Could anyone offer any advice if possible please?

tim2000s said:

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.

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This makes a lot of sense- I used to do my whole levemir dosage in one big lump, but I found its absorption rate was even more ropey for many years. A third less at night with a split dose sounds like a great starting point which I can adjust from. The impact of protein on BG levels is something I've experienced but never properly read about, confusing, but I'll definitely be learning more about it to factor this in. Timing of my jabs is definitely not a properly controlled factor in my current regime, other than levemir at roughly the same time and novorapid timed before meals.

Juicyj said:

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

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Sorry to hear about the yoyo rollercoaster Juicy! The mood side to it is very clear cut and easy to see, you can feel why it's going wrong but feel a bit helpless to control it- more stress, higher cortisol- it feels like one massive contradiction at times. You're right though staying positive helps a hugely.

Just in case I was a bit vague with my last post- I was intentionally consuming no carbs over the weekend so that the doctors could see what my basal is doing then sort that out before going back to sorting out the bolus again.

Although saying this, I intentionally consumed very few to no carbs last summer- I had the most stable levels recorded for a month or two, i.e. between 5–8 consistently. Bolus insulin requirements were virtually nil and basal was significantly lower (I adjusted it by instinct to cover the high protein and high fat). I stopped due to realising it was a bit dangerous due to the body dipping into glycogen stores in the liver which would not be there for emergency situations. I was also doing a lot of exercise at that time so night time lows were a risk, but funnily enough nowhere near as common as they are now.

I'm going to do a DAFNE course soon which should enlighten me to some more precision based work and help me self manage a bit better. Thanks for your replies and all the best.

LucySW said:

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

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Hi Lucy!

This was an intentional carb free weekend for doctors to reassess what I am to with my basal insulin- it included no bolus injection (other than necessary correction dose!). I've been weighing all my food and been using the carbs and cals book- which I find very helpful when I'm in a rush to see portion size or feeling frustrated with staring at numbers to get a shortcut with images of portion size which is helpful. I do 1 unit of novorapid per 8g of carbohydrate currently. Many of the UK measures seem to do this too! I just subtract the fibre and count the content of which sugars- is this correct?
I was thinking that there must be some kind adjustment to make in injection timing due to the fibre having such a direct impact of carb digestion time.

I use my Fitnesspal in order to get a complete breakdown of foods most of the time to get a more accurate breakdown to calculate bolus dosage. Despite saying this, I'm clearly currently doing something wrong!

iHs said:

@Maxy ........Ive never deducted fibre from my carb calculation, I just to look at the carb content per 100g weight on food and calculate from that. I also dont use the Carbs & Cals book either. I bought it when it first became available but was disappointed to see pictures of food on a dinner plate which included carb but didnt show the weight of the portion of carb of each item, instead it left it down to eye judgement to work out the portion size. Best really to use some weighing scales and calculate the carb that way and then just convert the weighed food into spoon measures.

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I was a bit confused this with this too- I've been recommended the carbs and cals book like it's holy diabetes bible. I get the impression it's more of non intimidating good starting point for those trying to approach carb counting? I just weight the food then calculate it after, (whilst my food is getting cold.. - this is my fault only!). I've been carb counting and calculating my bolus dose for months now, results seem to change direction with the wind.

Also, just to add a few more details to this thread:

Blood test results the other day all seemed fine- good kidney, liver and thyroid function- lipid profile was also fine. BP and pulse great.

Only other medication I am prescribed is dexamphetamine sulphate for my ADD
________

Further entry to yesterdays diary:

Fell asleep at BG 14.4, woke up 3.8

tim2000s said:

If you look at US foods, they include fibre and carbs separately, including both Soluble and non-soluble fibre. you are supposed to deduct soluble from the carb number to get the net carbs.

In the UK (and Europe I believe) this is done already to give the total carb number, which is the one you should work off. There is more info on this thread: http://www.diabetes.co.uk/forum/threads/total-carbohydrate-sugars-and-fibre.54865/

Are you sure you're getting your carb calcs right? For the majority of us, it works well, and the issue is likely to be one of either miscounting carbs or incorrect bolus ratio.

