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Type 1 Panic

D

dodge13

Member
Messages
19
Type of diabetes
Type 1
Treatment type
Insulin
Hey all,

I haven't posted in a while but I am having a bit of a middle of the night panic. It's 2:25am and I am working late on my PC (I'm on a week's holiday and tend to get my sleep pattern a bit backwards).

I just checked my blood sugar as I was needing the loo quite often this evening, and it read 29.1 mmol.
I have had one this like before about 3 years ago where it read 33.3 mmol - meter limit reached.

Anyway, I have had Diabetes Type 1 for about, 6 years now and I still struggle when blips like this happen, I acknowledge how dangerous this is, but I don't understand how these spikes keep happening.

For dinner I had a pizza, a small piece of chocolate cake, and a very tiny cinema sized pot of ice cream later on, I had injected 30 units of Novorapid.

Any advice on what I can do to prevent these incidents? I feel like I already inject a huge amount of insulin as it is, and needless to say these kind of results are getting me down pretty bad, it just makes me feel as though I might not wake up one of these days... :(

- Adam
 
Your meal was very high in carbs? You gave yourself a high dose of fast-acting insulin but it hasn't reduced your blood sugar to an acceptable level.
Don't panic but look at these possibilities:
Is your insulin in date and are you storing it correctly?
Reduce the carbs in your meals. Pizza, chocolate cake and ice-cream aren't ok for you. Eat maybe some fish or chicken, some salad and/or green beans, some fresh raspberries and fresh cream ...
Try sleeping 8 hours a night (I can talk, haha!) especially when on holiday!
Rotate your injection sites.
Take care and look after yourself!
 
@dodge13 . What was your blood sugar prior to eating your pizza, cake and ice cream? Where you start will always dictate where you finish.
Could be many reasons tor your high sugar. Do you carb count?


One thing you may find a lot of fellow T1's will tell you is that your meal isn't a good meal for a T1. No matter how much insulin you pump in you're gonna struggle.
 
dodge13 said:
I don't understand how these spikes keep happening.

For dinner I had a pizza, a small piece of chocolate cake, and a very tiny cinema sized pot of ice cream later on, I had injected 30 units of Novorapid.
Click to expand...

I don't think the reason for the site can be considered any great mystery. With a meal like that everyone, diabetic or not, will probably experience a significant blood sugar spike. A non diabetic can have random blood sugar up to 11 without being diagnosed, that will happen after a particularly carby meal. To manage blood sugar spikes as a type 1 diabetic and reduce the spikes as much as possible (maybe if you really fancy pizza, cake and ice cream you might occassionally put up with a spike up to 11 or 12 if it's a temporary spike, even though that's not ideal) you need to be sure of quite a few calculations:
  • What was your blood sugar pre meal? Did you need a correction? Did you give a correction and wait until you were in range before eating?
  • How many grams of carbs are in your meal? Do you carb count? Are you confident that your insulin to carb ratio is right for you? Are you confident that your insulin to carb ratio stays the same for particularly fatty meal or might it need bumping up a bit if high fat foods make you a bit insulin resistant?
  • Have you pre bolused and waited for the insulin to start working before eating? Do you have an understanding of when the carbs you are eating will start raising your blood sugar? You've got fast acting carbs in cake and ice cream, but the pizza carbs might not start working until 4 or 5 hours after eating because the fat in the pizza slows them down. You might need a second bolus to deal with this.
  • Did you test and bolus for the ice cream later on?
It's a tricky meal to deal with. When you found you were 29.1 did you test for ketones? Did you correct?
 
People with Type 1 can eat moderate portions of those things as long as they bolus correctly, and pay careful,attention to things like the timing of their meal and injections. Probably not wise to,eat them all at once, but they aren't forbidden.

In fact, ice cream was one of the 'diabetic desserts' I was given in hospital when I was diagnosed.

Do you carb count? Did you test frequently after eating so that you could catch any rise and correct?

I'd also add that I find staying up late causes my body to release hormones that push my BS up, so that could have contributed.
 
