I am a recently diagnosed type 1 diabetic. I am still in the emotional/what did I do stage...I am in my 20s, and a single mom...so that just compounds everything... I have a decent support system in that my mom is a type 2 diabetic and so is my best friend...but I have issues they don't have...for starters, I already have liver damage and have chronic pain...
My issue comes in the liver specialist wants me on a high fiber diet, which I can't do because it throws my sugars into the 300s...carb counting is keeping me in the 200s... I spike before and after lunch and am lower in the mornings and evenings... I was diagnosed by the PA so I have kind of have been left to my own devices to figure everything out. At first they started metformin and levemir...the metformin made me not able to sleep, so the put me on a half dose...well per the PA it was working even though I was staying in the 200s...after several 280 days and the confirmation it was type 1, I called the dr who added 4 units of Novolog at lunch... well the Novolog seems to have no effect at all... My breakfast is usually 1 carb, but my sugars will be the mid 200s by lunch and pushing 300 after...It seems to have gotten worse since the Novolog.
Does anyone have any advise on what I can do? Is it common to spike in the middle of the day? What types of things do I need to tell my doctor. I have left messages asking if I need to be concerned, but have not heard back...
I'm sorry you're having so hard a time. It can take some time for you to get a handle on your blood sugars but it will get better. The standard treatment for T1 is a combination of basal insulin (Levemir)to keep you steady when you don't eat and bolus insulin (Novolog) to be taken before each meal to limit the spike as carbs digest.
I don't understand why your doctor only added 4 units of Novolog at lunch. It sounds as if you need more Levemir to allow you to wake up at a decent number and Novolog before each meal in proportion to the number of carbs you're eating. I would log blood sugar readings at least upon waking, before every meal and at bedtime and call them into your doctor and ask for suggestions on adjusting your insulin dose every three days.
You will eventually be able to manage this yourself but you deserve help getting stabilized. If you can't get help from your doctor, you may need to find a new one. And if you can't stay under 300, you might consider going to the ER and telling them that you've been running high for a long time and can't get your blood sugar down.
Well welcome to the club none of us wanted to join. My first advice when it comes to this situation is take a deep breath and relax. Everything will be ok but theres a lot of work to do. I hope you have a doctor who advocates patient self education and self management-- if not, I'd make finding a replacement who is a high priority.
It takes quite a fair amount of time and figuring in order to pin down the correct doses of basal and bolus. Clearly you aren't quite there yet. It's disappointing to hear that you are in the 200s-300s on a daily basis and have not heard back from your doctor after calling. Yes, those levels are concerning and do certainly justify an adjustment in your insulin regime.
As far as the high fiber diet goes-- fiber is great except for its evil kissing cousin that it rarely leaves home without, carbohydrates. If your doctors only guidance was tell you to take 4 units of novolog at lunch regardless of what you eat-- I'm afraid your doctor may not be the best equipped for diabetes management. I would start looking for references for a quality endocrinologist in your area (although I don't practice what I preach because I've never seen one myself, although the family docs in my area are very experienced in diabetes) I would also recommend asking for a referral to a CDE (certified diabetes educator) and start reading up on your own on insulin management.... I truly believe wholeheartedly that self study and self management are the key to success. This is a day in day out rigmarole that never ends and requires almost constant adjustment, only the individual themselves have the resources to put all the pieces together and make it work. This website is a great resource and access point to combined tens of thousands of years of management... it was a very key resource for me to get my own situation under control.
Get Think Like a Pancreas or Using Insulin. They sell both on Amazon.com, and may have them at your local library, if you are lucky.
You need to know that Novolog usually works the following way (approximate values): after 1 hr - 30% used
after 1 1/2 hr - 50% used
after 2 hrs - 70% used
after 3 hours - 90% used.
That means that after 1 1/2 hours, only above 2 of those 4 units have dropped your bg. Just keep that in mind and don't get impatient waiting for the bg to drop.
