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Fletch

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I am a 38 year old man and been Type 1 diabetic for over 20 years. I have been reading this forum with great interest over the last few weeks and would like to ask for help. My last HBA1 reading was 8.4% and this is obviously of great concern to me and I am now looking at alternative methods to get my BG back into the normal range. I am now convinced that loweing the amount of carbohydrate consumption must be the answer to better controlling this condition and so for the last 2 weeks have adopted this approach. I have found a marked improvement in my daily BG levels and have found that I do not get the spikes post meal that I normally see after consuming the carbs. One question I did want to ask was to fellow Type 1's and it concerns how much fast acting insulin you take with each low carb meal and how do you calculate this. At the moment I am testing my BG every 30 mins or so post meal and then inject once I see my levels rising - normally about 2 hours after a meal. For example this morning at 07:30 I ate a cheese omellete for breakfact - my BG was 4.9 pre meal. By 11am my BG had risen to 7.9 so I injected 2 units of ActRapid - I find this brings me back to within normal range. Is there a better way of calculating how much insulin I need or is it simply trial and error. What do you guys do? I appreciate any advice you can give and would like to thank you all for the posting on this site which I am finding extremely helpful.
 
Hi there Fletch and welcome to the forum.
I'm delighted you've found the low-carb discussions useful. I'm also type1, 27 years and counting, and it took me 20 years of obediently following the 'carbs at every meal' advice before I saw the light too. I hope you find the same rapid improvements that many on the forum now find that a low carb approach brings.
A couple of thngs caught my eye from your post. You ate breakfast without insulin, then injected 2 hours after your meal. Is this a regular habit, or simply an experiment to see the effect on your BG so you can predict an appropriate dose the nest time?
I think there's a large element of trial and error in working out the right insulin dose regardless of the type of diet you follow to be honest. There's quite a large variation in the units of insulin/10g carbs calculation between some of the forum members, and the same is true, although probably to a smaller extent, with low carb meals. There are significant variations even according to the time of day that certain foods are eaten.
2 units of fast acting insulin would be about right for me with a cheese omelette at breakfast too. I doubt whether there would be a significant variation between individuals with doses that small.

Keep asking the questions and we'll do our best to help.

fergus
 
Thank you very much for your reply Fergus and I would like to say that I have found your posts to be very informative , you seem to talk alot of sense.

In answer to your question concerning when I inject insulin - normally when eating a carb laden meal I would inject pre meal to cover the fast acting affect of the said carbs - I have been injecting post meal whilst following the low carb regime really to see what affect not eating carbs has on my BS levels. It woul appear that the Protein from the meal(using the omelette an an example) does cause the BS to rise but it does not happen for an hour or two post meal - as a result I have been reluctant to inject pre meal for fear of Hypo. Do you inject pre meal and if so how does this affect your BS?

One thing I omitted from my first post was that following this low carb approach for the last 2 weeks has resulted in me dropping 7 pounds in weight - without going hungry. I have found that I have not experienced any cravings but generally felt alot better. (although my 18 month old son is testing my energy levels at the moment as he is teething so my wife and I are getting very little sleep.)

Once again thanks for you advice Fergus it is very much appreciated.
 
hya fletch and welcome,
as fergus says,we are all different and have different ratios, i lowish carb and i dont inject if eating under 10g carbs, if over at breakfast i inject 1 unit to 10g, dinner i inject 1 unit to 15g,tea and supper im back to 1 unit to 10g carbs, its trial and error, keep asking the questions as there are many on ere who will help
 
Hey Fletch, and thanks for the compliment!
In answer to your question, I always inject before I eat. Having said that, yours was a smart way to work out the rise and timescale of your BG levels following a low carb meal.

What I found worked for me was Humalog at breakfast and lunch, but Humulin at dinner. Humulin S is slower acting, with a flatter peak and longer half-life. It definitely works well for me when I use my largest dose (7 units) and have the time to wait for it to work (~30 mins.) It's still working as the protein is turning to glucose, but it doesn't rush ahead of itself as the Humalog would.

