T1 - drastically needing help with how to carb count and actually control my glucose levels

[JacquiMorrison]

I'm 23 and been diabetic for almost 16 years so you'd think I'd have a grasp of it by now. Only this year have I invested in the FreeStyle Libre and actually monitor my sugars frequently throughout the day and get the concept of carbohydrates. However, I have no idea how to carb count I've seen loads of nurses/doctors and they all say I've to find what works best for me but I don't know how haha I've tried 1:1 and 2:1 and still don't know what works and what doesn't or even how much to correct and how long it takes, or even why bran flakes makes me rocket up to 16 for 4 hours!

Is it best to take a note of every single thing I eat, every injection, and everything I do? Then assess it every few days?

Also don't understand how I've seen some people's Libre readings on here under 10 ALL day like do you guys not eat? Or inject like a year before eating? What if you want a custard cream? Or a sausage roll?

I'd really appreciate help and tips!

 

[steve_p6]

I'm 23 and been diabetic for almost 16 years so you'd think I'd have a grasp of it by now. Only this year have I invested in the FreeStyle Libre and actually monitor my sugars frequently throughout the day and get the concept of carbohydrates. However, I have no idea how to carb count I've seen loads of nurses/doctors and they all say I've to find what works best for me but I don't know how haha I've tried 1:1 and 2:1 and still don't know what works and what doesn't or even how much to correct and how long it takes, or even why bran flakes makes me rocket up to 16 for 4 hours!

Is it best to take a note of every single thing I eat, every injection, and everything I do? Then assess it every few days?

Also don't understand how I've seen some people's Libre readings on here under 10 ALL day like do you guys not eat? Or inject like a year before eating? What if you want a custard cream? Or a sausage roll?

I'd really appreciate help and tips!

Hi Jacqui, I had gone 38 yrs before I got my libre and woke up to the idea that there is a heck of a lot to still learn so you are 20 yrs ahead of me. First piece of advice is get hold of a copy of 'Think Like a Pancreas' to learn the concepts at your own pace, sort your basal out first and when changing things then change one thing at a time. Ie dont change basal, carb ratios and diet all in one go as you learn nothing. Final suggestion, try thr carbs and cals app for an easy way to estimate carbs, maybe also speak to your DSN about a DAFNE course.

 

[JacquiMorrison]

Hi Jacqui, I had gone 38 yrs before I got my libre and woke up to the idea that there is a heck of a lot to still learn so you are 20 yrs ahead of me. First piece of advice is get hold of a copy of 'Think Like a Pancreas' to learn the concepts at your own pace, sort your basal out first and when changing things then change one thing at a time. Ie dont change basal, carb ratios and diet all in one go as you learn nothing. Final suggestion, try thr carbs and cals app for an easy way to estimate carbs, maybe also speak to your DSN about a DAFNE course.

Thank you!

Got DAFNE course booked at end of May so hopefully that will help. Think I've got my basal under control cause when I go to bed with a reasonable sugar it is usually the same or slightly better when I wake.

I'll get the book and download the app - really appreciate your advice, Steve

 

[EllsKBells]

@JacquiMorrison definitely speak to your DSN about a DAFNE, but do be aware that there will probably be a waiting list. In the mean time, you might like to try this https://www.bertieonline.org.uk/

 

[JacquiMorrison]

@JacquiMorrison definitely speak to your DSN about a DAFNE, but do be aware that there will probably be a waiting list. In the mean time, you might like to try this https://www.bertieonline.org.uk/

Thank you! I've got a DAFNE course booked. I'll register to this too, is it an online education course or?

 

[EllsKBells]

@JacquiMorrison yes, you can do it online. BERTIE is a local variant of the DAFNE, mostly in the south - I did an in person one, but I know people have said good things about the online version. If nothing else, it gives you something to go on until you can do your DAFNE, and even a little bit will help. Now, when I think of the time before I was carb counting, I wonder how I did it!

 

[himtoo]

Hi @JacquiMorrison
if your BG's are fairly stable overnight that is the cornerstone of good control ---- getting to grips with carb counting does take some work because our ratios can change during the day
I am much more insulin resistant in the morning ( insulin to carb ratio = 1u per 4 carbs )
by evening meal it is 1u per 6 carbs )
might not seem a lot but the change is about 50% greater by evening meal compared to breakfast.

