Carb question

claridge

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Hi all,
So l have been type 1 diabetic for 4 years and low carber (no bread pasta pots rice, beans, legumes, or cooked starchy veg) and always had great control. Over the past year my background insulin of 25 has gone up to 60 (yes severely insulin resistant), my health was incredibly bad and l couldnt find a way out and no one could help me. Worst 6 months of my life. In the new year l decided to pay to go private myself (health insurance at work doesnt cover prior existing conditions) and he referred me to a dermatolologist. I have been diagnosed with a rare life threatening form of eczema, have been on steroids for past two weeks (which l hate but ld prefer to take them and live) and just been put on immune suppressants for next 3 months. I have also started seeing a sychiatrist for stress and anxiety (been crying a lot and havent wanted to leave flat at all for a while now). So all this stress/eczema etc has made me extremely insulin resistant. I have been at home for 4 weeks just sleeping, watching tv and reading books, not really left house and not allowed to exercise (any exercise/alcohol my rash all over my face worse- god it was awful).
My questions l have are:
1. I have since introduced carbs back in to help (whether or not they helped l dont know)... but if l have carbs and take novorapid that great over a short period but l believe they make the BS go up over 3 hours, so in 2/3 hours l will have a high BS so should l either just do corrections with Novorapid in a few hours, or if l take an extra unit or two of my background (levemir) my BS wont go up so much. Or is this something for me to work out? ie one size doesnt fit all.
2. Getting my background back down to what it should be (for my weight and height etc should be about 30 apparently).. any advice. I wont start exercising until my doctors say its okay although l can do daily walks at moment and l havent started that yet. I have to be quite careful as their is a chance the rash/eczema will get worse but lm on these tablets for a while so that will help.

Thanks all.
Jo
 

AMBrennan

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but if l have carbs and take novorapid that great over a short period but l believe they make the BS go up over 3 hours, so in 2/3 hours l will have a high BS so should l either just do corrections with Novorapid in a few hours, or if l take an extra unit or two of my background (levemir) my BS wont go up so much
Ideally, post-meal BG should be within 3 mmol/l of the pre-meal levels; if it's higher you need to take more Novorapid *with* the meal - correction doses are for when you get the carb estimate wrong etc. increasing basal insulin to cover the meal rise is inadvisable (you'll go hypo if you miss a meal).
Getting my background back down to what it should be (for my weight and height etc should be about 30 apparently)
The estimates for insulin requirement based on weight are just a starting point after which you have to use trial and error.

What's more, I would suggest not worrying about the insulin dose while you are taking as all those other drugs that play havoc with your BG levels.
 

Dougal

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Jo,

It sounds like you are going through a really difficult time. Do you know anyone else who is diabetic? I have in the past suffered from major depressive episodes. I think it would be useful if you could talk to someone with diabetes. Whereabouts are you? Are there any diabetic support groups local to you?

Have you spoken to your GP about going on to Metformin, as well as Insulin? I was extremely insulin resistant and nothing seemed to help until my Endocrinologist suggested taking metformin. Within a week my insulin levels were back down and I felt much healthier. It may be worth a try.
 

hanadr

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Jo
all that sounds very stressful Perhaps it's worth your while contacting the Diabetes Uk Careline? they may have encountered the same set of circumstances in other people and it is just possible they may be able to help. Since It's not just blood sugar you need to deal with, I'd also ask the consultant dealing with your dermatology, if he/she has any more suggestions. Once everything else comes under control, I'm sure the depression will resolve.
All the best!
Hana
 

claridge

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Thanks :)

I have had a lot of stressful situations in the past 4 years - starting with my diabetes, then parents split, dad had an affiair, then mum well ended up in hospital, huge stressful emotionally draining situations with ex, then emotionally bullied past year by the woman l work for. It has only been the past year (specifially 6 months where it got so bad).

I had a load of humms at lunch so took the right insulin and BS went up to nearly 11... l thought quick acting takes in the sugar in about 20 minutes or so but l didnt think it continues working for the next few hours? ie if my BS is above 7 in two hours it wont come back down without me taking more novorapid.
What is Metformin? I HATE the idea of taking non natural things... but l ended up on insulin and steroids and antidepressants so maybe l should give up on that. On this much background insulin l can keep my BS to normal figures if l low carb, and sort of okay if eating carbs. Although l have always had to have 1 unit to 4grams carb... which lm only learning means l was always a bit insulin resistant.

Im have just started seeing a psychiatrist to help and l have seen a diabetes specialist who lm emailing to help manage the blood sugars but too be honest it hasnt really helped at all - he suggested l increase my background by 5 units due to my higher blood sugars, but even an increase by 1 unit makes quite a difference, and l dont fancy going low.

I dont know any diabetics that l can talk to face to face, my old best friend in australia is diabetic so l have started emailing her. I live in Orpington in the UK. I might get in touch with diabetes UK as suggested thanks, l guess l just havent in the past becuase l was so in control of my diabetes (by really low carbing l guess and exercise) so l felt most other people handled it different.

Jo
 

AMBrennan

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What is Metformin? I HATE the idea of taking non natural things...
Well, it's not natural (NB this is called appeal to nature and is a logical fallacy - water's just "chemicals" at the end of the day)

Metformin is the first line treatment for t2 diabetes which aims to reduce insulin resistance. Wikipedia has more
 

phoenix

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I'm so sorry that you've had a horrible time of it recently. Stress and the steroids aren't going to help. TBH I'd try for a reasonable result with glucose levels. Over worrying about control isn't going to help :(

. l thought quick acting takes in the sugar in about 20 minutes or so but l didnt think it continues working for the next few hours? ie if my BS is above 7 in two hours it wont come back down without me taking more novorapid


It starts to work in about 20 min but its peak action is later
The maximum effect is exerted between 1 and 3 hours after the injection. The duration of action is 3 to 5 hours. The onset of action occurs within 10 to 20 minutes of injection
http://www.novonordisk.co.in/documents/ ... brands.asp

As it lasts from 3-5 hours , it doesn't make sense to think that glucose will be back down to before meal levels at 2 hours. If it was and you were say 5mmol/l before then you might very well be hypo at 3-4 hours. As AMBrennan says the target is usually said to be about 3mmol/l above the pre meal level.
If you start at 7mmol/l then that would be 10mml/l but I doubt many people get it right every time.
Your rise is 4mmol/l so not desperately huge.
.
I do know that quite a few people think that Novo doesn't have as fast an onset as they say. I have read that they have more success in lowering the post prandial by dosing a bit (careful, a bit means minutes not hours! ) before the meal rather than immediately before eating .I don't do it myself because I'm often in the 4s before a meal and it seems to work quite quickly for me. If I were higher pre meal I think that I would experiment with that.

I think that increasing your lantus might help keep background levels down. 5 units sounds a big hike and I can understand you feeling a bit worried. Unless you're going low at sometime of the day (or night) now, why not try increasing it just i unit at a time?
 

noblehead

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Sorry about your recent health Jo, can't add any more to the excellent advice you've received so far, take care and hope everything works out for you.
 

claridge

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I will do so with playing around increasing it a unit or two. I increased my morning insulin by two yesterday to 32 in morning and ate carbs (anywhere from 20-40 at a meal porridge, rice type thing) and the 2 unit increase of background helped a lot, although if l didnt eat carbs l may have gone a bit low.... Today l went back by 2 units of background to 30 had no carbs at breakfast and the hummas at lunch so playing around.
I may end up going back to low carb but its nice to know how to handle them if l feel l need/want them.
Thank you all, its really a nice feeling to get advice/emails from you knowing your not alone.
 

claridge

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Also a tiny part of me wonders whether my severe eczema was partly caused by low carb - possibly not but l dont know. With stress making me severely insulin resistant l wonder whether my body was not taking in any glucose etc...