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Type 1 Confused!

kleeblatt

Newbie
Messages
3
Hi everyone,
I'm about 9 months in to the joys of t1. Since my honeymoon period ended I've been struggling to keep my sugars under control.
The last three days for example I've had similar amounts of carbs (45-60) at dinner on the same ratio of bolus but overnight have seen stable one night, a rise one night and then last night a hypo.
How is this possible?!? I'm so confused about what I can be doing to get this to even out and have stable overnight sugars.
 
Hello there @kleeblatt !

Welcome to the forum - I'll tag @daisy1 also, who will send some additional info...

The first things that I come to think about are:
1) How much carbs in the evenings did you have, before you went to sleep - was it about the same amount, or was there possibly a noticeable difference?
2) Amount of exercise during the day and especially then in the evening. If you exercise heavily some day, you could have lower BSLs for up to nearly two days after the exercise.
3) A beginning flu or something like that.
4) The always fun part with T1 - there is not a clue why, and this unfortunately also happens every so often.

So, as you see, T1 is unfortunately not an exact science :)

The more scientific question here in your case is maybe then -what kind of insulin and/or other medication do you use.
What does your daily routines look like, especially thinking now about meal-times, boluses you take, amount of long-acting insulin and do you take long acting once or twice a day? When in that case?

If you can give some hints about how a normal day looks like, then maybe we could suggest something more palpable, but do remember - most of us answering, do not have a mandate to change medication or something like that - we can only give you suggestions and hints.
 
@kleeblatt
Hello and welcome to the Forum :) Here is the Basic Information we give to new members and I hope you will find it both interesting and helpful.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:
  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates
Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:
  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

  • Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why

  • Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
 
Sadly the amount of carbs you eat is not the only variable but I would not panic over 3 wobbly nights.
To add to Mike's suggestions (re insulin quality, exercise_, I'd consider if you had a high fat meal e.g. pizza which might have caused a delayed high? Or the converse.
Alcohol can cause hypos because it stops your liver making glucose whilst the alcohol is being processed.
On a general note you say you are out of the honeymoon stage and one of the things I did not get until recently is that your beta cells not only produce insulin but also inhibit the pancreatic alpha cells from signalling the liver to make glucose hence there are times when your blood sugar will rise for no obvious reason (note that taking insulin jabs does not replicate this function). Mine spike during intense exercise or when I skip a meal for example.
Another factor is good old girl hormones e.g. becoming insulin resistant during the last week of your cycle then back to normal soon after. If you took the same bolus dose across all these different circumstances you'd end up not quite in the right place.
It is a really individual disease so try and keep a note of anything that seems like a pattern alongside the factors we've mentioned thus far. I am putting a link to a free e book Bright Spots and Landmines by Adam Brown (a type 1 diabetic)
https://brightspotsandlandmines.org/ because I know it is not always easy to speak to your diabetes nurse about the daily practicalities but hope you feel you can ask any questions to the pro s on this site!
 
The carb amount may have been the same but if the meal had different fat compositions then that could affect carb absorption speed e.g pizza or curry higher later.
 
Don't forget that even though the 'honeymoon' may be over, your pancreas can still kick out the odd bit of insulin which can make it a bit of a nuisance.
 
On a general note you say you are out of the honeymoon stage and one of the things I did not get until recently is that your beta cells not only produce insulin but also inhibit the pancreatic alpha cells from signalling the liver to make glucose hence there are times when your blood sugar will rise for no obvious reason

This one was new to me - thx for the info @NicoleC1971 ! Do you possibly have a web-link to recommend?

Edited to say: the part about inhibiting alpha cells...
 
Last edited:
Thanks everyone. Last night it was soup and a bit of toast, 2 nights before meatballs with roasted vegetables and some pasta. Identical meals.
I've not been exercising lately to try and get done stability and I eat around 8pm each day....
 
Thanks everyone. Last night it was soup and a bit of toast, 2 nights before meatballs with roasted vegetables and some pasta. Identical meals.
I've not been exercising lately to try and get done stability and I eat around 8pm each day....

The last meal you mention will probably get your BS down faster, than the former two with meatballs and pasta.
Pasta in combination with the meatballs, could very well have given you a delayed blood sugar rise. To this equation you maybe also have to add some of the components mentioned above - take especially into consideration what "jackois" mentions...

I also agree with "NicoleC" that, as she puts it, "I would not panic over 3 wobbly nights." T1 is a balancing with so many factors involved, that on two otherwise identical days, you could have two very different blood sugar readings.
 
Thanks everyone. Last night it was soup and a bit of toast, 2 nights before meatballs with roasted vegetables and some pasta. Identical meals.
I've not been exercising lately to try and get done stability and I eat around 8pm each day....
hi @kleeblatt, For reasons as described in posts above the composition of the two meals you have quoted are not identical.
The carbs in both may be similar but not necessarily the timing of rise the BSL from each.
There may have been more fat in the meatballs than the soup and more protein in the meatballs than the soup.
What adds to the complexity is that 50% of the protein may be converted by the liver into glucose but maybe peaking nearer the 3 hours mark.
 
hi @kleeblatt, For reasons as described in posts above the composition of the two meals you have quoted are not identical.
The carbs in both may be similar but not necessarily the timing of rise the BSL from each.
There may have been more fat in the meatballs than the soup and more protein in the meatballs than the soup.
What adds to the complexity is that 50% of the protein may be converted by the liver into glucose but maybe peaking nearer the 3 hours mark.
Yes, I definitely understand that. I guess it's more the 2 identical food daysi don't understand. Lots more to learn I suppose...
 
Hi again @Klleblatt. even the order you eat food in, the weather, the unpredictability of those few remaining beta cells have some influence on BSLs.
I have heard that eating protein first, then veg and finally other carbs produces a lower 2 hour BSL (taken 2 hours after the end of the meal) than in a different order.
You are in a state of flux as there is no exact cutoff between honeymoon and non-honeymoon either, more a gradual, non-regular process.
I appreciate that it is confusing as things before were more predictable.
Just know that it will settle in time, assuming there is no other confounding factor.
Some people have reported their diabetes unsettled, to find that their thyroid gland was out of kilter so that may be a useful fact to discuss with your doctor as well.
 
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