Could anyone offer any advice if possible please?

[Maxy]

Hi, I'm not sure if I've posted this to the right thread or not.

I've been a T1 diabetic from age 12, I'm now 23. I've always been (mostly) responsible and health conscious- had good NHS healthcare, advice and supportive family members around me. Incidentally, my best mate I've grown up with is also a type 1 so I've had someone to talk to about these things. I'm a bit scared of sounding pathetic with this, but I feel something isn't right with my diabetes in general; I've always had a reasonable A1C, the highest its been is around 10.something and I'm currently around 7.7. I regularly go through spells of spontaneous highs and lows, ranging from 1.1–to 26 at either extreme.

I'd consider my hypo detection to be intermittent, sometimes I can be below 2- still walking around functioning normally (or so I think) then others be a lethargic mess at the same level. I can detect them the majority of time but it never stays the same. Although I'm struggling to understand what's going on, I've taken measures of getting on a better track such as splitting basal insulin into 2 injections- and begun introductory carb counting course, currently adjusting novorapid insulin. In a couple of months time I have an IDAC course scheduled which should also help me.

I finished university in June and have been searching for work, gone through an internship and a job abroad and throughout this time my levels have been continually yo-yoing. I really feel as if I'm perhaps a little bit oversensitive- my diabetic friend agrees that he feels rubbish during hypos/hypers but it doesn't seem to match anything that I've been feeling- to give a description of both:

Hypo: Trapped in a bubble from the outside world, blank and vacant- people speaking to me doesn't register. Brain doesn't function properly, concentration goes completely downhill to the point I can't do anything. Shaking, sweating, pale, vision goes sharp and jittery with high colour contrast. Feel severe anxiety and delusional, feel completely not like myself. Mouth goes numb and breathing becomes more shallow- heartbeat accelerates, funnily enough I sometimes feel energy at this point assuming it's adrenaline emergency response- (I'd most of the time notice by this point but sometimes lose awareness spontaneously), if untreated at this point I then suddenly get incredibly sleepy and fall asleep in an oddly 'tranquil' way.

I've had a number of serious hypos in my life involving needing medical attention and going to hospital, others have been close calls where someone has woken me up in time. I'm not suggesting these are regular by any means but they still can happen.

Hyper: Extremely lethargic and spaced out- feel let I'm being held back by something like a ball and chain. Eyes feel thick and glazed over as if there's a film coating over them, vision gets bleary and sometimes have to blink repeatedly in order to get clarity. Mouth has an odd taste and feels 'thick' also and when breathing through my nose there's a distinct smell of ammonia. I often feel dizzy and nauseous with absolutely 0 motivation to do anything but lie there and stare into space. Much more so than hypo I feel extremely anxious and depressed- low self worth and can't get much done.

I get high blood sugar readings on a daily basis, in the past week I've had 2 readings a day of 12–18 but mostly on the higher end. I recognise high blood sugars from around 12 onwards and the entirety of symptoms above come from 13–15 onwards.

I feel these constant episodes are affecting my daily performance in all aspects of life and have affected my education. I have embarrassed myself when hypo (said completely ridiculous embarrassing things) which have caused me to feel regret and anxiety when thinking back to this day.

I was told I would potentially be able to change insulin treatment to the pump before I left abruptly to work abroad, was shown all the options for different types of pumps I might be able to get after carb counting education, but since a clinic appointment recently I was told that due to NHS funding cuts and not fitting the NICE guidelines, I wouldn't really be suitable for the pump. The staff and diabetes care in my area has been fantastic and the staff friendly, helpful and caring. [continued in next post]

 

[Maxy]

