[lorilei]

I had to borrow this from another thread b/c it really hit home for me...thanks Gary!

[quote=Gary_W;405484]Yes.

"If you are T1 without insulin resistance issues then proteins and fats can cause more problems than carbs.

If the meal has loads of protein / fat in relation to a smaller number of carbs, the insulin can beat the food to it. What happens then is you go hypo 1 or 2 hours after eating. You correct the hypo, then you go high 4 or 5 hours after eating as the rest of the food starts coming in when there is no more insulin to soak it up.

For this reason (IMO), low carb eating can actually be a little harder to manage on insulin for an insulin sensitive T1." [quote]


oh my goodness, Gary...this is such a helpful paragraph for me...esp in relation to a mid morning challenge i've been having...however, if i add a little more carb to my morning ritual of bacon and cottage cheese and coffee (i use the sweetened cream as i love coffee this way only), I want to take a nap within the first hour or too and feel like i'm walking through sludge...I've just dropped my morning ratio down, but then double it for lunch as i also get another nappy surge in pm on less than 30g carbs (this part seems to be ironing out) but i have been trying to split some of the carbs over an hour pd b/c i can't handle them all at once....my new problem is a behavioral one....remembering to finish the rest of the carbs i'v bolused for....thus i'm a spikey gal!

[Subby]

As I appear to have primarily insulin resistance issues, I don't usually get the specific problem Gary was describing. My problem is 99.9999% insulin too slow... although tail end carbs still can be a factor. As I have the pump, I can also use slow released boluses which can really help solve the effect of held up carbs.

Does info help you? Not really... sorry... but I'm getting to maybe some more useful comments

I too get very "nappy" with certain types and certain amounts of carbs, which along with spiking continues to drive my ongoing interest in experimenting with lowish carb eating.

With your nappishness, it's important to recognise that there are (at least) three things that might be going on.

First, you might be getting nappy because your BG is dropping, due to the effect outlined by Gary.
Second, you might be getting nappy because your BG is spiking quickly with the carbs, despite the fat/protein (even an "acceptable" spike, if fast, can produce side effects).
Third, you might be getting nappy because you could have an allergy to the carb, that you are just getting "tuned into" especially now you take so much more notice of your food and body with your newish friend diabetes.

Fourth, it could be a combo of these effects. What would be useful would be to test test test at say 10 or 20 minute intervals a couple of times to see what trends are going on at those times you start feeling nappy. I know this is hard considering your terrible ration of strips... but such things help clear up all these perplexing possibilities...

The other thing to remember is that, while the info posted by Gary is very good info, it also stands to reason that if you minimise or remove the carbs for a certain meal/snack, you don't need the insulin in the first place... you do'nt have as iuch insulin in your system, and then these dynamics may well be much minimised. I'm not advocating a low-carb diet per se - just more to consider to consider for problem situations.

I also thing that low GI options for carbs are always worth heading towards and experimenting with. Out of interest what are you using for your morning tea? With lower GI, whenever they kick in, they should have less of a spike. Note that low GI for others may not be low GI for you, you need to test, but the lists you can find around can be a great start for experimenting.

[Subby]

Hmmm....

I also "thing" that I can't type today. Sorry.

4th line, instead of "Does info help you?" please read "Does this info help you?"

[lorilei]

Thanks as always Subby....I will be honest the idea that this spiking was an allergy was one i tried to present back when my numbers started running up again after delivery...labs said otherwise...as for low carbing, here's the low down on my path to get to here...starting with sept when after limiting to 100cho/day for approx 6 months, my Bg started sneaking up ...again...

