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What should I keep track of?

Discussion in 'Type 1 Diabetes' started by JJO, May 10, 2016.

  1. JJO

    JJO Type 1 · Well-Known Member

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    Hi there.

    So pretty new to my 'new' diagnosis of type 1(or 1.5 / lada, still not got a straight answer).

    Still getting used to insulin and pretty much having a hypo a day, but also high peaks.

    I appreciate HbA1c is the essential measurement on overall control. But it's difficult to know what other information I should be focusing on what info I can ignore on a more day by day basis.

    Just had dinner out and increased my insulin dose from 5 to 6u. Clearly ate too much sweet ( 'n sour) Chinese and now my BM before I go to bed is 16.2! So can't say today is a perfect day!

    My DN hasn't suggested correction doses yet and as I'm away from home probably not a night to try correction doses...

    Thanks for any thoughts.

    Josh
     
  2. BlaiseS

    BlaiseS Type 1 · Member

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    Are you currently on set doses through out the day?
    If so, it could be what is causing your hypo's and hypers. Eventually, you will be offered an appointment with a nutritionist who will explain carb counting to you (I highly recommend the carbs and cals book - it'll come in VERY handy). Right now, you are either having too much insulin for the carbs you're eating or not enough... Make sure you have some sort of low GI carb at each meal (potatoes, rice, pasta, wholemeal bread) as these are what the insulin works with.
    It's super difficult at first, but I'm only a month in and it's already so much easier - and I'm sure I've had much more help. Just try not to worry as the consistent lows and highs will not be forever, if you really want to do some research, I also recommend the book 'Think like a pancreas' it's taught me so much about my diabtes.
     
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  3. JJO

    JJO Type 1 · Well-Known Member

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    I'll check those books out! Thanks for the heads up!

    On 15u once daily levemir and fixed 5u of insulin for b'fast, lunch and tea

    Also on 1g metformin.
     
  4. BlaiseS

    BlaiseS Type 1 · Member

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    Try and see if there's a trend with your hypo's too - write everything down. Even if it turns out you're doing everything wrong at least you'll be able to pin point it right away.
     
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  5. Kristin251

    Kristin251 LADA · Expert

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    I'm sorry I completely disagree with eating fast acting carbs. It's nearly impossible to get your insulin there at the same time as your food thus creating a hypo and hyper reaction. The goal is to keep bs steady, not up and down.
    As you lower carbs you will need to lower insulin as well

    The lows and highs could very well be forever if you don't count carbs. Even then it's iffy.

    The lows and highs come from food being digested at different times. Very hard to control without being lower carb or at least knowing what and how many carbs you are eating. Pump users seem to do much better with carbs than MDIers. Sweet and sour sauce is off most diabetic menus.

    Also you do need to worry about lows as they can be life threatening.

    Chasing insulin is not so good. Eating for hypos and shooting for the after math hyper. Low carbing has helped millions maintain better control.

    Sorry to sound abrupt.
     
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  6. JJO

    JJO Type 1 · Well-Known Member

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    @Kristin251 Thankyou.

    It's difficult because I actually don't know these things. Knowing what should be off menu, or at least heavily curtailed.

    Because I've been essentially carb free for 4 years, when my DN said I gotta eat some carbs every meal I've gone to town with that. Quite clearly too much!

    Your comments weren't abrupt. That's why I've written this message, to seek people opinions on what I should be paying attention to.

    Clearly when my DN said eat some carbs she probably meant healthier, lower GI than my Chinese and I guess I knew that when I was having it.

    My question I guess though, do people write down every detail of their dinner for example and log that somewhere? I'm a bit overwhelmed by what I should be logging. I mean in a weeks time will I care that I logged 6u of insulin into my BM machine but my BM still was 16.2 (actually rose to 18 two hours later but back down to 16 now). Do people prefer to focus on the 7 day average feature on their BM machine?

    I don't what to become obsessed and write everything down on paper (excel or app) if I don't *need* to...


