Trying to keep levels normal!

[LozzaB]

Hi..
I was recently diagnosed with Type 1 in Feb. Levels at that time were through the roof, I had all the classic symptoms- thirst, needing the toilet a lot, headaches. Had tests and was sent straight to hospital and put on insulin. I’m currently taking Toujeo and Humalog for meals.
Over the past couple of weeks, I have had to up my Toujeo basal insulin to 40 units, which I take of a morning. This was because the team at the hospital didn’t like where my levels were when waking, which were somewhere between 8 mol to the mid teens.
But what is happening now is that I am hypoing through the day, especially when at work. To the point that 1 unit of insulin is too much sometimes when I’ve ate a meal.
I can never seem to keep a flat line between meals. It spikes after a meal, but then plummets even without insulin. Is this normal and is it a case of trial and error?
I have a Freestyle Libre 2 but sometimes I think that makes me overthink things too. I think at this moment it still is a lot to take in. Any suggestions?

 

[JAT1]

Welcome to the forums! Are you figuring out how much meal-time insulin you need to inject based on the amount of carbs you will eat? Perhaps, because you are recently diagnosed, you are on fixed amounts of meal-time insulin. Knowing first how many carbs you will eat and basing the meal-time insulin on that, gives more control, although it remains difficult to match the effects of the insulin to the time when the carbs are hitting your blood stream, and factors such as how long the food is in the stomach, how much fat and protein are in the meal, what order you eat your food, play an important part. If you are hypoing for 'no reason', it could indicate that your basal insulin is too much. Paying attention to these things is important. Obsessing can become useful 'over-thinking' and I spend much time researching the web and the threads on this website for information I can use. The day I was diagnosed Type 1 and given a finger-prick glucose monitor, the pharmacist told me that diabetes is a self-managed disease and it has been the best advice I ever received. Trial and error, yes, persistence and good luck, more so. Enjoy the journey and learn-learn-learn. No worries - it all becomes routine, like dishes and brushing your teeth.

 

[jonathan183]

Any suggestions?

Your insulin requirements can vary during the 24 hour period. Might be worth having a chat with your team about whether something like Levemir would be better for you as a long acting insulin so you can have different doses morning and evening. In my case the evening levemir dose is several time the morning dose, otherwise the fasting readings in the morning are high.

 

[EllieM]

Hi @LozzaB and welcome to the forums

It's possible that like @jonathan183 you need much less basal during the day than at night. I would suggest talking to your team urgently (hypos are no fun) and discussing either a change of insulin or a pump. (Though I susoect they won't be keen to give the latter to a newly diagnosed T1 you can always ask).

There's an interesting article here about the NHS making hybrid closed loop systems available to T1s

Hybrid closed-loop system for type 1 diabetes recommended for thousands in England and Wales

These recommendations are a significant step towards making this technology available on the NHS. If this proposal is approved in the consultation process – it would mean over time around 100,000 people with type 1 diabetes could be offered it as an option to help manage their condition.

www.diabetes.org.uk

In any case at such an early stage after your diagnosis you should be able to have frequent contact with your team to discuss dosing changes.

Good luck.

 

[Ra1234]

I have been recently diagnosed with possibly LADA cos my levels are so high. When I wake up and do a check it’s usually around the 12-13 level and fluctuates a lot during the day. The drs put me on Metformin and I have another appointment tomorrow to see what’s happening as I have been monitoring 4 times a day and have never registered lower then 9mmol so now I’m worried about potentially having to go onto insulin. I was told to change my diet and carbs and sugar intake but haven’t been told what’s an ideal amount to have a day so I’m kind of in limbo about what to eat. Even when I have a healthy meal of plain chicken and veg my levels shoot up to 16mmol or sometimes higher

 

[niblue]

I have been recently diagnosed with possibly LADA cos my levels are so high. When I wake up and do a check it’s usually around the 12-13 level and fluctuates a lot during the day. The drs put me on Metformin and I have another appointment tomorrow to see what’s happening as I have been monitoring 4 times a day and have never registered lower then 9mmol so now I’m worried about potentially having to go onto insulin. I was told to change my diet and carbs and sugar intake but haven’t been told what’s an ideal amount to have a day so I’m kind of in limbo about what to eat. Even when I have a healthy meal of plain chicken and veg my levels shoot up to 16mmol or sometimes higher

