4 months on Insulin

[Royjk]

So I was put on insulin before Christmas because my A1c was at 103.
I found out about this forum at just about the same time.
Here It was suggested that one answer to control of diabetes T2 was to go on a low carb diet. The thinking was no sugar going in will mean low BG levels and a reduced A1c. I was a bit skeptical about the diet because it meant a drastic change in my eating habits, and I did like bread and chips, but I wanted to move my blood test result into the green. So I cut out anything with high carbs.
The results are surprising, A1c is now 36, and BG tests are now in the green. I do not miss the food I used to eat. Doctor says I am now within normal person non diabetic BG level, all of which is very good.
There is just one small problem now, of course I can feel it when BG drops to below 3.8 with the finger blood tests.
So I don't want to add in carbs to bring BG up, and I am satisfied with my insulin dosing controlling BG.
What is the next step for control, how will I minimise hypo's?

 

[Jaylee]

So I was put on insulin before Christmas because my A1c was at 103.
I found out about this forum at just about the same time.
Here It was suggested that one answer to control of diabetes T2 was to go on a low carb diet. The thinking was no sugar going in will mean low BG levels and a reduced A1c. I was a bit skeptical about the diet because it meant a drastic change in my eating habits, and I did like bread and chips, but I wanted to move my blood test result into the green. So I cut out anything with high carbs.
The results are surprising, A1c is now 36, and BG tests are now in the green. I do not miss the food I used to eat. Doctor says I am now within normal person non diabetic BG level, all of which is very good.
There is just one small problem now, of course I can feel it when BG drops to below 3.8 with the finger blood tests.
So I don't want to add in carbs to bring BG up, and I am satisfied with my insulin dosing controlling BG.
What is the next step for control, how will I minimise hypo's?

Hi,

I’m a low carbing T1..

Can I ask what insulin or insulins you are prescribed?
Trying to understand what regime you deal with regarding any hypos?

 

[Royjk]

Hello @Jaylee, Yes, I do Fiasp, and Tresiba, with a Jardiance tablet.

 

[Royjk]

Hello @Jaylee, So what I have for Hypo's is a small box of sweets, that I take when I get wobbly. Then I re-test after 15 min.

 

[Jaylee]

Hello @Jaylee, So what I have for Hypo's is a small box of sweets, that I take when I get wobbly. Then I re-test after 15 min.

Sounds like you are doing the right thing in my book regarding treating hypos.

If the hypos mainly happening with your Fiasp on board it could be the timing of your dose for food or a slightly underestimated carb count..?
If it’s happening while fasting, it could be your long acting Tresiba.

You would need to consult your doctor or consultant.
But as a rule of thumb as a type 1 insulin user on MDI we start with “basal testing” the long acting insulin as a foundation to lower the risk of hypos before anything else.

 

[Royjk]

Hmm, Hello @Jaylee, OK so I do fiasp 15 min before eating, and Tresiba at 10 in the evening.
I have a problem with carb counting, as I am on a very low carb diet, and a small steroid. Counting gives me a very low Insulin dose, which leaves my BG still high. So instead of counting, I have a fixed dose each day which keeps BG tests near to my target of 5 mmol/l. This works most of the time, but I have had some low BG tests before my evening Tresiba.
I can reduce insulin, but that will bring up most of my BG tests to a higher value and increase my A1c overall. Or I could up my carb intake with an evening snack, which again would bring up my A1c. I am just looking for a good control.
So I suppose my question is, is 5 mmol/l a practical target for Type 2 diabetics.
My doctor tells me I am doing well, and keep up the good work.

 

[Jaylee]

Hmm, Hello @Jaylee, OK so I do fiasp 15 min before eating, and Tresiba at 10 in the evening.
I have a problem with carb counting, as I am on a very low carb diet, and a small steroid. Counting gives me a very low Insulin dose, which leaves my BG still high. So instead of counting, I have a fixed dose each day which keeps BG tests near to my target of 5 mmol/l. This works most of the time, but I have had some low BG tests before my evening Tresiba.
I can reduce insulin, but that will bring up most of my BG tests to a higher value and increase my A1c overall. Or I could up my carb intake with an evening snack, which again would bring up my A1c. I am just looking for a good control.
So I suppose my question is, is 5 mmol/l a practical target for Type 2 diabetics.
My doctor tells me I am doing well, and keep up the good work.

Hi,

Speaking from the perspective of an insulin using T1.
If I’m dropping or low I don’t need to eat a meal’s worth of carb to nudge me back in range. Just 5 or 10g

I’m not sure if you wear a CGM (Continuous Glucose Monitor.) but even the graphs of no-diabetics experimenting with these devices can occasionally jump around upto as high as 8 or 9mmol? Before comming back down.

You seem to be dong a great job.
Any insulin user will tell you hypos come with the territory. (Whatever diet is adopted to compliment management.)

Personally I don’t feel a few g of carbs to appropriately treat the occasional hypo is going to offset your A1c..

