Missing Insulin Doses.

You must continue taking the insulin as prescribed when your ketones are high as you probably know that DKA can follow and that is dangerous. Weight gain on insulin is not the result of the insulin itself but having too many carbs. You must reduce the carbs and balance with increasing the protein and fat.

Hi @Sam17 ,

The thing to remember is that it's not the insulin per se that makes you gain weight, it's the amount you need to take to balance the carbs . Insulin is a natural hormone, and the idea is to mimic the balancing act found in a non diabetic, but because it is administered differently in a Type 1 , it's more difficult to get that balance right.

I believe that problems have arisen in many Type 1's since the introduction of the idea that you can eat what you like and bolus for it. It would seem that " eating what you like " or " whatever you like " and attempting to cover what is essentially a non diabetics diet with insulin leads to higher doses of insulin to bring your blood glucose down than would ever be naturally produced by a non diabetic. This will very often lead to weight gain because of the high volume of insulin injected.

The answer is to be more controlled with carbohydrates, and thusly reduce the amount of insulin needed while still maintaining good blood glucose levels.

Weight is not the be all and end all, you risk becoming very ill, and having complications that are not as reversible as losing a few pounds can be . In the short term the high blood glucose levels will make you feel awful , and long term, complications can make you wish fervently that you could put back the clock and do things differently. If you had control over someone else, you wouldn't treat them in the same way you inflict on yourself, would you ?

The good news is, you recognise that you aren't doing yourself any favours, and you have been brave enough to post about it and ask for advice That's a great first step ! The second bit of good news is that start getting back on track right away, and immediately you will begin to feel better ( and therefore look healthier ) and lessen your chances of complications, possibly even reversing any damage that's already been done. It will take some changes in your actions and thoughts, and change isn't always comfortable, but it gets better. After all, you are worth that effort !

My advice is that you do speak to your diabetes team about what you are feeling and doing. Don't worry about a judgemental reaction - they have heard it all before . They will help you come up with a strategy to get your diabetes under control and address your concerns. Their dietry advice is perhaps not the best, but the important thing now is to be healthy. That is the position to be in to tackle your diet .

Signy

In my late teens I was hospitalised with ketoacidosis due to me sleeping in, delaying(and sometimes missing) my morning dose and eating all the wrong things. It was the most unpleasant thing that has ever happened to me. I vomited off and on for 24hrs, the thirst was unbelievable so I'd drink a ton of water. Ten minutes later I brought all that waterback up and continued to dry heave once my stomach wash empty. It was relentless and exhausting. I was in hospital for 3 weeks in total because 1 week after I was admitted I started to vomit again.

This actually happened to me again a few years later, but this time was due to me getting the flu. I'll never miss a dose again and neither should you

Seriously, It was horrible, thing is though, it's not even the worst thing that can happen to you when you go without your insulin(aside from death)

have a look at this
http://www.dailymail.co.uk/health/a...le-having-terminate-pregnancy-risk-death.html

Hey Sam, reading that post is like I've wrote it myself, not now but through my teens and early 20's I struggled with my weight, and this was the way I thought I could solve it, also like you said it was laziness too. I made myself very ill, was hospitalised many many times, but it still didn't scare me, I wouldn't admit what I was doing but people around me realised as I was always ill and losing an unhealthy amount of weight, I wish I stopped far sooner, actually I wish I never done it to begin with but I can't change that now. Signy has said most of what I was going to suggest about carbs etc if you would like someone to talk to I completely understand, Abbie xx

Thank you for your post.

I have spoke with my nurse specialist but she hasn't made any plan for me to deal with this and I have been completely honest with her.

I know what I'm doing is not right but I can't seem to stop my self and start taking things seriously and don't know what it will take for me to start giving myself the insulin again I feel I'm in a deep hole and there's no way out deep down I know what I'm doing isn't the answer and I have days where I'm sick and have absolutely no energy but it doesn't make me think I should take my insulin I kind of feel I just need to get on with it and feel awful I don't know if that make sense to anyone or not

@Sam17, you need to get in contact with your diabetes clinic and ask to be seen asap, your DSN is wrong not to have made any plans to help you come to terms with things, you need to be seen by a consultant so do get in touch.

