Which to choose - food variety or good control?

[everydayupsanddowns]

I was going to post this in another thread, but it felt like it might be a bit of a hijack so I'll start another and see how others feel...

Right now it feels like I have to make a choice between food variety and good control.

It's a little dramatic, and my own gut instinct if I were to read that would be, 'Oh no - that's not the case at all!' but let me explain...

For the second school holiday in a row I've had significantly worse levels. Not just a bit worse but lots, lots worse. Massive post-meal spikes. Or hypos. (17.x-2.x). Whole days in the teens. Liver dumps seeming to come from undetected overnight hypos (or possibly because for the second school holiday in a row I got a bit of a cold). During these times food tends to be a bit more varied and even 'only slightly unusual' things I'm sure I have counted correctly don't behave. Before the holiday I had several days with all but no readings lower than 3.8 or higher than 9.

So at the moment it feels like I have to choose between food variety and excellent control. The only way for me to achieve consistently good numbers seems to be to reduce the variables. To go with tried and tested meal choices and amounts. Some of those (fish and chips for example) might seem to be risky, but we use the same chippy, choose the same couple of things, and I've a split dose approach that seems to work most of the time. I'm not all 'woe is me' and think I've got a pretty good, varied diet, but it's far from eat whatever low-med GI stuff you want in whatever quantity.

My ratios, such as they are, seem more linked to responding appropriately to a few sets of meal types rather than being universally applicable. In short, they do not seem to be very scalable at all.

Do others feel the same way? Has anyone managed to get their ratios worked out that so that they can cope with anything from 30 - 150g CHO and have the doses work consistently well?

 

[FM001]

The erratic nature of your blood glucose would suggest two things to me, first would be your insulin is unsuitable and therefore I would be looking to change the humalog to novorapid to see if this helps, second would be site absorption problems, in the past I have suffered from this which resulted in swings from high to low similar to you.

On the whole and provided you ain't eating simple carbs as a meal and eating low to medium gi foods as you say then your bg shouldn't fluctuate that much, I can eat as little as 30g and even up to 120g should I choose and don't get the swings that you are experiencing, apart from what I've mentioned in the first paragraph I am unsure what to say - are you sure your ratio's are correct?

 

[everydayupsanddowns]

Hi Toby

Thanks for your thoughts.

I have been on NovoRapid and while fine for many years, I actually found it slightly flakier and less predictable than Humalog.

I have no lumps in any site that I can identify. These days I tend to use thighs as I overused abdomen for years. While I am aware that there is an appreciable difference for me in abdomen absorption I still don't really 'trust it' as it is still not quite completely consistent.

The extremes I noted were miscalculations plain and simple. The hypo was a tricky-to-guess mixture and it seems I went a unit and a bit over. For the massive spike yesterday, it was a combination of eating a little more than usual (though on paper the count was nothing like far enough out to give that result)

In short, no, I don't know whether my ratios are right today. Nor do I know if they will be right tomorrow. But I know they were perfect on day x, y and z.

From your previous posts you seem to get very consistent levels (as indeed do I under certain circumstances). Just a bit frustrated at the moment when perfection turns to chaos so easily.

 

[Pumper_Sue]

My ratios, such as they are, seem more linked to responding appropriately to a few sets of meal types rather than being universally applicable. In short, they do not seem to be very scalable at all.

Do others feel the same way? Has anyone managed to get their ratios worked out that so that they can cope with anything from 30 - 150g CHO and have the doses work consistently well?

Hi Mike,
you might find your problem is ever changing basal patterns.
I had this on MDI and obviously have the same problem on a pump.
The pump makes all the dif due to being able to pin point exactly what needs changing and where.
It's basically an on going battle 😡 The quality of life is so much better on a pump but twice as much work.
Things are a lot easier though if you have an upper limit to the carbs you eat at each meal. For me 60 is top wack so now stick to 50/meal and 60 if something nice on offer.

 

[Robster65]

Hi Mike.

I've found that going slightly over or under the suggested ratio can make a disproportionate difference to BG. Almost as if the ratio is non-linear and varies according to the amount of carbs.

Does stress come into play during the holidays ? That is one mummy of a variable in my life. Preceding anything I'm worried about, my BGs can run at silly highs for a couple of days or more.

Also, you could look at things like timing of breaks, drinks, etc.

