Spiraling out of control

morning letteyc, how are you today?

don't forget that all the carbs you eat will affect your blood sugar - that is probably why you went high again. Being taught carb counting should help with this.

if it would help you, post up on here what your readings and meals have been, we may be able to advise and point out what's causing the spikes?

Sorry to hear that our suspicions were proved correct.

Regarding ketones, I think that it's more important to purge ketones before lowering blood sugar (they kept me at 15+ mmol/l with insulin+glucose IV for two days).

Insulin requirements tend to vary significantly, and finding the right dose is a bit of trial and error. 10u Lantus is presumably average (that's the number given in Lantus prescribing information) and so is 6u Humalog per meal (assuming notional 60g carbs per meal). Some people will require more (Clickstar goes up to 80u, HumaPen up to 60u) and some will need less (I'm on 4u Lantus and 0.5-1u Humalog per meal i.e. 1u per 60g carbs and had to get a paediatric pen)

If I don't feel like eating breakfast for example, do I still need to take my humalog?

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No. However, I would strongly advise you to not skip meals while ketones are present. If you can't eat then have Lucozade or fruit juice. If you can't keep liquids down, go to A&E.

As for exercise and hypos, you have to be aware of the effect exercise has on your blood sugar. For example, 20min of moderate intensity swimming tends to lower my BG by about 5 mmol/l. So you'd need to either eat more (I tend to have 200ml orange juice at the start, after 20min, and a rice cake afterwards) or take less insulin with your meals (which I don't like since I'd either have to exercise right after eating a meal or have 15ish blood sugar for an hour). Obviously, eating extra carbs to cover exercise is not recommended if you want to lose weight.

So just have some carbs before exercising, test frequently, and wear a medic alert bracelet and you'll be fine.

letteyc said:

Also been reading about exercise and taking insulin and that causing hypos, which has put me in a bit of a bad mood as I love the gym! and it all looks so confusing looking at how to reduce your insulin... wow life is so much more complex all of a sudden - I don't want to put on weight :evil:

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It is confusing when you have to take everything in at once. Again, don't worry, you will be able to exercise again. It's just trial and error. But don't panic, don't try and factor exercise into it all just yet. You don't have to understand it all at once, you are trying to do something difficult and complex with only part of the info... your nurse still hasn't gone through carb counting with you?

As AMBrennan says, if you aren't eating carbs then don't inject the humalog. The humalog is there to match your carbohydrate intake. If you are eating more carbs you'll need more humalog, fewer carbs = less humalog, no carbs = no humalog.

my blood sugar was went down to 6 mmol!

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That's not really* supposed to happen - ideally the blood sugar 2h after a meal should be about the same as before the meal. Since your Lantus dose is too low (high fasting BG) your blood sugar will just go up again so I'd suggest making changes to Lantus dose first.

* You can with experience, and sufficiently precise delivery methods, correct for high blood sugar before a meal; this is effectively what you did here (spot on, too) but you cannot use to correct for a low basal insulin (never mind continuous subcutaneous insulin infusion therapy, aka insulin pump)

I would say I had maybe 15 carbs... is 6 humalog too much?

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If that ratio is based on the lunch dose, then yes. Otherwise you'll know in 2h.

6.4 is excellent. Hopefully tomorrow morning will be better as well.

But let me rephrase my earlier post: At the start, I think it's easier to think of correction (insulin you inject to correct for high blood sugar) and covering (insulin you inject for a meal you are about to eat) as completely different.
You had a wrap (20g carb?) for lunch, and took 6u Humalog which lowered your blood sugar from 15ish to 6. That means that 6u Humalog was too much to cover 20g of carbs. So maybe you should have had 4u for that meal (if you are carb counting 1u per 5g carbs rather than 1u per 3g carbs).
For that reason, I suggested that 6u for a 15g carb meal might have been too high since it would lower your blood sugar even more.

However, you do need to fix your Lantus dose before you can fine-tune mealtime insulin - if your basal insulin dose is too low, your blood sugar will keep rising even if you are not eating; if it's too high you'll constantly be going to low between meals - it will all be much easier once you get that right.
For that reason, I suggested that you might want to make adjustments to your Lantus dose first even if that means going a bit higher after dinner.

I'd say to stick with 4u with lunch and 6u with dinner and increase Lantus to 12u. If you are having trouble with carb counting you might find it easier to stick to similar meals (e.g. 15g for dinner) until you get more confident.

I don't have snacks before bed, but if you are worried do a blood test before bed. If you're still worried, have a snack - I doubt that it will do any harm at least as a short-term solution until your blood sugar is better controlled.

Hiya Letteyc!

I know you're confused, but I couldn't help laughing at your posts You sound like me 18 months ago! I'm now used to being my own guinea pig and find it kind of interesting in a bizarre way :lol:

OK, first, really well done for getting those figures down! Next, be careful with the exercise if you've still got ketones - I don't think you should do any gym work until they're gone. Now, try carb-counting for your meals. At first, use a 1:10 bolus insulin to carb ratio. Count your carbs and take 1 unit insulin for every 10g carb, but try to keep carb relatively low for a while to give your body a chance. The way i did it was to have a no-carb breakfast (e.g. bacon and egg - sorry, I know you're sick of eggs, but it's not for long!) - no bolus insulin; a low-carb lunch (e.g. roast chicken breast, salad, 2 or 3 strawberries and cream) no bolus insulin; tea with about 20g or 30g carb (e.g. 2 pork chops, 80g new potatoes, broccolli, green beans and cabbage) - take 2 or 3 unit bolus insulin to cover this. Take your basal as usual. Try not to vary your diet too much for a couple of weeks and learn how your body reacts. Adjust your bolus insullin accordingly until you work out your ratio for tea. You can then start experimenting with lunch to get you ratio there and lastly with breakfast. (you might be different with each of the three). Your basal should hold you steady between meals. If you are dropping, take less. If you are rising, take more. (But understand that it can take a couple of days for the effect of a change in basal dose to be noticed, so be patient and wait a couple of days before changing it again.) In a couple of months time, you'll have it sussed and will know how to deal with exercise, alcohol etc. Be patient! Keep smiling! You're doing great!

