New diagnosis - some questions

Hey all, I am a recently diagnosed type 1 diabetic. (2 weeks in). I’ve seen my endocrinologist and got some basic answers to some questions I have. At the urging of my brother (who has been a type 1 diabetic for 20 years) I’ve decided to try and get some insight with a forum. So, I’m a 28 y/o female who is otherwise healthy. I’m taking very low doses right now (appx. 25 for the whole day) as I am in the “honey moon” period.

My question, which will be one of many to come over time, is how do I know how much slow acting to take over night? What’s the math? I currently take 10 units and my sugars upon waking are on the low side (~4). I’m also using the libre sensor. Should I be taking less slow? Also, how early before bed should I take it? I go to bed routinely at 10, and have been taking it around 830

Hi @Bkrakken and welcome to the forum. Determining dosages takes some tweaking, and you’re newly diagnosed I recommend you talk to your doctor about your waking lows so s/he can help you adjust.
There’s not exactly a strict formula that applies to everyone, but you use your body as a guide to determine adjustments. Keep an annoyingly accurate log of what you eat and when/how much insulin you take - this is a good idea for all day even though your issue is overnight. Then review it with your doctor, who can guide you from there.
I use the Mynetdiary app myself although there are others. I can log meals, snacks, BG readings, insulin doses, and lots of health information. I find I do best when I keep it super accurate.
Wishing you the best.

Hi @Bkrakken Most long acting insulin formulations are nearly 24 hour release so it doesn’t matter that much when in the day you take it and it lasts pretty much until you take it again the next day. If you took 10 units that means you need 10 units and it releases over 24 hours or a “basal rate” of 0.4 units per hour. (There is a lot of math with diabetes).

The way you tell if your basal rate is right is if your blood sugar is rising or falling when you don’t eat. The way you tell us by skipping meals and testing or by watching your cgm if you have one.

This will change for you if your body is still making insulin. As you slowly stop you will need more insulin to replace what you are not making anymore.

The best thing is to work with a CDE and take really good notes. When you eat how much insulin and your blood sugar test results and when you are active (even walking). 4 is the floor. So yes you are a bit low in the morning. You may want to eat a mixed carb night snack or on the advice of a medical person, take a unit less but again, this depends on your notes and too many things to figure out for us. Also. You need to back up Libre sensor readings with finger stick readings at the same time.

We’re here. There are many thousands of years experience here so reach out with questions if you have them we never get tired.

I second working with a CDE recommended by your endocrinologist, who cam adjust your insulin to carb ratios as needed. Mine has helped me tremendously over the past 2 years, including when to take a night time snack to prevent an alert on my Dexcom and low morning BG. I’m learning what carb/protein mixes help after certain evening meals. A registered dietitian can also help with meal choices.

Also, my endocrinologist changed the timing of my basal (Toujeo) from evening to first thing in the morning. Even though the basal works for 24 ours, she said it peaks in about 2 hours and might help my after breakfast highs. I noticed that it prevented the 1 am-2 am alerts of a low. It wasn’t always a low that I had to treat, but it was annoying to have to get up to check and lose sleep.

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@Bkrakken Hi Kali and welcome to the JDRF TypeOneNation Forum! Thank you for joining with us, and thank you for creating a new topic for discussion.

Unfortunately, autoimmune diabetes, TypeOne, isn’t managed by a set formula, a one-size-fits-all; each of us is somewhat different and our effective diabetes management techniques can sometimes be unique.

I have a question for you as to the type “long-acting insulin” you are using: is it a level-release “background insulin” such as Lantus, or is it a “long-acting” that has peaks & valleys such as Humalin-N? If you are using a “back-ground” insulin and nothing more, in theory, the timing of the injection should not make any difference. What will affect the background insulin speed of action, is activity; for me when I was using this type insulin, I found walking after injecting in my thigh would often cause the insulin to take “quicker action” and cause my BG to drop.

Also, how do you know you are in “honeymoon”?; not everyone has that experience. The only way to really make this determination is through testing that demonstrates your body is still making insulin. An interesting finding is a study of a few thousand “Medalists” [people with diabetes for 50+ years] is that a significant number are still producing their own insulin; yes, “honeymoon” can be a life-time experience.

Thank you everyone for your advice. I currently log everything that I eat in my sensor Libre app. I also use the My GI app to get as accurate a measure I can on how many carbs I eat.

When I was discharged from the hospital, the doctor I saw there advised I start a keto diet - so I did for about two weeks. I was eating probably ~5-10g carbs per meal. My blood sugars were kept in line for the most part. After seeing my endo (who regrettably wasn’t as helpful as I wanted), he advised that keto is not the correct diet for me, and says I should aim for ~25-35g carbs per meal. So carb light, but still incorporating carbs. Exciting news I thought - I really do enjoy carbs! However, when I started to introduce more carbs in to the equation is when my sugars started to wiggle more. I currently use a 1:36 (round up to 4) carb to insulin ratio at meal time. What I am seeing right now is more peaks and dips instead of steady. I am seeing higher peaks after meals and lower dips in between meals.

To Dorie - Thank you for the suggestion for the app, I will look in to it. I currently log my meals on the Libre sensor app and use the My GI app to get carb information.