I would try a couple of predictable meals to eliminate any other variables and then go back to variety. As you may be aware, I find the profile of the novorapid/humalog insulins annoying when it comes to low GI meals. They peak at the wrong times and often would benefit from that 2nd bolus.

There's always the pump option 😉

Rob

 

[Caroline]

I'm type 2 so don't have insulin to cover it all. I find food quite a minefield. I don't always find it easy to get low carb food, and if I bring in food from home as healthier option I have only limited ways to keep it warm and no way of heating things like soup if I want them hot. Food in the staff restraunt is laden with fat, carbs sugar or all three and there is not always a healthier choice...

 

[Ellie Jones]

I would agree with that nope there's no such thing as 'Eat what you want and cover with insulin' there will be limits surrounding what you can achieve with your insulin..

In your case it seems that it sort of goes out the pot over a school holiday..

Several reasons for this, Yes different types of foods, but then you've got a different routine when you are on holiday..

It may be that if you want more variety over an holdiay period you've going to have to put in a lot of testing and working out not only the food side but the other factors such as change of routine, exercise etc to make it all work..

 

[Natalie123]

Hi Mike. That doesn't sound great. I do struggle with food but find I tend to eat about the same amount of carbs per meal anyway just because thats what I need to fill myself up.

I used to be on novorapid and found that (although I didn't know about carb counting and ratios at the time) that my carb to insulin needs were far from linear. It sounds to me like you are not on the right type of insulin for you as that shouldn't be happening. I am now on Apidra which peaks and dies away much quicker than novorapid so is good for people who have an active lifestyle or a job / life that doesn't allow a steady routine. I still struggle but I can eat a better variety now than I used to be able to.

 

[everydayupsanddowns]

Thanks all. Interesting comments.

Pumping is certainly more appealing than ever, though I still have significant concerns over it - still based around existing carb guess framework... connectedness... availability of decent/reliable sites.... kinked cannula fun n games... blah blah blah...

When I eventually have my annual review (14 months so far) I might cautiously ask about a Veo/CGM combo - 90% of the attraction of which is the CGM - but hold out absolutely no hope of success.

I might give split Levemir a whirl in the meantime to see if I can stabilise my overnight BG shenanigans.

Oh and btw, yes I completely accept that at least part of the chaos is down to routine changes/bit of a cold etc. And even more than that it's just a matter of miscalculating the darned meals when they're not 'normal'.

Would be nice if it was a bit easier though eh!

 

[Natalie123]

Have you tried asking for a cgm for a week?

 

[everydayupsanddowns]

Yup.

Never got a straight answer as to whether they actually have one at the hospital, but it didn't sound like it. 🙄

 

[Natalie123]

Yup.

Never got a straight answer as to whether they actually have one at the hospital, but it didn't sound like it. 🙄

Sounds familiar. I was promised one about a month ago, but then it didn't turn up on the day and I am still waiting I am hopeful though as my nurse is very good

 

[margie]

Mike - I am sorry to hear that our old friend the diabetes fairy has been up to her tricks.

Do you think something about your routine at holidays could be causing the problem. Maybe extra activity leading to the night time hypos that you think you may be having - and then your over active liver kicking it to knock your ratios out.

Its hard to know what to suggest - maybe when the holidays are upon you - you need to drop the basal.

Obvviously I am just guessing.

 

[heasandford]

Would love to hear if/when you manage to get one, if anyone deserves one and would put in the effort to justify the costs it has to be you!

your post is so familiar to me, my results vary with apparently minor changes at different times. I know from previous posts that you do check all types of variations. I sometimes find comments from those who aren't suffering the same problems not very helpful and quite disheartening, making you think you haven't tried hard enough when you have - you have! Also, I agree, is it not possible to have some food variation some of the time? I thought about Apidra for some meals, perhaps we need several insulins - oh no, another variable!

(Just a selfish addition, I have recently got an Expert meter thanks to information from the forum (proabably you?) progressing well with it and leading up to another education course which may or may not lead to better results!)

 

[bigpurpleduck]

Mike, I SO know what you mean. Anything above 70g for me is difficult, and triple-figures is a no-go area, even if I know for sure I've got the right amount of carbs from packaging.

The pump has definitely helped - it's easier to spot the problems, things are more consistent than they were, it's easier to experiment and easier to recover from highs/lows. However, I still have problems with high carbs or fatty foods. I definitely think my carb ratio changes from 70g-100g, then again for >100g. Unfortunately there's no way of programming this into my pump, although I could do it manually each time I bolus. It's just that there are so many variables; by the time I've checked basal, correction ratio, did I calculate the right carbs, was I stressed, was I feeling unwell, is my starting-point carb ratio okay... I never seem to get round to figuring out how to bolus for high carbs/fat.