Humalog at breakfast and lunch (3 units and 2 units) works partly because time is short and also because the doses are low enough that they don't send me too low before the protein gets to work.

The reduced appetite and the weight loss are the bonuses for having the intelligence and the balls to give it a fair go!

All the best,

fergus
 
Thanks for the replies - much appreciated. As previously mentioned I have been experimenting with the low carb approach over the last 2 weeks and have already had some great results. MY BG control seems a lot tighter and over the last few days I have not seen a reading out of the normal range. I have also lost 7 pounds without feeling any real hunger panks.

At the moment I have not been injecting pre meal and tend to check my BG roughly every 30 mins post meal to see what affect the meal has had. Once Isee my BG is rising I then inject 2 units of NovoRapid to take care of the rise.

Fergus you state that you always inject pre meal. My concern if I were to inject pre meal would be that I could end up going too low. I am finding with most of the foods I consume that my BG does not start to rise until about 2 hours post meal. I am no expert but assume that this is due to the process of the Protein being digested/turned into glugose. I have listed below a typical example of what I would eat over the course of a day and wondered if I am eating the right types of foods - is there anything I could be missing or should be including.

Do you weigh out all your food so that you know how many grams of protein you are consuming and how this will imapct your BG? An exapmle of how you calculate Insulin needs to meet the Protein consumption would be most helpfull.

A typical example of my daily diet would be as follows:

Breakfast - Cheese Omelette made with 3 eggs(about 2oz of cheese)
Lunch - Tuna Salad mixed with full fat Mayo - - normally add Feta Cheese/Olives/Olive Oil.
Tea - Meat with green veg - normally add garlic butter or olive oil to veg.
Snacks - Nuts/Salami/Ham/Cheese slices.

Thanks again.

Fletch.
 
Hi Fletch,

Your diet looks great to me, in fact it's pretty similar to the sorts of things I eat too.

If you are injecting after you eat and giving the protein time to be digested you might want to think about using something like the Humulin S I use? A I said it has a much less pronounced peak and a much slower action and it has worked well for me.

The University of Sydney did some work on an Insulin Index in an attempt to address some of the issues about the glucose generated by non-carbohydrate foods. It hasn't got very far (only 38 foods on it!) but it's worth a look all the same http://www.mendosa.com/insulin_index.htm

Personally, I've never weighed anything I've eaten. I think there are simply too many variables involved in tailoring an insulin dose for precise numbers to be much use. And I'm lazy. With low-carb meals, Bernstein's law of small numbers is more significant - that low insulin doses have a much reduced room for error.

A few weeks monitoring your own response to particular foods is probably the most useful information you can get. For me at least, I can work out pretty accurately how much insulin I need simply by experience. If in doubt, dose low and correct later, much as you are already doing.

I've got high hopes for you, Fletch :wink:

All the best,

fergus
 
Thank again Fergus - good to hear that I seem to be eating the right things.

One other question, although I am sure that I will have many more - I am about to start cycling again and this constitutes a daily commute to and from work of around 20 miles a day. I have not done any cycling for 3 or 4 months following a shoulder injury. I note from reading through this forum, to which I have been glued for the last few days, that you are also a keen cyclist. Do you eat any carbs before or after cycling to compensate for the exertion or are you able to get by on the low carb foods?

Thanks gain for all your help and advice. I have to say that at the moment I feel like I have a new lease of life as I have never before gained such good control, although I appreciate it is still early doors. My last HBA1 was 8.4% and it has been steadily rising over the last 2 years - I have been on the vicious circle of eating more carbs/injecting more insilun only to see my control getting worse. I am due to have another blood test in March and for the first time in years I am actually looking forward to it as I know there will be a dramatic improvement.

This forum is fantastic and has been responsible for me doing very little work over the last few days(luckily we are very quiet over the christmas period).

Anyway all the best to you and your family for 2009.

Thanks.

Fletch.
 
Another cyclist! Excellent!
Our local boy, Chris Hoy seems to be doing rather well out of it, eh?