Sept morn #'s 120-140...daytime low 120 daytime high~ 220
(110CHO/day...no more than 30/meal)...yes i was "nappy" esp at 1.5 ~2.5 hrs PP

Oct...dropped to ~35-45 gms CHO/day (started purusing DF lit)
Oct...morn #'s 90-110 usually high 160ish to just below 200..still some nappiness after all meals with any cho

Nov...morning #'s creeping up again 100-120...not too alarmed...some readings over 200 during day

Thanksgiving...all **** broke loose (true the scale is relative to me only)...first time #'s over 300 since initial dx GD 2 yrs ago (ate more carbs than usual...but not a bunch maybe 75)..hung mostly high for about 10 days

Dec 15th..am #'s over 150...daily consistently over 200-300

Dec 23rd..cashed in humalog script, i was just absolutely beat and tried to blame it on stress of holidays ( did not cash in levemir script...wanted to see if only basal would work...also wanted to more carefully watch specifc carbs and relax some with foods that had become ritualistic) (besides joel kept talking about the croutons he was eating, since he had added insulin...it was driving me nuts b/c i had eliminated so much)

Now since adding the humalog, i am very happy to say (and this is where i need to keep my focus positive b/c really it is)..my overall numbers "in range" have gone from less than 16% to 57% with lows (which i hadn't gotten since on insulin with GD) 13% and highs 28%...the am time is where most of my lows lie...and early morning may be a problem

so, i dropped the am ratio down and the evening ratio down...added a snack before bedtime...and increased my pm/lunchtime dose as this is where i still seem to get high and nappy....that is unless I add a little bit of CHO in the am...if I add it about 2 hrs after dose, (a small amt like 5-10 cho)..I feel okay if i REMEMBER to time it right ( Perhaps lori needs a watch that reminds her!!!)

For lunch, I am very recently trying to split the CHO over an hour as this seems to give me good energy during the afternoon (where i had previously lacked) without the afternoon nappiness...again, this relies heavily on being able to "get back to my lunch"...

soooo.....aren't you glad that you aren't new at all of this?? i think one of my problems is that i am not at all resistant...almost like i had a lag time, or sometimes, my pancreas kicks in itself...so i am also going to let myself run a little high to allow for this...i am not sure how much of this is a learning curve or adjustments my body is making for all of the new help it is getting..also, perhaps i just need to be patient and change one thing at a time and let it run its course, as this can feel a bit of a scramble for me...(esp as my cognition relies heavily on a stable BG)...

this is also a little tricky for me b/c, as i said above, i have limited so much, food wise, and it really constitutes a behavioral change in the completely opposite direction...so oftentimes, mistakes are simply my fault b/c i have to program myself and readjust a schedule (client wise) that shifts everyday...let alone that the physical needs each day can change drastically as different pts are available at diff times and require diff amts of energy...and i'm just not savvy enough to handle it all just yet..

i hope this all makes some kind of sense as it came out in a rush...

[Subby]

Lori,. it makes sense... it's very dense I'll come back to it again and maybe draw out a thing or two I might feel is worth doing... besides saying

- sounds like you're doing a great job, as I've said before imagine what torture a REAL perfectionist would be in, as for some of us at some times it's a case of muddling through with very tricky dynamics to deal with, which make the control we would like (for oh, small reasons like basic functioning in the head) virtually impossible... please be very happy for your constant efforts and achievements.

[lorilei]

"wanted to see if only basal would work... " error that, meant bolus...but am wondering if a basal test might be the way to go?? would love to sort this out before I see endo, at the end of the month..my own little control needs i suppose...

[Subby]

A really good idea. Much as I appreciate the wish to "hold off" therapies, your basal requirements may well need TLC to see some improvements in stability (and less frustration). Certainly pulling back the covers and having a good look is the way forward. Go forth and test!

Integrated Diabetes Services - Diabetes Management

(This is my favourite basic no nonsense basal testing "write up"... just ignore all pump references. Add if possible I prefer hourly tests)

Basal Testing for MDI - Diabetes Daily Forum

(Bluesky's words of wisdom, well worth a read. Remember, though, that however a segment of testing fits into your day... that's the best way. However long you wish to actually test for (beyond the 4 hour set up)... that's the best way. As long as the testing rules are adhered to)

Since you are just looking to reveal what kind of dynamics are happening in the background to inform a decision to do something about it, you can also (obviously) ignore all the dosage adjustment elements.