Really Annoyed...And more than a little scared.

[donnellysdogs]

It sounds to me as if you are eating rye bread to keep your blood levels raised during the day because you are having a lot of units of fast acting insulin, which then necessitates to have the ryebread..


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[XIX]

Thanks very much for your response.

Actually, I don't take any significant amount of long-acting insulin at all: I take just a tiny amount of Insulatard last thing at night. (This prevents my blood sugar rising overnight.)

I take 11 units of Actrapid first thing in the morning, then a further 11 units at 11.00am. Also, I take 6 units of Novorapid at 4.00pm. (I find that the effects of the 11.00am Actrapid and the afternoon Novorapid both run out together at 12.00 midnight.)

I check my blood sugar at 11.00pm. And so long as I didn't eat unwisely during the evening, I know that my blood sugar will fall by 2mmol/l by 12.00 midnight. (If my blood sugar is 4mmol/l at 11.00 - which it usually is, more or less - then I know I need to eat half a slice of the Co-Op's wholemeal wheat bread to balance the fall of 2mmol/l.)

Without the 'basal' insulin, I know that I will sleep safely. And I start each day anew.

So, to answer your question, I start off eating rye bread slowly. And as the insulin kicks in, I eat more, and then again more. I continue eating it until 4.00. (It's very good with Biona Pear & Apple Spread.) I don't eat any after 4.00pm. (If I did, then my blood sugar would become elevated later in the evening and perhaps even overnight.) And I find that the blood-sugar moderating effect lasts throughout the evening. (I'll explain what I mean below.)

I eat other stuff too, of course. But I never have to do any 'carb counting'. I only need to check my blood sugar quite a lot: on average, once per waking hour. (Mostly I use the ultra-cheap and thoroughly reliable Betachek Visual or Glucoflex-R - they're produced by an Australian company, incidentally.) I find that I eat around 225g of rye bread per day.

Apparently, what I do is called 'feeding the insulin'. And without the rye bread, I couldn't possibly do that safely.

And indeed I find it very striking that, even at 11.00pm, I can comfortably tolerate low blood-sugar readings - and relaxedly take action - which previously would have left me on the floor.

That's really interesting. Well, I'm off to buy some rye bread tomorrow. I think I'm going to have to some experiments on this....even though I don't particularly like the stuff.

 

[michaeldavid]

Thanks very much for your response XIX. Much of it involves expertise which I don't have.

But I can say for sure that the rye bread certainly would spike my blood sugar if I ate too much of it.

Also I know very well that if I don't eat rye bread, then I very soon find that my blood sugar begins to yo-yo. And that yo-yoing makes me - or anyone else - very much more susceptible to serious hypos.

 

[donnellysdogs]

225g of ryebread..I take it that's weight and not carbs? Because if it's carbs, that's a lot..as well as having other carbs throughout the day too.... Even 225 g of bread a day would cause me huge weight gain, even if it normalised my bloods... That's over 1/4 of a farmhouse sized loaf of bread.

Personally, I think you may have gained a balance, but it isn't sustainable longterm. And I do firmly believe that you are eating this because you haven't balanced your basal/bolus without the ryebread.


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[Omar101]

Since you seem to be only using fast acting insulin I think its pretty safe to say continuous eating is what is keeping your bloods stable. The sustainability of this is questionable because if you were to go without eating for some time you would have very serious hypos.

I would personally rather have a basal dosage working in the background and account for what I eat with a fast acting insulin and that works for me very well and is obviously safer as my levels will go up and down by about 0.5mmol throughout the day if I were to eat nothing.

However I know that doing this would mean a transition period of bad blood sugars for you until you can find your proper basal dosage so it's really up to you. If you were to count the carbs in the rye bread you were eating; depending on the brand or whether it is a mix of grains its very likely you could substitute another slow acting carb in the same amounts and see the same blood sugar trends you are experiencing now. Its very unlikely that the rye bread is anything special other than slow digesting. Give legumes a go or barley etc.

