Hi everyone.. So this is my first post, I've been lurking reading for awhile now, this seems like an awesome support group. :) So first I'll give you my story, then my questions.. Warning will probably be long lol.
So I'm 27. When I was pregnant with my third child I noticed I was peeing a lot, like more then when your pregnant lol I was getting up like every half hour to go to bathroom. I was gulping OJ :O and my vision was getting blurry. I knew something had to be wrong I would eat a meal and 30 minutes later go to sleep because I was so tired. The doctor noticed protein in my urine early about 15 or 16 wks and requested I get the glucose test done early so I did. When I did the test I was soo nauseous the lady who took my blood must have thought my sugar was low and told me me to drink some oj and get something to eat when I left. I felt sooo sick after that I slept the whole day, I can only imagine what my sugar was :O. So my results came back 1 hr glucose was 409.my A1c was 9. Was sent to a endo. He told me he thought that I had probably developed diabetes in the last few years and to not expect it to go away. So during pregnancy I was on insulin after pregnancy they took me off, guess the nurses and doctors at hospital thought it might go away. At first it wasn't so bad I was still having some highs but they said it could still go away so I waited. It didn't go away and eventually kept getting harder and harder to control. I have no insurance and have been trying for the past 9 months since my son was born to get medicaid but have been repeatedly denied. I am at a point where the past 4 months I have ate no carbs and when I feel like I'm having a better day I only eat up to 2gcarb per meal. I eat only protein and fat and my fasting are still 130 to 160 and my after meal blood sugars are anywhere between 130 to 220 and this is with no carbs. So finally I was told about this place Shepherds Hope and they have been awesome, specially since I also have a pituitary tumor and I know my prolactin levels are high as well so at least I can get help for this as well. I have finally been able to see and endo I actually just saw her yesterday, she said she thinks I have 1.5 lada which I was thinking anyway. So she is doing the Anti-GAD test and C peptide and A1c. She put me on insulin. Novolog before meals 1 unit for every 15g and Levemir 6 units at bedtime. She is starting me out low because she knows I have terrible anxiety about having lows, I had many when I was pregnant. So here are my questions I am really nervous about putting carbs back in my diet since I haven't had them in so long but excited to that I get to eat more. So what I want to know is my after breakfast is the worse some times I eat a piece of string cheese 0g and go to 220. If I'm suppose to have 1 unit for every 15g how am I going to do this at breakfast. Because I really don't think eating 15g at breakfast is a good idea. So my question is should I still take insulin if I have no carbs for breakfast like eggs? or what about if I only have like 5g. I'm suppose to take the amount I'm eating and divide it by 15 but you cant do that for 5g so I don't know what to do. I still haven't picked up my insulin so I'm trying to plan everything for tomorrow. And they said to take the insulin before every meal but what about snack can I have small snack in between I know I use to when I was on insulin while pregnant but it was mixed then. If I have a snack between meals do I take insulin for that as well? And this is a volunteer place so it's not like I can call or email them to ask that part kinda sucks but at least I'm finally getting help. I'm kinda scared that what if I eat 15g of carbs take 1unit of insulin and my blood sugar skyrockets because I mean it already goes high when none. What am I suppose to do then? Thanks for reading if you got this far lol. And thanks in advance for any advice.
Ok, first of all, take a deep breath! You are in a very tough space of being at the very beginning of your journey with diabetes. It will get better...I promise! I've been where you're at (well except for the whole pregnancy thing..lol) and it does get easier.
First, I know your funds are tight, but check the library and see if they have a copy of Using Insulin by John Walsh. it's a great overall book that many of us read to learn and then review all the things involved with using insulin.
