Officially migrated from the T2 crew to the T1 crew

Jeremy.M

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Hey folks.

Roughly four years ago, I was suspected to have developed type 2 diabetes when I was around 23 years old. Specialists outside of my GP concurred with this sentiment. My HbA1c was sitting around 8-9%. I was overweight at the time and had been all but completely immobile for almost an entire year as I was suffering from a dreadful herniated disc in my back in accordance with chronic insomnia. I poorly chose to cope with my pain via consuming ridiculous quantities of sugary foods and beverages – YouTube and Netflix aided as well, of course. Prior to this, I was an individual that decided to start eating quite healthily and begin exercising regularly on an elliptical after my mid teen years. I was very rarely overweight and my family doesn't have a history of type 2 diabetes.

At the time of my diagnosis, I weighed somewhere around 210-220 pounds (I'm 5'9 / 175cm). My doctor told me that some people are able to control type 2 diabetes through diet and exercise, thus I decided that I would attempt to do so as well before relying on medication. The prospects of risky back surgery and likely potential progression of type 2 diabetes inspired me to fight through my crippling pain and hop back on the elliptical for the first time in a year. Combining exercise with a low calorie ketogenic diet resulted in pounds metaphorically melting away, as I was able to drop 50 pounds in around 3-4 months. My weight loss resulted in my herniated disc eventually becoming asymptomatic and my HbA1c dropped to 5.2%.

Over the next three years, I increased my caloric intake, kept carbs very low, continued exercising, shed off a few more pounds until I sat comfortably at 140 and maintained a HbA1c that fluctuated between 5.0-5.6%. Things were great and my doctor, at some point during said years, claimed that I had entered remission.

At the inception of 2020, I had begun experiencing unintentional weight loss. I found myself struggling to maintain my weight at 140 pounds in spite of refraining from changing my eating and exercising habits. I had lost 10 pounds over the course of a few months, so I was advised by my doctor to speak with a pair of dietitians that specialize in advising diabetics. They told me that I was likely losing weight because of my extremely low carbohydrate consumption, yet I found this strange considering that I had essentially been neglecting carbs for the last three years. They said that my condition could be declining in spite of me having controlled my condition so well thus far, so I went back to my doctor, received a prescription for metformin and started consuming more carbs as the dietitians recommended.

A few more months passed and I continued to lose weight, eventually reaching a low of 120. I didn't even end up adding a significant amount of carbs to my diet, yet my HbA1c rose to 7-8%. At some point during the year, I noticed that exercise started having less of an effect on my blood sugar, thus my blood sugar average continued to climb. Around mid-December of 2020, I started seeing ridiculous numbers ranging from 15-20 mmol/l. I didn't know what my HbA1c was in the last quarter of 2020, but I imagine it must have been far greater than 9%. Going back to a low calorie keto diet did nothing to curb my blood sugar levels, so I called my doctor, who ended up swapping out my metformin for a metformin/sitagliptin combination. This ended up lowering my sugars, but my average readings were still far too high. A few weeks later, even after eventually adding gliclazide into the mix, my average readings were still too high. I started pondering that what was happening to me wasn't making much sense if I was supposedly an insulin-resistant type 2 diabetic, as I wasn't experiencing weight gain. I asked my GP if there was a test out there that could determine whether someone was insulin resistant or insulin deficient, suggesting to him if there was a possibility that I was instead insulin deficient. Sometime in January, my GP set me up an appointment with an endocrinologist that I had seen a few years prior, as they would likely be able to tackle my situation and shed light on what was happening to me in addition to being able to conduct certain tests. Unfortunately, I would have to wait 3 months to see this endocrinologist, so I just had to keep doing what I could while my GP gradually increased the dosage of my medications.

In April 2021, I finally saw the endocrinologist. She told me that she was going to conduct a few tests in order to determine what my HbA1c was in addition to a c-peptide test and GAD antibody test. For the time being, she started me on 8 units of basal / long-lasting insulin to take nightly. I immediately started seeing results, as nightly blood sugar readings as high as 13-15mmol/l were turning into 5 through 9s in the morning. Unfortunately, my tests were delayed a few times because the health centers I visited could only conduct a certain number of GAD antibody tests per day – or something like that. One time, I may have also neglected to remember that I had to come for the test in the morning. Oops.

Enter May 2021. My endocrinologist called me today with the test results. Even with all of the medication I was on, my HbA1c was sitting at 9%. While this is terrible, I took some comfort in the fact that it had not risen any higher than that. I just had a feeling that I knew what was coming next, but I was prepared to receive the news. First, I was told that I actually had very low insulin levels. Next, I was told that two types of antibodies were found within my pancreas, with the presence of GAD antibodies in particular being very high. I knew what this meant, but she stated it anyway: type 1 diabetes.

While I personally think this blows overall, I'm finding some solace in the fact that I didn't necessarily do anything to acquire this disease. Believing that I was a type 2 diabetic and failing to control it was extremely frustrating, thus I feel some relief in a strange way; I don't feel defeated anymore. The idea of struggling and losing ground against a disease that is said to be manageable via diet and exercise alone can be devastating.

Anyway, my prescription for NovoRapid should be coming in later today. It's been a long four-year struggle, but now it's time to continue the struggle in a new light. Everything I thought I knew about my condition has changed. This being said, I do have a few questions:

1.) Ideally, what should my meal-time dosage of insulin look like in terms of an insulin-to-carb ratio? My endocrinologist merely told me to start off with 4 units for breakfast, 3 units for lunch and 5 units for dinner to start. I've read that 1 unit of meal-time insulin can be used to drop blood sugar by 2 mmol/l per unit if needed for corrections, then 1 additional unit for every 10 grams of net carbs. Is this information accurate and a good place to start?

2.) My carb intake has been dreadfully low for the last 4 years. My diet has consisted of high healthy fats, moderate protein and low net carbs but high fiber. If I want to continue a diet similar to this and not merely meet a carb quota for the purpose of judging insulin dosage, how – if at all – would I judge my insulin dosage for protein consumption? Fat doesn't seem to be an issue, but protein consumption even without carbs can sometimes spike my blood sugar levels. I do know that excess / unused protein is converted to glucose, but is there a way to quantify protein consumption for insulin injections?

