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First visit to Diatetes Dietician

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draytop

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Hi,

I'm a newly diagnosed (December 2012) Type 1 Diabetic. I had my first visit to the Dietician, and one of things she told me I disagree with and wanted people's advice/opinions.

She asked me if I do not eat, what happens to my Blood Sugar count?

I replied "My evidence shows that it goes down."

She said that wasn't the case, that Blood Sugar count would rise?

How is that possible?
 
It's an odd conversation for a dietician because it is more complex than that. You are certainly at risk of very low blood glucose levels if you don't eat so it is odd that the dietician said they should rise, as if it is inevitable. It can rise because the body can draw on fat stores and put some glucose into your blood, but it can also go down, which is why people can have problems with hypos. I'm not type 1 but, as far as I understand, a regular and consistent diet is important for type 1 diabetics precisely because control, up or down, can be erratic.
 
I agree with Yorksman. Most of the time not eating for a T1 on insulin will push the blood sugar down and eventually into a hypo. At the lower limit your pancreas and liver may spot the problem and the latter will release Glucose to maintain a minimum sugar level. This may be what the dietician was getting at, but in some people the recovery mechanism won't work and we are talking about things at the lower, dangerous level. T1s do get hypos sometimes which is caused by too much insulin compared with food intake.
 
As others have said when you dont eat your blood glucose (bg) will start to drop but as it gets low your body senses this and glucose will be released into your blood stream causing your bg to rise.

Eating regular meals is important for all diabetics IMHO.
 
draytop said:
She asked me if I do not eat, what happens to my Blood Sugar count?
Click to expand...


The answer depends upon how long you fast for and what insulin regime you are on, for people on basal/bolus you can skip a meal provided your basal insulin is set at the right dose, if basal is too high then hypo's are guaranteed, if it's too low then bg will inevitably rise, stress and hormones can also make bg levels rise.

I try and eat 3 main meals a day but do occasionally miss lunch if I've eaten breakfast late and instead have my evening meal slightly earlier (I'm on basal/bolus).

On twice daily injections it's paramount to snack between meals to stop bg falling, so the answer does depend on what insulin you take amongst other things!
 
I find my BG goes down too if I don't eat. Years ago, when first diagnosed, I sometimes got increases when not eating. I surmised this was my livermaking extra.
However, In general not eating drops your blood glucose, especially if you haven't any "reserves" of raw materials to make glucose.
Looks like that dieticiqan was trying to scare you into compliance with NHS guidelines on diet. If you see her again ask her to explain the mechanism of what she said. In the meantime keep monitoring and ignore the advice. The less you eat, the less insulin you will need to cover it. My T1 husband [ aged 66] doesn't take any insulin if he misses a meal. Is lates Hb a1c was 6.8% and he almost never has a hypo.
Hana
 
Depends on whether you are taking insulin or not. Before you were diagnosed they would undoubtedly have risen, particularly over night when you weren't expending much energy.

In non diabetics two hormones are used to keep glucose levels balanced insulin and glucagon.
Your liver produces/releases glucose throughout the day and night. When between meals you are 'starving' or rather when your cells have used some energy then glucose levels drop. This will signal the release of glucagon and at the same time reduce the insulin. The glucagon stimulates the liver to release glucose. As levels rise then this will in turn signal the release of more insulin and the release of glucose will be decreased. Its like a see saw keeping your glucose balanced.

If you didn't inject background insulin either as a separate basal or as part of a mixed insulin, then levels will rise because there is nothing to slow down or stop the release of glucose from your liver. It would continue releasing it.
( indeed some researchers think that it might be better to suppress glucagon rather than inject insulin;it works in mice but then so do a lot of things )
As Nigel says if your background insulin is correct then you should be able to miss a meal without glucose levels rising (or indeed falling). This is what we strive for since it helps give good control but it is a counsel of perfection and many people allow for a rise of a couple of mmol/l overnight for example. Our activity levels also vary so a background dose that is right for a normal day may not work for an afternoon on the sun lounger (so levels may rise) or a jog round the park (they may fall)
 
Ok, thanks for all the advice.

I am on Novarapid for meals and Levemir at night.

I have had a few hypos, but they've all been due to over-injecting the Novarapid insulin at mealtimes.

I am still waiting for my carb-counting course, but am playing it be trial and error as to how much Novarapid to inject.
Currently between 6 and 10units depending on the amount of carbs guess work.
 
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