    Sent from my iPhone using Tapatalk
     
  7. tim2000s

    tim2000s Type 1 · Expert
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    @JJO welcome. Whilst @Kristin251 is providing a point of view on living with Type 1/LADA, it is not the only way and there are many approaches that have seen people manage just as well with carbs. I'll just state at this point that I tend to eat a lot lower carbs than the medical community recommends, but you don't need to completely eliminate them from your diet. Having said that, if you are on fixed bolus doses, you will need to adjust insulin for it, as low carbing will cause monumental hypos. This page will help you understand how to do this: http://www.bdec-e-learning.com/

    You may also need to adjust your levemir, and this one describes how to ensure you have the right levels: https://mysugr.com/basal-rate-testing/ Incidentally, MySugr is also the world's most popular recording app, and there are many people who find it really useful, so it might be worth you taking a look at for your other query.

    It's also worth mentioning that T1 and T1.5 are essentially the same thing. The only obvious difference tends to be the amount of time that the onset takes. Given that you are now seeing bg levels in the teens, T1 or T1.5 is really irrelevant!

    Having said that, the key relationship is between what you do and eat and your blood glucose levels. What logging does is allow you to understand what is happening to you and to see patterns of both behaviour, food and reactions between insulin and the food you eat. Have a read of this http://bit.ly/d_3Rs to help you understand - I've found it to be an effective way of using logging.

    Basically, it breaks down into three pieces, and early on in your diagnosis it's good to get into the habit of this, of Record, Review and React.

    If you Record everything, at first, it means that you simply have it there. Why is this important? It allows you to take responsibility for managing your own condition, which is critical in doing well with it. The quote from Simon Heller in my signature is very apt in this case, and learning the tools that enable this is really important.

    What are these later steps? Review. Look at the data. Look at meals and the effect they have on your BG level. Look at exercise, sleep, stress, etc. This helps you to build up a picture of what happens when you do various things and to understand which of those may need to variation in order to optimise your glucose levels.

    Then you React. That's making small changes, one at a time to address the patterns that you saw when you reviewed your data.

    You don't need to do this all the time, although many do. As I mentioned earlier, it's a good habit to get into. As you understand about Carb counting and adjusting insulin doses, yo'll see that these require you to go through this process to understand how it all works effectively.

    As you've mentioned, you are seeing that you hypo quite regularly. If you record your glucose and food intake consistently, it should help you understand what the cause of that is. The reality is that fixed doses of insulin don't really work on a basal/bolus regime, so work your way through the BDEC course I linked to earlier to understand better how that will benefit you.
     
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  8. BlaiseS

    BlaiseS Type 1 · Member

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    I definitely agree with the above, everything works differently for each person! Personally, I'm high carb - I eat bread, pasta and huge jacket potatoes - but I know some people's bodies go crazy with that. You'll work out what's good for you! Right now though, on set doses, you do need carbs. If you're injecting 5 units of insulin for a banana or single piece of bread you'll drop like a brick.
    I forgot to mention before, but if things are a bit overwhelming it could be an idea to take a DAFNE (carb counting) course. You should have access to these through your DN. I'm sure you'll find it fine once it's been explained, but it's always an idea. I know I found it difficult knowing WHAT has carbs rather than anything else (I mean I can't carelessly eat some pineapple?).
    For now, I really wouldn't worry. Because you're an adult people often expect you to get it right away and that's just not true - A lot of it you need outside support for and when you're more comfortable it'll be second nature with correction doses especially! I've only been diabetic for a month or so and I've already gotten myself stable - I've had 2 hypers and 1 hypo in the last 2 weeks - so don't rush anything! It's better to be on some insulin than none at all, a few more weeks to get things right wont do any permenant harm.
     
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  9. becky.ford93

    becky.ford93 Type 1 · Well-Known Member

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    Hi there,

    I average around 180g carb a day and that seems to be working for me, though I haven't had my HBA1C done since December. I don't think there's much more advice to give here than what's been given already, but just so you know the fat in the Chinese probably aided the bedtime high you were having. The fat means the blood sugar rise is slower so often if I have a take away I'll get a bit of a spike later on in the evening even if I've worked hard to prevent it.

    Because it's early days for you the best thing you can do is just keep track of all your pre-meal readings. Try whilst you're on fixed doses to eat similar amounts of carb for each meal every day, this will help show whether you need to increase the fixed dose for a certain meal, or if you find you're having hypos around the same time every day to decrease the dose for the meal you've had prior to the hypo occurring.

    Carb counting gives you so much more freedom but it took me a month to get on a course, and some people have to wait way longer than that. Nonetheless it never hurts to badger your nurse/consultant to get you on one ;)
     
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  10. JJO

    JJO Type 1 · Well-Known Member

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    Thank you everyone for your time and suggestions. I do appreciate there's lots of different styles to keeping BMs down!