When I was first diagnosed a month back my levels were ranging from 12 to 19 in the morning, and peaking up to as much as 25.5 at times during the day. Since switching to low-carb 3 weeks ago (targeting 50 to 100g per day) they've gradually been dropping and in the last week or my morning levels have been approximately in the 7 to 8 range. I'm on Metformin for about a month now as well (up to 2 x 500mg now) which now doubt will have had some impact, but I expect most of the improvement will be down to diet changes. I've also stopped snacking etc. and have reduced my calorie intake as well to try and lose some weight (5kg down in that period).

 

[EllieM]

Hi @Ra1234 have they done antibody and cpeptide tests to determine your type?

To be honest, you need those tests, as things stand you could be either.

So if it's LADA it isn't the end of the world. modern tech for T1s is great and the NHS will give it to you if you have a T1/LADA diagnosis. But you will have to inject insulin and worry about balancing your food, lifestyle (eg exercise) and the insulin.

If you are T2 and don't want to keep increasing meds (It tends to be progressive if you just use meds to control it) then I strongly recommend you to cut your carbs. Different people have different tolerances so you really need to test before and 2 hours after a meal to see if your body can cope with it. (If your blood sugar goes up more than 2mmol/L then there were probably too many carbs on that meal. There isn't really an ideal amount to take, as it depends on the person.

However if you tell the T2s on here what you eat in a typical day (eg yesterday) then I bet they can make some dietary suggestions.

Metformin helps a bit but generally doesn't reduce your hba1c by more than about 1.1% (or 12mmol/L)

https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=51cd3e0575a08c4e65c1b90961135614e9b69b16

 

[Juicyj]

Heya @LozzaB Welcome to the forum

Yes absolutely normal to spike between meals - non diabetics also spike, it's impossible to keep a straight line as spikes are affected by anything from carbs eaten, exercise, hormones, stress, heat, alcohol etc etc so try not to fixate on a straight line, as long as your back in range before your next meal around 4-5 hours later that's fine.

As a newly diagnosed you will experience a 'honeymoon phase' as your less stressed pancreas decides to kick out some more insulin, it can last from a few months to a year, mine was only short lived around 3-4 months but meant I had to reign my insulin in to avoid hypos, which I hate !!!

There's alot to learn but it will become intuitive over time. Just shout on here if you need any support, we have all been there x

 

[HSSS]

I have been recently diagnosed with possibly LADA cos my levels are so high. When I wake up and do a check it’s usually around the 12-13 level and fluctuates a lot during the day. The drs put me on Metformin and I have another appointment tomorrow to see what’s happening as I have been monitoring 4 times a day and have never registered lower then 9mmol so now I’m worried about potentially having to go onto insulin. I was told to change my diet and carbs and sugar intake but haven’t been told what’s an ideal amount to have a day so I’m kind of in limbo about what to eat. Even when I have a healthy meal of plain chicken and veg my levels shoot up to 16mmol or sometimes higher

Even a type 2 can be diagnosed with very high levels so that alone doesn’t indicate type. Any dr that believes it’s that simple needs some extra hours study. Age, weight, reaction to meals, weight loss, speed of onset, ketones, can all give further clues but all need more confirmation one way or another.

However I firmly believe we should all have better testing at diagnosis to check for antibodies and insulin production (to avoid missed diagnosis of type 1 or giving up the chance of remission/avoiding progression if type 2) so you should be getting those if they are unsure which is great. If not, ask for them to be done to be certain.

It makes a difference because type 1/LADA must use insulin and a type 2 has a chance at remission wit dietary control. Two very different situations. Also the tech available to type 1 is different to a type 2 on the nhs.

which veg? Are you drinking anything with it? What level were you at before the meal? And what else are you eating and drinking throughout the day? It is normal for some variation, which is why random tests helps very little other than if they are all excellent or not. You need to know what and when you ate (or exercise or stress) in relation to the testing to make use of it.

