New type 1

[Anna w]

Hi
I got taken to a&e last week with DKA -and discharged home on lantus 8 units and novorapid between 2-4 units (4 if BS higher than 14)
This is all very new to me (last week) and the diabetic nurses are short staffed so my support is little. I bought a libra 2 off Amazon as I have been told this can only be prescribed once confirmed with autoimmune bloods
I feel extremely scared I. Particular at this time as my blood sugars drop to 3.5
- I have eaten the 5 jelly babies which is bringing back up.
For my evening meal I didn’t know whether to take Insulin as BS was 6 so I took a jelly baby to go to 7 then had 2 units of novorapid with chicken brocolli and one slice of bread - I wouldn’t have had the bread but know I need carbs
(1) should I take insulin if Bs is 5?
(2) is it ok to not eat carbs and not to have insulin
(3) is the one piece of brown bread too little carb for the 2 units
(4) if my blood sugar goes high later should I drink water and exercise

So sorry for the questions but feeling very scared
Thanks
Ann

 

[lovinglife]

Hi @Anna w & welcome to the forum.

It’s always very scary when we are first diagnosed, especially for someone with T1 on insulin. I’m T2 diet only so can’t share any experience with you.

We can’t give dosing advice on the forum as none of us are medically trained or know your exact circumstances but what we can do is share our experiences with you and support you I’ll tag a few of our forum members who are T1 to see if they can help you
@EllieM @Nicola M @Hopeful34 @Antje77

 

[Nicola M]

Hello,

Welcome to the forums, you've come to the right place for advice and support. I honestly don't know what I'd do without these forums.

It can be extremely scary being diagnosed with Type 1 and being only at the start of your journey, having only been diagnosed you will be in your honeymoon period which means your pancreas may still be working and could still work for up to a year+

Having low blood sugar is awful (I don't think any of us ever really enjoy having them) and can come with so many varied symptoms that make you feel awful, I'm not sure if your nurse has been through this with you but anything 3.9mmol/mol or below is considered low and should be treated with your preference of treatment such as jelly babies, sugary drink etc. With that being said, I personally wouldn't have taken my low blood sugar treatment at 5 or 6mmol/mol as it's perfectly within range but I understand the worry as you're so newly diagnosed it's scary when you get closer to those lower numbers, you don't want to have a low blood sugar again, different insulins have different rules on when you should inject them and lots of other factors can come into play such as the type of food you're eating, for instance, I use Lyumjev which is quicker acting, I inject right as I am about to eat so long as I'm within range and not low.

You don't necessarily "need" carbs nor do you not "need" them, it's completely down to personal preference, as long as you are dosing correctly you can eat whatever you wish to, in time you will learn about carb counting which will make things a lot easier but due to being newly diagnosed that probably won't come for a little bit until everything is confirmed and they can see what your body is still doing. There is no right answer to how much insulin should be given for what food as we are all different and have different dosages.

In terms of going high, I would speak to your diabetes team for advice on what to do if you are high as we can't really advise on that here.

 

[EllieM]

Hi @Ana W and welcome to the forums.

That does sound very scary and a shock for you.

I'm surprised they haven't sent you home with a libre, though I would expect that they have at least given you a glucometer? (Unfortunately libres aren't accurate in all circumstances, so it's a good idea to have a glucometer to double check when your blood sugar is doing unusual things - high or low.)

The good news is that DKAs are usually pretty rare, they are most common at diagnosis when you don't know that you need insulin. (I've been T1 for 54 years and never had one, as I was diagnosed very early.)

The problem with insulin is that people need widely differing amounts (one person can need 10 units a day while another needs over a 100) , so there is no fixed amount of insulin for carbs. Generally they try to start people on a low dose and gradually increase it till the amount is right for that person. (And it doesn't help that insulin needs can change with time, particularly for new diabetics.)

It sounds like you are on a basal/bolus regime.

The long acting basal insulin (lantus for you) is meant to keep your levels steady when you don't eat eg through the night. It's often referred to as background insulin for that reason. The novorapid is meant to both cover the food you eat for meals and (when necessary) act as a correction dose to bring your blood sugar down when it is high. In the long run you'll probably learn to count carbs and then you'll be calculating your meal time dose on the basis of so much for the carbs plus a correction dose (which can be negative if your bg is too low). (Bg = blood glucose).

Have they given you a phone number or an email address to contact the clinic?

Hopefully now you've experienced your first hypo (hypoglycemia, low bood sugar) you'll recognise the symptoms in future? It's actually not uncommon for non diabetics to have blood sugar that goes that low, but the problem for diabetics that injecting insulin means that you can go much lower. So it's a good idea to always have emergency carbohydrate with you (jelly babies in your case but different people use different things) so that if you go low you can easily raise your blood sugar. (If you go lower you can start to get confused and it's no fun trying to search out carbs when you can't think straight.)

