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Please help me.

Discussion in 'Type 1 Diabetes' started by nickmorgan, Jan 11, 2011.

  1. moonstone

    moonstone · Well-Known Member

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    Ha ha you're not wrong, wait until you go on DAFNE!! I feel for people who can't do maths, I really do......

    Nick that link you were given in another answer,to the b-dec site, is invaluable - spend all your spare time reading it, that's all I can say about that - I was lucky in that when diagnosed I had to take a month off work so I had time to sit and read, and absorb.

    As for exercise, it affects different people in different ways and even the same person differently on two different occasions doing the same exercise with the same food before etc. I think it's got something to do with the wind direction or whether gnomes have been recently spotted in the area. So there's no real advice to give except never exercise when you have ketones (get them on prescription from your GP, they're sticks you wee on). Often, exercise is equal to having insulin so you either need to knock a few units off your previous dose, or eat during or after exercise; however that's not always the way and some people need to inject a unit or two before exercise, to make sure they don't go too high - random. Some people also need to reduce their previous background dose a bit. And the intensity of the exercise counts for a lot too, so keep a note of how intense each game was when analysing what's happening. So for now, test before, during and after your exercise and make changes accordingly next time - well, give something a try, anyway, and see if it works, and if it doesn't then try something else. It's a tricky one. I've got CFS (chronic fatigue syndrome) too so thankfully none of this applies to me but when I was briefly OK over the summer I did shedloads of exercise over a couple of weeks and I barely had to inject anything - it was almost like not being diabetic. It was a joy and a wonderful respite.

    When I first started carb counting I used one unit of novorapid to each 10g of carbs and 1 unit for each 5mmol/l that I was over target. I tried that because I read an American girl's blog and that was what she was told to do on diagnosis, so I gave it a go. You could perhaps try starting like that and using your new shiny filofax, look for patterns in your results, if eg each lunchtime you have to add on lots more because you're still high then you might need to go to 1.5 units for every 10g of carbs at lunchtime; or, if all your readings are too high for example you might want to up your background insulin by 1 or 2 units (maximum 2) at a time for a few days and see if that's helped. If you have an overnight hypo, you need to immediately reduce your background by 2 units. An 'overnight hypo' also covers/means a hypo on waking.

    It's very complicated and can't be explained by what I've written above but that is the basis of the DAFNE approach. I was already doing that for about 9 months before DAFNE and was essentially very stable with HbA1cs of 7.1-7.4%. The b-dec link will tell you a lot, lot more. 1 unit for every 10g of carbs actually doesn't sound like enough given what you say you normally inject and the readings you often have so any decisions on that would have to be down to you. It sounds to me as though your background is what needs working on (it should only be upped by 2 units at a time, every 3 days) for now. I'm not a professional though, only a diabetic, and you've got a lot of reading material available on b-dec and in the book you've ordered.

    And no please don't eat a whole chocolate cake when you have a hypo :wink: but if you do, and you find yourself high afterwards, the strict DAFNE advice is not to give yourself insulin to reduce the high - leave it. Your body will need it to replenish the liver (I'll be corrected if that's wrong I'm sure, but I think that's the deal), and you are also at further risk of another hypo so if you can put up with feeling rubbish for a few hours, the advice is "never correct after a hypo". People often apparently find themselves chasing their tails like that - up down up down up down up down....

    As I was writing this I saw the last 2 posts - no you should add the correction dose to your dinner, definitely, crikey if I injected 20 units then didn't eat I'd be dead! Also, Levemir is meant to be split, ie you're meant to take it twice a day - you've so far only mentioned taking it at night I think? It doesn't last 24hrs, nowhere near it, more like 16 hours.
     
  2. nickmorgan

    nickmorgan · Member

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    hi guys, bit of a tricky one. last night before ned I tested my blood after football and was really pleased to see that it was only 11.1 which is bl**dy fantastic for me because it was only 11.2 before football. I went to bed at around 1.30am and injected my long acting Levemir = 24 units to keep me quite low until the mornings dosage of Novorapid with my breakfast. I think I injected to much because at 3.00am I woke up sweating and feeling generally awful. I managed to get myself downstairs but instead of the normal choccy biscuits and sweets to get myself feeling 'OK' I had a banana, an apple and a swig of my new bestest friend, Lucozade.....Only a swig because I really want to beat these cravings of sugar. I then went to bed and woke up to test my glucose levels which were high...15.8 (I think the swig of lucozade might have been 2-3 swigs). So my question is this, How the hell do I feel normal when my sugars are really low in the night, is there a quick fix like lucozade that can make me feel well enough to sleep but without the risk of being high in the morning. Oooh yeah, by the way, when I woke up at 3.00am I tested and It read 3.5.

