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1

Hi guys! 

I am 22 years old and was diagnosed with Type 1 Diabetes last month when I went into DKA. I should have known better since I am a Physician Assistant student graduating soon and I had all the signs, but I just told myself I was being paranoid, but that's besides the point! I am currently trying to figure out a good carb to insulin ratio but am going low all the time! I am very active all day since I am doing my clinical year, and I am trying to pursue a career as a surgery PA, so I am looking for any advice on how to tweak my ratio and prevent lows. Also, does everyone else have it where they have to eat every 3 hours, is this normal? Any advice is much appreciated! 

Thanks!

Kristina

2

Hi Kristina,

it is ok to eat every 3 hours this way you always make sure you have something in your stomack....I was diagnosed in 2001. My Blood Suagar was 650....i was dka and n the verge of ketoacidoss....Have you talked to a diatition yet? i have recently lowered my A1c level back under 7% and am enjoying life again...it is hard at first to figure out your carb ratio....i have mine set at 5...and i am also wearing a onetouch ping insulin pump....the question i have for you is do you feel these lows comming on? anyway always make sure you have a good portion for Breakfast and could have a small lunch and a good size dinner meal...as for snacks go i always have a couple squares of gram crackers or  some fruit...just as long as your snack in take stays around 1 carb.....i will tell you this ...it will get better with time...take small steps....

3

Hi Kristina,

it is ok to eat every 3 hours this way you always make sure you have something in your stomack....I was diagnosed in 2001. My Blood Suagar was 650....i was dka and n the verge of ketoacidoss....Have you talked to a diatition yet? i have recently lowered my A1c level back under 7% and am enjoying life again...it is hard at first to figure out your carb ratio....i have mine set at 5...and i am also wearing a onetouch ping insulin pump....the question i have for you is do you feel these lows comming on? anyway always make sure you have a good portion for Breakfast and could have a small lunch and a good size dinner meal...as for snacks go i always have a couple squares of gram crackers or  some fruit...just as long as your snack in take stays around 1 carb.....i will tell you this ...it will get better with time...take small steps....

4

The lows can happen if your carb ratio is too low or if your base insulin (usually Lantus or Levemir) is too high.  Call your doctor and ask for his/her recommendations.  An ongoing low at the same time of day means something needs to be adjusted.  

Make sure to always have some kind of sugar and snack with you, in your car, by your bedside, and anywhere else you might spend time.  My husband teases me that I'm like a squirrel, with food stashed all over.

Carb ratios take a little experimenting to find.  To test your current carb ratio eat a meal that has carbs easy to count (like a frozen dinner that's fairly low carb) then take your meal insulin and test 2 hours later.  Your blood sugar should be close to your target range.  

There's a formula you can use called the 450/500 rule to find your carb ratio.  It's just a starting point and you should adjust if you have ongoing highs and lows:

- If you use Lantus or long acting insulin (with shots) then divide 500 by your total daily insulin dose.  That is your carb ratio.  

- If you use short acting insulin only (with an insulin pump) then divide 450 by your total insulin dose.  That is your carb ratio.   Again, this formula is just a starting point.  Adjust based on your actual blood sugars.

www.bd.com/.../page.aspx

dtc.ucsf.edu/.../calculating-insulin-dose

Ask your doctor about eating every 3 hours.  He/she may have recommended that because of your lows.  It's not a common practice for diabetics and is kind of old school, back when we were given set insulin doses and ate strict diets.    

There are a couple great books that will give you a crash course in diabetes:

* Think Like a Pancreas by Gary Scheiner

* Using Insulin by John Walsh

* 50 Diabetes Myths That Can Ruin Your Life; And the 50 Diabetes Truths That Can Save It by Riva Greenberg

College is a stressful time to be diagnosed, but it sounds like you're doing a really good job.  After a while some of the stuff, like carb counting, becomes second nature.

Take care.  -Jenna

5

Jenna's reply is very good and those books are worth reading. I suggest you look into a pump. The long acting insulins are hard to use if you have an active life. Once the long acting insulin is in you it is working and your life has to fit its action. With a pump you can control each day differently. Then you don't have to eat all the time. You can even skip meals and exercise and sleep late etc.  Also I suggest you get a CGMS.  It really makes life normal again.

6

Wow! I wish I got all this great advice when I was diagnosed. Jenna's response, especially her first paragraph, is gold. Also, I strongly agree with Maureen: insulin pumps rock! Simply put, a lot of the problems you're having now can be solved with the inherent flexibility of a pump. Other problems, such as figuring out exactly what your rates should be will take a good amount of time and experimentation. Definitely work with your doctor to help adjust your rates. Try to check your blood sugar as frequently as possible (once every 2-3 hours minimum), and keep excellent records of everything so that you and your doctor can make informed decisions as to what your bolus and basal rates should be.

In addition to all the above, try to avoid high glycemic foods (or high glycemic loads) as consuming these will make it extra difficult to maintain good control.

7

Being newly diagnosed you are probably still in the "honeymoon stage"  of the disease and producing a small amount of insulin.  Although it was LONG time ago when i was diagnosed, it took me about 3 months to get regulated just to the idea that i had diabetes much less what my BG was doing.  

I notice that many endo's wait a tleast 1 year  before putting someone on a pump - just to make sure they are stabilized.

Good Luck ...

Scott

8

Hi Kristina,

I was diagnosed at 22 as well (I'm 27 now). Early on, my ratios changed every few months. This was due to the fact I was in what they called the "honeymoon stage" which is probably where you are now.  Your body most likely is still producing a small amount of insulin which in tandem with the insulin you're injecting yourself with is probably causing the lows. These can be very difficult to control at first. My best advice would be to carry around some candy. I've always preferred Starburst since each piece is individually wrapped and you can open a package without having to consume it all at once. 2-3 pieces should fix any low.

As for having to eat every 3 hours, I've never had an issue with this. Eventually, I'm sure you won't either. Your body probably just needs time to adjust.

Best of luck to you!

Pat

9

I'd like to reiterate what Scott said.  When I was newly diagnosed I went into honeymoon stage and had to stop taking any insulin at all for a couple of months, or else my blood sugar would get low.  Keep making adjustments until you find what is right for you.  Just don't make big changes or make them too frequently, or you won't be able to determine the effect.