follow the meal plans and recipes set out elsewhere on the Diabetes UK website.

Will take a look, thank you so much

 

[JillFearn]

If he is found to have Type 1, there is nothing he cannot eat - Type 1 is managed with insulin, not diet.
Many people with type 2 reduce the carbs that they eat. However, doing so whilst they are still confirming type may hide any Type 1 symptoms and risk hypos whilst he is on a fixed dose.

This is really helpful thank you

 

[Inka]

Sorry I meant before dinner. Yes he can’t decide what to eat as he wants to limit his carbs

Bit of a personal question @JillFearn, but is he overweight? Why does he want to limit his carbs? If he’s on fixed doses of Novomix, he shouldn’t reduce his carbs without advice as it could cause him to have a hypo. With fixed doses of mixed insulin, it’s important to eat the same amount of carbs at the same time each day.

 

[JillFearn]

Hi @JillFearn - just picking up on this bit:

…he is on Novomix 20 in the morning and 18 after dinner…

Why is he injecting his Novomix after dinner rather than before? Does he have additional medical problems affecting his ability to eat, or do you just mean that he can’t decide what to eat? Novomix should usually be injected before a meal to reduce the risk of highs and lows.

Sorry meant before dinner, yes he just doesn’t know what to eat and think he has become a bit nervous of carbs

 

[JillFearn]

Bit of a personal question @JillFearn, but is he overweight? Why does he want to limit his carbs? If he’s on fixed doses of Novomix, he shouldn’t reduce his carbs without advice as it could cause him to have a hypo. With fixed doses of mixed insulin, it’s important to eat the same amount of carbs at the same time each day.

No he isn’t overweight, he lost quite a bit in a short time before hospital. I will pass this onto him, just feel like were floundering at the moment but we have only had one phone call from diabetes community nurse since he has been home. Now I think about it, she did say not to be afraid of the carbs. Thank you

 

[Inka]

No he isn’t overweight, he lost quite a bit in a short time before hospital. I will pass this onto him, just feel like were floundering at the moment but we have only had one phone call from diabetes community nurse since he has been home. Now I think about it, she did say not to be afraid of the carbs. Thank you

Unexpected weight loss can be a symptom of Type 1 so it makes sense they’re investigating this possibility. He should be aiming to eat pretty normal meals. As @helli said, if tests show he is Type 1, then the recommended diet is basically a normal healthy diet as Type 1 is an auto-immune condition and nothing to do with ‘bad’ diet.

 

[JITR]

@Inka
As I understand it a fixed dose of insulin corresponds in some way to an amount of carbs to be consumed. Approximately what amount of carbs per meal should be consumed when taking Novomix 20 and Novomix 18?

One set of guidelines for T2Ds recommends 50g of carbs per day for weight loss, 80g for maintenance, and up to 130g per day to support an 'active' lifestyle. What are typical ranges of carb consumption for T1Ds?

I assume (perhaps unwisely) that his doctors would have provided some guidance on the use of Novomix. He has a Libre to monitor his levels and help him avoid highs and hypos.

 

[Inka]

The amount of carbs will differ per person for those amounts of Novomix @JITR It sounds like the OP’s husband wasn’t given a lot of guidance.

Typical ranges of carb consumption for Type 1s vary enormously, just as they do for people without diabetes, but the point is that the Type 1 doesn’t require they eat a limited carb diet. The problem is not diet for Type 1s, it’s the auto-immune attack on the pancreas which destroys insulin production and thus requires injections of exogenous insulin. I eat what I’d eat if I didn’t have Type 1 basically.

The Libre is great, but if a person was to undereat carbs significantly for the amount of insulin they’re taking, even with the Libre they could still have a serious hypo (because the insulin will ‘beat’ any additional glucose/carbs they eat, potentially leading to a severe hypo, ie a seizure or unconsciousness requiring 3rd party assistance).

 

[Lucyr]

Good morning

I recently posted regarding my 56 year old husband being admitted to hospital as his blood sugars were unreadable. They are treating him as type 1 until blood tests come back to determine which it is. My question is that when he went into hospital is HbA1C was 111, his predicted HbA1C on the Libre App is now 61, he is on Novomix 20 in the morning and 18 after dinner, would that indicate that he is type 2? The HbA1C is really confusing us.
Many thanks
Jill

All that indicated is that he wasn’t using libre before diagnosed with diabetes and that insulin has improved his blood sugars. Tells you nothing about type.

 

[Lucyr]

Maybe you could start with calculating the carbs he is having with his meals to provide some background and put his BG readings into context.

