Newbie T1 questions

[Mad76]

Hi again all,
So a few questions..its all new to me so apologies if they're obvious.

A bit about me - 42 year old. About 6 weeks ago gp diagnosed type 2. Put me on metformin. 4 weeks ago I was hospitalised in DKA. very nearly didn't make it.
Diagnosed as type 1.
On novorapid 3 times a day. Lantus 1 time a day. Metformin 2 times a day
Sugar levels seem ok so far
I have the very expensive freestyle libre
Absolutely love it.

So my questions, and many thanks for any replies in advance.

1. The consultant at hospital put me on insulin before discharge. When I went to see him 3 days after he saw my glucose reading were still mainly above 10 despite the insulin
.he then added 2 tablets of metformin in morning and evening. He said this helps the insulin work? Also said with my BMI I should have it ( high BMI is what he ment I assume)
So is this the norm ?? I'm quite happy as a couple days after starting the metformin glucose levels have been in single figures. I'm just asking as a few people have questioned why I'm on both types of meds. The nurse said metformin is good for my heart. ?

2. I have been told to take novorapid with breakfast. Lunch. And dinner.
My question is if I end up for whatever reason eating between meals or after dinner can I take another dose ? Or is it strictly 3 times a day only? I know it's not healthy but as we are going to travel soon this might happen
When i asked the consultant about snacks generally he said if less than 10g carbs it's fine. I completely forgot to ask what if it's more

3 . I am using the freestyle libre . I love it. But I'm paying 60 quid per patch. This is pretty steep. My gp says he cant do it on prescription
. But then said 2 patients do have it. But only because they dont control their sugars. How is that ok?? Any thoughts /advice as to how I can push for this ??

4. I've been given the range to aim for glucose to be 4-7. But my question is is it better to be around 4 or is that a bit low. What should I aim for ?? Is it more healthy for the lower end of the range or is 7 ok ? If they were always 7 should I be satisfied or try to get lower ??

5. If i had a meal of say fish and boiled veg. Or something else with no carbs or very very little do I missy novorapid dose all together ?? And if i do could this be a problem??


I'm so sorry for the massive essay
Any help would be much appreciated

 

[evilclive]

Re 2 - I'll inject my bolus/fast (novorapid for you) insulin when my body needs it. So for a meal or snack or as a correction between meals. Now my snacks tend to be corrections the other way - sugars going low, so I'll eat, and obviously in that case I'm not going to inject. But if I was feeling like I wanted some food, and my sugars were such that I'd need some insulin for it. I'd take more.

A complication is insulin stacking - it takes a while for even the fastest insulin to disappear from your body, and the larger the dose the longer that while is. So remember if you're going to snack a couple of hours after an injection, there will still be insulin hanging around.

Some people say "Don't stack" - but I reckon if you're careful, keep measuring (in the way a libre can help with a lot), and have n idea what is going to happen, there's no reason not to if it'll help.

Re 3 - can't help on prescription side, I buy mine, but 60 quid/sensor seems steep. Are you remembering to claim VAT relief? Even Abbot mail order is slightly under 50 quid.

Re 4 - If you're good enough to get your blood sugars aimed at say 5 or 6, you're doing very well indeed! It's good to aim for somewhere in the middle - below 5 and driving is discouraged, and having some leeway to catch hypos is very useful. Below 4 is bad, below 3 is very bad, below 2 is going towards unconsciousness. At the other end, 8,9,10 could all be unnoticable, and even 13+ won't be a problem in the short term. So higher is definitely safer in the short term.
But don't be surprised if you miss the target a lot, especially while you're learning. I don't think I'm too bad at it, and double figures isn't that uncommon for me. Also remember after a big meal, even for non-diabetics the sugar level goes up. So if you don't make your targets, don't beat yourself up over it - this is entirely normal.

Re 5 - people say protein needs to be counted, roughly 1/2 the insulin per weight of carbs. Re missing dose of novorapid - see my first paragraph - in some situations, zero dose is the right thing. Others will be along with better advice.

