Am I doing this right?

[Jc3131]

Hello just after a bit of advice

I've just started to inject a few units of novorapid before certain meals. Im a type one still in honeymoon period.

Today i had spaghetti hoops on burgen bread toast. I added up carbs which was roughly 78g and injected 2units. Pre meal bs reading was 5.8mmol. 1 hr was 10.2 and 2 hr 10.4. I was at work at the time and i pushed myself a little harder and after 3 hrs i was 7.4. Would it be beneficial to inject 20 or so mins before eating instead of just before?

Tonights tea was a home made chicken curry with rice. Roughly 75g carbs. My pre meal reading was 7.4mmol so I gave myself 3 units. 2 hours after im at 4.7.

Should I have a snack or wait and see if I drop any more? Or do you think I should have took 2 units instead of 3?

Sorry if its confusing it's just I seem to be struggling with the doses as im still honeymooning.

Cheers John

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[GrantGam]

Tonights tea was a home made chicken curry with rice. Roughly 75g carbs. My pre meal reading was 7.4mmol so I gave myself 3 units. 2 hours after im at 4.7.

Should I have a snack or wait and see if I drop any more? Or do you think I should have took 2 units instead of 3?

Hi John,

The DIA of most rapid insulins (or simply how long they'll continue to lower BG) is 3-5 hours for most of us. So if I see a reading like 4.7mmol/l at two hours after my meal (and I haven't bolused in advance before eating) I'd expect to hypo within that 3-5 hour window. So it's worth looking out for that and maybe having an apple or something, but that's only advice based on what happens with me

Are you aware of carb counting and how to adjust doses for meals? If not, then it might be worth asking your DSN about that. But, you're honeymooning so it's early days and best to take each day as it comes and not be overly aggressive with your insulin dosing.

 

[db89]

So two things that spring to mind:

1) Do you have an insulin to carbs ratio or have you discussed this with someone on your care team yet as you're fairly new to this and as you say, honeymooning also? If you do have an insulin to carbs ratio it might be worth looking into different ones throughout the day as they can vary (again I'd discuss with your team). I'm also a honeymooning Type 1 and have 4 different ratios I'm working with depending on the time of day or night at the moment. It could explain why a similar amount of carbs with a similar amount of insulin produces different results in the evening compared to earlier in the day.

2) Bolusing in advance can improve the 2 hour reading but be careful with this. You should be confident you're taking the correct amount for what you've counted first really (not easy with the honeymoon phase and occasional endogenous insulin production I know). Once you are confident you could experiment by having a similar meal at a similar time of day and moving the bolus back by 5 minutes until you find a sweet spot. As with ratios, I've found I need to bolus in advance at different intervals throughout the day for good 2 hour postprandials.

 

[Jc3131]

Hi John,

The DIA of most rapid insulins (or simply how long they'll continue to lower BG) is 3-5 hours for most of us. So if I see a reading like 4.7mmol/l at two hours after my meal (and I haven't bolused in advance before eating) I'd expect to hypo within that 3-5 hour window. So it's worth looking out for that and maybe having an apple or something, but that's only advice based on what happens with me

Are you aware of carb counting and how to adjust doses for meals? If not, then it might be worth asking your DSN about that. But, you're honeymooning so it's early days and best to take each day as it comes and not be overly aggressive with your insulin dosing.

I was just told to try a few units before one meal a day. Ive just been eating salad and chicken without any bolus as my body is dealing with it ok. But I need to put a bit weight on and need a bit more energy especially as im due back to work full time soon. So Ive tried a few different meals and so far its been a bit hit and miss.

I've just checked there and im 5.3 now. That's 3 hours after the novorapid so its gone up a bit.

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[Jc3131]

So two things that spring to mind:

1) Do you have an insulin to carbs ratio or have you discussed this with someone on your care team yet as you're fairly new to this and as you say, honeymooning also? If you do have an insulin to carbs ratio it might be worth looking into different ones throughout the day as they can vary (again I'd discuss with your team). I'm also a honeymooning Type 1 and have 4 different ratios I'm working with depending on the time of day or night at the moment. It could explain why a similar amount of carbs with a similar amount of insulin produces different results in the evening compared to earlier in the day.

2) Bolusing in advance can improve the 2 hour reading but be careful with this. You should be confident you're taking the correct amount for what you've counted first really (not easy with the honeymoon phase and occasional endogenous insulin production I know). Once you are confident you could experiment by having a similar meal at a similar time of day and moving the bolus back by 5 minutes until you find a sweet spot. As with ratios, I've found I need to bolus in advance at different intervals throughout the day for good 2 hour postprandials.

