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Control problems and generally down

shedges

Well-Known Member
Messages
432
Location
Hampshire, Uk
Type of diabetes
Type 1
Treatment type
Pump
Hi All,

Has anyone else gone through what I'm about to describe? (I think I probably know the answer, but would like to get it off my chest).

I think my bg levels are too high!

12 months ago, at my last DN appointment, they told me I was having too many hypos - it was about 3 per week. I was told I need to eat more carbs with my meals (note: NOT told to reduce insulin). I am due to go back to see the diabetic doctor in about 3 weeks and have noticed my levels are creeping up. My meter is showing an average between 9.9 and 10.9 depending which time period the average is calculated. Now I think I know what the problem is: although I carb-count, I get nervous about injecting too much insulin and inducing a hypo. The result is that I don't inject enough, or I will go and have a little something extra after the meal to make sure I'm ok. I have only noticed myself having the extras recently and don't know if it is normal, or if my brain is going a bit haywire. I guess I need to have more confidence in my ability to carb-count, but the low numbers concept involved in the low-carb option is starting to appeal to me.

My Lifestyle
I take part in one sport or another about 5 days a week. I get home fairly late, so often don't have a four hour gap between dinner and bed - it's normally 1.5 to 2 hours, which results in me going to bed a little high, because I don't want to wake up in the night to eat... or run the risk of hypo in the night. I don't eat meat, and don't like the idea of eating much more cheese/eggs than I already do. The canteen at work serves a carb-rich menu, with a fair amount of meat, so I make my own lunches. Overall, I feel my lifestyle contributes well to controlling my bg levels, which is why I find myself troubled about the lack of control.

Is it psychological? Or physical? Should I consider eating meat again? Will it allow make me feel like I'm having a more varied, lower carb diet?

The problem I have is that I'm about to go back for my 6-month checkup and if I express these concerns, I fear I'll just get the same old answers.

I'm not sure what to do.

Hope someone out there can help.

Sam.
 
Hi Sam.

As we are a bit short of T1 experts at the moment here is some info which may be of help to you ?

Have you been on a DAFNE course at all ? Here is a ink to a website which explains what it is about.
http://www.dafne.uk.com/scripts/typeone ... dafne.html

Here is another link to an actual on-line Diabetes Learning Course which could help with adjusting your Insulin and Dietary intake.

http://www.bdec-e-learning.com/



Ken.
 
Thanks Ken - can't believe I haven't followed up on the BDEC site before. I've had it recommended before, but never got as far as actually doing anything.
 
Hi Sam,

I'm Type 1 and would say I would highly recommend really cutting down the carbs. I currently operate on about 30-40 per day, less if I can help it and it has really improved my control. Each to their own of course, but I can't really cope with any starch without blood sugar rocketing.

WIth the amount of sport you are doing you should be able to get great levels; and drop the amount of insulin you are taking. I appreciate it is a bit tougher to cut down on carbs if you don't eat meat, but maybe focusing on green vegetables as much as possible would help? Do you eat fish? There's more to low carb vegetarian food than cheese and eggs I'm sure... :wink:

What type of insulin are you on? When do you take it? I've just swapped to Levmir as my long acting insulin (on a split dose) and have found it great at calming down the blood sugars. Lantus kept peaking at odd times and then trailing off and it was just not much good for me.

I would also say you should never never eat to your insulin but always take insulin to match what you eat; with the idea that we try and reduce the amounts we are taking as much as possible.

That way you will avoid hypos and the highs that inevitably follow them. Hypos are I think a bit of a red-herring for us; they of course can be debilitating but they are pretty easy to take care of and we shouldn't be prejudicing our long term health to avoid potential short term hiccups. If you are having lots of hypos at night then you are taking too much insulin in all likelyhood; so take less insulin not more food.

Keep on questioning why your control isn't better and you will improve it; I guarantee it.

All the best

Dillinger
 
Thanks Dillinger,

A lot of the stuff you said makes great sense... especially the 'green vegetables' bit. That's a particular strong point with me... love the salads and veges at meals.

I use Lantis for my long acting insulin. I've not really considered discussing this with my consultant - I don't know how bad one should let things get before complaining. I don't like to be seen as a whinger, because when you really do have a problem, people might not then take is seriously. I will bring it up at my next appointment though. I inject 18 units before bed and that's it. May be worth splitting it if it means I don't need to raise my evening bg level just to see me through to the morning.

I don't have hypos in the night much... maybe 2 or 3 in the last 6 months?

Am seriously going to look at cutting down the carbs. I do eat fish and realise there's a fair amount of variety out there... just need to make myself put the effort in.

Same old story - you only get out what you put in.

Thanks again,
Sam.
 
Hey Sam,

Sorry you're feeling down - it sucks you're having such a tough time.

One thing I did want to mention is I think it's a shame your last hospital appointment seems to have made you so worried about hypos. Obviously they're to be avoided where possible...BUT I think those in the diabetes 'know' reckon these days that tight control is pretty much impossible to achieve without a few hypos.

The reason I say that is that when I went on the DAFNE course, they said that if you're aiming for tight control - and by tight control DAFNE mean between 5.5 and 7.5 first thing in the morning, between 4.5 and 7.5 pre-meals, and between 6.5 and 8 before bed (ie not what some people would regard as excessively tight numbers, although those targets suit me just fine) - you should EXPECT to have around two hypos per week. Note, not that you might have, or not that you'll only have them if you're not trying hard enough - DAFNE actually expects people who've been on its course and manage to get good control to have around two hypos a week.

Obviously if those hypos start regularly hitting levels of 1's or low 2's, or if you're having a whole heap of hypos a week, it's a different matter. But personally I reckon it's near impossible to eat anything like normally (I'm excluding serious low carbing here, as I know some people manage tight control with no hypos that way), exercise regularly, keep reasonably tight control and still avoid hypos all together - and anyone - medically trained or otherwise - that says it's easily possible is talking nonsense.

Good luck with it - fingers crossed you get some sensible answers at your next appointment.

CJ
 
Hi CJ,

Some very interesting points there! I haven't been on the DAFNE course, but the more I hear about it, the more I want to go on it. The numbers you stated seem very reasonable to me and are the kind of ranges I'm aiming for. When I say I'm having 2 or 3 hypos a week, the reading rarely gets below 3.5. I tend to feel symptoms around 3.8 to 4 and even at night it's never below 3.0

The comments and responses I've received have once again put things into perspective and given me the right motivation to get back on track. The forum does its job once again.

See you later,
Sam.
 
Hi, was thinking twice about posting, but having had another private message from a forum member today about this subject, decided to.
The best thing anyone having problems with control on Lantus or Levemir can do is get off it. Many people are having not only problems with control but feeling, tired and unwell. Many people report feeling ill, exhusted, and not feeling like themselves while taking synthetic and particularly analogue insulins. When these people change to animal insulin, they have consistency in control and feel 'normal' and well again.
Of course you can struggle on, blaming it on everything except the wind direction, as I did for 4 1/2 miserable years until realised what was causing all my probs,or you can ask your doctor to change your medication.
I changed to pork insulin (pork and beef are available),last year and feel better and have better control than I've ever had in 19 years on synthetic insulin.
It's quite scary how many people are having problems, paricularly on Lantus (glargine).
Contact me privately or the IDDT(Insulin Dependent Diabetes Trust) for further advice.
Jus
 
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