Weird after meal...

[Stuboy]

Last night we had a roast dinner for tea... Vegetables, potato's, parsnips, and a steak (not sure what meat). After i had a fruit salad type thing for desert.

Before the meal my levels were 10.2 (194.4), about an hour or so after i took my readings again and they went DOWN to 5.0 (90).

This is really wierd i thought they were supposed to go UP! They only thing is, it continued to drop and i started to feel a bit shakey so i took my levels again (this is about another 1.5 hours past) and i'd dropped to 3.3 (59.4).

So i guess last night i had my first hypo. Had three glucose tablets and a sandwhich (brown bread).

Why would it have gone down after a meal? Would the fat in the steak slowed down the carbs in the potato's and veg?

Thnks, still new to all this and it's sorta confused me as it's gone against all my other readings untill now!

[corwin]

Yes, a high fat content of a meal will slow the carbs. When you gain experience you learn how things effect you personally, in general fat and protein delay the raise in bg but you'll have to find out for yourself how much it does for you.
You handled it very well and didn't panic which is impressive, when I had my first hypo I paniced and ate way too much carbs and went sky high.
This is very common when you just get diagnosed, there are many things to learn both generally about this condition and specificly about your own system. You'll keep getting weird things that goes against what you learned and then you'll figure out new information. The good news is that it gets much easier very quickly.

[Stuboy]

So it was probably the fat and protein in the steak then!! Would you suggest that i avoid steak? or eat less of it? or eat something sugary to get my levels up a bit before the carbs kick in?

It happened a couple of days ago when i made a salmon salad... to i guess the protein in the fish was the culprit for that. Doesnt exlpain why it DIDN't happen when i had a grilled salmon ceasar salad tho! would the why salmon is cooked make a different perhaps?

[dbc]

Sounds like your insulin dose needs fine tuning - not surprising if you were only diagnosed a week ago. Most people here experience a couple of weeks "experimenting" to get the ratio of carbs/food eaten to insulin dose right, I'm sure they'll come forward with loads of tips. Have you spoken to a dietician/diabetic educator yet about changes you should consider to your diet? and the effect of various foods on your blood sugar?

[corwin]

Would you suggest that i avoid steak? or eat less of it? or eat something sugary to get my levels up a bit before the carbs kick in?


Definetly not. In fact these slow absorbing food types make it much easier to control with insulin. Sugar raise your bg in 15 minutes, steak in 6 hours. This cause a much smaller spike and it's much healthier for you. What you do need to figure out, and it will take some time, is how much and when you need to take insulin for your meals. If you got low from what you did now, try less insulin, or injecting later.

[KickStart101]

Yes, fat consumed during a meal is an issue but it also
sounds like you took more Insulin than you needed, since
your bg was already high before you started the meal.

[Stuboy]

i was told to take my insulin 20 minutes before i eat. i took 14units. so if i know that what im about to eat is higher in protein and fat then i should lower the dosage?

[seacomp]

It's more likely that the meal you ate was lower in carbs than what you normally eat. Eventually, you have to learn to "count carbs" and adjust your insulin dose in line with what you eat.
The fat you eat may or may not be an issue, but until you've adjust your doses for the carb count, you really can't tell.
(And actually before that, you should be sure that your basal dose(s) is correct.)

[Stuboy]

i dont even know what a basal dose is...

[corwin]

I'm not sure you mentioned it, what insulin are you taking?

[JediSkipdogg]

It appears that the main reason you dropped so much was because you gave too much insulin. The insulin worked so well that the food didn't really have a peak to it at all and then you just kept on going down. The fat in the steak may have had something to do with it, but it appears at first that you gave too much since you kept on going down hours after the meal.

Do you have a carb ratio yet? Or how do you decide what insulin to give with food?
Do you have a correction factor when running high? If not, how do you know how much insulin to give to bring you down?

[KickStart101]

i dont even know what a basal dose is...

The basal dose is the amount of your long acting Insulin(Lantus,
Levemir, etc.)that you take every day.

The bolus dose is the amount of your fast acting Insulin(Humalog,
Novolog, etc.), that you take in the morning, before meals or if your
sugar level is high and you want to get it down to normal levels sooner.

[corwin]

Do you have a carb ratio yet? Or how do you decide what insulin to give with food?
Do you have a correction factor when running high? If not, how do you know how much insulin to give to bring you down?

Jedi, buddy, the guy knows he's diabetic for exactly 1 week, you expect him to know all that? I didn't have a ratio, only a constant amount, and I gave no correction shots at all for at least few weeks post dx. There's a lot to learn at first, it takes time.

[JediSkipdogg]

Jedi, buddy, the guy knows he's diabetic for exactly 1 week, you expect him to know all that? I didn't have a ratio, only a constant amount, and I gave no correction shots at all for at least few weeks post dx. There's a lot to learn at first, it takes time.

