Where I am right now

It's 6 months now since I started on insulin. My Hb1ac has come down from 13.5 at diagnosis, to 9.6 last October and  8.4 just recently.  I am disappointed that my BS has not come down further.  

I am trying to eat a low carb diet and have eliminated potatoes, bread, pasta, rice and cereals completely from my diet.  I estimate I eat about 50g carb per day from milk and vegetables.  I exercise regularly at the gym, and am trying to walk every day.  The gym usually increases my BS by 3 or 4 , but walking and gardening tend to decrease my BS.

My BS readings are generally above 7 during the day, usually between 7 and 10.  I have increased my insulin and now take 10 units in the morning and 12 units with evening meal.  But I still get hypos!   For example, this week I have been working in the garden for about 1 hour at a time.  I always eat a muesli bar or something similar before gardening, but I still hypo'd.  Yesterday I did Pilates at the gym, then gardening, having eaten 2 muesli bars and had a latte coffee.  I even had a little bit of bread with my soup at lunchtime.  I hypo'd in the night 3.1, and treated it with a 1/3rd bottle of lucozade.  I woke up with 4.3 (quite happy because I usually overtreat!) and after eating a no-carb breakfast of poached egg, 1 rasher of bacon, mushrooms and tomato had BS of 12.3!!!  I did have a cup of tea on waking with milk and a coffee after my breakfast again with milk.  Could it be the milk spiking me?  I'll have to experiment and not have milk for a couple of days.  I've been trying not to take so much milk and have a splash of cream in my coffee sometimes.

I lost 2 stone before diagnosis, and have managed to keep it off until just recently.  I've put on about 5lbs.  Maybe this is a good sign, and that I am beginning to control my BS.   But, I'm fed up with that and don't want to put any more weight on!

I'm off on a big holiday in 2 weeks time, and am quite apprehensive about how I am going to cope with the long haul flights and time differences with my diabetes.

I'm pretty fed up with having to watch what I eat and worrying about hypos.  Plus the worry that I have had high BS for a long time now and how that might affect me in the future.  I hate this disease!  One thing that might make it easier is to switch from mixed insulin to basal/bolus and I'm going to ask after I get back from holiday - I thought it would be easier to just have the 2 injections per day for the holiday.

Sorry for the long post!

Ups and Downs

My blood sugars are still all over the place!  Last week I was helping out with decorating our son's flat.  It's amazing how much exercise is involved in preparing and painting.  I was up and down -standing, reaching, bending down, squatting, sitting on the floor, and getting up and down on a chair to reach the high bits.  It's amazing how much the exercise affects my BS!

I am getting to know how my insulin works now.  I tend to have a very low carbohydrate breakfast and inject either 8 or 10 units of Novomix 30, depending on how much exercise I think I am going to take.  Last week, I woke with BS mosttly over 7mmol/l, but only 1 day over 10.  I had a muesli bar every morning about 10.30 -11am, with a carb value of approx 10-12g, along with a milky coffee.  My BS still went low by the end of the morning! I definately need to have something else to eat during the morning if I am exercising and/or have less insulin.  

It's just gone low again now because I have been out on my bike this morning doing my errands!

I usually have a low carb lunch, either salad and cheese or homemade veg soup, plus berries and creme fraiche to follow.  If I eat anything carby in the afternoon my BS rockets up to the teens.  On Monday I had been out shopping and had a low carb lunch, then on the way home shared a 9 Bar.  My BS was 14.3 before dinner!  I must admit I try to snack on nuts and cheese in the afternoon and avoid the carbs.  This is the time when my rapid insulin is going down, until I inject again at dinner time.

Check up

Yesterday I went to my GP surgery to see the nurse.  I was hoping that she would have the results from my blood test last week, which included the c-peptide test to determine whether I am producing any insulin.  Unfortunately this test does take some time, so no result yet.  It is possible that the hospital will not let the GP know and that I won't get the result until I go to the hospital again in 6 months time!  Oh well, I guess it's the same treatment whether or not I am producing insulin!

I have been cutting down on carbohydrates, and avoiding rice, bread, pasta etc.  I am beginning to get used to it now, and enjoying finding different things to eat and drink.  I decided not to tell my nurse as I have read on the forum (www.diabetic.co.uk/forum) that the NHS are not too fond of the idea.  I don't want to create any conflict as I do appreciate her support.  She is a very nice person and very positive and uplifting.  But i did start to tell her that I have been testing postprandial, and finding that some foods 'spike' me quite high.  She immediately said 'You don't want to worry about that!' and crossed through the spaces in my book so that I couldn't test then any more!!!

