# Carbs vs Insulin units



## Nuttyal (Jun 7, 2015)

I am a male aged 67
Diagnosed Type2 in 2011
Placed on Gliclazide - 160mg twice per day.
This was keeping my diabetes under control until this year.
GP suggested I did not need to monitor my BG levels any more (2012)

From January to beginning of May this year I lost two & half stone (no dieting).  Beginning of May my thirst rocketed, toilet needs increased dramatically.  I tested
my BG and it had rocketed to 32mmol.
I am almost always totally exhausted and do not have any energy.  Any light work will leave me recovering for the rest of the day!
Immediately went to GP.  Told to attend hospital for Hba1c test.  Result was 105 (12%).  GP informed me that I needed to start taking insulin straight away.
Now on Humulin M3 @ 12 units twice daily.  This has now brought my BG levels back down.

My question is this:

I am adjusting my carb intake to keep my BG within range using the specified units of insulin.
I have now started carb counting and found that I my carb count for the day (yesterday 6th) only totalled 144.  Is this enough to provide me with the required energy, and stop me being fatigued all the time?
Should I be taking in more daily carbs and adjusting the units of insulin to keep my BG levels within range?

I read in my carb counting book that I should be taking in about 250 carbs per day, is this correct?

I will be seeing my diabetic nurse in a couple of weeks for routine check and will mention this to her.

Any help will be greatly appreciated.


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## KookyCat (Jun 7, 2015)

Hi Nuttyal
I'm not familiar with Humalin m3 but I assume it's a mixed insulin?  As in it has some long acting juice in there and a bit of rapid acting too?   Carbs are a bit of a hot issue for us, the medical advice is 200 to 300g a day I believe based on NHS advice.  I don't eat anywhere near the upper limit and most days don't go much over 100g of carb.  Some people would consider my carb consumption excessive with low carb folk going as low as 20-30g of carb a day.  So it's a choice really, based on how much control you want and how much you enjoy those carbs.  Those of use who use separate insulin for background and food have a carb ratio we use to work out how much insulin to take, I think the average is 1 unit of insulin to ten grams of carb, but it differs from one person to another (mine is 1:20).  If yours is a mixed insulin, they're usually 70/30, meaning 70% long acting and 30% short acting.  The short acting bit is what helps out with food, the other covers your needs between food and for lunch if you take it morning and evening.

How often do you test?  Have you been told about pre and post meal testing to see how the insulin is working with spikes from food?  I ask because I find it's the amount of carb in one go that makes the difference for me and that sort of dictates how much daily carb I eat.  Being tired can be high blood sugar related, or could be that you're not eating enough calories especially since a lot of people are told to eat low fat, high carb.  If you're not eating carb the calories need to come from somewhere else, so it can feel a it complex . 

There are some great resources to read on here about carbs and how to work out what you tolerate and how well insulin deals with the food, and I'm sure one the moderators/lovely admin will pop along with those links soon.  Welcome aboard


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## DeusXM (Jun 7, 2015)

M3 is a mixed insulin, which means you have to eat exactly the same amount of carbs at the same time every day.

There is no 'required' amount of carbohydrates for your body - there are marathon runners out there who don't actually eat carbs at all. However in your case you must eat a specific amount each day because of the insulin type you are using.

What are your blood sugars like and how many calories are you eating per day?

I'd also suggest that your original symptoms strongly suggest you have T1 rather than T2 - T2 doesn't create rapid weight loss nor does it usually result in blood sugar levels going as high as they did.


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## everydayupsanddowns (Jun 7, 2015)

There is also the possibility of LADA (sometimes nickamed type 1.5 or slow-onset T1). It's a variant that isn't always immediately considered by Doctors, but needs treating in more of a T1 way than a T2 way. 

Your age may have had a significant impact on the type of diabetes you were diagnosed with, plus the fact that type 2 is so much more common than the other varieties that sometimes it's just an easy assumption to make, even if some of the clinical factors of classic t2 are absent.