Many of us have the hardest time with carbs at breakfast, but that doesn't mean you shouldn't eat any! 1:15 is just a starting point to figure out your actual I:C ratio. From there you will need to see how that works and if you are still high then you need to decrease it to say 1:13 for a couple days, etc. Of course, if you are low (which doesn't sound likely for breakfast by your report) you would try 1:17. Just to give you an example (we are all different) my ratios for the three meals are 1:5, 1:10 and 1:18. We all make different decisions about carbs from very low, to moderate to a higher intake and you will do the same. But you are right, on shots you can't do the 1/3 of a unit you would want to try for 5 grams. (I have a pump, so I could do exactly that). My suggestion would be to go ahead and eat 15 grams and take one unit. Take it about 15 minutes before you eat. Then test your blood sugar at one hour and two hours if you can to see what happens. Do that for a couple days. Then you will begin to see if you need to change it. Do the same for lunch and dinner, seeing how the 1:15 works for a couple days and then switching as needed. Trial and error. Trial and error. That's what D is all about, and the good news is you are just as "qualified" to do that as someone with great insurance!
As for the "do I use insulin when I don't eat any carbs?" question - many type 1's who eat very low carbs find they have to bolus for protein or they will go high. But my recommendation is to not go there for now. For now you need to eat some carbs (15 is still a nice low carb breakfast!) and test your ratios. As for snacks, it depends on what you eat. If it is no carb, I wouldn't worry about it; if it has enough carbs to bolus for (which is 15 for you for now), go ahead and bolus.
Unfortunately, as you might be realizing, there are no hard and fast rules because we are all different. The only way to find out what works for you is to cautiously use trial and error . What is important for now is to keep really good records - what you eat, how much insulin you use and the results at two hours. That way you will begin to see patterns and "tweak" your ratios. So if you eat 15 grams for breakfast for three days and are under 140 each day - hooray! If you are 200, then you know to try 1:13 for three days. If that happens (the 200 every day), don't panic. It's just more information for you to work with. It takes time to get it right. Again these numbers are hard when all you have to work with are whole units. If you can get some syringes with 1/2 units that would help.
Finally, also keep track of your numbers between meals - like before meals, bedtime and waking. If those numbers are consistently too high or consistently too low that means that 6 units of Levemir need to be tweaked.
Don't hesitate to ask questions! We've all been there. You are lucky you have an endo that is testing you for LADA! I had to figure that out on my own...with help from TuD of course.
Thank you so much. I appreciate all you answers. I would also like to mention I was precribed the pen not the syringe. I'm really hoping some day I can get a pump instead though I hear they make things soo much easier. I'm soo nervous about eating 15g of carbs for breakfast and going like really high I just don't know what to do if it happens. I know when I was pregnant I was probably extremely high before I even knew. But now knowing anything over 200 totally freaks me out I drink tons of water and walk lots of miles is this going to affect my sugar with insulin? I also have 3 kids and babysit so I'm always on my feet I'm so nervous about going low just as much as going too high because I remember what 45 felt like when I almost passed out.. because of this and my anxiety I over test a lot well at least everyone says I do but it makes me feel more in control.
Testing is good. Yes, the pens are convenient - I was just suggesting an option to get 1/2 units. But I also feel a pump is the best way to manage, but there is a learning curve to them as well. One thing at a time is my opinion!
Remember when you eat 15 grams of carb you will be taking one unit of insulin to manage it (15 minutes before so it has time to work). You'd be amazing how much one unit can do (especially when you're very insulin sensitive!). If you go high, you go high. One high number won't do harm, it's only continuous highs over a period of time. Remember you are not worrying about affecting a baby now. You may need to go high in order to tweak your doses. Once you get your basal and your I:C right, the next thing to learn is your ISF -how much one unit of insulin lowers your blood sugar, so you can correct highs when they occur. But for now I'd focus on the basal and I:C ratios.
Yes, exercise will affect your blood sugar and you will have to figure out that influence. There are also groups on here about exercise.
Are you breathing? One step at a time.
I'm trying to breath lol. So is it ok for me to adjust my insulin myself? the doctor said we would probably be adjusting it next month when I see her.
Most of us find that we eventually end up tweaking our own numbers because we know our bodies the best and it can be a frequent tweaking that nobody wants to wait to ask somebody about. Some people rely more on their doctors, some less. But ultimately you are the one living with it 24/7.
