Low low to no carb....lots of lantus low dose novo....please help

megan

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Hi know ive written on here about doing this but now I am actually doing it and am on day 3 of atkins.......apart from a little greek yoghurt I have had no carbs......meat, cheese, green veg, lettuce, fish, nuts.......caffeine free drinks.....I am on 20 and 20 dose of lantus in a day and as my dr told me not to take insulin when I have no carb I have only taken novorapid for correctional doses...which is every meal.
I had initially cut my lantus from 20 and 20 to 18 and 18 anticipating a drop in sugars....but as they have remained high I have put the lantus back up to 20 and 20.

I dont feel great, but I dont normally feel great with CFS and fibromyalgia too.
am I doing the right thing.....I cannot get hold of any of the diabetes
I did have urine sticks but they are well out of day and discoloured.
Should I be testing for ketones?
should there be ketones as isnt that the point of the atkins?

Really could do with some opinions please
I am also on 200 thyroxine day

Thanks


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Charles Robin

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The first few days/weeks are difficult to get blood sugars right. Your cells can use protein and fat as a fuel source, but no one has let it know that yet. It will adjust over the coming weeks, but it takes a whole to get used to. You may feel tired and irritable in the early stages, and will probably have withdrawal symptoms from the lack of carbs. This will pass. I found it almost impossible I. The first couple of weeks to avoid snickers bars, but now I'm not even tempted.
Your insulin requirements will also fluctuate a lot in the short term. You will need less insulin most likely. Taking a smaller dose means your body will become less insulin resistant, and so you may need even less as the weeks go by. My advice is to keep your meals fairly similar for the first few days, and test regularly. That way you can tailor your insulin to a specific meal, and measure the results more easily.
Also, in case this was not mentioned to you, drink lots of water. While your body is adjusting, it will think that the lack of carbs means you are starving, and will release a lot of its glycogen stores (a short term reaction, it will get used to the low carbs soon enough), which will also dehydrate you. In the first few weeks I got the most excruciating stomach cramps, and my urine looked like it had dripped out of a rusty car engine. I thought I had kidney failure, which thank god was me being a hypochondriac. I just drank some water and the symptoms immediately cleared up.
 
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Spiker

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You will probably need to take very small bolus doses for the protein in the meals but it's hard to calculate it. A good guide would be to look at whatever correction doses you are taking around these meals. Is that after the meals, or before them, or both?

If your basal dose was calculated correctly, then it shouldn't change much, so it looks like you had it correctly calculated at 20. It may fall slowly as your improved diet improves your insulin sensitivity, and as your weight falls. Do you know when and why you are high? Were you high before? It would help if you did a fasting test to make sure your basal rate is actually high enough. It's possible that your basal wasn't high enough before you started the diet, and you were compensating by having too high of an insulin:carb ratio.

You should definitely go out and get a new pack of Ketostix. They are 3 quid or something. Do use them but don't worry unless the ketone reading is high. Mild ketones are to be expected, that's kind of the plan.
 
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megan

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hi thanks. I am on day 9 now..... basal doses daily were 20 and 20......now adjusted to 24 and 20.
I am still taking novorapid to correct
its not got a pattern or set amount at the moment
bloods are too high as usual
been trying to get hold of my own diabetes nurse for over two weeks now and left message with other nurses but no luck there. tried my old clinic and someone I didn't know called back just for an opinion.
he said I was on a lot of basal....sure im not type 2 but then he said I can't be as im on creon so pancreas not doing anything
ive been type 1 for about 24 years

he suggested perhaps metformin
then someone said is n't metformin for use with insulin and if im only taking for correctionals how can it help? I don't know...can it?

very little change in me at mo.
I'm very tired as normal
so i'll carry on
only thing is...I am making myself drink loads of water but particularly of an evening my upper tummy is so bloated im very uncomfortable

indigestion and tummy pains and feel awful......
tummy feels so fat and full
im not craving carbs...ive done ok on that part
miss my fruit
and of course other things but im sticking to it
but any more advice is very much appreciated

thanks all :)
 

Spiker

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Don't worry about metformin. Yes it would work for you, but you don't want to change now with everything else going on. Particularly not with tummy trouble.

