Lowering your basal insulin.

[nessa1970]

Hi everyone. I'm type 1 and was diagnosed type 1, 8 weeks ago. Though I was type 2 for 1 half years. I have put on 6kg since being on insulin... it's really depressing. I lost 23kg as a type 2 doing the low carb lifestyle and was really happy with this. I new all about type 2 and I was comfortable there.. now I'm told you can eat what you want etc as a type 1 etc. I was on 10 units of lantus an 3 apidra with meals. I've taken myself off the apidra. I'm taking 4 units of basal.. I'm going to try this for a few weeks see how I go. I'm not sure what to do really. But I do know I don't want too put on more weight... I am finding that my bs are higher but I'd rather that than the hypos anyway. There awful and I'm use to the symptoms of higher sugars I put up it for a long time being a type 2 and no one listened for a long time till I was really unwell... I'm wondering if anyone else has this issue and if so what did you do? I'm from New Zealand and we only have lantus and apidra. My dn gave me a script for metforman... only 8 weeks ago she told me I don't need it as a type one... so I haven't picked it up yet. Any insights from you all would be appreciated. Cheers

 

[noblehead]

As a type 1 you can still follow a lower carb diet if that's what you want to do, obviously you would need to adjust your bolus (Apidra) doses to match the type of meals you eat but it's not a impossibility but it will take some trial & error.

Going from 10u of basal to 4u and not taking Apidra is a big step and not one I'd advise, high bg levels can be dangerous and lead to long-term complications if your not careful.

 

[azure]

I agree with @noblehead that it sounds like you're making a fairly big change with your insulin.

You say you've put on weight being on insulin - can I ask what your BMI is? Or your weight/height if that's easier.

How are your blood sugars during the day?

Although in theory you can eat what you want and cover it with the appropriate insulin dose, if you overeat then you'd put on weight like anyone else. Would you be happy sharing what you'd eat for a normal day's meals?

Have you spoken to your DSN about what you've done to your insulin doses? It's always best to get advice when making any changes, especially if you've only been on insulin a short time.

Insulin in and of itself doesn't make you fat. You've mentioned Metformin. Do you have insulin resistance?

 

[Daibell]

Hi and welcome. Whoever told you that you can eat what you want when on insulin is an idiot. Yes, you can but you will gain weight as the insulin will convert any excess carbs to stored fat. Lantus is a very popular Basal and Apidra less common as a Bolus but should be fine. Are you carb-counting the Bolus to match the meal-time carbs? Have you adjusted the Basal to get it in balance. I would hope if you go back to your earlier low-carb life-style your excess weight will fade and you will need less insulin. If you carb-count with the Basal/Bolus and get the balance right, hypos should not be very common.

 

[nessa1970]

I agree with @noblehead that it sounds like you're making a fairly big change with your insulin.

You say you've put on weight being on insulin - can I ask what your BMI is? Or your weight/height if that's easier.

How are your blood sugars during the day?

Although in theory you can eat what you want and cover it with the appropriate insulin dose, if you overeat then you'd put on weight like anyone else. Would you be happy sharing what you'd eat for a normal day's meals?

Have you spoken to your DSN about what you've done to your insulin doses? It's always best to get advice when making any changes, especially if you've only been on insulin a short time.

Insulin in and of itself doesn't make you fat. You've mentioned Metformin. Do you have insulin resistance?

Hi azure.
I'm 5.7 in height
And currently 64kg I was 58kg. I wouldn't say I over eat but I have gone back to eating carbs like bread rice pasta potatoes chips etc that I gave up for a long time... I haven't told my dn as yet but I see her and the endocrinologist 10th August... I will fill them in. I was type 2 for nearly 2 years an lost 33 kg ate low carb an hba1c dropped from 56 to 36. Then my bs readings for 4 months were between 18 an HI....on my testing kit. They put me on lantus 10 units... hba1c came in at 78 and I was sick and they did a c.peptide and a gad and said I'm type 1... I think I am a little in denile actually as type 2 I had it sussed.... I was a coke add8ct for 30 years and I cut this out of my life type 2.... now I'm back on it I seem to crave it and choclate and sweets which I never ever ate before... only coke was my sweet tooth. My bs are 18 to 28 at mo an I'm OK with that for now as I'm use to the symptoms attached with that as apposed the bang I get low bs.... it's so sudden no warning and it's terrifying.

