drastically having to lower insulin levels...help!!

[faithelliott]

Hi all, if you can help me with my husbands dilemma I'd really appreciate it as there is not much help here in serbia...!!

My husband lives in Serbia (where I currently live - I am Enlgish) and has type 1 diabetes. He was diagnosed when he was 18 years old and is now 27. He was talking Actrapid Novolet Insulin at 9 in the morning and at 6 in the evening. He has been injecting 36 Isulatard in the morning and 14 actrapid; in the evening he was injecting 16 Insulatard and 6 in the evening. To explain a bit about his life: he is living in a small village in Serbia, his diet before he had diabetes was very bad - chocolate, white bread, alcohol. No fruit, no vegetables. He lives in a gypsy village and there is abosultely no education about diabetes and diet. He had a huge huge amount of stress in his life including attempting suicide with insulin overdose.
When he moved in with me last January his diet changed (much less bread, no alcohol, veg, frruit, no sugar unless necesarry, no potatoes etc) and had 100 % less stress. He cycles and walks a lot. He first lowered his insulin to 32 Insulatard and 10 astrapid in the morning, and then 12 Insulatard and 4 astrapid in the evening.

He has now reached a point where he is unsure what to do. Over the last 2 weeks his sugar levels have been continuously going below 3, and been continuously eating chocolate, bananas etc because of this. He lowered his morning dose to 28, then 26, and today tried 20 insulatard. Still all day he has had v low levels (3 - 6). Last night he tried an experiment to take no insulin and this morning his sugar was only 11. What does this mean that his levels were ok having not taken any insulin? What would you suggest he does and why is this happening!!!!

THANKYOU

 

[david252]

Is he eating any carbohydrate at all? From your description of his new diet he has cut most of it out ( bread, potatoes, sugar, chocolate etc). His diet is generally very healthy and certainly cutting out the chocolate and alcohol is a very good step but diabetics need SOME form of carbohydrate at every meal. A diabetic diet (especially type 1) tends to be carbohydrate heavy - although the right type pf carbohydrate.

It sounds like (and correct me if I'm wrong) he has gone from a diet with a lot of carbohydrate - hence the high insulin requirements - to one that almost has none - hence the drastic reduction in insulin.

He really needs to be having around 50-60g of carbohydrate at every meal.

Never, Never, EVER!! (I would underline it if I could work out how - LOL) stop insulin in type 1 diabetes. By all means reduce it as requirements fall but never stop it. The insulatard is moderately long acting which will give him soime protection for a day or 2 but once those 2 days are over he will very rapidly develop diabetic ketoacidosis - a very dangerous and potentially fatal complication. The body needs a continuous supply of insulin - even if just a very low dose - even if he ate absolutely nothing at all.

I would strongly suggest that he go back on a balanced diet which includes 50-60g of carbohydrate at every meal and he treats low blood sugars with rapid acting carbohydrate such as sugar, fruit juice, lucozade etc. Chocolate and bananas are generally a poor choice in treating low blood sugars, they take a long time to be absorbed - bananas because they have a high fibre content and chocolate because it has a high fat content. Use the "rule of 15s"- 15g of fast acting carbohydrates (ie 150ml fruit jusice, or 80ml of lucozade), wait 15 minutes and recheck blood sugars. If still < 4mmol/l repeat.

With regard to his insulin adjustments - ideally adjust by 2 units/dose - 4 units max and give it a day before adjusting again. The insulatard will start working after around 4 hours and lasts up to 16 hours, peaking at around 12 hours after injection. The actrapid starts working after 30 minutes, peaks at 2 hours and lasts 4 hours. If he is having lows an hour or 2 after eating a meal he is either not having enough carbohydrates or having too much actrapid. If he has lows mid - afternoon or middle of the night it is probably his morning insulatard. If he is having lows between 2am and 8am (before injecting actrapid) it will be his evening insulatard

If you are unsure about carbohydrate content of food, I am sure you can google it but a few quick tips - the following all have about 15g of carbohydrate : 1 slice bread, 1 1/2 tablespoons pasta cooked, 1 1/2 tablespoons cooked rice 1 apple, 300ml milk, 2 tablespoons of beans, peas, sweetcorn. 2 small boiled potatoes

 

[david252]

Oh and I forgot to mention - exercise will reduce his blood sugars more. This is the time to eat his bananas! Half an hour or so before he exercises, if he has a banana, that will give him a reasonable amount of slow release carbohydrate (sugars) that should help maintain his blood sugar at a reasonable level. But he should still carry an emergency supply of fast acting carbs with him to take if his blood sugars fall whilst exercising.

