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Basal not right or protein?

S

staffsmatt

Well-Known Member
Messages
320
Type of diabetes
Type 1
Treatment type
Insulin
Hi All,

I'm currently trying (with mixed results!) to put on a bit of weight. I seem to have without really trying gotten into a low(ish) carb diet which whilst it does seem to be cutting out some high results means that I'm stuck at about 9 stone and have, as the diabetic nurse at my doctors described it on my last visit "a childs waist" at about 28" - none of my clothes fit! (I've lost a stone - mainly due to picking up one stomach bug after another from my 1 year old!).

I have tried a carby snack at 10 o'clock but just can't get the insulin stacking to work so to put on weight I've tried to increase the amount of protein that I eat with meals and for snacks. Last night for tea I had 30g carbs worth of potato (weighed so I know that was accurate) veg and three 97% pork sausages, I was 10.8 before tea (a left over of a stacking insulin low mid afternoon) so had 5 units of apidra - 3 for the potato and 2 to correct. I was 8.2 at 8:15 and 7.8 when I went to bed at 10, so I had my 7 lantus.

This morning I was 9.6 which whilst not terrible is a bit more of a rise than I would like (I hadn't had anything to eat at all since tea at 6pm) and if I'd been a little higher before bed (say 9) would have meant that I was running high over night.

I don't think it's dawn phenomina as I've had just one correction and it seems to have brought me back down again (7.2 @ 08:50 and 6.8 at 10).I'm planning on not having a snackand seeing what I am at lunch...

Just wondering if I should up my long acting again (only just got it right on 7!!) or if I need to count the protein more (would 3 97% sausages or a serloin steak and tuna mayonaise together be enough protein to make a difference!?)... although with it kicking in 5 hours after eating that would mean another injection right before bed... Or if I'm just looking into it too much and can carry on as I am..

Cheers!

Matt
 
Oh and last HbA1C was 7.5 so whilt not brilliant I don't think the weight is due to that, thiroid etc... check out ok as well..
 
Personally, I would expect a rise from that sort of meal .It isn't a meal I would normally eat often but I'm staying with my father and have to cook what he likes and had almost the same meal last night.
I went to bed with a level of 4.3mmol/l without worrying because I 'knew' it would rise. I would attribute it to the fat in my meal (from the sausage and some oil used to stir fry courgettes, peppers and mange tout)
My glucose was 5.2mmol/l this morning so not as big a rise as you had.
If I eat a similar meal with say chicken breast, with the veg roasted in the oven with just a small amount of oil, I would expect no rise (In that case , I wouldn't have gone to bed in the low 4s. I would have adjusted my basal but I'm on a pump so can do that easily)
Don't change your basal on one nights experience but if your glucose continues to rise by more than 2mmol/l then think about changing it .
 
Thanks for that, yeah I'll give it a couple of days I think, I've been running fairly level so far this morning. Just trying to work out what I can actually eat that will put a bit of weight on and not send my levels up... Would you expect to see a rise from my steak and tuna mayonnaise example as well? I'm struggling to see how I can bolts for the protein if it kicks in after my shirt acting has finished acting...
 
See what the next few nights bg levels are like before adjusting your basal dose, you should never make adjustments going from one nights readings @staffsmatt.

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Yeah true, the night before I went from 14 to 12.9 overnight with a correction of 2 units (I would have expected to drop more) but again is had a fair amount of protein with tea (the steak and tuna) so that may have confused things.. I'll have a normal tea tonight and see how that goes, going to be hungry though!
 
I'm prone to skinniness and have to keep an eye on my weight to make sure it's not dropping. I find the best way to put weight on is extra carbs. I don't suddenly start eating vast amounts of carbs, I try to add in some throughout the day, eg having a larger potato, a larger snack, a dessert after my evening meal (all carb counted, of course).

If I'd eaten your meal, I'd have had a liitle insulin for the sausages too. I find some sausages have cereal or rusk in which can add up. The fat can also cause a delayed rise. I'd have aimed to go to bed around 5.5 to allow for any rise during the night.

For putting on weight, I also watch my sugar levels as if they get too high, that messes up my weight gain. So I aim for quite strict control so every bit of carb is used.

I'm not sure what you mean about the stacking insulin being involved with the 10.8 before your evening meal. If I have an afternoon snack, I bolus for it (I'm on a pump) and aim to have my sugars back to normal by my next meal.
 
Both fat and protein can effect bg levels for several hours after finishing the meal @staffsmatt, when you do a basal test the last meal has to be quite low in both so that it doesn't skew the results, the following explains how to do a basal test, it's for pump users but the procedure is much the same:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
 
Thanks @noblehead I'll give it a look.

Sorry @azure didn't explain fully (I was trying not to bore people!)

I had a carby snack at 10am (30g carbs counted) and injected for it (at 7.8), then at lunch I was 11.2 so got annoyed corrected, forgetting that I already had insulin on board so started to drop around 2pm I went from 9.7 at at half 1 to 6.1 at half 2. I absolutely had to be able to drive at 4 so had 10g at carbs which I thought may have sent me to 10.8 before lunch...

I have founf that if I have more carbs I spike a lot after a meal, even if I have my insulin up to 20 minutes before the meal (normally if I wait any longer I'll go low and then go high - I suppose I could have a more sugary dessert to go in quicker and catch the insulin but that all seems a bit to involved!).

Thanks for your help :)
 
Thanks for the explanation - and it wasn't boring at all :)

Yes, having to drive is a definite reason for eating to make sure your blood sugar stays within range.

I think eating carbs is an individual thing and a matter of experience - you learn what works. For me, there are certain foods that I seem to need a bit extra insulin for, so I do the carb count for them then add a tiny bit more to cover the rise. I do have a pump so I can also fiddle about and get a bolus type that suits me (eg have the insulin delivered over a longer period rather than all in one go). Have you looked at your ratios? It may be that they need adjusting for certain meals or snacks. I say that not so much because of your spikes, but because of the high results there (ignoring the driving one). Could it be you just need a little more insulin, either in your boluses or your basal?

Having your insulin in advance is good. And yes, it is very involved! I'm still tweaking things now after more than 20 years.

I tend to limit my snacks to 20 or 30g carbs and keep them away from my meals. I also add calories by adding things like extra cheese or olive oil or nuts to my food. That can work nicely when you're trying to put weight on.

Just a final,thought - are you bolusing for the whole meal in one go? If I'm having a dessert, I bolus for the main meal, then do another bolus for the dessert. I find that gives me smoother sugars.

I hope you get it all sorted :)
 
thanks! i dont think its my ratios as much as it is my starting point.. (queue another long winded explanation):

when i was diagnosed at 16 months my parents were advised to keep my levels at around 7 (5 minutes plus to do a blood check etc...) and this has kind of stuck with me for the last 32 years, so im normally around 7 or 8 before food, if im spiking by 4 after 2 hours this will take me well into double figures. if i was just below 6 it wouldnt... its not helped that every time ive tied to tighted up my control i have had crashing lows. i think this may have been due to my basal not being right all these years though so hopefully if ive finally gotten that sorted i can try and run a little lower and normal spikes wont be such an issue..

thats the plan anyway! appologies for lack of punctuation in this, the ipad seems to have gone off it!
 
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