 

[ann34+]

I was diagnosed about a year ago I'm also in uni (doing a chem degree with electives in biomed) I felt then very much the way you do now and I can honestly say what brought me the most comfort and satisfaction was gaining knowledge on how to control my blood levels, the effects of different macronutrients and metabolic factors etc. So the advice I would give is: accumulate as much knowledge as you can and just control the hell out of your levels. You have almost complete control of your diabetes there's no need to increase the risk of complications, just get a firm handle on it now and you'll be grateful for it in the future.

Hi, Omar101, while i very much agree with your posts re diet - veg and beans are a staple - i am not quite sure re your comment about being able to have 'almost complete control of ...diabetes' - maybe it works for you, but it has not always worked for me, and i would have been very l fed up if i had hoped that i could exactly control things day to day and then found i could not - over the years I have accepted i don't always know why something has happened, and then have just adjusted insulin and/or food. The problem , as one consultant explained it to me, is that there are so many different hormones circulating at any one time - some of which may have an anti insulin effect, and others the opposite, and that this means that control is an inexact science, different for everyone, partly depending on genetic factors, and also on any residual insulin, C-Peptide, amylin, etc.

 

[Omar101]

Hi, Omar101, while i very much agree with your posts re diet - veg and beans are a staple - i am not quite sure re your comment about being able to have 'almost complete control of ...diabetes' - maybe it works for you, but it has not always worked for me, and i would have been very l fed up if i had hoped that i could exactly control things day to day and then found i could not - over the years I have accepted i don't always know why something has happened, and then have just adjusted insulin and/or food. The problem , as one consultant explained it to me, is that there are so many different hormones circulating at any one time - some of which may have an anti insulin effect, and others the opposite, and that this means that control is an inexact science, different for everyone, partly depending on genetic factors, and also on any residual insulin, C-Peptide, amylin, etc.

ALMOST

I guess I should explain that I mean everyone has their off days and blood sugar incidents but noting them and taking into account your own personal factors can really make incidents like that negligable on your overall (yearly?) blood sugar averages especially when you have a good routine going as I do. For example realising that stress can be affecting your cortisol levels and in turn your body's absorption of glucose allows you to either compensate for or simply understand what is happening and why, to me that's control as opposed to seeing a rise in bs and simply accepting that it will happen for no reason and going on with my day not knowing what to do about it.

 

[parameswaran]

So I got diagnosed with T1 a couple of weeks ago, and at first I was surprisingly OK with it. Obviously I was shocked as it's a pretty rare disease, and I thought I was past the most common age for diagnosis, but at the time I just wanted to get out of hospital. I went back to uni the Monday after I was discharged and normality resumed.

However, lately I've just been so angry at everything. I know I shouldn't be as everyone around me has been really supportive and there are worst things that could have happened. It's just that it's all so unfair. I know that's how life is but seriously, the chances of me getting this were 17 in 100,000 - that's 0.017%. Yeah, maybe I should go buy a lottery ticket.

People keep telling me that it will get easier, and I believe them. But easier is a comparative....it's never going to be easy, and Iife's already hard enough as it is without this thrown in the mix. It dawned on me the other day that I will never "get better", there won't be a recovery, I'm just going to have to deal with this every single day for the rest of my life. It's rather sad when you realise that you can literally die by eating.

I'm scared because it's a chronic condition with the cure still a good ten years away (at least), I'm scared because I'm a recovered anorexic who used to suffer from anxiety/depression and this is going to make everything bad again. I'm stressed because it's March already and my end of year exams are less than two months away and I don't have the time to go to endless GP appointments and clinics even though I know they're necessary.

It annoys me that there are so many foods out there that I haven't tried and now I probably can't. It really irks me that my stomach is now a plateau of small bruises (yes, I'm very vain ). I'm just so sick of everything and I would sell my soul to have a normal functioning pancreas that produces insulin.

The worst thing is I'm a biomed student so I know exactly what's going to happen if I don't manage my diabetes properly. I also know that even with proper management I might still get complications. Because even if it's a small percentage, I'm part of the 0.017%.

