The Delight of Hypos

Hi Manxangel,

Sorry to hear you're struggling with it right now. It really does get easier as you get more accustomed to it. Besides, there isn't really an option, is there?

As for the Lantus, it's not just about controlling your morning levels. Once your Lantus dose is correctly set it should be able to keep your bs levels stable throughout the day, between meals. Many people find this works better when the Lantus is split into 2 doses at different times. I stopped having morning hypos when I figured that out!

When are your hypos happening? Are you more vulnerable at a particular time of day? If it happens within a couple of hours of eating, it's more likely that your Novorapid dose was out. After a hypo, it's not uncommon to feel a bit 'hungover' for a couple of hours. It's not a nice feeling before, during or after I'm afraid. Do you have symptoms of impending hypo's?

Whatever you do, don't consider avoiding your insulin will solve your problem, although it will give you some new ones to worry about!

All the best,

fergus

Hi manxangel,

I'm still above 8 (most of the time) so that would indicate to me that my Lantus needs adjusting?

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I think so. Ideally I think you should be aiming for a figure around 5 most of the time. You are using 2 powerful blood glucose lowering medications, so bring your bs figure down gradually if you can, not in a sudden jump.

You can do this in 1 or 2 ways. Either you need more insulin, and I wouldn't recommend that in the long term, or reduce the amount or type of carbs you eat. What does a typical day's diet look like at the moment?

I can't really tell if i going to have a Hypo

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Me neither, I'm afraid! I suspect you may be getting signals, but they might be very subtle and hard to spot at first. Tingling and sweating are both classic symptoms. My tongue used to tingle, as if it was getting excited at the iminent arrival of a Mars Bar! When you go hypo, your brain is being starved of glucose and it can be difficult to think straight, but try and remember where you get those feelings. For me these days I know I'm dropping too low when I start to feel depressed.

Is stopping the Insulin an option?

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No, it isn't. We all need insulin to survive, it's just that you and I have to get ours out of a little glass bottle. Without it I'm afraid you will not last very long at all.

I'm sorry if you have posted your insulin / meal details before and I've missed them. If you could let us know a little more, we'll see what other suggestions we might make.

Don't worry, there are lots off things you can do to make things better and we'll help you all we can.

All the best,

fergus

Hi manxangel,

All part of the service m'dear! My guess is that the afternoon hypos are the result of 2 things.
Firstly, your breakfast is entirely carbohydrate. Cheerios weigh in at 75g carbs per 100g and will deliver a ton of sugar into your bloodstream very quickly. You're using a big old dose of insulin to deal with that. The bigger the dose, the greater the uncertainty over the outcome.
Your lunch, on the other hand, looks pretty good and very low in carbs. You're still using quite a big dose of insulin however, and with little carbohydrate to use it up, your bs will drop low.
Dinner sounds OK too, although it wouldn't be enough for me! There can be a lot of carbs in some soups, depending on the ingredients of course. Curries, casseroles and stews can be great lower carb dishes, provided you watch out for the usual suspects of potatoes, rice etc.
My advice would be to find something for breakfast that looks a bit more like your lunch and dinner.
You will then be able to reduce your insulin doses and achieve greater predictability in your bs level.
Take it slowly though. Make small adjustments, check your results, then take it from there.

All the best,

fergus

Hi manxangel,

Eggcelent idea. Just try not to forget that you will need much less insulin than usual. For me, 2 large scrambled eggs, 2 thick slices of bacon and a large handful of mushrooms only requires 3 units of Humalog.

Good luck, and keep us posted.

fergus

Fergus,

I noticed you describing a protein based breakfast, with no carbohydrate foods on it, then saying that you take 3 units of insulin to deal with it. How do you work out insulin doses when you aren't having any carbs? The only instruction I've ever been given over the past 31 years is to take a set amount per 10 grams of cho!!!

Claire

Hi Claire,

I read your post on the 'success stories' thread, and I'll move it over here if you don't mind?
The 'starchy carbs at every meal' nonsense has caused nothing but misery for diabetics for far too long. It's completely irrational. I see your bs numbers are routinely too high and you need to normalise them before they do you permanent injury. Reducing your carb intake is the only sensible way of achieving this and lots of us have had great success with it.
To answer your question, carbs aren't the only source of glucose in your bloodstream. Protein can be metabolised into glucose (around 30% of dietary protein can become glucose), and your body can make its own glucose from other stores in the body. Even if you eat no carbs at all, your body will still require insulin to dispose of the glucose in your blood, even though you haven't eaten any.
It's the carbs in your diet which are pushing your bs too high, and the insulin you inject to deal with this will occasionally push your bs too low at times. The answer is to 'level out' these peaks and troughs by eating fewer carbs ( no sugar or starch!) and injecting less insulin.
I know 3 units of Humalog will cover bacon and eggs at breakfast with a bs in the 4% range before and after because I test regularly. Since I don't eat starchy carbs at all, my bs never goes above 6 and I need very little insulin so I rarely suffer hypos these days,
Incidentally, I've been t1 for 27 years, but only figured this out after 20 of them :shock:
Feel free to ask anything, or PM me if you prefer.

