Newly Diagnosed Type 1 - starving!

[dizzydonkeys]

Hi all, looking for some advise if possible.
Newly diagnosed type 1 last week - went to docs feeling a bit run down and suffering severe thrush and constant thirst/needing to pee = keeping me up all night = tired.
Thought was just stress/warmer weather but alas no, finger prick test showed 22.5 and urine test showing high sugar. So rushed off to hospital where more blood tests still showing high levels - the 22.5 was first thing in morning (hadn't eaten since previous lunch time either - naughty I know) Was given a sandwich and yoghurt - levels shot up to 30 odd!
So now on insulin and been told to cut carbs as much as possible til am at a sensible level, no sugar in my tea etc etc which is all well and good but I have no idea what to actually eat and fear I will waste away!

I am 30 yrs old, very small weighing just over 7 stone BMI around 16 - so can ill afford to loose weight! Am very active walking, running (though temporarily on hold) horse riding and in a stressful and active job - on feet all day and up and down lots of stairs.

My night time levels are currently at bedtime around 13, by morning around ten, lunch time anywhere from 15 to 18 but then by time get home from work am dropping to 7.2 ish and really feeling it.

I don't have facilities to cook at work on a lunch time, and for most of my life never bothered with lunch so really struggling, and just struggling generally with the whole food thing, I hate veggies mostly but will force carrots and peas, I mostly liveon pasta or did but understand this really is a no no - salad can surely only be tollerated for so long and i am not a big meat or fish fan really - takes too long to cook after 14 hours at work and an hours commute each way.

Sorry for massive ramble but feels better to write it down, am totally at a loss and hoping someone can inspire me with some food ideas - have a dreadful relationship with food at best of times and seems to be getting worse

 

[Pneu]

OK first off as a type I although I wouldn't personally recommend you gorge on carbohydrate it is not necessary to avoid at all costs assuming that you cover it with insulin.. Personally I would look to eat lower GI carbohydrates and cut out sugar as this will give more stable blood glucose.. I wouldn't suggest any large changes in diet until you are more confident and have a better understanding of your diabetes.. something that's going to take a few months minimum.

By far the most important thing you can be doing right now is building up your own personal bank of information as to how your body works and reacts to carbohydrate and insulin and that means routine, testing and food diaries.. Spending time to understand your diabetes is the only way to control it..

What insulins have you been given and what instructions have they given you..?

Also reference the feeling bad at 7.2 mmol/l... this is nothing to be concerned about.. your body has run high blood glucose now for so long that you are having what's called false hypo's.. your body is reacting as if it has low blood glucose even though it doesn't... right now I would suggest you aim to keep your blood glucose above the 5.5 - 6.0 mmol/l mark until you gain a better understanding then you can begin to push that lower.. that way you give yourself some buffer zone should anything go wrong before low blood glucose becomes an actual problem.

 

[Mileana]

What you should probably do if you can is learn to tell how many carbohydrates your insulin will cover. If you are on two kinds of insulin so you can inject to match your meal, this will be easier than if you are on a premixed insulin. What you want to know if how many carbohydrates are inside the things you eat, then you want to inject the amount of insulin that will cover this - for most people it is in the area of 10g of carbohydrate that you can eat per unit of quick acting insulin that is given at meal times. You want to carefully test eating 1 slice of toast and see if one unit of insulin will make your blood sugar return to no more than +3 mmol/l compared to what it was before. If yes, then you can work out how much insulin goes with a slice of toast, and a similar amount of carbohydrates. If not, you'll want to try with 2 units next time. You will probably find you need a little bit more insulin in the morning compared to in the evening.

If you are on a mixed insulin it will be a bit trickier, and it will also depend if you take this insulin once a day or twice - if it is twice, then you can try a rule of thumb that goes: 10 units of mixed insulin will allow 10g of carbohydrate for breakfast, 10g for lunch - then the insulin you take around dinner time, 10 units should allow for 20g carbohydrate at dinner, then 10g for an evening snack. The premix 30 is 70 percent intermidiate acting insulin which will not directly help with meals, and then 30 percent quick acting which will kick in around 30 minutes after you take it and last up to 5 hours. Then for every 10 units, you get 3 meal time units and the most of that comes early which is why the first meal on a dose can be slightly more carbohydrate loaded than the second. Many people however find that they are more insulin resistant in the morning, so that probably will only count half.