Would anyone be able to offer some advice on this? I'm told my A1C is good so I'm doing well and I'm a 'good diabetic', but my blood sugars levels have been all over the place and I feel really rubbish a lot of the time. One reason I've thought about that could have resulted in this level is my exercise regime- I've been exercising until recent time for 2 hours a day 5 times a week or so- high intensity weight training. Through careful of attention to diet, training, research I've been able to gain around 8kg of muscle- exercise overall has made me feel much better. However, the short term effect on my blood sugar levels has been really difficult- my body acts and needs a completely different regime to when I'm exercising and not-exercising- through speaking to my doctor I changed my basal dose for exercise and non-exercise days which marginally helped but I still spontaneously lose control regularly. I've been told by one nurse at uni that I should perhaps not exercise as much if it means better control but I'm not prepared to stop, my home doctor has rightly said it's one of the best things a diabetic can to help their overall health. I'm by no means an expert when it comes to science, but I have a really strong feeling the resistance exercise is causing my HbA1c to drop; it has lowered by 2 points since I took my exercise seriously if I remember correctly and would conveniently explain why my A1c has been okay whilst overall control all over the place. I looked up and found a study which tested a group of type 2's:
_______________________

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800839/

Resistance exercise training lowers HbA1c more than aerobic training in adults with type 2 diabetes


The aim of this study was to compare the effects of 10 weeks of resistance or treadmill exercises on glycemic indices levels prior to and immediately following exercise in adults with type 2 diabetes.

Research Design and Method

Twenty inactive subjects (mean age 53.5 years) with type 2 diabetes enrolled in the study. Baseline HbA1c, blood glucose levels, heart rate, and blood pressure were measured for each subject prior to the initiation of the exercise program. Subsequently, subjects were matched to age, waist circumference and sex and assigned to either isocaloric resistance or treadmill exercise groups, which met 3 times per week for 10 weeks.

Results

Both groups showed a reduction in pre and post-exercise blood glucose and HbA1c values. There was no change in resting blood pressure or heart rate in either group during the course of the 10 week intervention. The group receiving resistance exercises showed significant differences in the daily pre-exercise plasma glucose readings between the beginning and end of the exercise protocol (p < 0.001). There were significant improvements in the mean HbA1c reading pre and post training in both groups (p < 0.001). However, the greater reduction was noted in the resistance exercise group, and at 10 weeks their HbA1c levels were significantly lower than the group that received treadmill exercises (p < 0.006).

Conclusion

Ten weeks of resistance exercises were associated with a significantly better glycemic control in adults with type 2 diabetes compared to treadmill exercise.

_______________________

This makes me think the same thing could apply to a type 1, although this is only guess work in desperation why my control has been so bad.

I find this quite interesting:

"In fact, Ishii et al. [23] showed that the glucose disposal rate was nearly double following resistance training of 4-6 weeks, but HbA1c levels did not change. More recent studies have reported significant declines in HbA1c with resistance training [24-26], possibly by improving the storage and utilization of glucose in muscle [12,27]."

My scientific understand of the A1c test is that it measures the amount of glucose attached to the haemoglobin in red blood cells to give an average of your control over a moderate amount of time. Surely if during exercise the cardiovascular and muscular demand more oxygen and glucose, then alveoli the carriers of oxygen must be travelling round the body at a much more efficient rate. Again this is just speculation and trying to understand the science of these things makes my head spin.. Anyone with a good understanding please chime in. My levels could also be due to fluctuations between very high and very low levels - resulting in misleading glycated haemoglobin readings.


Below is a chart from the study showing exercise-induced reduction in HbA1c:

I have been doing only resistance training with some cardio added but not as much of a focus. Healthy balanced diet with high protein intake and drinking plenty of water.

Sorry for this extremely long winded post, joined the forum a while ago but haven't really been on since. I feel like I've let of some steam writing this and ranting, would greatly appreciate any input anyone has to offer.

To overview:

Could anyone offer explanation to this lack of control and why my A1c results don't reflect this?
Does anyone else get extreme mental impact (anxiety/depression) from T1 as I've described? (and do you know what solutions/treatments there are)

Thanks to anyone who reads this!