Actually, alot of places are starting people on carb ratios before they leave the hospital. It's easier to learn carb counting and a basic correction factor than it is to use a sliding scale or just a give 15 units at dinner and eat this and only this or eat whatever you want. So for liability reasons, many places won't let one leave the hospital without basic carb counting for a type 1.

[corwin]

Actually, alot of places are starting people on carb ratios before they leave the hospital. It's easier to learn carb counting and a basic correction factor than it is to use a sliding scale or just a give 15 units at dinner and eat this and only this or eat whatever you want. So for liability reasons, many places won't let one leave the hospital without basic carb counting for a type 1.

I didn't know that. Sounds way too much info in such a short time, but I'll take your word for it. For me they just told me at first to eat very few carbs, around 30g and inject 2u for every meal, then slowly tought me how to count the carbs, eat more and bolus\correct whenever needed.

[JediSkipdogg]

I didn't know that. Sounds way too much info in such a short time, but I'll take your word for it. For me they just told me at first to eat very few carbs, around 30g and inject 2u for every meal, then slowly tought me how to count the carbs, eat more and bolus\correct whenever needed.

For most people it is. And depending on what hospital you are at is how they treat and release you. Here in Cincinnati we have the nation's #8 pedriatic hospital, Cincinnati Children's Hospital and for kids they actually have a 3 day clinic that one attends under diagnosis where they teach carb counting, correction factors, different methods to give insulin, basically everything you need to know before they release you. I use to assist when I was still a patient there (was a patient till I was 22) and it was fun working with the young kids through those classes.

It's just pretty hard to give someone a vial of insulin and let them go. That just increases the chances of alot more ER runs and phone calls to the doctor on what to do. It also puts a huge liability in the hospital legally for not properly training someone on how to use insulin (although some doctors themselves don't know how to properly use it themselves.) Not all hospitals do this though. Personally, it's something that should be done everywhere, including other countries.

[DeusXM]

You're also all assuming he's on a basal/bolus regime. Without wanting to be presumtuous, £100 says Stu's on Mixtard.

Stu - don't worry about anything too much just yet. You were only diagnosed a week ago and there's no way you're going to be able to pull off all the little tricks some of us are able to do. It's going to take at least 3 months before you can even begin to get a handle on it and to be honest it's a learning curve that none of us will ever master. The basics which you need now are:

- Your sugars need to stay between 5 and 10mmol/l (although at this stage you're 'allowed' a few that are a little higher!)
- All foods affect your blood sugar in some way, however the ones you need to watch are your carbohydrates. Carbs have the most influence on your BG. More carbs = higher BG. Doesn't have to be sugar.
- Bigger meals generally make your blood sugar go higher. So you may want to think about giving yourself an extra unit to your normal dose if you're having a big meal, and one less if it's a smaller meal than normal.
- Stay away from pizza and booze. These are two things that you have to train for. You will be able to drink and eat pizza, but not yet.

[Cinnabon]

I think think he is very new to this and is also "honeymooning" ...


Stuboy, your body needs to get used to all this and it does take some time. You might be anxious to settle things out a bit, but your body needs a little time to be able to process and react to all this.

[CiContention]

Jedi is correct. I was diagnosed just over a month ago. Before the hospital released me I had to prove that I could give myself an injection properly and count carb intake for my food.

[Stuboy]

£100 on Mixtard... yeh, im on Mixtard 30.

Basically when i left hospital i was told that i need to inject 20 minutes before breakfast (12units) and 20 minutes before dinner (10 units).

I was told that i could pretty much continue with my normal diet as i dont eat a lot of **** anyway. but just to watch the sugary foods and drinks. ie change coke to diet coke etc and cut out cakes etc.

She gave me a rule of thumb... if my levels before dinner were above 15 three days on the trot, to up the morning dosage by 4, and if they were between 10 and 15 to up it by 2. and the same thing for the evening dosage to the morning levels.

Which is what i've been doing, and now im giving myself 18 in the morning and 14 before dinner.

I haven't been given any training at all about carb counting, corrections or anything like that yet. Im waiting for the dietician to contact me with an appt before I go away to Canada for three week in two weeks time.

[corwin]

I can't beleive people are still getting this insulin. I don't buy the "less injections" logic to start on 2 injections of something that is so far from the optimal treatment method for this condition. I just can't see any reason to get used to something that's bad for you and then move to what you really need. If it was me I would strongly pressure my doc for a basal/bolus insulin. The sooner you change, the easier it will be to get used to this new life style that was imposed on you.

[DeusXM]

You have to remember though that going onto injections is a **** of a shock. Going from no injections at all to injecting every time you eat is simply far too big a step for most people. Especially given that MDI requires a **** of a lot more work - work that you're really not giong to be in a fit state of mind to do. It carries far too many risks. At least with Mixtard you've only got two opportunities to make a mistake whereas with MDI you can put yourself in a coma pretty much whenever you want.