For now, I would say do what you are comfortable with. Since you don't have access to calls or e-mail in between you might want to start working on it yourself.The sooner you start doing that, the sooner you will be in range. The key is to only make changes when you see a pattern and then live with the change for 2-3 days. So if you see a 200 the first time you try 1:15 for breakfast, don't freak out and change it for the next morning. Try it for 3 days before going down to 1:13, etc. Every number you get, good or bad is useful information. Just think of it as a high now gives you good data to tweak your numbers so you have more stability down the road.
Hi Denise: Oh, I am so sorry about all this. But you have come to the right place for support and I am SO GLAD that you are on insulin, which is what you need. What happened to you (Type 1 diabetes with onset during pregnancy) is incredibly common. Many, many women here on TuDiabetes were diagnosed with diabetes during pregnancy, many/most of them misdiagnosed as you were. I wrote a blog about autoimmune gestational diabetes that you may find interesting. Also, I wrote my top ten tips for the newly diagnosed Type 1, which I hope you will find useful. Finally, Zoe has given you some great advice. The two books I always recommend are Think Like a Pancreas and Using Insulin. I hope your library has those. Best of luck, be sure to ask all the questions you want and get the support that you need.
Thank you both. Melitta I had already read your blog the other day :) Very interesting. So do you guys have any suggestions on what I should eat tomorrow when I start insulin for breakfast? I want to make sure it's something that doesn't usually have a major impact on blood sugar any suggestions? I want it to be close to 15g.Because I just want to start with 1unit and work my way up.
Hi Denise: Breakfast is tricky. Do you drink coffee? With milk? Gary Scheiner, in Think Like a Pancreas, explains how caffeine raises blood sugar (in the absence of carbs). I find that I have to take 1/2 unit to 1 unit of insulin just for a cup of coffee--and I am REALLY insulin sensitive. I have found that I really just need to eat protein and fat for breakfast, and avoid carbs. So I will have a cup of coffee and some scrambled eggs with salsa, and give myself 1 unit for that. I hope Zoe or others will give advice, too. I find that for breakfast, I need to bolus (I have an Animas pump) about 1/2 hour before the meal, not 15 minutes. My Dexcom CGM tells me so!
I recently reduced my regular weekday breakfast which was around 20 carbs as I'm trying to lose weight. This morning I had exactly 15 carbs: 1/2 vegan sausage for 6 carbs, scrambled with 2 eggs and 4 carbs of vegies and 1/3 c of milk split between my cappuccino and my eggs for 5 carbs.(I haven't had the experience that Melitta has had with caffeine raising my blood sugar - we're all different). I also have made omelettes with 7 carbs of vegies and the milk for a total of 12.(I add cheese with no carbs) I don't eat bread much (and if I do it's the thick kind) but I believe a regular slice of toast is around 15 so you could have that with any kind of eggs, meat or cheese. I also recently switched to unsweetened almond milk which eliminates the 5 carbs for milk. What you obviously want to stay away from to keep your carbs that low is any kind of cereal (which is hard to bolus for even with an accurate I:C ratio - I don't eat it at all anymore).
Just FYI my 15 grams of carbs are 3 units for me as I only can do 1:5 at breakfast. But you will find what is right for you by trial and error.
Thank you both for the ideas.
You must get Dr. Richard Bernstein's "Diabetes Solution" November 2011 edition. He is a Type 1 diabetic, himself. I eat under 30 carbs a day, but I still make Insulin as a LADA. That makes a huge difference. His book explains how to manage low carb and small amounts of insulin to avoid lows. There is a Dr. Bernstein group right here on Tu. He explains everything step by step. I thought that there was a way to read his book online. Your local library should be able to order his book for you from another lending library. I've seen older editions of his book in second hand bookstores, which would be adequate for most of your questions.
You obviously need better health care to manage diabetes. I'm hoping someone else will respond and offer options that will be available locally for you.