All the best,

fergus

Posted Mon Sep 01, 2008 9:53 pm by crafteclaire

Sorry, this is not a success story but a question. I have been a type 1 diabetic for 31 years (I'm 33 years old) and have never had much contact with other diabetics. I am struggling much the same as some of your 'before' testimonies, and am wondering what you mean by a low carb diet. I've always been told that I have to build my meals around starchy carbs and am experiencing average running bms of 12 - 15. My last HBA1c was 8.2% and I'm really dreading my next visit to the diabetic specialist at the end of this month. Can anyone help???? I'm willing to try anything. I'm on an insulin pump and am trying to do 2 hourly bms during waking hours to adjust the basal rate on my pump. At mealtimes, I tend to take 2 units of insulin per 10g cho, plus another unit per 2 mmol/ls to lower my bm from what it tests at to 5, but this seems to be resulting in increased hypos and then the good old tennis ball effect after I take sugary drinks / jam sandwiches to raise it up again. I'm a lone parent so can't be affording to have debilitating hypos. I'll check this page again to see if anyone has any suggestions for me.

Cheers, guys!

Claire

Fergus,

I have sent you a pm, but as I'm a bit new to this site, not sure if its been sent to you. it's currently in my outbox, so if I need to do more to send it, please can you let me know or e-mail me on cjcarter@ntlworld.com.

Thanks

Fergus,

I'll post my questions to you on here and check back tomorrow night.

What you're saying about the low carb / lower insulin doses makes perfect sense to me. I don't know why it has never occurred to me before, apart from the fact that I've always had the 'old school' way of thinking drummed in to me since being 2 years old.

I tend to have either porrige or slim fast for breakfast - I'm not a morning eater and if I had my way, I wouldn't eat until around lunch time, but that's a big 'no-no'.

lunch is usually a bowl of home made soup (all veg from the garden) rarely with any carbs in it, unless I add a few lentils for thickening. I'll have a sandwich with that using home made bread (very high in carbs)!

Evening meal can be anything from a pasta dish like spag bol to a curry with rice or a traditional meat and 2 veg type of meal - again with potatoes (often roasted)

Evening time is always nibble time .... sometimes something as simple as a bowl of mange tout from the garden, but can stretch to toast or cereal. I'll even admit to the odd chinese take away, and yes, that always includes rice or noodles.

As I'm typing this, I can hear all the groans and 'oh, noooooo's' in the background!!

I always count the carbs and have appropriate amounts of insulin to compensate, but as I'm getting older, the bms are jumping higher and higher.

Tonight, I had smoked haddock with plain rice ... about 70g of cho and took 15 units of insulin (at about 7pm). At 9.30pm my bm was 9.2, but 15 mins ago I checked it and its shot up to 20.8. ouch.

I'm sure you're all going to be slapping my wrists for me, but please please give all the advice you want.

My main question is this ..... if my meal contains virtually no cho, how the heck do I calculate the amount of insulin to take? I don't want to be shooting up into the 20s as I have been doing, but if its trial and error, I can't risk a severe hypo when I'm on my own with the kids.

The final question is on the subject of alcohol. I do enjoy a nice couple of glasses of red wine at the weekend, and if there are a big group of us, we might even have a couple of Vodka and Diet Cokes. Is there any guidelines on this, or do I need to completely cut it out of the equasion?

I'll leave it at that for one night ... don't want to fill up your board in one go!!!

Thanks for the help - I'll check for any answers tomorrow.

TTFN

Hi Claire,

I have PM'd you if you want to check.
I also wanted to say that no-one will slap your wrists on this forum. We've all been where you are at the moment and will happily share our experieces with you to help you gain control.
Oh, and enjoy your wine, because it won't cause you any problems at all in moderation!

All the best,

fergus

Thanks!

