New here, looking for some advice

Type 1 and LADA
1

Hi everyone.

Firstly, my name is Jake, I'm 31 and I live in Montana here in the U.S.

I've had Type 1 Diabetes for about 15 years.

I'm here firstly because I wanted to introduce myself. I've been reluctant to post here, but if it helps I'm on board to improve my life with diabetes.

Secondly,

About a week ago I went out with some friends after work. I had one piece of pizza and some beer. I went home after, took some Novolog to counteract the pizza, and I took my Lantus as I was falling asleep.

Next thing I remembered I was in a hospital room and my tongue really hurt, I guess I bit it pretty hard and my roommate said she was trying to get some food or sugar in me but I was getting combative. When I came home the next day my room was all torn up and my TV fell on the floor, I must have knocked it down.

Since this June, I've probably had paramedics come visit me almost once a month.

I've had trouble dealing with lows really since I've been diagnosed.

Part of my problem, I think, is that I'm not totally sure how many carbs I'm eating and how much insulin to take as a result of what I eat. A lot of times I end up taking too much insulin. Right now I'm using Novolog before meals and Lantus before I go to sleep.

So I realize this is all a bit abridged, but what might be some good things to try to avoid going back to the hospital?

Not only was it traumatic, it's also expensive. I don't make a whole lot of money, and the insurance I do have has a crazy-high deductible.

Any help would be much appreciated.

Merry Christmas! :-)

2

I've had crazy lows with pizza plus fast acting insulin too.

Pizza typically has a lot of grease and oil and protein and as a result the carbs get absorbed very much on the slow side. When the fast acting insulin kicks in before the pizza starts hitting the bloodstream, a doozy of a hypo results.

What's really loopy about these hypos, is that I just ate and I'm full and yet... I'm having a hypo and my bg is dropping even lower.

If you've been T1 15 years, you might remember the good old "Regular" "R" insulin. For things like pizza, Regular insulin can be a very good match.

3

I was on Regular a while back when I was first diagnosed. I didn't think about having some to use depending on what I was eating. And yeah, Novolog must just react too quickly whenever I eat pizza, especially if I have beer, too.

I don't drink all that much unless I'm out, or on special occasions I will have a few drinks. I figure I don't want my diabetes preventing me from living as normal of life as possible, with some exceptions.
I don't eat candy or a whole lot of carbohydrates, but I do drink now and then.

So, I guess just not drinking anything ever would probably be useful for my diabetes, but I guess I'm not ready to give it up entirely.

4

I am pretty dismissive of the reported effects of alcohol on making BG plummet I would blame the slow hand of the pizza. Maybe too that some pizza isn't all that many carbs.

It's also a good idea to practice counting carbs. I totally "seat of the pants-ed" it from 1984 until 2008, when I got my pump. Part of that also involved getting a scale and starting to see how much food I was eating. It's been a lot of work but it's made things a lot easier and helped me do a lot of things that have been a lot of fun.

5

You have a mix of many things.

Pizza is a diabetes carbohydrate blowout. One slice (1/8 of a medium) cheese only pizza is 26 carbs. That is a pretty normal carryout/restaurant carb count. For one piece. Also the fat makes a big difference. One normal beer is 15 carbs. For many here, that is an entire day of carbs--for the very low carb folks. The fat is another major issue--it changes the absorption of the food and impacts how the insulin works in your body--impacts the absorption of the carb, so you crash and then go to high readings.

Couple of quick thoughts...
-When I took Lantus, I split the dose into 2--1/2 in the AM and 1/2 in the PM. I found it a lot easier. The doses meld together more evenly.
-Check info about insulin pumps and continuous glucose monitors. You do not say if you live alone or with a significant other. No matter. Once everyone is trained the CGM can solve a lot of paramedic problems. With all these devastating lows (document them!) you can have a really strong case with your insurance folks.
-Like AR said, carb counting is critical and difficult. Maybe see a CDE and get some rally up to date advice and knowledge. However, counting carbs is still a crapshoot sometimes...
-How often do you test your blood glucose readings? Important to avoiding the paramedics.
-Stay here and learn. I find a lot of great advice and knowledge here. I learn so much from these folks.

Let us know how things go. Take care.

6

I can recommend two great books to help you get the hang of carb counting, setting your carb to insulin ratio (how many grams of carb will one unit of insulin handle) and correction rate (how much will one unit reduce my bg) They are: Think Like a Pancreas by Gary Scheiner and Using Insulin by John Walsh. Both are available at Walsh's website www.diabetesnet.com. He also has some oline tools for figuring out your person ratios/rates.

