Kinda confused

[SilverK]

Hello, I’m new here so please forgive me if I’m just asking questions that you’ve all answered so many times before.
I’ve been put on insulin following a heart attack. The Diabetes team at the hospital are great, lots of contact and support and regular phone calls since I got home. I really can’t fault them.
I take Lantus at night and a fixed dose of novorapid before each meal. My DN says that at this stage of trying to find the right background level of insulin I need to eat carbohydrate at each meal, including bread, pasta, potatoes and rice. I’m not at the point where they want me to carb count and inject insulin accordingly yet.
My levels are all still in the teens. The amount of insulin I inject doesn’t seem to make much difference. At least, I can’t see a pattern yet.
I think the levels will drop a bit if I cut the carbs, but I’m reluctant to mess with my diet too much at this stage Incase I disrupt what they’re trying to do. I am s’posed to be getting a call from a dietitian today so I’m hoping for some answers there.
Any advice???

 

[HSSS]

I’m not on insulin nor a dietician but I’d say eat how you want to eat and they should match the medication to that. Obviously I wouldn’t deliberately add carbs but if you want to long term eat a few less then do so. It seems crazy to eat just to justify medication.

 

[TashT1]

It’s a pretty common approach at first I think.

Initially the goal is to get your BG down slowly & establish the baseline. As you get more familiar with what causes fluctuations you will build confidence to carb count & make adjustments.

I initially got impatient & lowered my carbs to meet the fixed insulin doses, my BG dropped into range quickly. Then over time I started to fine tune the basal dose.

Once I became confident in carb counting & adjusting the ratio I started experimenting. This is where I am now. Sometimes it’s spot on & sometimes I spike to 9 & adjust for the next attempt.

How did it go with the dietician? I’m still waiting for my referral

 

[Resurgam]

That is a totally illogical way to deal with an inability to cope with carbohydrate..

Yes, I am raising one eyebrow.

 

[MarkMunday]

... My DN says that at this stage of trying to find the right background level of insulin I need to eat carbohydrate at each meal, including bread, pasta, potatoes and rice. ...

The mind boggles! This is like advising someone to use petrol to put a fire out. Especially as bolus insulin is not being used. The first challenge is to figure out how much basal insulin (Lantus) is required, and minimising carbs during tis time helps. Introducing carbs with mealtime bolusing become much easier.

 

[TashT1]

Especially as bolus insulin is not being used.

It says in the original post that bolus is being used (novarapid) it’s just a fixed dose.

Being advised to have some carbs is not the same as having a lot of carbs. Did they give you an exact amount to include in your diet? With a bit of experimenting you can figure out how many carbs are ‘safe’ to eat on your fixed dose and still bring your numbers down.

 

[SilverK]

Hello everybody, and thanks for responding!
No, no info as to how many carbs to have at each meal. I’m assuming the dietician will give me that info but they didn’t phone yesterday. I guess they got busy. I’m sure they’ll phone soon.

Fasting blood sugar is high teens.

Breakfast is the same every day. A latte and a piece of granary type toast with butter. (Approx 30g or 32 if I have marmite )

Lunch for the last few days has been one piece of toast with butter, with two eggs, scrambled with spring onion and a little bit of cheese.

That seems okay so far. My readings drop steadily from breakfast through to dinner to the low teens (I almost made single figures a few days ago but that seems to have been a one off)

Dinner was jacket potato, veg/salad and protein, sometimes a yogurt. Obviously too many carbs as my before bed reading is straight back up again. I tried rice (one of those little pre portioned triangular bags) - a little bit less of a pre bed rise but back to square one in the morning and less of a fall during the day.
Last night I had tuna salad and two pieces of toast. Pre bed reading was higher than for rice or jacket pot and back to square one today.

I’m a bit scared to back the carbs down too much for dinner. Not so much for the novorapid but I don’t know what the Lantus will do while I’m sleeping . I don’t know enough about this yet.
It’s getting a bit disillusioning. Insulin doses are going up and it doesn’t seem to be having any effect.

 

[Resurgam]

You are eating just about my whole day's carbs for breakfast - it really doesn't make sense to someone controlling type two by diet alone - as I seem to be able to do.
As others have pointed out, you are being told to eat carbs to counteract the insulin you are injecting - it is just not a sensible situation.
Your insulin use could/should go right down if you were to stop eating the high carb foods, because your BG levels are in the teens - I hardly ever see as high as 8 after eating, and I am really sensitive to carbs.

 

[Japes]

@SilverK One of the reasons for taking the first few weeks, at least, slowly on insulin is that if you've been running high for a long while you can do other damage, particularly to eyes, if you come down to "normal" levels too quickly. I believe there are people around on this forum who can attest to this being the case from personal experience.