3.) The target range for corrections and overall blood sugar average seems to be between 4 and 7 mmol/l. I'm quite fearful of long-term complications, considering that I've had a high HbA1c since December of last year. Should I start aiming for 4 mmol/l right off the bat, or should I aim for something higher until I get familiar with meal-time insulin dosages and their affect on my blood sugar levels?

4.) Is insulin resistance typical for type 1 diabetics? I've been told that it seems like I show no signs of insulin resistance, but that it could develop in type 1 diabetics if they gain weight and make unhealthy lifestyle choices. Is this accurate? Does the mere act of taking insulin, and an increasing amount of insulin over time, eventually lead to insulin resistance?
 
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dancer

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1,360
Type of diabetes
Type 1
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Pump
Everyone's insulin to carb ratio is different. In fact you may end up with one ratio for breakfast,another for lunch and a third for dinner. Your ideal carb ratio will be different from other Type 1s. What normally happens is we are told to start with a ratio of 1 unit to 10g of carbohydrate and use trial and error to find a ratio that works for that meal. Personally I would follow your doctor's advice to begin with, then ask about using carb ratios.

You say you were told to use particular insulin doses for each meal. Did he give these doses according to your normal eating? I presume he didn't just pluck them out of thin air . . . but some docs can be real idiots, so I didn't want to assume anything. If he didn't tell you how much carbohydrate to eat with those insulin doses, you should call him asap.

The normal BG level is 4 - 7. Some diabetics may have this target, but again everyone is different.. My own target is 6 - 8, but I am insulin sensitive. My brother 's target is 5.5 - 7.5.
It will take some time for your body to get used to insulin. You will probably go through a honeymoon period when insulin requirements fall but then they will rise again. Do not aim for a target of 4 or you will go hypo. Don't run before you can walk and wait for your doctor's advice or a course where you learn to adjust insulin doses according to carbs eaten and also how to make corrections.
Don't worry about insulin resistance . It sometimes happens in Type 1 but more often in Type 2.
 

Jeremy.M

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Everyone's insulin to carb ratio is different. In fact you may end up with one ratio for breakfast,another for lunch and a third for dinner. Your ideal carb ratio will be different from other Type 1s. What normally happens is we are told to start with a ratio of 1 unit to 10g of carbohydrate and use trial and error to find a ratio that works for that meal. Personally I would follow your doctor's advice to begin with, then ask about using carb ratios.

You say you were told to use particular insulin doses for each meal. Did he give these doses according to your normal eating? I presume he didn't just pluck them out of thin air . . . but some docs can be real idiots, so I didn't want to assume anything. If he didn't tell you how much carbohydrate to eat with those insulin doses, you should call him asap.

The normal BG level is 4 - 7. Some diabetics may have this target, but again everyone is different.. My own target is 6 - 8, but I am insulin sensitive. My brother 's target is 5.5 - 7.5.
It will take some time for your body to get used to insulin. You will probably go through a honeymoon period when insulin requirements fall but then they will rise again. Do not aim for a target of 4 or you will go hypo. Don't run before you can walk and wait for your doctor's advice or a course where you learn to adjust insulin doses according to carbs eaten and also how to make corrections.
Don't worry about insulin resistance . It sometimes happens in Type 1 but more often in Type 2.

Thank you for the response.

Both my GP and endo are aware that I had readopted a low calorie keto diet for the time being. I was assuming she made the 4 units, 3 units and 5 units for breakfast, lunch and dinner respectively with my extremely low carb intake in mind. I've been consuming less than 20g of net carbs with each meal. However, if a starting ratio of 1 unit to 10g of carbs is a typical for those beginning insulin treatment, perhaps I should give my endo another call and revisit this topic with her.

My endo never told me how much carbohydrates I should be consuming with each meal, but she did ask what was recommended to me by the dieticians I visited back in 2020. They recommended that I consume at least 30g of carbs per meal. However, their recommendations were based on the assumption that I was a type 2 diabetic that was being treated with metformin, thus I'm not sure whether my worsening carb tolerance and new diagnosis as a type 1 since then changes things.

Other than having high blood sugar, high cholesterol levels (which seems to ascend and descend in accordance with whatever my HbA1c is) and an abysmally low net carb intake, I do actually have healthy lifestyle habits so I suppose I can cease worrying about insulin resistance. I think I'll try to set my sights on 7 mmol/l for the time being and then worry about attaining better control over my blood sugar once I become more familiar with the dosing process.

Your post has made me feel a bit more at ease. Thank's again!
 

dancer

Well-Known Member
Messages
1,360
Type of diabetes
Type 1
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Pump
Thank you for the response.

Both my GP and endo are aware that I had readopted a low calorie keto diet for the time being. I was assuming she made the 4 units, 3 units and 5 units for breakfast, lunch and dinner respectively with my extremely low carb intake in mind. I've been consuming less than 20g of net carbs with each meal. However, if a starting ratio of 1 unit to 10g of carbs is a typical for those beginning insulin treatment, perhaps I should give my endo another call and revisit this topic with her.

My endo never told me how much carbohydrates I should be consuming with each meal, but she did ask what was recommended to me by the dieticians I visited back in 2020. They recommended that I consume at least 30g of carbs per meal. However, their recommendations were based on the assumption that I was a type 2 diabetic that was being treated with metformin, thus I'm not sure whether my worsening carb tolerance and new diagnosis as a type 1 since then changes things.

Other than having high blood sugar, high cholesterol levels (which seems to ascend and descend in accordance with whatever my HbA1c is) and an abysmally low net carb intake, I do actually have healthy lifestyle habits so I suppose I can cease worrying about insulin resistance. I think I'll try to set my sights on 7 mmol/l for the time being and then worry about attaining better control over my blood sugar once I become more familiar with the dosing process.

Your post has made me feel a bit more at ease. Thank's again!
One thing to remember is that Type 1s can eat any amount of carbs, as long as they know h ow to carb count and adjust insulin. Some Type 1s are happier following a low carb diet but it isn't necessary.
 

