Remember: I'm not a doctor, speaking from my 20 years of T1, and my mom also being T1 for 20 years. I am 23 at the moment, so I had a full 3 years of rockin out with my functioning pancreas. Don't assume the ratios here will work for you, it's best to check with a healthcare professional first. Proceed at your own risk.
This is how *I* handle diabetes, and understand the things to work. Yes not all of it may be true for some people. It's just here as my personal guide to getting by. You need not follow it.
Here’s my Life Plan for Living With the Diabolical Diabetes (yes me and my fiancé Bryan came up with ‘diabolical diabetes’, makes it sound like an old 60’s comic villain hahahaha).
I typed this up for a post recently and thought I would re-post it separately for anyone else who wants to read it (since I spent quite a while on it).
Carbohydrates are one of the food groups. Carbohydrates = sugars. From Wikipaedia:
"Foods high in carbohydrate include fruits, sweets, soft drinks, breads, pastas, beans, potatoes, bran, rice, and cereals. Carbohydrates are a common source of energy in living organisms, however, no carbohydrate is an essential nutrient in humans."
(I note here though, a healthy diet includes some carbohydrates, or carbs as I refer to them.)
Insulin is a hormone produced by beta cells in the Pancreas and secreted into the bloodstream. Insulin acts like a key, opening the doors on the membrane (skin) of each cell to allow food (blood sugar) to enter. Without it, the cells begin to starve, and the blood becomes full of sugar to the point of toxicity. The excess sugar gums up the blood system, which can lead to all kinds of complications. Many things can counteract insulin effectiveness, such as medicines, or other hormones. Even getting sick with a cold or the flu can cause elevated blood glucose, because the blood becomes full of all the virus gunk, and antibody reactions.
Type 1 diabetes is where the body has an auto-immune reaction. The white blood cells confuse the insulin-producing cells with something that shouldn't be there, and zaps them. Without the insulin, the BG (blood glucose rises). The body cells begin to starve. To feed itself, the body begins to burn fat (and then muscle once its out of fat) in a process called Ketoacidosis. The byproducts made by the burning of fat or muscle is toxic waste in the bloodstream, and can lead to coma and subsequent death. The byproducts are referred to as 'ketones'. Having a high BG doesn't necessarily mean that ketones are present; this happens mainly when the body runs out of insulin completely, since as long as there's still a little insulin, there is some cell-feeding going on. Symptoms for ketones include (but are not limited to): fruity breath, getting extremely, skeletally thin; losing hair; nausea; abdominal pains...etc.
As if that's not enough, the liver plays a big part in blood sugar. The liver takes in unprocessed carbohydrates digested by the body and turns it into sugary goodness: Glucagon, the arch nemesis of insulin (well not really but to a diabetic it can be). Glucagon is released into the blood stream when the blood glucose level becomes too low, and there is threat of there being not enough sugar to keep the body running. A little Glucagon is constantly released into the bloodstream, so without insulin, a person's BG will keep climbing slowly.
A type 1 diabetic requires two types of insulin to keep going: Basal and bolus, also referred to as long-acting and short-acting. Long acting is an insulin used to counter the slow drip of Glucagon, so the BG will stay exactly the same if the person doesn't eat. In other words, if a person goes without food for 24 hours, and there basal is correct, they could start out with a reading of 100 at 8 AM and end the day at 12 PM with a reading of 100. Basal insulin is regular insulin that is coated, so the body breaks down the coating before using the insulin, thus making this type of insulin work for longer. A good way to test if the basal rate is correct is to have a sugar-free jello day. Hooray!
Bolus (or short-acting) insulin is a fast insulin (regular insulin, no coating) used to cover foods that have just been consumed. Usually the ‘peaking’ time of fast acting is about 3-4 hours after taking it, depending on what insulin is used. Carbohydrates form the basis of insulin calculation. Proteins, to some small extent, can have a miniscule effect on the BG when consumed, but it is safer to not count them until you are testing BG regularly and have a grip on some other important numbers. Diabetes is a numbers game! It has been theorized that it is better to take several smaller injections than one huge one for big doses, as the tissue absorbs several small ones better, having more absorption area. A big dose can sit as a lump for hours and wait to bite you in the a** later when it DOES get absorbed.