 

[nessa1970]

Hi and welcome. Whoever told you that you can eat what you want when on insulin is an idiot. Yes, you can but you will gain weight as the insulin will convert any excess carbs to stored fat. Lantus is a very popular Basal and Apidra less common as a Bolus but should be fine. Are you carb-counting the Bolus to match the meal-time carbs? Have you adjusted the Basal to get it in balance. I would hope if you go back to your earlier low-carb life-style your excess weight will fade and you will need less insulin. If you carb-count with the Basal/Bolus and get the balance right, hypos should not be very common.

Hi. I was on 3 units apidra 10 lantus... I don't know how to carb count. My dn said not to worry about this yet. I get the feeling she thinks I have a food issue problem or a weight one... yes I don't like to go under 57kg or over 61kg. But that's a guide I gave myself as I worked hard to cut out bad food an my coke addiction and went lchf an maintained this for nearly two years... so i do get really paranoid and scared to put it back on and as a type 1 I can see how hard it would be to lose 23kg from the beginning all over. It scares me alot. I'm not 26 I'm 46 it's harder to lose anyway... my dn is over weight an I'm really sick of her comparisons as in probably thinks my 6kg gain is nothing as she can't see it. But I can see an feel it around my gut... Anyway sorry for the rant... guess I'm a bit mad inside as I was sick for a year and almost 2 years before I was off in an ambulance to hospital with breathing and chest pains to be told it's not a heart attack you have high sugars see gp asap. Then mucked around sick for months more in fact 1 and half years on an off to be really I'll to be told type 1. I'm not holding much faith in the hospital or Dr surgery to be honest.

 

[nessa1970]

Hi azure.
I'm 5.7 in height
And currently 64kg I was 58kg. I wouldn't say I over eat but I have gone back to eating carbs like bread rice pasta potatoes chips etc that I gave up for a long time... I haven't told my dn as yet but I see her and the endocrinologist 10th August... I will fill them in. I was type 2 for nearly 2 years an lost 33 kg ate low carb an hba1c dropped from 56 to 36. Then my bs readings for 4 months were between 18 an HI....on my testing kit. They put me on lantus 10 units... hba1c came in at 78 and I was sick and they did a c.peptide and a gad and said I'm type 1... I think I am a little in denile actually as type 2 I had it sussed.... I was a coke add8ct for 30 years and I cut this out of my life type 2.... now I'm back on it I seem to crave it and choclate and sweets which I never ever ate before... only coke was my sweet tooth. My bs are 18 to 28 at mo an I'm OK with that for now as I'm use to the symptoms attached with that as apposed the bang I get low bs.... it's so sudden no warning and it's terrifying.

23kg not 33

 

[tim2000s]

@nessa1970 I'm afraid that you've been fed rather an uninformed set of information. Even as a T1 on insulin, you can't eat anything you like. Specifically, cakes, coke and sweets all cause rapid rises in glucose levels that are damaging, and typically, rapid falls as the insulin kicks in. And as you've discovered, they tend to drive weight gains to the combination with insulin.

Whilst you had T2 sussed on low carb, I'd suggest that if you were to revert to that way of eating as a T1, you'd find that actually, you'd do pretty well there too. There are no issues with eating low carb as a t1 and many of us do it. It makes managing everything quite a lot easier.

The other benefit of lower carb eating is that you need less insulin and this means you don't get sudden spikes and drops. You already know that running at 18-28 is seriously damaging for you, and only you can make a decision, but in your shoes, I think I'd be looking at going back to Low Carb eating.

 

[nessa1970]

@nessa1970 I'm afraid that you've been fed rather an uninformed set of information. Even as a T1 on insulin, you can't eat anything you like. Specifically, cakes, coke and sweets all cause rapid rises in glucose levels that are damaging, and typically, rapid falls as the insulin kicks in. And as you've discovered, they tend to drive weight gains to the combination with insulin.