I recommend doing loads of testing and recording and making small adjustments to your bolus doses -- hopefully you have a 1/2 unit pen or are on a pump which helps a lot

 

[kimrooney89]

Hi @JacquiMorrison
Your post really made me smile. I often used to compare my BG readings to those I seen on the forum and also wondered if they eat
Now I'm following a low carb eating regime; no bread, pasta, potatoes, rice etc. No sweets or crisps, chocolate with only 70% cocoa content or more. Plenty eggs, fish, meat, cheese, sausages (at least 97% meat content) and lots of veggies. Only drink water with a splash of diluting juice and spirits with a diet mixer.
I have seen a huge difference in my control since changing my eating habits There's a wealth of knowledge on this forum, think like a pancreas is a fab book and the bertie course is a great Base for learning about carbs and ratios.
Good luck

 

[JacquiMorrison]

Hi @JacquiMorrison
if your BG's are fairly stable overnight that is the cornerstone of good control ---- getting to grips with carb counting does take some work because our ratios can change during the day
I am much more insulin resistant in the morning ( insulin to carb ratio = 1u per 4 carbs )
by evening meal it is 1u per 6 carbs )
might not seem a lot but the change is about 50% greater by evening meal compared to breakfast.

I recommend doing loads of testing and recording and making small adjustments to your bolus doses -- hopefully you have a 1/2 unit pen or are on a pump which helps a lot

Thank you - firstly how did you find out your carb ratio? It baffles me.

I have only singular units on my novo rapid pen, not had the chance to try the pump, is it free on the NHS?

 

[JacquiMorrison]

Hi @JacquiMorrison
Your post really made me smile. I often used to compare my BG readings to those I seen on the forum and also wondered if they eat
Now I'm following a low carb eating regime; no bread, pasta, potatoes, rice etc. No sweets or crisps, chocolate with only 70% cocoa content or more. Plenty eggs, fish, meat, cheese, and veggies. Only drink water with a splash of diluting juice and spirits with a diet mixer.
I have seen a huge difference in my control since changing my eating habits There's a wealth of knowledge on this forum, think like a pancreas is a fab book and the bertie course is a great Base for learning about carbs and ratios.
Good luck

Wow, thank you! I can get on board with the diet thing I think is there a source that shows what to eat and what not to eat? Just google low carb diets?

I've ordered the book heard only good things about it!

 

[kimrooney89]

Wow, thank you! I can get on board with the diet thing I think is there a source that shows what to eat and what not to eat? Just google low carb diets?

I've ordered the book heard only good things about it!

https://www.dietdoctor.com/low-carb

https://www.diabetes.org.uk/Guide-t...and-diabetes/nuts-and-bolts-of-carb-counting/

https://www.verywell.com/getting-through-the-first-week-2242037

It's actually really easy after a few days! These links really helped me to wrap my head around low carb eating and the do's and don'ts.

 

[DaftThoughts]

Thank you - firstly how did you find out your carb ratio? It baffles me.

I'm not the person you replied to, but I kinda winged it myself. I assumed 1 unit of Novorapid per 15g carbs to begin with and worked from there. I'm now at 1:12.

Whenever I ate, I injected for those carbs 10-20 minutes before, then ate, and checked 1.5 and 2 hours later. If I had gone up more than 1.5-2mmol/L, I reduced my ratio down a point and tried again next meal. When I hit 1:12 I didn't rise more than 1.5mmol/L and left it at that. (You need to rise a little usually, insulin can remain when your food has mostly been digested so if you're not high enough to process that last bit of insulin, you can crash into a hypo.)

I erred on the side of caution and started with a ratio that wouldn't send me into a hypo straight away and adjusted gradually. I also found out that 1 unit of insulin lowered me by about 1.2mmol/L. I checked this by waiting until my NovoRapid had worn off (4 hours after my last injection, preferably 6 hours after my last meal too) and correcting my slightly too high bloodsugar by 1 unit and testing frequently afterwards.

