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What to do?

Discussion in 'Insulin' started by 4mum_, Jun 18, 2017.

  1. 4mum_

    4mum_ Type 1 · Well-Known Member

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    I was diagnosed t1d on 12th May as I had dka. I'm currently injected set units of novarapid and lantus. My question is I've just had a sandwich and bits and taken my 6 units. I have people coming in a couple hour for nibbles. How do I manage that as is will be my main meal of the day. Thanks in advance from a novice.
     
  2. urbanracer

    urbanracer Type 1 · Expert
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    hmmmmm,

    You have a few variables here, the exact timing of your previous insulin shot, the amount (and type) of carbohydrate in your 'nibbles' , the temperature today (warm weather generally aids insulin absorption), will you be drinking alcohol? Alcohol lowers blood glucose levels (at least for a while).

    As you are relatively new to this, how stable are your glucose levels at the moment?

    The profile of your rapid acting insulin means that it's activity peaks in about 2hrs after injecting, but it stays active in the body for up to around 4+ hrs.

    Based on your first post, I don't think there's an easy answer - sorry, but please feel free to fill in some of the blanks.
     
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  3. Scott-C

    Scott-C Type 1 · Well-Known Member

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    That won't always be the case. I can quite understand you being on set units for a while till you and doctors see how you settle down with limited variables in the sense of set insulin and set food amounts. But eventually, once you've learned some basic carb counting and dosing rules novorapid gives you a large amount of flexibility with what and when and how much you eat.

    But that's for the future. For this afternoon, I agree with @urbanracer 's point about the shape or pattern of insulin. It's an important point generally to keep in mind which will stand you in good stead for the rest of your T1 career, realising that insulin isn't "fire and forget", that it'll be doing it's stuff for 4 to 5 hours, peaking after 1 to 2, and realising how matching digestion rates to that pattern can help. That's why guestimating the gi of your meal plays a part. And why you can still have substantial drops in the last hour or two of action.

    With experience, eating again during that 4 to 5 hour action period is totally do-able, but the main thing to think about is that if the second meal has carbs which you need to dose for, you'll then have two lots of insulin in you working in tandem but with different peaking times, which can become unpredictable for newbies. It's called insulin stacking. There's nothing intrinsically wrong or bad about it, but, like I say, needs a bit of attention, so you should probably avoid it at this stage until you're more familiar with things.

    Your nibbles situation could work out in a number of ways.

    If it turns out the 6u for the sandwich was too much and drops you, you'll be needing some more food anyway. If you get anywhere near hypo, use fast sugar, not nibbles, but if it's more of a gentle slide which you just need to tail off a bit and lift before you hit 4, some carb nibbles might be just the trick to bring it up a bit.

    If the 6u was correct and you're not sliding, then, generally speaking people like DAFNE will say you can get away with about 10g between meals without bolus, but that's obviously a really small amount, like a digestive biscuit.

    So, if the nibbles are going to be more than 10g, you're getting into territory where you're going to have to think about taking another shot, and then you're insulin stacking. As you're on set doses in these early stages, your dsn probably won't be wild about that idea, but, obviously if you've been taught enough already by your dsn about how to deal with such situations, then follow that advice. Personally, if I'm insulin stacking, I'd generally think about how much I'd normally bolus for that meal, but then tail it off a bit to allow for the fact that I've still got some active insulin on board.

    If the nibbles are carb free, then there are no real issues. If you're talking about olives, nuts, ham, cheese, salad , you'll not need to bolus for those, so go for it. Sure, there can be issues about needing to bolus for protein in some circumstances, but let's not complicate matters!

    Personally, seeing as you're on set rates, I'd be inclined to stick to no carb stuff, unless you've been taught enough to calculate bolus for additional food, and are confident enough to deal with stacking issues.

    Like I say, this won't always be the case: bit of experience under you're belt and this'll be second nature, but for this afternoon, be cautious about it.
     
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  4. 4mum_

    4mum_ Type 1 · Well-Known Member

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  5. 4mum_

    4mum_ Type 1 · Well-Known Member

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    Thanks. It's still early days for me but I'm beginning to realise how it works. The 6 units was too much and I dipped to 2.8 quickly.I find glucotabs work well for me. I've been dipping to that mid morning and have recently reduced the units by 1 and that helped. Nibble time happened later in the end and when I tested it was up to 9.6 due to the tabs. I don't see the consultant until July so see what happens 're more info and dafne courses. The whole thing was a surprise as I'm 55 without any previous history. I was admitted with dka and bg of 23.
     
  6. 4mum_

    4mum_ Type 1 · Well-Known Member

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  7. 4mum_

    4mum_ Type 1 · Well-Known Member

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    Thanks for you r guidance. I read the links and took note of your comments. So much to remember at this stage for me.
     
  8. Slideysarego!

    Slideysarego! · Newbie

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    Hi, I was also diagnosed at the age of 55 with no history, 20 months ago. I was started on carb counting almost straight away and, after a year, went on the DAFNE course. I think things would be a lot easier for you if you could carb count. Could you ask your diabetes team about it? It will get easier.
     
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  9. 4mum_

    4mum_ Type 1 · Well-Known Member

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    Sorry I never replied. The delay to get carb counting was due to waiting to see the dietician..
    Which happened in August!
     
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