Having been very low carb for the months prior to going on insulin, I found the weeks before I was let loose to carb count frustratingly cautious. My team found me frustrating, I'm sure, as low carb suited me well. So, I didn't go overboard with "Eatwell" plate level of carbs until my numbers began coming down properly after about 4 or 5 weeks. It did happen quite suddenly, as I remember.

Then, I was allowed to carb count though, in effect, I'd already been doing it as I knew more about it from the nature of support work I do. I tried higher levels of carbs whilst doing the DAFNE course last year, and it really doesn't suit me even with adjusting my insulin accordingly. So, these days, I seem to be sitting in a happy medium. Slightly more carbs than I used to eat in my pre-LADA diagnosis, but not so low my team has hysterics. I'm content with that and it shows in my bloods results.

I also should point out, I'm treated as T1, (LADA being a slow onset T1 and my insulin use is not high, as I'm not resistant to insulin, unless unwell or eating too many for me carbs,) but if my diagnosis had remained T2, on insulin, I personally would have restricted carbs to a level to suit me once my team we satisfied I knew what I was doing.

 

[ickihun]

Hello everybody, and thanks for responding!
No, no info as to how many carbs to have at each meal. I’m assuming the dietician will give me that info but they didn’t phone yesterday. I guess they got busy. I’m sure they’ll phone soon.

Fasting blood sugar is high teens.

Breakfast is the same every day. A latte and a piece of granary type toast with butter. (Approx 30g or 32 if I have marmite )

Lunch for the last few days has been one piece of toast with butter, with two eggs, scrambled with spring onion and a little bit of cheese.

That seems okay so far. My readings drop steadily from breakfast through to dinner to the low teens (I almost made single figures a few days ago but that seems to have been a one off)

Dinner was jacket potato, veg/salad and protein, sometimes a yogurt. Obviously too many carbs as my before bed reading is straight back up again. I tried rice (one of those little pre portioned triangular bags) - a little bit less of a pre bed rise but back to square one in the morning and less of a fall during the day.
Last night I had tuna salad and two pieces of toast. Pre bed reading was higher than for rice or jacket pot and back to square one today.

I’m a bit scared to back the carbs down too much for dinner. Not so much for the novorapid but I don’t know what the Lantus will do while I’m sleeping . I don’t know enough about this yet.
It’s getting a bit disillusioning. Insulin doses are going up and it doesn’t seem to be having any effect.

Hi @SilverK
I'm on insulin and still producing a little of my own insulin but not enough for my 15st body.
Your weight will always determine how much insulin your body will need.
The hospital want to stop you having another heart attack and/or much more complications from diabetes. Hence why they gave you insulin immediately.
Now.
What you and the hospital need to find out is how much YOU need. Not even a C-peptide test will tell any of us that.
Yes depending on how you process protein as well as Carbs will determine how much you will need. (Obviously depending on your own production and fat deposits too) .

First of all. You need to find what gets your bgs at the right level to stop more complications.

I'd start as the hospital have. Allowing you to eat normally so they have a base to start from. It's imperative you get those bgs down.
Myself I've done a hellava lot of searching for whether I was type1 or 2. I will hv proof on my next C-peptide result.
Many type1s don't produce enough of their own insulin.
Many type2s have a faulty insulin pathway due to too much fat deposits or other interferences (which increases Insulin resistance).

Test test test. I test 7 times a day. You will be given enough testing strips to do just that. Later with confidence you can reduce thee amount.
Myself I use fatty protein to assist my higher bgs. Especially before bed so I wake on a good fasting blood glucose.
Don't over medicate before bed. Dangerous hypos are mostly in sleep.
If you start with these needs then on seeing dietician you can both determine how low your Carbs should be to be able to function well.
Later you can adapt to any of the low carb diets which you may perform better on.
Any questions let me know.
I'm very experienced in using mixed and individual insulin for what I feel I'm a little type1 and huge type2 diabetic.

Soak up everyone's opinion but ultimately even the hospital know its your journey. No one else's.

 

[SilverK]

@ickihun,
Thank you so much for the reply! Reassuring, encouraging and helpful all at the same time .
I’ve reduced my carbs a bit and I’m hoping that will help bring the numbers down faster.
I am worried about having another heart attack. I hate that there are things going on in my body that I can’t pull out and examine properly, if you know what I mean. All the guess work makes me anxious. The heart attack didn’t really hurt, it was just uncomfortable, and now every muscle twinge has me wondering. I hurt, all over, most of the time so it’s hard to tell what to pay attention to. I know that bringing my blood sugar down will help but I’m not sure how to manage a low carb diet which may be higher in fat with a heart healthy diet and the need to reduce my cholesterol. Hoping the dietician will be able to help there.
Just had a call from the cardiac rehab unit at my local hospital - most follow ups are being done by phone due to Covid. She mentioned that on my file there is some question about whether I’m T2 or something else entirely. That’s confusing, but I guess as I’m already on insulin it doesn’t really matter at this point either way?

Thanks again, so much, for all the help!