Newly diagnosed T1

susieg · Dec 19, 2010

Hi, I'm Susie, just been diagnosed (3wks) with type 1. I have ben put on Humulin M3 combined insulin to be injected twice a day.
I seem to be ok so far, between 5.1 whe I wake and 8.0 in the evening. I am confused though, about carbs???
Some say eat carbs at every meal, which I am doing, pasta, rice, potatoes, granary bread. But I find I'm having to eat a small bowl of cereal before bed.(or I go into a hypo around 2am) I thought I needed to look after my weight not eat all this carb laden food???
anyone on Humulin M3? and have any advice for me?

I am still in the grieving period too, I'm angry, sad, self pityiny, especially no as it's christmas and all I see are adverts for chocolates and sugar rich food!!!

I need othes to talk to and make me feel 'normal'

Cheers! Susie.

sugarless sue · Dec 19, 2010

Welcome to the Forum, Susie.

It's confusing at first but you will find many Type 1's on here to help you.

Here is the basic advice we give to new diabetics so I hope some of it will help you. Have a good look round the Forum and ask us questions.

Here is the advice we usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, Diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

The main carbs to avoid OR reduce are the complex or starchy Carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of Insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause Insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting Carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total Carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a Diabetic.

As for a tester, try asking the Nurse/Doctor and explain that you want to be proactive in managing your own Diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try !!

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking).......between 4 - 7 mmol/l........(Type 1 & 2)
2 hrs after meals......no more than 8.5 mmol/l.....( Type 2)

2hrs after meals....... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Sue/Ken.

AL1 · Dec 19, 2010

Hi Susie & welcome.

I can't advise regarding the medication you mention but I can totally relate to your feelings about being angry, upset and the injustice of having this now, right before Xmas
I actually dreamt about Cadbury's Roses chocolate last night, I'm at the obsessing/grieving stage still I think! I can't help but feel bitter about this situation coupled with being teary, such a strange place to be.

This is my first Xmas as a Diabetic, and I think it's going to be a tough one if I'm honest.

I'm low carbing it, no white bread, pasta, rice, pots. Living on fish, eggs, nuts, certain veg, yoghurt, cheese, meat. Wheatgerm bread seems ok for me.

I'm sure someone will be along to answer your questions re your meds and food choices.

Ali

sailorj · Dec 20, 2010

Hi Susie,

I've only recently been diagnosed as T2 and am still reacting to the diagnosis. It seams really normal to have the odd moment shedding a tear, but I think in the last 3 weeks I have realised there is little you can't have, you just have to think ahead.

I was really chuffed to save up my carbs yesterday and enjoy a lovely meal with friends who did not know I'm diabetic but were curious when I refused the liqour and mints!

So everything in moderation and look at the site about christmas foods. It was a revelation for me.

Sorry I can't help with the meds question but keep smiling and you'll get there.

susieg · Dec 20, 2010

Thanks for your comforting replies!! I know it'll be ok, everyone keeps telling me!! lol BUT they haven't got it!...lol..
I saw the Diabetic nurse today, she said I was getting on very well, and reduced my insulin. I know I can cope when I eat properly, but what do I do if I want that bit extra? no-one has told me what to do then? do you adjust your insulin...i.e. take more? I am on a 30/70 mix insulin, a fast acting mixed with a longer acting, so it's quite complicated (for me) to know what to do.
(sorry if I seem to be moaning...but I am still a little confused... will it all fall into place??) :?

cugila · Dec 20, 2010

susieg.

Seems the T1's who have been around are not looking here, so we will move your post into the T1 area.....see if we can get you some more answers to your questions ?

Personally, you need to decide....do you want more Insulin or that little treat....... :wink:

HLW · Dec 20, 2010

I'm on separate insulins, so I can use more of the fast acting when I eat more. I have no idea what you would do in this situation if you had only mixed insulin, I don't know what you'd do about correction doses either.
It might be worth asking your nurse why they have chosen mixed insulin for you? Have they explained the alternatives? A basal bolus regime with two separate insulins is much more flexible, but does mean 4 injections per day.
My treatment team actually refused to prescribe mixed insulin to me (I was scared about all the injections so wanted mixed because it meant fewer), they said it was too inflexible and gave poor control.

copepod · Dec 20, 2010

Hi Susie
Sorry to hear about your diagnosis, but more angry that you've been put on bimodal insulin without offering you the alternative and far more flexible basal bolus regime (long acting insulin once or twice a day, plus short acting with each meal). I was put on bimodal when diagnosed as a 30 year old some 15 years ago. Fortunately went on holiday with a friend whose mother was a pharmacist in Tasmania who sent me an article about basal bolus regime, so I was able to ask my clinic to change over. I found the requirement to eat a bedtime snack one of the worse things about bimodal regime, but it is the only way to avoid a night-time hypo. However, after a period of higher blood sugars, even a normal level can feel hypo, so it's worth checking before eating any extra sugar / sweets etc. These days, I eat pretty much what and when I want, adjusting doses according to carbohydrate intake, physical activity, infections (very rare), weather etc.

noblehead · Dec 20, 2010

susieg said:
but what do I do if I want that bit extra? no-one has told me what to do then? do you adjust your insulin...i.e. take more? I am on a 30/70 mix insulin, a fast acting mixed with a longer acting, so it's quite complicated (for me) to know what to do.

