Snacking and insulin

[geoffryh]

Can others share what they do? I am a type 1.5 female and have been for about 2 yrs. I am now on lantus twice a day (on advice from hospital as once a day didn't work for me) and novorapid and having done a carb counting course have a carb insulin ratio. It was also confirmed a few months ago by blood tests that at long last my pancreas had stopped which was good as suddenly I started to get some stability. Before, despite weighing everything my bgs were v unpredictable. However that stability hasn't lasted and once again I am all over the place. Slight adjustments suggested by the hospital with my long acting help for a few days then its back to being all over the place. I am very sensitive to any physical activity and underweight. I do eat healthily but not low carb as such as I cannot lose more weight and would prefer to adjust insulin to what I eat. I also have a stoma so that affects what I can eat as well. What I am really struggling with is snacking for pleasure and to help weight gain. Eg last night having done decorating during the day, I had my evening meal, underdosed my quick acting insulin by about .7 as usually the affect of physical activity on my bgs continues for a few hrs after and I wanted to have a few doritos as an evening snack. Yet my BG was 13 at bedtime and 19 this morning. It is really getting me down. I don't want to snack all the time nor am I wanting to eat rubbish but I do want to feel I don't just have to eat at meal times and also I get hungry and need to gain weight. The hospital are supportive but even they say I am complex. We have no idea how much my stoma, affects my digestion and bgs and whether this adds to the unpredictability. I can still go from 2.6 to 19 and yet we weigh out everything we poss can and I am diligent with working out my insulin. Can I /should I in inject separately for snacks? Not being able to live and eat normally, bgs being so up and down despite all I do to stop this and my weight is really getting me down. Even the diabetes centre I am under are wary of me doing any exercise as my bgs are so sensitive to physical stuff so I can't even feel I can get fit. Sorry for the long post but I am so fed up. Any thoughts would be appreciated.

 

[tim2000s]

My advice would be to initially stop snacking and get your bg control in place. Once you've done this, you can experiment with timing and insulin. Unfortunately it tends to be a one step at a time process and you have to experiment and fix each bit on its own so you can see what it going on.

 

[Ian DP]

Many of us find that we don't need to snack when on a high fat diet. Fat sustains our energy levels much more than carbs. So my suggestion would be to eat more fat (cheese, double cream, coconut oil, butter, nuts, meat, fish etc). If you do need to snack try cheese, ham, peperami etc.... All of these will also help lower / bring your BG levels under control. If you are looking to put some weight on try a bullet proof coffee every day (I have been doing this every day for over a year now).

A bulletproof coffe consists of around 30g butter and 30g coconut oil (or palm oil) in a mug. Then pour in filter coffee or add a spoon of coffee granules and hot water, then whisk until all melted and you have a nice froth on top. I add some double cream to it. I use a battery whisk. Around 500 calories and no carbs. Also indications are this helps increase your HDL colestrial (the good one) which is now considered very healthy.

 

[geoffryh]

Unfortunately I have to avoid too much fat. Hospital team wanted me to go on stations but have had family member who had v bad life changing reaction to stations so they respect the reasons why I want to avoid them but this does mean I need to not go down the high fat root. If I am careful with what ieat can I not give a bolus dose of insulin to cover my bgs if and when I snack?

I also appreciate it is one step at a time but this is heading for 3 yrs and I do have periods when my bgs are relatively stable but then suddenly they are not plus no matter what, anything physical and it could just be walking around shops, can bring me right down. Do people have any thoughts re the benefit of switching insulin's, eg from lantus to something else as I get the impression some find other long acting suit them better?

 

[noblehead]

Are you under the care of a Endocrinologist @geoffryh, if not then I'd recommend that you be seen by one as they are more adapt at dealing with complex issues to do with diabetes.

As for snacking between meals, you have to be aware that if you do snack and bolus then your insulin doses will over-lap and this can lead to postprandial hypo's (Google Insulin Stacking).

