# Do/can Type 1s have a lower carb diet?



## pawprint91 (Jul 5, 2022)

Hello all,

2 weeks into this new journey now and I'm back with another question. Still only on basal insulin and having to alter the doses all over the shop as I seem to be in the 'hoenymoon' phase. Have next appt with diabetes nurse on Monday, has been delayed as she has been on holiday. Before she left, she left me with the advice to practice some carb counting with apps etc but to eat normally avoiding the obvious e.g. pizzas, mars bars, coca cola. I've been off work with blurred vision, which has left me a bit too much time on my hands, so I started a food diary. I have been eating things like bread, potatoes, rice etc but have just managed the portion size rather than doing it 'freehand' as it were. I generally eat between 145 and 160 carbs a day it would appear. However, I have made a few 'swaps' when I started realising that some things I enjoy were quite carby (namely snack things like cereal bars, breakfast biscuits, fruit yogurts) and have started having only one wrap rather than 2 etc (how does something so flat have so many carbs??). I also bought a few 'low carb' treats to try as I do have quite a sweet tooth.

So my question is, as a suspected T1, am I doing the right thing? I'm still eating my three meals a day plus snacks, I've just cut out the crazily high carb things as I don't want my bs to spike, particularly whilst I'm not on novorapid. I have seen online that low carb diets are beneficial for Type 2 rather than Type 1, so I'm guessing I don't need to cut down any more. Do Type 1s on novorapid eat whatever they wish (within reason, maybe not a mars bar!) and then bolus for it to cover it, or do you bolus but be 'sensible' and choose the best option going for carbs without making wild adjustments (e.g. having no potatoes as opposed to having some)? Is there a limt to the amount of insulin you can bolus with in a day, or do you need to keep it within a ballpark figure? Any advice greatly appreciated, thank you!


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## helli (Jul 5, 2022)

One thing you will learn on your Type 1 journey is that we are all different. 
There are certainly some people with Type 1 who prefer to eat a lower carb diet as they find it easier to dose for an with smaller insulin doses, a mistake is likely to be smaller. 
However, I have found very low carb difficulty to dose for - in the absence of carbs, our bodies break down the protein into sugar and we need to protein count. For me, the protein to insulin ratio varies for different protein and the absorption rate differs. AS a result, I gave up on low carb and decided I wanted to focus on a "healthy" diet without going over the top on carbs. I still eat pasta, bread, pizza, rice ... but maybe less than my partner


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## pawprint91 (Jul 5, 2022)

helli said:


> One thing you will learn on your Type 1 journey is that we are all different.
> There are certainly some people with Type 1 who prefer to eat a lower carb diet as they find it easier to dose for an with smaller insulin doses, a mistake is likely to be smaller.
> However, I have found very low carb difficulty to dose for - in the absence of carbs, our bodies break down the protein into sugar and we need to protein count. For me, the protein to insulin ratio varies for different protein and the absorption rate differs. AS a result, I gave up on low carb and decided I wanted to focus on a "healthy" diet without going over the top on carbs. I still eat pasta, bread, pizza, rice ... but maybe less than my partner


Thanks for the advice  would/do you eat chocolate/cake in very small amounts, or is this to be avoided on the whole?


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## helli (Jul 5, 2022)

pawprint91 said:


> Thanks for the advice  would/do you eat chocolate/cake in very small amounts, or is this to be avoided on the whole?


Avoid cake and chocolate   
Definitely not! 
I prefer dark chocolate which has less carbs in it but that does not mean I don't enjoy a cheeky mint Aero. 
And I enjoy baking so often eat cakes (not every day or even every weekend) and usually have some scones in the freezer which are quick to defrost and eat with my Mum's homemade raspberry jam.


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## Inka (Jul 5, 2022)

pawprint91 said:


> Thanks for the advice  would/do you eat chocolate/cake in very small amounts, or is this to be avoided on the whole?



Avoid chocolate?? What madness is this?  I eat chocolate, cake, cheesecake, fruit crumble, etc etc. Diabetes U.K. used to do a good poster that tried to counteract the incorrect idea that Type 1s needed special food. It said something like “The recommended diet for Type 1 is the same diet recommended for everyone - low fat, low salt, low sugar, high fibre” etc

So, two things limit my cake intake: firstly, eating vast amounts of cake isn’t healthy for anyone; secondly, although someone without Type 1 could eat a whole cake themselves, I would find that amount of carbs harder to dose for in one go. I could do it, for sure, but I find approx 100g carbs per meal is my sweet spot. After that, I need to space out my boluses because the rate my body can process that food is extended.

I just eat a normal diet but limit my cake portions to a normal size and don’t have them everyday. I eat cereal, bread, pasta, rice, quinoa, beans, lentils, cake, desserts, whatever. The only thing I was told to avoid was sugary drinks except when treating hypos or before exercise.

Type 1 is a very different condition to Type 2. Even if a Type 1 ate zero carbs, they’d still die without insulin. Some quickly, some slowly. That’s the blunt answer. The solution for Type 1 is insulin not diet.


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## Sally71 (Jul 5, 2022)

If you are carb counting and dosing for it you can theoretically eat what you like, which is what my daughter does.  We do find however that the blood sugar spikes are less severe and insulin doses easier to manage if she tries not to go too crazy on the carbs.  It’s entirely up to you how low you go, eat whatever feels like a healthy diet to you that you can stick to.  Cakes and so on should probably only be reserved for occasional treats whether you have diabetes or not.


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## rayray119 (Jul 5, 2022)

I don't stick to a certin amount of carbs however if i had a bad blood suger day and I had controll over what i was eating( and by not round someone elses house etc) i may not go for that pizza or huge pasta dish.


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## pawprint91 (Jul 5, 2022)

Inka said:


> Avoid chocolate?? What madness is this?  I eat chocolate, cake, cheesecake, fruit crumble, etc etc. Diabetes U.K. used to do a good poster that tried to counteract the incorrect idea that Type 1s needed special food. It said something like “The recommended diet for Type 1 is the same diet recommended for everyone - low fat, low salt, low sugar, high fibre” etc
> 
> So, two things limit my cake intake: firstly, eating vast amounts of cake isn’t healthy for anyone; secondly, although someone without Type 1 could eat a whole cake themselves, I would find that amount of carbs harder to dose for in one go. I could do it, for sure, but I find approx 100g carbs per meal is my sweet spot. After that, I need to space out my boluses because the rate my body can process that food is extended.


 Thank you (again!) for this. As a newbie currently not bolusing, what do you mean when you say spacing out your boluses because of how your body processes the food?


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## khskel (Jul 5, 2022)

pawprint91 said:


> Thank you (again!) for this. As a newbie currently not bolusing, what do you mean when you say spacing out your boluses because of how your body processes the food?


Some foods take longer to digest than others, so taking all your bolus (fast acting) up front could lead to a hypo, so some people split the dose with an interval between.