    Thanks everyone for their support with these matters, I will beat this at last with everyones kind advice, I am reading through the links as we speak.

    Nick
     
  3. alaska

    alaska · Well-Known Member

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    I used to have all sorts of sweets/drinks/whatever I could find for treating hypos but these things never seemed to get things right so now I just take glucose sweets to treat hypos as they're quick and I know how many carbs are in them.

    The fact that they're quick helps because they help to dampen down the extreme hunger quicker.

    The fact that I know how many carbs are in them is invaluable. I'll take 3 dextro tablets which I know is approx 10g of carbs, or 4 tablets if I'm under 3 mmols/l.

    Lucozade/coke is less accurate and I often got the amounts completely wrong :(

    It can be very tempting to go on an eating binge when low on sugar. It's best to be strong with yourself and let your mind know that the sugar cravings will pass after 15-20 mins when your sugar levels have risen again.

    I'd also suggest re-testing an hour or so after your hypo just to check your sugars are back on the straight and narrow.

    As for the hypo whilst asleep - it could be a result of the football earlier, which can cause lower sugar levels up to 36 hours (or more) after exercising.

    A potential option to avoid night time hypos may be to have a protein based pre-bed snack as it'll be absorbed and turned to blood sugar more gradually than carbohydrates.

    Keep up the great work Nick, it'll be well worth it :)
     
  4. moonstone

    moonstone · Well-Known Member

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    Hi Nick, well done on the much, much better readings, and I think you've hit the nail on the head here. So the first thing to try is only injecting 22 units of levemir after your next football match. As the previous poster explained, exercise has an after-effect for many hours. If you also want to eat a source of long-acting carbs before bed then do so, I don't know what else is in a protein shake and I know protein alone has no effect on my sugars but even a glass of milk or a digestive biscuit could do the trick and keep you level through the night.

    Well done!
     
  5. moonstone

    moonstone · Well-Known Member

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    PS don't be alarmed at the higher reading in the morning, it's as expected. Also when you drop your liver can produce glucose to help you so sometimes with the best will in the world and eating precise amounts of carbs you can still sometimes go high after a hypo. I'd much rather wake up high after a night time hypo than wake up in another hypo.
     
  6. Patch

    Patch Type 2 · Well-Known Member

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    My Diabetic Specialist explained "The Rule of Thirds"to me, but I can't remember how it went... :( (Hope I don't get a hypo!!!)

    It was to do with the amount of Lucozade (from a standard , single serve 500ml bottle) that you should drink to raise you BG from certain levels:

    Bg at ?mmol - drink 1/3 of a bottle (166ml)
    Bg at ?mmol - drink 2/3 of a bottle (332ml)
    Bg at ?mmol - drink 3/3 of a bottle (500ml)

    (Or is it that a 3rd of a bottle will raise your BG by a fixed amount?) Can anyone fill in the question marks?

    Also, nick - DON'T BUY A METER!!! If you send a nice e-mail to the meter manufacturers they'll send you a meter free of charge. Shop around until you find one you like, then have your prescription for test strips altered to match the meter that you prefer.
     
  7. sugar2

    sugar2 · Well-Known Member

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    Hi Nick...welsome!

    I just wanted to point out that, the problem with diabetes, is, that it may geta little bit worse, before getting a whole lot better. From what you have said, I am not surprised that you insulin doses are completely wrong....I *think* that your levimir has been compensating a little bit for your high blood sugars...so now you are improvingthem, you may hypo a little bit.. Please don't let it put you off...hypos are awful...but it does get better.

    PS...when you wake up with the sweats...if you can, test your blood, just to confirm that you are low. If you did, and you were low...then I would reduce the levimir a fraction.

    I imagine, what you may end up with is a lower levimir dose, and doses of novorapid that vary depending upon what you eat, and what you are about to do....but for now, one step at a time...best of luck :D
     
  8. cugila

    cugila · Master

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    I wouldn't take that too literally !!! :shock:

    166 mil of Lucozade is equivalent to consuming 28.55g of Carbs. More than a meal for me.
    332 mil is equivalent to 57.09g carbs.
    500 mil is equivalent to 85.99g carbs. .......

    Definitely not a good way to treat a Hypo level where you should only consume enough fast acting carbs to raise the level, around 10g carbs maybe. Then test after 10 - 15 minutes and consume a small carby snack to stabilise if the levels are OK. Drinking that much in one go would rapidly escalate my levels into hyperglycaemic territory........not recommended.

    I dread to think what the Bg levels would be after drinking such amounts. I would only ever have about 30 mil of Lucozade if levels were way too low, then the snack.