EllieM

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Welcome to the T1 club @Jeremy.M

Those are a really good set of questions and I suggest you take them to your diabetic team asap. It also sounds like they may be assuming you are on 30g a meal, which is considered low carb by many/most but is significantly different to 20g.

Some dieticians and doctors don't like T1s to eat too few carbs because they are worried about diabetic ketoacidosis (the blood develops high levels of ketones because you haven't got enough insulin in there.) High blood sugars and ketones are life threatening and some doctors worry that the normal ketones present due to dietary ketosis may mean you don't detect a DKA attack. I've never had a DKA in 51 years of T1 so they are by no means common, but they are something to worry about if your blood sugars go very high due to eg illness or skipping your insulin doses. (And the latter can happen accidentally if your insulin goes off in the heat or if there is a crack in your insulin vial.) Anyway, there are T1s out there who eat keto diets, just be aware that your team may or may not be supportive.

Hopefully your team have talked to you about hypos, which I would regard as one of the most important topics for a new insulin user. Most people get symptoms when their bg goes too low (eg shakiness, sweating, hunger, difficulty in concentration) and you need to always have access to some form of sugar so that you can treat them. (I'm a big fan of glucotabs because I don't feel tempted to eat them when I'm not hypo but other people just go for something like some jelly babies or some high sugar fizzy drink. If you drive, you'll need to tell the licensing authority and always test before you get in a car. (Those are UK rules and I appreciate you may not be in the UK, but the test before you drive is good practice anywhere.)

Anyway, good luck and once more welcome.
 
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sleepster

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Pump
I suppose I can cease worrying about insulin resistance
Hello @Jeremy.M, welcome.
You've been given lots of good info above but I just want to point out that insulin resistance can be a problem if you have high blood sugars, if you're ill for instance or have missed your insulin. I find if I get over 14 or so I need extra insulin to bring my BG down. Whilst eating a low carb diet will reduce the number of BG spikes you have they can still happen and you may temporarily have issues with insulin resistance if they do.
 
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KK123

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Messages
3,967
Type of diabetes
Type 1
Treatment type
Insulin
Hi @Jeremy.M , wow, what a story, you've definitely been on a roller coaster. When I read your post my first thought was anger at how long it's taken them to diagnose you properly even with fairly obvious signs along the way. It was similar for me too. You sound like you have made yourself extremely knowledgeable about all of this so I am positive you are going to crack it!

When you are first (properly) diagnosed they always like to put you on an 'average' carb/insulin routine. So they say 'Eat 30 carbs and take 3 units of insulin' for example, this is so they can gauge your carb to insulin ratio (the 'average' non diabetic produces roughly 1 unit of insulin to cope with 10 carbs is how they explained it to me, based on size and weight, etc). Of course this is a very crude calculation so it then becomes trial and error at the start and they don't seem to take much notice of what an individual's normal eating patterns are like.

Again the issue of being told 'take this amount of insulin at meal times' as if it was a medicine means you end up HAVING to eat to your insulin instead of what it should be, adjusting your insulin to what you EAT.

None of us can give you medical advice but I can say that what I would do (and I did) is stick to meals that YOU want to eat whether that be lower carb or not. I have never eaten 3 x meals a day for starters. Any meal I did have, I started off testing, testing, testing, and found that my initial ratio was about 1 unit of insulin to 20 carbs, but that was me. When I was confident enough of this ratio, I added in my normal exercise routines etc, which also affect how much insulin you may need to decrease or increase.

Take it slowly, make notes, be careful of hypo's, I wouldn't necessarily aim for levels of 4 at this stage as I suspect you will end up hypo'ing all over the place, levels can drop quickly. I note they have prescribed novarapid (for meals) but are they giving you any basal (long acting, background insulin)? If not, find out WHY not as both are normally required to get a good type 1 regime going.

I hope this helps. x
 
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Circuspony

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959
Type of diabetes
Type 1
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Insulin
A detailed diary is essential when you first start on insulin. Food (exact portions inc weight), time of day, BG before you eat and 2 hours after, insulin dosage etc.

I have a very different insulin to carb ratio at breakfast than dinner for instance. If i am planning on exercising then I need a 75% reduction

It's also worth noting that not all carbs act the same. For me 50g carbs of bread vs 50g carbs of potatoes need different insulin dosages. I would need about 5 units for the bread and half that for the spuds. Trial and error!!!
 

Jeremy.M

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Thanks for the responses, everyone.

@EllieM I've just been used to keto-like diets as I've been on one for the last five years. If it turns out that I don't end up having much insulin resistance, I'll definitely try to work some healthy carbs into my meals, such as Oat Bran. I'll have to see what passes as a decent general insulin-to-carb ratio for my meals.

@sleepster It seems like 1 unit of NovoRapid is bringing my sugars down by about 1.5 mmol/l, give or take a few decimals. I was reading that 1 unit of insulin typically lowers blood sugar by about 2-3 mmol/l, so I might have some resistance.

@KK123 I am taking 6 units of a basal insulin (lantus? glargine?) nightly in accordance with rapid-acting insulin for meals, which has had a profound positive effect on my morning blood sugar levels. However, I'm finding it tough attempting to get an idea of what my insulin-to-carb ratio could be. As you said, I imagine that it will differ from meal to meal, depending on what type of carbs are being consumed in accordance with the other two macronutrients, but I seem to be missing the mark quite a bit.

For instance, my dinner on May 19th consisted of 21 grams of carbs (Oat Bran & Walnuts), 36g of protein (Turkey, Keto Bread & a bit from Walnuts again) and about 30g of fat (Almond Butter & from the few Walnuts). This was the first meal I was going to have with insulin (and the first time I've eaten this much food at once in quite a while), so I had to estimate. I was sitting at 6.8 mmol/l before dinner, so I figure I would try 3 units of NovoRapid and see what happens. Two hours later, I ended up with a whopping 13.0 mmol/l, so I injected another 3 units to correct things. Two hours after that, I was sitting at 8.1 mmol/l.

The following day, I had the same meal, but for breakfast this time. Prior to eating, I was sitting at 6.2 mmol/l, but I injected 6 units of NovoRapid this time. Two hours later, I ended up at 6.4 mmol/l, which I felt decent about. I figured that the protein and fat would raise my levels up a bit more over the course of the next few hours, so I went on my elliptical for 20 minutes. My sugar levels were at 5.8 about an hour later.

