Hello. I am new to this site so hopefully I'm posting in the correct area. I'm 23 and was just diagnosed with Type 1 diabetes three months ago. I'm still learning new things and trying to get used to everything but I have a question I was hoping could be addressed by some seasoned diabetics. Right now I am counting carbs and injecting insulin before meals along with a long-acting insulin once each evening. My numbers are usually consistent throughout the day, but are always high after breakfast even when I correctly count my carbs and administer insulin. Here are two scenarios: one morning my blood sugar was 89 before breakfast and I was eating 40g of carbs (a bowl of cheerios and 1 cup of milk). Based on my calculations I gave myself 1 unit of insulin. (My carb ratio is 30g = 1 unit and my correction factor is 90). Two hours after breakfast I checked my blood sugar and it was 286. Another scenario: my blood sugar was 101 before breakfast and I was eating 26g of carbs (2 waffles), using the same calculations I gave myself 1 unit of insulin. Two hours after eating my blood sugar was 215. I am really surprised by these numbers. I guess I don't understand how 26g of carbs can make my blood sugar rise by 114 even when I give myself insulin. I spoke to my doctor about this but he didn't seem concerned. He informed me to stop checking my blood sugar after 2 hours (which is what I was originially told) and only check it before meals and before going to bed at night. I'm not sure if I agree with his thought process on the matter because I'm worried that being this high after breakfast will cause me complications down the road. Does anyone else have this problem or have any thoughts/ideas on the topic? Thank you so much in advance!
There's no reason your 2hr. post meal numbers can't be good. It's concerning that your doctor said to stop checking your 2hr. post meal glucose. You might want to find a better doctor.
Carb counting isn't an exact science. Sometimes you have to experiment and figure out how much insulin you personally need to cover a specific food.
A lot of people have insulin resistance in the mornings. So you might need to change your carbohydrate factor at breakfast. Check with your doctor, but you might try 1unit of insulin for every 15g or some similar number until you find the sweet spot.
Because of insulin resistance a lot of people with diabetes avoid certain foods in the morning. I usually don't eat most cereals, juice or waffles for breakfast because it's just not worth the blood sugar spike. If you really love a certain breakfast food then experiment and find the amount of insulin needed to cover it.
Caffeine also causes insulin resistance so keep that in mind if you have coffee in the morning. I usually take a few units of insulin to cover a cup of coffee with Splenda, even though the carb count wouldn't indicate that's necessary.
Many people with diabetes have dawn phenemonon. That's where your liver releases glucose in the early morning hours, causing your base insulin needs to increase. Because you wake up with normal blood sugars that's not probably what you're experiencing. But if you ever have ongoing unexpected highs first thing in the morning, mention it to your doctor.
There are a couple of great books that can help you understand some of the details of insulin therapy. "Think Like a Pancreas" by Gary Scheiner or "Using Insulin" by John Walsh.
Hope this helps. -Jenna
Thank you so much for the information! I had been wondering about changing my carb ratio for breakfast. I have also been finding ways to make my breakfast more balanced. With lunch and dinner it's easier to incorporate protein but I always find it harder with breakfast, especially since I'm on the go and don't have a lot of time to prepare food. Usually when my meal is more balanced I don't have spikes.
Thanks again! -Kristen
Every persons response to insulin is a little bit different. You have to find out what carb count works for you - specifically. I like to eat pasta with marinara sauce, garlic bread and I have to account for that when I take my Humalog insulin. When I eat 4 ounces of pasta and 3 ounces of marinara sauce with two pieces of wheat bread I usually take 9 units of insulin for this meal. The carbs equal out to 54grams. I weigh 148 lbs and I am of slender build. I have been trying to gain weight since I was in high school, but it has not happened. I usually eat about 2500 - 3000 calories a day to keep my slender build. If I eat less than 2500 calories per day I lose weight. I cannot wait for my metabolism to slow down. I saw in your question that you are eating a cup of milk with your cereal. I use 2% milk so I can get a little more fat in my diet. You do know that once fat is digested it turns to sugar. I hope you are also on Lantus, a no peak insulin. I take 32 units of Lantus each morning, instead of in the evening. I get better results this way. The doctor you are going to does not sound like he is giving you good advice. Is he or she an endocrinologist which is the type of doctor you should be seeing. Just make sure you have something sweet with no fat in it like skittles, they usually get into blood sugar in about 15-20 minutes. If the sweet treat has fat in it it will take longer to get into your blood sugar, because the body will breakdown the fat before the sugar. Your carb ratio of 30g = 1 unit sounds like it needs to be adjusted. If I where you I would increase my insulin to 3 units in the morning and see what that does for your blood glucose levels. Learn as much as you can about your food so that you can be an informed diabetic. Counting carbohydrates is a good place to start, but I would try to find out how you respond to the carbs yourself - everybody reacts differently. Hope this helps you out. Anymore questions you can email me email@example.com.
Thanks for the response! What is your carb ratio, if you don't mind me asking? I do take Lantus, 10 units in the evening and Humalog before each meal. My doctor is an endocrinologist, I was thinking maybe since I'm newly dignosed he was just waiting to see how things are working out. I was considering switching to another doctor in the practice. I really would just like my blood sugar to be more controlled. My numbers are all over the place and I fear complications. I'm currently in nursing school so I am always paranoid about the complications since we are constantly learning about them in school. I'm getting my next A1c level this week so hopefully it will be an improvement from my last one. Thanks again for your advice, I really appreciate it! -Kristen
I agree there should be no reason you can't have good numbers 2 hours after eating. That whole thing about not checking your blood sugar after you eat is crazy talk in my mind. I've never heard a doctor tell me to check less! I say you can't check enough, but know what insulin you have in your body, how much, and when you took it.