I can't imagine they put you on only long acting, but if that is the case, you need to watch your carbs because if you get so much long acting that it will cover meals properly while eating ordinarily, you will get hypo's when you exercise, so that's hardly a valid option and I would certainly ask to get that changed, but I don't think they did that either.

In any case, while insulin dose is being worked on, you should be happy to see your levels drop by about 1-2 mmol/l each week as the dose is adjusted - much more will mean they are upping it too fast for you to really adjust and know what is going on.

The blood sugar being high before lunch points to your dose at breakfast being a bit too low - you could try multiplying the dose you take with breakfast now by 1.5 and ask them if that would be an okay number to try. If you are then nolonger running high around lunch, you will want to omit a matching level of units so you don't get too much for lunch - you nolonger should have excess blood glucose to cover in that injection. So if you have 3 for breakkie, ask about trying 4 and if you normally have 5 for lunch, ask about trying 3 or 4 there. Always round down, never increase by more than 1 or max 2 units a time so you have a bit of margin. Do discuss it with them, though.

 

[dizzydonkeys]

Thanks guys, alot to take in at the moment, I am currently on 8 units of Lantus at night and 3 units of humalog at meal times. Am not due to see nurse again until next Friday though am supposed to check in every few days - just feel abit like am out on a limb, quick to diagnose and give me these pens etc but then thats about it -maybe I'm just impatient!?

Have never done the counting calories thing so reading packets is not normal to me lol think I need a shopping trip when a few hours to spare, no more just throwing what I fancy in the trolley!

 

[Mileana]

In that case, I'd be in touch with them on Monday informing them that you need 4 units of humalog at breakfast, it seems, and perhaps still 3 or only 2 at lunch, rest unchanged, see if they agree.

It is normal to need more insulin than you normally do in the early am's because your muscles need time to get moving before they will react to the insulin properly.

Otherwise if you can fit in a brisk walk just around breakkie for 10 minutes, that may help also.

Also calories is one thing - what you really want to pay attention to is the Carbohydrate content. On insulin you can have whatever you like once it works properly (within reason of course) as long as you know how many carbohydrates are covered by a unit of insulin so you can match one to the other. It varies from person to person, but as I said, it will normally be in the area of 10g covered per unit for type 1s.

 

[Pneu]

Thanks guys, alot to take in at the moment, I am currently on 8 units of Lantus at night and 3 units of humalog at meal times. Am not due to see nurse again until next Friday though am supposed to check in every few days - just feel abit like am out on a limb, quick to diagnose and give me these pens etc but then thats about it -maybe I'm just impatient!?

Have never done the counting calories thing so reading packets is not normal to me lol think I need a shopping trip when a few hours to spare, no more just throwing what I fancy in the trolley!

You certainly appear to need a bit more insulin post your morning meal and post your evening meal.. now the correct thing to do here first is to check that your background insulin dose (Lantus) is correct... now for a newly diagnosed where your Pancreas may still be producing insulin you might need to do this every few weeks just to make sure..

What I would do is have some 'no carb' days... eat nothing that contains carbohydrate.. you then check your blood glucose hourly.. the idea being that the Lantus should be dealing with the glucose that your liver produces naturally and therefore if your not eating anything then your blood glucose should not fluctuate by more that 1mmol/l.. over the course of the day.. you then need to repeat this over night (a massive pain!) but well worth it..

Once you have your background insulin correct then you can work out your correct ratio's for the carbohydrate you eat vs. the insulin you inject to cover.. if your background insulin is incorrect then you have no way to telling what insulin you need to change or why you might get unexpected highs / lows..

Now from the blood glucose results you posted in your first post clearly something is incorrect and I suspect it is your rapid ratio's BUT its best to rule out the background first.. good control can only be achieved from a solid base of correct background insulin..