My feelings are that non-diabetics would not get a spike after meals, so why should I as a diabetic tolerate it?  I do think that having blood sugars swinging violently from normal to high and sometimes back too low is what has made me feel under par for the past few months.  If I can do something about the spikes then it can only be good for me. The only thing that I can do to reduce the spikes is to cut out the carbohydrates that are producing the spikes.  The Hb1Ac test shows the average blood sugar for the past 3 months, and even short periods of time at high levels will affect it.

By the way, Hb1Ac is still at 9.5.  I wasn't expecting another drop so soon.  Still a way to go to get it below 7.  Just these last few days I have got BS readings consistenetly below 10.  Now to get it below 7!  May have to be brave enough to inject a bit more insulin - I am always worried about hypos!

But I forgot my insulin this morning!!!  I ate a weightwatchers choc bar before I went out to sewing class, and tested before lunch.  I was expecting a low reading, but it was 12.2!!  EEK!  Looking in my notebook, I had not written down my units, and I could not remember injecting.  So I have injected 6u just before lunch.  Much less than usual so that it doesn't clash with evening insulin.  

Why me?

Since my symptoms started, not a minute has gone past without me thinking about my disease.  Are my blood sugars too high?  or too low?  Have I eaten the wrong thing?  Have I eaten at the wrong time?  Have I remembered my insulin injection?  Have I tested my blood?  Have I tested too much?  Will the GP keep prescribing all the things I need?  Diabetes is not something I have thought about much before my diagnosis.  Yes my Dad had type 2, but we all thought that it was something to do with his myeloma, and anyway, the myeloma was a much more serious condition.

Recently, there has been much publicity about type 2 diabetes, and the 'obesity' epidemic.  But, I have not been obese!  I have been moderately overweight for the last 20 years or so, and a little bit yo-yo with my weight, but only by 1 stone (14lbs) or so.  I have been to weightwatchers a few times and regularly attended Rosemary Conley for a number of years.  Although I do not class myself  as athletic in anyway, I have done regular exercise over the years.  Most recently I attend a local gym for 4 classes per week, and up until last year walked our dog for at least 1 hour a day.  I cycle once or twice a week, especially if I want to go into town and try to always cycle to CAB.

So a question I keep having to ask is - why me?  I have to pinch myself sometimes as though I will wake myself from a horrible dream.  Here I am injecting myself with insulin twice a day!!!  Gone are the 'carefree' days now.  I have to inject the correct amount of insulin, and watch what I eat, as there are extreme dangers with too high or too low blood sugars.  It is a life long condition that will not go away.

It is something I have to learn to live with.  I need to be in control of my life, not let diabetes control me.  I am very grateful for the support from family and friends, and from the internet!

Starting on Insulin

The nurse at my GP's surgery had mentioned insulin a couple of times, as no matter which drug she prescribed, my BS were not coming down.  I had by this time discovered www.diabetes.co.uk, and had begun reading about low carbohydrate diets.  Many diabetics both type 1 and type 2 have had good results by restricting carbs.  I tried it for a week or two, and did see a reduction in the very high blood sugars.

So at my appointment with the specialist nurse, I was prescribed insulin.  Novomix30, which is a mixed insulin, consisting of 30% fast acting and 70% long acting insulin.  Anne, my surgery nurse showed me how to inject using a pen.  The needle is really tiny, and I hardly felt a thing.  I don't think I will have problems injecting.  They went through all the symptoms of hypoglycemia, and what to do on sick days.  I was given a new meter which also checks for ketones if my BS is high.  This is to check that I am not going into diabetic ketoacidosis, another life threatening condition that type 1 diabetics can get if they have no insulin on board.

Oooer!  I was a bit shell shocked!  Unfortunately, none of the chemists I went into could do my prescription that day, so I left it with the chemist near the doctors and went to pick it up the next day.  It was the bank holiday weekend, and Maurice was flying off to Phoenix on business for 1 week.  But there is a lot of support.  I can phone my nurse at the surgery, I can phone the specialist nurses at the hospital, or there is an out of hours helpline run by the drug company that make the insulin.  Knowing that the support was there was very comforting.

I picked up the prescription on the Friday, which included insulin (keep in the fridge), 2 pens, disposable needles, test strips for my meter, for BS and ketones, metformin, and lancets for the stabber!  I went home, made a cup of tea and sat down and read all the leaflets.