THE NUMBERS GAME:
A1C is a blood test run by the lab every 3 months, to tell the patient their AVERAGE BG reading. The average ‘good’ A1C is somewhere around 5-6. By good, it means the person is much less likely to develop complications later, and is probably feeling pretty fine and dandy. 7 (in my opinion) is not too bad, room for improvement to lower it, but getting there, while say a 4 would mean the person is probably running low a lot. A single high or low isn’t going to affect this average much. Being consistently high or low will tip the scale quite a bit. In diabetes, the average is far more important than any given moment.
Daily readings are taken on a meter, usually multiple times a day (around 10-15 is most T1’s average number of tests per day).
The A1C ideal number works again for the daily number desired. However, there are 2 systems: the American system, and the Canadian system (either may apply to other countries as well, but this is what I know). American system runs on mmol/gram (mili-mol of blood sugar per gram of blood), while Canadian system runs on mmol/L (mili-mol of blood sugar per liter of blood). Confusing huh?
So here’s how to figure it out:
A1C mostly works on metric, as I figure it, since (for example) an A1C of 5.0 would be smooth sailing. So if you were to randomly test and the result is 5.0 mmol/L, that is a great reading! Even up to 10.0 mmol/L isn’t the end of the world, since having that a few times won’t mess things up too much. Going lower than 3.0 mmol/L however is verging into potentially dangerous low territory. Usually around 4.0 mmol/L becomes uncomfortable for a lot of people.
Most of you are using the American scale. To convert between metric and imperial BG measurements:
Canadian ----multiply by 18---> American
American --divide by 18-----> Canadian
Many meters offer an averaging feature, which does not always give an accurate measure as the A1C does (and does not cover the same period of time; usually meter gives a 2-week average), but gives you a good idea of where you are sitting.
Say you got 110, 180, 200, 220, and 150 as readings. To find the average of those manually: add, divide sum by 5, then divide that by 18.
110 + 180 + 200 + 220 + 150 = 860
860/5 = 172
172/18= approximately 9.5 mmol/L (would be around that on A1C test if those were 3-month results).
Considering this, a good average reading in imperial units would be: 90! Going lower than that, not a great idea. Going higher….little higher is OK, like 100 or 110, but on average good to keep it around that.
A GOOD TESTING PLAN:
Test in the morning, upon waking (this is called a fasting test). This number is important and will usually affect the whole day. If it’s good, the day has a great chance of turning out manageable. If it’s too high, this can spiral into crazy high’s and low’s later on.
Test before eating. If a correction is required, give it with the food insulin (discussed below). Then test 2 hours after eating. The goal is for the BG to return to it’s pre-meal level within about 2 hours. Sometimes 3 hours is OK. Even normal people have fluctuations after eating, so if you see a spike upwards, it’s nothing to become frightened about, although if you can time the food and insulin to work together with no spike, you’ll feel better.
CARB AND CORRECTION RATIOS
A carb ratio is how much insulin a person has to take to cover 10 grams of carbs. The carbohydrate content of a food can be checked on its nutritional listing (if there is a box or bag), or from a little handy pocket book from the Calorie King: Calorie Fat & Carbohydrate counter. This thing is my bible! It was $10 and it is my ultimate tool. My favorite thing to do (very occasionally) with it is order dinner at the restaurant with my fiancé, wait till he’s halfway through, then casually mention the carb and calorie contents of his meal to him. He’s expressed a desire to count carbs himself, so I’m not being the Plate Police, just that I enjoy his serious “OMG! Crap!” reaction (it’s way too cute). Ahem. ANYWAYS! The best ratio to assume, in the beginning, is 1 unit of insulin will cover 30g of carbohydrates. So for a meal containing 90 carbs, it would be 3 units of insulin. Go from there, see if you need more or less. I personally am insulin resistant and use 1 unit per 10 grams of carbs. This is because I am fighting some nasty girly hormones that interfere with the insulin. I picture them with frowny faces having sword fights with my insulin. =(
Correction ratio: How much insulin is needed to ‘correct’ (lower) a BG reading. Again, a 1:3 ratio is good to start with. This says that 1 unit insulin will lower your reading by 3 mmol/L (or 3 X 18= 54 mmol/g). Everyone’s different. Again, I have the stupid hormones, so I have a 1:2 ratio (1 unit takes me down 2 mmol/L).