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## helli (Jul 5, 2022)

pawprint91 said:


> Thank you (again!) for this. As a newbie currently not bolusing, what do you mean when you say spacing out your boluses because of how your body processes the food?


Different food is absorbed/processed at different rates. For example, we have fast acting carbs such as jelly babies to treat a hypo whereas adding fat to anything slows down the rate at which the carbs affect our blood sugars so chocolate and pizza are not good for hypos.
Whilst food is processed at different rates, the fast acting insulin you use will work at the same rate regardless what you eat. NovoRapid, for example lasts about 4 hours and has a peak about 30 minutes are injecting. If you bolused and then immediately ate something fast acting like a packet of sweets would result in a spike even if you calculated your dose correctly. Whereas, if you pre-bolused (injected 15 to 30 minutes before eating) for a pizza your levels may dip as the insulin starts working before the carbs in the pizza.
So, over time, as well as getting good at carb guestimating on sight and calculating your insulin dose, you will start to learn whether to take all your insulin 30 minutes before eating or half when you start eating and the other half an hour later.

Few people get this right and before the introduction of LIbre, we only knew what our levels were before we injected and before the next meal so had no idea of the ups and downs in between. And 20 years ago, people with diabetes only tested once or twice a day. Given there are people who are celebrating 60 years with Type 1, I try not to get too obsessed by the bumps in my Libre graph and remember people without diabetes can also have a graph that looks like a rollercoaster.


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## rayray119 (Jul 5, 2022)

pawprint91 said:


> Thank you (again!) for this. As a newbie currently not bolusing, what do you mean when you say spacing out your boluses because of how your body processes the food?


a higher carb meal will be take longer to diggist so if people dose its for all at once some carbs might be not disgesited until all hours after the insulin has stooped being active so this could lead to hyping then ended really high hours after(the amount of carbs and types of food  people need to split dose for will depends on the person) the pizzas offen trickky because of all the fat slowing the digestion and as well as the high amount of carbs heence why i might consider not having it if i was having a bad blood sugar day


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## rayray119 (Jul 5, 2022)

i happened to be typing this as the same time as others so so sorry for the repeatability


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## trophywench (Jul 5, 2022)

Even as a child without diabetes, I ate the boring carbs first to get them over and done with before enjoying the other things on my plate - this was the 1950s so nothing exotic was ever on offer hence cereal and milk for breakfast (cooked brekkie once a week on a Sunday only) lunchtime was a cooked meal - meat spuds and one other veg followed by a pudding, once a week fish and chips + pudding.  Teatime would be bread and butter with jam or cheese, once a week, with cooked meat, followed by cake.  On a Saturday and Sunday, tea would include salad items with hardboiled egg, or a tin of salmon and on a Sunday tinned fruit and evaporated milk (fresh cream only at eg Christmas) AND cake.  Sweets were on ration so the week's worth were bought on Saturday morning and were duly divided up so we could both have a bit every day - one Mars bar and either a Bounty or a Crunchie, cut into as many slices as poss, or a box of Smarties (not a tube), so big sis and I had one of each colour of them = 8 plus one tube of fruit gums and one of fruit pastilles.  Sometimes a tube of Munchies - whey hey!  Mom also bought a quarter of grown up individually wrapped sweets for her and dad - different ones every week, all tipped into a metal tin on a higher shelf in the pantry, it was a treat when us two were offered one of those, and always best to have a little rummage, cos below the boring toffees and fruit drops you might find the treat of a humbug, a Mintoe or a Bluebird toffee ie a chocolate coated one.  No good whingeing about it whatsoever - my mom & dad really didn't have enough money to indulge us more.  

But anyway after that nostalgia trip - before I had diabetes I never liked stodgy stuff anyway and once I was a teenager in the early-mid 60s nobody wanted to be podgy or Eeek! have spots and OMG once Twiggy put in an appearance, that was who we all wanted to be.  Nobody cared she was 5ft8 and blonde so a dark haired 5ft1 girl was never going to look quite the same, but come on, you have to try, don't you!  It was brill when I could run up a presentable summer dress from a yard and a quarter of cheap 36in dress material off the market - but obviously needed to rely on mom's benefice to treat me to the Sylko to sew it with and the zip ......

So here we are 50 years later and I generally eat getting on for 100g per day of carbs - sometimes as low as 80g, rarely as high as 130g. 

I have already put on a good stone during lockdown and as I really can't/don't move as much as I used to there's no way I need any more, so I won't be increasing my consumption of anything, any time soon.


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## pawprint91 (Jul 5, 2022)

trophywench said:


> So here we are 50 years later and I generally eat getting on for 100g per day of carbs - sometimes as low as 80g, rarely as high as 130g.



Is this a conscious decision to eat 'lower carb' (smaller portions etc) or is it just naturally how you would eat anyway without diabetes coming into it? I do find when trying to eat the less sugary things I seem to be eating more fat, but then I suppose for now I've cut out the pizza and chocolate so it's probably swings and roundabouts, really!


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## Drummer (Jul 5, 2022)

Although we were not well off in some ways there were always hens and eggs, and pork/bacon/sausages when I was growing up - and yet I never had a spotty face or greasy hair whilst those who were constantly avoiding fats and cleansing etc, they broke out dreadfully all the time.
It was my job to collect the eggs - I soon learned to grasp the neck gently with one hand and remove the eggs with the other - they were quite protective of their nests. 
When I was a bit older I used to wear mini skirts, waistcoats and long boots of suede and leather - some of those skirts I still have  - it would be difficult to make a good sized handbag from any one of them. I found the white jeans I wore to the Isle of Wight pop festival the other day - I think they are a 30 inch waist, and I had to find a belt narrow enough to go through the loops to hold them up for dancing.
The 'normal' diet back then was so very different.


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## Inka (Jul 5, 2022)

pawprint91 said:


> Thank you (again!) for this. As a newbie currently not bolusing, what do you mean when you say spacing out your boluses because of how your body processes the food?



I simply mean that instead of injecting all the meal-time (bolus) insulin in one go before the meal, I spread it over a period of time because if I eat a large/carby meal my body takes longer to process the food, so if I injected all the insulin in one go, I might go hypo (because not all the food would have been processed by my body) 

With a pump, I can do an extended bolus (it spreads the insulin out over a period of time) and with injections, I’d inject a bit of insulin before the meal, then decide when to inject the rest. This is called a split bolus.


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## nonethewiser (Jul 5, 2022)

Of course they can do lower carb diet, did below 60g for 3 months once, it had its own challenges mind having to double amount of injections & test more often to spot bg rises but it is doable.

Enjoy food so have rich variety of foods in my diet now, it includes chocolate pots pasta oats beans bread such like, only last weekend went out with wife to local garden centre & had coffee & cake, it was chocolate éclair & delicious it was.

