hypo after eating. Type1

Hello @spammy

The regime your husband has been advised to follow is now the new way to control bg levels.....being fixed bolus doses with a fixed basal dose as it is thought that adjusting insulin to suit the amount of food that's going to be eaten, is too difficult for most so fixed doses appear to be used. Im notsure how this way of thinking will work out for people especially with bg teststrips being reduced, but I think its thought that its easier to adjust the amount of food containing ccarbohydrate to be eaten than adjust the insulin. At the moment yr husbands bg is dropping too much because of not eating enough carbohydrate or put another way......too much bolus insulin.

Once youve got the amounts of carbohydrate sorted correctly so that bg stays within a good range, the hypo feeling should occur a lot less.

Did the nurse give any advice on how much carbohydrate meals husband needs to eat and what to do if bg goes too low or too high?

iHs said:

Hello @spammy

The regime your husband has been advised to follow is now the new way to control bg levels.....being fixed bolus doses with a fixed basal dose as it is thought that adjusting insulin to suit the amount of food that's going to be eaten, is too difficult for most so fixed doses appear to be used. Im notsure how this way of thinking will work out for people especially with bg teststrips being reduced, but I think its thought that its easier to adjust the amount of food containing ccarbohydrate to be eaten than adjust the insulin. At the moment yr husbands bg is dropping too much because of not eating enough carbohydrate or put another way......too much bolus insulin.

Once youve got the amounts of carbohydrate sorted correctly so that bg stays within a good range, the hypo feeling should occur a lot less.

Did the nurse give any advice on how much carbohydrate meals husband needs to eat and what to do if bg goes too low or too high?

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WOW iHs -- that starts off a completely new debate -- I am not saying you are wrong but if that is the newest way forward for Diabetics it is a complete step backward --- shocked here reading your post !!

iHs said:

Hello @spammy

The regime your husband has been advised to follow is now the new way to control bg levels.....being fixed bolus doses with a fixed basal dose as it is thought that adjusting insulin to suit the amount of food that's going to be eaten, is too difficult for most so fixed doses appear to be used. Im notsure how this way of thinking will work out for people especially with bg teststrips being reduced, but I think its thought that its easier to adjust the amount of food containing ccarbohydrate to be eaten than adjust the insulin. At the moment yr husbands bg is dropping too much because of not eating enough carbohydrate or put another way......too much bolus insulin.

Once youve got the amounts of carbohydrate sorted correctly so that bg stays within a good range, the hypo feeling should occur a lot less.

Did the nurse give any advice on how much carbohydrate meals husband needs to eat and what to do if bg goes too low or too high?

Click to expand...

OP's hubby is newly diagnosed, thus has been given a fixed dose whilst apts sorted out for him.
His pancreas is also having a fling due to the honeymoon period hence why we have suggested his meal time bolus is reduced.

himtoo said:

WOW iHs -- that starts off a completely new debate -- I am not saying you are wrong but if that is the newest way forward for Diabetics it is a complete step backward --- shocked here reading your post !!

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I think you will find all newly diagnosed start off on a fixed dose until they find their feet. If iHs's statement is correct then everyone will be moved to mixed insulin as a cheaper option.

With respect although fixed doses is a reasonably good way to find one's way with using bolus basal and then adjusting it using a carb ratio, where I live, bolus basal is being used but with fixed doses only and using a carb ratio to adjust the bolus, is thought to be not needed. I dont know how this will work out for people as I use a pump.

iHs said:

With respect although fixed doses is a reasonably good way to find one's way with using bolus basal and then adjusting it using a carb ratio, where I live, bolus basal is being used but with fixed doses only and using a carb ratio to adjust the bolus, is thought to be not needed. I dont know how this will work out for people as I use a pump.

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i suppose that is what I am saying -- it is a starting point not a regime !
fixed dose insulin is always going to be a retrograde step as opposed to self adjusting -- was just surprised to hear it was the way forward @iHs

himtoo said:

i suppose that is what I am saying -- it is a starting point not a regime !
fixed dose insulin is always going to be a retrograde step as opposed to self adjusting -- was just surprised to hear it was the way forward @iHs

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Yes, interesting idea! I haven't heard of this lately, but when diagnosed 30 years ago, this, effectively, was the regime recommended to me. It's a bit hazy now, so perhaps someone can jog my memory? I think I had one injection of Actrapid in the morning, and one injection of Insulatard at bedtime!
So, like you say, I would have thought that Fixed Dose is just a starting-point until patient learns to self-adjust insulin / mimic pump therapy? After all, a fixed dose is directly opposed to what a pump does.