BRINGING READINGS DOWN OR UP:
Low (or insulin shock, or hypoglycemia) is when a person enters the low BG territory, and there’s not enough sugar to run the brain or other basic biological functions. Low symptoms can vary. Some people get confused, shaky, sweaty, headachey, all sorts of good stuff. Fastest way to correct this is with glucose tablets. Marketed under the name “Dex 4”, they are available at Walgreens in convenient carry tubes and all sorts of fun flavors (grape, nomnomnom). You can buy big tubs to refill the tubes for $5, and tubes are about $2 each. There are 4 grams of carbs in each tablet. For a low, follow the 15-15 rule: 15 grams of carbs, wait 15 minutes and test. If low, repeat. Clear juice like apple is also great for lows, if no tabs are handy.
A REAL safety thing to have around is a glucagon kit. This is basically sugar that you inject into the bloodstream, if the person is going unconscious. It will hit like a towtruck and bring them back pretty effin fast. I was told by a nurse that this can be used in tiny amounts too, if a person is too ill to eat and their readings are going down (as in not use the whole kit). This is a safety godsend that makes me feel safer about dicking around with my insulin to achieve lower numbers. If you’ve ever played a video game, it’s like an instant full-health refresher button. Kind of.
High (or hyperglycemia) is when a person’s BG is on the high side of normal, and there’s too much sugar. Symptoms again vary; extreme thirst, frequent urination, irritability, drowsiness, general blah feeling, nausea, headaches…all symptoms. Even though some symptoms sound similar to being low, they *feel* different when you have it. Perhaps it’s because there are usually several symptoms in combination. I can usually tell which way I’m sliding just by feeling.
All people are different. Some can manage themselves no matter what their BG is, like myself. Others can’t, and it has nothing to do with self control…just that their bodies react that way. It is never that person’s fault, ever. =)
If a person has consistently high BG, they will become ‘used’ to the feeling, and will begin to feel low at what is actually a good BG reading. This makes trying to play with numbers to lower them a real pain in the a**. The good part is that this won’t last forever. Give it a few weeks, and my biggest recommendation: do everything in small amounts! Don’t go from an average of 220 to an average of 90 in two days. Bring it down to say 170, then 140, then 100 and so on. Give your poor body some time to adjust to your new strict attitude (or else it will be like WTF are you doing?! o,O)
In reverse, if a person gets used to being low a lot, they can develop hypoglycemia unawareness, where they will not feel themselves going low. This too can be fixed by bringing up the average a bit and going low less.
The moral is: The body gets used to whatever BG reading it sits at usually, and will start to feel the symptoms of it less. This is just like if you rest your hand on something, at first you will notice what it’s touching, and then gradually it slips into the background.
In general, I’d rather be a teensy bit high than low. Remember: a high might do lasting damage gradually over time, but a low can kill you LIKE THAT. I’m also thoroughly convinced it’s not good for your brain, to be low.
High-fat foots process *a lot* slower than pure carbohydrate foods. Pizza is going to digest way slower than cake, for example. This is because the body digests fats by sorting them out of the carbs, and processing them with a different organ (gall bladder). So often it’s good to mix in something like a few slices of cheese with bread.
This is called the Glycemic Index. Foods with a high GI hit the blood fast; foods with a low GI hit it slow. Anything refined or processed will usually have a higher GI than something natural. Do some research on this, google the term.
Pizza (since I mentioned it above) usually has a medium GI due to all the melty cheesy goodness, nomnomnom. It can take 4 hours to digest! As such, dosing for a food like that can be tricky, but great if you’re like me and generally digest before the insulin can hit you. For pizza, some people increase their basal slightly instead of blousing, to avoid going low.
AFTER MEAL HIGHS
If you notice the insulin not meeting the food right, taking it sometime before or after the meal may help. If it works too slow, then take it 15-30 minutes before. If it’s too fast, take it like 5 minutes after. Again, this depends on the type of insulin being used.
I SERIOUSLY recommend having a good solid meal before doing any drinking.
Beverages such as beer have carbs, and should be bolused for. Clear alcohols such as rum or vodka have no carbs in them.
