Type 1, Low Carb, Rising Sugars

[jerseybelle]

Hi there, Advice appreciated!
I'm type 1 and am desperate to lose some weight so I'm trying the low carb diet. My sugars are now rising so I'm bolusing to try and adjust. I'm worried about the ketone issue!

 

[kitedoc]

Hi @jerseybelle,
Have you discussed your diet change and wish to lose weight with your health team?
And what insulin are prescribed and how delivered ?
Have you been advised to lose weight ? And are you overweight ?
My personal experience with Novorapid via an insulin pump is that with reducing carbs I have less bolus dose and more increase in basal insulin. I think this is because the increased protein intake might cause BSLS to rise less dramatically than from carbs, but at the 3 to 4 hour mark after a meal. I have assumed that the increased basal amount helps to ward off excessive ketones BUT this is only a guess based on my experience only.
Of course your doctor and dsn would need to advise you regarding your insulin doses and also your dietician regarding the diet and the number of calories you need in order to lose weight plus to ensure you are receiving sufficient vitamins and minerals.
Best Wishes.

 

[Juicyj]

Hello @jerseybelle As a type 1 you should have a means of testing for ketones ? if you can tell us what insulin regime you are on and what your blood glucose readings are ?

If you are unwell then ketones are an issue and you should check when your blood glucose levels are above 15mmol/l, if you are bolusing for food then test and correct with quick acting insulin.

As kitedoc has mentioned if your not bolusing for protein in the absence of carbs then your blood glucose levels will rise as your body converts protein to glucose.

 

[jerseybelle]

Hi @kitedoc and @Juicyj,

Thanks for your replies so early in the morning! I was woken early by my 2 year old appearing in the bed - thus the early post!

I've been type 1 since 1984 - since the age of 9. My control is usually good. My latest HBa1C was done in the last month (on my request by my GP) and it was 7.

My weight has always been an issue. I am overweight and need and want to lose. I have always been careful with what I eat - even though many doctors have struggled to believe me. I have significantly lowered my carbohydrate intake since Christmas but have been stricter over the last month since my GP expressed his support for it. I have lost a small amount of weight.

Alongside this, I strongly believe that I am pretty insulin resistant. Before lowering my carbohydrate intake I was administering huge amounts of insulin (eg. 45 units bolus for a sandwich).

I have an appointment to see my diabetic consultant in September but have struggled to see a DSN since last September. I have made two requests in the last 6 months to be told they are too busy. An understaffed service where I live - unless you are type 2 or have more complications, it seems. I often feel frustrated at their lack of interest and that even when I do see them that none of them really offer me any advice that is new or very helpful.

I inject NovoRapid (bolus) and Degludec (basal).

I currently take 12 units of my basal insulin in the evening. I have never - in all my years as a diabetic - found any long-acting insulin that has much effect at all. I changed to deludec last year after about 7 years on Levermir. I have found no difference.

I traditionally CHO count. For the last 8 years I have woken myself at 4.30am to bolus (currently 8 units). At about 7.30 I'll need another 4-6 units - even with just a coffee - depending on BSL. Sometimes I'll need an extra bolus mid-morning of 2 units to stop my BSL rising still further before lunch. Lunch I currently give 7-14 units and dinner around 8. This is all with a LCHF diet.

I have not been feeling well for the last couple of days - I'm not sure if it's the effects of the diet or a bug. Sugars have been creeping up to 9/10. Tummy cramps, nausea and then last night hot and cold. When I checked my sugars at 4ish I was 16. I bolused 12 units. At 6 I was still 12 so bolused 4 more. On checking again at 7.30 I was 10 and my ketones were 0.2.

Apologies for the long reply!

 

[kitedoc]

Hi @jerseybelle,
Thank you for your insulin types and doses: If I have read your post correctly your current total insulin dose per day is between 41 and 50 units: and this is comprised of 29 to 38 units Novorapid and 12 units of Degludec.
Four thoughts for your nurses and doctors:
1) Is the Degludec (long acting insulin) dosage high enough ? In other words is the Novorapid dosages covering not only the BSL rises from meals and Dawn phenomenon ( the 4.30 am shot) but also in between meals?
If you think about low carb diets, the extra protein and some fat make up from some of the calories lost by reducing carbs,.
Some of that protein (?50%) will be turned into glucose and appear in the blood stream as a more gentler rise than the carbs induce, and this protein-related rise is around the at ? 3 to 4 hours mark after eating it. The Novorapid may not be fully covering this and is it supposed to anyway ?
So it maybe partially a matter of increasing Degludec and easing back Novorapid. Plus going through your low carb diet with your dietician to ensure you have an appropriate calorie intake etc and THEN re-matching your insulin to that.
2) Some persons on insulin have Metformin prescribed to reduce insulin resistance, and it sometimes helps weight loss as well
3) Do you undertake regular exercise? Exercise can increase insulin sensitivity
4) Injection sites - if persons inject insulin into the same area these places become swollen, scarred and may not absorb insulin reliably or well - have your injection sites been checked and do you rotate them to avoid using the same spot again?
I hope some of these thoughts might help and at least improve things until the powers that be get around to giving you an appointment with the specialist !
Finally it sounds like you may have a viral infection or something like that brewing so your insulin resistance may increase. Your dsn should be able to advise you on increasing both your short and long acting insulins to cope with this, if need be for the short-term.