To Joe - Would you happen to know of any links for the basic calculations? I can start eating a mixed carb snack before bed, I don’t typically snack that late but will give it a go to see if it effects my morning blood sugar.

To Sally Ann - I have an appointment with a dietician this upcoming week, which will be a big help I’m sure! I also plan to give the diabetes clinic a call to ask some questions. My experience with the professionals as of now however, has felt rushed and dismissive. My brother fears that because the doctors and staff were aware of my situation, having a sibling with T1D for over 20 years, made them dismiss my situation - like I already knew it all. I feel like he was right, as when I was speaking with the doctor and nurses who administered my insulin, they kept saying for me to lean on my brother for support.

To Dennis, I take long acting Basaglar. I am not very active late at night when I take the long-acting. This is usually 1-2 hours before bed. Also, as for being in the “honeymoon” phase, I don’t know if I am or not to be honest. My endo, who seemed a bit dismissive and rushed with me, suggested it, but didn’t clarify. He said something to the tune of my pancreas “is probably working at 15%, but will inevitably fail entirely”. So I took that as a confirmation, but to be fair, I don’t really know. I suppose there are tests that would be done to determine that? I have a followup appointment in July.

Hi @Bkrakken. I’m so sorry to hear you feel your doctor rushes you. Especially when you’re new it’s important for them to take time to help you understand, even though you do have a sibling to lean on.
If you feel you’re not getting what you need you’re perfectly within your rights to change doctors - although given the current situation with the Coronavirus it might be difficult to find one taking new patients, so perhaps set that on the back burner.
I’ve found it helpful to go in with a list of questions prepared - I tend to get a bit chatty with my endo and it helps both of us with efficiency - we can cover my prepared questions quickly, leaving time to branch out to other topics that come up as a result.
You started seeing more fluctuations when you added carbs - did you adjust your insulin for the increase? The diabetes clinic should be able to help you with that. BTW, diabetes nurse educators are a great post of the treatment team, and might be able to give you more concentrated attention than your endo does while helping you understand and manage your diabetes. While my visits with my endo include the usual BP check, occasional foot check, and a look at my eyes, ears and throat - when I’ve seen my DNE it’s typically a specific purpose that doesn’t require the other “stuff.”

Hi. You have gotten some good suggestions, so I’m not going to add to those. Perhaps your CDE can recommend a better endo. As you walk this path, having a trustworthy endocrinologist will help a lot. Since you’re fairly new to diabetes, I want to recommend two resources you might not be aware of:

  • Diabetes Strong, https://diabetesstrong.com/, Christel Oerum, covers issues related to diet, injections, pumping, exercises, etc.
  • DiaTribe, https://diatribe.org/, for all things diabetes. Adam Brown provides a free book download through this site, Bright Spots and Landmines, that will answer many of your questions. Good Luck!

@Bkrakken responding to your question. There aren’t any calculations because of differences in metabolisms. What you do is find the right basal dose by trial and error. Your overnight sugars may rise or drop a little, but you also have to see if you skip lunch if your dinner time fasting sugar is dropping or rising. If it drops at night and drops when you skip lunch, you reduce 10% ( for you 1 unit) and try again the day after you make the change. You are not shooting for perfection here. You musk keep your activity typical. Done right this will take a month.

Once your basal shot is good enough, you start with a good blood sugar take your meal insulin and eat 20 grams of carbs, I like to use lunch time. Test with a blood meter at + 2 hours after eating You should be about than 3 mmol/l higher than your before lunch number. You add or subtract insulin until you get a good result and the 20g carb divided by how much insulin you need is your carb ratio in grams carbs per unit insulin.

Starting with a higher blood sugar and with very low fat you inject a correction bolus and determine your blood sugar drop in 4 hours. This is your sensitivity in delta mmol/l per unit insulin.

You are now a scientist. Take good notes. Good luck :four_leaf_clover:

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Get a good endocrinologist. It took me about 6 tries when I moved here 25 uears ago. They all appreciate clients who will pay for their services. Right now video visits are being used to limit contact.

I have learned that a protein snack at bedtime (HS) helps prevent low blood glucose in my mornings. I generally have ¼ cup of cottage cheese, alone.

Proteins take about 5-7 hours to digest. Fats about 9 hours. When carbohydrates are combined with either, or both. their digestion is also slowed.
For me, bit of protein at every meal helps my total of 20-30 total units of Novolog & Levemir insulin keep me content.

We are all individual experiments. My formula numbers right now are:
I take 4½ units Levemir HS and 2 in the morning. My carb:insulin ratio is 10:1 at breakfast, 13:1 at lunch and 15:1 at dinner.
I have used Humalog & Novolog recently. Their peak times and durations differ slightly, but they are very similar for me

I’m curious whether you were able to see a dietitian this week. With “social distancing” in place, most doctors in PA are only meeting patients in-person for emergencies. In fact, my appointment with my endo on the 29th will either be a tele-chat or a virtual chat using a mobile App, if I can get it to work. (the directions don’t sync with the app itself)

I hope you can chat with a dietitian or cde soon for additional professional advice tailored to your diabetic issues.

It is not need to over do any thing like dieting, eating other thing.Fill always happy and eat digestive food which give you energy.