Today, I had the same meal once again at dinner, but I started dinner at 4.9 mmol/l, so I decided that I would only take 5 units of NovoRapid. I guess I felt that I shouldn't take as many units because my pre-meal blood glucose levels weren't as high for this specific meal, yet I regret that decision. Two hours later, I ended up with 10.7 mmol/l, so I took 4 units for correction. One hour after that, I decided to check again, but I went up to 13.5 mmol/l, so I took 2 more units of NovoRapid to hopefully stop it from rising any further. I realize that I probably shouldn't have administered another correction so soon, but I'm going to be keeping an eye on things every half hour. As I said, I'm not sure what my insulin-to-carb ratio is yet, but when it comes to corrections, I'm definitely not seeing the expected 2-3 mmol/l drop per unit. It might be due to the amount of protein and fat I'm consuming with my meals, but I suppose I'll eventually figure out why. Regardless, not a problem though, as I have some Sour Cream chips (haven't had these bad boys in years) and cookies handy just in case something happens.

I'm sure I'll eventually get the hang of things, but I'm just petrified about having high sugar levels over a long period of time. I really want to try my best to avoid diabetic complications in the future by attaining a HbA1c in the low 5s, which was something I was doing for nearly four years without medication in the past, but this is actually tougher than I first anticipated. In my five-ish years of being a diabetic, I've had around 8 months of bad blood sugar (most of which have occurred recently) and I really want to keep it that way. In the long run, this disease terrifies me, but at least I feel better about adding healthy carbs back into my diet – as long as I can account for them properly via insulin. Since the end of 2020; and I can't believe I'm saying this, but the blood sugar increases over time caused by protein and fat consumption seem to be more problematic than carbs. It's just strange transitioning from a 'reject all carbs' mentality to a 'consume carbs because they're easier to dose for' mentality.

I almost want to take a bit more insulin than I feel I need (perhaps one unit extra), but no one really seems to share that sentiment, thus it might not be as wise as I initially thought. Rapid-acting insulin doesn't seem to be all that rapid if I'm being honest, as it seems to start to have its significant impact one-to-three hours after taken – according to my testing anyway. I've dealt with hypos in the past and I've always been able to detect when my blood sugar dips into the high 3s, but I'm not sure how reliable that sensation will be with insulin added into the mix.
 

Hertfordshiremum

Well-Known Member
Messages
385
Type of diabetes
LADA
Treatment type
Insulin
Thanks for the responses, everyone.

@EllieM I've just been used to keto-like diets as I've been on one for the last five years. If it turns out that I don't end up having much insulin resistance, I'll definitely try to work some healthy carbs into my meals, such as Oat Bran. I'll have to see what passes as a decent general insulin-to-carb ratio for my meals.

@sleepster It seems like 1 unit of NovoRapid is bringing my sugars down by about 1.5 mmol/l, give or take a few decimals. I was reading that 1 unit of insulin typically lowers blood sugar by about 2-3 mmol/l, so I might have some resistance.

@KK123 I am taking 6 units of a basal insulin (lantus? glargine?) nightly in accordance with rapid-acting insulin for meals, which has had a profound positive effect on my morning blood sugar levels. However, I'm finding it tough attempting to get an idea of what my insulin-to-carb ratio could be. As you said, I imagine that it will differ from meal to meal, depending on what type of carbs are being consumed in accordance with the other two macronutrients, but I seem to be missing the mark quite a bit.

For instance, my dinner on May 19th consisted of 21 grams of carbs (Oat Bran & Walnuts), 36g of protein (Turkey, Keto Bread & a bit from Walnuts again) and about 30g of fat (Almond Butter & from the few Walnuts). This was the first meal I was going to have with insulin (and the first time I've eaten this much food at once in quite a while), so I had to estimate. I was sitting at 6.8 mmol/l before dinner, so I figure I would try 3 units of NovoRapid and see what happens. Two hours later, I ended up with a whopping 13.0 mmol/l, so I injected another 3 units to correct things. Two hours after that, I was sitting at 8.1 mmol/l.

The following day, I had the same meal, but for breakfast this time. Prior to eating, I was sitting at 6.2 mmol/l, but I injected 6 units of NovoRapid this time. Two hours later, I ended up at 6.4 mmol/l, which I felt decent about. I figured that the protein and fat would raise my levels up a bit more over the course of the next few hours, so I went on my elliptical for 20 minutes. My sugar levels were at 5.8 about an hour later.

Today, I had the same meal once again at dinner, but I started dinner at 4.9 mmol/l, so I decided that I would only take 5 units of NovoRapid. I guess I felt that I shouldn't take as many units because my pre-meal blood glucose levels weren't as high for this specific meal, yet I regret that decision. Two hours later, I ended up with 10.7 mmol/l, so I took 4 units for correction. One hour after that, I decided to check again, but I went up to 13.5 mmol/l, so I took 2 more units of NovoRapid to hopefully stop it from rising any further. I realize that I probably shouldn't have administered another correction so soon, but I'm going to be keeping an eye on things every half hour. As I said, I'm not sure what my insulin-to-carb ratio is yet, but when it comes to corrections, I'm definitely not seeing the expected 2-3 mmol/l drop per unit. It might be due to the amount of protein and fat I'm consuming with my meals, but I suppose I'll eventually figure out why. Regardless, not a problem though, as I have some Sour Cream chips (haven't had these bad boys in years) and cookies handy just in case something happens.

I'm sure I'll eventually get the hang of things, but I'm just petrified about having high sugar levels over a long period of time. I really want to try my best to avoid diabetic complications in the future by attaining a HbA1c in the low 5s, which was something I was doing for nearly four years without medication in the past, but this is actually tougher than I first anticipated. In my five-ish years of being a diabetic, I've had around 8 months of bad blood sugar (most of which have occurred recently) and I really want to keep it that way. In the long run, this disease terrifies me, but at least I feel better about adding healthy carbs back into my diet – as long as I can account for them properly via insulin. Since the end of 2020; and I can't believe I'm saying this, but the blood sugar increases over time caused by protein and fat consumption seem to be more problematic than carbs. It's just strange transitioning from a 'reject all carbs' mentality to a 'consume carbs because they're easier to dose for' mentality.