What I've often noticed on longer weekend rides is that I don't seem to suffer from the 'bonk' in the way that the muesli & OJ riders do. A number of times I've had to pull over for guys who've run out of gas and it's usually the same story - a high carb breakfast lead to a flood of insulin. Add in excercise and their blood sugar levels drop like a stone. I've tested non-diabetics on long rides and their BG's are occasionally in the 2's!

One of the many low-carb benefits seems to me to be a much easier and less hurty access to free fatty acids as a back-up fuel source. Not a big issue on shorter commutes and stuff, but I often inject half a unit less, or eat a wee bit more at those times.

All the best,

fergus
 
Hi Fletch,

Your delay in blood sugar rise after meals could be due to delayed stomach empyting. This condition is due to nerve damage to the autonomic nerves that control digestive processes and is common in people who have had diabetes for 20 years or more. In this case you can expect to have to inject your meal insulin later than most other people who have diabetes.

As a general rule, most people will need two units of regular insulin ( eg humulin S or hypurin) for every 3oz of lean protein. If this was a bit of steak it would have the dimensions of a pack of playing cards. One medium egg is about one once of protein.

Rules of thumb are just that. You always need to check out what is going on with your meter and adjust sensibly. The course at www.dsolve.com can help as can other resources.
 
Katharine and Fergus, have you seen this?

http://213.105.192.75/bdec2/index.shtml

It's an online version of DAFNE which I've seen recommended in other forums but not being an insulin user I can't have a personal opinion.

Might be of use in the many places where DAFNE or equivalent courses, or in fact information in general, is not available locally?
 
Yes, Trinkwasser. I have also done it.

Pluses are:

It is a good basic carb counting/insulin to meal matching course.
It is free of charge.
It is available on line.
You get plenty of practice at carb counting.

What could be better:

The basic assumption is that you will be eating loads of carbs and that this is "normal" for a diabetic. Maybe it is, but optimal eating for diabetes is not discussed. It is discussed in DAFNE courses but the Food standard agencies high carb/low protein/low fat advice predominates here.

The carb counting/ insulin matching is awkward and peculiar to Great Britain. I just don't think it is so great. Instead of how many carbs you can eat per unit of insulin, you calculate how much insulin you would need for each 10g of carbs. The authors want to fit in with how DAFNE is taught rather than use the simplest method. They don't think that people in the UK can do division well enough to use the USA / every other country system. Maybe they are correct.

The carb / insulin matching is too basic. No coverage of protein, scant advice ref dose splitting or different insulins for higher fat foods, no 7 unit rule to improve predictability, no carb weighting for higher carb meals.

The basal insulin matching advice is potentially dangerous for those with a prominent dawn phenomenon. They advise using the am bs value instead of the 3am bs value.

Most of the problem is that the authors have stuck to the DAFNE system rather than tried to iron out it's faults.


It is fine to do the course. The photos and pure carb counting practice are excellent. My advice is that course users also need to heed the pluses and minuses. Once they have done the course it is worth having another look at the course at www.dsolve.com so that the basic advice in the BDEC course can be usefully built on.
 

Thanks for the input, yes I often recommend your site. Other Type 1s recommend

http://www.insulin-pumpers.org/

even for non=pumpers and the usual books are John Walsh and Gary Scheiner
 
Thanks for all the advice - I have now made an appointment to see my GP tomorrow to obtain some regular insulin which will hopefully cover the Protein consumption more appropriately. At present I continue to inject Actrapid about 1-2 hours following a meal. My BG has been excellent over the last few days and I have not had a reading any higher than 7.5 and that was post meal reading - pre meal they are in the 4-5 range. Also had a couple of fasting readings of 2.9 and 3.1 but funnily enough did not feel at all low which is strange as would have been running for the chocolate with these readings when following high carb approach.

I have dropped about 7 pounds in weight but this seems to have stalled at the moment - I may need to address my portion sizes as I am probably over-eating but one step at a time - at the moment I am more than happy with BG results and am confident that further weight loss will follow - want to lose about another 12 pounds to get within ideal BMI.

Once again thanks to all for the advice it is much appreciated.
 
You're very welcome fletch, and please keep in touch.

All the best,

fergus
 
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