Brittle diabetes anyone?

I have been on insulin for almost 2 yrs now. Type 1.5. I have always maintained a very low carbohydrate consumption and strict A1C always around 6. However, over the past month I have tried increasing my carbs (to about 75-100 a day) as demanded by my doctors due to being "underweight". My blood sugar is CRAZY!!! For example today I had a low of 65, ate 25 carbs and took one unit. Within 30 minutes my blood sugar was 347!? Now it will take many many hours to come down with several units of insulin. This seems to happen daily. I have been running 300-400 or else plummeting to 50-60. I apparently cannot handle carbohydrates. Thoughts?

If you were managing to control your blood sugar better before with whatever you were doing I would just go back to that instead of adding extra carbs. Maybe you can try more fat and protein for weight gain? Unless you're severely underweight I wouldn't worry about that. Fluctuations like that are not good. Someone, my inr nurse, told me she thinks I'm a brittle diabetic- I do have a lot of rapid fluctuations at times but I'm not that high and not that much of a jump. Do you wait after taking insulin to eat? Not that you should if your'e 65 though.

Another possibility is that you need to change your insulin to carb ratio?

The problem is that you have trained your body to just get little amounts of carbs. For this the body falls back into starvation mode. Usually your body will respond to this by slowing down the metabolic rate. Furthermore very carb consuming tissue will be consumed like muscle cells. This adjustment process will take some months but should show first progress within weeks. With a higher metabolic rate and some additional muscle tissue your body can find more use for the additional carbs you are consuming. Your body will learn to depend more on carbs.

If you are on MDI it would be helpful to know the insulins and pattern of application for the basal.

i would say the most logical thing would be to go back to eating lower carb, and trying meee´s suggestion for increasing fat. of course we cant handle carbs, were diabetic!

There is a bottom line for low carbing. If the doctor advises 75g to 100g per day - which is not that much for being underweight - this should be taken seriously.

Nope I took one unit and ate 25 carbs with a blood sugar of 65. I then took three more units to finally get it to 150 7 hours later. I only weigh 100 lbs and take a low basal bc I'm pretty insulin sensitive (until I go over 200 and theres no going back down anytime soon!). Seems like I'm very carb sensitive as well.
And your theory about why stop what works is my thought. I cannot handle these rollercoaster rides they make me feel AWFUL!! Not to mention time consuming and stressful, I have babies to take care of.

Good thoughts, I kind of had a feeling I was carb sensitive due to being low carb for so long but I never eat more than 25 at a time and I bolus at least 30 minutes before. I am on minimed pump and LOVE my pump! I even usually take little boluses all day long to compensate for the increase in carbs and have increased my daily basal. I also may add I bike 1-2 hours a day.

The low carb lifestyle was SO much easier, starting back tomorrow!

No Im very happy with my body size and prefer to stay small. I have plenty of energy and chase my kids all day long as well as bike daily. I have NO energy now that I have added carbs. I'm def going back to low carb. Maybe its just me but its so much easier with much less thinking or math or mistakes involved!

Does anyone else have blood sugar swings this dramatic? For example last week I was 312, took two units and within an hour I was 70. Same with eating carbs, I can take the "correct" amount of insulin eat and jump up to several hundred points in a matter of 30-60 minutes. Does this make me a "brittle diabetic"? My 24 hour graph on my CGM literally is a roller coaster.

I used to before I was put on a pump. They used to term my diabetes brittle because of those swings. The smallest adjustments would throw it off bad. That’s when i realized that a pump was needed for better control. Or to be pregnant 24/7. I had awesome control then.

I don't take 25G of carbs to correct a low. These days, I'm finding like 5 or 6 Smarties/ Jellybeans (I started mixing them, Smarties have dextrose so theoretically they work faster, but are too dusty, like glucose tabs, to eat by themselves when I'm running. Mixing them with Starburst jelly beans is *really* tasty and works great!) will dig me out of a low. For 65, depending on IOB and other factors, I might have like 3 or 4 and see how I pull out of it. Sometimes when I had shots, the NPH would do weird stuff, like come on slowly, so I'd run high, correct and then it would crash out.