Hi Adam
I totally agree with the advise that Catapillar has offered. I had similar problems until I started Carb Counting, and discussed the same (Pizza) problem with my diabetes team. They advised me to split the insulin dose over several hours, I was able to take 2 injections, 60% up front at the time of the meal then the remainder 2-3 hours later. The ratio and timing of the second injection takes some working out, but you will get there.

Pizza and other fatty foods (the other one I struggled with is chips from the fish & chip shop) do take much longer for your body to process, some people up to 4-6 hours later, so this is probably why you are going high later.

Before I changed how I took my insulin, I used to find I may go a bit low a couple of hours after a big meal, you probably wouldn't get that with the cake and ice cream, that was because the carbs hadn't been digested before my insulin was at its peak.

I have since changes over to an insulin pump, which has made managing this type of thing so much simpler :-)

Hope this helps.
 
lizdeluz said:
Your meal was very high in carbs? You gave yourself a high dose of fast-acting insulin but it hasn't reduced your blood sugar to an acceptable level.
Don't panic but look at these possibilities:
Is your insulin in date and are you storing it correctly?
Reduce the carbs in your meals. Pizza, chocolate cake and ice-cream aren't ok for you. Eat maybe some fish or chicken, some salad and/or green beans, some fresh raspberries and fresh cream ...
Try sleeping 8 hours a night (I can talk, haha!) especially when on holiday!
Rotate your injection sites.
Take care and look after yourself!
Click to expand...

Hi Lizdeluz, I checked my insulin, all my current cycle of pens are in date, all I can think is perhaps I may have used one that wasn't refridgerated?

I think my issue with food is deeper than decisions, recently I went through a bit of a health kick and ate a lot less and was lucky enough to be able to inject a lot less as a result which helped my injection sites recover too. But recently it's gone back to bad habits.


therower said:
@dodge13 . What was your blood sugar prior to eating your pizza, cake and ice cream? Where you start will always dictate where you finish.
Could be many reasons tor your high sugar. Do you carb count?


One thing you may find a lot of fellow T1's will tell you is that your meal isn't a good meal for a T1. No matter how much insulin you pump in you're gonna struggle.
Click to expand...

Hey, therower

I have to be honest, I can't remember for sure checking my bloods before I ate that meal, I was rushing around and think I may not have checked, but all meals prior I injected generously and ate much more sensibly.

It's that old chestnut of "this meal isn't healthy for someone who ISN'T diabetic, never mind for someone who is".
 
catapillar said:
I don't think the reason for the site can be considered any great mystery. With a meal like that everyone, diabetic or not, will probably experience a significant blood sugar spike. A non diabetic can have random blood sugar up to 11 without being diagnosed, that will happen after a particularly carby meal. To manage blood sugar spikes as a type 1 diabetic and reduce the spikes as much as possible (maybe if you really fancy pizza, cake and ice cream you might occassionally put up with a spike up to 11 or 12 if it's a temporary spike, even though that's not ideal) you need to be sure of quite a few calculations:
  • What was your blood sugar pre meal? Did you need a correction? Did you give a correction and wait until you were in range before eating?
  • How many grams of carbs are in your meal? Do you carb count? Are you confident that your insulin to carb ratio is right for you? Are you confident that your insulin to carb ratio stays the same for particularly fatty meal or might it need bumping up a bit if high fat foods make you a bit insulin resistant?
  • Have you pre bolused and waited for the insulin to start working before eating? Do you have an understanding of when the carbs you are eating will start raising your blood sugar? You've got fast acting carbs in cake and ice cream, but the pizza carbs might not start working until 4 or 5 hours after eating because the fat in the pizza slows them down. You might need a second bolus to deal with this.
  • Did you test and bolus for the ice cream later on?
It's a tricky meal to deal with. When you found you were 29.1 did you test for ketones? Did you correct?
Click to expand...

Hi Catapillar,

Thanks for your advice, I absolutely get the sugar spike situation, I think it's just when it reaches that high it instantly puts the fear into me - as it probably should! I understand carb counting but I haven't practiced it enough to be able to do it at any given time, I need to brush up on it.