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woodlands

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hi thanks. I am on day 9 now..... basal doses daily were 20 and 20......now adjusted to 24 and 20.
I am still taking novorapid to correct
its not got a pattern or set amount at the moment
bloods are too high as usual
been trying to get hold of my own diabetes nurse for over two weeks now and left message with other nurses but no luck there. tried my old clinic and someone I didn't know called back just for an opinion.
he said I was on a lot of basal....sure im not type 2 but then he said I can't be as im on creon so pancreas not doing anything
ive been type 1 for about 24 years

he suggested perhaps metformin
then someone said is n't metformin for use with insulin and if im only taking for correctionals how can it help? I don't know...can it?

very little change in me at mo.
I'm very tired as normal
so i'll carry on
only thing is...I am making myself drink loads of water but particularly of an evening my upper tummy is so bloated im very uncomfortable

indigestion and tummy pains and feel awful......
tummy feels so fat and full
im not craving carbs...ive done ok on that part
miss my fruit
and of course other things but im sticking to it
but any more advice is very much appreciated

thanks all :)
l am on metformin with lantus and have had no trouble 2x500 twice a day and 18 units
 

Spiker

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Megan it is really important that you resume taking bolus insulin. Atkins is low carb, it is not zero carb. You need a lot less bolus insulin, but not none. You need to carb count your meals and take a bolus dose accordingly. By running high all the time and doing only correction doses you are harming yourself. This is why you are feeling tired.

Do you know your insulin:carb ratio? If not, start by comparing your food diary to your correction doses. Match up each meal (food type and quantity) with the correction dose that was needed. Take the relevant correction dose as a bolus dose instead, next time you have that particular meal.
 

megan

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hi, thanks for your reply....... I've been carb counting after doing DAFNE years ago. I am not eating any carbs at the moment and my diabetes dr told me not to take any novo when I don't have any carbs in my meal. I told her my sugars would go up any way and she told me not to take the novo on a no carb meal anyway..... but I do have to take a correctional before the meal. I take a blood test. its normally high and so I calculate what I have to take 'in theory' , what that correctional will need...which is 1:1 ratio.

I have lived with high sugars for years and hate it with a passion....and its not through a lack of effort on my part to get it down. I have tried everything I can possibly think of including metformin, gliclazide and byetta.

one antibiotic helped loads but its one rare side effect is severe hypos (which is what would have been happening had I not reduced my insulin by a 3rd over the week I was on the tablets).....so ideally I would want that antibiotic without the antibiotic part to help bring down my sugars and insulin requirement.......dr told me that was gliclazide.....but he let me try it for 6 weeks and it didn't do any thing at the time.
so back to the drawing board.

I am carefully increasing my basal dose to try to get my sugars down and reduce the need for quite so many correctional doses. so you see I feel a little misunderstood, I am still taking novo and I am not purposely running my sugars high....I hope I have cleared this up and am open to suggestions all the time so please don't hesitate to respond back if you get any more thoughts :)
I have also had more contact with dieticians than I can shake a stick at.................checked out the GI of foods and of course over the years how my body reacts to them. I am overweight and this is what I have been trying to improve to help my insulin matters....but alas am having no luck so far and this is years of effort.:(

going back over dr bernsteins book again........I'll keep plodding along but I am miserable with it.......and am so uncomfortable with the bloating I cannot drink any more water and my food is reducing further as the bloating and indigestion is horrible.
found out today that my referral to gastro team didn't go through when it was meant to and now I have another age to wait!!!

however 9 weeks after referral for tummy scan I do have that appoint finally come through.......blimey.......I can't help but feel there is something being missed and when found it will help to make things easier....I have to hope eh :)

thanks guys
 

Spiker

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Unless you are eating nothing but fat, you have carbs going into your bloodstream, and it is extremely unlikely that you don't have carbs going into your stomach. Even if you are eating raw meat, that has carbs in it. There are traces of carbs in nearly everything. I think it is very bad and dangerous advice from your doctor for you to stop bolus insulin doses. It also is a pretty good explanation of why you are running pre-meal highs all the time. You really need to count the carbs that are in your food - and they are there, they are not zero. And you might also need to count the protein as well. But start by counting the carbs and dosing accordingly for them.

