A late starter – advice


#1

Hello,

I was diagnosed around five years ago (exact date escapes me at the mo). Following some pretty severe symptoms and around a reading of around 400 when diagnosed, I went straight on to insulin.

Now, I have obviously been using insulin for the past five years and now I realize that I don’t really know how to do that!! In the beginning I had great readings, then they started to taper off, now I think I have to inject a lot more just to get good results. Due to pure exhaustion I let things drop a bit, but I am back and ready to start again.

That being said, about 3 months ago I tried to eat very healthy and kept records and for two weeks I had the best readings – it was like I didn’t have diabetes. Then I realized – YOU’RE NOT EATING HEALTHY! YOU’RE STARVING YOURSELF! So that didn’t really last!

Now I am trying to eat healthy and filling, so today I made a dish with quinoa but then I realized – I have no idea what to inject for this!

Basically, I need to start everything again from scratch – but where should I start? Are there good books with normal plans to eat healthy? Any advice in general?

I have a diabetes doctor and his nurse – but I’ll be honest, I don’t find them very proactive and getting info out of them is a bit tough….

Apologies for a post which is a bit “all over the place” – any good advice and recommendations are welcomed!!


#2

Taking the last point first, yes, there are some very good books out there. My top four, in no particular order, are listed below:

Richard K. Bernstein, Dr. Bernstein’s Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)

Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)

John Walsh et al., Using Insulin (San Diego: Torrey Pines Press, 2003)

Gary Scheiner, The Ultimate Guide To Accurate Carb Counting (Boston: Da Capo Press, 2011)

You mentioned insulin but didn’t indicate whether you are using a pump. If you are, then you definitely want Walsh’s book Pumping Insulin.

The lack of involvement by your medical team is depressing but extremely common. Sooner or later, every diabetic who is intent on taking charge of their condition realizes that you have to do it yourself. Your medical team can provide access to treatment via prescriptions, samples, etc., and in ideal circumstances they will be fully engaged with hands-on, informed help and advice. Unfortunately, ideal circumstances are . . . let’s just say, “rare”.

The bottom line is that no one can manage your diabetes but you. In the first place, no one knows your body like you do, and in the second place, you’re the only one who is there 24x7 to do it. That being so, knowledge is power. The more you learn, the better the job you can do.


#3

Congrats on taking control of your diabetes. As you have seen using insulin is an art, and a science, mixed with a little faith.

Through experimenting I am confident you will find a meal plan that satisfies you and helps you meet your goals. The easiest way in my experience is to reduce your carb level for a week or two, then increase your carb levels until you find it difficult to manage, then reduce to the level that satiates your hunger and is easy to manage. For my son, who is very carb sensitive, we landed around 100 carbs per day. For other diabetics we socialize with their level is much higher.

A good website to get recipes that includes all of the nutrition information (and is therefore easy) is:
http://alldayidreamaboutfood.com/

Another good site for ideas if you have food allergies or preferences is:

Both offer tasty recipes and good ideas, until you can land on the meal plan that works for you.


#4

You’ve definitely come to the right place for advice! Welcome to Tud, @Shea613! The above advice all looks great to me, so I won’t repeat it :slight_smile:

I was also diagnosed around five years ago. It took me a few months before going on insulin. I did not get good advice from my medical team as to how to manage with insulin. I looked here and to others in the DOC (Diabetes online community) for help – even then, it is always a challenge. Sometime last year, I changed to a low-carb diet most of the week (I still eat more carbs on Friday night and Saturdays, though I may have to modify that as well). I have found that approach to make things MUCH easier. Challenges continue, though – what works today might not work tomorrow.

Just remember to take ‘baby steps’ – don’t expect to change the world overnight. As its often said around here, diabetes is a marathon, not a sprint – You’ll have successes and you’ll have setbacks. Enjoy the victories and learn from the mistakes. Pretty standard life advice and no different where diabetes is concerned.