    I guess I need to look a logging app or diary that works for me and be disciplined in completing it.

    I haven't had a chance to go through the links but will!

    Thanks sooooo much for all the support and help! I'm sure I'll need more as I bumble my way through getting some sense of control!

    Josh


    Sent from my iPhone using Tapatalk
     
  11. LucyM88

    LucyM88 Type 1 · Well-Known Member

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    I know it's easier said then done but if you're new, you will have days like this. Better to just take action when you can and learn from the experience. Some of the time is guess-work and doing corrections. Hopefully they will put you on a DAFNE course where you will learn about CP's and how certain foods and even emotions affect your blood sugars.

    Lots of people recommended a book called Think Like A Pancreas by Gary Scheiner. I bought the book a couple of days ago and I wish I had this when I was first diagnosed.

    Hope all goes well for you!


    Sent from my iPhone using DCUK Forum mobile app
     
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  12. Juicyj

    Juicyj Type 1 · Expert
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    Hi @JJO Try downloading an app on your phone - I have used Diaconnect in the past and it's great for emailing info to HCP's and also to track and monitor patterns as you can create reports (if you like that sort of thing, I certainly do). Have patience also, it takes a while to learn what works and what doesn't, but above all remain positive, mindset is the battle won with diabetes, whatever type.
     
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  13. Erin85

    Erin85 Type 1 · Well-Known Member

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    Hi @JJO , sounds like you're taking on board all your nurse has advised and you're doing well! When I was first diagnosed, I was desperate to understand it all and every situation, but it is just not possible at the start, and it takes a while to build your knowledge up. If you are on set insulin doses, your DSN or dietitian should have advised you what kind of things you should eat for each meal (for me, it was the same cereal every day, a sandwich for lunch and dinner with a certain number of carbs), or a number of carbs to have with each meal. If you are having hypo's, it would suggest too much insulin (be aware of 'feeding insulin', where you have to eat more than normal to avoid hypos, because your insulin dose is too high). I would suggest arranging an appointment with your diabetes team to make a couple of adjustments. In the meantime, as many have said, an app or logbook would be useful for your appts, to help you and your nurse identify any patterns and make adjustments from there.

    This might just be for a short while, you certainly won't have to write everything down forever. I have been t1 for 16months now (and still honeymooning) so have had to make a LOT of adjustments upwards and downwards, and each time, I have found a log of my bg levels and insulin taken (as well as carbs/food diaries on some occasions) has helped a lot.

    All the best, you will get there in time (and learn what takeaways are better/worse for your bg levels ;) - for me, chippy chips are out for a while. Plenty of other things for me to work out before I can work that headscratcher out lol)

    x x
     
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  14. Kristin251

    Kristin251 LADA · Expert

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    I am not saying low carb is the ONLY way to go but rather many of us find it much easier to manage our BS and keep good control. The problem I had with carbs is they all come in at different times and we never know when that it. Carbs as you know are the macronutrients that effects our bs the most. If yiu were low carb before then you might choose to continue that. But yiu will also need to reduce insulin and error on the side of caution. I do eat a few carbs at every meal to bridge the gap until protein comes in but it's all above ground veggies.
    I typically eat the same BF everyday, guacamole and celery. I found my bolus that works for that. Then lunch and dinner eat the same size meals and macros at each meal but mix up the veggies protein and fats. I found my bolus for that meal. Eating fairy consistently allowed me to find a bolus that worked to keep me steady without highs and lows so I stick to it. I did log for a while until I figured it out. Foods also can work different at different times of day. I take the same 1/2 unit at all 3 meals but by dinner I am eating 3 times the amount of food with the same dose as BF. I understand loads of people don't want to be so regimented ( nor do I) however in my experience it gives me peace of mind and I don't worry about hypos and spikes. I know where my BS is going to be. Then I can focus on other things in my life other than food and BS.
    carbs if any kind in the morning send me through the roof. I need high fat BF.. BF was the hardest meal to get right but if I didn't get it right I was messed up the rest of the day and couldn't fix it until the next day. I eat no grains starch sugar dairy or fruit. This helps my insulin sensitivity.
    I was somewhat excited to be able to add some carbs back when starting insulin but it turned out to be a disaster for me. We all have our personal BS goals and admittedly mine is on the low side but I do achieve it.. You will find your comfort zone