The alcohol effect, however, applies to all alcohol. There is a funny process in digestion that hits much later, such as the morning afterward. The effect is that the person can go low. This is why I recommend a meal to drink on, and watching the basal later at night. If I go out drinking, I usually force myself to stay up and supervise my reading.
NIGHT TIME STUFF:
If lots of night time lows are experienced, try having a high-fat snack before bed, ex: bread and cheese, and bolus a bit less for it.
Another option is to lower the basal rate for the night. Also make sure you’re not taking big boluses, then heading right to bed. Stay up and make sure it works out OK.
The body usually requires a lower basal rate at night than during the day. However, around about 5-7 AM, some people experience “the dawn effect”, a period of time where wake-up hormones begin working, and interfering with the movement of insulin. At this time, a higher basal setting is needed.
Animal insulin: Natural animal insulin. Available in both fast and slow acting. Not certain about specifics.
Humalog insulin: Fast-acting synthetic insulin. Begins working in 15 minutes, peaks at around 2 hours, out of the system in 4 hours.
Apidra: Supposed to be similar to Humalog.
Lantus insulin: Long-acting synthetic insulin. One dose is supposed to spread itself out amongst 24 hours, with no peak time. However, in my experience, this had a major peak time of about 4-6 hours. Everyone is different though.
NPH- Synthetic insulin. Begins work around an hour in. Somewhere around 3-4 hour peak time. Out of the system within 6 hours for sure. NEEDS to be used with a long-acting insulin.
Not sure about the other Humulin lines. I used to take Toronto as my long-acting insulin, had the 6-12 hour peak time.
Levemier: Can’t say much on this one, no experience.
NOTE: If you don't have health insurance, check out the assistance programs that the various companies have.
PENS- for shooting up! These are made by Eli Lilly, and are very nice alternatives to the ol’ safety cones (I see the orange caps as that...). They feature metal bodies; you change the vial when it empties; and for each injection, you change the needle. Not too much risk of unwanted pokings. http://www.bd.com/us/diabetes/page.aspx?cat=7002&id=10257
An idea of what they look like. Pretty discreet!
PUMPS- an entirely different and expensive approach to diabetes, but it is truly life-changing. Pumps eliminate injections; instead, you have a little infusion you wear for 3-5 days at a time with the pump attached (either directly or by thin tubing). Pumps use only fast acting insulin, such as Humalog, because the pump is constantly giving your basal in increments every 5 minutes. You can make different programs for active or sleep-in days, and within these programs, set a schedule for how much the pump should deliver every 5 minutes, and when it should increase/decrease rates. Phenomenal control, and it almost eliminates night time lows. I’m on a pump—Medtronic mini-med paradigm 722 (I always read that as Paradiggem) and will never go back to shots, ever.
Several different pumps out there (check em out):
They all have great customer service departments, and will help you figure out how to get one with whatever insurance plan you have.
Aviva Accu-check: Has a rotating test strip drum that you refill every 17 tests (with a new drum).
Countour (Bayer): Nice and small, uses individual strips. On their website they have lots of cool meter accessories for free, like pouches. I go shopping there when I’m too broke to afford real shopping, and make myself feel special with a new meter pouch for free, woot! =)
There are lots of other mini meters if you’d rather go smaller. The Accucheck Aviva Nano looks cool, except I can’t vouch for it. I had a Freestyle meter for a bit, but swapped out for an Accu-check for the drum feature. I currently have a Countour link which talks to my pump…’tis awesome.
BEST POKER DEVICE: Accu-check Multiclix
Uses poker cartridges, so you don’t need to handle individual poking lancets. You can get a big box for $15 with no insurance. I say big because you don’t need to change them too often! I do mine like once a month, using each poker a fair amount of times. This may sound gross, but it isn’t. My fingers are clean and the pokers for this are so good that they last for many rounds without becoming dull. =D
SECOND BEST: The poker from the accu-check meter. Those lancets are not too painful.
COOL DIABETES WEBSITES:
TuDiabetes (duh)—check out all of the links on the site!!
Also, do a search for “Diabetic Alert Dogs”; these guys are trained to detect hypoglycemia.
