Type 1 and low bmi

Hi James,

It's quite common for people to put weight on when they first start on insulin, especially if you're being told to follow a high carb diet. I was only a kid when I was diagnosed but I was very underweight for my age. My parents were told to put me on a high cab diet and administer x units of insulin with each meal. It took a little while for my levels to stabalise but that's not uncommon. You might have heard about the honeymoon effect? This is where newly diagnosed diabetics continue to produce some insulin of their own. It can mean our sugars go up and down a bit but it will calm down.

If your sugars have been very high then it's not unusual to lose weight. Bringing your levels back down into the target range will make the weight easier to maintain.

Anyway, good luck with it all! Do use the forum to ask any questions as there are loads of people on here who have been diabetic or years. I've had type 1 for almost 22 years now and I still learn things from other members.

Take care, Em

joeyhudson said:

Hi all

I'm recently diagnosed of 6 weeks and had a bmi of just 15 upon diagnosis,for me that was a weight loss of about 13/14 kgs over 2/3 weeks.

I've recently started novomix 30 4 units am and 6 units pm giving me big moves in bg over the day and night but the dietician has said I need 270g of carbs a day to put the weight back on and my DSN has said no exercise other than dog walking.

I'm a 42 yr old bloke who has never carried any fat but with a bmi of just 15 have never been this underweight either. The high carb diet is sending my levels all over and am wondering how people put weight on as I've not seen any topics on this subject so far.

james.

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Hi

Have you been given any guidance at all with eating carbohydrate with Novomix 30, like eat set amounts of carb little and often? If not, then you should your dsn and ask. 4 units am and 6 units pm against 270g carb per day doesn't sound as though you are using enough of the insulin. If you are losing weight, then it might be because your bg levels are too high as insulin should be matched correctly with carbohydrate eaten at different times of the day. Once your bg levels are balanced out ok, then you will start to put on weight but that unfortunately can only be sorted out correctly through doing bg tests before eating breakfast, mid morning, before lunch, mid afternoon, before eve meal and before going to bed and eating carb so that your bg levels stay within targets when you test. Just how high are your bg levels going and also what amounts of carb are you eating?

In addition to the very relevant questions above, you can always also eat some almonds, nuts, seeds etc as snacks. They are relatively low in carbohydrate so should not affect your bg too much in flocks of 10-15, but they will add a bit of calories in a fairly easy way - high in good fats, calcium, fibre and vit E. If you can fit those in a couple or three times a day, you should get a bit extra.

But aye, what does your blood sugar do, how many carbs are you eating etc?

Hi Joey, low carbing is very effective for t2 who are controlling their BG with diet or using tablets, it is great for more experienced t1 to lower BG and reduce insulin consumption , but for a newly diagnosed underweight individual it may not be the best solution. Don't be afraid to try a basal bolus regime as it gives you much more freedom in your choice of diet as you use only enough medication for the amount of carbohydrate you eat whether that's a little or a lot, but this early in your diagnosis you must listen to your DN, as she will have considerable experience in treating diabetes, when you are more experienced yourself you can play around with your regime, but please listen to her as she is the best person to help you at this time. I hope things go well for you, good luck.

joeyhudson said:

Hi all

I'm recently diagnosed of 6 weeks and had a bmi of just 15 upon diagnosis,for me that was a weight loss of about 13/14 kgs over 2/3 weeks.

I've recently started novomix 30 4 units am and 6 units pm giving me big moves in bg over the day and night but the dietician has said I need 270g of carbs a day to put the weight back on and my DSN has said no exercise other than dog walking.

I'm a 42 yr old bloke who has never carried any fat but with a bmi of just 15 have never been this underweight either. The high carb diet is sending my levels all over and am wondering how people put weight on as I've not seen any topics on this subject so far.

james.

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Hi James,
if you are running high, then no you wont gain any weight infact you would loose weight. So no amount of carbs will help you.
Mixed insulin is not ideal for anyone and I can not understand why they started you on it with the intention of swoping you at a later date.
If it were me I would do some research and then go back to your GP or nurse and say this is not working for me. MDI is my choice of treatment. Also insist that you are shown how to carb count and adjust your insulin.

They type of insulin you are using at the moment dictates how many carbohydrates you can eat and when you eat them. At the moment, your glucose levels are still high which suggests that the amount of insulin you are taking isn't yet reducing your glucose levels enough, even with fairly low carb meals. It's early days yet though so you will have to be guided by your DSN on doses. As others say, i whilst your levels are high then you will continue to lose weight.

