For the past few weeks that I have been checking my blood sugar I can never seem to keep it below 100.. I notice this during two occasions: when I have hypoglycemia and drink some milk, and a few hours after a meal. It's pretty frustrating. I would check my blood sugar because I feel that it is low (like 37 or so) so I drink about a cup of milk to raise it up, and it shoots all the way up to 198? What the heck. Ugh, it's so frustrating.... I don't know why this just started happening about a month ago and I have not had this problem for the last 5 months since my diabetes diagnosis.... could it be that my pancreatic beta cells are dying off, if there were any remaining functioning ones left? If so, how can I ask the doctor about which test determines the actual amount of remaining functioning beta cells left in my pancreas? I am aware that I am in need of an endocrinologist, but I can't afford one with my insurance... so I have to figure these things out myself... Back to another point, usually I check my blood sugar after eating a meal and my glucometer reads 54, then two or three hour later it will read 148... so should I just give up carbs? Meaning, no carbs included in my meals anymore? Money is pretty tight, so my family can't always afford the best, healthiest foods... processed foods such as packages of microwavable burritos seem to be what I survive on... I do try to fit in fruit but I can't always have meat balanced with vegetables and 1 carb serving such as half a potato... Does this mean I might be possibly going through the "honeymoon" phase, where the remaining beta cells are dying off, causing abnormally high blood sugar levels? 10-12 units of insulin can't seem to be enough to cover 45 carbs in a meal anymore like it used to... I think I should cut down my carb intake( about 30 or less) per meals? No more than that anymore, since my blood sugar can't be kept within normal range after eating anymore...
You will harm your body if you neglect his needs for carbohydrates. I recommend 90 to 100g of carbs per day - more for someone still growing. A healthy body will produce up to 20 units of insulin per hour if necessary. What insulins do you use right now? How do you use those insulins (the appplication pattern)?
Very likely your honeymoon phase is over. A GP can handle this situation but he must be really on top of things with T1 Diabetes. Actually I expect him to refer you to an endo because this is a lot of responsibility on his shoulders.
I don't think that there's a good test that provides a useful measurement of how much insulin you are producing re the honeymoon business. I suspect that w/ a problem with your pancreas it may not be a "flat" amount but may go up and down, sputtering as it were? I don't have any evidence or studies, just a wild guess.
If my post-meal #s run up, I would look to adjust my carb insulin ratio, maybe by 10%, so if you are at 10-1, maybe try to calcluate out 9-1 to increase the amt of insulin a shade and see what happens? If it's the before meal #s, then I figure I need some more basal and adjust that.
A good "manual" is "Think Like a Pancreas" by Gary Scheiner (who I think has a chat here soon? or did I miss it?) or "Using Insulin" by John Walsh. If $$$ is tight, maybe you can get it at the library but, at $15-20, they're probably still < a doctor visit would cost and will probably tell you more as they have pretty precise directions about figuring out doses and adjusting them.
Greatly reducing the number of carbs has helped a number of people with diabetes achieve more control of their bg levels. Dr. Bernstein's Diabetes Solution calls for about 30 carbs a day, 6g at breakfast and 12g each at lunch and dinner. These should be low glycemic carbs and high glycemic carbs should be avoided at all times.
By reducing the number of carbs you eat, you reduce the intensity of any bg spikes. It also allows you to use less insulin to cover so you have less risk of overcompensating. He refers to this as the rule of small numbers. Here's a link to an online excerpt from his book that explains it in more detail.
http://www.diabetes-book.com/book/chapter7.shtml
There's also a Dr. Bernstein's group here that is a good source of information on going low carb.
Wow, lots of good questions. I just read "Think Like A Pancreas" and he answers all of these questions and more. But it takes him about 260 pages to do so, so I will not attempt to summarize here. He also has a couple of web sights that may help: www.integrateddiabetes.com, www.type1university.com. Hope this helps, good luck!
I put in a long answer to this yesterday and then my new laptop blocked the site and I just got it unblocked, so I'll try again!
We all make different choices about the amount of carbs we eat, but what's most important is that you are correctly dosing your insulin to manage your blood sugar.
First of all, you are probably overtreating your lows. A cup of milk is around 15 carbs which is probably more than you need. I generally use 2 glucose tabs (8 carbs), 3 if I'm seriously low. Glucose tabs are the best because they act quickly and are precise doses, but if you can't afford them, then try more like 1/C of milk.
Then, if you are having lows a lot, between meals, in the morning or before bed, you probably need to reduce your basal insulin.
You said you were "54 after eating a meal then two or three hours later 148". Why are you checking right after eating? You need to check before you eat. Then if you are low you have a couple choices: You can treat the low (don't overtreat!) and wait to bolus and eat. Or you can go ahead and eat and then check your blood sugar after eating and bolus as soon as you are up in range. Then check for results 2 hours after eating. 148 may be higher than you want, and if that is a typical result then you want to adjust your I:C ratios to take a bit more insulin. But 148 at 2 hours means you have enough insulin on board that should bring it back down.
You say "10-12 units of insulin can't seem to be enough to cover 45 carbs in a meal anymore like it used to. You don't want to take a set dose for your meals, but bolus according to an I:C ratio. That means this many units of insulin for that many carbs. To determine your I:C ratio just try trial and error until you find the ratio that works to keep you in range at 2 hours. You say 10-12 units isn't enough for 45 carbs. That's a lot of insulin for a Type 1. Are you sure you're Type 1? If so, are you taking long acting insulin as well as short acting? You need both to manage your blood sugar. I strongly encourage you to get the book Using Insulin by John Walsh as someone suggested and it will help you figure these things out like basal/bolus and I:C ratios.
