Constantly needing to eat to avoid low sugars

[Horsewithoutaname]

Hi everyone

I have been diabetic for a year now and everything is going well so far. However, there is one thing which is bothering me. I need to eat every two hours in order to avoid a hypo, which means that I eat up to seven times a day. Every time I need to take a snack, I eat 15 grams of carbs and if I am walking through town this can be up to 20 grams of carbs. I have tried lower amounts of carbs but this resulted in hypo's. It is also not possible to lower the 24 hour dose (I am on injections), as I would end up too high in the morning. Since the facilities of my university are located all through to town I am frequently walking throughout the day and this contant need to eat is quite frustrating.

Are they any alternatives I could try to reduce the amounts of snacks between meals ?

 

[Lynz84]

Hi there

Are you certain you cant lower your basal injection?
All sounds very frustrating!xx

 

[TorqPenderloin]

Are you on lantus and doing 1 injection a day? If so, I would consider looking into Levemir and possibly switching to two basal injections a day. That would allow you more control to avoid hypos but also avoid the morning hypers.

One way or another, it sounds like your insulin needs adjusting. What time(s) are you injecting?

 

[Horsewithoutaname]

Are you on lantus and doing 1 injection a day? If so, I would consider looking into Levemir and possibly switching to two basal injections a day. That would allow you more control to avoid hypos but also avoid the morning hypers.

One way or another, it sounds like your insulin needs adjusting. What time(s) are you injecting?

I am on two injections. One Lantus (in the evening) and the other is the short acting Apridra Solostar for dinner. I don't inject short acting insulin in the morning and afternoon as the ratio is then 1:50. I don't know if it is possible to split the dose, since I am on a very low dose (I only inject 6 units of Lantus ).

 

[TorqPenderloin]

I've hypoed on 5 units of Levemir (similar to Lantus) just to put it in perspective...and I weigh about 210 lbs.

6 units may not be a lot for many, but it sounds like that may be too much for you.

 

[jevans82]

What is your carb / unit ratio? Sounds like this might need looking at? And also with regards to adjusting bolus - do you think you are too high when trying to reduce it as you're eating the same amount of food as you would on the regular dose? Sounds silly I know but sometimes these things pass us by!

 

[rachel162]

@Horsewithoutaname, I would agree with TorqPenderloin about considering splitting your basal so you could take less in the day and more overnight to combat the morning highs.
Alternatively I'd suggest lowering your basal and injecting a (very small) amount of fast acting in the morning on waking, so you could combat the early spike but your basal wouldn't be making you low the rest of the day.
See what your dsn suggests as well. Good luck finding a solution!

 

[donnellysdogs]

Also, see if you can use 1/2 unit pens if you aren't already. 1/2 a unit makes a big difference to 1 unit changes.
Also have you ever considered a pump which would allow smaller fine tuned doses of basal?

 

[Horsewithoutaname]

@ mahola @jevans82

I only know that my ratio for the afternoon and morning is 1:50. Dinner is always a wild guess how much my ration/carb is. I did take a count carbing course a couple of months a ago though, but the dietician was not very helpfull. She doubted that I was T1 because 'I had been for such a long time in the honeymoon' and she thought it was not necessary to teach me how to calculate ratio to carb, because I only inject insulin two times a day. Before I could copy the ratio/carb formula from her, she put it away and started to discuss my eating habits pointing out that I eat too much snacks throughout the day. Then it became more like a judgement hour than a consultation hour. Last time I will ever go to a dietician.

@ rachel162 [URL='http://www.diabetes.co.uk/forum/members/donnellysdogs.17713/']@ donnellysdogs[/URL]
[URL='http://www.diabetes.co.uk/forum/members/jevans82.149812/'][/URL]
Thanks for the tips. I have an appointment with my nurse next week, so I will discuss these options and talk about the experience with the dietician. I don't think that I will get a pump as I am on such a low of dose of insulin and my HBAC1 is good.

 

[noblehead]

@Horsewithoutaname, if you've already been on a carb counting course you'll be aware of basal testing, in the absence of food (and of course bolus doses) basal insulin should keep our bg steady if the dosage is correct and you shouldn't need to snack, so I would do some basal checks just to be sure it isn't your basal that's causing the lows. if that's OK then you can then look at your insulin-to-carb ratio's.

The following (although it's for pump users but still relevant) explains how to do a basal check in different time frames:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[Daibell]

Hi and welcome. First, dieticians are not qualified medics so you may choose to ignore their medical advice and talk to the nurse. To me it sounds like your Basal needs lowering just a tad. There are half-unit pens (I have one for my NovoRapid) which might be relevant. If you do lower the Basal and/or split it then you may need to have some Bolus at other meals. Carb-counting in practice is based on personal experience having used the meter with various meals and 'eye-balling' the restaurant food (to quote my lovely DN) when there isn't any packaging to look at

 

[Horsewithoutaname]

@Horsewithoutaname, if you've already been on a carb counting course you'll be aware of basal testing, in the absence of food (and of course bolus doses) basal insulin should keep our bg steady if the dosage is correct and you shouldn't need to snack, so I would do some basal checks just to be sure it isn't your basal that's causing the lows. if that's OK then you can then look at your insulin-to-carb ratio's.

The following (although it's for pump users but still relevant) explains how to do a basal check in different time frames:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Thanks for the website. I only know about basal testing prèbreakfast, but my learning of diabetes was a bit messy anyway, as I was diagnosed during my internship abroad.

 

[jackois]

I'm another voter for splitting your Lantus. I was diagnosed a couple of years ago & am still tinkering with my insulin rates, successfully maintaining a HB1AC of 5.1%.

I take 9 units in the evening and currently 7 units first thing in the morning. Currently this is working fine for everyday circumstances, waking between 5 & 6mmol/l, but I find I have your problem if I play a round of golf. I have to nibble as I go round the course otherwise my levels drop to the point where I literally can't hit a straight shot.

Each alteration I make is small, one unit and it then has a week or so to pan out and I can look at the trends and adjust again. I think that a pump, where you can suspend your basal would be the ideal for my golf, but I don't meet the criteria for funding and don't have funds enough to pay for it myself.

I also think that one of the side effects of multi daily injections and trying to keep blood levels tight is the possibility of over medication which give many of us weight gains due to the snacking as the snacks add calories when all we actually want is the blood sugar rise.

I don't any of us can truly say we have cracked our treatment of diabetes as just when you think you have, something new comes along to bite our sorry arses! Hope this helps.