(Sorry that this is basically a reeeeally long rant)

XIX

Hi,

If you can adapt a lifestyle suitable for T1, need not worry about health.
I am quoting your words "I also know that even with proper management I might still get complications."
I think if you can manage your diabetes well, chances of getting complications is very less.
I have been detected T2 when I was below 30. Now I am 56 and healthy. So dont worry. Concentrate on your studies (and also controll your diabetes - diet and exercise are the keys).

 

[tomvonc]

A top tip for you. I reckon when the waitress says it's diet, 30% of the time she is lying ;-)

 

[michaeldavid]

It's not just continuous eating that keeps my blood sugar stable, it's the continuous eating of rye bread.

Not long after I was first diagnosed 30 years ago, I returned to work as a motorcycle messenger. And I ate continuously then too. But I had to keep my blood sugar high, because I hadn't then discovered the moderating effect on my blood sugar of eating rye bread.

My blood sugar now tends to be pretty level throughout the 24-hour day.

When I tested first thing this morning, it was 7mmol/l. And for the rest of the day, it will very likely be significantly lower than that.

If my blood sugar is significantly higher than 4mmol/l first thing (as it was this morning), then I subtract 4 from the value of that level, and I divide by 3; and - in addition to my normal 11 units of Actrapid - I take that amount of Novorapid.

So this morning I took (7-4)/3 units of Novorapid. And I injected that single unit of Novorapid in my stomach area, for I find this makes the effect more rapid in onset. Half an hour later, my blood sugar was back down to normal.

 

[donnellysdogs]

Michaedavid why do you do all these subtract ions and ad dings on to work out how much insulin to give? Don't you just know your carb ratio work out the carbs in the food and inject the right qty for what you are about to eat? I been t1 30 years and I've never used your add and subtract to work out my dosages...


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[michaeldavid]

Most of the time, I don't need to take extra insulin. Most of the time, my blood sugar is pretty well spot on.

So most of the time I don't need to do any calculations. I normally take exactly the same insulin every day.

And thank goodness! For I do not have a clue what a 'carb ratio' is.

 

[michaeldavid]

So, at 11.00pm my blood sugar was 2.6 mmol/l. And that's not untypical for me at this time of night. (Nb. The remaining effect of the rye bread I ate during the day makes this near-hypo perfectly manageable.)

My blood sugar is still going down, only very slowly: the effect of the insulin I took earlier is all but finished.

And I know from experience that my blood sugar will drop by a further 2mmol/l by midnight.

I also know from experience that that 2mmol/l drop will be covered by half a slice of the Co-op's wholemeal bread.

So, I've just eaten a little under one slice of that wholemeal bread - with yeast extract, as it happens.

And now I know that I will be safe overnight.

I've also just taken my 1.5 units of Insulatard, which covers my normal slight overnight rise.

But suppose my blood sugar had been higher at 11.00: suppose it had been, say, 9mmol/l.

So, I know that by midnight it will be 7mmol/l (because I've eaten sensibly during the evening).

And I know from experience that I will need to take a further (7-4)/3 units of Insulatard - ie. a further single unit - to ensure that my blood sugar will be near normal in the morning.

 

[iHs]

I understand the calculation..... your correction factor is 1u lowers yr bg by 3mmol and your target bg is 4mmol so that is why you subtracted 4mmol away from the 7mmol which leaves the difference of 3 and so divide by 3 gives you your correction of 1u. I more or less used the same method when on mdi too but my target bg was 6mmol. 4mmol is a bit low as your target???

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[Dzialo]

Let me tell you I got diagnosed 4 weeks ago and there isn't a day that I don't stop thinking about it but I'm not angry I'm just depressed, so I go and try to find something to cheer me up and I find sometimes things but it's very difficult for my family as I was always the happy and funny one but now just quiet. My advice try to find something or someone that makes you happy for me it's spending time with my nephews and nieces

Hope I helped

 

[michaeldavid]

Thanks for what you wrote. I'm interested.

Er, what's 'mdi'?

The target isn't too strict, really. I didn't scrimp on the toast..

