Question for the experts

[Dstream]

I'm awaiting to go on the DAFNE course having being diagnosed as a type 1. Yet to be fully confirmed however I'm on lantus and novo rapid. My 11 units of lantus is keeping my background down between meals my bloods run at 5 to 7. For instance wake up I'm at 5.7 average. If I don't take it I wake upto 11 13 15. So we know this is working and the background is fine. Till I go on the course my nurse has said I can inject novorapid 2 to 4 units max. Here's what's happing granola for breakfast 3 units two hours post 7.7 all good. Last night for tea qtr steak pie baked beans portion of roast potatoes, small I may add. Two slices of bread. 3 units novo bang 2 hours post 15 mmol 3 hours 11 four hours 8.8. Can I take this till the course should I of used 4 units. Is this normal occurrence. Should
I of put
More in to max It. Did I do wrong eat the wrong food. Sorry I've so many questions.

Edited to clarify DAFNE course for Dstream

 

[jack412]

this will give you a lot of info, to get your head around it...don't go above the 2-4U unless your nurse ok's it

it's not too late to work out how many carbs were in that meal and write it down, you really need a food diary

or next time you could weigh/measure the carbs in the meal and worked out the dose, but as you saw..with that meal you needed a bit more, so I would try 3.5-4U, if your pen does half units with that many carbs, next time

There is an online course for background and an idea to it. Free to register
http://www.bdec-e-learning.com/
This set of workbooks are worth reading and practising working examples of carbs and doses and corrections
Don't change dose without nurse approval
Workbook 1
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2
http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb list
http://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diary
http://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Basal testing
http://www.diabetes-support.org.uk/info/?page_id=120

Sick day rules
http://www.diabetes-support.org.uk/info/?page_id=141
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf

Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf

A workbook with USA numbers and math rules, but it has a good trouble shoot at the end
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[PaulinaB]

Hi @Dstream. You did right! You could raise your dose for this meal, but honestly I'd wait for the DAFNE course where you'll learn about carb-counting and adjusting your doses for a meal. There's also an online version of a similar thing called bdec, but I don't have a link at hand.

Do you know when your course may happen?

 

[PaulinaB]

Do you really want to raise the insulin to cope with such high carbs? Wouldn't it be better to drop the roast potatoes and the bread, then need less insulin?

Just wondering. For me, I would prefer to give up the carbs.

I'd say this answer is utterly unhelpful given the OP is newly diagnosed, doesn't know yet how to carb count and is taking tiny boluses. It's only scaring a person, not helping at all...

 

[Dstream]

I have no idea how to carb count tbh those readings scared me and started to go towards my diagnosis figures 23 25 mmol plus. Is this normal to happen and then go down like this is this the novo rapid working. My target is 7 to 9 pre
Meal two hours I was 4 to 5 hours before it was normal. Does a meal goto those kind of figures in those two hours say like 16mmol in an hour in the space where I do not do a blood sugar test down to 9 mmol two hours. Does novo rapid cap it off? I'm asking as these high readings scare me. I'm trying to deal with it till the course comes up and I've no date set yet. So the nurse and I speak twice a week. I don't want high readings as then it's headaches etc. the gym was a bad idea as all the next day and from two hours after the gym was constant hypos. Apparently that made me very sensitive to the insulin.

Sometimes I just wish I could cry. One day I was fine the next day nothing worked and you get all this to deal with. Sorry for my outpourings. I'm trying to return to normal.

 

[jack412]

you are doing very well, there is nothing to be scared about, it's natural for your blood glucose to go up after a meal and when you learn to carb count and adjust your insulin to the meal, it wont go as high.

it's going to take a while to get your head around it, the online course and workbook 1 has info on carb counting
this is a good food counter and free to join
http://www.myfitnesspal.com/



one thing is if you get sick, don't mess about... it's better to bother the Queen, than sit at home.
if you feel unwell and your sugar stays high seek assistance straight away, so that you don't have any real problems, like high ketones
were you given urine or blood ketostrips?
, I would ring the nurse or the mon-fri http://www.diabetes.org.uk/careline or the nhs 24hr help line for assistance

 

[noblehead]

I agree with lucy that 3 slices of bread with your meal wasn't necesary and you would do wellto limit the carbs in your meal, you don't have to go too low but keeping them within reason will produce more favourable bg results.

There's an excellent article by Gary Scheiner about postprandial spikes and how you can help to limit them, you'll need to convert the bg readings from mg/dl to mmol but it's a great write-up and has helped many of us on the forum:

http://www.diabetesselfmanagement.com/articles/high-blood-glucose/strike-the-spike-ii/all/

As for going on DAFNE, they will teach you many things about carb counting and other aspects of type 1 diabetes management, but if you can't wait have a look at the following which is an on-line version of the DAFNE course:

http://www.bdec-e-learning.com/

Do try to get hold of the book Think Like a Pancreas by Gary Scheiner, it has a wealth of information on how to control type 1 diabetes and it's a book you can go back to time and time again, good luck Dstream and hope you enjoy and learn lots from the DAFNE course.

