Multiple Daily Injections and Corrections and/or snacks

[JPW1]

Hi All,

I'm not fomally carb counting yet, (February) but trying to get my head around a couple of things for when I do, but it's also relevant to where I'm at at the moment.

I need to take breakfast early (6 a.m.) on weekdays and necessarily have lunch around 1-2pm. Now I can usually last without a snack or a handful of almonds etc. if I have to. However should I wish to have say a slice of toast (wholemeal of course) or a croissant around 10:30/11:00am what is the usual protocol re: dealing with such a carb intake?

It seems to me the options are:

1. Don't bother taking the carbohydrate at all - or very minimal i.e. stick to almonds or vegs etc.
   
2. Take additiiona correction dose of insulin at lunchtime (though this will entail leaving BG high for a few hours probably unless I was fairly low 5/6s when I took the carbs).
3. Take a smallish insulin injection to cover at the time of consumption. (i'm guessing that's exactly what a pump user would do).

I suppose the question in my mind is this - as MDI folks should we be trying to minimize the number of injections we have per day - if for no other reason, because it will increase the liklihood of scar tissue and absorption problems in the future? I'm assuming that is the case - as otherwise the idea of a correction does would be a more rare thing that it seems it is.

Any advice welcome.

For interest - started insulin 18/02/19 on 2 units of Tresiba. Now on 12 along with min. 3 Fiasp with breakfast, 4/5 lunch and 7 dinner.....things finally settling now I think at least when I don't mess up between meals or over indulge at meals.

 

[Rokaab]

1. Don't bother taking the carbohydrate at all - or very minimal i.e. stick to almonds or vegs etc.
   
2. Take additiiona correction dose of insulin at lunchtime (though this will entail leaving BG high for a few hours probably unless I was fairly low 5/6s when I took the carbs).
3. Take a smallish insulin injection to cover at the time of consumption. (i'm guessing that's exactly what a pump user would do).

I do either 1 or 3, so I try take hard boiled eggs to work for snacks, but there are just times when you just want something carby as a snack.
If I waited til lunchtime to take a correction for something with carbs I'd be high as a kite by lunchtime (and probably more irritable as well).

 

[Antje77]

I inject any time I fancy carbs.

 

[porl69]

Number 3 wins only just over number 1. My BG would rise pretty quickly if I ate carbs with no insulin to cover them. When I was on MDI I could take 6 - 8 jabs a day with ease with correction doses and dosing for food

 

[Diakat]

The clue is in the name, multiple, I’d inject for carbs.
Could be tricky if you aren’t carb counting though.

 

[JPW1]

Great, thanks all - my BG skyrockets with even a small handul of crisps or such like - was just wondering how everyone dealt with that.
Looks like avoidance or a cheeky wee jag is the way to sort it out! (which is kind of obvious really - but just wasn't sure if people were actually injecting along the way so to speak).

 

[MeiChanski]

Great, thanks all - my BG skyrockets with even a small handul of crisps or such like - was just wondering how everyone dealt with that.
Looks like avoidance or a cheeky wee jag is the way to sort it out! (which is kind of obvious really - but just wasn't sure if people were actually injecting along the way so to speak).

Hello, it’s a bit difficult without carb counting. Have you asked to see a dietitian to get the basics of it? Once you get your head around it, you’ll find that fat slows down carb absorption so people actually split dose for takeaways, high fat foods like crisps, chocolate etc. I do inject for crisps but split it to cover the carb and fat action profile of it so I don’t run high later.

 

[JPW1]

Hello, it’s a bit difficult without carb counting. Have you asked to see a dietitian to get the basics of it?

Yep seeing dietitian early February - will probably refrain rather than does until then. Have read fairly extensively on it and understand concepts well, but won't start it until I'm given the go ahead!

Re: fat etc. I've had "off the record discussions" about fat and some foods like lentils etc. about the wisdom of splitting doses - also things like pizza etc. I've noticed they have a more peculiar effect than many other foods myself even in a few weeks.