Really not sure myself Susie as it's that long since I was on a mixed insulin dose, no doubt the insulin doses were worked out for you by the nurse and told to eat a fixed amount of carbs per meal, so your best bet would be to discuss this with the diabetes nurse.

Much like other I am on the MDI (multiple daily injections) using separate insulin's I can cover extra food simply by giving myself an extra unit or two of quick acting insulin, the basal/bolus regime does give a greater flexibility to eating and perhaps you may want to discuss this at your next clinic appointment.

Nigel

susieg · Dec 21, 2010

Thanks for this info. being new to this I had no idea of the different types of insulin, I know there ARE different types but as I was given this in Hospital I thought it was the best for me, not knowing any different.

I have reduced my second injection with my evening meal by 2 units, but still have a hypo at night, the Nurse said I shouldn't be having these...derrr....

I am seeing her again on 31st and will mention what you all suggest. I hope I can take it all in as I am still trying to get my head round this one.

we will persevere, as she (nurse) said it takes months/years to get it all right. I think the more flexible regime sounds better by far though.

moonstone · Dec 25, 2010

Hi Susie,

I too am sorry you've had this happen to you. I can't offer anything about the insulin doses but yes it seems to me that the medium-acting profile (ie when it acts, when its peak is, how long it acts for) of these insulins requires you to be quite strict about feeding the insulin, so if you have to eat cereal before bed for now, so be it, and perhaps you can now talk to them about the basal bolus regime - it's much more flexible but it won't stop the risk of night-time hypos, or any other hypos, until you fine-tune it (the DAFNE course is marvellous for that) but it takes time, things also change over time and you can of course still go wrong, even armed with all that knowledge. And it can be complicated to work everything out on occasion, particularly for women if you know what I mean :roll: I had lots of 'unexplained' hypos until I started noting certain other events in my sugar diary.... apparently it's very common for ladies to have fluctuating insulin requirements throughout the month and I wouldn't imagine it's different for you just because you're on mixed insulin so keep a note of these things and see if all ties up with more hypos. Often women's sugars go higher before, and lower when it starts, according to my nurse (and me, and my diabetic friend). I'm sure over time you'll be adjusting your own insulin even on mixed, but basal bolus is very flexible for that kind of temporary adjustment.

I would ask you to look up 'the honeymoon period', a phenomenon that happened to me and lots of other diabetics - it's more common the older you are at diagnosis. It's when your pancreas randomly starts making its own insulin again for a while - no-one knows why. But the reason I say to look out for it is because if you get it, there'll be a period of time where you'll be both injecting and making insulin - which means hypos, and, until it's recognised and the hospital adjust your insulin again, could mean quite a lot more eating than a bowl of cereal before bed! I actually became a piece of weetabix and my hair was truly made of pasta for about two weeks, I had to eat soooo many carbs to counter the twice-daily overdoses.... so keep an eye out, it took two weeks for mine to kick in, two weeks for the hospital to work it out, and it lasted a year. Forewarned is forearmed and if you sense this is happening to you, please don't be afraid to raise the subject with your hospital.

It's a hard diagnosis, as you've said. Some people seem to adjust very well though. If you're on facebook there's a group called Shoot Up or Put Up which often posts stories about living with Type 1 diabetes but always in a light-hearted, amusing way and it makes me feel a bit better about things.

I wish you all the best and try to have a happy Christmas.

Moonstone.

susieg · Dec 25, 2010

moonstone said:
Hi Susie,

I too am sorry you've had this happen to you. I can't offer anything about the insulin doses but yes it seems to me that the medium-acting profile (ie when it acts, when its peak is, how long it acts for) of these insulins requires you to be quite strict about feeding the insulin, so if you have to eat cereal before bed for now, so be it, and perhaps you can now talk to them about the basal bolus regime - it's much more flexible but it won't stop the risk of night-time hypos, or any other hypos, until you fine-tune it (the DAFNE course is marvellous for that) but it takes time, things also change over time and you can of course still go wrong, even armed with all that knowledge. And it can be complicated to work everything out on occasion, particularly for women if you know what I mean :roll: I had lots of 'unexplained' hypos until I started noting certain other events in my sugar diary.... apparently it's very common for ladies to have fluctuating insulin requirements throughout the month and I wouldn't imagine it's different for you just because you're on mixed insulin so keep a note of these things and see if all ties up with more hypos. Often women's sugars go higher before, and lower when it starts, according to my nurse (and me, and my diabetic friend). I'm sure over time you'll be adjusting your own insulin even on mixed, but basal bolus is very flexible for that kind of temporary adjustment.