Are these the options for Type 1 currently?

• If you can, get a pump and training
• If you can't get, or don't want to use a pump, adjust your multiple daily injections (Basal/Bolus) to match your carb intake
• If newly diagnosed Type 1, inject a fixed dose, but you have to make sure your meals/carbs match the dose! Otherwise, risk of hypos/hypers.
• Or, if newly diagnosed Type 1, go on a steep learning curve to match your insulin dose to the meals/carbs you choose to eat.

I'm a new T1 and on fixed doses for now. Definitely need to make sure I eat carbs with each meal - I've had a couple of hypos in the last few days as my blood glucose is now better controlled overall but I'm injecting 4 units of Novorapid at breakfast and lunch and 6 with my evening meal. I think at diagnosis you are focussed on different things and I personally would have found information on carb counting, on top of everything else, too much to take in. Now 3 weeks after diagnosis, I feel ready to handle more and hope that I can start adjusting my insulin so I can eat as I want to, rather than eating to the insulin. Hope things get sorted for your husband Spammy.

Goldmum said:

I'm a new T1 and on fixed doses for now. Definitely need to make sure I eat carbs with each meal - I've had a couple of hypos in the last few days as my blood glucose is now better controlled overall but I'm injecting 4 units of Novorapid at breakfast and lunch and 6 with my evening meal. I think at diagnosis you are focussed on different things and I personally would have found information on carb counting, on top of everything else, too much to take in. Now 3 weeks after diagnosis, I feel ready to handle more and hope that I can start adjusting my insulin so I can eat as I want to, rather than eating to the insulin. Hope things get sorted for your husband Spammy.

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I agree with your comment. When I was first diagnosed, it was such a lot to take in, the last thing I needed was to learn carb counting as well. I was put on mixed insulin and have managed to keep my bg levels within the normal range ever since. However 7 months down the line, I do find it a little restrictive and may well get to the point of giving up and changing to basal/bolus. I've learned to carb count in readiness for the change over, but at the moment I feel "If it ain't broke, don't fix it"....................

I'm newly diagnosed and was put on a fixed dose initially, this is most definitely only a temporary measure to bring BG levels down but within about 5 days they gave me an insulin to carb ration of 1:10 and I started carb counting. I've since reduced my background from 8 units to 4 as I kept going low overnight, honeymoon phase seems to have kicked in!
I have been doing a not very mathematical 'round down and knock one off' my bolus since then as 1:10 also keeps sending me low. My husband is king of the spreadsheet and we reckon my ratio should be about 1:13, so I'm trying this.

I couldn't stick it for long on a fixed dose, 6 units for my 20g of carb for breakfast just sent me hypo.

My consultant agreed a half unit pen would be useful and I'm waiting for it to be prescribed.

To be honest I think they look at the individual, if you can handle carb counting straight away great but if you need a little more time they stick you on a fixed dose to get used to testing and injecting.

Its getting that individual recognition.... Sometimes we are all treated as "average".. "This works for ms "xx" and the others so we'll try you on that"

I remember totally different but being told to test day for basal testing on pump because thats the way we teach you...no consideration that nights I was alone whilst hubby worked and I thought nights more important. ;still did it my own way!!).

Without being admitted to hospital nowadays and getting a good induction to diabetes as I was 30 years ago I think that "average" or "clinical guidelines" has taken over.

It is a huge diagnosis and life changing and it just seems nowadays that so many young children (especially) are getting T1. No easy answer in this climate of the NHS trying to manage their budgets and trying to care.

I too, like Claire007, was initially put on a fixed dose but within days realised this wasn't going to work and began readjusting. The hospital team were fantastic. We were booked on an Xmas 2 week cruise in less than 2 months and Hubby wanted to cancel. My team were appalled at the idea of not going! Suddenly I was given a new meter - Aviva Accu Chek expert and the carbs and cals book - go forth and learn, Grasshopper. Within 10 days of going onto insulin I was weighing and guesstimating my way through every meal. The cruise was a great success and I haven't looked back. Still make some horrendous mistakes but am learning all the time. It's a steep learning curve - one I'm sure we would all prefer not to have - but with loads of you posting great stuff on here I'm getting there! Chin up Spammy! You're difinitely in good company on here!