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So confused and depressed

Discussion in 'Type 1 Diabetes' started by hellobear007, Mar 28, 2012.

  1. hellobear007

    hellobear007 Type 1 · Member

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    Hi all

    I am a very low ebb with everything, sorry if this post seems to ramble on but I need to try and get everything out and hope that maybe someone will understand.

    I am 28, was diagnosed at 13. Never really had great control over my blood sugars but badly abused my body in my late teens / early 20's through alcohol abuse and not eating properly.

    I have not touched a drop of alcohol for 6 years but my diet has been poor, lots of takeaways and convenience foods, cakes etc which has resulted in macular degeneration.

    I have been on anti depressants (venlafaxine) since the age of 18, I cant get off them, ive asked for help but no one seems to listen. Also hooked on diazepam which I use to try and get some sleep as I have bad insomnia.

    I have taken the DAFNE course and learnt how to carb count although ive only recently started doing this again.

    My blood sugar levels are never below 14, I mostly average about 17 and often in the 20s, and sometimes 30s.

    For a long time I was taking 40 lantus in the evening, and around 80 humalog througout the day, not really testing my sugars and eating whatever I liked.

    Because of my crazy sleep pattern my mealtimes are totally messed up. I dont usually eat until around 7pm and then again at about 1 or 2am. I occasionally snack on fruit, yoghurs, crackers if I am awake earlier or up until early morning. My GP seems to think I can change my sleep pattern overnight, but after years of living like this it seems impossible.

    After going back to see my DSN, utterly depressed with everything she suggested I was taking too much insulin!! and that my body had become used to it. We discussed everything and now I am carb counting again and with my DSN advice have lowered my insulin levels. I now take 30 lantus in the evening and stick to the carb ratio of 1 unit to every 10g of carbs, and I use 1 unit to reduce my insulin level by 2mmol in a correctional dose.

    I chucked out all of the junk food and filled up on fresh fruit and veg, pasta etc... all good slow release carbs but my blood sugars keep RISING. Even with a correctional dose the insulin does not seem to make any difference at all. Im testing 5 + times a day to try and build up a pattern of whats going on. Have changed injection sites etc but nothing is working.

    For example, before my dinner (I made my own sweet and sour chicken, steamed rice and veg and chicken, microwaved the sauce) my blood was 17.8. I added up the carbs in my meal to be 80g so I took 8 units and an extra 6 units as a correctional dose. Now, 3 hours later my blood is 24.9!!

    I keep doing correctional doses throughout the day but it never works. The more insulin I give myself with the correctional dose the hungrier I feel. I have so far managed to ignore the hunger pangs and only snack on an apple or orange if really hungry. And still I get the blood sugar spikes.

    I have an appointment with my DSN in 3 weeks but I dont know whether to contact her before then as surely giving myself correctional doses of about 8 units a time and it not working... something is wrong. I also take Metformin 500mg with my dinner.

    I am sorry this post is so long, I just needed to get it all out somehow :(

    I know the complications I am suffering from the years of abuse are my own fault, but now I feel the harder I try to take control of my diabetes (and my life) the further I am losing it... I hate it so much and it makes me so angry that I cry. I have never not taken an injection, I relent it at times but I just want it to work.

    Have asked about the pump but apparantly I dont meet the criterea??

    Thanks to anyone for listening to my rant, sorry to be so downbeat xxx

    Diane
     
  2. jdm

    jdm · Member

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    hi Diane,

    first think first, its never late to change anything in your life so never give up.
    i am not a expert but it seems like you have problem what you eat. sauces can be tricky because of high level of sugar also the rice if its white rice it is normal your BG to rise. again how big is your portions? fresh veg are always good but again you can go wrong with fruit sometimes and low fat yogurt is always good. why don't you try to have just plain meat ( roast chicken, grilled fish or grilled meat etc.) and lots of salad, when you feel like snacking try cucumber and yogurt, try for 2 days and check your BG all the time, as i said i am not a expert but i got feeling that it will help big time.

    please let us know the out comes.

    don't forget Diane, don't feel guilty and never give up
    you will see once the things are getting a bit better you will feel much better.
    best of lluck

    jd
    :thumbup:
     
  3. Cheryl

    Cheryl · Well-Known Member

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    Do you see the DSN at your GP surgery? If so, why not ask (and I really mean demand) a referral to the specialist diabetes clinic at your local hospital (or even a big teaching hospital a little further away if you can manage it). A lot of people find GP DSNs lacking in knowledge of Type 1 as they deal mainly with Type 2. Dome GPs react better to their diabetic patients attending the hospital clinic than others. Mine is fine, other people on this forum have a big problem getting referred, but it is your right.

    As for the pump, the criteria are listed on NICE, as I remember, an hba1c of over 8 or 8.5 despite you making an effort to bring it down, disabling hypos, or lots of mild hypos which affect quality of life. The thing with a pump is that, before going on it, you have to show that you've done all you can to straighten yourself out. A pump takes a lot of work to get right & testing 6+ times a day is the norm on a pump. Plus, if you don't look after yourself on the pump, you can quickly develop DKA so the motivation to test & eat sensibly has to be there.

    Diabetes is a horrible, invisible disease which, despite what many people think, us Type 1s did nothing to bring on ourselves. It is very difficult to manage with so many external influencing factors other than just food (exercise, hormones etc.)