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I was counting net carbs originally, then confused- for the best part of a week was only counting sugars (realised that I was off) then have returned to counting net carbs. My bolus ratio is still under construction, only been adjusted once (from 1 unit to 10, then to one unit to 8). Doubt I'll be advised anymore adjustment to the ratio until I've got the readjusted basal sorted. I wasn't aware of the soluble vs. insoluble fibres, I'm going to read on this now

"You would be correct to deduct the fibre if you lived in the USA.
However, food labelling is different in the UK. Here, the fibre element has already been deducted, so you need to look at the total carbs.
In the USA the fibre is not deducted on the label, so in USA you would be correct in deducting it and using net carbs."

The plot thickens.. Perhaps many of the food entries on Myfitnesspal are US measurements so there could have been a number of meals that were calculated incorrectly. The majority of the time I used the nutritional labels on UK products then calculate insulin dose based on food weight. All so confusing.

Hi everyone I'm back, 3 weeks into Insulin Dose Adjustment Course- finding it helpful but it's still not helping me with the problems I've been experiencing.

At the moment I'm consistent pattern that is happening is that I will jump really high straight after eating a meal, even when I do my bolus insulin 15-25 minutes before. The insulin doesn't work for 4–5 hours on average, then eventually it all releases simultaneously and I go low. My diabetic nurse has forbid me from doing any night-time basal insulin anymore as I keep getting waking hypos regardless.

I've come to the conclusion that my metabolism is very high due to how fast my body absorbs the food immediately afterwards and that I've become resistant to the insulin I'm taking.
I did some reading through other forums online and found others experiencing the exact same thing:

"I have had type 1 diabetes for 15 years. I was diagnosed when I was 9 years old. All seemed to go well for the longest time; about 13 1/2 years. I cannot really even remember ever worrying about having diabetes. I counted carbs religiously and had my ratios down pat. I remember when I switched to Humolog from R and the doc told me to make sure that I ate within 10 minutes after giving myself humolog lest I become hypoglycemic. I followed orders and so long as I did the correct amount of humolog I would not get hyperglycemia (i.e. my blood sugar would maybe get up to 150 an hour or so after eating and then come down to the correct range within 2 hours after eating).
About a year ago I found myself getting up into the 200's after eating even if I would give myself the correct amount of insulin. I know my ratios were correct (despite getting up into the 200's) because my blood sugars would eventually come down within range within a 3-4 hours after eating. For a while I would "stack" (or over correct my 200's blood sugar only to get hypoglycemia an hour or two later). I began to think that the insulin was just not working or something, so I tried switching to a "faster insulin" thinking that may fix the problem; first I switched to novolog but when the problem continued I even tried Apidra, which is supposedly the fastest. But the problem persists. "

This guy was apparently put on metformin then his insulins effectiveness returned to normal.

A reply to this poster said:
"I understand your situation because I am living through the same one. This problem started two years after I was diagnosed with type one, and at the same time that I was diagnosed with hypothyroid. I started noticing that my blood sugar was very high after breakfast but the the insulin would kick in around 11:30 and go back to normal. Like you, if I gave more insulin, I would experience hypoglycemia before lunch.It is a very, very, very sad and complicated problem for me and often leaves me depressed and feeling guilty about my high blood sugars. Like you, it is most terrible in the morning. "

This is everything that I am repeatedly experiencing.

I read that this is called 'Double Diabetes', where type 1's become insulin resistant like a type 2. Has anyone ever experienced anything like this or think it could be a possibility to what's going on with me?

Also just for reference, this evening for dinner (19:47) I ate 120g of carbs, did 18 units of insulin- tested at 22:03 and I'm 21.3.
I'm really short of breath, i.e. not being able to get to the end of a sentence without being out of breath. Ammonia smell up my nose and hard heartbeat.

Emily95 said:

That's diabetic ketoacidosis
Please go to A&E

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I get it whenever my bloodsugars go high and get all symptoms except vomiting. I'll do a ketone test now and report back, but this is almost a daily occurrence- the nurses are wanting to run me high to avoid the hypos, which means extreme discomfort for me.

Charles Robin said:

Have you ever thought about dispensing with the carbohydrate? Low carbohydrate means far less insulin, so easier to calculate an accurate dose. Search for Dr Troy Stapleton on YouTube, and watch his videos. They were revolutionary for me.

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This is actually my dietary preference and what I choose to do usually and I have the best results doing this. The health professionals have always shunned the idea and say it's ridiculous and that I won't be eating enough to replenish liver glycogen. On this carb counting course there's the attitude that you can eat any amount of carbs you want as long as you do the personally proportionate dose of insulin to cover it.