Surely that’s a job for the diabetic themselves, not the wife’s responsibility. It’s his diabetes so it’s up to him if he wants to count carbs and monitor Bgs to see what amount of carbs matches his doses. If he does then he should do the carb calculations.

 

[JimG]

Sorry that I'm a bit late to the thread but I've been following it. I agree with the posts about a high HbA1C not indicating the type. On diagnosis, my HbA1C was 110 but I was diagnosed type 2. When I was in hospital Iaround 6 years later, I spent a time in an induced coma following an emergency operation. I was given an IV drip for the time if the coma and a few days after when I was still not able to communicate properly. The hospital tried to control my diabetes by adding insulin to the drip and my blood sugars were all over the place. It was only when I was able to take my oral medication that things settled down. I'm not saying that this is the case here. Just suggesting that until the situation is clarified you cannot assume what the correct diagnosis is.

 

[SB2015]

Hi @JillFearn
Sorry to read of your husband’s hospitalisation and diagnosis of diabetes.
As you will have seen from the discussions above treatment for T1 and T2 are very different. As a T1 I choose what I eat, which is much the same as what I ate before diagnosis, and then match the amount of insulin to the amount of carbs in my meal.

As your husband is on Novomix this is a combination of slow acting insulin, to deal with the glucose our bodies release to keep us ticking over, and fast acting insulin to deal with the carbs in our meals. On this regime it will help your husband to eat about the same amount of carbs at each meal. That may sound daunting but I knew nothing about carbs when I was diagnosed but as @helli said this becomes second nature after a while. He could start by just working out the carbs in your normal meals. If he finds that his glucose levels are going high after the meals and staying high (there is always a rise after a meal but then the insulin brings it down) then that is more carbs than the novomix can deal with. If he goes low after the meal then there are not enough carbs in the meal.

It is good that they have done the GAD antibody test to confirm his type of diabetes. With his rapid weight loss it does sound like T1 but the tests will show. I lost 1 1/2stone in one week at diagnosis.

Let us know how he gets on.

 

[JimG]

Sorry, but you do need to edit this to change diabetes to Type 2 diabetes.
Diet and weight are NOT risk factors for Type 1 and nor is control of diet and weight a way of dealing with it.

It's already been done by a moderator. I know diet is not a risk factor for type 1. Blame my error on the fact that I was updating on a phone, not a PC,
and couldn't see to review the whole post. Inka had already pointed out above that diet is not a factor in type 1. However, there are now three posts mine, yours and this response to explain that diet and weight are only two risk factors in type 2 and are not THE cause of it as so many people seem to think. I just thought that the thread had moved away from the original post about the differences between type 1 and type 2 and one or two posts, in trying to point out the differences, could have been taken to mean that diet was the only thing to watch in type 2 diabetes. So, no need to apologise and thank you for pointing out.

 

[saffron15]

I thought you might find this website helpful

Diabetes & Metabolic Health | New Forest PCN

newforestpcn.co.uk

For me the information about type 2 including on left handsids links to websites like freshwell was really useful. It seems from your posts your husband is more likely to be type 1 so dietary advice is unnecessary. However the information for a type 1 looks useful to me. I hope you can both find useful information as your husband works back to good health.

 

[everydayupsanddowns]

Hope you both get some clarity over his diabetes type really soon @JillFearn

It can be so unsettling in the beginning to have that extended period of not knowing quite what it is you are dealing with, and the evidence-based approaches that are likely to be effective.

 

[JITR]

@JillFearn

Had your husband been a patient at our local hospital, I imagine he would have been given this 'Basic dietary advice for people newly diagnosed with diabetes'. I came across it today by chance. It would have been helpful if my GPs had given me a copy when they diagnosed me 2 years ago, much better than nothing.

You may find it interesting.

In view of this discussion, please note this advice applies to Type 1 and Type 2 diabetics. It says, Insulin lets your body use the supply of glucose. When you eat foods that contain carbohydrate you will make your blood glucose/sugar rise – so your body needs to have INSULIN [available to cope] with foods that have carbohydrate in them. Whether that is insulin you make yourself or insulin which is injected or medication which helps your own insulin production.

 

[everydayupsanddowns]

I’m not sure if the OP has been browsing this thread as a guest in more recent days (it looks like you were last on the forum several days ago @JillFearn )

I’ve snipped away some of the last posts, which may have been a little confusing/overwhelming, and will close the thread for now.

Do let me know if you’d like it re-opened @JillFearn when your husband’s results come back, or simply start a new thread once his type has been confirmed.

Do keep in contact with his nurse/GP, and follow their advice on the best diet to match his mixed insulin doses.