    Just to be clear, these were/are my personal experiences and comfort zones. They certainly are not the only way to do it. Many do well on high carb, I just never found how, and many prefer low carb. My DN said 20 carbs per meal and I couldn't even get that right with out a hypo or hyper. As I lowered carbs I lowered insulin accordingly and as I said if you chose lower carbs error on the side of caution with insulin. As a side note, carbs were packing in the pounds and I wasn't interested in that and I just feel better lower carb, more energy, better sleep etc. like you I had been low carb for a long time before insulin simply because I felt better. You will find your comfort zone and it certainly doesn't have to be the same as mine. We all have different goals and comfort zones and none are right or wrong as long as you can get and keep your BS where you want it.
    Logging is a goodidea. Seems tedious but worth it in the end.
    Just right your BS numbers, time of day and foods you are as well as portion sizes as all of it matters.
     
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  15. JJO

    JJO Type 1 · Well-Known Member

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    @Kristin251 @Erin85 @Juicyj @LucyM88 Thanks for you comments.

    I'll check the book about the pancreas asap. Will order on Friday as well as the carb one already recommended. So thanks for that.

    The DAFNE thingy has previously recommended to me and I guess I need to try that course to see what it's about. I'm expecting a DN call next week so can ask about that then.

    I'll check out that app Juicyj and see if it works.

    What I could do with is something I can import alongside my BM machine so I don't need to type / duplicate what my BM machine is already storing.

    I really do appreciate everyone's thoughts and I'm finding them all very interesting and learning from them all.

    Thank you again for you thoughts and suggestions.

    @Kristin251 I find it very thought provoking about different effects vs different times of day. I can become obsessive (perhaps too much so) and I'm interesting in personal data collection to see if this is also the case for me. But equally I'm also struggling to keep a sense of normality without weighing each meal out ATM.

    Sooo much to learn and trial, so little time. Back to work next week which I have to do for my sanity but seriously don't have a real grasp on what's what!

    Again massive than you for past (and future) posts!

    Josh


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  16. tim2000s

    tim2000s Type 1 · Expert
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    This might sound nuts, but you will more or less have to do this to dose correctly.

    Every packet of bought stuff needs to be checked for carb content so you can dose the right amount of insulin. When making food, you weigh everything that goes into it so you can calculate the carb content and dose properly.

    Once you get a handle on what portion sizes match to carb content, then you can do it much less, but that is, however nuts, life as a T1. All food ends up being assessed for carbs, weighed out or not.

    It's no wonder that there is a high incidence of eating disorders amongst diabetics, when you consider the above!

    Life goes on. Normality is what you make it and how you live it, not necessarily what others say and do.
     
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  17. azure

    azure Type 1 · Expert

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    If you're on fixed doses of insulin, definitely don't remove carbs - that could lead to severe hypos.

    Most people here avoid excessive carbs. There was a thread ages ago about how many carbs we Type 1s eat, and it was interesting to see.

    I eat something like 150-180g and my control is very good. Carb counting is absolutely key. That and timing your bolus appropriately.

    With experience, you'll learn how insulins works for you and how to use it to best cover your food :)

    Think Like A Pancreas is often recommended here - it's my fav diabetes book. You really do have to be your own pancreas.
     
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  18. JJO

    JJO Type 1 · Well-Known Member

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    Just as a heads up, and a way of repeating my thanks!

    Think like a pancreas and carbs and cal arrived this morning via Amazon Prime. Also downloaded and upgraded to pro version of MySugr. Very impressed with all of those. Haven't had a chance to read the books yet as they only just arrived.

    Ive started logging everything as logging nothing wasn't ever going to get me anywhere!

    So thank you to everyone who contributed and I'll keep you all posted on the process, had a great day yesterday with my sugars so feeling encouraged!
     
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  19. noblehead

    noblehead Type 1 · Guru
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    Two great books @JJO:)

    Regards to carb counting, it's quite easy and will become second nature before long, Carbs & Cals also comes as an App which is handy for times when you are eating out and want a visual guide to portion sizes in order to work out your insulin dose. Good luck.
     
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  20. JJO

    JJO Type 1 · Well-Known Member

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