I almost want to take a bit more insulin than I feel I need (perhaps one unit extra), but no one really seems to share that sentiment, thus it might not be as wise as I initially thought. Rapid-acting insulin doesn't seem to be all that rapid if I'm being honest, as it seems to start to have its significant impact one-to-three hours after taken – according to my testing anyway. I've dealt with hypos in the past and I've always been able to detect when my blood sugar dips into the high 3s, but I'm not sure how reliable that sensation will be with insulin added into the mix.
Hi Jeremy

please be very careful with multiple correction doses, too many in a short space of time can result in a bad hypo later. It’s called stacking. Novorapid takes between 30 mins and an hour and a half to peak and lasts for 4 hours. The exact timings probably also vary from person to person. Don’t rush to correct if it’s not quite right after only 2 hours, it often takes me 3 hours to get back to a similar starting point and if I corrected any earlier I would probably hypo a couple of hours later. Remember also your basal might not be quite right yet either so be careful overnight, you don’t want to be going too high or low while sleeping. It took me quite a while to get the hang of ratios and different foods especially when the same carb content can give different results depending on the food. Keep a diary. A Libre sensor if possible might also be a big help at the moment to see how you react to exercise and different food and record results. I started off at 1 unit to 10g carbs but quickly found I only needed 1 unit to 20g carbs but 3 years later it’s changed again but you get to know to adapt.
Have some juice, orange, apple, cranberry for hypos. Juice acts quicker than cookies or crisps. I always go out with jelly beans in my pocket. 6 should stop a hypo. Also if you hypo have about 15g of carbs, have a look how much that is on the packet/ cartons before this happens, then retest in 15mins and hopefully you will be back in range otherwise have another 15g. By the way I also eat a low carb diet to avoid spiking after meals. It’s very daunting at the beginning but you will get the hang of it.
 
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Jeremy.M

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Type of diabetes
Type 1
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@Hertfordshiremum I've ended up checking every half hour just to be safe, with a bottle of OJ and a measuring glass to be extra safe and precise. Lol.

Looks like my corrections seem to be working in my favour this time, as I seem to have remained in the low 7's for my last couple checks over the last 40 minutes, but I'm still going to keep an eye out as I've read / have been told that it can continue to work for up to 4 hours. I dropped from 13.5 to 8 mmol/l fairly quickly, which is why I'm going to continue checking for a couple hours. I'm absolutely not going to take another dose of rapid-acting insulin this close to bed. I ended up doing about 6 units worth of corrections over the last several hours, so it looks like 1 unit = -1.5 mmol\l might be my standard? Seems a bit low of a ratio compared to the suggested standard for a 5'9 male sitting at 125-128 pounds. I still don't know how my protein and fat intake affected things though.

This sucks. I've been trying to eat more because I've been underweight for quite a while (125 - 128 now, but was 116-120 for nearly 8 months prior to this), but perhaps I should try smaller, more frequent meals rather than attempting to shove 20g of carbs, 25-30g of protein and 25-35g of fat into one meal 3x a day when I have yet to get a passable grasp on dosing for meals and corrections.
 
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EllieM

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I've dealt with hypos in the past and I've always been able to detect when my blood sugar dips into the high 3s, but I'm not sure how reliable that sensation will be with insulin added into the mix.

The problem with having too many hypos is that just as people who maintain high blood sugars for a while can get used to them and get false hypos at normal levels, if you maintain low bgs for too long and have too many hypos, you can start to lose hypo awareness. And loss of hypo awareness for a person on insulin is a big big deal.

Anecdotally, it seems that loss of hypo awareness is more of an issue for long term T1s (and some T3cs who may have their glucagon production reduced : glucagon is produced by the pancreas to tell the liver to pump out sugar), but it can happen to anyone. The problem with going too low is that you judgement goes, and it can seem like too much effort to get up and take some sugar (particularly at night), so you really need to treat a hypo before your judgement is compromised, and for that you need hypo awareness.

The reason that some DNs take issue with T1s with hba1cs in the 5s is that those levels are often accompanied by lots of hypos (it's a measure of average glucose, so you can compensate for the highs with lows). I've lost hypo awareness 3 times : all when I was keeping my bgs relatively low and I had too many hypo. I literally had to have a friend over to watch me with my toddler when I was pregnant with my second child, because I couldn't trust my hypo awareness. Luckily I could get it back (my current endo recommended a bg of 6-12 for a couple of months) but life without hypo awareness can be terrifying.

The good news is that as cgms become more available it becomes easier to avoid hypos and also to maintain hypo awareness so I am lucky enough to be able to self fund a dexcom.

Anyway, I don't want to discourage you, you sound like you are doing really well with your control.
 

Hertfordshiremum

Well-Known Member
Messages
385
Type of diabetes
LADA
Treatment type
Insulin
@Hertfordshiremum I've ended up checking every half hour just to be safe, with a bottle of OJ and a measuring glass to be extra safe and precise. Lol.

Looks like my corrections seem to be working in my favour this time, as I seem to have remained in the low 7's for my last couple checks over the last 40 minutes, but I'm still going to keep an eye out as I've read / have been told that it can continue to work for up to 4 hours. I dropped from 13.5 to 8 mmol/l fairly quickly, which is why I'm going to continue checking for a couple hours. I'm absolutely not going to take another dose of rapid-acting insulin this close to bed. I ended up doing about 6 units worth of corrections over the last several hours, so it looks like 1 unit = -1.5 mmol\l might be my standard? Seems a bit low of a ratio compared to the suggested standard for a 5'9 male sitting at 125-128 pounds. I still don't know how my protein and fat intake affected things though.

