Need Help - Type 1 Diabetes

Type 1 and LADA
1

Hello,

I am really impressed with this great forum! Amazing infos and great help!

Im 28years old and i have been diagnosed with type 1 diabetes on april 2007, 6years ago.

I am using Levemir & Humalog for my daily treatment.

Levemir: 2 shots, one at noon (30units) and one at night (35units)

Humalog: my ratio is 1unit for every 5grams of carbs

In the past 2 years i gained some noticeable weight, from 72kgs to 78/80 kgs (im 173cm) although i dont eat that much but maybe due to the quality of my food.
I usually don't eat at breakfast and weren't always following a diabetic diet. Just to let you understand my case, i got a nice body but the stomach area is overweight by 3 to 4 kgs.

Anyway last month got my Hb1ac results and wasn't happy with my result, was near 8.1
So i took a decision to follow a strict diet accompanied with 3hours of tennis per week (1hour per day) and will start gym next week.

Once real fact that i found losing weight now to be more difficult even if i am following a healthy diet, maybe because of the amount of insulin.

When my BMI started to be near 27, i started Xenical with my diet.
I dropped a significant quantity of carbs from my meals and keep on playing tennis 3 days per week.

I dropped 3kgs in 1 week, and that was great, but i am facing some hypos during the day, i know i should change the dosage of insulin but any tips how?

As i said before, Levemir shots were divided by two, one at noon and one at midnight, i reducing 2 units per day from each shot.

Now im taking 26units instead of 30 for day shot and 33units instead of 35 for night shot, but im still facing multiple hypos.

Im feeling that even my insulin/carb ratio has changed, is it possible? im currently on 1unit of humalog for every 5grams of carbs.

Its really difficult because im feeling as if it is my 1st month on treatment and i should start it all over again.

I understand Xenical drop blood sugar but by how much?!

Lets say i will change my dosage now because im on a strict diet/exercising + Xenical, but after 1month i wont be using Xenical anymore, so i will be forced to adjust my dosage again?!

Thank you for your help

Shady

2

Losing weighty with diabetes can be tricky. An important first step is to reduce/eliminate lows. Lows cause you to eat unnecessary calories to treat. Lows can also create rebound highs.

I recommend that you test your basal insulin first. Integrated Diabetes Services has a good protocol.

Then you'll need to test/adjust your insulin to carb ratio. This ratio (I:C) is the amount of carbs that one unit of insulin can control.

Another important factor to discover is your insulin sensitivity factor (ISF). This is how much your blood glucose level will drop when you take one unit of insulin.

These concepts are all outlined in various books, like Think Like a Pancreas by Gary Scheiner and Pumping Insulin by John Walsh.

If you are serious about losing weight, you'll need to be willing to test a lot and keep track, in writing, about what's going on. I think that losing weight is a great goal and can really help with overall BG control.

If you seriously take this on you can learn how sensitive your body is to carbohydrates. I believe that we, as diabetics, each have our own "carb-sensitivity threshold," the amount of carbs that cannot be exceeded in one day or meal without losing control and hopping on the glucose roller coaster.

Be aware that the concept of limiting carbs is still a controversial one that the mainstream medical/nutritional does not support. Having said that, there are many diabetics that have successfully lost significant weight (for me, 13% of my body weight) by limiting carbs. And medical science contains many studies that support the concept of carb limitation as part of a healthy lifestyle.

Sorry if I've answered with too much information. Losing weight as a diabetic is harder than a non-diabetic. I've failed much more often than I've succeeded but my last effort has seen my weight loss sustained for one year and counting. Good luck.

3

Keep dropping your basal, until you stop seeing fasting lows. You have only lowered your basal insulin by 10% so far which isn't really very much. When it comes to insulin, you need what you need. And yes, as you become more insulin sensitive, not only will your basal needs go down, but you I/C ratio can change too. When your weight and exercise level stabilizes, so will you basal/bolus needs (until they change again when something else changes). I seem to be able to go only about six months before I need to adjust again - I seem to need less insulin in the summer than I do in the winter so I watch for this and adjust accordingly. It's just part of having T1 diabetes I'm afraid.

4

Thank you for your great reply!
im seeing hypos mainly during sleeping.
I take 2 shots of LEVEMIR per day. the 1st one at 1am and i sleep around 3am
and the second one at 1pm.