    Here is a link to information regarding what to do in the event of a hypo. Scroll down for treatment.

    viewtopic.php?f=20&t=18529&start=0
     
  9. Patch

    Patch Type 2 · Well-Known Member

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    Maybe she's not such a "specialist" after all... :?
     
  10. cugila

    cugila · Master

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    Not sure Patch but you need to be very careful with fast acting carby drinks, you can end up on a massive 'Roller Coaster' ride.......I can assure you it is NO fun. :(

    Same way as yesterday, I asked for a Diet Pepsi (bottled) and was given it, poured same into glass and settled down for a read. Got home about an hour later and found my levels were sky high..... :?
    Then I got to thinking how come.......the breakfast was bacon, egg, black pudding etc and normally has no effect on me. This time my reading had more than doubled from a 6 to 13 mmol/l !!

    I have a feeling that the bottle I was given wasn't a diet one. I never checked just picked it up and poured it into the glass.

    I shall be more careful next time I go. :)
     
  11. nickmorgan

    nickmorgan · Member

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    To late. I was so focussed on testing my blood so often that I ran out of test strips. I went to the chemist and my doctors surgery (which was closed) and the prescription is due to collect tomorrow. Went into town and bought a new monitor, which is a lot more modern that my current OneTouch Vito monster....I am now the proud owner of a fururistic looking meter called AccuCheck Aviva Nano and im quite impressed so far. It is far more in keeping with my techy gadget filled lifestyle. I tested before my lunch around half and hour ago and I was surprised to see that my sugars are now at 3.5 so I tried to calculate my dosage using an iPhone app called 'carb master'. I had 2 slices of toast (32g in total) a fried egg, some freshly cut ham and a tiny dollop of HP tomato sauce. Not sure why but I decided to inject about 18 units of Novorapid. Can someone please help me with how to calculate what to inject for what I eat and what my sugar levels are? Would it just be a case of trial and error...???

    Thanks to everyone for the replies again, Im quite impressed with my progress so far. Dont think I could have stuck with it without the help from people like you.

    Nick
     
  12. cugila

    cugila · Master

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    Not a Type 1.......

    However, the meal you have just eaten is slow acting carbohydrates, the Insulin you injected is quick acting I believe ?

    Your level pre meal was in hypo level. Now to me that could mean that the peak level would not be till later on, but the Insulin may kick in quite soon.......therefore that would lower your Bg level.

    I think if I were you I would check your Bg level frequently at the moment to make sure you don't drop too low ! If that is the case then you need to treat that level as it could keep dropping.

    Let's hope a T1 comes along soon to better advise you about Insulin/Carb ratios.......
     
  13. alaska

    alaska · Well-Known Member

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    I would be rather wary of using an iphone app to calculate your insulin dose - if you do use it be sure to test to see how accurate it predicts dosages.

    Be particularly on the watch out for hypos during any experimental phase.
     
  14. nickmorgan

    nickmorgan · Member

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    I will do, Thank you all. These factors have all been noted and taken on board. Will update you all soon with some more questions.

    Nick
     
  15. AndyS

    AndyS Type 1 · Well-Known Member

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    Yes I can't see an iPhone app being particularly accurate.

    I have looked at this sort of problem and spoken to some researchers where I work who are experts in either statistical modeling or modeling biological systems. I showed them my stats, which are quite detailed, since the day I was diagnosed.

    My ratios have changed and I have gone from 8u of lantus to 34u and from 15g carb per unit of rapid down as low as 4g per unit. The ratios even change depending on stress levels. (yes I even record that occasionally, though it's a little subjective even with my own scale).
    But my point is that a couple of people glanced at the data and were very interested in how I calculated my corrections (up or down) and were not surprised to learn that everyone was different.

    Their responses were, that is not a trivial problem. This I have learned is researcher speak for "That looks scary difficult, though possibly very interesting"
    Which is not surprising since I know this is the one area they are sturggling with in research for an "artificial pancreas" type system.

    Don't trust off the peg iPhone or PC apps. They will not be very accurate at all until they have a LOT of YOUR readings. This is also why it is so imprtant to be brutally honest when you have highs or lows and share with your DNS's and Dr's.

    It is a bit hit and miss until you find your ratios and a system that works for you, but that is the key. It's a system that works for you, they dont tend to port well to other people.

    Good luck all the same :)
     
  16. moonstone

    moonstone · Well-Known Member

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    The problem with hypos is how much insulin you've got on board, so it can never be a precise science. I've had to call an ambulance in the middle of the night because I'd already had 3/4 litre lucozade and had only got up to 2.1 (after getting down to 1.9) - I live alone and had to make a decision to call for help while I still could (things were getting very questionable at that point). It was only one hour after about 6 units of novorapid. If it had been 4-6hrs after the same, I'm completely sure the standard advice would have worked! I had a whole litre bottle sitting on the table and I was eyeing that up too before the paramedics arrived... and I only hit 16 afterwards, with a slice of bread they made me eat in the mix too - I was amazed.
     