 

[Shannon27]

Hi All,

1. Don't bother taking the carbohydrate at all - or very minimal i.e. stick to almonds or vegs etc.
   
2. Take additiiona correction dose of insulin at lunchtime (though this will entail leaving BG high for a few hours probably unless I was fairly low 5/6s when I took the carbs).
3. Take a smallish insulin injection to cover at the time of consumption. (i'm guessing that's exactly what a pump user would do).

Any advice welcome.

For interest - started insulin 18/02/19 on 2 units of Tresiba. Now on 12 along with min. 3 Fiasp with breakfast, 4/5 lunch and 7 dinner.....things finally settling now I think at least when I don't mess up between meals or over indulge at meals.

Hi @JPW1
If you are just starting with carb counting, i would recommend the Carbs and Cals app on your phone to help you get started. I think you still have to pay for it but it's not much, and it's invaluable to a lot of people. It shows portion sizes, with pictures, and you can multiply it by how much food you are having (e.g. one slice of toast or two?), it does the maths for you. You can create a bit of a food diary on it, which is very useful for diabetics! It's what my dietitian recommended for me it even has different pizza types on it!

Do you have ratios, or how much insulin you do for how many carbs you eat? I do 1 unit of Novorapid for every 4 or 5 grams of carbs, depending on the time of day. If you don't, your dietitian may try to set this up with you.

To comfortably live with your diabetes, i would balance your bgs, with the carbs you are eating and your mood. Plan your diabetes around your life, not the other way around. Don't worry about injecting too much, as long as you don't use the same spot you will be fine. Try to rotate - i use my belly and my bum

 

[JPW1]

Shannon great advice!

• Have Carbs and Cals really useful and easy to use (on £3.99 I think!)
• I don't have my ratios - but I'm keeping data to calculate them - on evidence so far, in my opinion at least the "common" 1:10 ain't gonna do it may 1:7-8 or thereabouts - but I think around lunchtime seems to be the worst time for me. I just took a very measured meal with 5 units and which on a 1:10 should have covered it - but I still rose after 2 hours by about 3 mmol/L

 

[MeiChanski]

Shannon great advice!

• Have Carbs and Cals really useful and easy to use (on £3.99 I think!)
• I don't have my ratios - but I'm keeping data to calculate them - on evidence so far, in my opinion at least the "common" 1:10 ain't gonna do it may 1:7-8 or thereabouts - but I think around lunchtime seems to be the worst time for me. I just took a very measured meal with 5 units and which on a 1:10 should have covered it - but I still rose after 2 hours by about 3 mmol/L

You can get started with BERTIE online course to help you along with carbs and cals.

 

[KK123]

Yep seeing dietitian early February - will probably refrain rather than does until then. Have read fairly extensively on it and understand concepts well, but won't start it until I'm given the go ahead!

Re: fat etc. I've had "off the record discussions" about fat and some foods like lentils etc. about the wisdom of splitting doses - also things like pizza etc. I've noticed they have a more peculiar effect than many other foods myself even in a few weeks.

Hi there, you are really well informed which is brilliant, it took me a while to get up to speed as it were. Even now that 'concept' still throws in a curve ball every so often. The thing to remember is that it is not a scientific formula, for me even the slightest change in routine or even no change at all affects how much insulin I need for meals that appear identical. I only mention this because it can sometimes be frustrating at the start of the carb counting approach when you are weighing things down to the exact carb and injecting very carefully...and still sometimes higher than the 2mmol or sometimes in a hypo. x

 

[JPW1]

I only mention this because it can sometimes be frustrating at the start of the carb counting approach when you are weighing things down to the exact carb and injecting very carefully...and still sometimes higher than the 2mmol or sometimes in a hypo. x

Indeed , i had a wonderfully measured lunch today to match my current 5 units..... I rose by 3mmol/l.... I do wonder if my Fiasp peaks too quickly, leaving me floundering with my slower digesting wholemeal bread?

Or maybe thats just the way it is now and again!