Its been 2 days im facing the same hypos at the same time, although i reduced my basal night dose by 4units... im taking 31units instead of 35.

at 07:20am : 55 mg/dl i took 20grams of carbs (juice) and slept again.
at 11:00am : 61 mg/dl i took 20grams of carbs.

at 14:45pm: my BG is now 188 mg/dl

Can i know the best way to take my 2 basal shots? is it okay to take it right before i sleep and right after i wake up?

5

Thanks terry, your link helped me a lot but i got some few questions.

Sometimes i work at night and sometimes not.
Anyway my usual schedule is as follows:
1- sleep at 2am or 3am and wake up at 9am
2- sleep at 2am or 3am and wake up at 11am

as i said before i take 2 shots of Levemir (bed time & day time)
what is the best time to take it? Right before i sleep? or as im doing now before approx 2hours?

and the 2nd shot? right when i wake up?

I take 2 shots of LEVEMIR per day. the 1st one at 1am and i sleep around 3am
and the second one at 1pm.
Its been 2 days im facing the same hypos at the same time, although i reduced my basal night dose by 4units... im taking 31units instead of 35.
at 07:20am : 55 mg/dl i took 20grams of carbs (juice) and slept again.
at 11:00am : 61 mg/dl i took 20grams of carbs.
at 14:45pm : my BG is now 188 mg/dl and its a little bit high!

6

Hey! i appreciate your reply! thank again!

I am dropping my basal and i did it this night too, dropped my basal night shot from 33 to 31units of LEVEMIR ( the total of reduced units of the night shot are now 4, down from 35)

And i reduced my Daily shot of Levemir from 26 to 24 (the total of reduced units of the day shot are now 6, down from 30units)

But still im facing fasting hypos.

I take 2 shots of LEVEMIR per day. the 1st one at 1am and i sleep around 3am
and the second one at 1pm.
Its been 2 days im facing the same hypos at the same time
at 07:20am : 55 mg/dl i took 20grams of carbs (juice) and slept again.
at 11:00am : 61 mg/dl i took 20grams of carbs.
at 14:45pm : my BG is now 188 mg/dl and its a little bit high!

7

losing weight can also make you more insulin sensitive, and as others said changes of seasons and so many other factors. you can just try reducing basal and see what happens. when I first started on insulin they told me to have a protein snack before going to sleep with the nighttime basal. I have lost weight recently but I'm not sure why, my bg has been pretty good with some spikes and lower overall. did that 188 happen after a meal? maybe you just didn't bolus enough for it.

8

hey! no it didnt happen after a meal, didn't ate yet!

just after my 2 hypos at 7am & 11am

9

Shad - The only way to make sense, at least for me, of all the data is to create a chart that tracks everything that influences your BG. It will contain BG fingersticks, Levemir insulin doses, short-acting insulin doses, food carb amounts, any exercise, as well as the timing of each. I would recommend one page per day. You can make your own or look at the books that I referenced.

I don't use multiple daily injections, I'm on a pump. You need to know the action times of both of your insulins. These are published in the package inserts that come with each type. What you're looking for is onset, peak, and duration times. Even though Levemir is supposedly "flat," it does have a peak of some sort. These published times will vary from person to person but they're a good place to start.

I kept a similar schedule to yours for many years. What screwed me up the most was my late night snacking. It was hard to resist and meant dosing some insulin to cover the snacks. This meant my overnight BGs and control were complicated by the digestion going on. Looking back, I realize that this was a bad habit for me. It made my control difficult and didn't give my body optimal rest as it still had to process the food I ate while I slept.

Your two days in a row hypo's could be your nighttime Levemir dose if the Levemir peak occurs around the time of the hypos. You'll have to do the math. You could also set your alarm to wake you up for a BG test and carbs if necessary just before that low time.

I know that doing the charting is a burden and most people are reluctant to follow through, but I've always solved problems like this when I do it. There are several moving parts to this equation. The charting exercise has the added benefit of making you better at analysis and troubleshooting. You don't have to do this every day, just during times when you're trying to straghten out some control issue.

Good luck.

10

Maybe it was a glucagon reaction to the lows, sometimes I think that happens to me, but honestly I'm not sure what the cause is a lot of the time, because there are so many variables and I fluctuate a lot. I would just continue to reduce your basal and see what happens, and treat the spikes with corrections.