 

[phoenix]

HbA1c . This is a model of the haemoglobin molecule. From you tube video by Casey Steffen

The blue blobs represent glucose. (the red represents the heme or iron) As you can see some have become bound to the haemoglobin. There are other glucose molecules outside the molecule as they would be in the blood. If the two come together then these molecules will bind to the haemoglobin. If there is a lot of glucose there then far more will get bound to the haemoglobin so at periods of high glucose concentration more glycation will take place. But it takes time (hours) for the reaction that causes glycation to become fully permanent . I infer from this that short periods of high levels may not be fully reflected since during this period the protein and glucose can separate. Once permanently bound the glucose remains there for the lifetime of the cell ie up to three months. It does not get removed during periods of low blood glucose levels.
Basically a high HbA1c reflects time at higher levels . Glycation still takes place at lower blood glucose concentrations but there will be less glucose around so less of it will happen http://www.diabetesinfo.org.nz/hba1c.html

Your high intensity exercise regime may indeed cause periods of highs with the anaerobic exercise and also lows during the cardio aerobic exercise. People with T1 have different responses to exercise than many people with T2 (because of injectable insulin which doesn't go away and also possibly because of an increased adrenaline response. )
Have a look at the sections on runsweet , diabetes and sport and starting sport (there are several pages that explain in detail in this section) As to how to deal with it, have a look at some of the sports that involve this mixture of aerobic and anaerobic exercise. http://www.runsweet.com/DiabetesAndSport.html

 

[himtoo]

Hi @Maxy
i have read through your entire post and you have given a lot of information.

first (and most important in my humble opinion) is that you sound as if you are yo-yoing ( which you mention too ) with your lows and highs in a short period of time.
it will be intensive work but i think you should start keeping a daily food and insulin diary to look for patterns. ( have your care team already asked you to do this ? )
as to a pump if you are experiencing some hypos without recognising symptoms you may still qualify within NICE guidelines-- this is something else to talk to your care team about. Keeping the journal is important too as it shows your commitment to getting things right.

 

[novorapidboi26]

pumps are good, but only if you have had a good lengthy experience carb counting and trying out different doses and timings to try and get better control.......

the criteria to get a pump can be loosely interpreted I suppose but it is a postcode lottery to be honest.........

once you get the basic in carb counting and dose adjustment you will find gaining control much easier, especially if you exercise regularly, this helps a lot.........and a goo educational course should touch on adjusting insulin for exercise.....

 

[Maxy]

HbA1c . This is a model of the haemoglobin molecule. From you tube video by Casey Steffen
View attachment 10793
The blue blobs represent glucose. (the red represents the heme or iron) As you can see some have become bound to the haemoglobin. There are other glucose molecules outside the molecule as they would be in the blood. If the two come together then these molecules will bind to the haemoglobin. If there is a lot of glucose there then far more will get bound to the haemoglobin so at periods of high glucose concentration more glycation will take place. But it takes time (hours) for the reaction that causes glycation to become fully permanent . I infer from this that short periods of high levels may not be fully reflected since during this period the protein and glucose can separate. Once permanently bound the glucose remains there for the lifetime of the cell ie up to three months. It does not get removed during periods of low blood glucose levels.
Basically a high HbA1c reflects time at higher levels . Glycation still takes place at lower blood glucose concentrations but there will be less glucose around so less of it will happen http://www.diabetesinfo.org.nz/hba1c.html

Your high intensity exercise regime may indeed cause periods of highs with the anaerobic exercise and also lows during the cardio aerobic exercise. People with T1 have different responses to exercise than many people with T2 (because of injectable insulin which doesn't go away and also possibly because of an increased adrenaline response. )
Have a look at the sections on runsweet , diabetes and sport and starting sport (there are several pages that explain in detail in this section) As to how to deal with it, have a look at some of the sports that involve this mixture of aerobic and anaerobic exercise. http://www.runsweet.com/DiabetesAndSport.html