It's a looot of testing and trying to reduce variables, but once I got it down I can safely rely on these numbers. The MySugr app helps me calculate everything too, which is super useful. I assume the DAFNE course will teach you most of what you need to know to get started, but if you feel confident knowing how you respond to food and insulin overall, you could experiment with some numbers yourself. Check with your DSN first just to be sure, and aim for slightly too high than too low when adjusting your insulin to avoid hypos until you hit your sweet spot.

 

[Scott-C]

Got DAFNE course booked at end of May

Good, you'll learn a lot from it.I went on a DAFNE course about a year ago. It was really useful. There was a mix of recently dx'd and old timers. We all learned a lot by comparing notes, just by talking to each other. Some of it was really basic stuff and some more complex. Content will differ depending on which part of the country you're in, but mine went more or less like this. You'll do a lot of carb counting with pretend meals and a booklet listing carbs (get the Carbs & Cals app on your phone before you go), and then they'll take you to, variously, the hospital snack shop, cafe, for some real meals and get you to carb count those. They gave us a clear plastic sheet to mark up bg tests at various points in the day pre-meal and post meal and carb count and then put those on an overhead projector so we could all see each others results, the good, the bad and the ugly, and then analyise what went wrong and what went right.

Only sore point was that they had an obsession about insisting we all started and kept at 1 to 10 (actually they call it 1 to 1 - they call 10 grams 1 Carb Portion, don't see the point of that, I'm not eating a Portion, I'm eating literally10 grams, not conceptually a Portion, it's a needless calculation). I remember buying a meal from the snack shop, carb count was on the back of the packs, the dietician said OK Scott, you'll need X units for that at 1 to 10, I said nah, 30 years of experience tells me it'll be Y units. But I agreed to try X. Guess what happened? Blood sugar ended up through the roof, always will, always does if I do 1 to 10, yet at my next consultation, I was showing the doc (who had sat in on the course) my libre results, barely any hypos or hypers with a typical ratio of 1.5u for each 10 grams, hba1c of 36,and she had the gall to say to me, but Scott, you were on the course, you were told it was 1 to 10, why aren't you doing that? Err, because the results from that on the overhead projector showed everyone my sugars go through the roof if I do that. The first page of the DAFNE booklets says ratios vary, so why the hell do they insist that 1 to 10 is right for everyone? I've read another post saying their DAFNE people insisted on everyone taking the same basal dose, no matter their weight! Reminds me of this cartoon:

 

[Scott-C]

Or inject like a year before eating?

Pre-bolusing makes a hell of a difference. If you're on Novorapid, the leaflet says it takes 20 minutes to start working, and that normally works for me, but you might need to experiment. It means that the insulin is already there working when the food hits it, whereas if you bolus at the first bite, the insulin will be playing catch up with the meal.

 

[Sibyl]

Thank you!

Got DAFNE course booked at end of May so hopefully that will help. Think I've got my basal under control cause when I go to bed with a reasonable sugar it is usually the same or slightly better when I wake.

I'll get the book and download the app - really appreciate your advice, Steve

Hi Jacqui! I like you thought I was doing well at night - going to bed and waking with similar figures - but the libre showed me a different story. I was actually hypoing 2 or 3 times a night. Just mild ones and I guess my liver was compensating. Winding my slow acting insulin back by one unit has sorted that.

 

[Scott-C]

firstly how did you find out your carb ratio?

You've got a libre, so scan when you bolus and eat and enter the dose and carbs. Then, once in a while, have a look at the daily graphs and find ones where it worked out OK.

For example:

Limits are set to 4.7 and 7.8, running fairly stable overnight within range, took 3 units to pin my usual foot on floor morning rise, took 9u about twenty minutes before a a 65g lunch, so that's about 1.5 to 10, levels are dropping before the meal so I know the insulin is working, yet it continues to pick up over the afternoon to out of range by teatime, so maybe 1.5 wasn't enough. Then teatime, 12u for 90g, a bit below 1.5 because generally I'm more insulin sensitive later in the day, sure enough, starts dropping so even that was may be too much, so I have a couple of biscuits 15g to pick back up, overshoots slightly, maybe 10g would have been enough, before some 20g toast at 2u, 1 to 10, and there's still a drop to about about 5 before going to bed, probably a combination of the tail end of the teatime bolus and the supper bolus peaking.

