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Fairly new Type 1 - any advice?

J

JP83

Member
Messages
8
Hi there,

I was diagnosed with type 1 about a month ago after showing some of the tell tail symptoms for around 8 weeks before. After the initial shock and disapointment, one of my first thoughts was that I must have in some way brought it upon myself - I'm not sure of that is a common irrational though after being diagnosed? Anyhow I'm now settling into a bit of a routine and not looking too downbeat about my new outlook on life (at least not for the moment).

I've been put on Levemir and Novorapid and managed for the last few days to keep my BG levels below around 8 which I'm pleased with. It has meant I've had a few hypos, usually when approaching meal times. One thing I'm not sure about is wheter there are any long term affect of having hypos like there is for having sustained high BG levels? I think I've read somewhere that repeated severe hypos can lead to brain damage, but what about the moderate controlled ones - will they have any impact over the years?

The symptoms of my hypos seems to vary a bit and when I've tested my BG seem to have varied from between 2.3 and 3.5 when I'm feeling woosy enough to check. Is it possible to pass out from a hypo without having realised any symptoms as there doesn't seem to be that much consistency with them from what I can tell so far and they seem to come on very fast. Also, what would happen if you hypo in your sleep - would you even know?

I think this depends on the type of food eaten, but is there in general a time after eating when BG levels will peak? Also how long does the Novorapid take to kick in and how long does it work for?

Sorry to go on, but one final thing is that I've been told I should look after my feet, but I'm not really sure what I should be looking out for to be honest. Should I be moisturising them or anything like that, or is this something to look out for further down the line?

Thanks in advance for any thoughts or advice. Jon
 
Hi Jon and welcome to the forum :)
Some T1s will be along soon to help you with your specific questions, but in the meantime here is the information we give to new members and I hope you will find it helpful. Ask any more questions you like as there is always someone who can help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS


Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find well over 30,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes ... rains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips
The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.
----------------------------------------------------------------------------------------------------------------------------------------------------

Please sign our e-petition for free testing for all type 2's; here's the link:
http://www.diabetes.co.uk/petition/

Do get your friends and colleagues to sign as well.
 
Hi Jon,

I'm pretty sure moisturising your feet is not a good idea when diabetic as it softens them and can make them easier to cut. I read that somewhere and hopefully someone can back it up! I have terrible feet from running. They are always cut and blistered but tend to heal quickly which I am happy with. What you should be checking for is any cuts or sores that don't appear to be healing, checking daily means you can tell if they have been there for long or not.

Other than that it sounds like your getting your BG levels under control quickly. When first diagnosed I was always likely to have a hypo before a meal so I would start to have a little snack between meals or a piece of fruit when I started cooking. Often I would be fine when starting to cook but then my BG would just drop away before it was ready. It's all trial and error really.

Main bit of advice is just to test test test. I like to take a day every month (now that I've been diabetic for 4+ years) and test myself every hour. It hurts the old fingers but gives me confidence that I know what my BG levels are doing between meals.

Any questions, post them. You will never be short of people with good advice here.
 
Hi Jon,
I dont think mild hypos have any long term effect. Before I was diabetic I used to get the shakes and feel irritable when I was hungry, which was mild hypoglycaemia. As for hypos at night, I tend to wake up, but your liver will normally produce glucagen to raise your levels should you go low, unless you've been drinking.

Novorapid normally peaks about 1.5 to 2 hours after eating so its best to test then to see if you've given the correct amount.

My advice to you would be to get yourself in a routine, eating the same quantity of carbs for each meal. E.g. eat the same quantity of carbs for breakfast from day to day, same for lunch and tea. Once youve got the hang of things, then you can be a bit more variable in what you eat. Always test before and after each meal. Always test before bed and upon waking so you know that your long acting insulin is correct. Same for exercise. Switch your carbs to low GI so you dont get any peaks in your levels.

Buy Gary Schneider's Think Like a Pancreas. Its a must, it will teach you a lot. Once you've got the hang of things you may want to consider low carbing. Also pay attention to the advice on here, its been invaluable to me.

I wish you all the best, I really do. Once you get the hang of things you can live a completely normal life. In fact, my diabetes has made me much more healthy than any of ny friends. All the best.
 