Thanks phoenix, you explained that in a way I could understand. Does it mean that these higher levels don't cause as much damage to the body due to them being present for short amounts of time? I am currently adding approx 15–20 minutes 'sprint type' cardio to each session with weight lifting and find I have quite a serious dip far into the next day.
I've been given the info you stated about diabetes and exercise in introductory carb counting course- I find the blood sugars being pushed higher during anaerobic exercise and push lower during aerobic personally happens to me; but overall I find insulin never acts in the same way everytime. I am currently doing 1 unit bolus for every 8gs carbohydrate (was doing 1 for every 10 before but adjusted the dose), some days the bolus works and gets my levels in the golden spot range in perfect time. Other times, it takes longer than 2 hours to take effect and either drives me way too low, or leaves me with levels that would indicate I hadn't done any insulin at all (hope that all makes sense). It's tempting at this time to bolus more, especially as after 2 hours the insulin should be in the blood stream.

Just to add, I do about 6/7 injections a day average (bolus and basal)- rotate injection sites between arms, legs (quad and hamstring area), upper buttocks and torso

 

[Maxy]

Hi @Maxy
i have read through your entire post and you have given a lot of information.

first (and most important in my humble opinion) is that you sound as if you are yo-yoing ( which you mention too ) with your lows and highs in a short period of time.
it will be intensive work but i think you should start keeping a daily food and insulin diary to look for patterns. ( have your care team already asked you to do this ? )
as to a pump if you are experiencing some hypos without recognising symptoms you may still qualify within NICE guidelines-- this is something else to talk to your care team about. Keeping the journal is important too as it shows your commitment to getting things right.

Hi himtoo,

I agree fully that I am yo yoing quite frequently. It has been better with accurate hypo treatment. I was taking a written diary- but I've been given a carb counting blood tester which has so far been quite helpful, has logs of net consumed carbs and injections with correct timing. I'll post an example below of what my written diary has looked like- any specific advice on how to write them would be appreciated! This was on a really bad day when nothing was going right:

 

[tim2000s]

Hi Maxy, it sounds as though you are finding it quite hard. One of the symptoms you are describing is issues with bolus ratios. I don't see you saying anywhere that you've done a basal test to determine that this is at the right level. It might be a place to start and would at least allow you to benchmark where you are. This is a useful link http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

I do a lot of gym work, and have had to undertake this process to get my old basal under control and since changed to a new one. Once you have this to the right level, the bolusing becomes a lot easier. I too have different basals for gym and for non-gym days.

Always worth a try.

 

[Maxy]

pumps are good, but only if you have had a good lengthy experience carb counting and trying out different doses and timings to try and get better control.......

the criteria to get a pump can be loosely interpreted I suppose but it is a postcode lottery to be honest.........

once you get the basic in carb counting and dose adjustment you will find gaining control much easier, especially if you exercise regularly, this helps a lot.........and a goo educational course should touch on adjusting insulin for exercise.....

You're right about that, I've spoken to other people in the same area who have been put on the pump without undergoing carb counting course- all tell me how it has changed their life and their levels have been very even and manageable. It doesn't seem to be an age thing either, I have seen both older and younger been put on the pump before carb counting. I know the pump is by no means a magic solution but I believe it would suit my situation- I would want to have completed carb counting course before I do it though. Another step I'm going to take is getting the more precise insulin pen (can't remember what it's called but it can do half units etc)

 

[Maxy]

Hi Maxy, it sounds as though you are finding it quite hard. One of the symptoms you are describing is issues with bolus ratios. I don't see you saying anywhere that you've done a basal test to determine that this is at the right level. It might be a place to start and would at least allow you to benchmark where you are. This is a useful link http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

I do a lot of gym work, and have had to undertake this process to get my old basal under control and since changed to a new one. Once you have this to the right level, the bolusing becomes a lot easier. I too have different basals for gym and for non-gym days.

Always worth a try.

Cheers Tim, "Type 1, proud and if you don't like it, I'll fight ya! " love your sig btw

I changed my levemir to 2 injections instead of the 1 a few months ago and found it to be much better. When I was at uni I changed my macro ratios to extremely low carbohydrate intake, adjusting rapid accordingly to requirements (changed basal also) and my levels were the most stable they had ever been in my life. They remained between 5.5–7 the entire time with no big jumps. This was only for a couple of months though with careful diet planning. That page looks interesting mate, I remember doctor going through something like this with me a while ago.