  17. head323

    head323 Type 1 · Active Member

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    hi nick

    i hve diabetes since i was 4 and i had it now 23 yrs and i same age as u .

    it was ok back tan cause i was a young kid and not a care in the wrld but now i hve .

    i inject 4 times daily every day 365 times a yr so i well uesed to injecting .

    counting carbo no need to i use to do it wen little but u get a average idea of wat is on ure plate by how much u goin to give insulin .

    i never coung tem cause imagin countin carbo in restaurant ppl think we mad .

    life will get better i sud know as i hve it longer tan most ppl here.

    belly good place to inject as more mussle tere but yeah tummy getting big with all the injections i doing . another place i find eay is backside just stick needle in and be done with it .

    u sud try change areas of injections around day by day if possible .

    fizzy drinks cnt be allowed cause it make ure levels rock high but u can drink sugar free coke 7 up as long as it sugar free u be ok.

    if u want to know more just as away i love helping ppl with daibetic problems

    let u know this nurses doc dont know everything about this we know more tan they do cause we live with it tey dont so just remebr that .

    best of look with it all .
     
  18. Catherine_h

    Catherine_h · Well-Known Member

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    Nick

    You mentioned blood monitors I recently bought a Bayer’s countor USB Monitor and I love it!

    I can plug it straight into my laptop and it gives me lots of very useful charts and graphs! I print these graphs and take them along to my appointments with me! you could also email them straight to your DSN!

    It also has an alarm on there to remind me two hours after eating that I need to test! all the records are stored and recorded! its great!

    Think I paid about £40 for it (it is on offer on this site) but I feel well worth it and the test strips are available on prescription!

    Catherine x
     
  19. jameshallam

    jameshallam · Well-Known Member

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    Hi Nick - Hope your well on your diabetic journey!

    Regarding meters - when I first went to see my diabetic nurse I asked her about meters and she led me to a cupboard full of various bits of diabetic kit and let me choose whatever I wanted. I picked a few and ended up using the Contour USB due to it's simplicity. She said they get given lots of free samples from the manufacturers and pass them on to diabetics to try for free. They had things like diaries, insulin pen cases etc.

    I use an iPhone app "Glucose Buddy", not to calculate carbs but instead of a log book. I record blood sugar, insulin, food and exercise. It's useful as it is linked to their website where you can look at various graphs if you like that kind of thing.

    Insulin Sites: I use my tummy normally, and bum if there is no one around. Others use the triceps (I find it difficult to reach), and thighs (my thighs are not fatty enough). When at the clinic as them what size needles you should be using. They vary from 10mm down to 4mm i think. The less fat you have the lower the needle size should be. I think the guidelines have also reduced the needle size in recent years.

    Carb counting: Get a set of digital scales and practice your fractions! On most food it says how many carbs for 100g of whatever you are eating. If there is no label, you can get a little book "Colins Carb Counting" which will tell you, or put this site into you iphone faves: ccm.about.com its a searchable datebase of carbs. You'll soon be pretty good at estimating carbs and won't need to look everything up.
    You might want to ask your diabetic nurse if there is a dietician you can make an appointment with. After they had gone through the standard: eat 5 a day, lower your fat etc. They were quite useful in giving advice on carb counting.

    As for how much insulin to take, I was advised to start with 1 unit for every 10grams of carbs.
    And corrections use 1 unit to reduce you blood sugar by 3.
    These figures very from person to person, so you might be a bit different, but it's a good starting point. I was also told not to inject more than 4 units as a correction, just to be on the safe side.

    The recommended levels are between 4-7.
    However, because you have had high readings for a while, you will want to reduce you blood sugar in stages. If you went straight down to readings og 5-6 you may have hypo symptoms. Ask your diabetic nurse about this too.

    Sport - test lots, always have the sugar nearby. Also remember to test after sports/exercise. I find after a game of squash for 45mins, my sugar will drop for about the next 12 hours or so. I combat this by either having more food or reducing the amount of insulin I take. It takes a bit of practice, so remember to write everything down, and then you can learn from your own experiences.

    Good luck with the control, hopefully you'll learn alot when you have your appointment - remember to always ask questions if your unsure about anything. I found it useful to write down questions whenever I thought of them (they always occur at the most random of times!) and then bring a long list at the appointment.

    Cheers,
    James
     
  20. jameshallam

    jameshallam · Well-Known Member

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    P.S. I found browsing the old topics on this forums was as good as any book when trying to learn about diabetes... I was lucky enough to have a bit of time of work when diagnosed and spent a while just reading!
     
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