Not went into any depth with my ratio and carb counting. I've just read up on it and been cautious with my injections.

Yesterday i had a mild hypo after injecting 4 units for about 120g carbs. I was 5.5 to start and after about 1hr 40 mins i felt the hypo coming, i was 3.2. I soon sorted that and was ok after 10 mins. I had a busy day at work which involved a lot of walking and lifting so maybe that was what caused the drop yesterday.

For safety im going to just go for light carb lunch before work as I hate feeling like a ticking time bomb while im at work.

I know its trial and error but im wondering if its easier during honeymoon period or afterwards.

How long have you been diagnosed a type 1? And with the honeymoon period do you have much flexibility with food? Im only on 4 units of Lantus at mo.

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[GrantGam]

I was just told to try a few units before one meal a day. Ive just been eating salad and chicken without any bolus as my body is dealing with it ok. But I need to put a bit weight on and need a bit more energy especially as im due back to work full time soon. So Ive tried a few different meals and so far its been a bit hit and miss.

I've just checked there and im 5.3 now. That's 3 hours after the novorapid so its gone up a bit.

Sent from my SM-G930F using Diabetes.co.uk Forum mobile app

My advice, eat in a similar fashion as you did before diagnosis John, and your care team will be in a better place to sort your doses out for you.

If you're writing off carbs (as you've suggested by eating salad and chicken) - you're unlikely to gain back the weight that you've probably lost as a result of hyperglycemia. You'll also be entirely lacking in energy, eating that way.

Some T1's do eat the way you're doing now, but they are experienced in what they're doing for the most part and compensate for a lack of carbs elsewhere in their diet.

If I were in your position, I'd be eating a diet similar to that before diagnosis and just monitoring your BG as advised. Your care team will soon advise you on how to tailor your bolus doses to deal with varying amounts of carbs and how best to match your macros, etc. What you need now is to get back to normal weight and feel human again. A diet of chicken and salad is highly unlikely to do that for you.

One day at a time John

 

[Jc3131]

My advice, eat in a similar fashion as you did before diagnosis John, and your care team will be in a better place to sort your doses out for you.

If you're writing off carbs (as you've suggested by eating salad and chicken) - you're likely to not gain weight that you've likely lost through the asymptomatic result of hyperglycemia - and also be entirely lacking in energy.

Some T1's do eat the way you're doing now, but they are experienced in what they're doing for the most part and compensate for a lack of carbs elsewhere in their diet.

If I were in your position, I'd be eating a diet similar to that before diagnosis and just monitoring your BG as advised. Your care team will soon advise you on how to tailor your bolus doses to deal with varying amounts of carbs and how best to match your macros, etc. What you need now is to get back to normal weight and feel human again. A diet of chicken and salad is highly unlikely to do that for you.

One day at a time John

Cheers. The only reason Ive cut down on the carbs is because my sugars were quite high and it made me unwell and my vision was all over the place. It's been easier to monitor with eating a lower carb meal. As soon as I eat normal like I used to my sugars shoot right up. No bread(apart from burgen), cereal and pizzas make me rocket. I couldn't live on some of the ultra low carb diet that some do. And in reality I don't want to, but I want to give myself a chance to get on top of the diabetes as much as I can.

I just want to try and be ready for when the honeymoon is over.

Cheers John

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[GrantGam]

Cheers. The only reason Ive cut down on the carbs is because my sugars were quite high and it made me unwell and my vision was all over the place. It's been easier to monitor with eating a lower carb meal. As soon as I eat normal like I used to my sugars shoot right up. No bread(apart from burgen), cereal and pizzas make me rocket. I couldn't live on some of the ultra low carb diet that some do. And in reality I don't want to, but I want to give myself a chance to get on top of the diabetes as much as I can.

I just want to try and be ready for when the honeymoon is over.

Cheers John

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How long have you had T1 John?

When you're ready to adjust your doses, your care team will be ready to advise you accordingly.

If you feel like you can carb count effectively but don't know how to adjust your doses, then it would be well worth asking your care team to attend a DIANE course. If you're in England, then you'd be looking at a DAPHNE course.

This online course is actually very good, and something I'd highly recommend you going through:

https://www.bertieonline.org.uk

There is no actual requirement for you to do an official course to learn to adjust your doses, I've not actually completed one myself. Your DSN and dietician will be more than qualified to advise you as it stands, so never be hesitant to check in with them. They can usually be reached over the phone, so you don't have to wait for your Clinic visit to put feelers out with regards to carb counting and adjusting insulin.