 

[urbanracer]

Hi @Mad76

Broadly agree with @evilclive above. Regarding Q1 and giving Metformin to T1's, this is a relatively new thing. Although Metformin was developed to restrict the amount of glucose your liver releases, studies have shown it to be beneficial in other areas - reduction in number of heart problems being one of them.
Consequently some docs want their T1 patients on it but I don't think it's that common yet.

 

[karen8967]

Re the libre question you have to meet a criteria mine was that i tested at least 8 times a day it was consultant at hospital who prescribed mine then he wrote to gp.i am also on 3 metformin 1 with every meal if i have a snack and numbers start rising quickly il take some insulin if numbers only rise a bit il wait till next meal then add a bit extra.my consultant told me to keep my bgs between 5 - 10mmol for me i feel great between 7-8 but were all different x

 

[EllieM]

Also re the libre thing. It is a wonderful device, and for the first 8 months I was on it I was in diabetic heaven. After 8 months of continuous use I developed an allergiv reaction to it and its results became completely erratic. I had to stop using it. I would hesitate to rely on its results too much just because it doesn't work well for everyone - maybe do some checks against blood sugar tests before you assume a particular sensor is accurate. It's great for trends but I wouldn't want to count on its accuracy, particularly at low and high levels.

RE the metformin. I was actually one of those who queried the medication. However it is true that plenty of T1s are on it : I believe it can help possible insulin resistance if you are slightly overweight?. I was (possibly, 50% chance) on it for a couple of years when they did a double blind trial to see if it would help T1s : am guessing the result was positive . Unfortunately they never got back to me to say whether I was on it, as I would probably start taking it if I knew that I was on it before (I think my control was better then but it's difficult to judge as this period coincided with having libre work for me.)

The 4-7 thing. Is this before meals? Ideally you'd be at the lower end before meals because you want to reduce the peak after meals. And there's no way that I'd go to bed with a level of 4 because night time hypos are no fun at all. . But honestly you'd be doing better than 90% of the T1s on here if you kept within those limits most of the time, whether you're at the top or bottom end of the range. You'd certainly be doing better than me (only achieved those ranges during pregnancies) and I've been T1 for 49 years with no real complications.

 

[Deleted Account]

Re: NovoRapid - simply (and very simplified) this is taken to convert the carbs you eat into energy. Lantus is taken to mop up the glucose which is dripped from your liver all day every day (again simplified because there can be times when this doesn't happen).
Lantus assumes our background insulin needs are the same 24 hours a day whereas typically we need a little more during the night. This means we may have a little spare insulin our bodies during the day which allows us to have small snacks (below 15g carbs - e.g. a biscuit or packet of crisps) between meals.
It is normal to be advised to take fixed doses of insulin when you are first diagnosed. As we get familiar with injecting, carb counting is introduced and we start to adjust our insulin dose according to how many carbs we eat. I am not going to suggest you try to run before you can walk but if you are interested, there is an online course (https://www.bertieonline.org.uk/) which explains this and more.

RE: target BG, a few things to bear in mind
- most people without diabetes will have a BG between 5 and 6 when they are not exercising and have not just eaten. So this is, typically, the area to aim. If you get close to 4, you are risking hypo and if you get nearer to 7 longer time you are more at risk of complications. But don't get hung up about being exact.
- carbs raise everyone's BG, even when they do not have diabetes. There are now some internet pages of Libre graphs from people without diabetes. Looking at these reminds me to keep my targets in perspective - one of these graphs I was looking at had readings over 9 so I don't consider beating myself up if my BG reaches 10.
- if you don't want diabetes to dominate your life, you want to exercise, you want to eat different types of food, you want to continue to live your life to the full, it is incredibly (if not impossible) to maintain a perfect BG all the time. Personally, I want to manage my total health which includes my mental health and diabetes is only part of that so diabetes management has to balance with the rest of my health. This may mean I have days when my Libre graph is high, days when it is low and days when it is a roller coaster. The Libre is great but don't let it become an obsession.