You mention GI. The only time you would not need any bolus insulin is if every food you ate had a GI of exactly 0.00. That means water and pure fat. Everything else will raise your blood glucose to some extent. I don't understand why your doctor advised you not to bolus. I could guess that maybe she is applying the DAFNE rules, which ignore low levels of carbs? Those rules are just not appropriate for when you are doing an Atkins diet or other low carb diet.
 
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Spiker

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Put it another way - if you are regularly taking correctional doses before each meal, it's obvious that your insulin needs to increase. Either bolus or basal. Prevention is better than cure. You can't have your blood glucose being high all the time. That's what's happening if you only do the correction doses before meals.
 

Dillinger

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Megan,

I agree with Spiker; you need to take some basal if your blood sugars are high; your doctor is wrong on that.

Please post some info so we can help; what did you eat today and what were your blood sugars and insulin doses?

Does Atkins induction really say zero carbs? It's been a while since I looked at it but I thought it had about 20 carbs a day?

Best

Dillinger
 
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robert72

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It would be worth using myfitnesspal to see where the carbs and protein are in your meals. I have to bolus about 50% for protein as I am <30g carbs per day.
 
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megan

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Thanks for the replys. I dont want high sugars. I am not and would never choose to ride them high. I have been heavily criticised by my previous diabetes team for being on too much insulin. At one point I was told not to increase it!
So I am gradually increasing my basal as thats what ive been told to do.
I am not having hig steaks or anything like that and I dont know how much to bolus for meat. Ive never done that. There is also not the same amount I am needing to correctional bolus for each time so no pattern for me to work on.

Today was was massively different to yesterday. I woke up with a 7. Mid morning 14. Lunch 14. Dinner 12...mid eve 18!

So yes I need to make adjustments and am. But I was also taught to allow 3 days between changing my basal levels


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megan

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I am a big believer in prevention is better than the cure which is why I struggle and work so hard at it every day and have for years....theres no let up....no pattern...no other help

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Spiker

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Unless you are able to count carbs (and if low carb, also protein) in each meal you will never be able to see the correction pattern. You are right that you need to be able to see the patterns to correct them. You are also quite right that you should see a pattern for 3 days before making a change of basal rate, carb ratio or correction ratio.

It is ridiculous for any health care team to tell a T1 patient they are taking "too much insulin" and let their blood sugar go high. That really is jaw-droppingly ridiculous. Sure if they had your blood sugar good and stable, as "extra credit" it would then be good to get your insulin requirements down. But priority 1 has always got to be to get to target blood sugars and keep that stable. The only good reason I can think of for giving that advice is if you were having loads of hypos.
 

Spiker

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I am a big believer in prevention is better than the cure which is why I struggle and work so hard at it every day and have for years....theres no let up....no pattern...no other help
What I mean by "prevention is better than cure" is "a bolus dose before is better than a correction dose after".
 

megan

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Hi thanks. Yes I agree quite ridiculous for my diabetes dr and nurse to tell me that but they did and for over a decade! They even told my gp who then gave me lecture about it! They even had me stop increasing my dose at 5 months during my second pregnancy! I over road this in the end as I was scared for my baby!...they kept telling me I took more insulin than a big builder and I would get big as a house!


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megan

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I was heavily criticised for not trying hard for years as they didnt believe me. After seeing my more during my pregnacies they realised id been telling the truth all along and then told me I couldn't carry on like that as I was trying too hard and obsessing over it!

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megan

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So I have moved now and have a new team. My first visit to the nurse was a two way conversation. ...with respect and decency and no patronising and stupid lectures!!....however the diabetic dr said I was over using site (I dont use!!)....so my sites are regularly rotated and theres no point in arguing with her as her mind was made up she was right and she had another box to tick!....

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