    If your BGs ate always over 10, even before meals, you're not getting enough insulin, for the DSN to tell you to reduce the amount you take is appalling. If you read up online, you'll find that people (on average) need between 0.5 & 2 units of insulin per 10 grammes of carb, if you're being told to stick to 1u/10grc that may well not be enough for you. Also the average insulin requirement per day is between 0.5 & 2u per kilo of body weight per day. BUT some people need more & some need less. I for example have a maximum of 0.5u per kg of body weight per day and I am outside the 'average' ranges for just about everything!

    Also, the starting point for basal/bolus ratio is 50/50, though metabolic rate & total carb intake will influence this (I'm always active & am on 35/65) so, if you're fairly sedentary & eating normal portions, your Lantus & quick acting insulin should be about the same averaged over the day.

    Don't feel alone, there are many people using this forum with the same issues, so go see your GP (not the DSN) & demand to take control of your treatment.
     
  4. robert72

    robert72 Type 1 · Well-Known Member

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    Hi Diane

    Crazy sleep patterns… insulin that doesn't seem to work… I thought I was the only one. I also get really depressed when I see blood sugars rising when I know I've done the carb counting and taken the right bolus.

    I am so pleased you posted here because, in reading your story, I think I might have been making some slow progress and I wonder if this would help.

    Around this time last year I was getting some really high reading at times like yours, up in the mid 20s (I even got one error code which, when I looked it up, meant it was off the scale and up in the 30s!!). I can't remember how many large boluses of Humalog it took to get it down but I spent the best part of a day wrestling it back to single figures.

    I seemed to be taking more and more insulin for the carbs I was eating (around 300 grams a day). The one thing I had noticed through all this was that if I left the house, the insulin seemed to work (I lead a fairly sedentary life… work from home).

    It occurred to me that maybe I was taking on too many carbs for my sedentary lifestyle, so I started to cut them down a little, not too much because my body would need to get used to it. So now I am down to around 150 grams a day and I find it easier to control and I can take less insulin as a result, but I still get some unexplained BG rises (I wonder if it's the liver dump) but nowhere near as high as last year.

    The other thing I did a couple of weeks ago, was change from Humalog to Novorapid. I need to take a bit more of it and it seems a little slower, but it makes me plan ahead instead of react. I think where this is going is getting back to basics - trying to stick to set meals and stop the roller coaster.

    You seem to be full of determination so keep at it. There's no overnight fix but I believe it can be turned around over the months. Again thanks for sharing, it's helped me to see that I am making progress even though I still have a bad days.

    Good luck

    Robert
     
  5. hellobear007

    hellobear007 Type 1 · Member

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    Thank you all so much for your replies, it feels better to know I am not alone :) and Robert thanks for sharing - im pleased you are making some progress, and you are right, its back to basics, like learning from scratch. I actually said to my DSN that I wish I was still a child or newly diagnosed so that I could go into hospital and have it put right lol

    I love cucumber :) and I am now trying brown rice instead of white. I have the carbs and cals book and also the app for the iphone and sometimes I weigh my portions if I cant be sure of the exact amount of carbs. Im now using the DAFNE online to log my results and also the iBG STAR app - Im a bit of a techie and just purchased the iBG STAR meter for the iPhone as I think it will motivate me to test more.

    I am actually seeing the same DSN that I saw from when I was first diagnosed at the hospital, and she also does the DAFNE course too. Im hoping that by taking note of every single reading, logging my carbs, my normal doses and correction doses that next time I go they will be able to see some sort of pattern (I cant, it just looks like a graph that goes up and down between 13mmol and 25mmol!!!)

    A lot of the time during the day I dont feel hungry so if I test my blood and it is high I do a correction dose but without anything to eat. Im not sure if that is the right thing to do but it takes hours for my blood sugars to return to normal (which for me is about 14mmol) if at all.

    I have taken notes from the forum of suggestions and will be speaking to my DSN about these.

    Again, thanks so much for your help and to listening to my rant, I am feeling more positive today, even if my blood readings are still crazy.

    Diane xx
     
  6. iHs

    iHs · Well-Known Member

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    Hello Diane

    I agree mostly with what Cheryl has said to you. I think too that your control will be better if you split your basal insulin but that's for you to decide on.

    Carb ratios are much easier to figure out by testing 6 times a day and slowly increasing the insulin in the ratio or reducing the carb so that when you test yr bg before you eat your levels are within a target and then by testing approx 2hrs later your levels are also within the correct target (no more than 2.5mmol above your before you eat levels). If you are lower then you can eat a small snack or if you are higher but not really off the scale you can wait until the next meal time to see what your levels are and decide to do a correctio n if you need to.

    Until you find your way again with carb ratios try keeping your meals to a set amount of carb like 30g. It will be easier for you bolus insulin. As a really general rule (its only approx) most people will need to use more bolus insulin at breakfast than at lunch. My ratios have never been 1:10. The 1:10 is only a rough guide so test yr bg levels like I said, write all your carb intake down and then start to adjust. Also ask your GP or DSN for insulin pens that delivery in 0.5u increments.
     
  7. robert72

    robert72 Type 1 · Well-Known Member

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    Hi Diane

    Glad to read that you're feeling more positive.

    Snap... I ordered the iBGStar on Wednesday from Boots. Supposed to be here by next Tuesday although I hear it's difficult to get strips for them.

    I really started to get to grips with things when I got a phone app in February - so easy to keep track of things and notice patterns. I also downloaded the iBGStar app but am sticking with my current one for now.

    Let us know how you get on

    Robert
     
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