With right skills knowledge tech & bolus timing you can eat what you want within reason with type 1, that is my view anyway after 4o years of living with condtion


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## Inka (Jul 5, 2022)

And, of course, the normal things apply to us too eg if we want to lose or gain weight that would obviously affect our dietary choices, depending on our sex we may eat more or less, we might be an athlete or sedentary, we might be pregnant or breastfeeding if we’re female, we might be older and need less calories overall, etc, etc.

You shouldn’t need to choose your diet for your Type 1. I eat pretty much what I would have eaten if I hadn’t got Type 1. All we have to do is be our own pancreas and use our insulin(s) appropriately.


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## trophywench (Jul 5, 2022)

I don't 'low carb' whatsoever and never have in my own view - I just eat exactly what I happen to want to eat.  The fact that I don't eat less of anything than I actually wish to, means that I don't need to replace the missing anything with summat else.  I won an After Eight Easter Egg in a quiz in a presentation package with a box of AE mint creams on a camping rally not long after Easter.  I opened the mints and took 2, Pete also had a couple.  Neither of us has been tempted further since.  I found them unbearably sweet with nothing to relieve that.  If you choose eg a cream cake there will usually be a variety of tastes and textures, to enhance the experience of eating it.   Last week, we won a smallish box of Quality Street as a minor prize in a raffle.  That's unopened too, but I fully expect we'll both enjoy them more, because of the variety within them.  I haven't given anything up.   If I facy X, if I can eyeball it, and therefore roughly estimate the carb content and therefore the bolus needed for it - I'll have it unless I'm so full already I'd throw up if I ate it.  If my guesstimates were wrong, I'll soon find out by what my Libre and my meter both tell me - so I can correct either with more crabs or more insulin.   Nothing's rocket science with Type 1 diabetes so nothing much is insurmountable  - except I expect death will be once it comes knocking.  (But I would like to meet Binky!)

No way am I deprived either nutritionally or in texture or taste.


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## AndBreathe (Jul 5, 2022)

@pawprint91 - I'm not T1 so won't comment specifically, but if you are interested/curious to explore T1s who do live low carb lifestyles, the Dr Ian Lake (a GP) is a decent enough starting point.  This Google search throws up plenty of stuff he has done, including endurance exercise, if that happens to be your bag.



			dr ian lake type 1 diabetes - Google Search


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## Deleted member 33898 (Jul 15, 2022)

just over a year with type 1 diabetes. I don't have the knowledge and experience of others but this is what I found

I was told like others you can eat whatever but in moderation and learn to dose for it. I've largely stuck to my diet before diagnosis but reduced my portions after finding an upper limit for carbs I could have in one meal were I was happy with the post meal spikes. Again told I could have as much as I want and just dose more but that hasn't worked for me, might for you. I have swapped most carbs for healthier options like having wholemeal rice, sweet potato etc but I still have the bad kind a few times a week and eat out once a week. I eat plenty of fruit and veg everyday. I found when increasing the fat and protein in each meal I saw less huge spikes after  each meal but also having too much can cause problems. Too much protein and you'll push post meal levels higher, too much fat and you'll delay the release of glucose and before that you'll go low with the insulin on board. Its all about testing.  If you aren't too concerned with losing weight then adding some protein and fat to a meal can help, you'll find a threshold for each before seeing issues. I still eat treats like chocolate and ice cream but just not crazy amounts, days of eating a tub in one sitting are behind me. 

I have tried lower carb meals a few times, especially at breakfast were I'm normally quite insulin resistant. I found my insulin to carb ratio didn't work as well and I needed even more insulin to fix my levels. Every meal will need different bolus timing and perhaps different amounts of insulin. For example I find for sweet potato in a meal I can dose straight before but plain chips need at least 15 minutes. The downside I find with more carbs is the more insulin that is needed and the increased likelihood of hypos. 

Here's what I had yesterday:

breakfast : Branflakes, milk, peanut butter, banana, raspberries and an egg ( carbs 75g)
Lunch: 2 slices wholemeal bread, chicken with veg, coleslaw, apple, almonds and protein bar (carbs 70g)
dinner:  baked potato, lasagne , few squares of dark chocolate with soya greek yogurt (70g)

snacks throughout the day: biltong, pear, almonds, belvita biscuit, rich tea biscuit. (carbs 30g)

averaged 6 mmol that day, spiked to 7.5 at breakfast and lunch, dinner 6 and had a bit of a low after but that was more to do with exercise. 

if you are able, exercise helps to get the insulin to work harder. And you could time exercise round bigger meals. If I head out for a meal with friends we'll go for a walk after. I jog twice a week, do strength routine twice a week, walk everyday and do the odd hike each month. 

I could say a lot more but don't want to bore you haha


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## pawprint91 (Jul 18, 2022)

phil90 said:


> just over a year with type 1 diabetes. I don't have the knowledge and experience of others but this is what I found
> 
> I was told like others you can eat whatever but in moderation and learn to dose for it. I've largely stuck to my diet before diagnosis but reduced my portions after finding an upper limit for carbs I could have in one meal were I was happy with the post meal spikes. Again told I could have as much as I want and just dose more but that hasn't worked for me, might for you. I have swapped most carbs for healthier options like having wholemeal rice, sweet potato etc but I still have the bad kind a few times a week and eat out once a week. I eat plenty of fruit and veg everyday. I found when increasing the fat and protein in each meal I saw less huge spikes after  each meal but also having too much can cause problems. Too much protein and you'll push post meal levels higher, too much fat and you'll delay the release of glucose and before that you'll go low with the insulin on board. Its all about testing.  If you aren't too concerned with losing weight then adding some protein and fat to a meal can help, you'll find a threshold for each before seeing issues. I still eat treats like chocolate and ice cream but just not crazy amounts, days of eating a tub in one sitting are behind me.
> 
> ...


This was an incredibly helpful post - thank you! If you have more advice, I am happy to hear it


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## Deleted member 33898 (Jul 19, 2022)

pawprint91 said:


> This was an incredibly helpful post - thank you! If you have more advice, I am happy to hear it


Of course. Where to start. I will say I've made a lot of mistakes over the last year. It depends how you want to go about this. Some people just go with the flow and others record a lot. I recorded a lot at the start and still do , more soo when things are going a bit pear shaped and I wanna get back on track. The food diary you are doing is a great idea. 

At the beginning I had set amount of carbs per meal and ate similarly to what I always did but counted the carbs. I took a recommended amount of insulin per meal and through testing tried to figure out my insulin to carb ratio, which is what you'll need if you want to be flexible with how much you eat (you might find there is an upper limit to how many carbs you can handle in one meal too ) The ratios may differ throughout the day for example I need to have 1 to 12g before 8am but after 1 to 15g works well. Try finding these ratios under normal circumstances as in no major exercise or alcohol. After that you can experiment with how many less or more units you'll need depending on what you are doing or not doing. You might also find once you add in exercise on a regular basis that the ratios will change as you become more insulin sensitive but don't worry about that til later. You'll know the insulin amount is correct when after about 2 hours of eating the peak glucose level you hit will fall and after 4 hours you should be close to what level you started at before eating. If before or just after the 2 hours your levels fly down low to the point you are hypo and need to snack the insulin is too much. If on the other hand at 2 hours after you have peaked your levels either stay at that peak level or go even higher then the insulin isn't enough.  Bear in mind your basal insulin should be correct in the background also. Once you have the bolus insulin set right you can work on keeping post meal spikes lower. For that it involves timing, the types of carbs and what you have with your meal.