SamJB said:
Buy Gary Schneider's Think Like a Pancreas. Its a must, it will teach you a lot.
Click to expand...



Good book and would second Sam's recommendation.

Novorapid takes around 15 mins to kick-in and peaks around 2 hours, it's said to still be active up to 4-5 hours after injecting.

Not sure of the long-term effects of hypo's as research is still on-going, however without stating the obvious they are best avoided and by adjusting your insulin to the food you eat should keep them to a minimum, around 6 months after diagnosis you are eligible to enroll on a carb-counting course such as DAFNE (google for info).

Keep in close contact with your DSN and diabetes team as being newly diagnosed you'll still be in the 'honeymoon period' so your control may be erratic, they will advise you on adjusting your insulin over the coming months.

Definately keep a close eye on your feet and have them checked regularly, I use a product called Flexitol Heel Balm which is available on prescription, after showering each morning I rub this into my feet which keeps them moisturised and soft. BTW, you didn't bring your diabetes onto yourself, type 1 is an autoimmune disorder so don't join the blame game.
 
JP83 said:
Hi there,

I was diagnosed with type 1 about a month ago after showing some of the tell tail symptoms for around 8 weeks before. After the initial shock and disapointment, one of my first thoughts was that I must have in some way brought it upon myself - I'm not sure of that is a common irrational though after being diagnosed? Anyhow I'm now settling into a bit of a routine and not looking too downbeat about my new outlook on life (at least not for the moment).

I've been put on Levemir and Novorapid and managed for the last few days to keep my BG levels below around 8 which I'm pleased with. It has meant I've had a few hypos, usually when approaching meal times. One thing I'm not sure about is wheter there are any long term affect of having hypos like there is for having sustained high BG levels? I think I've read somewhere that repeated severe hypos can lead to brain damage, but what about the moderate controlled ones - will they have any impact over the years?

The symptoms of my hypos seems to vary a bit and when I've tested my BG seem to have varied from between 2.3 and 3.5 when I'm feeling woosy enough to check. Is it possible to pass out from a hypo without having realised any symptoms as there doesn't seem to be that much consistency with them from what I can tell so far and they seem to come on very fast. Also, what would happen if you hypo in your sleep - would you even know?

I think this depends on the type of food eaten, but is there in general a time after eating when BG levels will peak? Also how long does the Novorapid take to kick in and how long does it work for?

Sorry to go on, but one final thing is that I've been told I should look after my feet, but I'm not really sure what I should be looking out for to be honest. Should I be moisturising them or anything like that, or is this something to look out for further down the line?

Thanks in advance for any thoughts or advice. Jon
Click to expand...

Hi Jon Welcome and sorry to hear of your recent diagnosis. You must not blame yourself for anything, Type 1 is when the pancreas stops working completely, it could be genetic, stress, a shock and worry could of played a part. People just dont know why, and lots of children are also dianosed with Type 1. I was reading an article in The Express today about Diabetes ( but not Type 1) and we make up just 10% of the diabetes population in the UK. It will be difficult to try and get your head around, lots of changes, but things will fall into place and in time it will get easier.

Hypo's could be down to too uch Insulin when taken with food and also any form of exercise will play a big part as excercise lowers the blood sugar. Please be very careful with hypos and treat them very quickly with fast acting carbs, such as jelly babies, jam, or glucose tablets and keep testing, testing and more testing!

You seem to be doing well and acting sensibly, so well done and if you need to ask anything else, someone will be able to help. I have to go now. ps You could also have a look on line at the Diabetes sites and they will give you advice,support and practical advice.

Best wishes RRB
 
I don't know about insulin activity curves, but I do know that blood glucose hits its peak near enough 72 minutes after commencing a meal. It's much sooner than many people think.
Hana
 
Hi Jon

After being diagnosed your emotions can go all over the place, it's natural a kind of grieving for a life you've lost and coming to terms with a new life and future you perceived... In reality apart from now bringing diabetic management into the scheme of things, your perceived future isn't going to change that much, unless you were heading towards becoming a astronaut of cause.