 

[nigelho]

Can others share what they do? I am a type 1.5 female and have been for about 2 yrs. I am now on lantus twice a day (on advice from hospital as once a day didn't work for me) and novorapid and having done a carb counting course have a carb insulin ratio. It was also confirmed a few months ago by blood tests that at long last my pancreas had stopped which was good as suddenly I started to get some stability. Before, despite weighing everything my bgs were v unpredictable. However that stability hasn't lasted and once again I am all over the place. Slight adjustments suggested by the hospital with my long acting help for a few days then its back to being all over the place. I am very sensitive to any physical activity and underweight. I do eat healthily but not low carb as such as I cannot lose more weight and would prefer to adjust insulin to what I eat. I also have a stoma so that affects what I can eat as well. What I am really struggling with is snacking for pleasure and to help weight gain. Eg last night having done decorating during the day, I had my evening meal, underdosed my quick acting insulin by about .7 as usually the affect of physical activity on my bgs continues for a few hrs after and I wanted to have a few doritos as an evening snack. Yet my BG was 13 at bedtime and 19 this morning. It is really getting me down. I don't want to snack all the time nor am I wanting to eat rubbish but I do want to feel I don't just have to eat at meal times and also I get hungry and need to gain weight. The hospital are supportive but even they say I am complex. We have no idea how much my stoma, affects my digestion and bgs and whether this adds to the unpredictability. I can still go from 2.6 to 19 and yet we weigh out everything we poss can and I am diligent with working out my insulin. Can I /should I in inject separately for snacks? Not being able to live and eat normally, bgs being so up and down despite all I do to stop this and my weight is really getting me down. Even the diabetes centre I am under are wary of me doing any exercise as my bgs are so sensitive to physical stuff so I can't even feel I can get fit. Sorry for the long post but I am so fed up. Any thoughts would be appreciated.

Try and get yourself onto a DAFNE course ASAP. You will learn much more that the carb counting course you've just been on. When you do activities etc, alter the meal ratio before the activity so that you inject less insulin. It seems that you are very resistant to insulin....like me. Any activity which uses arm like DIY, even mowing the lawn with an electric mower would cause my BSs to drop rapidly. Normally I use a ratio of 1 unit quick acting insulin for 5 grams carbs 1:5 or 2:1CP for DAFNE trained folk. I prefer to use the 1:5 method as I just have to divide the amount of carbs by 5. I alter my ratio all the time depending on what's happening. I also take 2 X 500mg metformin SR tablets with my meals as I very insulin resistant. OK, you want to gain weight so don't bother too much about low carbs..have a good size meal and carb count correctly. Test before the meal and 4 hours after. Don't do any corrections if you prefer to test after 2 hours and find that you're high. It can take up to 4 hours for the novorapid to work.. I use Apidra as novorapid stopped working for me. Sorry don't know anything about STOMA. If you have a snack still carb count and allow insulin for the carbs eaten. Be aware of overlapping (stacking) insulin as it depends on when your next meal will be. If you're planning a good amount of DIY say in the next few hours you can half the insulin at the previous meal. Sometimes you can even have the meal without injecting novorapid but it all depends on how activities work on your BSs. I hope you are keeping a blood glucose monitoring diary, then you can see what is happening to your BSs with what you eat and how activities react to your body. Eating healthy can be misleading, as any carbs eaten will raise BSs. Sorry for running on so long.

 

[geoffryh]

Thank you. Glad I am not the only one who is v sensitive. I am under a v gd endocrinologist team. We don't have access to the Dafne course but I did their equivalent over a period of weeks and from that a carb insulin ratio was worked out but I had been wondering if I should change the ratio (always seem to be high in the evenings) esp pre activity (yes, mowing the lawn drops me as well) or simply drop a few units when I know I am active. Any experience of switching long acting insulin? Re comment about low carb, yes with being so thin and having a stoma, I really don't want to go down v low carb route, simply want to get a better level with the carb/insulin/activity ratio.

 

[Daibell]

HI. I think you shouldn't worry about losing more weight thru reducing the carbs as you can to some extent increase proteins and fats, but of course I have no idea what the effect of stoma would be. The lower the carbs the easier it is to control blood sugar swings as the insulin used will be less. I'm interested that you weigh your food as I think I'm right in saying that few of us would do that. May be you do that becuase of the stoma? Otherwise looking at labels and as my DN said 'eyeballing' your food is probaly as good as weighing something unless you really know it's ingredient make up. Yes, avoid snacking where you can otherwise as someone has posted to get into a loop and possibly stacking the Bolus. Yes, if you can see and Endo that might help.