# newbie! not sure how this works!



## southerner12 (Oct 10, 2014)

hey there!
I am new to this so not really sure how it all works! 
it seems like a good place for advice, and I like the idea of talking to people who can fully understand the condition.  There also seems to be a lot of info on here!
I myself don't really understand the condition very well. I actually have steroid induced diabetes, and only found out in july after being rushed to resus with blood sugar levels of 44!
I inject insulin 4 times a day as a result. 

I couldn't select steroid induced diabetes as an option, but would love to know if anyone else has any useful information, or even tips or advice.


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## Northerner (Oct 10, 2014)

Hi Southerner12, welcome to the forum  Very sorry to hear about your diagnosis  What insulin are you on? 

I don't personally have much knowledge of steroid-induced diabetes, but I am sure that there will be people here who know more. I do know that steroids can play havoc with blood sugar control though - are you still on them?


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## southerner12 (Oct 10, 2014)

hi
thanks for the response!
I take novorapid 3 times daily, then lantus once daily!
unfortunately yes I am still on them. I have been on them for over 5 months now following a liver transplant I had in may!
they are trying to wean me off them but this has to be done gradually.


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## southerner12 (Oct 10, 2014)

the worrying thing is I don't really know much about it at all. 
for eg, I don't know whether I have to inject insulin if I have something small to eat like an apple? if I don't my blood sugar does tend to shoot up.. but If I do I don't know how much you are meant to inject. 
it all seems so confusing to me


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## Redkite (Oct 10, 2014)

Welcome to the forum Southerner12 (bit of a North/South conversation in this thread!) 

Have you been told whether your need for insulin will be permanent?  The reason I ask is that there was a little boy at one of our local support groups (years ago) with steroid induced diabetes, and his Mum had been led to believe that he may recover beta cell function and insulin sensitivity if/when he was able to come off the steroids.


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## Redkite (Oct 10, 2014)

southerner12 said:


> the worrying thing is I don't really know much about it at all.
> for eg, I don't know whether I have to inject insulin if I have something small to eat like an apple? if I don't my blood sugar does tend to shoot up.. but If I do I don't know how much you are meant to inject.
> it all seems so confusing to me



Has your healthcare team given you an insulin ratio to use, e.g. 1unit of insulin per 10g of carbohydrate?  If so, you can count the carbs in what you eat, and inject insulin to match.  An apple would be around 10g of carb.  The book and app "Carbs and Cals" is brilliant - lots of meals and snacks photographed in different portion sizes with the carb content.


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## southerner12 (Oct 10, 2014)

haha yes I noticed that lol
they cant give a definite answer until I have come off them completely. 
I was on 40mg pred when I was diagnosed
at the moment I am only on 5mg, so it has reduced a lot, however I am still in need on insulin therapy 4 times daily. 
so I am not really sure what is going to happen. 

praying I can eventually stop injecting! finding it quite painful, and keep bruising, is this normal and does it get any easier/ does the bruising stop?
and no they haven't actually told me anything like that. 

after being diagnosed I was discharged with all the testing kit/ insulin/ needles/ sharps box etc I then saw them in clinic the following week where they gave me a magazine thing on type 1, (as they were not certain if it was type 1 or steroid induced) then I saw them 1 time after to get the results of my bloods confirming it was steroid induced but I have not had any contact with them since! (this was early august!)


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## Northerner (Oct 10, 2014)

southerner12 said:


> the worrying thing is I don't really know much about it at all.
> for eg, I don't know whether I have to inject insulin if I have something small to eat like an apple? if I don't my blood sugar does tend to shoot up.. but If I do I don't know how much you are meant to inject.
> it all seems so confusing to me



Are you on fixed doses of the novorapid? Have you been taught how to 'carb count'? This is a method of matching the carbs in the food you eat to the insulin doses, and also how to do 'corrections' in order to bring your blood sugar levels under control when they go too high. You can read about it here:

https://shop.diabetes.org.uk/usr/downloads/Carbs-Count-2012-reduced.pdf

But you really need to speak to a DSN (Diabetes Specialist Nurse) before trying this, if you haven't already.

It is confusing at first, as there are no really hard and fast rules - everyone will have slightly different responses to each other, but there are general principles, and you learn by testing a lot and through experience. Please ask any questions you have and we will try to help!


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## southerner12 (Oct 10, 2014)

yes I am on fixed doses. 
but this in itself is confusing as I do not eat the same food/same amount every mealtime and this evidently affects my blood sugar levels.

some mornings I will only have a slice of toast, but then end up getting low blood sugar by about 11am-12pm.

or if I have quite a big meal or something that is quite sugary, my blood sugar goes high. 

I haven't been taught how to adjust doses, or whether I should in the first place, but surely it would make more sense since my diet is not consistent in that respect.
thanks, I shall read that now!


also- how many times should you test a day ideally?