Same here! My A1C while pregnant was in the 5's! Do you eat low carb to control the big swings?

I usually eat one starburst or 2 sweettarts. I was just very hungry so went ahead and actually had a snack, hence the taking one unit as well.

Ah, gotcha, I thought that you meant 25G of quick carbs which will generally blow me up too.

If low-carb is working well for you, then I agree with the thought of keeping what works for you. Fat and protein can definitely help. I'm considered underweight. Roasting my veggies with oil and adding fats in ways like that is what keeps my weight stable. When I was seeing a nutritionist, she would joke that I was taking in more protein than her bodybuilders :)
Another thought- have you considered low-carb snacks without the insulin? A cheese stick or sunflower seeds might take care of the hunger without spiking you. If you're insulin-sensitive, maybe with a small snack you'd be better off trying to go without.

Good to see you LilMama! Question: Have you tested your I:C ratios since you increased your carbs? They might have changed and 1:25 is a pretty generous ratio. Also your basals might need adjusting. I would go back to the drawing board with your doses. Good luck.

Oh, I see that you were low-ish. and had a snack for the low and bolused as well.. That's pretty much a crapshoot. I would have either treated for the low and waited with the usual carbs you use to treat a low. Or, what I would have done at 65 is just gone ahead and ate. In general when I am low, I don't subtract insulin for the blood sugar. I just take whatever my I:C ratio suggests. (if I subtract, I will be high later). If I'm low before eating what I will play with is the time. At 65 I would have just bolused and ate. Lower and I would eat first and then test after eating and bolus when I came up into the 70s or higher.

Good luck to you, it must be very difficult trying to sort this out for a child. Hopefully it will be sorted soon. Is your child newly diagnosed and could you get in touch with your diabetic team before December.

Obvious question, but have you checked your meter to make sure it's accurate? When I was using a Freestyle meter it used to pick up sugar and food on my hands. A few times I corrected "highs" in the 300s only to crash to 40 less than an hour later. Then I started double-checking highs by washing my hands and re-testing, and found that some weren't really high. This hasn't been as much of a problem since I switched meter brands, but I still always double-check highs before correcting (unless I feel high and it's obvious).

Also, I eat around 75-100 grams of carbohydrates per day but I still find it very difficult to not go to 200+ at one hour after eating, even if I only eat 20 grams. I know some people say the glycemic index doesn't really matter, but I find for me trying to eat protein/fat with foods and also pre-bolusing helps a LOT. Otherwise it just seems like the insulin can't keep up.

Also, you say you have LADA, so is it possible that you've been honeymooning and are now needing more insulin (people diagnosed as adults can honeymoon for years)?

I know what you mean about feeling awful- I feel every little change in my blood sugars with sweating, palpitations and hot flashes etc. even minor ones.. it's horrible. I guess you could try a different ratio: I use 1:10, 1:12 or 1:15. Actually I've gotten kind of lazy about counting everything so precisely because sometimes even when I do it is never really predictable what will happen and I tend to eat the same things most of the time except when I eat out which is rare now.

But with 1:10 I have some left over for my protein and fat. I am eating 30-50 g per day. I do feel hungry a lot of the time though, but I felt that way at much higher carbs too- I think it is just the unnatural reaction of injected insulin.

So far the highest fluctuations I have had were in DKA I think, from 240 to 40. I had some after I got home- once I went from 170 to 40 in 1/2 hr while vacuuming. I overcorrected a low of 29 in August and wound up at 220 or so. Within an hour after a correction I was back down to 175 and then back to normal by morning.. it was quite a rollercoaster though- I had not been in the 200's for ages and it felt horrible for a few days.