A final note: remember that the body is a miracle! Don’t take a doom-and-gloom attitude to diabetes. Stress can kill a lot faster, and make everything worse. Stress makes readings run high! School stress, money stress, work stress...and stressing about readings makes them go high. The liver releases glucagon under stress. So if your readings aren’t the best, BIG WHOOP. Do what you can to bring it down, and pat yourself on the back for giving it a whirl. Never let a doctor or nurse make you feel bad. I feel it should be law that those medical practitioners have to be diabetic for like 2 years before they are allowed to give input.
MAJOR THING (FOR STUDENTS): Check if you can apply for disability funding through student loans. Check if you qualify for grants or scholarships especially for students with disabilities. Go to the disabilities office at your school and get a councilor. With a doctor’s letter, you should qualify for time-and-a-half exams and a private testing room where you will be allowed to bring you supplies into. Don’t let the disability term fool you; I press for this at every school I attend, and I get it, because it helps me do my best. It doesn’t mean disability in a derogatory way, it means we have unfair challenges, and the school gods are tipping their caps to us and letting us play on a more even field.
I wish you, the reader, the best, feel free to message me with any questions! I hope my novel here helped!
~Kate // onelildustbunni
PS: Attached the file as a word document, in case someone (for who knows what reason) wants to save this =) it took me like 3 hours to write...lol >,>
Another piece of information: healthy intake values for the 3 major things to watch for, Calories, Fat and Carbs.
From my handy Calorieking bible:
Total calories are a sum of all the fat/oil, carbs, protein and alcohol in a food item.
A burger that has 26g fat, 40g carbs, and 29g Protein is calculated as follows:
26g fat (x 9 cals/g) = 234
40g carbs (x 4 cals/g) = 160
29 g Protein (x 4 cals/g) = + 116
Total = 510 calories
APPROXIMATE DAILY CALORIE INTAKE:
Women (none-active) 1000-1200 calories/day
Women (active) 1200-1500 calories/day
Men (none active) 1200-1500 calories/day
Men (active) 1500-1800 calories/day
APPROXIMATE DAILY CARBOHYDRATE INTAKE:
Daily cal intake ............. .....Daily carbs intake............% of daily calories
1200 cal ..................................... 120g.......................................40%
For myself, 120g carbs/day is my general target. If I go over, no big deal....but I try to stay within that. On my normal schedule, I often eat under that, like 100 carbs carbs (with a dinner of 30g, then a breakfast of 30g carbs, and maybe a snack or two along the way...). For some, lower carbs=easier BG management (this is an easy enough concept), but I *really* don't agree with anyone trying to eliminate carbs or go too low under the daily value. 40g a day? I'd feel starved all the time if I did that! In my opinion, you definitley need carb intake to stay healthy and in the natural cycle of things. I don't mean junk food; I mean carbs found in meals. I personally do eat some junk food, and enjoy it; I just try to make sure I know the carb count and compensate for it with insulin. Adds flavor to life (literally!)
Having like 80g-100g carbs is more my idea of a healthy low-carb diet.
APPROXIMATE DAILY FAT INTAKE
MAXIMUM DESIRABLE FAT INTAKE (Daily)
Calories.........................Fat..............% Fat calories
1200 cals....................30g fat............23%
1500 cals....................40g fat............24%
1800 cals....................50g fat............25%
2000 cals....................60g fat............27%
2200 cals....................70g fat............28%
2500 cals....................80g fat............29%
3000 cals....................100g fat.........30%
4000 cals....................135g fat.........30%
Percentage fat calories formula:
Grams of fat per serving (X 900)
Total Calories per serving
FIGURING OUT BMI
BMI stands for Body Mass Index. This is basically a tool to tell you if you're at a healthy weight for your height.
Weight (in kilograms)
Height (meters)^2 (<----------that means squared in case you're rusty! ;-)
A BMI between 19-24.9 means you're in a great weight range and at low risk of health complications.
A BMI of between 25-29.9 is overweight; moderate risk.
A BMI of between 30-40 is obese and is a high risk.
A BMI of over 40 is morbid obesity, with a very high risk of health complications.
The book says to go to http://www.calorieking.com to use their interactive BMI calculator.
Man o Man, what a good article!
I am a 20 year Type 1 diabetic and this article says things
no doctor has ever told me, this kind of knowledge comes with
a person owning this disease and researching with trial and error.
I appreciate this article. Thanks lildustbunni