Whilst you had T2 sussed on low carb, I'd suggest that if you were to revert to that way of eating as a T1, you'd find that actually, you'd do pretty well there too. There are no issues with eating low carb as a t1 and many of us do it. It makes managing everything quite a lot easier.

The other benefit of lower carb eating is that you need less insulin and this means you don't get sudden spikes and drops. You already know that running at 18-28 is seriously damaging for you, and only you can make a decision, but in your shoes, I think I'd be looking at going back to Low Carb eating.

Hi Tim
Yes I am going to do low carb again as soon as I'm back to 60kg. My dn said you can eat what you like cause you can bolus but not all the time as in junk constantly... I do find tho when you hypo cause you need sugar I find it sort of sets me off on a sugary day full stop really.... it's quite frustrating I guess I just have to be stronger.... thank you

 

[tim2000s]

Hi Tim
Yes I am going to do low carb again as soon as I'm back to 60kg. My dn said you can eat what you like cause you can bolus but not all the time as in junk constantly... I do find tho when you hypo cause you need sugar I find it sort of sets me off on a sugary day full stop really.... it's quite frustrating I guess I just have to be stronger.... thank you

I find it easier to lose weight low carb than normal, so you may find going earlier will help more!

 

[nessa1970]

I find it easier to lose weight low carb than normal, so you may find going earlier will help more!

I'll start tomorrow but I won't change my basal from 4 units yet an I'll continue with no bolus for a few days anyway just to see how 30grams of low carb will go on only 4 units basal... I suspect I'll have to raise it to 6 in a few days but while I'm on 4 I may as well go up slowly and see what suits me best. I'd definitely be happier as type 1 if I didn't have to have bolus unless it was a treat cake etc and lantus at 6 to 8 at most... I feel I wouldn't put on weight...

 

[azure]

Hi Tim
Yes I am going to do low carb again as soon as I'm back to 60kg. My dn said you can eat what you like cause you can bolus but not all the time as in junk constantly... I do find tho when you hypo cause you need sugar I find it sort of sets me off on a sugary day full stop really.... it's quite frustrating I guess I just have to be stronger.... thank you

Your BMI at 64kg is 22 which is in the healthy range I understand why you're scared of putting on weight and that you have a weight range you feel comfortable in. I think we all have that - a weight we feel 'right' at. As long as that weight pretty much coincides with the weight your body naturally prefers to sit at, then that's fine.

Carb counting is crucial for control. Do push to be taught this. I have no idea why they stopped teaching this on diagnosis. It doesn't make things more complicated, it actually makes it a hell of a lot easier. You get much better blood sugars so feel better physically, mentally and emotionally.

There is nothing wrong with moderate carbs! It sounds like your problem isn't the carbs, but more the fact you've not received all the education and support you need. Push for that and you'll feel a lot more positive and more in control - of everything, including your weight

Yes, some Type 1s eat low carb, but many eat moderate carbs and have very good control. The trick is to carb count, bolus at the right time and learn how your body deals with carbs. I eat cereal, bread, rice, pasta, etc but all in moderate portions and with the appropriate dose of insulin at the right time. I also eat desserts on occasion but avoid very sugary ones and large portions.

Think about what works for you food-wise, push for education particularly about carb counting, and maybe get a good book eg Think Like A Pancreas.

I understand how disorientating a Type 1 diagnosis is, but give yourself (and your weight/body) a chance to settle down and I don't doubt you'll do fine

 

[azure]

@nessa1970 Check out this thread. It's one of a number here about the amount of carbs Type 1s eat:

http://www.diabetes.co.uk/forum/threads/t1s-how-many-carbs-do-you-have-a-day-typically.104957/

Just to give you an idea

 

[nessa1970]

@nessa1970 Check out this thread. It's one of a number here about the amount of carbs Type 1s eat:

http://www.diabetes.co.uk/forum/threads/t1s-how-many-carbs-do-you-have-a-day-typically.104957/

Just to give you an idea

I've ordered that book from the library I think you may have mentioned it in another thread of mine. It must be popular as its still out... I will ask the endocrinologist on the 10th re info on carb counting too. How do you mean "when" to bolus and "how" much? I was on 3 apidra each meal time... and the saying was.... jab an eat. Don't eat don't jab. Thank you for your advice. I will research myself also re carb counting and look at your link.