 

[KK123]

Indeed , i had a wonderfully measured lunch today to match my current 5 units..... I rose by 3mmol/l.... I do wonder if my Fiasp peaks too quickly, leaving me floundering with my slower digesting wholemeal bread?

Or maybe thats just the way it is now and again!

Hi JPW, do you mean your 2 hour test showed you were 3mmol above where you started prior to the meal? My understanding is that if it is within 2mmol of your starting point then that is fine, in which case you were only 1mmol above where you should have been? I am one day into a 4 day carb counting course run by the NHS and the Nurse said that it actually can take a type 1 up to 4 hours to be back to where they were to begin with, this was in the context of not rushing to take a correction dose after 2 hours so a bit different to what you are talking about but it does show that our 'system' is indeed a bit slow. I find wholemeal bread affects me exactly the same as white bread to be honest, a very quick (large) spike which then starts to go down but only gets back to normal after about 2 hours. If I take more insulin to try and counteract this then I can guarantee I will hypo after the 2 hours. Oh, the joys! x

 

[Circuspony]

About day 3 after my diagnosis I told the diabetic nurse I needed to inject for 2nd breakfast. So my doses were changed to 4 meals a day.

By day 6 I'd worked out carb counting / approximation and just got on with it really!!

 

[JPW1]

Yeah i know, but because I'm new, i expect it all to be perfect and precise and predictable .

It came down nicely before dinner, and more insulin would almost certainly have sent my hypo.

 

[JPW1]

About day 3 after my diagnosis I told the diabetic nurse I needed to inject for 2nd breakfast. So my doses were changed to 4 meals a day

Like a hobbit! That would suit me, sorry if the Lord of the Rings allusion means nothing! Sounds lije a great plan.

 

[Circuspony]

Like a hobbit! That would suit me, sorry if the Lord of the Rings allusion means nothing! Sounds lije a great plan.

Like a hobbit is just what the nurse said to me when I phoned to say I needed a 2nd breakfast!

 

[scotteric]

(i'm guessing that's exactly what a pump user would do

You should approach MDI exactly how a pump user would approach diabetes. There's really no difference between a pump and MDI, other than the ability to control basal rates on a pump (which can somewhat be mimicked by taking Levemir every 12 hours or so and adjusting the dose as needed) or the ability to extended a dose over time for high fat/protein meals (which can be mimicked using the older Regular/Actrapid insulin on MDI or by taking multiple injections). I have used both a pump and pens, and can maintain roughly the same level of control because I approach diabetes exactly the same no matter how my insulin is being delivered. I might inject 10-12 times a day if I have to, just as I would push the bolus button 10-12 times a day on my pump. You're less likely to develop scar tissue than a pump user is as long as you rotate enough. It is constantly injecting insulin into the same area that causes scar tissue, not the needle. I like to eat and inject every time I eat something. I also like to have blood sugars as close to normal as possible, so I inject every time I'm high. I don't see any reason to keep your BG high for any length of time to avoid an injection.

 

[JPW1]

You should approach MDI exactly how a pump user would approach diabetes. There's really no difference between a pump and MDI, other than the ability to control basal rates on a pump (which can somewhat be mimicked by taking Levemir every 12 hours or so and adjusting the dose as needed) or the ability to extended a dose over time for high fat/protein meals (which can be mimicked using the older Regular/Actrapid insulin on MDI or by taking multiple injections). I have used both a pump and pens, and can maintain roughly the same level of control because I approach diabetes exactly the same no matter how my insulin is being delivered. I might inject 10-12 times a day if I have to, just as I would push the bolus button 10-12 times a day on my pump. You're less likely to develop scar tissue than a pump user is as long as you rotate enough. It is constantly injecting insulin into the same area that causes scar tissue, not the needle. I like to eat and inject every time I eat something. I also like to have blood sugars as close to normal as possible, so I inject every time I'm high. I don't see any reason to keep your BG high for any length of time to avoid an injection.

Sounds like a good plan to me!....especially the "I like to eat" bit....I have a shocking appetite and can't put weight on....