Another new T1

After being PU/PD for months (thirsty all the time and having to run to the restroom the rest of the time).. and losing 23 pounds over the course of 10 months without trying.. some of my friends were concerned about me, and I got concerned too. I kept blaming it on the fact that this is a stressful time in my life as I finish up with veterinary school. I went to student health and had bloodwork run. Lo and behold, a fasting BG of 293 prompted a call the next morning for me to come back in. Too numerous to count ketones in my urine along with glucose and protein prompted a visit to the ER because they thought I would go into DKA. They ran a couple liters of fluids in, set me up with insulin on what I realize now is a pathetic scale to use, and sent me home.

Since then, I've had 3 doctor's visits and am trying to get set up with an endo. On Friday, I received the call that I do have GAD antibodies and so I am type 1. My pancreas is still making a little insulin, but it's on it's way out the door. My A1C was 12.4, which means my average was running around 315. I feel really lucky that I had bloodwork run when I did, and that I didn't have to be hospitalized for DKA.

I'm currently on 8u Lantus at night, and 3 units of Humalog with every meal + 1 unit for every 50mg/dl over 150mg/dl. This is just until I meet with a diabetic educator a week from today. I've already got much better control, I'm waking up between 102 and 140. If I knew how to calculate my insulin to carb ratio, I'd go ahead and try it beforehand. Yesterday, I felt a little ill around 4pm in the afternoon; checked my sugar and it was 82. I realize my body's been running on high so I'm probably just not used to it- but I got scared and took a glucose tablet anyway since I don't know what my 'low' threshold is. Looking back I think I would have been fine. I wound up shooting my sugar up to 160- so I probably didn't handle it the best, but this is a learning experience.

I've been hanging around the diabetes.org forums and someone talked about this website and how much they liked it, so I decided to join too. It's really nice to have people to talk to who have been there before and can give little tips and suggestions that they don't tell you in the doctor's office.

That was a long ramble, and if you made it this far, thanks for reading.

Welcome to the club! Nice "catch" on avoiding the hospital! Good job w/ the low too, and great attitude looking at it as a learning experience. That's exactly what you need to do.

Perhaps you've run into "Think Like a Pancreas" by Gary Scheiner or "Using Insulin" by John Walsh. These books are great "owner's manuals" and it would be awesome if you can get one *before* you get in too deep with the CDE/ Endo so you can kind of know what they are talking about and do what it takes to get the best care for yourself? Hanging around forums is also a great way to learn things. I wish I had done it sooner!

Your experience is not too different from mine... I was diagnosed last March.

You're doing a good job getting started. Yes, you are exactly right...you're body got used to the high sugars and its sensitivity to low sugars is set higher now. It will come down as you stay under control.

You may find that your need for insulin will rise over the next few months as the autoimmune process continues...sometimes there is an easing up when you first get on insulin as glucose toxicity shuts down some of the beta cell production of insulin...when that is relieved, the cells start working for awhile again. Expect your basal insulin, insulin to carb ratios and insulin sensitivity factors to change over time. This is normal. Also, now that you can actually use the food you are eating, your weight may return to its pre-hyperglycemic levels and that too will change your insulin needs.

When I first started on insulin I found I didn't have to cover everything I ate - like snacks - later I found I had to inhect for everything. I started carb counting about 1 month after diagnosis and that helped alot.

It was scary at first, but I slowly started learning and started doing everything I did before diagnosis, including international travel.

About 8 months after diagnosis I decided to switch from MDI to a pump (Omnipod) to deal with the dawn phenomenon (high overnight/morning blood sugars) and that has made things even easier.

All the learning is like drinking from a firehose at first, but it soon becomes 2nd nature. Hang in there. It does get better. You're doing great already.

Thanks for the suggestions- I keep hearing about those books everywhere, and did order them. I'm hoping they arrive this week and that I can read them over the weekend before my appointment on Monday.

But the forums are definitely helping a lot. The doctor only briefly mentioned carb counting, ratios, etc and I was able to find more information about them online. So in preparation, at most meals I am calculating how many carbs I'm eating and then testing again 2 hours later. Hoping to get enough data points that it will be useful at my visit.

I figured out today that my BG drops between lunch and dinner significantly. Then learned that's what normal people's BG levels do.. so I'll have to start factoring that in at lunch too eventually. So many things to learn, but I'll get there.

Thanks again!

Do you even have to inject for things like nuts? Right now I snack on those in between meals because it does not seem to affect my blood glucose a lot. Of course if I eat too many, it jumps way up... but a handful or two seems fine.

I'm not sure how I feel about the insulin pumps yet. Working with animals, I feel like it will become more of a hindrance than an asset. If it gets ripped out... oy.

One of the things that terrifies me is getting too low at night. I don't feel like I have much of a threat of that right now because I am not extremely well controlled, but it scares me for the future. I'm keeping glucose pills and a can of regular coke by my bed at night as well as my glucometer, but what if I'm not coherent enough to use it?

I hadn't thought about glucose toxicity and all that comes with it. Thank you for the heads up, I appreciate it.

If you are considering a pump, don't worry about infusions being ripped out; there are many ways to secure them. I have a tubed pump (MM522) and use smith&nephew I.V. Preps to secure the adhesives, followed by using cloth tape over the top of the SureT infusion sets. Because I like to be really, really safe with my three Goldens who can get excited, I add a 2 1/4 x 3" adhesive pad. There is no possibility whatsoever that it can be ripped out!