So for months I saw my levels going up to 13 or 14 from 4 after meals then shooting back down really fast. I added more insulin only making it worse and the spikes would still happen. Timing of bolus is important but I found the earlier I took my insulin the more hypos I had when I started to eat or when I finished eating. Read a few bits and figured it was the lack of fat and protein my meal. I definitely read at the beginning diabetics should cut fat intake down so thats what i did but obviously too much reduction. So when I had my branflakes with fruit in the morning for instance there was barely any fat or protein in the meal and I would just rocket up. When I started adding extras like peanut butter, chia seeds or flax seed to the meal I saw less huge spikes and crashes( these are all fairly healthy  fat/protein choices). I will say I've had issues with having a lot of hypos so careful if you go about this way at all. Try tackle one thing at a time. Get a routine set up at first if you can and eat at similar times. Some days I go lower after a meal (with no exercise or alcohol) and it might be because I'm bit busier or one of many reasons I cant figure out so I just top up with a snack. So that list of snacks I detailed may be less carby one day than another. No point in pushing levels up again if you are sitting steady. Always try to be at a good level before each meal aswell, this will help avoid going too high. You'll achieve this by having the basal insulin correct and the previous meal bolus working well. Don't worry if you don't all the time. You can do corrections( id discuss with hospital before attempting this) This morning I was 7 before my meal so not ideal but okay and I went to 10 after. If I had of started at 5 then technically I would have went to 8. In the mean time if levels are a bit out of target before your next meal you can always go for a short walk. I go for 10 minutes walks on my breaks at work and it helps nudge me down a bit if I'm sitting a little higher than id like. If you have similar meals alot you can see how best to dose for them. Probably find its whatever food is the bulk of the carbs will need considered say rice or potato. Over time you can learn how to deal with certain meals and it really does help when heading out for food. All the carb counting at home helps me look at a meal I cant weigh or refer to packets and guess pretty well how many carbs are in it.

Just don't get too obsessed, I did and still suffer from time to time about getting my levels consistent, its a work in progress.  All I've said might be garbage but I can only say what I've done. It is very tough doing all this but if you are able to still enjoy food like before and be reasonably healthy then great. If you have any questions ask away, it can be difficult to describe everything ive done without sounding like jibberish haha


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## pawprint91 (Jul 19, 2022)

phil90 said:


> Of course. Where to start. I will say I've made a lot of mistakes over the last year. It depends how you want to go about this. Some people just go with the flow and others record a lot. I recorded a lot at the start and still do , more soo when things are going a bit pear shaped and I wanna get back on track. The food diary you are doing is a great idea.
> 
> At the beginning I had set amount of carbs per meal and ate similarly to what I always did but counted the carbs. I took a recommended amount of insulin per meal and through testing tried to figure out my insulin to carb ratio, which is what you'll need if you want to be flexible with how much you eat (you might find there is an upper limit to how many carbs you can handle in one meal too ) The ratios may differ throughout the day for example I need to have 1 to 12g before 8am but after 1 to 15g works well. Try finding these ratios under normal circumstances as in no major exercise or alcohol. After that you can experiment with how many less or more units you'll need depending on what you are doing or not doing. You might also find once you add in exercise on a regular basis that the ratios will change as you become more insulin sensitive but don't worry about that til later. You'll know the insulin amount is correct when after about 2 hours of eating the peak glucose level you hit will fall and after 4 hours you should be close to what level you started at before eating. If before or just after the 2 hours your levels fly down low to the point you are hypo and need to snack the insulin is too much. If on the other hand at 2 hours after you have peaked your levels either stay at that peak level or go even higher then the insulin isn't enough.  Bear in mind your basal insulin should be correct in the background also. Once you have the bolus insulin set right you can work on keeping post meal spikes lower. For that it involves timing, the types of carbs and what you have with your meal.
> 
> ...


Not jibberish at all, thank you and I am so grateful for any and all advice, whether it differs from person to person or not! I'm finding it hard at the moment as I am only on basal insulin - from the advice of the hospital - but I know I am spiking after meals, which is frustrating. BUT my levels are coming back down to 5-7 before meals, so I'm guessing something somewhere must be working okay. Thank you for the walk/exercise tip, that will definitely help me in the future, I am sure! I feel like I'm still just starting on this journey a month in, and I still have loads to learn when I eventually need to bolus too. But maybe better to just have small steps at a time. Thank you so much!


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## Deleted member 33898 (Jul 19, 2022)

pawprint91 said:


> Not jibberish at all, thank you and I am so grateful for any and all advice, whether it differs from person to person or not! I'm finding it hard at the moment as I am only on basal insulin - from the advice of the hospital - but I know I am spiking after meals, which is frustrating. BUT my levels are coming back down to 5-7 before meals, so I'm guessing something somewhere must be working okay. Thank you for the walk/exercise tip, that will definitely help me in the future, I am sure! I feel like I'm still just starting on this journey a month in, and I still have loads to learn when I eventually need to bolus too. But maybe better to just have small steps at a time. Thank you so much!


no problem. thats good something is working right there.  Guess it depends how big the spikes are. Everyone seems to be different on what is acceptable to them. I think the main thing is just dont stay up high for hours and hours a day. A diabetic nurse told me she wore the libre sensor to test it as a non diabetic and claims she was spiking to 11 for some meals, i dont know about that though, maybe just wanted to calm me down haha I tested my partner's blood once 30 mins after a meal once and she was 8mmol, though pretty sure she isn't diabetic, i hope not!


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## pawprint91 (Jul 19, 2022)

phil90 said:


> no problem. thats good something is working right there.  Guess it depends how big the spikes are. Everyone seems to be different on what is acceptable to them. I think the main thing is just dont stay up high for hours and hours a day. A diabetic nurse told me she wore the libre sensor to test it as a non diabetic and claims she was spiking to 11 for some meals, i dont know about that though, maybe just wanted to calm me down haha I tested my partner's blood once 30 mins after a meal once and she was 8mmol, though pretty sure she isn't diabetic, i hope not!


Considering how high I was spiking pre-diagnosis (I think I would have been lucky to get a single figure reading then, probably not even in the am!) I can handle teen numbers for now, as I have the reassurance I come back down. I'd rather be on insulin and be able to keep them in a better range, but I guess baby steps! Thank you for all your help and advice!!


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## DeeM (Jul 26, 2022)

pawprint91 said:


> Considering how high I was spiking pre-diagnosis (I think I would have been lucky to get a single figure reading then, probably not even in the am!) I can handle teen numbers for now, as I have the reassurance I come back down. I'd rather be on insulin and be able to keep them in a better range, but I guess baby steps! Thank you for all your help and advice!!