Looking after your feet, yes should be checking them daily, ensuring that you dry them probably etc... As to moisturising them, if you suffer with dry skin then yes if not then no need to. A good tip here, if you buy a new pair of shoes put plasters on where the shoes are most likely to rub, heels, little toe etc.. And check to ensure that they aren't rubbing, if they do the plasters will help protect the skin (this is a trick my mum taught me even before I was diabetic)

As to Frequent mild hypo's, yes these do have an impact long term, the more frequent you suffer a mild hypo the more the body can desensitise itself to them, causing hypo unawareness.. If you are a driver then you need a good standard of hypo awareness.. if you suffer 2 hypos that required somebody else to bail you out, such as a paramedic you will lose your driving licence.. So if you've got one, I suggest that you check out the DLVA's guidelines to testing BG's with driving.

As to whether it causes long term brain damage or impairment, the jury is still out and still a lot of research being done in this area... Some say yes others say no!

But one thing they have found in elderly diabetics is that if they suffer a medium plus hypo they are more likely to suffer a heart attack or stroke not long after the event!

Good blood testing routines are a must, at the start you do really need to be keeping a food diary, with carb amount/type eaten, exercise levels etc (testing around exercising) as this data will be what you'll using to fathom out your control needs....

As to testing every hour, well this only works if you doing a fasting test to check out if your basal (background) insulin is correct... Otherwise the information being collected will be almost effected by quick acting insulin, food eaten etc..

The basal profile is actually the kingpin to control, if the background is set correctly here then all the other calculations for quick acting insulin, such as carb/insulin rations, correction factors will all work off the basal profile line..

But remember, at first diabetes and it's control is a very steep learning curve, with a lot of information/data to collect but over time it does get easier and more natural within your routine... so don't get too despondent if things don't quite pan out, draw a line under it, look at your data to see if you can work out what went wrong, so you can adjust for next time..
 
WOW!! Thanks so much to each of you for taking the time to share some of your knowledge and tips with me. Some really great information there for me to take onboard. I'll definately get myself a copy of Think Like a Pancreas.

At the moment I take 16 units of Levemir in the morning, I'll discuss with my DSN splitting the dose as since returning to work my night time levels have been around 4 but rising to about 8 by the morning. Perhaps splitting will improve things a bit.

I work abroad living on a construction camp and I'm finding that although the food is extremely repetative and boring... rice for lunch and dinner everyday! No variety, but on the bright side it's making it easier for me to monitor my carb intake than it was back home. I think I'm taking on board around 65g carbs for breaky and around 120g for lunch and dinner. I've been consistantly having hypos before lunch with my current insulin arangement, my morning dose of Novorapid is probably a touch high - I've been taking 6 units with breakfast and 8 units at lunch and dinner. I'll try 5 tomorrow and see if that helps.

I really appreciate the responses I've recieved here - thanks once again. I'll perhaps post an update a little further down the line, I'll prob have plenty more questions in the coming months.

Best wishes, Jon
 
Hey Jon!

I can't add much to what others have said, except that i suspect it your basal (Levemir) that's causing the pre-lunch hypo rather than the bolus (Novorapid). You might be able to correct it by droppping the Novo dose, but it would be better to get the Levemir right first and then see whether your novo is correct. Splitting the Levemir will probably help with this but you then have to be aware that as levemir lasts for about 18 hours for many people, there will be times when you've got a 'double-dose' in you and you might need to adjust your novo ratio accordingly :crazy: Don't worry, you'll figure it out. It's just a bit trial and error unfortunately.

Take care

Smidge
 
JP83 said:
I've been consistantly having hypos before lunch with my current insulin arangement, my morning dose of Novorapid is probably a touch high
Click to expand...

A lot of diabetics experience something called Dawn Phenomena. This is where the body produces hormones that raise sugar levels during the morning. It happens to me and it means that I need to give myself more insulin for breakfast than what I would if I ate my breakfast later in the day. In my case I think the hormones disappear quite quickly, but I'm left with the insulin in my body. So two hours after eating breakfast I'll have some carbs (15g), which see me through until lunch time.

If your pre- and post-breakfast readings are similar and you think you've got your long acting insulin correct (because if you're giving yourself too much, then it will cause you to go hypo between meals) then it might mean that you need to top up your sugar levels mid-morning with a snack.
 
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