I wholeheartedly agree that Mixtard is not a viable option as a long-term treatment plan, however I think it's important to maintain it as a 'training' insulin. You wouldn't learn to ride a bike without stablisers or learn to drive without first driving in a dual-control car - so you shouldn't have to be chucked in at the deep end with insulin either.

[corwin]

I don't know. I was put on lantus and novo from day one. I was really scared of needles and it took me about 10 minutes at first to actually manage to jab myself. However since I did it so many times every day I got used to it very quickly. I agree about the risks, what my health team did was just aiming for a much higher bg level then optimal untill I got used to it and knew what I'm doing. I was also on the phone with them on a daily basis to make sure I'm not doing anything that can put me at risk. From what I've seen so far it's only in the UK where they start you with Mixtard and I think it's a mistake. Maybe it's just me.

[DeusXM]

I dunno. I understand exactly where you're coming from, and if I knew back then what I know now, I'd have wanted to have been put on MDI from day one. But at 14 and suddenly having to cope with a condition that up until that point my sum total knowledge was 'you can't eat sweets if you're diabetic', I think I'd have freaked out far too much, gone into denial and not followed my treatment plan. As it stands, within 6 months I was on MDI, so it all worked out pretty well in the end.

The fact that you were able to start on MDI and make a success of it right from the get-go is an amazing acheivement and one you should be rightly proud of. I'd suggest though that you're the exception rather than the rule.

[JediSkipdogg]

The problem I see with starting people out on Mixtard is they are going to want to stay on Mixtard. If you know that it exists, then you will want that treatment method from day one. I'm sure there's patients out them using the new inhaled insulin that shouldn't be put on it because they hate needles even though it's not giving them adequate control.

Yes, going from no shots to shots is a shock. But persuading a person to go from 2 shots a day to possibly 4 shots a day is just as much as a shock. Some won't want to do it at all. I think persuading someone to go on shots is easier than persuading them to double the number of shots they take.

[corwin]

But at 14 and suddenly having to cope with a condition that up until that point my sum total knowledge was 'you can't eat sweets if you're diabetic', I think I'd have freaked out far too much, gone into denial and not followed my treatment plan.


Good point, I was diagnosed at 29 and I make it a rule not to give advice and opinion to anyone younger then 18. I can't even imagine what it's like to be a teenager with diabetes and even worse to be too young to be able to handle this condition yourself. I was talking to my girl about the possibility of passing diabetes to our future kids and it really scared me. Compared to that my own diabetes seems like a walk in the park.
I guess we'll let the doctors make these decisions, they are doing that anyway without consulting us. :)

[Stuboy]

Well im aware that i wont be on mixtard forever... the nurse told me that on day one... she didn't say what i would be doing in the future but she did say she was going to START me on mixtard.

I dont have a fear of needles... and although the thought of having to inject everytime i eat sounds like a pain in the arse... if it gives me better control ill do what i have to do. Going on the pump sounds like a better idea tho! lol

I want to ask about this "jet system" that i've heard about too, sounds much easier than injecting (not that injecting it hard, it's just all the changing of needles etc)

I think it's actually considerate that the nurses dont want to overload you with info when you're just diagnosed... there's SO much to take in and get your head around, even just coming to terms with the fact is enough.

took me 10 minutes to jab myself for the first time too... but after that i could do it straight away no problem.

I guess i'll just ride the roller coaster and see what happens! :)

[corwin]

It's not that bad to inject whenever you eat. You get used to it very quickly. For me it's such an instinct now "Great here's my food, now where's my novo pen". I'm not even thinking about it and I'm doing this for less then 5 months.
The "jet system" is in the same category as the inhaler, the CGMS, Diapep277 and many others. It either doesn't work or too new to be trusted. For now you have 2 options to achieve good control MDI and pump. Between the 2 it's a matter or personal choice and life style.

[jenet]

It's not that bad to inject whenever you eat. You get used to it very quickly. For me it's such an instinct now "Great here's my food, now where's my novo pen". I'm not even thinking about it and I'm doing this for less then 5 months.
The "jet system" is in the same category as the inhaler, the CGMS, Diapep277 and many others. It either doesn't work or too new to be trusted. For now you have 2 options to achieve good control MDI and pump. Between the 2 it's a matter or personal choice and life style.
I used a Medijector for 10+ years before getting my pump. It worked fine, but it probably hurt more than most small insulin needles do. And it's definitely more expensive for the device and for the insulin vial adaptors you have to use to load it. I just couldn't get past the needle thing. :(

cheers,
j

[jenet]

I used a Medijector for 10+ years before getting my pump. It worked fine, but it probably hurt more than most small insulin needles do. And it's definitely more expensive for the device and for the insulin vial adaptors you have to use to load it. I just couldn't get past the needle thing. :(

cheers,
j
Oh, I never actually said... the Medijector is a jet system.
j