 

[novorapidboi26]

receiving a structured educational program is on the NICE criteria I believe, but as I say, it isn't followed strictly.........

I believe that you should definitely go on a course before the pump though otherwise you wont be using it to the best of its ability............

the pump generally delivers a much more efficient dose of insulin, this being down to not having to give yourself one big load of insulin by injection, then hoping for a nice, smooth, even absorption......you will use less insulin, which will result in much more reliable doses etc.....

this fact alone will make for a noticeably better control, easier control...........an understanding of your basal and bolus needs is essential though...

get the ball rolling though for the pump and get swatting up on the carb counting and dose adjustment.........

 

[Maxy]

receiving a structured educational program is on the NICE criteria I believe, but as I say, it isn't followed strictly.........

I believe that you should definitely go on a course before the pump though otherwise you wont be using it to the best of its ability............

the pump generally delivers a much more efficient dose of insulin, this being down to not having to give yourself one big load of insulin by injection, then hoping for a nice, smooth, even absorption......you will use less insulin, which will result in much more reliable doses etc.....

this fact alone will make for a noticeably better control, easier control...........an understanding of your basal and bolus needs is essential though...

get the ball rolling though for the pump and get swatting up on the carb counting and dose adjustment.........

This makes a lot of sense to me: would explain why low carb diet worked in a way- insulin requirements were very minimal, less insulin resulted in reliable doses and stability. I've got IDAC booked for March, looking forward to it- trying to do loads of research and observation in the mean time

 

[himtoo]

Hi himtoo,

I agree fully that I am yo yoing quite frequently. It has been better with accurate hypo treatment. I was taking a written diary- but I've been given a carb counting blood tester which has so far been quite helpful, has logs of net consumed carbs and injections with correct timing. I'll post an example below of what my written diary has looked like- any specific advice on how to write them would be appreciated! This was on a really bad day when nothing was going right:

yes looking at your intitial bolus and subsequent corrections that 2.8 @ 8:34pm fits nicely near the end on the life of the 7 unit correction

 

[Maxy]

yes looking at your intitial bolus and subsequent corrections that 2.8 @ 8:34pm fits nicely near the end on the life of the 7 unit correction

Would you say the bolus and corrections not working over that timeframe is odd?

 

[himtoo]

Would you say the bolus and corrections not working over that timeframe is odd?

i don't find it odd at all -- it is consistent with an overcorrection

 

[phoenix]

Does it mean that these higher levels don't cause as much damage to the body due to them being present for short amounts of time?

That's unfortunately the million dollar question and hotly debated amongst diabetes researchers. (I've been following the debate for several years and really there is no answer. Some experiments with cells and short term measurements of biological markers suggest problems caused by spikes. There isn't really any long term evidence to confirm this; it actually points to averages or HbA1c being important (and stability in those is important too) The big caveat is that there are no long term trials using continuous monitoring )

 

[Maxy]

That's unfortunately the million dollar question and hotly debated amongst diabetes researchers. (I've been following the debate for several years and really there is no answer. Some experiments with cells and short term measurements of biological markers suggest problems caused by spikes. There isn't really any long term evidence to confirm this; it actually points to averages or HbA1c being important (and stability in those is important too) The big caveat is that there are no long term trials using continuous monitoring )

Sorry for this very belated reply Phoenix, I guess due to CGM's recent development and availability in time studies have been an impossibility to conduct on a study of that timescale.

Since I started this thread my levels got a lot worse. I was experiencing highs 16–24 usually once per day and 9–14 each day consistently. I was beginning to get really ill around wednesday this week- was able to get hold of doctor who referred me to a nurse. I did a ketone test on tuesday which registered as 0.1 and the following day it rose to 0.4 (my BG reading at this point of 24). Although this was below the safe level of ketones, the fact that it had risen and that they were present at all worried me. As I was experiencing most symptoms of DKA, the doctor recommended (I think this was about 8am) that I retest ketone and BG every 2 hours, and if it had shown no signs of improvement that I ought to go to A&E. Luckily the ketone level decreased to 0.1 by the 2 hour mark, but I was still feeling very unwell, same pattern of past few days.