How are you finding the mixed insulin? As has been suggested, one of the complications with premixed and pre-injected insulin that is supposed to last you from breakfast until evening meal time is that you are likely to need to 'feed it' at various points to prevent your levels going too low, but there may not be quite enough 'oomph' in it to come with the size of lunch you would like.

It might be worth asking your Dr/nurse if you could try basal:bolus (also called MDI, multiple daily injections) if you find your current insulin a little inflexible. MDI separates out the slow and fast acting insulin into one or two 'background' doses, and an injection for each meal which can be varied in terms of timing and amount to match the size and time of any of your meals. It does mean more injections, but it allows you to eat earlier, later, smaller, larger, or not at all as you choose. 

As for amounts of carbs per day - I average around 150-180 grams of carbs and certainly do not feel like I am scrimping or denying myself things unduly. My weight is stable and my BGs are usually relatively OK (though I confess they can be somewhat easier to manage when I reduce my carb intake a little). The 'eatwell plate' suggestion of 250-300g of carbs really has more to do with attempts to limit fat intake. However much recent research suggests fat has had rather an unfair time of things over the past few decades and new advice in many places (including the U.S.) has removed both saturated fat and cholesterol from the 'foods to watch' list. Cynics are often quick to point out how many cereal, grain and confectionery producers are sponsors of the body of nutritionists that developed the eatwell plate. 

Good luck finding your own 'balance'.


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## Nuttyal (Jun 8, 2015)

Thanks guys for responding so quickly.

Responding to your questions:

My BG levels are now stabilising very well.
Figures below for last 7 days:
My pre-breakfast is now consistently between 6 & 8
Mid-morning is 8 - 15 with reading taken at 11:00am each day
Mid-afternoon is between 9 & 14 with reading taken at 4:00pm daily
Bedtime level is between 7 & 10 with one reading at 15

My insulin is taken pre-breakfast and pre-evening meal.

I feel more confident now about carb levels.  My carb intake for last 2 days is 144 (Saturday) - BG's 6.8, 8.7, 9.9 & 8.3, and 200 yesterday (Sunday) - BG's 7.7, 10.3, 14.6 & 6.9

I haven't yet taken to counting the daily calorie intake, too much else going on at the moment.

I believe that my exhaustion is probably down to the fact I lost ALL muscle tone in arms and legs from the rapid weight loss.  My wife says I look like a skeleton!  I can only hope that I get it back by putting in extra calories.

My diabetic nurse also commented that I may have Type1 rather than Type2 with the symptoms that I presented.  I will have to ask for a clarification when next I see my GP.

Thank you guys for your responses, they have been really helpful.


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## DeusXM (Jun 8, 2015)

Another point to mention is that your blood sugars are quite high, which could account for the fatigue. There is quite a range in your post-meal readings which suggests you need to look at standardising your meals - it's not just about the total number of carbs in the day, it's about the kinds of carbs and when. I'm guessing what you had for breakfast on Sunday was different in some way from what you had on Saturday, as was your evening meal, which on the face of it I would bet was much lower in carbs than the one you had on Saturday. 

The rapid weight loss and loss of muscle tone almost certainly points to T1 or T1.5 - it sounds near identical to the diagnosis situation of many people with T1 and you've basically had the 'classic' symptoms of diabetic ketoacedosis


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## DaveB (Jun 8, 2015)

Hi. Ignore all the nonsense about minimum carbs per day that comes from the NHS and others. Some carbs are needed for the fibre they provide but the body can derive the glucose it needs from fats and proteins. The current carb advice is one cause of the obesity epidemic. Some keep their carbs down below 50gm/day. I choose to have around 150gm. Always match the insulin to the carbs you choose to take and don't 'feed' insulin. I've been down the LADA route with the symptoms of rapid weight loss, never been overweight etc. Many GPs and DNs don't know about Late onset T1 and just assume T2. As another poster said, if over time the twice daily mixed insulin no longer matches your needs then do ask to go over to the Basal/Bolus regime.


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