 

[nessa1970]

I've ordered that book from the library I think you may have mentioned it in another thread of mine. It must be popular as its still out... I will ask the endocrinologist on the 10th re info on carb counting too. How do you mean "when" to bolus and "how" much? I was on 3 apidra each meal time... and the saying was.... jab an eat. Don't eat don't jab. Thank you for your advice. I will research myself also re carb counting and look at your link.

I noticed most people have between 80g and 150g.
That seems alot. I have always done 20-50g. Nothing to do with diabetes I use to do Atkins years ago and have stuck to that on and off. Tho I don't really count veges as there healthy.... I do include fruit tho... an that's from an Atkins carb book with amounts in it. I add them up. I wouldn't really have a clue as to how you add it up say you ate a pancake an say that was 20g how you would equal that into a unit...... but I'll sure be asking at my endocro app next week and will look on net too. Is there a carb count ap you can download for a diabetic?

 

[azure]

I've ordered that book from the library I think you may have mentioned it in another thread of mine. It must be popular as its still out... I will ask the endocrinologist on the 10th re info on carb counting too. How do you mean "when" to bolus and "how" much? I was on 3 apidra each meal time... and the saying was.... jab an eat. Don't eat don't jab. Thank you for your advice. I will research myself also re carb counting and look at your link.

Ah, the book is so good I mentioned it twice Seriously, it has a lot of info but is in a friendly, easy to read tone.

Sorry if I'm saying things you already know re bolusing, but the important thing I had to get in my head when I was diagnosed was that insulin isn't like other meds where the Dr gives you a dosage, you just take that dosage and everything is fine. The amount of insulin you need will vary - particularly the bolus insulin. That will depend on your blood sugar, what you're about to eat, what you're going to do after the meal (eg exercise)

The amount of carbs in your meal, and, to a lesser extent, the protein will affect how much insulin you need. Hence the crucial importance of carb counting. When you don't have Type 1, your body will deal with whatever you eat perfectly, but for us we have to 'be our own pancreas' and try to match our insulin to our food.

When I was first diagnosed, I was initially on set doses of insulin for meals like you. BUT the crucial difference is I was told how many carbs I needed to match that dose of insulin. If I hadn't known that, I could have eaten lasagne and chips one night (lots of carbs) and had an after meal blood sugar of 15, and then the next night decide to have a tuna steak and salad (minimal carbs) and have a big hypo before I even got round to testing my after meal blood sugar. Knowing how many carbs to have for my set insulin dose meant I avoided both highs and lows.

I also mentioned "when" to have your bolus. I'm not familiar with Apidra and have never used it, so this may be different for you, but the insulin I was on was Humalog. I was told to inject it right before I started to eat, but as many others have found, that doesn't usually work and causes a spike in blood sugar because even very fast acting insulins take a while to work, and so your blood sugar goes up. Most people find injecting Humalog more in advance of your meal stops the spike. Often people come on here and say things like "I can't eat toast because it spikes me" when actually they could eat toast if they simply had their bolus a little earlier.

Although "don't eat, don't jab" is true - you certainly don't want to have your meal time injection if you're not going to eat - you might also need to use your fast acting insulin in a correction dose. This is to bring down a high sugar. Do not do this until you've been taught how to obviously because you need to know what you're doing, but that is an occasion where you could take fast acting insulin without food.

But for "when" I simply meant timing your pre-meal bolus accurately to prevent spikes in your blood sugar.

 

[azure]

I noticed most people have between 80g and 150g.
That seems alot. I have always done 20-50g. Nothing to do with diabetes I use to do Atkins years ago and have stuck to that on and off. Tho I don't really count veges as there healthy.... I do include fruit tho... an that's from an Atkins carb book with amounts in it. I add them up. I wouldn't really have a clue as to how you add it up say you ate a pancake an say that was 20g how you would equal that into a unit...... but I'll sure be asking at my endocro app next week and will look on net too. Is there a carb count ap you can download for a diabetic?