If you keep good records of the amount you eat and your blood sugars before and after meals your team should be able to adjust your insulin doses and ratios for you. Yes, the idea of a basal/bolus regime is you only take the bolus (novorapid for you) when you eat carbs, but I suspect that at this stage your team will want you to eat normally in order to find out how much insulin you need. (I stress that this is not medical advice, we're not allowed to give you medical advice.) In theory you can adjust your insulin to eat a high or low carb diet - if it's very low carb you may have to start allowing insulin for protein and fat as well as for carbs. But at this stage we have no idea whether you are still producing small amounts if your own insulin so that is really hard to say.

If I was in your position I'd probably try to concentrate on
1) good record keeping for my team to calculate my insulin needs. (Some kitchen scales might help here, a typical slice of bread can be between 10 and 40g of carbs, depending on size. Luckily lots of supermarket foods have carb counts on them)
2) avoiding and treating hypos.

And if you've got an email address or phone number, keep asking your team questions. In particular, the 4 you've asked here are ones they should answer for you. They may be busy but as a new insulin user they need to help you.

Sorry for the (too) long essay, good luck. Things will get easier with time.

 

[Antje77]

Hi @Anna w , welcome to the forum.

First, don't panic!
There is a steep learnin curve ahead, you won't get it right all the time, and that's completely ok. This is a marathon, not a sprint, you can take your time learning to get the hang of this, as long as you keep hypo treatments on you everywhere you go.

For what it's worth, I'm 8 years in now, and at this point my T1 is sometimes annoying and frustrating, but mostly some background noise. I hope you'll find the same, given some time.

I feel extremely scared I. Particular at this time as my blood sugars drop to 3.5
- I have eaten the 5 jelly babies which is bringing back up.

Well handled with the treatment!
A tip: Please confirm a sensor low with a fingerprick, especially if you don't feel symptoms. Sensors are a very useful tool but not as trustworthy as a fingerprick.

(1) should I take insulin if Bs is 5?

novorapid between 2-4 units (4 if BS higher than 14)

In time, you'll learn to adjust your insulin doses based on the carbs you're eating, although you'll still take current blood glucose in account.
So in my case I'd take insulin for a meal if my bg was at 5 if my meal had enough carbs to need insulin, but not if I didn't expect this particular meal to give me a significant rise. You'll get there, take your time learning!

(2) is it ok to not eat carbs and not to have insulin

If this keeps your bg in range, perfectly fine!
Some people find they may need some insulin even for very little carbs, or protein, especially in the morning, it's all trial and error and learning about the patterns of your particular diabetes.

(3) is the one piece of brown bread too little carb for the 2 units

Some people only need .5 of a unit for one slice of bread, others need 25 units for that same slice of bread.
So again, it's about getting to know your own diabetes, finding the patterns between your doses, the food you have, and the resulting bg.

(4) if my blood sugar goes high later should I drink water and exercise

Drinking water never hurts, exercise depends on how high and the type of exercise.
A stroll around the block can help, but I wouldn't do vigourous exercise in the higher teens. This may make you rise even more.
Again, take your time learning, in time you'll learn to use correction doses as well as dosing for your meals.

Hang in there and keep those questions coming!

 

[SimonP78]

I would start carb counting from the get-go, it's not rocket science and you don't need to be trained. I would suggest that a single slice of bread is probably too little carbohydrate to take 2U of bolus - we're all different of course! You're in what's known as the honeymoon period, where you body will still sporadically produce its own insulin, which doesn't help very much when you're trying to work out what effect you get from a given quantity of carbs or insulin (or the combo thereof).

If a slice of bread contains ~20g of carbs, I might need 2U (depending on the time of day - you get used to these things don't worry!) but as you may be producing your own insulin, I'm not so sure I'd pitch in with a whole 2U if it were me.

As mentioned above the CGM may be not be accurate, always confirm with a finger prick test (which may also not be accurate, but will certainly be much much closer to reality than the CGM if the CGM is playing up or currently has a calibration offset.)

If you have some insulin on board then I'd not worry about doing exercise in the higher teens, though you may not feel wonderful. Typically the amount of exercise required to up insulin sensitivity is quite low - don't start a 5km run with significant IoB, go for a walk or a quick run if you must. 10min on the turbo trainer will start my BG falling like a stone if I also have a full correction dose onboard.

In the absence of (bolus) insulin, you can (and will) get a rise in BG for aerobic/hard exercise (sprinting, riding a bike at high powers) and indeed for other things which generate stress hormones (which is what the exercise is doing). These homones cause your liver to helpfully release stored glycogen and turn it into glucose just in case you're escaping from lions, or similar. Therefore gentle exercise is most effective, though even hard exercise will eventually produce a drop in BG (after the initial spike) once you stress hormones abate and your muscle insulin sensitivity increases.