 

[searley]

When on insulin hypos will happen as it only takes a little too much to take you low

Bearing in mind your diet changes your body's needs for insulin may change as you can become less insulin resistant

So if hypos are regular you may need to talk to your doctor about how to reduce the insulin you take to help prevent hypos

In the meantime time keep testing and keeping hypo treatment on hand

 

[Royjk]

Hello @Jaylee, @searley, I think I can see the answer now. Long before I had diabetes, sometimes I would feel a bit wobbly like a hypo, and my solution was to drink a can of cola, and have a couple of mars bars, then rest a while. Maybe I still think the solution to hypo's are the same as it used to be.
But as you both point out, the drop into hypo is only a 0.6 mmol/l, so a small 5-10 carbs would put my body back on track. Just raising BG a little to clear out of the hypo situation. Perhaps I have been overdoing the remedial hypo action and that is what has been taking my BG up into double figures.

Thanks

 

[Jaylee]

Hello @Jaylee, @searley, I think I can see the answer now. Long before I had diabetes, sometimes I would feel a bit wobbly like a hypo, and my solution was to drink a can of cola, and have a couple of mars bars, then rest a while. Maybe I still think the solution to hypo's are the same as it used to be.
But as you both point out, the drop into hypo is only a 0.6 mmol/l, so a small 5-10 carbs would put my body back on track. Just raising BG a little to clear out of the hypo situation. Perhaps I have been overdoing the remedial hypo action and that is what has been taking my BG up into double figures.

Thanks

It’s easy to panic with hypos the worst ones have woken me up & I’ve gone full “locust” in the past. It’s a self preservation thing when the brain waves the “white flag.”
It can also be awful an hour later after an overreaction?

But I know how many grams of fast acting carbs can raise me by,

 

[Taighnamona]

So I was put on insulin before Christmas because my A1c was at 103.
I found out about this forum at just about the same time.
Here It was suggested that one answer to control of diabetes T2 was to go on a low carb diet. The thinking was no sugar going in will mean low BG levels and a reduced A1c. I was a bit skeptical about the diet because it meant a drastic change in my eating habits, and I did like bread and chips, but I wanted to move my blood test result into the green. So I cut out anything with high carbs.
The results are surprising, A1c is now 36, and BG tests are now in the green. I do not miss the food I used to eat. Doctor says I am now within normal person non diabetic BG level, all of which is very good.
There is just one small problem now, of course I can feel it when BG drops to below 3.8 with the finger blood tests.
So I don't want to add in carbs to bring BG up, and I am satisfied with my insulin dosing controlling BG.
What is the next step for control, how will I minimise hypo's?

I’ve been on insulin for a year and a half now. One basal insulin dose per day. After years on tablets this worked very well for me and I also went low carb, dropped weight and reduced my basal dose as low as I could. I’ve tried twice to do without insulin since my last three A1c’s have been 41, 39 and 38. I felt I had good control with my low carb approach but without insulin my glucose levels rose too high.
I’ve now got a working plan where I split my insulin into two equal doses instead of the recommended one dose and this keeps me ticking over between 5-6 mmmol and very seldom going over 8mmol. My time in range averages 95% but as high as 99%.
I still enjoy a glass of wine, dark chocolate and a shortbread finger. I self fund a CGM and use this to keep me on target. I would love to lose another couple of kilos but overall am happy with my health and fitness.
Reducing carbs is defo the way to go and hopefully that message is spreading far and wide.
Re your hypos. It sounds as if your insulin needs reduced and as others have said it’s best to discuss this with your medical team.

 

[Royjk]

Hello @Taighnamona, Thanks for your reply. One of the suggestions from my AI was to divide fast acting insulin into two doses, with doctors approval. It was suggested that this would control the dosing closer, but of course that could need the CGM or more finger blood tests. Maybe that comes at a later date, but I am seriously thinking about it.
I will agree that very low carb diet is the way with this, I just find it difficault if someone else choses my diet, as I generally under dose when I do not have the low carb option.
My doctor advises same dose each day, if it needs adjustment move 1 unit at a time, adjust down to your target. So I do not normally count carbs.
For 4 months I have tuned BG down, just need to get a grip on the hypo's, and not over do the carbs to bring BG up a little.

 

[Taighnamona]

Hello @Taighnamona, Thanks for your reply. One of the suggestions from my AI was to divide fast acting insulin into two doses, with doctors approval. It was suggested that this would control the dosing closer, but of course that could need the CGM or more finger blood tests. Maybe that comes at a later date, but I am seriously thinking about it.
I will agree that very low carb diet is the way with this, I just find it difficault if someone else choses my diet, as I generally under dose when I do not have the low carb option.
My doctor advises same dose each day, if it needs adjustment move 1 unit at a time, adjust down to your target. So I do not normally count carbs.
For 4 months I have tuned BG down, just need to get a grip on the hypo's, and not over do the carbs to bring BG up a little.

It is a dilemma. My diabetic nurse thinks that my control is too tight for my age (75) and is worried about hypos. I don’t tend to get them as I’ve got the balance between carbs (50/70 per day) and insulin just about right so that I don’t need to eat more carbs if I’m going low… 4.5 just before evening meal.
Split basal is defo more helpful to me as is the info from the CGM. Best wishes.