People use Carbs and Cals, I believe. I just use my 20+ years of carb counting or Collins Gem Carb Counting book to check foods I don't eat that often. Mainly, it becomes second nature eg I usually have the same cereal for breakfast so don't have to count carbs each time, I just know that a certain weight of that cereal means I need X amount of insulin. For evening meals, we tend to have the same 20 or 30 meals spread over the weeks, so, again, I weigh things like pasta to make sure I'm having the same amount and know how much insulin I need for that meal. I even write carb counts by my favourite recipes.

Everyone has an insulin to carb ratio. This is the amount of insulin you need for a certain amount of carbs. It varies per person, and it can be different for different meals eg for breakfast I have approx 45g carbs and need more insulin for those carbs then than I would if I had 45g carbs for my evening meal. Your DSN should help you estimate this. So if, just as an example, your DSN told you you had an insulin to carb ratio of 1 to 10g, that'd mean you'd need 1 unit of insulin for every 10g of carbs you ate. So, in your example, your pancake with 20g carbs would need 2 units of insulin

I stress that's just an example. Your DSN will help with your own personal ratio(s)

Does that help and make sense? It's not as complicated as I probably made it sound : D

 

[nessa1970]

People use Carbs and Cals, I believe. I just use my 20+ years of carb counting or Collins Gem Carb Counting book to check foods I don't eat that often. Mainly, it becomes second nature eg I usually have the same cereal for breakfast so don't have to count carbs each time, I just know that a certain weight of that cereal means I need X amount of insulin. For evening meals, we tend to have the same 20 or 30 meals spread over the weeks, so, again, I weigh things like pasta to make sure I'm having the same amount and know how much insulin I need for that meal. I even write carb counts by my favourite recipes.

Everyone has an insulin to carb ratio. This is the amount of insulin you need for a certain amount of carbs. It varies per person, and it can be different for different meals eg for breakfast I have approx 45g carbs and need more insulin for those carbs then than I would if I had 45g carbs for my evening meal. Your DSN should help you estimate this. So if, just as an example, your DSN told you you had an insulin to carb ratio of 1 to 10g, that'd mean you'd need 1 unit of insulin for every 10g of carbs you ate. So, in your example, your pancake with 20g carbs would need 2 units of insulin

I stress that's just an example. Your DSN will help with your own personal ratio(s)

Does that help and make sense? It's not as complicated as I probably made it sound : D

Yes that was a great example. I cook for 4 tho so if I make say lasagna I would have to guess as to my slice of it what the carb content would be. Or do I weigh it all and then divide by 4? I think I'll ask to see a dietitian as well just so I'm on the right track. Thank you so much for your help I really appreciate it. It's alot to learn.

 

[azure]

Yes that was a great example. I cook for 4 tho so if I make say lasagna I would have to guess as to my slice of it what the carb content would be. Or do I weigh it all and then divide by 4? I think I'll ask to see a dietitian as well just so I'm on the right track. Thank you so much for your help I really appreciate it. It's alot to learn.

For lasagne, I write the carbs on the recipe in my book, ingredient by ingredient, then I work out what portion I'm going to have and work out the carbs for that by dividing the total. I then write that info on my recipe so I know for future reference eg I woukd write something like 1/6 == 35g carbs.

Yes, it's a lot to learn, but I promise it gets easier

 

[nessa1970]

For lasagne, I write the carbs on the recipe in my book, ingredient by ingredient, then I work out what portion I'm going to have and work out the carbs for that by dividing the total. I then write that info on my recipe so I know for future reference eg I woukd write something like 1/6 == 35g carbs.

Yes, it's a lot to learn, but I promise it gets easier

Oh okay. Great thanks alot. Yes I'm sure I'll be a whizz in a year or so. For now I'm taking notes.. thank you very much for all the information. Much appreciated...