You’ve got this! :smile:


#5

Welcome to TUD @Shea613. Some good advice here already, but can you tell us what your treatment regimen is now? What kind(s) of insulin are you taking, are you using a basal-bolus approach–those kinds of questions. That would help refine any advice we might give.


#6

My additional two cents will address your implicit feeling that somehow needing to use more insulin than you started on is a sign of failure on your part. It is not! Very likely you were going through what is (romantically) called the “honeymoon phase” common to many newly diagnosed PWD. Changes in your needs will continue to happen based on a wide variety of factors (hormonal changes, especially but not only if you are a woman; seasonal changes; whether you have any illnesses at any one time; pattern of activity and stress; obviously, food choices; etc.; etc.) The only failure is to NOT adjust your insulin intake to address the circumstances that arise.

In order to be able to do that, I do agree with all the previous posters who point you to different useful sources of knowledge on the topic. However, you have to find the approach that works FOR YOU and in a sustainable manner.

(As one example of what I mean, while I recognize that low-carb eating might make BG management a somewhat simpler task, I long ago determined it is not for me. I eat what I would call medium carb (= 100 grams or so a day) and do fine without compromising what I consider important to my quality of life.)


#7

Piling on to what @Dessito said, the amount of insulin you need means one thing and one thing only: it’s the amount of insulin you need. The amount isn’t good or bad, and it doesn’t mean you are good or bad. Insulin is just a tool for solving a problem—and that’s all. You use what you need to use.

Think of it this way. If one aspirin isn’t enough to fix your headache, you use two. All it means is that you need two, not one. Nothing more.


#8

I agree with everyone’s suggestions. The last thing I would add is that the most important thing is that you’ve got your head in the game. Don’t berate yourself for the past. Because here’s what you can DO about the past: …

Got the point? If you learned anything from the past, cool. If not, forget it. Coulda-Woulda-Shoulda is the sound an out-of-balanced washing machine. It is NOT a helpful expression for dealing with now.


#9

Agree. “You can’t fix yesterday” ought to be carved in stone someplace.


#10

Everyone else has given fantastic starting places for insulin therapy. You also asked about food (and how to dose for it). While you will need to figure out I:C ratio, you also need to know how many carbs (and also protein and fat) your food contains. In your quinoa example, if I’d made a dish with 1/4 cup of cooked quinoa, I would know there was approximately ~10g of carbohydrate in the quinoa portion of the dish. I use sites like the USDA database to look up nutritional info.

If you use the USDA, remember that in the U.S., Total Carbohydrate and Fiber are both reported, and you can subtract fiber from carbs to get “net” or digestible carbohydrate. Protein and fat are also sometimes bolused for, depending on your routine.

Last thing is to get a food tracking app. I use MyFitnessPal, although I know there are better out there (MFP is free). MFP has both a website and phone apps, both of which can be used to track foods eaten, and also to estimate nutritional values for food not cooked at home. So, that’s one way to “take control” on the dietary front: know what’s in your food! That, along with a food scale, has allowed me to achieve some pretty good control in the last few months.


#11

Hi David,

Thanks so much for taking the time out to reply to me.

I am happy to say that I have ordered, The Ultimate Guide To Accurate Carb Counting, and my mother will be bringing it with her to Israel next month.

I have a copy of Thinking Like a Pancreas, I purchased a copy right after I was diagnosed but after the inital excitement it was relegated to “the books of much dust”, I will however dig it out again as I enjoyed it the first time round.

Armed with this information and your encouragement to keep going even without the medical team, I hope to be back on track soon enough.

Thanks.
Shea
_


#12

Great site Chris - thanks for taking the time out to recommend this! I hope to be able to report culinary success in no time!!

Best,
Shea


#13

Hi Thas - nice to hear from you, thanks for taking time out to respond to my post!

Can’t remember the last time I sprinted to do anything so I hope I can make diabetes a success baby step journey also :slight_smile:

Am sure this will be me in no time:


#14

Hi @DrBB - thanks for taking out to the time to reply to my post! You raise an excellent point, I skipped over the insulin details!