Hi and welcome! Sounds like you are doing great, and what a relief to know what is going on and to catch it early. I also always recommend the two books that AcidRock suggests; I am glad you have them on order. And HPNpilot has given you some excellent "newbie" advice. As he says, there is SO much to learn at the beginning, but it does become second nature over time, and less overwhelming. Get the support you need here from your fellow D people.

I feel like I need to start a list somewhere of all these little tips and ideas... thanks! I will consider the pump a little more now, maybe in a few months I'll see about getting one.

Do you know of any books or a website I could use to help educate people who don't have the disease? My mother has been trying to help me and I very much appreciate her but sometimes I don't feel like she understands, and that I am perhaps not doing a good job at explaining.

Thanks for the welcome!

LOL, the list is at tudiabetes.org/forum and you already found it! I bolus for nuts. If you eat them and don't get a rise, even a slight one, it may be an indication that your basal rate is a shade high but that's the sort of thing that can take a while to figure out for sure. I think my inclination is to run the rates a bit high all the time too, as I'd rather steer "into the wind" a bit and sort of tack back and forth with it.

The omnipod I use is a tubeless pump and fits under your clothes or on your arm, no danger of it getting entagled with the animals. Some people love it, some hate it. No need to worry about such decisions right now...take things at your own pace.

I can usually get away with eating low carb things like nuts, avocados, etc without bolusing, unless I go crazy, like you say.

I've only had this thing for about a year, and so far no problem of hypos at night...I have more of a problem with too high at night. I'm going to try the Dexcom continuous glucose monitor for a week to get some insight into what happens overnight...though I really don't want two devices attached to me all the time.

I'd refer her here too (Tu?)? I don't think that anyone who doesn't have it can get it. They figure that if you screw up and are a bit whacked out it means you are a loser who doesn't know what the hell they are doing, rather than a scientist trying to boldly go where no one has gone before?

My glucose seems to spike in the evening around 10pm. The last few nights it can be upwards of 212-250, even though during the day I've been around 120-140 most of the time. I don't know if it's because I take my Lantus at night, and it doesn't really have a full 24 hour effect, or what. I went ahead and took 1 extra unit of Humalog with dinner. Before dinner, it was 147. I took 5 units and two hours later it was 103, the lowest it's been all day. I'll see what it is at my bedtime dose; hopefully not 200 + again, like it always seems to be!

I think my basal level of insulin is still too low right now, but I'm not going to go up on it until I go to my appointment in a week. My numbers are MUCH lower than they were, but they are still too high. :/ The nuts don't seem to affect it much for now.. unless combined with a sugar pill, haha.

This is the problem I was having when on Lantus.

The problem is your body starts producing hormones at night that trigger the liver to send glucose into the blood. Everyone's body clock is a little different. For some this starts at 3am, for me , it seems to start earlier in the evening. Without diabetes, your pancreas will increase insulin production to compensate for the glucose being dumped into the bloodstream. With diabetes, it has to be compensated for by a change in basal rate. This is a case where the flat output of Lantus is not helpful.

THe problem I had is if I cranked up the Lantus high enough for the night time, then I went low around 5-7 PM. The solution for me was the programmable basal rates provided by a pump. Many people can find an acceptable compromise with Lantus or Levemir, sometimes by splitting the dose.

I didn't realize that it could vary that much from person to person. I still feel like the Lantus is petering out by the time 10pm rolls around and that is contributing.

I'm wondering now if I should give Levemir a try.

Or maybe I could give the Lantus earlier in the evening so that it has time to take more effect before my body spikes the glucose on its own.

Also... I have heard conflicting opinions on whether to give your long acting insulin at night or in the morning. Thoughts?

You are right, Lantus doesn't really last 24 hours. You could play with the time you take it to see if it reduces that high at 10PM. But many of us find we get better result with splitting it into two doses. Many also get a better result switching to Levemir. And, of course, the best result of all is using a pump because you can have varied hourly rates to better match your body's chemistry. I have 9 different rates and it works great.

I tried both and it made no difference for me. It was flat all 24 hours and the problem was really my body needs a very varied basal rate : I'm at 1.75u/hr at night and 0.65 u / hour in the afternoon...with some intermediate steps at other times of the day...kind of extreme, but it keeps me relatively flat when not eating. Everyone is different and it changes from time to time.

As they say "Your Diabetes May Vary."

Welcome to our exclusive T1 club where everybody is an involuntary member!

I agree your evening highs could be due to your Lantus conking out.

I was in mild shock for months after dx, so I guess I was kind of crazy and figured out my insulin to carb ratio on my own. My GP was not a good guide (he advised me to take 40u of Lantus when I only needed 14u), so...I just experimented by taking the carb count of something I eat all the time (pb sandwiches) and trying doses. I don't recall any disastrous results so it must have worked!

You've done well to have already discovered this site. I will always need a doc to provide my scrips but the online community is golden.

Hi palominovet,
I, too, was only diagnosed 7 months ago (at the age of 33) but I'd been having symptoms for 2 years before that. Like you, everyone else thought it was stress from the major changes going on in my life.

There will be a lot to learn in the next few months, and after gaining some tools a lot of that learning will be tailored to you and how your body responds to different conditions. I strongly recommend a Dexcom to help you "see" how things affect your BG and to give you a little rest from worrying about your numbers (you can set alarms).

Your body will still adapt to having lower numbers, depending on how high for how long you were before diagnosis. It took me quite awhile, and I'm still not 100%, but it is getting better.

It does get easier, and the pain lessons. I still have some shock over having T1, but it isn't the first thing I think of when I wake up (the anxiety about it, that is).

Virtual hugs to you