I have found this thread so helpful to read - thank you!

@pawprint91 it sounds like we’re on very similar paths. I’m likewise newly diagnosed and also on this (rather unromantic!) ‘honeymoon’, just on basal insulin at the moment, trying to record as much as I can and learn as much as I can from everyone else on here and all the Learning Zone and other links.

I asked a similar question about low carbs on another thread and found it so helpful to be directed to Gary Scheiner’s Think Like a Pancreas - there is lots in there that completely makes my head spin, and I can’t believe how much daily maths diabetes is going to require, but I found it incredibly helpful. But @phil90 has pretty much summed up the key points.

I’ve also cut out the obvious pure sugar stuff and learning that my usual low-ish carb meals don’t spike too badly at all, but it’s only been a few days for me… 

I will be interested to hear what/when the next steps are for you - interesting you are still only on basal a month in. Have you been given any indication when you might start on the bolus side of things?


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## CatTails (Jul 26, 2022)

This is a fascinating thread. I was diagnosed with T1 in 1982, and have been carb-counting ever since. The field of dietetics has expanded so much since then  and as a few folks have mentioned carb-absorbtion rates, I’ll recommend another area to look up when you have a bit of brain space: the GI (ie glycaemic index) of foods. The GL (glycaemic load) is the total carb amount. This sheds some light on why eg 50g of some carbs make your blood sugar rocket more than the same amount of carb taken in a different form… then you can manage spikes by eg having a meal of low carb cheese salad before your slice of cake to slow down blood sugar spikes if you find that high spikes start making you feel rubbish (as they do me). For me, the GI of foods makes a big difference to my blood glucose management as my blood sugars are very volatile and everything from stress to blinking seems to affect my blood sugar levels  But, as seems to be the mantra on this forum, we are all different!


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## DeeM (Jul 27, 2022)

CatTails said:


> This is a fascinating thread. I was diagnosed with T1 in 1982, and have been carb-counting ever since. The field of dietetics has expanded so much since then  and as a few folks have mentioned carb-absorbtion rates, I’ll recommend another area to look up when you have a bit of brain space: the GI (ie glycaemic index) of foods. The GL (glycaemic load) is the total carb amount. This sheds some light on why eg 50g of some carbs make your blood sugar rocket more than the same amount of carb taken in a different form… then you can manage spikes by eg having a meal of low carb cheese salad before your slice of cake to slow down blood sugar spikes if you find that high spikes start making you feel rubbish (as they do me). For me, the GI of foods makes a big difference to my blood glucose management as my blood sugars are very volatile and everything from stress to blinking seems to affect my blood sugar levels  But, as seems to be the mantra on this forum, we are all different!


Yes! Gary Scheiner does mention this in Think Like a Pancreas (which others on here had recommended) and GL is something I’ve known about for a while - in the past it really helped me with portion control and knowing what will help feel fuller rather than creating cravings, so it all makes sense now in terms of glucose management as well.
Last night I tried out the suggestion of eating the protein and fat first and then managed to eat a small portion of gnocchi without having a ridiculous spike afterwards.


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## pawprint91 (Jul 27, 2022)

DeeM said:


> I have found this thread so helpful to read - thank you!
> 
> @pawprint91 it sounds like we’re on very similar paths. I’m likewise newly diagnosed and also on this (rather unromantic!) ‘honeymoon’, just on basal insulin at the moment, trying to record as much as I can and learn as much as I can from everyone else on here and all the Learning Zone and other links.
> 
> ...


 I'm so happy this has helped you. This forum is invaluable to me, so I'm so happy I have been of some help to you, too!

As of today, I am now on bolus insulin too, but a fixed amount and only before my evening meal, and I'm now only having basal in the morning for now. Are you on basal/bolus insulin if you don't mind me asking?


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## DeeM (Jul 27, 2022)

pawprint91 said:


> I'm so happy this has helped you. This forum is invaluable to me, so I'm so happy I have been of some help to you, too!
> 
> As of today, I am now on bolus insulin too, but a fixed amount and only before my evening meal, and I'm now only having basal in the morning for now. Are you on basal/bolus insulin if you don't mind me asking?


So far I am only on basal - one dose in the evening of glargine (Lantus) - but I have the aspart bolus (Fiasp) prescribed for as and when that starts. It is still very early days for me - I have been on the insulin for about 10 days in total and on the Libre for 5 days. My DSN says that I am still in the 'honeymoon' period when my pancreas is still making some insulin and although the numbers go up after I eat they do still come down again. So for the moment he feels that I am fine to stay just on the basal while we figure out the right dose for that. 

This does make me nervous, and I am being quite tentative in trying out the effect of eating the various types of carbs, but I can also see the value in not going too quickly onto the bolus and risking hypos. He likewise said I would then eventually move on to fixed (conservatively sized) doses for the bolus doses to see how that went, but not until it's clear that's needed.

In fact, when I spoke to him yesterday he said that I should dial down the basal a notch to see how I get on. We are due to go to Greece for a week, leaving on Saturday, and he thinks the hotter weather and more activity will mean I don't need as much basal while I am there. 

It sounds like you are on a different basal regime to me, as it was two injections a day rather than one? That sounds like it gives a bit more flexibility in terms of using the bolus for your evening meal while not risking hypos in the night. Do you mind me asking what kind it is?


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## helli (Jul 27, 2022)

@DeeM sounds as if you have a very helpful DSN.

Regarding the honeymoon period, it is not surprising you are still there after only 10 days. I think my honeymoon period lasted about 8 years. It is not uncommon for adults' pancreas to keep limping along for a few years. Over this time, my insulin dose slowly increased and then, finally stabilised. Some people are less lucky and their pancreas has the occasional splutter when it kicks into life for a day or two and then sleeps it off for a week or so. This makes things very unpredictable.


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## DeeM (Jul 27, 2022)

helli said:


> @DeeM sounds as if you have a very helpful DSN.
> 
> Regarding the honeymoon period, it is not surprising you are still there after only 10 days. I think my honeymoon period lasted about 8 years. It is not uncommon for adults' pancreas to keep limping along for a few years. Over this time, my insulin dose slowly increased and then, finally stabilised. Some people are less lucky and their pancreas has the occasional splutter when it kicks into life for a day or two and then sleeps it off for a week or so. This makes things very unpredictable.


Yes, he is great. He seems to be famed in the area for being great and the doctors and patients all just mention him by (first) name. So I am very lucky.

Wow @helli I am amazed to hear that the honeymoon period can go on for that long! I had somehow gathered the impression (not sure from where) that it was more like weeks or a few months at most. Although it sounds like it might be a mixed blessing if it means things can be quite unpredictable?