I use Levemir and Novo Rapid. Levemir I take 22 units in the morning and night - but I totally made that up and have used more and less previously… :confounded:

Novo Rapid I kind of guess… and over time I figured out what is works and what doesn’t… I try and only eat bread on my Sabbath - which is Fri night and Sat and even then I keep it to a minimum. Then in the week I generally aim (when not in a rush and have right foods in house, etc, etc) to stay off carbs and have filing health things… this keeps the novo rapid to a minimum.

I once asked my doctor if there is any benefit to eating foods which require less insulin and thus help to minimize the intake over a monthly period - he told me definitively “No, eat what you want and compensate with insulin”. What is your view and experience with this?

Best,
Shea


#15

Hi @Dessito - thanks for replying to my post.

You really hit the nail on the head!! Keeping the right frame of mind. When I initially realized I need to take more insulin these days, I thought “Great! If it keeps going this way, I will be using “a pen a meal” in ten years time” - luckily I caught myself and continued on the positive thinking path!

I am now beginning to consider more seriously a set exercise regime - at the moment I endeavor to walk for a period of one hour, three times a week. Any views/experience on introducing exercise?

Regards,
Shea


#16

Hi @Timbeak48 - thanks for replying - and an excellent response at that. Couldn’t agree with you more, we have to learn from the past but never let the past drag us down!


#17

@David49 - thanks for taking time out to respond and sending me over that site - looks like it’s going to be a big help!!


#18

I got that advice, too – Bad idea for many people. In my case, it resulted in quite a bit of unwanted weight gain with which I am now struggling. Sure, you CAN take enough insulin to cover what you want, but that will lead to bigger problems – more frequently and higher spikes, as you try and chase the carbs, and more frequent and dangerous lows, as you error in trying to compensate. It’s a lot easier to restrict carbs most of the times and make insulin doses smaller and ultimately more accurate.

I also avoid bread all week, except on Shabbos. (I’m probably not as good as you in minimizing it, then, however! :laughing:). Most of the week, I stick to a very low carb approach - keeping to 50g or less of carbs. Doing that has helped me manage to all-but eliminate episodes of low blood sugar, and keep my A1c in the low-mid 5’s. Have lost half the insulin-assisted weight gain, but still have a long way to go.

I do have the benefit of using a CGM (continuous glucose monitor), which I know isn’t so easy to get approve in Israel… I also have an insulin pump, so I can take even very small adjustment doses of insulin (<1U). That helps me micro-manage my numbers throughout the day, when needed. Still eating fewer carbs helps a lot more – and most of the time, I don’t miss them.


#19

Hi Thas - nice to hear from you.

I have recently put on a lot of weight and i realized it was from this approach of eating whatever I pleased and injecting to compensate. So, like you, I have now cut out as much carbs as possible.

Please let me know if you have any good low carb ideas - I feel like i eat the same thing everyday due to lack of inspiration.

Challah is a real tough one to overcome! Also I live in Eretz Yisrael when “dips” is an actual course haha! I do a yetzer horah trade off which involves keeping a bottle of Arak in the freezer and allowing myself an Arak after the fish, if I behaved with the challah. Oooooh the yeridas hadoros :slight_smile:

Do you exercise? Again, any tips welcome, I am never going to run anywhere :joy: - so I am always looking for “in the home simple exercises” - are they a myth?

Best wishes for continued success!!
Shea


#20

My yetzer horah of choice is a single-malt Scotch…

I also eat the same things most days, actually. I’ve been trying to come up with new ideas. I know there are all sorts of low-carb eating and ‘keto diet’ web sites out there with recipes, but most haven’t inspired me yet…

I do exercise, but not enough. I try and get a walk of some sort in every day. I’m starting to try and get to the gym again more frequently - hopefully at least twice a week. I also ride a bike, when I can - again, not as much this summer as I’d like, but there’s still time. I don’t run, either. heh. I have done pushups regularly at home at times - pretty effective if you do enough of them and do them every day…