7

What about getting a CGM? My Dexcom has been invaluable. If I go low during the night, it wakes me up. It helps me better understand my BG behavior.
Are you testing your blood sugar enough?

8

Welcome Jake taking the first step to improve your control and avoid the ER and paramedic visits is a great start. It sounds as though you have something called hypoglycemia unawareness if you can't feel the low, you don't treat the low and eventually end up in the hospital. It also sounds as though you know the basic problems with self care, you don't count carbs and don't know your Insulin/Carb ratios or correction factors. I'm not sure what if any system you are using to figure out your novolog dose but the books that have been suggested are incredibly helpful. Another thing you might want to do is get a glucagon emergency kit which requires a prescription, and teach your roommate how to use it. I have avoided paramedic visits and trips to the emergency room several times when my husband used the kit on me. Keep asking questions, most everyone here has had the same experience at some point in their lives and we're all more than happy to share what we know. Good luck, Clare (T1D 38 years and counting).

9

Jake - Welcome to TuD. Sorry about your ER visit. That whole severe hypo scene is a bit hard to take, especially when you look back on it. Been there, done that. In fact, most of us have. I sounds like you're ready to take some steps to prevent that from happening again. Good for you!

Most of what I'm going to tell you has already been noted by others here, but what they've recommended is important enough to repeat.

Learn more about insulin dosing by buying, reading, and studying one or both of the books recommended, one by Walsh and the other by Scheiner. You need to learn your insulin to carbohydrate ratio and also recognize when and how to adjust it when necessary. You also need know how much one unit of rapid acting insulin (Novalog) will drop your blood glucose. That's also known as insulin sensitivity factor or ISF. Learning how long a typical dose of Novalog lasts in your body is good to know.

Like AR, I "flew by the seat of my pants" for many years when it came to counting carbs and dosing insulin. It doesn't work very well; it's the diabetic version of Russian roulette. Buy a food scale and use it. It's a bit inconvenient but way better than waking up in an ambulance on your way to the ER with all kinds of embarrassment in your wake.

Know your BGs. Check, check, check. Check when you wake up, before every meal, and at least two hours after every meal. Check before you go to bed and every time before you drive. Check before, during and after you exercise. All these fingersticks yield valuable information but only if keep track of them in some sort of system and analyze them from time to time. You don't need to do this meticulously, forever, just until you figure out your patterns and your insulin dosing is in a groove. When your patterns change, and they will, you need to make good adjustments by checking your blood sugar.

You just need to up your D-game a notch or two. It's a little more complicated but pays big dividends. Diabetes is not going to go away, so you may as well get good at it. You're a young man and you deserve a good, less stressful life! Good luck.

10

My cgm changed my life. I used to have severe lows all the time before I got one. I also had hypo unawareness. After I got my cgm I realized how my control was really not so good. I made a lot of adjustments. And learned even better how different foods effect me.
I got pizza down to a 2 hr square bollus. Of course that’s a pump situation.
Still after a few months of good control, I began to feel my sugars again after 20 years of diabetes. Now I know when I’m over 200 and under say 70. Where I would not notice a 35 in the past. The combination of cgm and having awareness back has kept me totally free of paramedics and the ER. I won’t say it will never happen. But I’m sure it’s not so likely anymore.
I can’t believe I lived like that for so many years. I started back on NPH AND REGULAR.
It was the perfect situation for crashing. Even with the new insulins, I just couldn’t tighten it up til I started with CGM.

11

I agree with you whole heartedly Timothy, the Dexcom has changed my life dramatically. The only thing that made me not suggest it in Jake's case is he mentioned his insurance has an insanely high deductible and he doesn't make a whole lot of money. While a CGM could be extremely helpful in this case, I'm not sure about the funding part. Maybe just testing a whole lot more would be a good place to start.

12

Wow,

Thank you all for the helpful, caring tips. I really appreciate it very much.

I will be looking over all of them here today and digging into them.

I want to improve my BG numbers. I just got my A1C checked and the doc said it was decent. I'll know Monday what the exact number was, but I've never had TOO high number, between 6 and 7.5 or so.
I need to get the hypos under control, though. It's getting out of hand, affecting my life in some real, detrimental ways, and it's something that I know is within reach.

Thank you all again! :-)

13

I saw the CGM suggestions and agree that those are really useful but carb counting is pretty necessary to figure out what's going on and correctly balance your insulin and food. That's easier said than done but I suspect that if you're close, you'll feel pretty good about it and can decide how many resources you want to put into improving things. A scale is like $20 but CGM sensors are like $20/ week.