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## pawprint91 (Jul 27, 2022)

DeeM said:


> So far I am only on basal - one dose in the evening of glargine (Lantus) - but I have the aspart bolus (Fiasp) prescribed for as and when that starts. It is still very early days for me - I have been on the insulin for about 10 days in total and on the Libre for 5 days. My DSN says that I am still in the 'honeymoon' period when my pancreas is still making some insulin and although the numbers go up after I eat they do still come down again. So for the moment he feels that I am fine to stay just on the basal while we figure out the right dose for that.
> 
> This does make me nervous, and I am being quite tentative in trying out the effect of eating the various types of carbs, but I can also see the value in not going too quickly onto the bolus and risking hypos. He likewise said I would then eventually move on to fixed (conservatively sized) doses for the bolus doses to see how that went, but not until it's clear that's needed.


This part of your post totally sounds as though you are describing me! Add to this the fact that I was diagnosed then left to my own devices for three weeks before another appointment showed up, and you can imagine how I felt I am sure! Please can I ask how you managed to get the Libre so quickly? My nurse mentioned it upon my diagnosis but it has never been discussed again - bearing in mind, we are entering the 6th week of my diagnosis (and honeymoon phase) - and today is only the second time following this that I have spoken to my nurse; it wasn't a planned appt, I basically harassed the diabetes team daily until I got her on the phone!


DeeM said:


> It sounds like you are on a different basal regime to me, as it was two injections a day rather than one? That sounds like it gives a bit more flexibility in terms of using the bolus for your evening meal while not risking hypos in the night. Do you mind me asking what kind it is?


Of course not - it's called Levemir. I'm no longer using the evening dose (was only on 1 unit, but that was after a few weeks of trial and error, when I was first diagnosed I was on 8 units morning and pm, which seems crazy now!) as I begin to try evening fixed boluses of 2 units.


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## DeeM (Jul 27, 2022)

pawprint91 said:


> This part of your post totally sounds as though you are describing me! Add to this the fact that I was diagnosed then left to my own devices for three weeks before another appointment showed up, and you can imagine how I felt I am sure! Please can I ask how you managed to get the Libre so quickly? My nurse mentioned it upon my diagnosis but it has never been discussed again - bearing in mind, we are entering the 6th week of my diagnosis (and honeymoon phase) - and today is only the second time following this that I have spoken to my nurse; it wasn't a planned appt, I basically harassed the diabetes team daily until I got her on the phone!


Yes, I felt the same when I saw what you had posted earlier! 

I feel more and more lucky as I hear other people's experiences - I didn't realise that I was getting such a quick response on things, by comparison. I think I must have just had a lucky set of circumstances really, although it didn't start out that way... 

I knew about the Libre and was able to ask about it because someone I know who was diagnosed last year said 'Ask for the Libre!' - so I did. And I think the reason it was agreed so quickly is because I had had an unusually quick confirmation that I am definitely Type 1, from an absolutely unequivocal antibody test, and I was pretty freaked out. And the reason I was pretty freaked out and had got that quick confirmation is because of the relatively unusual way I found out about the diabetes in the first place:

I was out in Australia visiting friends and family eating lots more sugary and carb-y stuff than I usually would have done (daily cake, biscuits, dried fruit, chocolate covered liquorice, crisps, you name it - on holiday and all that) and started getting all the key symptoms (desperate thirst, up all night to the loo, bad leg cramps) plus I was just dropping weight like nobody's business - so went to a local GP, got a finger prick test reading 33 and they diagnosed me with Type 2 and prescribed the highest strength of Jardiamet and to eat no carbs and come back the following week... By day 2 of this I became extremely unwell and after a night of vomiting had to be taken to hospital (45 minutes away as I was deep in rural Victoria) where it turned out my ketones were 7.7. Pretty scary.

By this stage, however, with 24 hours of not eating and vomiting my glucose was right down in the 5s and they managed to stabilise me and get the ketones starting to drop with just a hydration drip and no insulin, so the doctors were a bit puzzled and I think they didn't quite believe the 33 finger prick and still thought I might be Type 2 but had just had a bad reaction to the meds. However, they ran all the full bloods and tests and put an urgent on it, as I was in a foreign land and needed some answers in order to fully stabilise and get home. I've since been told it takes months to get these tests in the NHS, and even in Australia they expected it to take weeks, but somehow it only took 5 days and the endocrinologist I saw was able to tell me that I unequivocally had the antibodies, that my HbA1C was 104 so I'd clearly had it for months, and that I also had Hashimoto's disease, so the whole late onset autoimmune syndrome....

So by the time I saw the DSN, having flown home in a state of shock, I had a full set of test results to show and was fairly freaked out and emotional, and asked about the Libre to help me feel a bit less worried about it all - not sure which of those factors counted or whether I would have got it anyway, because the service is just good where I am!?


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## pawprint91 (Jul 29, 2022)

DeeM said:


> Yes, I felt the same when I saw what you had posted earlier!
> 
> I feel more and more lucky as I hear other people's experiences - I didn't realise that I was getting such a quick response on things, by comparison. I think I must have just had a lucky set of circumstances really, although it didn't start out that way...
> 
> ...


I'm sorry you had such a horrible experience with your diagnosis, but glad you are feeling slightly less worried now. Are you booked in on a DAFNE course do you know? And how are you finding the Libre?


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## DeeM (Jul 29, 2022)

pawprint91 said:


> I'm sorry you had such a horrible experience with your diagnosis, but glad you are feeling slightly less worried now. Are you booked in on a DAFNE course do you know? And how are you finding the Libre?


Thanks! I do feel a lot calmer now. I find the Libre really helps me as I can see exactly what is happening, and am getting bolder about trying out (small amounts of) different types of carbs to see what happens. It's often surprising. Though having comes across a post about 'resistant starch' the other day, I wonder if some of my surprises relate to that - eg. I realised that one of the pasta meals that gave a surprisingly low(ish) rise was one that had been reheated from the day before.

I do find it a bit disconcerting that the Libre is neither accurate to the BG nor consistently inaccurate. But at the moment I'm just trying to do BG fairly often to make the comparison and see if I can figure it out.

DAFNE hasn't been mentioned yet, and I get the sense that it's not available in my area, which is a pity. I would really like to do one. Even if it's online, though I think I'd much rather do it in person.

How about you, @pawprint91? Are you due to go on a DAFNE? How has it been going with your evening bolus dose??


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## travellor (Jul 29, 2022)

DeeM said:


> Thanks! I do feel a lot calmer now. I find the Libre really helps me as I can see exactly what is happening, and am getting bolder about trying out (small amounts of) different types of carbs to see what happens. It's often surprising. Though having comes across a post about 'resistant starch' the other day, I wonder if some of my surprises relate to that - eg. I realised that one of the pasta meals that gave a surprisingly low(ish) rise was one that had been reheated from the day before.
> 
> I do find it a bit disconcerting that the Libre is neither accurate to the BG nor consistently inaccurate. But at the moment I'm just trying to do BG fairly often to make the comparison and see if I can figure it out.
> 
> ...