Smidge

As for ketones, they can vary a bit after treatment is started and urine tests obviously lag. I wouldn't worry too much unless they remain high.

So this patterns tells me I have to up my Lantus, like was suggested to me?

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Yes.

so I will try this 1 unit to 10 carb ratio tomorrow

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I will have to disagree with Smidge here - if 4u Humalog with a 6g lunch works (i.e. if BG is <16 2h after lunch) then 1u per 10g carbs can't possibly work.

[In addition, have you been given any advice by a dietician? I know many people here successfully follow a low carb diet but I will stick with the advice that I got (I was specifically told that low-carb is unsuitable when I asked her about low carb diets).]

AMBrennan said:

I will have to disagree with Smidge here - if 4u Humalog with a 6g lunch works (i.e. if BG is <16 2h after lunch) then 1u per 10g carbs can't possibly work.

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Don't forget the Lantus dose isn't quite right yet - probably too low. So some of that humalog is probably soaking up the sugar that the Lantus will eventually take care of once the dose is right.

I was diagnosed type 1 just over a year ago. It was a pretty scary few months while I got to grips with my new routines. I still feel pretty nervous if I start something new especially if I don't have someone with me (for example I haven't yet braved the swimming pool on my own).

A few things which my DSN told me back then which you might find useful
first off was that she expected it to take at least a month to get my sugars back into the normal range. Part of that was getting my doses right and part was allowing my body time to adjust to the new lower levels.

Also she told me to expect to feel hypo symptoms (shaky, sweaty etc) as my levels started to drop even if my sugars were still high. Again it was just as my body adjusted to the new levels. I had some pretty horrible moments when I had levels of 6 and 7. I usually ate something at those times but tried to keep it pretty small as I didn't want to shoot my levels up to far. Now I feel fine until much lower and usually notice the symptoms somewhere between 4.5 and 3.5.

I was on fixed doses of rapid acting insulin for the first couple of weeks. During that time I was asked to keep a log of food, exercise and sugar levels. I took that along with me to the dietician who got me started with calculating carbs and calculating the right dose of insulin. It was only after that that I really felt I was getting my levels under control.

I have gone through this online carb counting course a few times http://www.bdec-e-learning.com/ and found it quite helpful. Also the folks here are usually pretty quick to answer questions.

Hiya!

AMBrennan said:

I will have to disagree with Smidge here - if 4u Humalog with a 6g lunch works (i.e. if BG is <16 2h after lunch) then 1u per 10g carbs can't possibly work.

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You might well be right AMBrennan, but I'm betting that once the basal dose is sorted out, the bolus will need to be somewhere around 1:10 (maybe 1:8 or 1:12, but not much different! Unless there is some insulin resistance involved, 4 units to 6g carb will be way too much) - it will depend on the amount of carbs Letteyc is eating (I find that if I low-carb, the ratio is lower than if I eat a higher carb meal - the units are obviously lower, but the ratio seems to change aswell!) Anyway, 1:10 is a good starting point and then you higher it or lower it from there depending on how your body reacts to the food. I can only say that's what I did - before that it just seemed random to me - you need a fixed point from which to start, I think.

Letteyc - I don't know how many carbs you are eating, but please keep a food diary and record the amounts you eat, the dose of bolus you take and your pre and post meal BG - it will help you work out your ratio and make the adjustment. It looks like your basal needs to be increased a little bit which will hold you steady between meals and then you'll start to need a fairly predictable amount of bolus with each meal depending on how much carb you're eating. BTW, you are quite right not to take the bolus if you are not having much carb for your meal. In terms of the amount of carb you want to eat, I'm only suggesting keeping it low and predictable while you sort out a pattern and work out your ratio - once you're more confident with calculating the doses, you will need to decide for yourself what type of diet you wish to follow.

At least your levels are coming down! Good luck for tomorrow.

Smidge

letteyc said:

then ate a ham and salad low car wrap... probably around 6g carbs...

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Can I ask if the wraps you have came from a specialist low carb seller as normal tortilla wraps are usually around 30g to 50g carbs each not 6g. The carbs per wrap or per 100g should be clearly printed on the packaging.

letteyc said:

i'm feeling down atm, since starting insulin i've probably been eating less, and low carb.. alot of salads etc.. but i've put on 7 pounds ... and it's only been a week... my weight is going up and up... im doing light excercise now too but no to avail. i've spent the morning reading about insulin and weight gain... so what now im expecting to pile on a whole lot of weight :cry: i mentioned it to the nurse and she said it's probably portion sizes... my portions are small to normal, I dont snack between meals or anything.

I dont no what to do... i spent days of hard work getting my weight down... and now its all going back on.. and quickly!!!!

so i assume i have to chose between high sugar levels, and feel ****... or being fat again and feeling ****...

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you've only just started on insulin, you are only just starting to learn about it - not surprising your weight is unpredictable at the moment. Being on insulin doesn't mean you will definitely put on weight. It's just a question of getting the right dose, and if you are low-carbing, being aware of the calorie value of the things you are eating instead of carbs.