I hadn't considered taking into account the fatty foods and having to potentially inject an additional amount after the first one.

Interestingly, with the subject of ketones, I didn't do these tests before today because I hadn't really been taught about it, I tested this morning and it was completely negative, luckily.
 
Leelittler said:
Hi Adam
I totally agree with the advise that Catapillar has offered. I had similar problems until I started Carb Counting, and discussed the same (Pizza) problem with my diabetes team. They advised me to split the insulin dose over several hours, I was able to take 2 injections, 60% up front at the time of the meal then the remainder 2-3 hours later. The ratio and timing of the second injection takes some working out, but you will get there.

Pizza and other fatty foods (the other one I struggled with is chips from the fish & chip shop) do take much longer for your body to process, some people up to 4-6 hours later, so this is probably why you are going high later.

Before I changed how I took my insulin, I used to find I may go a bit low a couple of hours after a big meal, you probably wouldn't get that with the cake and ice cream, that was because the carbs hadn't been digested before my insulin was at its peak.

I have since changes over to an insulin pump, which has made managing this type of thing so much simpler :)

Hope this helps.
Click to expand...

Hey Leelittler,

Thanks for your comments, I have thought an insulin pump would really solve the issue since if I understand it correctly, it's autonomous to some extent? I hope you don't mind me asking, and I am sure it's a ridiculously naive question on this forum of all forums, but how do the pumps work?
 
dodge13 said:
Hey Leelittler,

Thanks for your comments, I have thought an insulin pump would really solve the issue since if I understand it correctly, it's autonomous to some extent? I hope you don't mind me asking, and I am sure it's a ridiculously naive question on this forum of all forums, but how do the pumps work?
Click to expand...

Check out the pump,section here :)

Pumps use only fast acting insulin. You can vary basal rates more easily and do different boluses. You do need to have a thorough understand of carb counting though. Pumps aren't automatic - they still need user input to make sure all is ok and to,control the amount of insulin delivered.

If you're interested, why not ask your DSN? :)
 
dodge13 said:
but how do the pumps work?
Click to expand...

Take a look at INPUT for an explanation and how a pump is funded here in the UK:

http://www.inputdiabetes.org.uk/alt-insulin-pumps/what-is/

dodge13 said:
I hadn't considered taking into account the fatty foods and having to potentially inject an additional amount after the first one.
Click to expand...

Just posted this on another thread but it's worth posting again as it explains the process involved when eating a meal which is high in both carbs & fat:

http://www.mendosa.com/The-Fat-of-the-Matter-How-Dietary-Fat-Effects-Blood-Glucose.htm
 
dodge13 said:
Hey Leelittler,

Thanks for your comments, I have thought an insulin pump would really solve the issue since if I understand it correctly, it's autonomous to some extent? I hope you don't mind me asking, and I am sure it's a ridiculously naive question on this forum of all forums, but how do the pumps work?
Click to expand...

No, pumps are not autonomous. You have to tell the pump how much basal to deliver and when, you have to tell the pump what your target blood sugar is, and what your correction factor is at different times of day, you have to tell the pump what your insulin to carb ratio is at different times of day, you have to tell the pump how many carbs you are eating, the bolus wizard will then work out your bolus dose with that info, but you check the dose is correct and you decide when it gets delivered.

Insulin pumps are subcutaneous continuous insulin infusion systems. They work by delivering continuous tiny amounts of fast acting insulin as your basal insulin and then they deliver additional fast acting as bolus. You control the pump doses. It doesn't do anything without being told.

We are a long way from a marketed functioning "autonomous" pump. The closest is Medtronic 640 that will speak to an enlite continuous glucose monitor and suspend insulin if it thinks you're going to drop low. It won't do anything automatically to deal with high blood sugar.
 
Thanks for all the information, I absolutely need to make sure I am checking my blood sugars more regularly, and that I try and control my diet a lot better. Appreciate your comments :)
 
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