This sucks. I've been trying to eat more because I've been underweight for quite a while (125 - 128 now, but was 116-120 for nearly 8 months prior to this), but perhaps I should try smaller, more frequent meals rather than attempting to shove 20g of carbs, 25-30g of protein and 25-35g of fat into one meal 3x a day when I have yet to get a passable grasp on dosing for meals and corrections.
Hi Jeremy

If you are underweight it does seem a low ratio, I know my nurse would say if too many corrections are needed it’s a basal issue. So don’t think this is it. Maybe you need a split dose for the basal, or dose change, there could be lots of reasons, I would go back to your nurse and ask.

Another thing you mention that might be worth changing and has worked for me, you say you had the same meal 3 days in a row. I have a nutritionist call me every couple of months as I have terrible trouble with spiking too high after certain foods but then having a hypo. She has been incredibly helpful, and told me to vary my diet a lot more. Apparently with some people the more you eat the same thing the more efficient your body becomes at processing that meal and that will mean the carb content is extracted quicker and if you are diabetic cause spikes after certain foods. If you mix it up a lot more with different foods your body won’t recognise it so quickly and will take longer to extract the carb content. therefore your blood glucose will go up slower and the insulin has time to keep things under control and in range. It doesn’t happen with everyone but is certainly my problem. She tells me she has seen this before, not often, but with a small number of type 1’s. There were certain foods I had given up eating, such as plain yogurt, but with her advice I tried a small amount again after a 2 month break and was fine. Now I make sure I rotate foods including the yogurt, it has really helped me.
Also as you have eaten low carb for a while start gradually with some low GI carbs to allow your body to adapt, just because you went too high this week doesn’t mean that would necessarily happen again on a different day. Especially if your basal bolus is not quite right yet. Also cooking carbs helps slow the release, so I just can’t eat porridge due to the spiking problem I have, however she has given me a twice baked oat cracker recipe and I can eat those. Again I only make them every couple of months.
At Easter I made the diabetic low carb hot cross bun recipe from this site, it’s great, I could eat it no problem. It even had dark chocolate in it! I then left it a month then made it again as it is so delicious. How are you at cooking and baking? Try some new things.
You are obviously making huge effort to do all the right things so keep going It takes time to adjust and sort this out and frustratingly at the beginning things change a lot but you will definitely get there. I hope this information might give you another idea to try. I was diagnosed 3 years ago and found it’s all trial and error and every one is different but the more ideas from people you try you will find what works for you. I still find this site incredibly helpful.
 

Jeremy.M

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
@Hertfordshiremum

Perhaps I'll try switching up the foods I'm eating then. My initial intention was to have one of my meals be the same, every day for one week, in order to attempt to figure out what my insulin-to-carb ratio is as well as how many millimoles per liter each unit of insulin seems to be dropping me by when it comes to corrections.

I had a fraction of the meal I mentioned again today (22g net carbs, 12g protein & 30g fat [Oat Bran mixed with almond milk, a bit of cinnamon & 3 tbsp of almond butter]) and took 4 units of insulin beforehand. My pre-meal reading was 6.7 mmol/l and my 2 hour postprandial reading was 10.2 mmol/l, so I took 3 units as a correction. Two hours later, my reading was 8.0 mmol/l. At said time, I also had a salad with some lean protein, some cheese and walnuts on my break at work (roughly 25g of protein, 10g of fat and virtually no carbs). I took 3 units of insulin prior to eating and ended up with 5.4 mmol/l two hours later, so I did not administer any additional insulin. A couple hours following that last reading, I finished working and headed home. My blood sugar level was roughly the same.

It seems like my insulin-to-carb ratio could be as low as 1:5, which sounds insane. I wonder if it has something to do with my HbA1c being as high – or even slightly higher – than 9% for the last 6 months. With said ratio being so low, it doesn't surprise me that protein and fats seem to be having a higher than anticipated effect on my blood glucose levels as well. If I'm going to be consuming a balance of the three macronutrients, I think I'm going to continue taking an extra fractional dose of rapid-acting insulin 2 hours after my balanced meals in order to somewhat cover the impact of protein and fats.

With Oat Bran already being a low GI food, it looks like I'm going to be taking upwards of 5 to 6 units of insulin for a balanced meal that has at least 20g of net carbs. Does that sound right based on the numbers I have reported? It seems to be what's close to working for the time being. As long as I keep an eye on things, should I be safe sticking with my assumptions that my insulin-to-carb ratio might be 1 unit for 5 carbs in accordance with 1 unit of insulin bringing my blood sugar down by roughly 1.5 mmol/l? My basal insulin dose is 6 units nightly and I seem to be waking up with a glucose reading between 5 - 7 mmol/l IF I go to bed with a glucose level within said range as well.

I don't follow up with my endocrinologist until June 28th. Should I keep fine-tuning things with trial and error, or should I contact my endocrinologist? She advised me to use 3 - 5 units of insulin for my meals as a start and lower my basal dose from 8 units to 6 units, the latter of which I started doing on Wednesday May 19th, as I was waking up with glucose readings in the high 3s if I went to bed with a reading between 5 and 7 mmol/l.
 
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Hertfordshiremum

Well-Known Member
Messages
385
Type of diabetes
LADA
Treatment type
Insulin
@Hertfordshiremum

Perhaps I'll try switching up the foods I'm eating then. My initial intention was to have one of my meals be the same, every day for one week, in order to attempt to figure out what my insulin-to-carb ratio is as well as how many millimoles per liter each unit of insulin seems to be dropping me by when it comes to corrections.

I had a fraction of the meal I mentioned again today (22g net carbs, 12g protein & 30g fat [Oat Bran mixed with almond milk, a bit of cinnamon & 3 tbsp of almond butter]) and took 4 units of insulin beforehand. My pre-meal reading was 6.7 mmol/l and my 2 hour postprandial reading was 10.2 mmol/l, so I took 3 units as a correction. Two hours later, my reading was 8.0 mmol/l. At said time, I also had a salad with some lean protein, some cheese and walnuts on my break at work (roughly 25g of protein, 10g of fat and virtually no carbs). I took 3 units of insulin prior to eating and ended up with 5.4 mmol/l two hours later, so I did not administer any additional insulin. A couple hours following that last reading, I finished working and headed home. My blood sugar level was roughly the same.