You can be far more flexible with a basal bolus insulin regime. You would be able to make choices making decisions about what you want to eat and to a degree when you want to eat . You also have a choice over the quality of the diet . If by standard English diet you mean lots of takeaways, over processed ready meals, full of fat and sugar (exaggeration maybe), well that's not a healthy choice for anyone. You can though choose to eat a diet of good quality foods and that includes protein, fat and carbs (carbs as contained in pulses, fruit, vegetables, some whole grain and milk rather than those in sugary puds, sodas, pastries, etc).

Once you have gained some weight, and it is safer to exercise it would be much easier on a basal bolus regime than on a mixed insulin. (can't say it is simple/just easier) I would think that you have lost a lot of lean tissue ie muscle and exercise will help in developing it. It also helps in keeping glucose levels down.

joeyhudson said:

Thanks to everybody for the replies.

I first started off by eating no carbs at all really to get my levels out of dangerous levels for the first month, just eating green salads, green juice and nuts such as almonds and hazelnuts, basically nothing above a GL of 3. This worked to bring my bg and ketones down,but is a very radical limited diet.

My DSN calls that starvation, so she and the dietician have turned the thumb screws, and now I'm steadily upping my levels of insulin on a trial and error basis to control bg levels. This I am happy to give a go as if I ate any carbs at all before it would take days to bring back down again.

As I'm 6 ft and only 53 kgs now I am more concerned with weight issues as this is not a good ratio for a man I'm sure.

My levels are on average before breakfast 12, 2 boiled eggs and 2 burgen then 16. Before lunch 13 salad, before dinner 12 cauli cheese/canneloni, some soup and 2 burgen, by bed its up to 20 having had salted peanuts as snack in evening.

I understand after reading other peoples posts I've moved into high carbs, but am continuosly hungry and need to gain weight, whereas I imagine although there are skinnies on here, a higher proportion of people are losing weight and talking about that.

My DSN has also given me leaflets on Levemir and Novorapid, this I understand gives more freedom of diet and better control of bg, but have only been on Novomix 1 week and don't have any real experience of insulin, so don't know if I want to go down the route of just injecting to eat anything put in front of me, excuse my ignorance, but what is the big deal over low carb diets, is it weight gain related or is it to minimise insulin requirements, or some other reason.

The NHS want me to eat a standard English diet and inject to it, but that is not what is being said on here as I understand it, this confuses me and would like to gather opinion to make my own conclusions on this.

Thankyou to any who respond.

James.

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Hi

From reading yr msg, it does very much look as though you are eating too much carb for the amount of insulin you are injecting and that is why your bg levels are as high as they are and why you are losing weight.

You will be ok with twice daily Novomix as long as you adjust your carbohydrate and insulin accordingly. Twice daily insulins are fairly easy for people to comply with whereas MDI has hit lots of problems and is an insulin regime that needs to be chosen by the patient and not imposed upon people by a dsn or consultant.... Basal/bolus or MDI demands compliance and you will need to be ok at giving yourself a background insulin once or twice per day and then all the bolus injections to cover your food.... this will enable you to eat whatever food containing carb that you want but unless you get good advice regarding insulin to carb ratios, you will struggle a bit. Whatever regime you use.... testing your bg levels frequently will determine how your bg control is going..

A tip from me until you see your dsn is to cut down on the carb that you eat at breakfast and only eat 1 slice of burgen instead of 2. Most twice daily insulins take a little while to have their impact so eat less at breakfast and depending on what your bg level is mid morning, eat a bit more mid morning. You are looking at trying to achieve bg levels within a healthy target range of 6mmol before breakfast, then rising up to not being above 8mmol by mid morning and then falling back to being between 5mmol - 7mmol. The Novomix will then have reached its peak and will then start lowering your bg... you will probably need to eat a very small snack but this is where trial and error comes into it all where you do a bg test before lunch and then you will know if the carb snack is too high or whether its ok or not enough....... Once youve been able to figure out the correct amount of carb that you need to eat at different times of the day..... you can then cut back a bit on the bg testing as the twice daily insulins should keep you fairly well controlled and will only need to be adjusted when the weather temperatures change.

Give yourself some time to get used to injecting insulin James by using twice daily and then as time goes on, then decide to move to MDI....

All the best..... I used twice daily insulins for many years and was fairly ok. I only moved to MDI because I thought that I get away with injecting insulin just once per day (Lantus) and then eat whatever I wanted..... Just shows you how little I knew at the time.....