Help with diet and frustrating high sugar levels

[benunited]

Just really don't understand things sometimes...

Take this morning for instance, blood sugar was 10 when I woke up. This can be quite typical for me in the mornings if I haven't exercised the day before.

So, for breakfast:

3 boiled eggs - think these have no carbs and basically very low on the glycaemic index
Some smoked salmon - as above
Glass of milk - as above?
Lo-fat yakult - 6.6g of carbs

Normally the 1 x unit of novorapid to 10g of carbs works quite well for me, so breakfast logically should have been only 1 unit?

Bearing in mind I'm trying to switch from a previous diet which would have been toast or cereal for breakfast with around 8-10 units.

Also bearing in mind my morning readings I took 3 units.

Results, an hour later I feel horrendous and my BS is 15+.

Now, should I seriously have taken 6 or 7 units of insulin for boiled eggs, fish, milk and a tiny yoghurt drink? I know if I had I'd have been hypo within half an hour.

So instead I take 3 units and have ridiculously high BS levels.

Trying my best to switch to as healthy a diet as possible and in all honesty finding it harder to control my BS then when I just ate what I wanted and dosed accordingly.

Any advice much appreciated!

Ben

 

[hale710]

Hi, sorry I'm not expert. But I DO know that milk has carbs in it. A normal smallish glass is about 7-10g carbs. So depending on glass size that may have pushed you up by as much as 3mmol, more for a large glass

Other than that I'm not sure. Someone else will probably be along with some pearls of wisdom!

 

[Dillinger]

Hi Ben,

You need to think of your sensitivity to insulin as a variable thing throughout the day not a constant. For me I need twice the amount of insulin in the morning as I do in the evening for the same amount of carbs.

In fact in the morning I need to take short acting insulin to cover about 3 grams of carbs even if I don't eat anything. I would ask about getting an insulin pen that allows half unit doses so you can be more accurate.

It was right to give yourself a correction dose for the 10 - but you need to know much insulin to take at each meal to lower your blood sugars by a set amount - and that will take some experimenting.

It sounds like your long acting night time dose needs to go up a unit as well if you are not exercising.

Milk has carbs and you need to count them.

Get the Collins carb/calorie counter book and review what you are eating and the carbs involved.

Best

Dillinger

 

[Dennis]

Just really don't understand things sometimes...
3 boiled eggs - think these have no carbs and basically very low on the glycaemic index
Some smoked salmon - as above
Glass of milk - as above?
Lo-fat yakult - 6.6g of carbs
Ben

Hi Ben

I'm afraid you made some common mistakes in the carbs calculation.
Eggs (hard or soft) contain about ½g carb each, so 1.5g for 3. Eggs are often quoted as zero carbs because many of the carb tables count anything below 1g as zero.
Milk has 12g carbs per half pint (250ml)
Smoked salmon - zero carbs

So your breakfast would have been around 20g carbs (assuming ½ pint of milk), or 32g if you had a pint of milk. Can I suggest that you treat yourself to a little book called the Collins Gem Carb Counter (available from most bookshops - I think it is currently cheapest at Waterstones but prices vary week on week).

Hope this helps
Dennis

 

[benunited]

Thanks for the advice folks, much appreciated!

 

[SamJB]

Some good advice here and it's good to have Dillinger back!

Ben, one if the things I've learned is how to adjust my insulin dose according to when I last did exercise. When you exercise your body produces hormones that makes your cells more absorbent, thus increasing your insulin sensitivity. This can last anything from a day to a few days. Ever had a hypo after exercise? Well this is why.

When I exercise I give myself one unit less of short acting for my next meal and drop my Lantus by 20% for two days, then put it back to what it was originally.

I'm going to sound like a broken record as I recommend this book to everyone, but buy Think Like A Pancreas by Gary Scheiner. Adjusting insulin according to exercise is detailed in here amongst a plethora of other useful bits of information.

 

[noblehead]

Just really don't understand things sometimes...

Take this morning for instance, blood sugar was 10 when I woke up. This can be quite typical for me in the mornings if I haven't exercised the day before.

So, for breakfast:

3 boiled eggs - think these have no carbs and basically very low on the glycaemic index
Some smoked salmon - as above
Glass of milk - as above?
Lo-fat yakult - 6.6g of carbs

Normally the 1 x unit of novorapid to 10g of carbs works quite well for me, so breakfast logically should have been only 1 unit?

Bearing in mind I'm trying to switch from a previous diet which would have been toast or cereal for breakfast with around 8-10 units.

Also bearing in mind my morning readings I took 3 units.

Results, an hour later I feel horrendous and my BS is 15+.

Now, should I seriously have taken 6 or 7 units of insulin for boiled eggs, fish, milk and a tiny yoghurt drink? I know if I had I'd have been hypo within half an hour.

So instead I take 3 units and have ridiculously high BS levels.

Trying my best to switch to as healthy a diet as possible and in all honesty finding it harder to control my BS then when I just ate what I wanted and dosed accordingly.

Any advice much appreciated!

Ben

You have to remember Ben that your bg was already high upon waking so your postprandial bg rise at one hour was 5mmol, more interesting would be what your bg levels were at the 2, 3, 4 and 5 hour mark. Sometimes bolus timing can make a big difference to postprandial bg readings and I wonder if you injected a little ahead of eating your food (say 10-20 mins before) the bg rise might have been slightly less.

I think injecting 6-7 units would have been too much and might have left you hypo, some type 1's who low-carb and eat a lot of protein find that splitting their bolus dose works wonders and prevents the delayed rise many hours after eating, when carbs are absent from a meal or it contains very few carbs the body converts protein to glucose by around 60% but does so over a longer period, I know when I eat a low carb meal my postprandial bg readings can be fine up 2-3 hours after but can be in double figures by the 4-5 hour mark....hence why some people split their insulin dose.

If you enjoy a glass of milk with your breakfast and want to low-carb then I suggest you try lactose-free milk. it has around half the carbs as standard milk and tastes just as delicious, Arla do a lactose-free milk and it can be found in most major supermarkets.

Good luck!

 

[phoenix]

I agree that you have to take into account prior levels and prior exercise. Personally I also find that every lower carb meal I eat requires more insulin than dosing by carb counting alone would suggest. (normally my main meals have a consistent amount of carbs)
Certainly boiled eggs seem to require quite a bit of insulin; for me they count the same as about 7-8g of carbs each.

This makes perfect sense when you look at the insulin index which was devised some time ago. They compared the amount of insulin released by normal people for different foods. Eggs were found to be about on par with all bran and a bit less than porridge.http://en.wikipedia.org/wiki/Insulin_index
This particular index was fairly exploratory and needed (still needs) a lot more work on it.

More recently researchers have started to develop the idea .
First they looked at using the insulin index to predict the insulin response for mixed meals in non diabetics. They found that they could make reasonably accurate predictions.
Using the data they obtained, they devised an algorithm(FII) for calculating insulin doses . They used that to calculate doses for 2 different meals eaten by T1s using a pump.

On one occasion, a carbohydrate-counting algorithm was applied to meal A (75 g carbohydrate) for determining bolus insulin dose. On the other two occasions, carbohydrate counting (about half the insulin dose as meal A) and the FII algorithm (same dose as meal A) were applied to meal B (41 g carbohydrate). A real-time continuous glucose monitor was used to assess 3-h postprandial glycemia.
RESULTS:
Compared with carbohydrate counting, the FII algorithm significantly decreased glucose incremental area under the curve over 3 h (-52%, P = 0.013) and peak glucose excursion (-41%, P = 0.01) and improved the percentage of time within the normal blood glucose range (4-10 mmol/L) (31%, P = 0.001

ie taking into account the normal insulin demand of the meal was a much more sucessful method of calculating the dose. Non carb containing foods had an effect.
Improving the Estimation of Mealtime Insulin Dose in Adults With Type 1 Diabetes
The Normal Insulin Demand for Dose Adjustment (NIDDA) study
Jiansong Bao, MSC1, Heather R. Gilbertson, PHD, ADVAPD2, Robyn Gray, CDE3, Diane Munns, APD3, Gabrielle Howard, MD, FRACP3, Peter Petocz, PHD4, Stephen Colagiuri, MD, FRACP1 and Jennie C. Brand-Miller, PHD
http://care.diabetesjournals.org/conten ... /2146.long

There isn't nearly enough info available for this concept to be used outside the lab so it's not yet a practical method. It does suggest that we have to be aware of the demands of non carb containing foods. This may vary from person to person.. like the glycemic index, the insulin index is based on average responses.

if you keep good records then over time you can work out what type of results you have from different types of meals and adjust the insulin accordingly.

 

[Isobel94]

Hi beunited,

The glass of milk, the eggs, and the yakult probably messed you up big time. You would be surprised how a little carbs in different things can sometimes add up. If it was me, I'd have had 3 units for the Yakult, 1 for the glass of milk, and maybe 3 for the eggs. The carbs in the Yakult were also pure sugar (always the case with yoghurts and yoghurt drinks) and that may not have reacted well with you. Hell, I probably would have even added a unit or two for good measure there.

You're saying to 1:10 ratio is working for you but maybe it doesn't work so well in the morning. I have to take 12 units in the morning because of whatever happens deep in the pits of my digestive system at 8 a.m... according to the 1:10 ratio I'd only need about 4 units. The 1:10 ratio is at best a guide, really, though. You just need eat similar foods every day and monitor your BG maybe every hour at "problem" times during the day. Some people are more insulin resistant in the morning, others in the evening. Figuring out the perfect dose for you takes work but it's well worth it.

Best wishes,

Izzy

 

[Riesenburg]

Hi Ben,

Milk does push up your sugars due to the lactose. The other thing you forgot to count is the protein, I have found that you need some (alberit very little) insulin to process the protein you intake too. Might be something to look into, I'm afraid there's no established rules for it so it's a matter of just experimenting with the readings. I'm on Humalog and it takes me about 1unit of insulin per 20g of protein. So on your breakfast in my case I would have taken 3 units, 1.5 to cover the proteins, 0.5 to cover the lactose and 1 to cover the yakult.

You will need to experiment a bit to find the right balance.

Just something to keep in mind,
Frankie

 

[Patch13]

Hi

Firstly I agree that you may need go drop your basal insulin if you have done exercise or increase it if you haven't (in my experience exercise always required a change to my basal rate).

Also I need to take more insulin in the morning than any other time of day - an extra two units for me than my carb / insulin ratio suggests.

I have found that when eating low carb meals I need to calculate for insulin AND protein or I will get high sugar. A helpful guide to this is dr bernstein a diabetes solution which gives a way to work out your carb / protein calculations. This is just a starting point and may have to be adjusted for you, but I found it helpful.

 

[Robinredbreast]

Just really don't understand things sometimes...

Take this morning for instance, blood sugar was 10 when I woke up. This can be quite typical for me in the mornings if I haven't exercised the day before.

So, for breakfast:

3 boiled eggs - think these have no carbs and basically very low on the glycaemic index
Some smoked salmon - as above
Glass of milk - as above?
Lo-fat yakult - 6.6g of carbs

Normally the 1 x unit of novorapid to 10g of carbs works quite well for me, so breakfast logically should have been only 1 unit?

Bearing in mind I'm trying to switch from a previous diet which would have been toast or cereal for breakfast with around 8-10 units.

Also bearing in mind my morning readings I took 3 units.

Results, an hour later I feel horrendous and my BS is 15+.

Now, should I seriously have taken 6 or 7 units of insulin for boiled eggs, fish, milk and a tiny yoghurt drink? I know if I had I'd have been hypo within half an hour.

So instead I take 3 units and have ridiculously high BS levels.

Trying my best to switch to as healthy a diet as possible and in all honesty finding it harder to control my BS then when I just ate what I wanted and dosed accordingly.

Any advice much appreciated!

Ben

Hi Ben trying to get things right with food and ratio's can be a nightmare. My BS on waking before breakfast on Bank holiday Monday was 9.5 I had 30 carbs, (GF toast) and took 1 and 1/2 units of NovoRapid, BS before lunch 6.8
This morning, BS 6.9 I had egg on toast and only carbed for the 2 slices of toast, before lunch BS 11.4 so not happy with that. My ratio's are all different throughout the day, and even if my breakfast reading was high, I still could only take 3 to 4 units.

Milk does have carbs , a 160ml glass is 8 grm, a 284 ml ( half pint) is 13 grm and a pint of milk is 27 grm. Years ago it was used to treat hypo's, a glass of milk and something else ???

Eggs and bacon don't have carbs, but when cooked they do have some, but it's trying to work out a safe amount of Insulin to take. I am better off with my GF fibre flakes or a banana or toast and a yogurt drink.

I hope you find the right dose to go with your healthier eating.

Best wishes RRB