All meters have an appalling accuracy.


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## grovesy (Jul 30, 2022)

DeeM said:


> Thanks! I do feel a lot calmer now. I find the Libre really helps me as I can see exactly what is happening, and am getting bolder about trying out (small amounts of) different types of carbs to see what happens. It's often surprising. Though having comes across a post about 'resistant starch' the other day, I wonder if some of my surprises relate to that - eg. I realised that one of the pasta meals that gave a surprisingly low(ish) rise was one that had been reheated from the day before.
> 
> I do find it a bit disconcerting that the Libre is neither accurate to the BG nor consistently inaccurate. But at the moment I'm just trying to do BG fairly often to make the comparison and see if I can figure it out.
> 
> ...


In some areas they have alternative courses to DAFNE, that have different names.


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## pawprint91 (Jul 30, 2022)

DeeM said:


> DAFNE hasn't been mentioned yet, and I get the sense that it's not available in my area, which is a pity. I would really like to do one. Even if it's online, though I think I'd much rather do it in person.
> 
> How about you, @pawprint91? Are you due to go on a DAFNE? How has it been going with your evening bolus dose??


I hope you find out about a similar/relevant course in your area, I'm hoping mine will be helpful and shed some light on areas I'm still yet to hear about in terms of my own diabetes management. 

This will be my 4th day of an evening bolus dose, and I would say 2/3 of the previous evenings have gone really well, thank you - had a reading of 6.9 last night and that was after half a pizza for tea!! The one day it didn't go as well I had a reading of 8.3 before bed, but that was down to 6.8 in the morning so it wasn't awful! I certainly feel more confident about eating more 'normally' with it on board.


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## Inka (Jul 30, 2022)

@pawprint91 8.3 isn’t bad! Blimey - long-term Type 1s can get 8.3s at bedtime, and it’s still such early days for you. I know this will seem a million years away but burnout is a real thing. Pace yourself and set reasonable targets. 4 days on bolus and an 8.3 at bedtime is far, far from bad.


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## Proud to be erratic (Jul 30, 2022)

The OP asked can T1s have low carb diets and there is lots in the information following the origin question that basically says yes, if you want to.

Gary Scheiner in his excellent book 'Think Like a Pancreas' points out that our brains only use glucose and if we eat very few carbs then the body will convert proteins and ultimately fats into glucose. As said earlier the conversion rates are not straightforward. But Gary Scheiner also points out that if any meal (not a snack) exceeds 30 gm CHO then the protein conversion doesn't occur. Accepting that the guideline is for adults and that we're all different so it could be +/- 30gms CHO, I make a point of trying to routinely keep above 30 per meal to avoid the protein conversion; I don't think he clarifies if one routinely only has 2 main meals daily whether those 60 gms CHO are sufficient - or 3 meals and 90 gms should be the target.

For your information (comparison if that helps), while I'm T3c following a total pancreatectomy, I'm broadly treated as T1 (without the honeymoon period confusion factor, but with missing hormones and digestive enzymes that went with the total panc'y). I started at a great weight for me, with BMI at 23 so not concerned about my weight but was concerned about obvious malabsorption; carb counting originally was totally distorted by that. I have settled into eating +/- 200gms CHO daily, starting my day with a breakfast of c.100gms; that large starting meal was (and still is) very balanced - including a small amount of cereal, but lots of milk, yoghurt, seeds and nuts (10gms), fresh fruit (3 or 4 varieties) and some prunes.

The issue for me until I got Libre and then much better stability, turned out to be not the amount of carbs but the bolus calculation: 

the carb counting was straightforward; 

correction for being high or pretty low (when necessary) has taken time to feel content with my ratio; my DSN and Endo each felt my 1:2 ratio was too aggressive and encouraged me to soften that - which I tried twice but have reverted to 1:2; so wasn't resolved promptly;

applying an 'activity' factor (how busy / full on was my day going to be?) still feels like guesswork, but I'm getting better with my guesses; initially I had no idea this was going to be such a big influencer and was definitely exacerbating my roller coaster graph;

pre-bolus timing is super critical for me. I'd found by trial and error (for breakfast) that I seemed to need 45 mins between taking the bolus and eating; but I hadn't appreciated that if I'd needed a correction for being too high that my insulin sensitivity meant that I MUST wait before starting to eat for my actual BG  to be at least below 7.5. If I don't wait then invariably I end up high for hours, until I take a further correction. This has meant significant delay to my breakfast and that can become very unhelpful. I'm retired and can accept this consequence, but realise if I was working then I'd definitely need a different strategy and perhaps go for a lower carb different sort of breakfast, eg scrambled eggs and toast, but still getting a minimum of 30 gms CHO.

I use the prunes as a meal regulator (along with the benefits of getting a daily routine). I flash scan not only at the start of eating but at intervals during breakfast; my alarm is set at 5.6 and if this sounds during breakfast I immediately eat some or all the prunes, with their relatively high GI. Otherwise I eat them at the end if my flash scan suggests the insulin is dominating the carbs coming along; sometimes I don't eat them until much later if I'm edging above 8. Happened today.

Sometimes I reflect that it's all become more 'black art' than science - needing to use a high GI supplement to manage the theoretically highly calculated bolus! But the activity factor is necessary, yet part guesswork and the prebolus timing is very much influenced by what my body is doing on anyone day; some of that might be because of being T3c, particularly needing Creon to replace the non-existent digestive enzymes - did I take those at suitable intervals today?

Overall it has taken the best part of 18 months with Libre to find patterns and trends, along with so much help from this forum: some of that help very specific, some just 'background wash'. I did a fair amount of research and book reading, particularly to get a better understanding of my T3c; I do very little research nowadays.


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## pawprint91 (Jul 30, 2022)

Inka said:


> @pawprint91 8.3 isn’t bad! Blimey - long-term Type 1s can get 8.3s at bedtime, and it’s still such early days for you. I know this will seem a million years away but burnout is a real thing. Pace yourself and set reasonable targets. 4 days on bolus and an 8.3 at bedtime is far, far from bad.


Thank you. I am just happy with a single figure to be honest   I know that 8.3 is okay - I think I was more frustrated that on Day 1 I was pretty much back where I started with my pre-meal reading before bed, and then Day 2 I started on a 5 but was an 8- but yes, I appreciate your advice that I probably need to calm down and be patient with myself!! (Something I am not always the best at!)


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## pawprint91 (Jul 30, 2022)

Proud to be erratic said:


> applying an 'activity' factor (how busy / full on was my day going to be?) still feels like guesswork, but I'm getting better with my guesses; initially I had no idea this was going to be such a big influencer and was definitely exacerbating my roller coaster graph;


Thank you again for taking the time to write another thorough and helpful reply to one of my posts. Activity seems to affect me quite a lot at the moment - after lunch with a friend yesterday (I started at 9 because I made the mistake of having a snack), I spiked at 14. My friend seemed a bit concerned, until I reassured her that after an intensive uphill walk home plus some shopping on the way I would be fine. Sure enough, 3 hours later, I was a 5.8. 