 

[HSSS]

Heya @LozzaB Welcome to the forum

Yes absolutely normal to spike between meals - non diabetics also spike, it's impossible to keep a straight line as spikes are affected by anything from carbs eaten, exercise, hormones, stress, heat, alcohol etc etc so try not to fixate on a straight line, as long as your back in range before your next meal around 4-5 hours later that's fine.

As a newly diagnosed you will experience a 'honeymoon phase' as your less stressed pancreas decides to kick out some more insulin, it can last from a few months to a year, mine was only short lived around 3-4 months but meant I had to reign my insulin in to avoid hypos, which I hate !!!

There's alot to learn but it will become intuitive over time. Just shout on here if you need any support, we have all been there x

Type 1 isn’t confirmed, yet and Lozza is not on insulin yet either - so a little early even if accurate and useful should she be.

 

[Juicyj]

Type 1 isn’t confirmed, yet and Lozza is not on insulin yet either - so a little early even if accurate and useful should she be.

Thanks but I read from her first sentence that she was diagnosed type 1 in Feb and taking insulin ?? Confused..

- I was recently diagnosed with Type 1 in Feb. Levels at that time were through the roof, I had all the classic symptoms- thirst, needing the toilet a lot, headaches. Had tests and was sent straight to hospital and put on insulin. I’m currently taking Toujeo and Humalog for meals.

 

[Antje77]

@HSSS and @Juicyj , there are two newly diagnosed members in this thread: @LozzaB , who was diagnosed with T1 in januari and who uses insulin, she started the thread, and @Ra1234 , who was diagnosed with possible LADA and currently on metformin.

I have been recently diagnosed with possibly LADA cos my levels are so high. When I wake up and do a check it’s usually around the 12-13 level and fluctuates a lot during the day. The drs put me on Metformin and I have another appointment tomorrow to see what’s happening as I have been monitoring 4 times a day and have never registered lower then 9mmol so now I’m worried about potentially having to go onto insulin. I was told to change my diet and carbs and sugar intake but haven’t been told what’s an ideal amount to have a day so I’m kind of in limbo about what to eat. Even when I have a healthy meal of plain chicken and veg my levels shoot up to 16mmol or sometimes higher

@Ra1234 , would you like me or another mod to move your post and the replies to a thread of its own? Your situation is differentthan LozzaB's so having your own thread prevents confusion.

 

[Juicyj]

@HSSS and @Juicyj , there are two newly diagnosed members in this thread: @LozzaB , who was diagnosed with T1 in januari and who uses insulin, she started the thread, and @Ra1234 , who was diagnosed with possible LADA and currently on metformin.


@Ra1234 , would you like me or another mod to move your post and the replies to a thread of its own? Your situation is differentthan LozzaB's so having your own thread prevents confusion.

Ok thanks for clarifying, HSS had me confuddled !

 

[HSSS]

Type 1 isn’t confirmed, yet and Lozza is not on insulin yet either - so a little early even if accurate and useful should she be.

Sorry. I’m confusing things. I was replying to @Ra1234 and then named @LozzaB to really make things even more confuddling. Oops.

 

[LozzaB]

Thanks for all your well wishes guys. Lovely to feel like I’m not alone lol. Much better week this week, waking up in the 5 to 6 region and feeling generally better.

One thing I have found over the course of these couple weeks is that, my job working in a busy cafe, I will eat without taking insulin and my level will naturally go down. I will eat say for breakfast, toast or a sandwich, my levels will go to about 9 or 10, no insulin, and about an hour or two later dropping to 5 to 4 mol. I’m having to constantly snack to get me from dropping below 4 all the time.
I confirm with finger prick to make sure and they are generally similar to my Freestyle so I do drop.

Have brought down my Toujeo from 40 to 38 as it was far too much for overnight. Waking up sometimes below 4mol

 

[Juicyj]

That's good to hear @LozzaB - also sounds like you have a good handle on things with checking again the meter and adjusting your basal too, I find that I am quite intuitive to going low and can feel the sensation of dropping, so I can treat before it goes too low, it's always work in progress as far as i'm concerned ! Best wishes J