 

[Jc3131]

Ok mate cheers for the info. I was diagnosed mid June as a type 2. But they did the gad test as dr said it was odd that I would be a type 2 because of my build etc. First week in July I found out about being a type 1

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[GrantGam]

Ok mate cheers for the info. I was diagnosed mid June as a type 2. But they did the gad test as dr said it was odd that I would be a type 2 because of my build etc. First week in July I found out about being a type 1

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Each day as it comes

Remember that life is for living. Having BG at 5mmol/l permanently as a T1 is not achievable. So relax a bit and put life before diabetes; diabetes can become quite obsessive...

Take it easy and try not to obsess

 

[db89]

Not went into any depth with my ratio and carb counting. I've just read up on it and been cautious with my injections.

Yesterday i had a mild hypo after injecting 4 units for about 120g carbs. I was 5.5 to start and after about 1hr 40 mins i felt the hypo coming, i was 3.2. I soon sorted that and was ok after 10 mins. I had a busy day at work which involved a lot of walking and lifting so maybe that was what caused the drop yesterday.

For safety im going to just go for light carb lunch before work as I hate feeling like a ticking time bomb while im at work.

I know its trial and error but im wondering if its easier during honeymoon period or afterwards.

How long have you been diagnosed a type 1? And with the honeymoon period do you have much flexibility with food? Im only on 4 units of Lantus at mo.

Sent from my SM-G930F using Diabetes.co.uk Forum mobile app

I'm a little surprised they've started you on Novorapid with no idea how much to use. You shouldn't be restricted by what you're eating and I agree with @GrantGam to try and return to your previous diet before the diagnosis as this will help with learning the amount of basal and bolus insulin you'll need normally. Do you have a DSN you can contact and discuss your dosages with? Using the carb counting and dosage data you've already been gathering hopefully they could give you a starting dose or ratio and suggest when to adjust at first.

Dosages are individual to the person so not comparable but one other suggestion that may help is to request a half unit pen like the Novopen Echo for your bolus insulin. I got one of these and it helped greatly with flexibility and adjusting doses as I'm fairly sensitive to insulin in the honeymoon period.

I didn't enter the honeymoon period for around 6 weeks after diagnosis after I was admitted in DKA. I was told I was in it by my team after I had to reduce both basal doses and bolus ratio. I've been diagnosed nearly 11 months now. I'm fairly flexible with food within reason as I like variety (get bored easily having the same thing).

I'd also recommend you have a look at the BERTIE course if you can as all reference is useful - my consultant wants to wait before trying to get me on DAFNE because of honeymoon even though I've been counting and adjusting since a couple of weeks in.

 

[Jc3131]

I'm a little surprised they've started you on Novorapid with no idea how much to use. You shouldn't be restricted by what you're eating and I agree with @GrantGam to try and return to your previous diet before the diagnosis as this will help with learning the amount of basal and bolus insulin you'll need normally. Do you have a DSN you can contact and discuss your dosages with? Using the carb counting and dosage data you've already been gathering hopefully they could give you a starting dose or ratio and suggest when to adjust at first.

Dosages are individual to the person so not comparable but one other suggestion that may help is to request a half unit pen like the Novopen Echo for your bolus insulin. I got one of these and it helped greatly with flexibility and adjusting doses as I'm fairly sensitive to insulin in the honeymoon period.

I didn't enter the honeymoon period for around 6 weeks after diagnosis after I was admitted in DKA. I was told I was in it by my team after I had to reduce both basal doses and bolus ratio. I've been diagnosed nearly 11 months now. I'm fairly flexible with food within reason as I like variety (get bored easily having the same thing).

I'd also recommend you have a look at the BERTIE course if you can as all reference is useful - my consultant wants to wait before trying to get me on DAFNE because of honeymoon even though I've been counting and adjusting since a couple of weeks in.

I think the nurse is going to discuss carb counting etc at my next appointment in 3 weeks. She just said to help me along to give myself a few units before a meal. But if i eat things like i used to, for example a healthy pie, peas and chips, I would guarantee a blood sugar reading over 15mmol. Even breaded chicken pieces send my levels high. I've started to be ambitious a bit more but I'm not sure what sort of blood sugar levels are not going to do as much long term damage.

The long term damage is my main worry. I have seen a close family member not have good control and ended up a mess because of it. I want to still be here for my Wife and kids for a while yet, even though they don't like me .

As soon as my sugars are high, my eyes go blurry so that's my warning sign and I normally do some exercise to get back to normal.

I'm such a worrier, hopefully I will chill overtime.

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[donnellysdogs]

Make sure you ask nurse for 1/2 unit pens. They are invaluable.

Also ask for an aviva expert blood testing machine so you can enter carbs and your ratios eventually....