Docs typically say to drop you 50 points, take 1 unit of insulin. For every 10 to 15 g carbohydrates, take 1 unit of insulin.
That is typically a good place to start. You will have to fine tune it. It is exhausting, but it is best to keep records while you learn. Also, since you are a young female, you should read in those books, and on this website about insulin requirements different times of the month. I have 3 different sets of ratios I used. Some women have 2.
I am type 1 also. Do not skip breakfast. If I skip breakfast, my bg will raise about 150 to 200 points by 11am. A cheese stick will stop this from happening to me.
Carbs hit us hardest first thing in the morning, so try to keep them as low as you can. I usually eat a frittata (scrambled eggs with veggies) or a whey protein shake with coconut milk and berries. Berries are a fairly low carb fruit.
I do think that you will need to work on getting your insulin dosed properly. And that should help, but it is also important to see about getting your diet manageable within the constraints you have been given. While many high fiber foods contain large amounts of carbs, there are high fiber foods that are relatively low carb. These include avocado, greens such as spinach, collard and chard, broccoli and cauliflower, flax, celery, cabbage, and lentils. And my favorite source of high fiber is shirataki noodles.
Hi Misst26: A new diagnosis is really overwhelming! But you definitely have come to a good place (TuDiabetes) to get support and ask questions. Are you able to get an appointment with a good CDE/nutritionist who can help you with insulin dosing and carb counting? Also, I wrote a blog on my top ten tips for the newly diagnosed Type 1 that you may find useful. Best of luck to you!
I think the most important thing to do is find a doctor who is responsive. I know that endo’s are very busy these days but if they don’t respond to you in a day or two after a message, you need to find someone else. A diabetes diagnosis is stressful enough without an endo adding to it!
Also, as other’s have said, read How to Think like a Pancreas. It provides what is the best way forward for just about any insulin dependent diabetic. You might even start thinking about getting an insulin pump as just about everyone says they help keep them under control with fewer highs and lows as it most closely mimics the actions of a working pancreas that is available today.
Anyway, good luck, welcome to a great diabetic support community and keep us posted on how you are doing. The solution is most likely going to be more insulin.
So sorry about your diagnosis, hang in there, it is very overwhelming & a big adjustment but things will get better.
I think you need to go to an endo who can really help you with a whole team. I would try waiting 15- 20 minutes to eat after you bolus, this might help you not to spike so much after meals. Many insulins such as novolog don't star working till then. You may need to adjust your basal dose and split it in two, one dose at night and one dose in the early morning to stop dawn phenomenon. Try reading these books too: think like a pancreas, using insulin and dr. Bernsten's diabetes solution. Maybe you can add some methylcellulose fiber pills to add fiber to your diet? Try eating low carb, high fiber veggies like celery too. Your novolog dose should be according to how many carbs you're eating, not some random dose. i.e. : 1 unit insulin to 10-20g of carbs. Some people also need to bolus more for protein and fat if you're on a low carb diet. You can do corrections two hours or more after a meal if you're still too high then but be careful not to stack insulin. Some people do double wave bolus for higher carb/fat/protein meals. Keeping meal proportions smaller and limiting amount of carbs per meal helps stop spikes too.
Getting your basal dose worked out is very important because this will keep your bg stable most of the time through the day. I would also go for a 1-2 mile walk or exercise every day. If you time the exercise with meals, before or after, this can help lower stabilize your bg too.
I remember feeling overwhelmed by all the advice I was getting. I can only say this: trust your meter. Take Rick's advice and do a basal test. Then, try something. Try the standard diet. If your meter says it doesn't work for you, go to the next plan. Maybe it's low carb, or maybe it's a brisk walk after a meal, or maybe it's a handful of nuts before bed. Take some advice and test how it works for you with your meter. Because what works great for me (very low carb) may not work for you. And that's OK, because we're all different.