 

[iHs]

I hope I am right about yr calculation and that Ive not misunderstood. MDI is another term used like bolus basal...... multi daily injections

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[ann34+]

ALMOST

I guess I should explain that I mean everyone has their off days and blood sugar incidents but noting them and taking into account your own personal factors can really make incidents like that negligable on your overall (yearly?) blood sugar averages especially when you have a good routine going as I do. For example realising that stress can be affecting your cortisol levels and in turn your body's absorption of glucose allows you to either compensate for or simply understand what is happening and why, to me that's control as opposed to seeing a rise in bs and simply accepting that it will happen for no reason and going on with my day not knowing what to do about it.

Re ALMOST - thanks, Omar101, for clarifying your meaning - I realise you are very aware of the complexities, and also that things are so much better these days, but my own early experience over 30 years ago comes back to me when i see a thread where someone says 'more than a little scared' . ......... i was fairly confident in the early years of Type 1, i had good control, i was on the same insulins i had used since diagnosis, I was buying extra test strips, doing a lot of tests, and was on a many injection regime with no base rate, due to my insulin sensitivity. - i was swimming regularly, a once a week routine, at a time the pool was nearly empty, and i wore a warning bracelet. My consultant had discussed hypos and exercise, and in particular swimming dangers, and i had followed all the rules . I tested just before and after every swim, and always had a larger pre swim snack than I usually needed, just to be safe, but, even so......................i have no memory at all of what happened less than 15 mins into a slow swim............. just that I came to flat on my back, on the cold, wet, poolside concrete, with the 3 lifesavers who had dived in to rescue me standing over me. i had apparently passed out and all 3 had noticed me suddenly sink underwater. An ambulance arrived. I realised i had been handed a mars bar. I recovered quickly but my lungs had taken in water and i developed a painful chest infection. However, the main effect was that my confidence was shattered - I realised that, at least for me, things were rather more scary than i had thought ......

 

[Omar101]

Re ALMOST - thanks, Omar101, for clarifying your meaning - I realise you are very aware of the complexities, and also that things are so much better these days, but my own early experience over 30 years ago comes back to me when i see a thread where someone says 'more than a little scared' . ......... i was fairly confident in the early years of Type 1, i had good control, i was on the same insulins i had used since diagnosis, I was buying extra test strips, doing a lot of tests, and was on a many injection regime with no base rate, due to my insulin sensitivity. - i was swimming regularly, a once a week routine, at a time the pool was nearly empty, and i wore a warning bracelet. My consultant had discussed hypos and exercise, and in particular swimming dangers, and i had followed all the rules . I tested just before and after every swim, and always had a larger pre swim snack than I usually needed, just to be safe, but, even so......................i have no memory at all of what happened less than 15 mins into a slow swim............. just that I came to flat on my back, on the cold, wet, poolside concrete, with the 3 lifesavers who had dived in to rescue me standing over me. i had apparently passed out and all 3 had noticed me suddenly sink underwater. An ambulance arrived. I realised i had been handed a mars bar. I recovered quickly but my lungs had taken in water and i developed a painful chest infection. However, the main effect was that my confidence was shattered - I realised that, at least for me, things were rather more scary than i had thought ......

Thanks for sharing your experience, you're right those kind of incidents can be hard to predict/control. I was talking specifically about limiting long term complications however, which in my opinion is very controllable in comparison.

 

[donnellysdogs]

Michaeldavid

My concern for your managing your diabetes is that it is so restrictive if you have to have rye bread every single day.

After being T1 for 30 years I can tell you that I certainly wouldnt have ate rye bread for 30 years and hopefully another 20....

What happens if you go on holiday abroad for 2 weeks for example.. What would happen (god forbid) if you had to have an operation such as my friend who has had to be fed through his stomach for 5 months?

It may well be ok for a while, but seriously I really wonder if you are thinking longterm and just how sustainable it is to limit your lifestyle so much.

Much better to be honest to find other things AND most definitely 4.0 is way too low with anybody having insulin of any sort. AND knowing that you will drop to 2.0 and having co-op wholemeal bread every night? Seriously, you are condeming yourself to a rigid non sustainable restrictive way of eating and diabetes is not in this day and age meant to be managed like this.


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