I was able to see a practising nurse and a doctor on friday. Due to there being morning lows between 2.9–4.6 or so, I have been instructed to lower my evening levemir dosage from 17 to 15 (so I am doing split levemir dosage 17 and 15 on a sedentary day). I had to have a day of the weekend carb free in order to reassess my basal dosage.

I ceased carb intake from late afternoon Saturday. I did 17 of units of levemir midday saturday. Here is the diary: (shameful sleep cycle currently)..

Saturday 5:52pm: BG 12.9 - Meal before: Piece of rump steak seared in olive oil with mushrooms and a large portion of fresh steamed spinach. No bolus injection

(Friend of mine picked me up to go to their house, where I would be staying over night. I took with me food provisions including eggs, bacon, mushroom and fresh tomatoes).

7:20pm: BG 8.4 (Sitting watching TV, drinking Coke-Zero- Jealous that I couldn't drink a beer!)

10:21pm: BG 9.5 (Activity had not really changed other than drinking some water and herbal tea, completely sedentary)

11:31pm: BG 11.2 (I got very hungry at this point, as I was away from home and wanted to save food I had until the morning and the following day- I went to the shop and bought a large chicken shish kebab with lettuce, cabbage, tomatoes and a tiny bit of chilli sauce I left the bread which my friends happily took off my hands. This meal I ate around midnight and did my second levemir dosage of 15 units as instructed- I also injection 1 unit of novorapid with advice from BG meter bolus advisor due to the strong suspicion after reading online that there could have been sugar in the meat marinade and the chili sauce, as well as already not feeling great from being 11.2- this could well have been what caused the following reading: )

1:42am: BG 4.2 (I feel early stages of hypo- adrenaline rush, nervousness, the shakes- I have no choice but to consume carbs for hypo treatment. I eat 3 glucose tablets containing a total of 10.8g carbs.)

2:04am: BG 6.4 (Feel significantly better, but still a bit 'light' feeling with hypo panic hunger which I resisted)

2:44am: BG 4.7 (Same feelings as before but less pronounced, a bit confused to this result, assumed it might be 1 unit rapid still circulating- I treat this with a further 3 glucose tablets 10.8g carbs)

4:15am: BG 8.8 (My two friends and I are practically asleep by this point and all head to bed, I feel comfortable at this reading to turn in safely with no further carb corrections)

I wake up 12:00ish- the three of us relax downstairs with a cup of tea. I don't feel too bad, neither hungry. I sit and chill with their
beautiful new cat.

Sunday: 1.07pm: BG 3.6 (I do my first test, quite confused with the result, I treat the hypo with 4 glucose tablets 14.4 carbs and do 17 units of levemir. We begin preparing food- fresh mushroom and tomatoes lightly fried in olive oil with peppercorns and crumbled sea salt with 3 pieces of grilled bacon and 3 fried eggs).

2:51pm: BG 12.5 (The meal is finished and ready to eat so I tested at this point, then ate the meal.)

3:17pm: BG 11.2 (I am drinking water and have a herbal tea, but have made no more eating arrangements for now. Strange skin reaction rears its ugly head again; red hives one of which was uncomfortably on my upper lip, possibly from being in a damp house- which I had the same problem with before when I used to live in one with black mold growing up the walls. I walk to pop by and see other friends I hadn't seen for a while down the road, 15 minute walk- leisurely pace but by no means dordling.

6:11pm: BG 13.5 (Feeling rather hungry and make my way home on train, couldn't really see any food that safely didn't contain any sugar- Pasty bars, icky Burger King and Mc.Donalds. I figured it would be better to get home quickly as possible and have a safe home cooked meal, I jump on the train.)