I would ask you to look up 'the honeymoon period', a phenomenon that happened to me and lots of other diabetics - it's more common the older you are at diagnosis. It's when your pancreas randomly starts making its own insulin again for a while - no-one knows why. But the reason I say to look out for it is because if you get it, there'll be a period of time where you'll be both injecting and making insulin - which means hypos, and, until it's recognised and the hospital adjust your insulin again, could mean quite a lot more eating than a bowl of cereal before bed! I actually became a piece of weetabix and my hair was truly made of pasta for about two weeks, I had to eat soooo many carbs to counter the twice-daily overdoses.... so keep an eye out, it took two weeks for mine to kick in, two weeks for the hospital to work it out, and it lasted a year. Forewarned is forearmed and if you sense this is happening to you, please don't be afraid to raise the subject with your hospital.

It's a hard diagnosis, as you've said. Some people seem to adjust very well though. If you're on facebook there's a group called Shoot Up or Put Up which often posts stories about living with Type 1 diabetes but always in a light-hearted, amusing way and it makes me feel a bit better about things.

I wish you all the best and try to have a happy Christmas.

Moonstone.

Thanks for your kind reply, It was very interesting. I had a chat with my practice nurse about basal bolus regime, she agreed it was a more flexible way to go, but also said that they first started me off on the mixed insulin as it was the easiest to grasp and also you only have to inject twice a day. we have reduced my insulin by quite a lot over the past week, and for the past 2 nights i've been hypo free. I'm not expecting it to dissapear altogether, but It's a start for me in understanding the feeding the insulin bit.
I don't have the problem of 'monthly' fluctuations ...lol so that's one less problem to cope with.
I am keeping quite regular appointments with the nurse to see how things are going. i'm understanding it a bit more now, thanks to people on this site, people like yourself who take the time to explain things. it really helps, also it makes you feel less alone.
I'm going to have a look on facebook too and join in the discussions there also. thanks for that. The more I read and chat the more it is all falling into place.
Thanks once again...BTW..... I had a 'small' xmas dinner and a bit of figgy pud and my BG went up to 10.0 not toooo bad eh? for the past week it's been inbetween 4.5 and 8.1 which is good I am told. it's also sinking in a bit now that this is for LIFE !! at first I was almost expecting them to say that it was a mis-diagnosis and I wasn't really diabetic at all! So, I'm in the real world now and hopefully will cope with this and get it sorted!! lol

iHs · Dec 25, 2010

hello Susie

I agree with yr dsn about using biphasic insulin to begin with as opposed to using bolus/basal regime.

Biphasic insulins are a simplier way to manage bg levels as all that is needed is to test bg levels about 4 times a day and eat specific amounts of food containing carbohydrate at breakfast, mid morning, lunch, mid afternoon, dinner and bedtime. By doing so you will be able to balance out your bg levels using food rather than using fast acting insulin.

Bolus/basal will give you more flexibility over what you can eat but its at the cost of being ok with injecting insulin about 4-6 times a day. Many people suffer from daytime hypos using bb and have to learn to be able to adjust their bolus insulin fairly accurately. Also not all pcts are willing to fund DAFNE courses and those that do usually have long waiting lists of people who are not managing their bg levels that well using bolus/basal. If you read a lot of the threads on the forum, the majority relating to insulin are all about the bolus/basal regime.

I stayed on biphasic insulin for about 20yrs without any real problems. I worked for many years in a busy office and asked my consultant to give me a Humalog pen to use at lunch so that if I wanted to eat more than 30g carb which was on a Friday lunchtime when I went out for a pub lunch, I could do so by injecting 1 or 2 units of Humalog. So you see you can get the best of both worlds with twice daily insulins. They are not as restrictive as you might be led to think. I used Humalog Mix 25/75.

Good luck with whatever you decide to do. As long as you can be ok and happy then that is what matters.

susieg · Dec 25, 2010

Thanks for that. I'm sticking to the Humulin M3 for now anyway and getting used to it. I haven't upped the dose as yet only decreased it. But it seems a little simpler to grasp now.
Glad to hear a positive vote for the mixed insulins !!! it's all been quite ngative up till now and made me think what am I on this for??? but reading your response has given me some reassurance. Thanks

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