 

[faithelliott]

Hi David, thankyou so much for your reply (and Branko sends his thanks). All the doctors have to say here is to eat more meat!!!

So, a few questions and replies - you seem to really know what you're talking about. Re. never skipping and insulin dose, I researched and relayed this info. Can you tell me what is happening as he needs less insulin? In January he was eating no white bread, loads of salad, pretty much not touching anything we thought he 'shouldn't' and he was on 32 units in the morning. Now he is finding he has to eat as much 'bad food' as he can and he is on 24 units in the morning. Eg his diet has much more carbohydrates/sugar than 6 months ago but his body requires much less insulin. Does his pancreas make any insulin? Is it possible to keep lowering and lowering the dosage do you think until he will only require a small amount - and if so what is going on here, is he more sensitive to it, or is his pancreas making some insulin??

So I have taken on board your advice about carbs. Can I describe a typical day to you and its problems and see what you think? 9, gets up, measures sugar. Sometimes it is 4, sometimes 13. If it is above 9 he injects his insulin and about 20 mins later eats. Eats brown bread, an egg, feta cheese, tomato, yogurt. Then - 2 hours later his sugar will be 4 or below. Before he was eating chocolate, but I told him that this was a slow reaction as is banana - so he eats a glucose tab or sugar. Waits 15 mins etc. Sometimes for 2 hours his blood sugar won't go up - he eats crisps, bread, glucose - 'bad food' potato. He has been eating every 2 hours as I think he should, but is literally having to stuff food and glucose, peanut butter and honey in to stop his sugar being low. Then in the evening he normally injects at about 8. Sometimes he has to wait till midnight for his sugar to be above 8 - and has to keep eating to make this happen.

This is normally how it is for 3 days or so - he wakes up and his sugar is low, injects 24 units which is the lowest ever for him, and keeps being hypoglcemic all day, now eating carbs and crisps and bread etc. He is too full to eat any more and this stresses him out! Then after about 3 days he'll wake up and his blood sugar is really high - his theory being that 3 days worth of stuffing himself with sugar have now caught up with him. When he tries lowering his insulin dosage below 24 units in the morning his sugar goes above 11 and has to inject more in the afternoon. His life is like heaven now - he is just walking in the woods, building a fountain, playing music - so pyscologically so different from anything he had before - and I don't know what affect this is having. What do you think is best for him to eat when his blood sugar is falling in this period when he is lowering his insulin doses - to eat a glucose tab each time? He is eating 'normal' food every couple of hours but this just isn't enough. He does still eat a lot of chocolate to boost his levels - could this contribute to his blood sugar not rising immediately but over a period of a couple of days?

He is due to go to his 'control' in a week and they want him to go on I think levemir, or lantus. They say it should help with hypoglecemia, and is better to inject 4 times a day. What do you think about the difference between astrapid insulatard and this? Thanks for the advice about the banana half hour before exercising.

Just to ask you one more thing if you might know about this: 4 years ago he injected 1.5 months worth of insulin over a period of 1 day. He went to the hospital in the end - having changed his mind about what he was doing to himself! They said 'ha ha very funny if you'd done that you would be dead by now' and took him to a phsyciatrist who declared him normal. They took his levels and yep they were 1.2. He was on a drip for 2 days while his levels repeatedly fell and fell. What he and I don't understand is how did he survive all day having injected this much - he just went walking in the woods, went home fell asleep ate some chocolate, ate a bit more - but not so much. Is it normal that a body could survive this, and could this have any long term affect on him?

Thankyou if you have time to answer any of these questions!!!!! Faith

 

[Dillinger]

A diabetic diet (especially type 1) tends to be carbohydrate heavy - although the right type pf carbohydrate.

He really needs to be having around 50-60g of carbohydrate at every meal.

Hi, well that's not true at all; technically you don't need any carbohydrate and certainly 50-60g at each meal is high. I have about 30 grams a day. If it were easy to have none I would have none. There is no such thing as an essential carbohydrate; you need protein, fats and certain vitamins but that's it, non diabetics can tolerate carbohydrate but they don't need it.

Have a look at Viv's Modified Atkins diet for some ideas on what to eat.

By reducing your boyfriend's carb intake you are doing the right thing; you need to balance the insulin though to what he is eating, so the levels need to come down. The 11 mmol/l reading after not taking insulin was probably the remains of previous insulin still active in his body.

I do agree with David252 that you must not stop taking insulin; but you can drastically reduce it.

Getting rid of carbs in his diet is a key way of getting really excellent blood glucose control and thereby control of his diabetes; don't be scared of it. Reduce the insulin and keep testing until his blood sugars are stable.

Best

Dillinger