@Sam17, insulin is something many of us think wont harm us if we decide that we wont do an injection for the food that we eat but initially, high bg levels just cause a bit of thirst so it seems no big deal but over time, when we keep having high bg, the body appears on the outside to adapt but on the inside, it doesnt and the high bg starts to do internal damage to all our organs and a lot people do in actual fact, die in not a very nice way and thats after high bg levels has damaged the eyes, the feet and the hands. No one likes being diabetic but in life there are far far worse illness to suffer from than diabetes so please look after yourself. Insulin pen injections only take no more than a few minutes to do and although frowned upon by the medical profession, many people inject through thin clothing and very very few have developed any infection.
In the next few years, the closed loop artificial pancreas does look set to beome a reality. I hope to use it so keep yourself well and you will too.

Sam17 said:

Thank you for your post.

I have spoke with my nurse specialist but she hasn't made any plan for me to deal with this and I have been completely honest with her.

I know what I'm doing is not right but I can't seem to stop my self and start taking things seriously and don't know what it will take for me to start giving myself the insulin again I feel I'm in a deep hole and there's no way out deep down I know what I'm doing isn't the answer and I have days where I'm sick and have absolutely no energy but it doesn't make me think I should take my insulin I kind of feel I just need to get on with it and feel awful I don't know if that make sense to anyone or not

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I don't know if this helps, but you are not the only one to have felt like this, it's surprisingly common, and yet not often talked about . It's not only a case of just " pulling yourself together" and start taking your insulin, it's as you describe so well, a deep dark hole where you know ( and are afraid of) the consequences, but just can't get yourself to do anything about it. Others have been in that place too, and have got out of it also. Alone, it's a struggle to be sure. I'm surprised that your DSN hasn't recognised what is happening with you and been more active in your care. There is a lot of support from your HCP's that you are entitled to, and should be offered.

It's difficult to be assertive when you are feeling the way you do, but I would suggest that you get the help of others on your side. I'm assuming that is your husband in your avatar ? Does he know what you are doing and how you are feeling ? If not, tell him. Ask for his support. Make an appointment with your GP, go alone or with someone, and ask for help. Do the same with your DSN or another member of the team. If your GP is on your side, it's hugely helpful.

Sometimes it's easier too to start again, from scratch. Baby steps. " Just for today " I will take my insulin / test at least once/ whatever goal you wish .

Post on the forum, there are many many people idealing with the same condition , all with their own stories to tell and advice to give.

Value yourself . Easier said than done, I know, but again, baby steps.

My concern at the moment is that you avoid DKA ( you really, truly, don't want to experience this ) . What is your BG. At the moment ?

Signy

Hi @Sam17

Please don't despair, your situation is not uncommon and DSNs should be aware of it and offer appropriate support and advice.

Living with uncontrolled glucose levels doesn't immediately stop you in your tracks, not like a hypo - if only it did. Please don't damage your body, you can achieve a happy balance between insulin, food, weight and all other the other facets of life. Start by taking just a small step, test and correct your blood glucose appropriately -it will have an almost instant effect on how you feel both physically and mentally.

I am a living example of what can happen with insulin manipulation and as @Heathenlass puts it so well, I fervently wish I could turn the clock back and undo my complications. Managing insulin/carbs /weight is doable and it is infinitely more doable than having to live with the permanent consequences of serious complications a few years down the line.

I know It is so difficult to muster any enthusiasm to even care what happens next when you are living with uncontrolled blood glucose but please summon the energy to seek help. Ask to speak to someone else in your diabetes care team - Dietician, consultant, a different DSN or your GP, and also get support from us on here. Too many of us have been in the same place but don't despair, it might take a bit of time to sort out but you can do it . Best Wishes..

My bloods are mainly running above 20 at the moment. And to be honest my diabetic nurse and consultant have never been particuly helpful at the best of times I saw her thurs and told her my ketones were at 6.7 and she did nothing about it and just told me my body may just be able to tolerate having ketones this high and sent me on my way.

I am seening my gp this week who is very good so may get some advice regarding things because I don't seem to be getting the support from anyone else !!!!

I think you and your GP should be looking for a transfer to another diabetic team at another hospital if possible . That a DSN should do nothing, and say that is frankly outrageous .

Even care via your GP and practice DN is better than that !

Signy

Sam17 said:

My bloods are mainly running above 20 at the moment. And to be honest my diabetic nurse and consultant have never been particuly helpful at the best of times I saw her thurs and told her my ketones were at 6.7 and she did nothing about it and just told me my body may just be able to tolerate having ketones this high and sent me on my way.