Finally, the test to see how much insulin you are making is called c-peptide. But I don't know if that is so important (unless there is a question about your diagnosis). What is important is to learn how to figure your insulin doses to manage your blood sugar.
You will harm your body if you neglect his needs for carbohydrates. I recommend 90 to 100g of carbs per day - more for someone still growing.
This is often repeted, but has been widely disputed here before. Some members have been eating ~30g / day for many years. My own experience with this subject is limited, but I cannot find a single, verifiable case of one suffering from "carbohydrate deprivation".
I've been < 50 g/day for going on 3 years. Still waiting for predicted problems.
I find it curious that so much of nutritional advice does not seem to be based on science. Read Taubes about how the anti fat crusade started. Just read an article in the NY Times that says salt restriction seems to be bad, especially in folks that have had a heart attack. These are just the folks who it is supposed to help.
You will find heavy smokers aged 80 or more. But this does not validate the claim that smoking is not bad for your health. A scientific analysis would compare the life expectancy of huger groups of smokers with huger groups of non-smokers. In my opinion there are good reasons why nutritional experts do recommend higher amounts of carbohydrates. If you look at the amounts recommended for healthy people this can be jaw dropping. Of course we should moderate our input of carbohydrates if the aftermath for our glucose control is not good. But some diabetics can even manage higher loads of carbs very well with exogenous insulin.
Of course you will find negative aspects of "carbohydrate deprivation". The loss in muscle mass is a good example of that. No active human can maintain his muscle mass with 30g of carbs per day. The loss of muscles will have negative effects on the basic metabolic rate with all the negative effects for our glucose control. There are other negative side effects for brain and nervous system in general.
Rules for high life expectancy: 2000 calories per day for a man and 1500 calories per day for a woman. Combined with 30 minutes of sports per day. It is obvious that 30g of carbs per day is not enough (30g carbs = 120 calories). Otherwise huge parts of the calories would come from other sources making the equation unbalanced and more unhealthy in my opinion.
Is there another concern here : rebounding after the low of 37, 54 to 198 ???
Not sure where you are getting your data. I'm usually under 30g day and almost always under 40g. Since starting low carb in March 2011, I've lost over 50 pounds of fat, while increasing muscle mass. Calories mostly come from fats & protein, working to lower the protein and raise the healthy fats.
My weight has remained constant for the last few months at around 225 while I've lost more than 2" from my waist line. The obvious explanation is that I'm losing fat and gaining muscle.
I'm shooting for 350 minutes of exercise a week, but travel often on business and often don't reach that goal. Not traveling this week, so had the luxury of a 6.7 mile walk this morning. Breakfast was an Western omelet - estimated around 5-6 carbs from the peppers and tomato. Lunch was liverwurst & butter on a rye Wasa - around 9g carbs. Probably too much salt in the liverwurst, but it's an occasional treat, not a daily indulgence.
One thing I've found when correcting a low, if you have little to no insulin on board it generally doesn't require the 15g of carbs to raise your sugar to a safe level that they stress so much. One 4g sugar tab is usually enough to correct me from a minor low and two tabs if I'm close to or below 50 will correct me to the 90-110 range if I don't have any active mealtime insulin. I've never done the cup of milk or 8 oz of juice or 4 sugar tabs to correct a low or I'd spike high like you seem to be.
Holger, I know you maintain excellent control with higher amounts of carbs. Here's a talk by Dr. Bernstein, I think he is doing a good job of maintain muscle mass after decades of low carbing. Pretty good biceps for a man in his late 70's.
Why wouldn't a C-peptide test fit the bill? As it is a byproduct / "coproduct" of natural insulin production
hate to say this but because we're diabetic- expect fluctuations in our blood sugars
Holger, I know you maintain excellent control with higher amounts of carbs.Holger: Can you briefly explain how to do this?
I think you have to rise your BG target, it's too low.
You talk about 37-54 as normality, and 54 after eating ?
When you find a 37 why do you drink milk ? 37 is red alarm, you need your BG quick up, take sugar. Do you know low numbers have bad effects too ? Heart first of all.
Insulin has 3-6 hours action time, depends on insulin type and personal sensitivity, it's not over when you check BG, usually it will come down later more or less.
"processed foods such as packages of microwavable burritos seem to be what I survive on": between having bad carbs and no carbs there is a wise "middle point" to get good carbs.
I mean, carbs without all that bad fats which bring up your BG later in time, and bad for your health.
C-peptide is a blood measure of your natural beta cell activity. C-peptide is produced qhen your body produces insulin, so it measures your fasting natural insulin production.
Neither a healhy person as BG always under 100 .....
I like milk for hypos, I think the protein is good to have "on board" along with the lactose and I think it works pretty quickly? We usually only have skim on hand so maybe 10G of carbs but that's what I'm usually shooting for anyway. I don't think 100 is a bad target. I want the approach to the target to be smooth but 100 seems reasonable. If you aim at that and run low, turn your pump down a little bit and I think you can hit it without crashing out and feel pretty good?
I'll do 4-6 oz milk if I'm a little low at night.