Here we go!  Now I have to inject insulin every day for the rest of my life!

Isn't it amazing?

Isn't it amazing at how well our bodies work?  In a non-diabetic, insulin and glycogen work to stabilise the amount of glucose in the blood.  Normal values are between 5 and 7 mmol of glucose per litre of blood.

Diagram found on http://www.biology-online.org/4/3_blood_sugar.htm

I find it amazing that crude injections of insulin will keep a diabetic alive!  Over the years the method, timing and duration of insulin has improved so it more mimics the normal human system. 

Insulin is required for the glucose in the blood to gain entry into cells to be used for energy.  In type 2 diabetes, the receptors on the cells do not work properly so glucose cannot enter the cells.  The pancreas works harder to create more insulin and eventually 'tires' and stops producing insulin all together.

In type 1 diabetes the cells in the pancreas that produce insulin (beta cells) are attacked by the immune system, and there is no insulin produced.

I am having a blood test to find out whether I am producing any of my own insulin (c-peptide test) - but this will not tell me whether I have type 1 or type 2 diabetes.  I should have the GAD antibody test which will show whether I have the antibodies which are destroying my own cells.  

Not so good today...

I am interrupting my story to record how awful today has been!  I was out for dinner last night at a thai restaurant.  I did my research before we went and decided to have a thai stirfry in oyster sauce.   I even looked up the amount of carbs in oyster sauce (11g in 100g of suace if you are interested)  I wasn't sure how much oyster sauce I would get in a portion of stirfry but decided it was the best on the menu.  I also had a small glass of dry white wine.  I avoided the prawn crackers, just having 1.  That was hard, I love prawn crackers!!  My portion of stirfry was very tasty but not enough.  I ended up eating mine far before my friends had finished theirs!  It would have been wonderful with lashings of white rice, but that looked like poison to me, as I knew it would spike my blood sugars really high.  The restaurant poured us a small glass of Baileys which I am afraid to say I did drink.

So I did feel hungry when I went to bed, but blood sugars were 11, so I just had my low fat hot choc which has a carb content of 3g per serving.  At 5.20am I awoke feeling really weird!  Of course, it was the one night I had forgotten to take my meter upstairs with me!  A trip to the loo and then downstairs for my meter, blood sugars 3.3, eeek!  I ate about 5 glucose tablets and tested again a few minutes later.  I also ate a fruit muesli bar.  After about 15 mins or so I began to feel better and went back to sleep.

I stayed in bed a bit longer as I had had the hypo in the night.  BS 12, only to be expected.  So I decided to go for a walk after breakfast of 1 poached egg on small slice of sourdough bread.  I took my usual 10u insulin after I had eaten.  I usually try and take it just before I eat, but isn't it funny, I can be reading the diabetes forum and still not remember to take my insulin!  After I got back from the walk BS were 11.2, so I drunk a bulletproof coffee (1tsp coconut oil and 1tsp butter)and decided not to have a snack with it.  I went back outside to fill the green bin.  The walk or the gardening were hardly arduous exercise!  But then when I came back in my BS had crashed down to 3.6 and I felt dreadful!  I drank some lucozade, tested again 5 mins later 10.5, which may have been a rogue reading, as I tested again 4.3, but still felt awful, so waited another 5 mins, BS back down to 3.2.  After another swig or 2 of lucozade, my BS started to rise.  Phew!  But I felt bad for quite some time, sort of shaky, anxious, and a bit nauseous.  I went upstairs to have  a shower.  I must admit to having visions of me collapsing in the shower and the kids coming home to the not-such-pretty sight!

I made my usual salad and cheese lunch but had a cup-a-soup with it.  They are about 14g carb, and of course really fast acting.  1 hour later my BS was 19.4!  I went to CAB, but really didn't feel very with it, I seem to have ended up with massive brain fog after 2 hypos in quick succession.  I'm guessing it's the fast rise of BS that makes me feel so rough.

So why the hypos?  The wine?  but it was only 1 small glass.  Not enough to eat?  Maybe.  Maybe not enough carbs in dinner.  The exercise this morning?  Obviously, that contributed to today's hypo.

It is very scary having a hypo, especially when I don't start to feel better quickly.  And I always seem to over treat, so have a massive post-hypo rise in BS which cannot be good and must make me feel worse.

Now what I do about tonight and tomorrows insulin?  Shall I take less?  I think I will drop by 2 u for both tonight and tomorrow.  Bet that means I'll have higher BS tomorrow, sigh!