9:46pm: BG 11.7 (Test taken on home arrival, I am famished hungry and feeling weak from lack of carbs. I make myself a moderate portion of fried steak with steamed green runner beans, carrots and broccoli.)

10:25pm: BG 10.3 (Still extremely hungry despite the large meal, eat a small lump of mature cheddar cheese with a bit of salad)

10:45pm: BG 11.0

12:28am: BG 13.2 (I do evening dose of levemir 15 units, still feel rather hungry but also lousy from hyperglycaemia- hunger is more than likely the high blood sugar. I eat approx 100gs of grilled chicken breast.)
________

Recorded number of steps Sunday: 5,324
Carbohydrates consumed of which sugars not including negligible quantities in form of lactose or in carrot: 14.4g

May be some unnecessary detail in here but it's helping me to try and figure out and get a bearing on what's going on. I feel really terrible all the time at the moment, tired all the time and have lost 5kg weight (roughly 11 pounds). It's caused me to not be able to keep up my exercise regime that kept me healthy, plus is causing me real depressive feelings. At the moment it feels like a complete full time job that I can't return home from until I sleep.. one which you can't just quit either! Would be grateful for any analysis anyone might be able to draw from this.

Cheers for reading

 

[tim2000s]

Looking at what you've written, your bg levels are still high during the day. I'd also look at your levemir timings. Doing midnight/midday injections doesn't leave you much room for management before bed, but this is your choice entirely.

Given the reaction overnight and your bg levels during the day, it suggests your levemir split is wrong. You might want to look at a more 1/3 overnight, 2/3 during the day split and treat it as two different basals. This has worked for me.

The other point to be aware of is the impact of protein. Even if you aren't eating carbs, protein does cause a bg level increase. It's harder to bolus for, and I find that I require a delayed shot of fast acting to cover it.

I'd also suggest redoing the basal testing according to the Salford guidelines.

I don't know if any of this helps.

 

[Juicyj]

Hey Maxy,

I'm sat after just coming out of a hypo, took too much QA last night !! I read your analysis of hypos and hypers and sympathasise with this completely !

My moods were pretty **** last year, based on the fact I was yo-yoing a lot and my doc said low mood was reflective of my BG bouncing around so much, so I took the step of learning more about Dr Bernstein's methods. I try to low carb as much as possible, sometimes it's tough particularly when I am really hungry, but on the whole I've cut out rice, pasta, bread, sugar, cereals and eat a high protein diet which with some QA tweaking, has stabilised my sugars. When I get into it then I generally see better readings, however you still have to take QA for a protein diet as your body is clever at converting this into sugar for energy. So are you taking anything when you eat a protein only meal ? And have you read up on his method ?

Also are you correcting before meals ? I used to correct whenever I tested but after doing DAFNE I now only correct at meal times.

It also sounds like you are down with a bug so all in all a bad combo at this present time.

I always see type 1 as work in progress, what works for one doesn't necessarily have the same effect on another as we are all so unique, but recording your results is vital.

Stay positive though it will come right again

 

[LucySW]

Poor Maxy.

It sounds as if your bolusing is out. Carb counting may need a bit of work to get it more precise, and many would advise bolusing for protein. And you'll need to spend a week or so taking lots of measurements and skipping meals to test basal rates.

But all that can be done, and then you'll feel a lot better.

Accurate carb counting - Get an app? Weigh everything? Carbs & Cals is good, especially if supplemented with your own items under the My Foods feature. I use the USDA database at http://ndb.nal.usda.gov/ndb/search/list and have added lots of foods that I eat/use to my Carbs & Cals. US nutritional measures give fibre as part of the total carb measurement, but UK measures subtract it from the carb number and give a net carb figure, so that's what I do too when I add things.

The online DAFNE-type course is at http://www.bdec-e-learning.com/

BTW, I've found lo carb high fat really helps. Look at the nutritional calculator at http://www.phlaunt.com/diabetes/33614154.php to play with carb/fat/protein levels and to figure out a regime that might suit you.

Best of luck!

Lucy