 

[phoenix]

It is early days yet. Actually they didn't used to let people do DAFNE for some time (6 months/1 year) after diagnosis because in the early months things can vary a lot (at diagnosis you may need a bit more insulin and then sometimes peoples needs drop off considerably for a while before increasing a but again) Thats one reason that your nurse is being conservative about how much insulin you take and how much she wants you to vary it by. If you vary too many things at once it really is difficult to work out what's causing what. The rise after your dinner suggests that you are correct and that 4 units would have been better but until you know how many carbs you are eating then it's hard to judge.

Carb counting is a very important skill to learn.
Jack has linked to two carbohydrate counting primers, there is also one from diabetes UK https://shop.diabetes.org.uk/usr/downloads/Carbs-Count-2012-reduced.pdf

Personally, I would stick with learning to count carbs to start with (rather than trying to do too much dosing adjustment without the guidance of your nurse)
Get yourself some scales, a calculator, read labels and get a carb counting book or use a web based resource
(You have to be careful though with some of the web based sites as they are crowd sourced with people from all over the world , the US lists carbs slightly differently to the UK and unfortunately the input methods don't allow for this, also people vary in how accurate they are with their data entry )
Personally, I would use a good UK book. There are two that from reports seem to be good ( I use a French book as I'm based there)
1) Carbs and Cals this helps give a visual record of the carbs in foods at different portion sizes (you can google them they have a website)
2) The calorie, carb and fat Bible (this is a UK based book)
(You will often find people suggesting the little Gem carb counting book It's small and good for carrying around but I have got that book and , I've seen some very odd carb counts . I won't add to the complications by trying to explain why I think that has happened !.)
This site uses the C Cand fat bible and has quite a lot of free listings which can be useful.

I would keep very detailed records of what insulin you take, glucose levels before and two hours after meals (and on waking and going to bed)
What was in the meals and how many carbs the meal contained. When you exercised an it's result on glucose levels (test before during after and have some hypo treatment on hand)
It sounds a hassle and to be honest it does take time but you won't have to keep such detailed notes for ever. What you will learn is how your body reacts to different foods, exercise etc. You will be able to see patterns.

 

[Daibell]

Hi. As others have said by reducing the carbs in your diet you will help control the blood sugar and less rapid insulin will be needed, but at the moment your 2-4 units should not be enough to make you go hypo (i.e have very low blood sugar). Hopefully your DAFNE course will be soon. If not within a few weeks then I would see the DN and ask her to advise on carb-counting. My DN put me straight onto carb-counting and gave me a leaflet showing food portions on a plate for a 10gm portion size; took only about 10 minutes to cover the basic subject but she knew I was a nerdy engineer! DAFNE should cover a bit more like rules for sickness and so on. Much of this is common sense as long as you use the meter frequently. BTW as you have found pies have a lot of carbs and standard baked beans are full of added sugar although the beans themselves are good low-GI carbs with fibre. Carbs with fat such as roast potatoes can sometimes be reasonable as the fat slows and smooths the carb absorption

 

[AlexMBrennan]

More in to max It. Did I do wrong eat the wrong food. Sorry I've so many questions

Simply put, you need to take more insulin for your food but your nurse seems to think that it's safer for you to have high BG until such a time that you have learned how to properly adjust insulin doses.

Whilst that is not entirely unreasonable there's obviously a problem if you can't go on this course soon after diagnosis; if that is the case you may want to have a look at the resources linked to earlier and decide to apply them if you feel confident you understand them (it's not like your nurse has a secret magical algorithm - at best, she can apply the rules described there and tell you the result).

Personally I don't see a difference between telling a diabetic to inject more insulin or to eat less carbs (or to exercise heavily for that matter) - all three things can easily lead to hypos if you don't know how to adjust insulin doses properly, so the solution ought to be to learn how to adjust insulin doses and not to avoid the activity indefinitely.

 

[Dstream]

Thank you for the replies tbh it's made me feel a lot better about myself knowing there's people who can help. Your right about the nurse she said it's okay for me to be high temporarily while she is sorting things out. Beats the 27 mmol 23 mmol previous readings. I now get carbs are bad and limit them. I got put on Desmond wrongly hence second day me when we carb counting ?? Oops why you on this course our mistake. Hence my own nurse for a while.

Thank you all for someone to turn to.

 

[logindetails]

Great advice above, the only thing I would add is, if you haven't already got one, ask your DSN for an insulin pen that can inject half doses (0.5u). You're currently on a low insulin regime so an increase of one whole unit at a time may be too much whereas a half unit maybe just right. Oh - and test, test and test again so ask for plenty of strips.

 

[moz1]

Don't get too hung up on bg readings this early into diagnosis you seem to be doing really well! Once you do the DAFNE course you will have a firm understanding to build upon. Readings 2 hours post meal are of limited use as you will experience a rise in your levels after eating before they finally settle down to normal range. Also this early on in diagnosis you may still be in the "honeymoon" period where your pancreas is still producing some insulin which can affect your bg levels. All the best.