It seems like my insulin-to-carb ratio could be as low as 1:5, which sounds insane. I wonder if it has something to do with my HbA1c being as high – or even slightly higher – than 9% for the last 6 months. With said ratio being so low, it doesn't surprise me that protein and fats seem to be having a higher than anticipated effect on my blood glucose levels as well. If I'm going to be consuming a balance of the three macronutrients, I think I'm going to continue taking an extra fractional dose of rapid-acting insulin 2 hours after my balanced meals in order to somewhat cover the impact of protein and fats.

With Oat Bran already being a low GI food, it looks like I'm going to be taking upwards of 5 to 6 units of insulin for a balanced meal that has at least 20g of net carbs. Does that sound right based on the numbers I have reported? It seems to be what's close to working for the time being. As long as I keep an eye on things, should I be safe sticking with my assumptions that my insulin-to-carb ratio might be 1 unit for 5 carbs in accordance with 1 unit of insulin bringing my blood sugar down by roughly 1.5 mmol/l? My basal insulin dose is 6 units nightly and I seem to be waking up with a glucose reading between 5 - 7 mmol/l IF I go to bed with a glucose level within said range as well.

I don't follow up with my endocrinologist until June 28th. Should I keep fine-tuning things with trial and error, or should I contact my endocrinologist? She advised me to use 3 - 5 units of insulin for my meals as a start and lower my basal dose from 8 units to 6 units, the latter of which I started doing on Wednesday May 19th, as I was waking up with glucose readings in the high 3s if I went to bed with a reading between 5 and 7 mmol/l.
@Hertfordshiremum

Perhaps I'll try switching up the foods I'm eating then. My initial intention was to have one of my meals be the same, every day for one week, in order to attempt to figure out what my insulin-to-carb ratio is as well as how many millimoles per liter each unit of insulin seems to be dropping me by when it comes to corrections.

I had a fraction of the meal I mentioned again today (22g net carbs, 12g protein & 30g fat [Oat Bran mixed with almond milk, a bit of cinnamon & 3 tbsp of almond butter]) and took 4 units of insulin beforehand. My pre-meal reading was 6.7 mmol/l and my 2 hour postprandial reading was 10.2 mmol/l, so I took 3 units as a correction. Two hours later, my reading was 8.0 mmol/l. At said time, I also had a salad with some lean protein, some cheese and walnuts on my break at work (roughly 25g of protein, 10g of fat and virtually no carbs). I took 3 units of insulin prior to eating and ended up with 5.4 mmol/l two hours later, so I did not administer any additional insulin. A couple hours following that last reading, I finished working and headed home. My blood sugar level was roughly the same.

It seems like my insulin-to-carb ratio could be as low as 1:5, which sounds insane. I wonder if it has something to do with my HbA1c being as high – or even slightly higher – than 9% for the last 6 months. With said ratio being so low, it doesn't surprise me that protein and fats seem to be having a higher than anticipated effect on my blood glucose levels as well. If I'm going to be consuming a balance of the three macronutrients, I think I'm going to continue taking an extra fractional dose of rapid-acting insulin 2 hours after my balanced meals in order to somewhat cover the impact of protein and fats.

With Oat Bran already being a low GI food, it looks like I'm going to be taking upwards of 5 to 6 units of insulin for a balanced meal that has at least 20g of net carbs. Does that sound right based on the numbers I have reported? It seems to be what's close to working for the time being. As long as I keep an eye on things, should I be safe sticking with my assumptions that my insulin-to-carb ratio might be 1 unit for 5 carbs in accordance with 1 unit of insulin bringing my blood sugar down by roughly 1.5 mmol/l? My basal insulin dose is 6 units nightly and I seem to be waking up with a glucose reading between 5 - 7 mmol/l IF I go to bed with a glucose level within said range as well.

I don't follow up with my endocrinologist until June 28th. Should I keep fine-tuning things with trial and error, or should I contact my endocrinologist? She advised me to use 3 - 5 units of insulin for my meals as a start and lower my basal dose from 8 units to 6 units, the latter of which I started doing on Wednesday May 19th, as I was waking up with glucose readings in the high 3s if I went to bed with a reading between 5 and 7 mmol/l.
Hi Jeremy

I think you could do with a diabetic nurse to help you with this, have you been assigned someone? Do you have a number you can call other than the GP or endo? I have an email for my nurse and a number for their Hertfordshire diabetes central office where I can leave a message for her or the on duty diabetic nurse will call me back. I wouldn’t like to advise you on doses but if you are regularly having to correct it doesn’t sound right yet. I see why you have lowered the basal if you were often waking up with a hypo or almost hypo. It is important to avoid a nighttime hypo.
I think you have had such a rough ride you could do with the correct help this time around. In my experience endocrinologists are more concerned with the bigger picture and getting the insulin right seems to be the diabetic nurses specialism. Might be different with you though. The problem is your body won’t always react in a consistent way, keeping a detailed diary which you obviously are is the way forward. But there are so many factors that effect the results, if you had the same meal but at different times of the day you will most likely get different results afterwards, the weather plays a part as well, too hot and you absorb any carbs in your system quicker and therefore go high much more quickly, too cold and you can drop by quite a bit. If you have been busy at work or exercised more that day, if your body has kicked out a small amount of insulin on it’s own... Just to check when you inject are you holding the pen in and counting to 10 slowly? Also for me slightly longer needles 6mm rather than 4mm saw a massive improvement.
If you don’t have a nurse yet I would get onto your GP on Monday, mention you are having to correct with Novorapid often, I have a bit of a horror story at the beginning as well, but once on the right track I saw a diabetic nurse every fortnight at the beginning which she said should have happened straight away. If you have no luck with the GP maybe the endo could assist with this? As you are under weight perhaps see if you too could get a nutritionist specialising in diabetes? Mine really studied my Libre output, food and exercise diary and insulin dose recording, she spotted a complex pattern that I hadn’t realised.
In the meantime I think you are doing a great job, keep recording everything but don’t be surprised at differences even if you have eaten the same thing, with Type 1 other factors effect your blood glucose to varying degrees. Keep us posted
 
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KK123

Well-Known Member
Messages
3,967
Type of diabetes
Type 1
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Insulin
Hi @Jeremy.M , there is a lot of great information in these responses, I'm learning new things myself! One thing I would add is that it is nigh on impossible to identify any one thing that might be affecting your levels at any one moment in time. You might try to follow the exact same pattern in a day but the effects will still manifest themselves differently one way or another. You can end up chopping and changing frequently and quickly and still not get the numbers you want, in fact that can make things worse. That's why, for type 1s in particular, the targets are set fairly widely (ie, they know you are likely to reach a 10 or above sometimes). I'm like you in that I prefer to be between 4 and 8 mostly and I can achieve that with fasting levels.

