Re: Trouble with beans?
- From: "oldal4865" <oldal4865@xxxxxxxxx>
- Date: Mon, 6 Feb 2006 19:09:29 -0500
LisaKirkman@xxxxxxxxx wrote in message
<1139260055.456937.47740@xxxxxxxxxxxxxxxxxxxxxxxxxxxx>...
Hi All,.. . .(snip). . .
I am new to the group and new to diabetes. I was just diagnosed at 34
with T1. My first week with Lantus long-acting and Novolog
short-acting went pretty well, though I need to make some adjustments
to protect against hypos--got candybars in my purse for the first time
in my life!
But even after 13g of carbs in an ice cream bar, it took FOREVER to
climb back up (OK, forever=four hours). Now in the morning, I'm way
high at 200 FBG.
Thanks,
-Lisa
A few things to think about:
1. ". . . .to protect against hypos--got candybars in my purse . . ."
". . . after 13g of carbs in an ice cream bar, it took FOREVER. . ."
Among the worst sources of carb for fighting a T1 hypo are those based on
chocolate and/or ice cream.
Fat slows the carb absorption. You want pure glucose for speed.
You can buy glucose tabs at any pharmacy (a bit pricey), or (cheap)
Smarties candy in the U.S. U.S. Smarties are individually wrapped and
essentially pure glucose. Smarties produce a response in 11 minutes on
an empty stomach for me, a bit longer if there's fat in there. A 150
lb T1 would expect to see a 5 mg/dL jump for 1 gram glucose; a 125 lb T1
would expect to see about a 6 mg/dL jump for 1 gram glucose.
Read the label if you buy Smarties. Some are 5 gram glucose per roll,
some are 7 gram glucose per roll.
Surprise: pure table sugar breaks down into 50% glucose and 50% fructose.
The carb in sugared soda pop is about 45% glucose and 55% fructose. Only
the glucose counts, fructose is useless for bringing you out of a hypo.
2. Young T1, (like you) and especially skinny T1 commonly exhibit a
carb/insulin ratio of about 15 gram carb per unit insulin, i.e. you shoot 1
unit insulin bolus for each 15 gram of carb in an upcoming meal. (You
have to find your own ratio by trial and error, the 15:1 ratio is a
starting point.)
For youngish, skinny T1, five units of Novolog should cover about 75
gram of carb. That's a fairly hefty helping of carb, e.g. a full plate
of spaghetti. Old chubbos like me would shoot about 8 units for 70 gram
in a spaghetti meal.
3. One definition of a low used by many docs is a sugar below 70 mg/dL.
They call a hypo a sugar below 50 mg/dL IOW, by many standards, your 55
mg/dL meant that you went very low but not hypo.
4. You didn't say who was helping you set your basal dose (Lantus). That's
about the toughest set of insulin decisions for a T1. A rule of thumb is
0.2 units per day per kg body weight.
I suggest that you seek out a Certified Diabetes Educator (CDE) nurse to
help you with your dose patterns. The odds are that he/she will be better
than a doc. CDE nurses do this all day, every day and have the time to
deal with your problems.
Note that many folks only see 19 hours activity from Lantus. That puts
them into danger of "basal fade" when the Lantus wears off. Basal fade
means a sudden jump in bG, perhaps to 300 mg/dL when the basal wears off
(unless of course you still have some Novolog dribbling into your blood).
You fight basal fade from Lantus by splitting your total daily dose into two
shots, spaced about 12 hours apart.
We T1 must keep our level of circulating insulin about 8-12 microUnits/L to
avoid basal fade. You can't "calculate" a dose pattern needed to do that;
you find out by trial and error, i.e. what kind of dose schedule do you
need to avoid that sudden "mystery high".
5. "Morning Effect" can be gruesome for a T1. Setting your basal so that
your 7 a.m. bG is not too far removed from your 3 a.m. bG which is not too
far removed from your midnight bG is a difficult problem. Again, we solve
it by trial and error. Of course, trial and error means you must test at
midnight and 3 a.m. until you get it right.
My morning effect is fierce. I can be 100 mg/dL at 5 a.m. and 200 mg/dL at
7 a.m. if things aren't going well. No sleeping in for me. My sugars
start to rise as soon as I wake up.
The techniques used by the Insulin Pump folks are good to know. They have
MDI (Multiple Daily Injection) down to a fairly exact science.
http://www.insulin-pumpers.org/
6. Oatmeal is a high carb-fast carb meal. I eat it every day as a
Heart-Smart breakfast but it's almost like a military exercise, i.e.
a. Check my bG
b. Inject Humalog
c. Wait till the Humalog starts working and I start going low.
d. Eat the oatmeal
e. Exercise to keep the spike down
For a T1, "Pasta is your friend" I often see a small drop (compared to
bG immediately before eating) in bG at 2 hours after eating pasta.
7. March is National Diabetes "Something-or-other" Month. November is
National Diabetes "Something-Else" Month. Many diabetic training
facilities have free Diabetic Expos' during either March or November.
Keep your ears open; find one; attend. Free medical lectures and
exposure to the best CDE nurses in the area!
(Hey. . ."free" and "medical" in the same sentence. . .can't beat that)
Find a CDE and get to know him/her. You'll live longer.
Keep coming back.
Regards
Old Al
.
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