One big difference between DAFNE and cgm is that on DAFNE, they'll say don't test between meals unless feeling hypo,and save corrections until meals, whereas with cgm (and that includes you as a libre user) you can be a hell of a lot more proactive in sorting shifting levels before they get too out of range. As in the graph above, I took a 15g correction before I got hypo, I'm still above 4.7 at that point but I reckoned I'd be below 4 if I'd left it. Fair enough, it overshot me a bit, so playing it again, would have just done 7 or 10g but I now know that for next time. And the rise after lunch suggests either the ratio was wrong or I miscalculated the carbs. Looking at it now, I should probably have taken a 1 or 2u correction mid-afternoon to tail off the rise. I've done that plenty of times. These little tweaks and nudges, 1u, 5g are common with cgm, but frowned upon by DAFNE.

There's a good book, Sugar Surfing by Stephen Ponder which explains all the ins and outs of this for cgm users
https://www.amazon.co.uk/Sugar-Surfing-manage-diabetes-modern-ebook/dp/B017EIX9HG

 

[Gemsydodger]

Hey, I'm only a gestational diabetic, so truthfully I'm only standing on the edge of carb counting looking in. I'm on insulin this time and couldn't control my bg so thought what have I got to lose?!

I came across this list first clip, which helped a lot

http://www.lnds.nhs.uk/Library/CarbohydratePortionListBooklet111215.pdf
I don't think it's all right, some of the things, like potatoes are off, but it got me on the right track to begin with.

I bought myself a cheap set of scales from b&m bargains. Religiously weigh everything and write it all down. I think I stumbled across what works for me by accident.

I have to hit targets in an hour so I if I brought it in under for the hour I was hypoing by hour 2. So the diabetic team suggested I split each meal in 2. So eg. I eat one slice of toast at 8am, check bloods at 9, eat another slice of toast, check at 10.
For lunch and tea I use the second meal for "dessert" ... basically fruit or a yoghurt. I tried eating real food for the second meal but it made me feel sick... now that I mentally have a dessert it's easier. So, for the custard cream... I could have one of those for dessert according to that list... which now has me in the notion for a custard cream lol

Hope my ramble helps a little.. good luck

 

[DunePlodder]

Hi JacquiMorrison, It's great that you now have a Libre. I suggest that you use it to do some simple but useful experiments.

1. Choose a time when the graph on the Libre has been steady, level & not too high for a while & you are not doing any exercise & haven't eaten recently. Eat a small amount of carbohydrate - I'd use a jelly baby which is about 5gm, a glucose tablet is about 3gm I think.
Then sit back & watch what happens with the graph. After a little while it will start to rise - note the time & the bg reading. It will then climb for some time then slevel off. Keep watching until you are sure it is steady again then make a note of what the reading is and the time it levelled off.
You now know how much one jelly baby (or glucose tablet) raises your blood glucose. You also know how long before it is before takes effect*, & how long before your body has finished absorbing it. And all whilst sitting around doing nothing!

2. Again choose a time when the graph on the Libre has been steady, level for a while & you are not doing any exercise & haven't eaten recently. You don't want it to be too low - say over 8, check with a blood test. Take 1 unit of insulin.
Back to the exhausting sitting around doing nothing, nothing energetic that is. Don't eat anything. Watch the graph. Be patient, it takes longer than you might think for insulin to do anything. In my case about an hour if I'm just sitting around. Again note when your bg starts to drop, for how long & when it steadies. Keep a close eye on it just in case it drops you too far - it shouldn't but it's still wise to have your usual hypo treatment available.
You now know how much 1 unit reduces your blood sugar, & how long before it takes effect.*

Repeat the experiments art different times of day.

The fact that insulin takes a lot longer to take effect than food does is the reason why people pre bolus before a meal

*Actually the Libre reading is a little delayed (10 - 15minutes?)