When I eat I like to be no higher than 7 after a meal but accept that sometimes it won't happen (I went for a carvery the other day, over indulged on roast potatoes and zipped up to a 12 after 3 hours having never done that in the last 3 years). I did not rush to do a correction on the basis my insulin was still working (up to 5 hours) and lo and behold, by hour 4 it had dropped back into the 5s. IF I had rushed to correct it it is likely I would have gone swiftly into a hypo around hour 4/5.

I was told on a course that unless you are sky high (as in the teens at least) 2/3 hours after a meal or your level has stubbornly stayed high well after the 5th hour or so, then don't correct. Correcting at hour 2 (as you did) especially when it was only around the 10 mark, can have the opposite effect, ie, your levels are slowly dropping themselves (because of your initial dose), then suddenly they go into a panic because you've added more insulin, so they drop faster and your body starts releasing its supply of glucose and whips it UP again. Also any insulin you may still be producing of your own could also be working and you'd have NO control over that being added to the mix and wouldn't even know when it decides to say hello to your injected insulin.

I know it's really hard at the start as you want everything to be well controlled but I would say maybe ease off a little with the 2 hour corrections because this 2 hour target isn't really intended to be a mantra for type 1s but more of a guideline as to whether a meal was 'ok' ish (for type 2s), with type 1s it can take 3/4/5 hours to get back to pre meal levels. x
 
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Jeremy.M

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
I'm completely at a loss, so I'm going to go ahead and talk to my GP and endo. Woke up with 8.7 mmol/l this morning and had turkey, lettuce and cheese on keto bread. Had an additional half slice with peanut butter on it – probably about 33g of protein in total. I also had a few nuts, maybe about 10g of carbs worth. I took 4 units of NovoRapid with the meal.

Two hours later, I ended up with 15 mmol/l and it would not budge even one hour later, which hit me as a massive surprise, considering that much of that protein shouldn't have even converted itself to glucose. I lost my composure and decided that I was just going to correct it and keep a small bottle OJ handy in case I needed it, so I took 6 more units of NovoRapid. However, turns out I didn't even need the OJ because it took four hours for my sugar to come down to 7.6 mmol/l. After that, it slowly trickled down to 4.2 mmol/l, so I ate a small salad that had cheese, lettuce and small amount of chicken on it. Didn't take any more insulin. One hour later, I'm back at 10 mmol/l.

Something seems very, very wrong here. Am I insulin resistant, even though I've supposedly had low insulin levels this entire time? Could I have 'double diabetes'? Is my insulin not working properly? I'm becoming fearful of eating food and injecting rapid-acting insulin. I've been rotating spots and priming it before I use it, so I know that insulin is being put into my body. My endo's office is closed until Tuesday, but I'm going to contact my GP tomorrow / Monday.

This is insane, it's extremely frustrating. I haven't been able to get a handle on anything; not my insulin-to-carb ratio, correction factor, nor a sense of what my insulin sensitivity factor is. Everything seems so far out of whack and getting rapid-acting insulin was supposed to be the key that would allow me to actually start consuming a healthy amount of calories again; from different sources once again.
 
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Antje77

Oracle
Retired Moderator
Messages
19,284
Type of diabetes
LADA
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Two hours later, I ended up with 15 mmol/l
Have you looked into 'foot on the floor' effect? I need to inject for it, it might be your liver dumping glucose into your bloodstream to help get you going for the day.
 

Jeremy.M

Member
Messages
9
Type of diabetes
Type 1
Treatment type
Insulin
Have you looked into 'foot on the floor' effect? I need to inject for it, it might be your liver dumping glucose into your bloodstream to help get you going for the day.

I've never really noticed this in my five years of having diabetes, but who knows what's going on at this point. This is the first time I've experienced an incredibly high jump in blood sugar early on in the day, following a meal that barely contained any carbs.

I'm not really sure how to proceed for the rest of the day. If <30g of protein is spiking me, I don't know what I should eat later on and how it's going to effect me. I almost just want to wait 3-4 hours and then eat 10g worth of carbs via Oat Bran, bolus for it with 3 units of NovoRapid and see where I end up two hours later. It seems like I need much more insulin for my meals and corrections than what was recommended to me, but I have yet to test myself out on a meal that wasn't balanced between carbs, protein and fat. Should I even bother trying to test that way though?

I don't know how I'm going to manage until Tuesday. Even then, I have nothing consistent to relay to my endocrinologist and my blood sugar readings have been all over the place.
 

Hertfordshiremum

Well-Known Member
Messages
385
Type of diabetes
LADA
Treatment type
Insulin
I've never really noticed this in my five years of having diabetes, but who knows what's going on at this point. This is the first time I've experienced an incredibly high jump in blood sugar early on in the day, following a meal that barely contained any carbs.

I'm not really sure how to proceed for the rest of the day. If <30g of protein is spiking me, I don't know what I should eat later on and how it's going to effect me. I almost just want to wait 3-4 hours and then eat 10g worth of carbs via Oat Bran, bolus for it with 3 units of NovoRapid and see where I end up two hours later. It seems like I need much more insulin for my meals and corrections than what was recommended to me, but I have yet to test myself out on a meal that wasn't balanced between carbs, protein and fat. Should I even bother trying to test that way though?

I don't know how I'm going to manage until Tuesday. Even then, I have nothing consistent to relay to my endocrinologist and my blood sugar readings have been all over the place.
Hi Jeremy
Sorry to hear you have had another frustrating day, and you are not even having much to eat. As you are underweight I would be surprised to hear that you are insulin resistant however something is obviously not working so I think calling the GP tomorrow is absolutely the right thing. Let us know how you get on.
 
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