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## Northerner (Oct 10, 2014)

Southerner, you need to go back to your doctor and ask for someone to teach you about dose adjustment. It is appalling that you have been through what you have been, and then are being left to soldier on for so long!

You are absolutely right that, if you eat different amounts of carbs then you need to have different doses of insulin. You should be testing when you wake (for your fasting level), before you eat, if your levels feel low at any time, and before you go to bed. These are the minimum tests to do. What sort of readings are you getting, and when do you test currently?


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## Redkite (Oct 10, 2014)

Re the painful injections and bruising, what length of needles are you using?  You may find 4-5mm needles better.  Are you pinching up a fold of skin to insert the needle into?


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## Northerner (Oct 10, 2014)

By the way, the fact that your diabetes is steroid-induced should have nothing to do with your care - you are on precisely the same insulin regime as most Type 1 diabetics and should have access to a consultant and a DSN.


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## southerner12 (Oct 10, 2014)

im struggling to get my head around it all, and my parents know even less than I do about the condition so I currently feel like I am trying to manage everything by myself without having support from a medical professional, which obviously makes me anxious. (I have only really just turned 17). 

so should everyone with diabetes adjust there dose?

and in the past month or so my lowest has been 2.5, and my highest has been 19.3 (could definitely feel that the levels weren't normal at these 2 points)

it usually stays between around 3.4 to 10.4 ish depending on what I have eaten. it does seem all over the place at times however it does average out.
however as previously stated, it varies quite a lot depending on what I eat, and how much I eat.
I seem to have a pattern however:

funnily enough I usually have low blood sugar around late morning (11am ish) and it is usually highest after lunch before dinner. (3pm ish) and it can sometimes remain high after dinner. First thing in the morning my blood sugar is usually around the 5 or 6 mark which is normal!

should probably also mention in the past month my prednisolone has been reduced by about 10mg. 
(so blood sugar thankfully hasn't reached near 19 since)

and thankyou for letting me know that!  
currently I test just before meals. in morning. however I don't tend to test before bed, I shall start doing that. 

what do I do if I test say around midday and my blood sugar is really high? do I administer insulin or do I just wait to take insulin before my next meal?


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## southerner12 (Oct 10, 2014)

Redkite said:


> Re the painful injections and bruising, what length of needles are you using?  You may find 4-5mm needles better.  Are you pinching up a fold of skin to insert the needle into?



im not sure what size the needles are but they seem pretty large. to change the size do I just ask the gp? and I don't pinch my skin, would you suggest to do so?


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## Redkite (Oct 11, 2014)

The needle length should be printed on the box of needles and probably also on each needle's paper seal.  Doctors often automatically dish out 8mm or longer needles, but you can ask your GP to change this on your prescription.

When my son was on injections we were taught to pinch up some flesh so that the needle would only go into the subcutaneous fat layer and not into muscle below that.  But this may not be necessary with the short needle lengths.


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## Tina63 (Oct 11, 2014)

And reading about the lack of education from your team, have you actually been taught how to treat a hypo (low reading below 4)?


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## Northerner (Oct 11, 2014)

southerner12 said:


> ...what do I do if I test say around midday and my blood sugar is really high? do I administer insulin or do I just wait to take insulin before my next meal?



I'm even more appalled at the lack of advice you have received, given your age  

The key to blood sugar control is finding out how different meals affect you. To do this, I would suggest starting a food diary. Note down your blood sugar reading before eating and work out the amount of carbohydrate in what you intend to eat (also note what the actual food is!). Take your insulin then test again 2 hours after eating - this should give you an indication of how quickly the food has digested and how much it has raised your levels. If your levels are around the same or lower at the 2 hour mark then the chances are that your dose was too high for the amount of carbs you ate. If they are much higher then it is likely that the dose was too low. However, you would need to  repeat this procedure on more than one day to get a better picture of what is happening when you eat that particular meal, as there can be other factors involved.

Follow this for each of your meals. Eventually, you will learn what dose you generally need for a particular meal - as you are learning it's a good idea to keep your meals boring and simple so there are fewer factors to consider.

I have found that I tend to eat meals with similar amounts of carbs in them, so my doses for each meal tends to be similar each day - you may find this also, and if so it makes life much easier! I usually have toast in the morning, a sandwich and yoghurt for lunch and an evening meal with a similar amount of carbs each day from either rice, potatoes, pasta or bread.

What sort of meals do you normally eat?

The answer to your question about what to do if high at midday will depend on two things: 1) How long since you last ate (as your novorapid might still be working to lower your levels) and 2) How long until your next meal. Personally, I tend to just wait until the next meal and if still high then I increase my insulin dose by an appropriate amount - but you would need to discuss this and find out what 'an appropriate amount' would mean in your case, as people vary.