I'm afraid I can't offer much advice (other than to get a pump, 'cos I guarantee that although it won't solve all the problems, it'll definitely improve things ). Just wanted to say I'm right there with ya, and offer a ((((hug)))). It's incredibly frustrating.

 

[randomange]

Do others feel the same way? Has anyone managed to get their ratios worked out that so that they can cope with anything from 30 - 150g CHO and have the doses work consistently well?

I definitely think my carb ratio changes from 70g-100g, then again for >100g. Unfortunately there's no way of programming this into my pump, although I could do it manually each time I bolus.

My ratios don't work if I eat a lot of carbs, and I suspect it's very similar to what you've described - it's ok up until about 70-80, then it's a bit off, and then it's way off over 100.

I once read somewhere (think it might have been one of the recommended books - Think Like a Pancreas or Using Insulin) that if you work out your weight in pounds, and then half it, then that is the amount of carbs (in grams!) that most people can eat in one go using their normal ratio - anything above that and you need more insulin. I have no idea how anyone worked that out 😛 , and I don't know if it only applies within a certain weight range, but it seems to work pretty well for me.

I haven't done enough experimenting to work out what happens between 80-100 g carbs, but if I eat over 100g, then I add 30% onto the total carbs, and program that into my pump. I then use a combo bolus, and extend the 30% (or sometimes more, if I'm eating something like pizza) over 2-3 hours. It took a bit of trial and error to work out, and I still screw it up sometimes, but it seems to work for me. Can you work out something like that, but split the injection instead?

 

[Robster65]

Another point I forgot to pick up on Mike was the novorapid in the legs. I was told by the DSN that the major muscles in the legs slow down absorption of quick acting insulins, hence the basal in the legs and buttocks.

Could you use your arms for the NR ?

I'm pleased you may try to split your levemir. I think the benefits outweigh the hassle by far.

@Heasandford. Your thoughts about several insulins is spot on IMO. We could do with a range of them to cover different GI meals and scenarios.
I think Apidra may be too fast for many of the low GI meals for me but soemthing a bit longer lasting than humalog would be nice sometimes.🙂

Rob

 

[everydayupsanddowns]

@heasandford Yes the Expert might have been me. Mrs EDU&D and I had a conversation this morning which half-prompted this thread. I'm happy enough with the Expert when it's not holiday time and normal meals +/- 15% (having fine-tuned the settings for that context), but next time I'll be more tempted to wing it with gut instinct rather than use the calculator.

@margie Yes I'm sure you are right. There is a basal tweak needed (though actually I think I need slightly more as I don't go to the gym during hols). I've tried a few changes but not got it right yet. The fall-off in sensitivity is gradual, Lantus drags its feet and then the hol is over before I find the 'magic' setting. 1u too much or too little Lantus is has been seen to be catastrophic for me in the past.

It's important to realise that my general feeling extends outside of holidays (though they do add to the complexity when the changes involved also come along with generally more different foods).

@randomange Thanks for the half-your-weight-in-pounds snippet. Pretty much confirms my observations.

By and large (holiday or not) I'm more confident when I have experience of that meal (whatever its size) against that dose.

Ho hum.

 

[Ellie Jones]

Another point I forgot to pick up on Mike was the novorapid in the legs. I was told by the DSN that the major muscles in the legs slow down absorption of quick acting insulins, hence the basal in the legs and buttocks.

Rob

I was told different to this..

The 3rd time I went on insulin (long story) I was then cycling to work not to inject into my legs, because I would be crashing into a hypo before I got to work, as the action of the legs exercising will adsorb the insulin a lot faster!

 

[everydayupsanddowns]

Another point I forgot to pick up on Mike was the novorapid in the legs. I was told by the DSN that the major muscles in the legs slow down absorption of quick acting insulins, hence the basal in the legs and buttocks.

Could you use your arms for the NR ?

What I notice is that absorption speed varies at different times of the day (possibly a degree of basal inaccuracy with the Humalog having to cover? though not something that is readily observed in basal tests). Effectively I can have 45min-1hour onset at breakfast/lunch. But more like 10-15 minutes at evening meal. It doesn't make sense to me, but there you go!