OK, Claire.
If you've had a look around the forum, you can probably guess what's coming next!
Your diet seems to contain a lot of carbohydrate. Like many people, you've probably been advised to eat this at every meal. This makes no sense because there is a great deal of sugar bound up in bread, cereals, pasta, rice and potatoes but very few important nutrients. If you can eliminate these sorts of foods and replace them with foods high in nutrients but low in carbohydrate you will feel better and have much lower blood sugar levels. You can also expect to have much more physical energy because your metabolism will begin to work properly again.
These so called staples should be replaced by foods such as meats, fish, eggs, dairy foods, nuts and vegetables. These require much less insulin but have all the energy, vitamins and minerals you will ever need.
Like me, you're type 1 and this makes the transition to a lower carb diet a little more difficult as you reduce your insulin needs. Take it slowly, small changes and small restrictions until you start to get a feel for it.
Choose a time of day when you can experiment a little, perhaps at dinner? Eat as you would normally, only try reducing the pasta / rice / potatoes / bread by half. Replace these foods with more protein foods and more vegetables, enough to satisfy you. Don't ever go hungry.
Reduce your insulin accordingly, and monitor your bs every hour to see how it effects you. Your bs won't spike as much, and you may feel less hungry too.
Use what you learn to reduce your carbs at each meal, and eat more of the alternatives. Before long you will find your bs much more stable. You should never have to experience a bs in double figures.
Let me know how you feel about not eting pasta, for example, and what sorts of foods you like instead.

All the best,

fergus

Hi Fergus,

Thanks for the reply. I have tried to do what you recommend today and have had some pretty good results so far.

I had an egg and milk shake for breakfast - only 1/2 glass of milk to the egg - and Cauliflower soup for lunch. Both foods I enjoy but would normally have a lot more milk at breakfast, and would then add a couple of rounds of bread to lunch.

I took 4 units at breakfast and 2 units at lunch. This has resulted in my bm staying between 5.6 and 9.0 all day (apart from the waking bm of 15.6, but I'll address that in a few days if it becomes a constant thing. todays will be due to the number of hypos yesterday - I always suffer some sort of rebound the day after a bad day).

We're on a rice dish for tea, so can't do much there today (approx 60g of cho by my reckonning and 12u of Novorapid), but as the cupboard is currently bare, I'm off to Asda in a mo so this is the perfect time to adopt a new eating habit!

I'm absolutely fine with reducing the carbs - I only eat bread, cereal and potatoes out of necessity, and I'm quite happy to take smaller portions of rice and pasta as they can tend to leave me feeling rather bloated. Not only will this help the diabetes, but it will also help me lose a bit of weight - I've got 1 stone to lose to be my ideal weight :mrgreen: .

I know its only been one day, but I do feel better in my self already (not difficult after yesterdays performance!), so am very taken with the whole idea of this new approach.

I would be interested to know if there is any sort of chart or list available to help in counting carbs in common food types. I used to know it off the top of my head, but to be honest, I've lost track of a lot of it as the years have gone by, and portion sizes do tend to grow a little without you noticing, over time.

My fave foods are dark greens (like Kale), carrotts (high GI, I Know), sweetcorn (on and off the cob). Jacket potatoes are nice now and again, but not a regular thing in my diet. I make lots of broths, curries, bolognase sauce, casseroles - trying to use as much home grown produce as I can, basically. I don't tend to go for convenience foods much, apart from 'pasta n Sauce' which I love, but only tend to eat if I'm grabbing something on the hop.

The only think I'm reluctant to change is my Slimfast milkshake at breakfast, when I'm doing a workout at the gym. I tend to work out quite hard, so the fast release carbs are handy on those days. Once I've got used to the new eating plan and the associated insulin doses, I'll take a look at if and how that needs to change. As you said, take it slowly!! (Totally out of character for me, I'm afraid )

Other than the old red wine, that's about it, really!

well, I'll be doing hourly bms for the rest of the evening, and will try not to start the 'cat and mouse' game chasing high bms with too much insulin.

Thanks for the support - it's much appreciated.

Speak soon,

Great stuff, Claire! It sounds as if you've been able to both lower your bs and lower your insulin level at the same time, which is good going.
What many people seem to forget is that insulin is the main fat building hormone and, if you lower your insulin use, weight loss should follow. Yet another benfit of low-carb!
I won't bang on about which carbs to exclude as far as possible, because you'll quickly discover for yourself which foods have the biggest impact on your blood sugar levels. The lessons learned first-hand always stay learned!
I don't have a carb counter book myself, but others on the forum have been recommending a Collins version currently available, so that's probably worth a try. Avoid the American ones if you can.
I have to say, you sound really determined to make this work. Try and keep a diary for a few weeks if you have the time. Record your bs, insulin and food eaten. This will help you analyse your successes and failures, manage your insulin reductions, and hopefully give you a good laugh this time next year when your bs's are spot on and the stone in weight long gone.
Glad I could help you and all the best,

fergus

Will do. I'm fortunate eough to have the One Touch Ultra Smart BM machine, and the software allows you to record every single thing you do, so I'm going to download it every night and fill in the comments with what I've eaten. When I go to the hospital, I'll take a data list to show how its working.

Well, thanks again for the help - I'll take it from here on my own. Might have a few questions from time to time, but I'll also share my experiences with everyone.

Right - back to embroidering names on the kids school pe kits now - oh, the joys of being a mum!!!!

See you later :lol: