insulin and skipping meals?

[vulnerable26]

So basically I have been on insulin only for about 2 weeks now. I see a major improvement compared to before. However I find myself skipping breakfast sometimes then lunch and all I will eat is dinner.

I'll notice I go hypo towards the end of work so Ill drink an energy drink to get some carbs. Sometimes thats enough to pull me back up sometimes not. So what I have been doing is skipping my morning lantus ( i am 20 units moring and 20 at night). That seems to be helping somewhat.

Is it really that dangerous or horrible for me to skip meals? I always have been like this so its very difficult for me to schedule meals. I also have an eating disorder so I am sure this plays into affect with the whole thing.

Also, I am very embarrassed about having to take insulin at work so I refuse to eat there. I don't want to take the insulin in the bathroom because it is certainly not clean at work. And anywhere else I can take it is full of nosy people. (I work in an office with about 35 other people, and do not have a private desk).

I know this is probably very stupid for me to do and probably dangerous? I need to get over my fear of having to test my sugar and take insulin in public or work and also get over my fear of eating in public. I guess an eating disorder is hard enough to fight but when you take insulin into the picture it seems to make things so much more complicated.

Thanks for reading.

[xMenace]

I'll notice I go hypo towards the end of work so Ill drink an energy drink to get some carbs. Sometimes thats enough to pull me back up sometimes not. So what I have been doing is skipping my morning lantus ( i am 20 units moring and 20 at night). That seems to be helping somewhat.


Skipping basal insulins is not the way to go. Basals are supposed to cover your basals, not food. You do have a timing issue. If you maintain this eating pattern, perhaps combine the morning and evening dose to evening or just after this low period. The idea is to get it to tail off when you don't need it. It's a 24 hour insulin, so it won't matter the other times of day. Your stacking two flat bricks.

Is it really that dangerous or horrible for me to skip meals? I always have been like this so its very difficult for me to schedule meals. I also have an eating disorder so I am sure this plays into affect with the whole thing.


Yes and no. Your body can shut down without food and actually trigger weight gains. If you are functioning ok with this, stick with it. Beware of weird liver dumps though. e.g. If I skip breakfast, I need to double my lunch bolus.


Also, I am very embarrassed about having to take insulin at work so I refuse to eat there. I don't want to take the insulin in the bathroom because it is certainly not clean at work. And anywhere else I can take it is full of nosy people. (I work in an office with about 35 other people, and do not have a private desk).


Do you use a pen? You should be able to inject easily in a bathroom without touching anything. Actually anything at any workplace probably contains nasties.

We tend to be inundated with nasties and it's been surmised that we develop extra resistance to them. Most of us never use whipes, reuse needles, and hardly ever chance lancets. The risk is minimal. I've never read of anyone actually getting infected.



I know this is probably very stupid for me to do and probably dangerous? I need to get over my fear of having to test my sugar and take insulin in public or work and also get over my fear of eating in public. I guess an eating disorder is hard enough to fight but when you take insulin into the picture it seems to make things so much more complicated.

Thanks for reading.

My opinion is always do what works for you. Make the D fit your life, not the other way around.

[Eddy]

So basically I have been on insulin only for about 2 weeks now. I see a major improvement compared to before.


Glad you're feeling better!


However I find myself skipping breakfast sometimes then lunch and all I will eat is dinner.

I'll notice I go hypo towards the end of work so Ill drink an energy drink to get some carbs. Sometimes thats enough to pull me back up sometimes not. So what I have been doing is skipping my morning lantus ( i am 20 units moring and 20 at night). That seems to be helping somewhat.


Like John said... you don't want to mess around with Lantus. Your Lantus dose should be set to hold you roughly constant in the absence of food/bolus. It should not change regularly.

Are you certain you're supposed to be 20U twice a day, and not 20U split into two different doses? I realize that everyone's body is different, but 40U/day is a big Lantus dose.

For a given Lantus dose, what sort of blood sugar numbers are you seeing at bedtime and in the morning?


Is it really that dangerous or horrible for me to skip meals? I always have been like this so its very difficult for me to schedule meals. I also have an eating disorder so I am sure this plays into affect with the whole thing.


Going too high or too low too often, or not giving your body what it needs, is what is dangerous. You'll have to find what eating habit works for you.

Some days are busy enough that I don't want to mess with eating very much, and I'll eat nearly a day's worth of food for lunch. Others, I never have a real meal, and simply snack as needed.


Also, I am very embarrassed about having to take insulin at work so I refuse to eat there. I don't want to take the insulin in the bathroom because it is certainly not clean at work. And anywhere else I can take it is full of nosy people. (I work in an office with about 35 other people, and do not have a private desk).


John made some good points "from the trenches". I've not yet started reusing needles, but I now use a lancet until it's too dull to use any more -- usually a week or so. I usually disinfect before shots, but almost never before checking sugar. Cleanliness is advisable... but... we seem to get lax about it.

I'm unsure what to say about your workplace environment. Any time one is dealing with people, all bets are off...


I know this is probably very stupid for me to do and probably dangerous? I need to get over my fear of having to test my sugar and take insulin in public or work and also get over my fear of eating in public. I guess an eating disorder is hard enough to fight but when you take insulin into the picture it seems to make things so much more complicated.


Some people are unnerved by the sight of needles. Some don't care. Others are intrigued.

Once, when eating at a restaurant, I split my bolus into multiple parts. A member of the wait staff came around both times. He remarked, "You must really like that stuff. That's the second time I've seen you using it." I found that rather amusing. :)

Eating is a necessary part of life. When you take an insulin shot, that's part of your eating routine. It's mandatory, non-negotiable, and something you must do to remain healthy. If someone has a problem with that, they're probably either ignorant or insensitive.

[KCP]

Eating is a necessary part of life. When you take an insulin shot, that's part of your eating routine. It's mandatory, non-negotiable, and something you must do to remain healthy. If someone has a problem with that, they're probably either ignorant or insensitive.

HEAR HEAR!!!!!! :tee:

[Glucoweb]

I am not a breakfast eater. The only time I eat breakfast is when I am on vacation, and even then it is beacuse everyone else in the family wants to. Never have to use a basal insulin with MDI's. I always just had insulin to take as boluses at mealtimes, until I started pumping. Now I have a constant basal rate. I would say you probably need to find somewhere to inject at work. After you fill the syringe, the needle goes straight into your body, not like you are laying the needle down on the counter or wiping it with anything prior to injection, right? When I had to inject in a place I did not feel was very clean, I always made sure I wiped the top of the insulin bottle with an alcohol wipe to make sure any germs on top where the needle goes in was clean.
Where do you test at while at work? (Assuming you do test at least on occasion at work.) If the area is suitable for testing, it is probably clean enough to give yourself s shot.

[Emm]

Could your Lantus be a little too much? You shouldn't be dropping by the end of the day if you're not eating - actually, the lack of eating normally pushes a persons blood sugar UP.

If you're on the right doses of insulin you shouldn't have a problem missing meals. It's not recommended of course, and it takes some practice. I find I'm better off just getting a bite of something (and dosing for it) just to hold me through and stop the BGs going wild. But if you really don't want to eat, you should be able to work it out.

Injecting and testing in public can be done quite secretively if you want! I jab in my thigh when I'm sat at a table, and no one even knows I've done it.

[gobbly2100]

Sounds like you need a pump, that way you can go without food if you really want while getting the insulin you need to hold your blood sugar stable and not do any damage.

[UpNorth]

Since you have been on insulin for such a short time, it is a possibility your doses needs to be looked at. You definitely shouldn't skip basal injections since that's what keeps you going when you don't eat and then don't have rapid acting in your body.

It is fully possible to skip meals sometimes, when on the right basal doses. I'm not big on breakfast when i don't work, while i can have breakfast twice on days i work :T On days i don't work i sometimes don't eat until sometime in the afternoon, and it works for me quite ok.

As long as you don't put your pen or syringe somewhere, it is fully ok to use the restrooms to inject, it's actually cleaner than an office desk:eek:

Do you get any help with the eating disorder?

Learn to take control over your diabetes, and don't let it control you :)

[Lizzie G]

Hi

I dont like to skip meals as Im a little and often type eater, but on occasions I do, if my basal is right, that is fine (but see next paragraph for exception!). If your basal is too high however, then you will have problems and it will be a constant downward pull which will require snacking and result in weight gain (be very careful about this early on; if your basal is set too high this is what happens). As others have mentioned, 20u twice a day is an AWFUL lot for a type 1 (its not even worth comparing what T2's have to take, I saw a dietician last week who met people who needed 300u a day - WOW). For reference Im a 140 pound woman and my basal needs vary between 8 and 14 units per day.

One other thing, within a given day your basal requirements vary, depending on the relative concentration of adrenal hormones in the blood which counter the effects of insulin. Basically you will probably observe that you tend to run slightly higher in the dawn hours and morning and perhaps will have a tendency to go lower late afternoon, which will require the odd snack. You can also help yourself on this by timing your basal so it is 'wearing off' at the times when you find you are most likely to go low. Id say the bottom line is to do some basal testing (I dont have any of the links on me to tell you how and havent got time to type the whole thing but Im sure someone will tell you), take only what you need, and that will give you freedom to do what you want with food.

As for injecting at work, it's a bridge we all have to cross. I feel for you not having nice bathrooms but Im afraid its a case of just making do. I would agree with people that it is an ignorant attitude in other people to not tolerate your diabetes and you having to inject yourself however, you will always find that there are some people who couldnt give a hoot whether you feel inject, whilst others you can see are visibly uncomfortable. i inject in a 'non private' setting where i can a)do so discreetly (eg if im tucked away in corner of restaurant and no one at all can see and b)if its not going to upset my friends or family. i know theres this whole thing about how people should tolerate it and its hard to deal with it when people dont (you know those thoughts 'how dare you object its not like i enjoy this' etc etc) but since i have come to terms with things and dropped the anger im just polite and accomodating!

Liz

[Gary_W]

Skipping insulin is not a practice that is going to end well. Don't do it.

Your decision to do so seems to be based on the assumption that your colleagues are going to look on you in a negative light. This is really being quite presumptive regarding their feelings. Out of the 35 people there, you'll most likely find that 2 or 3 are really concerned and will ask questions but the rest will not give a stuff. The folks that ask questions are just trying to understand. If you get that conversation out of the way, you can get on with the process of your own health and wellbeing. Apart from the odd 'should you be eating that now you're diabetic?' comment that we all get from time to time, all will be well.

I work from home, but have a rather extended group of people that I have to inject with. At meetings with my company, I have a group of 15 or so people that I eat with. They all know that I have diabetes and, once the initial questions were answered, they don't mention it if I don't. I then meet customers. If I eat with them, I have to inject. I just say 'By the way, I have diabetes. You don't mind if I just inject, do you?'. No-one minds. Everyone knows you don't do it because you like it. I feel it necessary to point out to strangers that you're about to plunge a needle into yourself as it is a somewhat strange thing to see a person do if you don't know up-front why they are doing it. Once people know, problem solved.

I'm looking forward to pumping so I can avoid that conversation. It's not that I'm embarressed, its just that dining with strangers means I have to have the 'diabetic' conversation so often that it gets rather dull and boring. You only have to do it a few times to cover all 35 people, so it shouldn't be too bad. The sooner you get it out of the way the better.

Also, the advice on basal testing is sound. I weigh just under 200lbs and my basal varies between 12 and 14u per day. Too much Lantus syndrome is rife; I am sure that Sanofi shares would plummet if we all just put in the right amount of the stuff, but as few hospitals seem to teach the practice of basal testing, it is only the enlightened few that seek out the knowledge that can actually get the dose right. And it's amazing how much better you can keep if your basal makes sense... I was on 35u per day with the full backing of my healthcare team, so it's entirely possible you are having too much. Don't just skip shots, though. Test it and adjust it. When it's right you can eat what you want, when you want (or not). It's just a case of doing it in an informed manner rather than guessing / doing it for the wrong reasons.

Gary

[Dimes]

Regular meals help my control immensely. I've changed my life a bit to accomodate them, and overall it's been worth it, as I've seen my control go sideways when I just live on a whim like I used to.

As for public injections, I don't think it's anything to be embarassed about. I think it's better that people know you have the disease, because they might be more accomodating, or understanding, or worst come to worst might be able to help you better in an emergency.

[Eddy]

"You don't like the sight of me injecting? I'm sorry. Would you rather witness a hyperosmolar coma?" ;)

(I'm obviously feeling a bit belligerent...)

[HollyB]

Hi, for me the first question is: are you skipping meals because you really don't like to eat until dinner, or because you're uncomfortable eating and injecting in front of people?

If you would really prefer and feel better eating lunch, then I'd suggest a little behavioural therapy to help you gradually become more comfortable with handling meals out of your home, so you can eat the way you like and feel best with.

If you prefer not to eat in the day, then you can try some adjustments to help this work better. You could considering lowering your morning lantus dose a bit (rather than skipping it altogether) -- testing a couple of times through the day to see how your BG is holding. You could also plan to have a snack midafternoon, BEFORE you tend to go low, as a pre-emptive move.

The other thing is that once you're more used to taking insulin, injecting in public may seem less of a big deal. You'll find people become accustomed to it very fast.

[Razo681]

Well I've only been on insulin since January, but I can tell you NOT to skip the lantus. You need that, its your virtual pancreas. I would suggest sending your BG levels in every week along with what you ate (carb wise) and times since you ate. Granted my Dr. sucks and he still gets back to me in a day and tells me to change the dosage if you need to.

I can sympathize with the whole injection thing. I was like that for about 3 days :) then I just said "screw this" if they have a problem don't look. I also have great friends that said they could care less, one even passes out at the site of a needle. I also switched to pens for my fast acting (novolog) and let me tell you its the best thing. Fits in your pocket and just looks like you're a little geeky (especially if you put in a shirt pocket ) LOL. Just remember you gotta do what you gotta do to make yourself better, and screw the rest.

Good luck!!

[fgummett]

You need to read this with a really strong Scottish (Glaswegan) accent, but the discussion here just reminded me of a comic named Billy Connelly who was talking about how when you are in a crowded street you sometimes feel like scratching your butt... rather than be embarrassed and try to find a sneaky way to do it he recommended shouting at the top of your voice, "Oh My Gosh.. my ar$e is sooo itchy I think I will go ahead and scratch it!"... his theory was that everyone else would be so embarrassed that they would look away and you could scratch to your heart's content :) Maybe I'm being a bit crude but I agree with the statement above that out of 35 people, the majority won't even bat an eyelid :)