Hope that helps a little, but do insist on seeing either a diabetes consultant or specialist nurse so you can discuss the problems you have been encountering and how best to tackle them. Let us know how you get on!


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## jalapino (Oct 11, 2014)

A warm welcome!

You have most definitely not been getting the best care!!!

In my opinion you have been left in the dark with not even a candle to find your way around!....nice one NHS!


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## southerner12 (Oct 14, 2014)

Tina63 said:


> And reading about the lack of education from your team, have you actually been taught how to treat a hypo (low reading below 4)?



I read online that you're meant to have something like 250ml full fat coke, or like 7 jelly babies or something, test 20 mins later then if its not gone up much you repeat or something like that? not sure if this is correct or not though


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## southerner12 (Oct 14, 2014)

Northerner said:


> I'm even more appalled at the lack of advice you have received, given your age
> 
> The key to blood sugar control is finding out how different meals affect you. To do this, I would suggest starting a food diary. Note down your blood sugar reading before eating and work out the amount of carbohydrate in what you intend to eat (also note what the actual food is!). Take your insulin then test again 2 hours after eating - this should give you an indication of how quickly the food has digested and how much it has raised your levels. If your levels are around the same or lower at the 2 hour mark then the chances are that your dose was too high for the amount of carbs you ate. If they are much higher then it is likely that the dose was too low. However, you would need to  repeat this procedure on more than one day to get a better picture of what is happening when you eat that particular meal, as there can be other factors involved.
> 
> ...



this is really good advice, thank you. I shall definitely start a food diary. As for the meals I usually eat, is either a cereal bar and a banana for breakfast, or a bowl of cereal. lunch is usually a sandwich,some fruit, a pack of crisps and a bottle of sugar free fruit shoot. dinner depends, but it could be things like fish or chicken, with either pasta, roast potatoes, new potatoes, rice, or spaghetti. or sometimes I have something like a chicken ceaser wrap, or macaroni cheese, spag bol.. things like that. 

I am going to be getting in contact with the clinic I think. I saw my consultant in august and her response was "I don't need to see you for four months" (DECEMBER!!) bearing in mind I was diagnosed late july, and this was only a couple of weeks after my diagnosis!


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## southerner12 (Oct 14, 2014)

jalapino said:


> A warm welcome!
> 
> You have most definitely not been getting the best care!!!
> 
> In my opinion you have been left in the dark with not even a candle to find your way around!....nice one NHS!



Thank you for the welcome
and no, it is definitely very disappointing. haven't been particularly lucky with the NHS regarding diabetes care.
the week prior to my diagnosis I even went to the doctors 3 TIMES. I went on the Monday, Thursday, and the Friday! I felt so poorly and could barely walk because I thought I was going to collapse, my breathing was really fast for some reason, my pulse was 115 RESTING (taken in appointment) then if I literally just stood up from the chair it went up to 130! I was throwing up, and felt incredibly dizzy, yet they said they couldn't find anything wrong. Friday after again being turned away by the doctors my transplant nurse sent me to a&e, where I went straight to resus with a bm of 44 and was very dehydrated (which I didn't think was possible because I was drinking A LOT because I was very thirsty). even had people from intensive care checking up on me. was a v. scary time. Would be useful if dr's actually listened when things are clearly wrong. I am not one to complain about my health and am no hypochondriac, but you know your own body and when something is wrong you expect to be listened to. 

at least now people will hopefully take me seriously. They probably thought I was just another teenager making a big deal out of nothing.


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## Northerner (Oct 14, 2014)

southerner12 said:


> I read online that you're meant to have something like 250ml full fat coke, or like 7 jelly babies or something, test 20 mins later then if its not gone up much you repeat or something like that? not sure if this is correct or not though



The general rule is 15g of fast acting carbs, which is 3 jelly babies or 150ml of full fat coke (you can get mini cans which hold just the right amount) - or anything really, most sweets are OK as long as you know their carb content and they can be eaten quickly to get into your system. Avoid things like chocolate or things that need a lot of chewing as these may not work fast enough. Then, test after 15 minutes to ensure levels are rising.



southerner12 said:


> I am going to be getting in contact with the clinic I think. I saw my consultant in august and her response was "I don't need to see you for four months" (DECEMBER!!) bearing in mind I was diagnosed late july, and this was only a couple of weeks after my diagnosis!



Do please get in touch with your clinic, they really ought to be doing more for you than this! Whether they believe it to be temporary or not, whilst you are on insulin you need to know how to use it properly and what to do if things go wrong 

Regarding the food diary: the main thing to look at is the amount of carbs you are eating. I eat 'medium carb' which is around 100g-150g a day. If you find you are eating a lot more than this then you may need to make adjustments e.g. eating more veg and fewer potatoes


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