Type 1. New diagnosis. Advice.

Jaylee said:

No problem Richard,

If I was to add anything at this stage? Test two hours after your meals too..it gives an idea of what the effects of your insulin dose is doing with what's eaten.

When is your next apointment with a health care professional?

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Juicyj said:

Hello @RichardSp8 and welcome

I was diagnosed over 6 years now and still remember how bewildered I felt with all the information, it’s good that you understand food, a good app for getting your head round carbs is ‘carbs and cals’ which is comprehensive with carb values, My best advice at this stage is to learn as
much as you can and keep a diary of your readings as it will help to see patterns, also get ‘think like a pancreas’ which is written by a type 1.

We are also here to help support and no question is too silly, I haven’t seen one yet

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therower said:

Hi @RichardSp8 . Welcome to the forum.
Congratulations on joining an esteemed club.
Everyone has given great advice and as you are maybe beginning to realise there are numerous ways to incorporate diabetes into your life. Most importantly you do have to incorporate it. You can fight it, make it your enemy. You can embrace it, make it your best friend. I prefer the latter.
Definitely do not worry at this early stage, get used to the basics. This is for life, cast your mind back to childhood, diabetes is no different, it will grow, it will develop, it will evolve, it will play up and you'll have fun going through all this together.
Diabetes is a lot about averages and trends. One high reading isn't going to kill you.
You will see a lot of posts here from different types of diabetics you have to remember that you are T1 and that is specific to you.
There are no rules. Everyone manages their diabetes their way. You , through trial and error will find what suits you best.
A few things I tell people ( listening is optional ).
1. Diabetes control is 80% mental/ emotional, 15% medication and 5% just winging it.
2. Diabetes wants to destroy you and it will try every trick in the book. It thrives in dark, stressful, argumentative places. Don't let it. Open up and let the light in, tell people you're diabetic, be proud. Don't get overly stressed, learn to shrug your shoulders, smile and move on. Don't fight it , embrace it, make it the reason you live and succeed..
Good luck and keep posting.

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Scott-C said:

Thanks for the tag, @Jaylee .

@RichardSp8 , you've asked about it being erratic. It comes with the territory but as time goes by you'll learn skills to make it less so.

The main problem is that, although there's some basic rules, for example 1 u for each 10 g (that can vary a lot too, often within the same person at different times of day), as soon as you inject and eat food, they are subject to a whole lot of bodily processes which can throw the calculations out.

In a non-T1, most insulin goes straight to the liver to tell it to suck up excess glucose. Our injected insulin tends to get nowhere near the liver, and some of it will be destroyed by insulin antagonists before it does anything. There's some work being done on adding, " hepatic directed vesicles" to insulin, which taxis insulin straight to the liver so that it more closely emulates normal insulin function, so that might be a new toy to play with in the next few years.

So, it's always going to have a degree of uncertainty to it.

One useful way of dealing with it is to understand how insulin operates over time. It has a pattern, not sure what humalog looks like, there's no doubt a graph on the internet, but my novorapid, for example, takes about 20 mins to get to work, peaks after about an hour or hour and a half, and works at a declining rate for about 3 to 5 hours.

Knowing that, it means that I can take a shot about 20 mins before a meal, so that it'll already be working when the food hits it, instead of playing catch it, and then I'll know about the hour mark whether I've got it right or under or over bolused. I'll also know that if I'm going to be doing some exercise later on within the 3 to 5 hour window, I'll still have some active insulin on board, and that might lower me a lot if I'm exercising because things called glut4 transporters in each of my cells will be stimulated by exercise and lower bg.

Once those basic mechanisms are understood, it lets you then think about tweaking doses and timing. For example, if I'm having a Thai green curry, white rice, with me, at least, gets absorbed fairly quickly, so I'll pre-bolus about 20 mins, but if it's brown rice, it's absorbed more slowly, so 20 mins would make me hypo, so 10 mins would do. Or, if I know I'm going to be sitting in the office after lunch, it'll be x units, whereas if I'm on holiday and know I'm going to be spending a few hours walking around sightseeing, I'll know that'll bring glut4 into play, so I'll likely shave quite a few units off to avoid the insulin and glut4 doubling up. Or I might leave it at the same amount as I often holiday in Krakow and there's always a quality ice cream parlour at hand! I might also shave off or add a few units if my levels are on a downward or upwards trend at the time of the shot


I suppose the point I'm trying to make is that just looking at the number of carbs when carb counting is too simplistic. We have to consider the surrounding circumstances too, in terms of type of food, what's happened in the last few hours, and what might happen in the next few hours.

One of the big things happening in the UK at the moment is freestyle libre starting to become available on the nhs. It's still very much a postcode lottery at the moment. Some areas are very liberal with it, but most are not - google your area's health authority and there will likely be a policy statement on it. Strips just give you a snapshot in time, which is of limited use when you're dealing with a constantly moving target. But then you've got cgm - continuous glucose monitoring. It makes it a much fairer game when you can actually see what you're dealing with. Formal nhs education is not keeping up . It's based on strips. Official carb counting courses like DAFNE will say things like don't test between meals unless you feel hypo and save corrections until meals. Sorry, f*ck that. With cgm, if I see my graph starting to inflect up or down, I can decide on the fly whether I need a small 5g or 1 or 2u correction to tweak it back imto line before it gets anywhere near out of range. It removes a lot of the uncertainty and erraticness. Plus your phone will ring if you go below a set point, so you can avoid hypos.

Cgm is hugely liberating and I'd strongly encourage you to look into it. There's dexcom, officially costs £200 per month, but there's ways of using it unofficially which bring it down to about £100 per month. Libre is £100 per month, and there's a small add on transmitter called blucon for £96 one off cost which turns it into cgm. If you live in an area which does libre on the nhs, all the better - cgm for free.

Some good books:

Think Like a Pancreas - Gary Scheiner
Sugar Surfing - Stephen Ponder
Beyond Fingersticks - William Lee Dubois
Breakthrough... - Thea Cooper

The middle two are about cgm. The last one won't teach you much about the management of T1, but it's still worth a read. Well researched book about the history of the discovery of insulin. The stories about parents queuing up around the block in the desperate hope of getting some of the limited supplies are harrowing. We're not lucky to be T1, but we've got it relatively easy compared to back then.

Good luck, mate, this is often not an easy ride, but it's do-able. Once you get the basic rules under your belt, you'll be surprised how much latitude there is. And if it all goes wrong, there's nothing a bag of jelly babies won't sort!

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