I am seening my gp this week who is very good so may get some advice regarding things because I don't seem to be getting the support from anyone else !!!!

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Thats appalling..its good that you are seeing GP.
Find out if your practice Nurse is willing to help you through and see you on a weekly or fortnightly basis currently...

Struggling out of this by yourself is going to be hard.. So perhaps GP and practice will give the additional support.

We're here. Let us know how you get on.

There is only one issue here; that is, this is an eating disorder.

Yes, it is coloured (and certainly complicated) by the fact that you are diabetic, but first and foremost is that it is manifested by your attitude towards your self image.

Those with eating disorders will use what they can, starvation, vomiting, laxatives and, in this case, failing to take medication.

Telling Sam17 to see her DSN, to take her insulin, scaring her with details of SKA etc. is like telling an anorexic to eat because otherwise his or her organs will shut down.... she knows what the consequences are, but until she is able to deal with the underlying issue, whatever that may be, she is just going to carry on.

Sam17, your first step I think ought to be to try to understand your behaviour. There are support groups out there for you to do this.

You know what you are doing. You know what it is doing to you. Do you know why you have chosen to do it?

Can I actually say one thing it's nothing to do with self image I have or never had any confidence in how I look and never will.

Missing insulin doses isn't just due to me loosing weight there's more to it than that and don't belive I have any eating disorder in and shape or form.

I JUST WANTED to clarify that

Hi Sam17

would you consider making a compromise between food and injections?

Do you think you would be ok injecting a pen needle twice per day and eat carbohydrate in different qtys within set time frames as opposed to using the bolus basal way of managing bg levels which unfortunately involves 4 to 6 injections?

Sam17, you know yourself better than anything. So, you will know why you have just said this:

"Can I actually say one thing it's nothing to do with self image I have or never had any confidence in how I look and never will.

Missing insulin doses isn't just due to me loosing weight there's more to it than that and don't belive I have any eating disorder in and shape or form."

- the first part that I have put in bold and underlined is confusing me as it contradicts the first part of the statement. Remember that self image isn't necessarily about the way you feel about yourself. It includes the way you consider other people to perceive you.

- with reference to the second part that I have put in bold and underlined, an eating disorder is rarely just about losing weight. In fact, often it doesn't have anything to do with losing weight, that is just how it manifests itself. Overeating can be an eating disorder and is not about losing weight. There are underlying issues (and that is what I am asking you to get at) that are going on, inside a person. As an example, a person may be going through a bereavement, a divorce, some sort of emotional upheaval and find themselves dealing with it in an unhealthy way - self harm perhaps, or developing an eating disorder. That person may not want to lose weight, that person just wants a way of coping.

@Postitnote wrote :
"There is only one issue here; that is, this is an eating disorder.

Yes, it is coloured (and certainly complicated) by the fact that you are diabetic, but first and foremost is that it is manifested by your attitude towards your self image.

Those with eating disorders will use what they can, starvation, vomiting, laxatives and, in this case, failing to take medication.

Telling Sam17 to see her DSN, to take her insulin, scaring her with details of SKA etc. is like telling an anorexic to eat because otherwise his or her organs will shut down.... she knows what the consequences are, but until she is able to deal with the underlying issue, whatever that may be, she is just going to carry on.

Sam17, your first step I think ought to be to try to understand your behaviour. There are support groups out there for you to do this.

You know what you are doing. You know what it is doing to you. Do you know why you have chosen to doit,"





@ Sam17 has emphatically said she doesn't have an eating disorder , and has mentioned in passing in her original post that her first concern is not her weight, but the state of mind in which she finds herself.

There is a condition of diabetes that is to do with that state of mind, an inexplicable avoidance of taking insulin despite feeling ill, and in full knowledge that not to do so is dangerous. It's a cycle of fear and depression that can be very difficult to break free from. Sometimes people do notice that they lose weight when not taking their insulin, and it becomes something of a reinforcer of the decision not to take it. It is a very complicated issue, and while I am not saying this is what Sam is going through, it is not linked to eating disorders.

It is common enough in Type 1's for specialist HCPS's to recognise it, diagnose it, and offer the appropriate help and support, which is why various people on here have advised that Sam speak to her DSN and her GP .

Signy

As long as she knows that there is help available, and where to get it, then that's really everything that matters.

Sam, I was a young girl like you bothered about my weight. I never skipped insulin injections. I exercised. It's fun, makes you lose weight and you get rid of depression.