It may also help to really understand how insulin works in your body, how fast it works. When I was first diagnosed I just used the doctor's recommended ratios and correction factors. But as time went on, I just knew there could be tighter control. So I did a few tests on my own to figure out how my body dealt with insulin. I was on a 9 hour car trip where I was really just sitting there. Not using any energy that would affect my blood sugar. I checked my glucose and I was 110. Awesome. Then I ate a prepared snack with exactly 30g of carbs. I didn't take any insulin and waited for 2 hours. I checked my blood sugar and it read 172. So then I did some math. Ok, for every 10g of carbs, my glucose rises about 20 points. So from there I took some insulin. I took 4 units of insulin and waited another 2 hours. Then checked my glucose and it read 93. So then a little more math and I figured my correction ratio would be about 1 unit for every 20g of carbs. Ever since I figured this out my dosages and results after eating have been tighter than ever.
I'm not a doctor and I also don't condone eating without taking insulin, but in this case it gave me the knowledge I needed to figure out my dosage to carb ratios and life is a little easier.
To your point about breakfast though, I have a similar issue with mornings and my blood sugar. I have had several mornings where I'd wake up at 120 and just an hour later without eating a single thing be over 200. Some doctors have told me that it's an affect that happens when you wake up and your body releases adrenaline like hormones to wake you up and start the day that naturally elevate you glucose. Now that doesn't fit in my ratios! Kind of annoying! =)
Thanks for your response! It's awesome that you were able to figure out your carb ratio and correction factor like that. I was thining about changing my calculations as well. When I was first told about carb ratios I was under the impression that everyone followed the same ratio but have learned that isn't the case. It also does make sense to me that your body releases glucose as energy in the mornings. Just makes things more difficult I suppose! Thanks for the information, I've learned so much on here! -Kristen
I had the same problem with mornings and blood sugars. (seems to be a common theme around here) Like Ryan said hormones in the morning when waking up can make our blood sugars get all whacked out.
Having said that it is a lot of trial and error with different types of foods. After a while you will learn which foods cause huge spikes and will be able to adjust accordingly. But, you won't know until it happens. I know you said you take insulin before you eat a meal but, how long before each meal? Recommended is 15 minutes but, for foods like cereal maybe you could try 20 min? I don't know why your doctor told you not to keep checking at 2 hours because that really gives good information on how food is affecting your blood sugars. I would continue to do it because it will help you figure out the cereal/milk combo.
While I love my cereal foods, I do try to stay away from it because it does cause those pesky spikes. I am not really a breakfast food eater but the foods I usually have a good relationship with are english muffins with eggs or peanut butter, cream cheese or butter, whole wheat toast/egg or peanut butter. The reason I use peanut butter is because when I was going to work everyday it was easy and fast and I could take it on the go. I also like to have yogurts or sometimes a meal replacement like ensure because i am not huge on milk products or a vitamin taker and it gives me the nutrients i need. I try to stick to the things that work because it takes all that guess work out of everything.
Also, you should talk to your doc about the possibility of going on the pump in the future because that can also help better with higher blood sugars in the mornings and other times during the day. You could need different carb ratios for meals and snacks as well. I have three different carb ratios and 8 different basals. I just had a baby in November and without the pump I would never have been in the control i had without a pump!
I hope this helps a little!
Are you on lantus (a long lasting insulin) as well? If so, what I find when I use lantus is there is a window as it wears off where I begin to run higher numbers. And in that case it is just a matter of taking the lantus on time.
What I take from this is as a newly diagnosed Diabetic you want to be on top of things, which is awesome but your numbers are going to fluctuate, possibly even tremendously until you fall out of the "honeymoon period" lasting anywhere from a few weeks to a year. It is likely the reason he is telling you not to take your blood sugars as much is so you don't obsess over your diabetes. You will burn yourself out! Trust me I have 12 years of diabetes under my belt with an a1c of 7.1 it takes work and dedication to keep blood sugars under control. Diabetes should not be your life! What I would say to do is wait it out a little bit and see how your blood sugars even out. These high numbers could be because the sky is blue. Good Luck!
I do not have a carb ratio. I usually eat the same meals during the week and have keep a journal of my intake and my insulin to keep track. I also take a nutrition course every few years to see what information has changed in the food world. I have been a type 1 diabetic since 1982 when I was 13. I use to keep my A1C around 6.8 until I was having too many hypoglycemic episodes. I now try to keep my A1C around 7.5 and this seems to work much better with my physically demanding job. If you do not know I am a "brittle" diabetic and with my body mass not being as much as I would like it to be makes my glucose fluctuate quickly. I always have something sweet with me where ever I am. Trying to keep you blood sugar controlled so tightly is not always that good. About ten years ago I became hypoglycemic unaware. I got that situation under control by keeping my blood sugar above 175 for ten days to get my nerves and body reacustomized to feeling hypoglycemia again. This is what I have learned to do to keep my blood sugar more stable. I know you are knew to this - just keep on doing what you need to and learn as much as you can about food, treatment, and interaction between the two in your system. Just keep in mind that you need to keep up with your intake of everything, hormones, vitamins and minerals because some of these can upset your digestive system. There are guidelines out there, but they are only guidelines you have to find out what works for you. If you take a diabetic nutrition course that will give you good information about what you can eat and when to eat it. This is a lifelong process and no one is perfect just learn from the mistakes and try to do better. I would think twice before switching doctors, unless you are not happy with yours. You could see more than one until you decide who is the best for you. I hope you have someone that can help with your treatment. My wife helps me and she even notices things before I notice them. This is quite a bit to keep up with, but there are others out there doing the same things. You and your doctor should be making the decisions that will affect your life. Take care and be happy.