 

[JacquiMorrison]

Good, you'll learn a lot from it.I went on a DAFNE course about a year ago. It was really useful. There was a mix of recently dx'd and old timers. We all learned a lot by comparing notes, just by talking to each other. Some of it was really basic stuff and some more complex. Content will differ depending on which part of the country you're in, but mine went more or less like this. You'll do a lot of carb counting with pretend meals and a booklet listing carbs (get the Carbs & Cals app on your phone before you go), and then they'll take you to, variously, the hospital snack shop, cafe, for some real meals and get you to carb count those. They gave us a clear plastic sheet to mark up bg tests at various points in the day pre-meal and post meal and carb count and then put those on an overhead projector so we could all see each others results, the good, the bad and the ugly, and then analyise what went wrong and what went right.

Only sore point was that they had an obsession about insisting we all started and kept at 1 to 10 (actually they call it 1 to 1 - they call 10 grams 1 Carb Portion, don't see the point of that, I'm not eating a Portion, I'm eating literally10 grams, not conceptually a Portion, it's a needless calculation). I remember buying a meal from the snack shop, carb count was on the back of the packs, the dietician said OK Scott, you'll need X units for that at 1 to 10, I said nah, 30 years of experience tells me it'll be Y units. But I agreed to try X. Guess what happened? Blood sugar ended up through the roof, always will, always does if I do 1 to 10, yet at my next consultation, I was showing the doc (who had sat in on the course) my libre results, barely any hypos or hypers with a typical ratio of 1.5u for each 10 grams, hba1c of 36,and she had the gall to say to me, but Scott, you were on the course, you were told it was 1 to 10, why aren't you doing that? Err, because the results from that on the overhead projector showed everyone my sugars go through the roof if I do that. The first page of the DAFNE booklets says ratios vary, so why the hell do they insist that 1 to 10 is right for everyone? I've read another post saying their DAFNE people insisted on everyone taking the same basal dose, no matter their weight! Reminds me of this cartoon:

Hahaha brilliant thank you so much. I'll keep that in mind. I think I'm roughly 2 units for 10. But hopefully they'll help me adjust it better and not just wing 1:10

 

[JacquiMorrison]

You've got a libre, so scan when you bolus and eat and enter the dose and carbs. Then, once in a while, have a look at the daily graphs and find ones where it worked out OK.

For example:

View attachment 22862

Limits are set to 4.7 and 7.8, running fairly stable overnight within range, took 3 units to pin my usual foot on floor morning rise, took 9u about twenty minutes before a a 65g lunch, so that's about 1.5 to 10, levels are dropping before the meal so I know the insulin is working, yet it continues to pick up over the afternoon to out of range by teatime, so maybe 1.5 wasn't enough. Then teatime, 12u for 90g, a bit below 1.5 because generally I'm more insulin sensitive later in the day, sure enough, starts dropping so even that was may be too much, so I have a couple of biscuits 15g to pick back up, overshoots slightly, maybe 10g would have been enough, before some 20g toast at 2u, 1 to 10, and there's still a drop to about about 5 before going to bed, probably a combination of the tail end of the teatime bolus and the supper bolus peaking.

One big difference between DAFNE and cgm is that on DAFNE, they'll say don't test between meals unless feeling hypo,and save corrections until meals, whereas with cgm (and that includes you as a libre user) you can be a hell of a lot more proactive in sorting shifting levels before they get too out of range. As in the graph above, I took a 15g correction before I got hypo, I'm still above 4.7 at that point but I reckoned I'd be below 4 if I'd left it. Fair enough, it overshot me a bit, so playing it again, would have just done 7 or 10g but I now know that for next time. And the rise after lunch suggests either the ratio was wrong or I miscalculated the carbs. Looking at it now, I should probably have taken a 1 or 2u correction mid-afternoon to tail off the rise. I've done that plenty of times. These little tweaks and nudges, 1u, 5g are common with cgm, but frowned upon by DAFNE.

There's a good book, Sugar Surfing by Stephen Ponder which explains all the ins and outs of this for cgm users
https://www.amazon.co.uk/Sugar-Surfing-manage-diabetes-modern-ebook/dp/B017EIX9HG

That's helped massively put it into perspective thank you! I think I'm going to buy a notebook and keep a track of everything I eat and how much carbs are in it etc and see what works best. Appreciate it. Your sugars are beautiful haha like perfect! This is mine for today, rising because I had a white bread bacon sandwich haha! However was up at 20 yesterday and I couldn't find out why so I'll definitely monitor to find out my corrections etc