Proud to be erratic said:


> Sometimes I reflect that it's all become more 'black art' than science - needing to use a high GI supplement to manage the theoretically highly calculated bolus! But the activity factor is necessary, yet part guesswork and the prebolus timing is very much influenced by what my body is doing on anyone day; some of that might be because of being T3c, particularly needing Creon to replace the non-existent digestive enzymes - did I take those at suitable intervals today?
> 
> Overall it has taken the best part of 18 months with Libre to find patterns and trends, along with so much help from this forum: some of that help very specific, some just 'background wash'. I did a fair amount of research and book reading, particularly to get a better understanding of my T3c; I do very little research nowadays.


I feel like I have a lot to learn - but as @Inka has so kindly said, I think I need to pace myself a bit. I don't know if I'll learn more in my upcoming DAFNE course, but I feel like the nurses make it seem far more straightforward than perhaps it actually is when we are living with it! (But perhaps to begin with, that's a good thing!)


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## Inka (Jul 30, 2022)

pawprint91 said:


> Thank you. I am just happy with a single figure to be honest   I know that 8.3 is okay - I think I was more frustrated that on Day 1 I was pretty much back where I started with my pre-meal reading before bed, and then Day 2 I started on a 5 but was an 8- but yes, I appreciate your advice that I probably need to calm down and be patient with myself!! (Something I am not always the best at!)



But that all makes sense. When you first start insulin/bolusing, you always err on the side of caution, so your ratio will probably be slightly off. That is good. Your priority should be to avoid hypos. More than that, many Type 1s are advised to be at least 8 before bed, so your result wasn’t out of the ordinary anyway  

The target levels for Type 1 are very different to those for diet-only Type 2s. We don’t have a 2hrs after-meal target, for example.

The biggest things to get your head around - and I speak from experience here - is that perfection is impossible, and there is no ‘answer’. You could spend hours a day calculating carbs, GI, micronutrients, ratios, digestive speed, calories burnt through exercise or whatever, think you’ve got the answer - and then things change again a few weeks later! Or the next day!! It’s that relentless changing that’s a big part of the burden. If we just had to take 5 injections of X amount of insulin a day and eat X amount of carbs, that would be a walk in the park! But it’s not like that. It’s a pretty constant process of tweaking, changing, things going well, things going badly (even though you’ve done exactly the same thing), getting things ok only to see them all go wrong again. It’s a pain in the bum, frankly, but accepting that does reduce the stress and pressure.


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## DeeM (Aug 5, 2022)

Inka said:


> But that all makes sense. When you first start insulin/bolusing, you always err on the side of caution, so your ratio will probably be slightly off. That is good. Your priority should be to avoid hypos. More than that, many Type 1s are advised to be at least 8 before bed, so your result wasn’t out of the ordinary anyway
> 
> The target levels for Type 1 are very different to those for diet-only Type 2s. We don’t have a 2hrs after-meal target, for example.
> 
> The biggest things to get your head around - and I speak from experience here - is that perfection is impossible, and there is no ‘answer’. You could spend hours a day calculating carbs, GI, micronutrients, ratios, digestive speed, calories burnt through exercise or whatever, think you’ve got the answer - and then things change again a few weeks later! Or the next day!! It’s that relentless changing that’s a big part of the burden. If we just had to take 5 injections of X amount of insulin a day and eat X amount of carbs, that would be a walk in the park! But it’s not like that. It’s a pretty constant process of tweaking, changing, things going well, things going badly (even though you’ve done exactly the same thing), getting things ok only to see them all go wrong again. It’s a pain in the bum, frankly, but accepting that does reduce the stress and pressure.


Again, this thread is so helpful - I am learning such a lot from everyone on here with so much more experience. The bit @Inka has said about the priority being to avoid the hypos - I don’t think I have fully understood that before, but this was also a key point in another article I read recently from a diabetes consultant. It seems obvious now, but because I haven’t yet experienced a severe hypo but had experienced the ketoacidosis I guess I was just focusing on that side of things more.


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## DeeM (Aug 5, 2022)

Inka said:


> But that all makes sense. When you first start insulin/bolusing, you always err on the side of caution, so your ratio will probably be slightly off. That is good. Your priority should be to avoid hypos. More than that, many Type 1s are advised to be at least 8 before bed, so your result wasn’t out of the ordinary anyway
> 
> The target levels for Type 1 are very different to those for diet-only Type 2s. We don’t have a 2hrs after-meal target, for example.
> 
> The biggest things to get your head around - and I speak from experience here - is that perfection is impossible, and there is no ‘answer’. You could spend hours a day calculating carbs, GI, micronutrients, ratios, digestive speed, calories burnt through exercise or whatever, think you’ve got the answer - and then things change again a few weeks later! Or the next day!! It’s that relentless changing that’s a big part of the burden. If we just had to take 5 injections of X amount of insulin a day and eat X amount of carbs, that would be a walk in the park! But it’s not like that. It’s a pretty constant process of tweaking, changing, things going well, things going badly (even though you’ve done exactly the same thing), getting things ok only to see them all go wrong again. It’s a pain in the bum, frankly, but accepting that does reduce the stress and pressure.


I also so appreciate the advice about not aiming for perfection, with all the complex variables and algorithms to take into account.


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## Inka (Aug 5, 2022)

DeeM said:


> I also so appreciate the advice about not aiming for perfection, with all the complex variables and algorithms to take into account.



It’s not just the complexity, it’s the _extremely_ annoying change-ability too. It’s so frustrating! Knowing things can change helps you deal with it and be as ready as you can be.

Severe hypos are awful, and best avoided as much as possible. Because our target range is so close to hypo territory, it does make it hard. I try to have a buffer zone so I’m a bit further away from a hypo, but even then s**t happens so it’s hard to avoid them completely. Always err on the side of caution and always be prepared for a hypo by having treatment with you.


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## DeeM (Aug 5, 2022)

Inka said:


> It’s not just the complexity, it’s the _extremely_ annoying change-ability too. It’s so frustrating! Knowing things can change helps you deal with it and be as ready as you can be.
> 
> Severe hypos are awful, and best avoided as much as possible. Because our target range is so close to hypo territory, it does make it hard. I try to have a buffer zone so I’m a bit further away from a hypo, but even then s**t happens so it’s hard to avoid them completely. Always err on the side of caution and always be prepared for a hypo by having treatment with you.


Thank you. It does all sound and feel like walking a tightrope in the wind! 
It feels especially annoying that something that could be so helpful - exercise - is also such a tricky complicating factor in all the calculations.


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## Inka (Aug 5, 2022)

Absolutely! And it can be off-putting too, worrying about having a hypo if you exercise ‘too much’. In this hot weather, I’ve cut my exercise back because my blood sugar is dropping super-fast, but even in normal times it can make exercise seem like a major chore because of the diabetes.


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