The Twists and Turns of Type 1 Diabetes - Where Do We Start?

If only there was a complete list of Do's and Dont's but unfortunately Type 1 Diabetes is not like that. It's not as simple as taking a paracetamol for a headache, sticking a plaster on a wound, drinking plenty of water before going to bed to avoid a hangover.

In fact although we all have our regime, "the Holy Grail of life as we must live it with type 1 diabetes" doesn't really exist.Yes we have our ratios, and our DAFNE type courses, but there are just so very many variables, absolutely everything we do, and everything we eat impacts on our blood glucose in different ways, all effecting our blood glucose readings at various times of the day and night and for various reasons.

I'm going to attempt to highlight some of these, but only as a type 1 diabetic, I'm not a professional. Please discuss any of the content in this blog with your diabetes team, and seek their advice in relation to your own type 1 management. This is just a guide to questions you'll need to ask.

First let me say other than not producing our own insulin causing us to be type 1 diabetics, our diabetes basically leaves us with an intolerance to carbohydrates, which by the way is sugar in another form. Most foods have carbohydrate ( carbs ) so not only do i consider the food I'm eating when I'm calculating my insulin dose for that food, I'm also considering what form that food is in. (whole, mashed, pulped, cooked etc ) because yes this makes a difference. Il also take into account what my blood glucose reading is at the time, whether I'm going for a walk soon, going to do a lot of housework, whether or not I'm sick, is the weather very hot or very cold, so it's not just eat and apple and inject xx amount of insulin. It's really about understanding your food, not just knowing it.

The all important carb counting :

We all have an insulin to carb ratio.That's the amount of insulin we take per gram of carbohydrate (carb) we have our correction ratio,
(a means of using our insulin to correct a blood glucose that's higher than our recommended guidelines) and our sick day plan (a plan to manage our blood glucose and insulin while enduring a vomiting bug or other illness. NO you don't stop injecting if your vomiting and not keeping food down) Your sick day plan is a special set of instruction given to you by our Diabetes team. If your not clear about yours then ask them for it. Its a very specific set of rules to be followed. Children, pumpers and people on multiple daily injections ( MDI ) may all have different instruction of what to do in this situation.

A food / carb EXAMPLE ONLY :

Bread roll 30 gms carbs

Insulin - carb ratio 5/1 ( that's 5gms carbs to 1 unit of insulin )

That big bread roll would mean 6 units of insulin in this example 
( 30 divided by 5 = 6 ) 

Simple Ye ?

Now let me bring you further on this journey......

Slap a thick couple of slices of my favorite cheese in that bread roll. Even toast it or melt it if you like. 

The cheese has no carbs, so it's still only 30gms carbs for what's now a delicious cheesy bread roll, however things have changed a bit now. 
But why?

My cheese has a high fat content, fat slows down the impact the carb in the bread roll has on my blood glucose (BG) I may find if i inject just as i start to eat, that after my insulin ( fast acting / bolus ) has peeked and is now becoming a distant memory that my blood glucose is still rising​! I haven't reached the magic 2 and a 1/2 hour period (insulin peek time) 
since i last injected, so 

I​ 

can't really safely inject again just yet, but still the BG numbers climb higher. So what could 

I​ 

have done differently?

Split the insulin dose ......

Using the same delicious cheesy bread roll example 30 gms carbs / 6 units of insulin.

​Il take ​3 units as I ​start eating and 3 units when iv finished. Giving the effect of the insulin longer to work. In other words it will be longer before my much needed insulin peeks and then starts to dwindle away, giving the insulin iv injected a longer period to work or lengthening its effect. (Seek advice from your diabetes team about this)

​​

Now to a sample list of foods that have this effect : 

• Pitza.
• Garlic bread.
• Chinese takeaway.
• Battered foods that are deep fried.
• Chips,
• Pasta ( in some people ).
• Ice cream.
• Milk Chocolate.
• White chocolate.
• Cakes with a butter icing or frosting

There will be other foods you'll come across that have a high fat content, these are just the ones I can think of. Everyone's diet is different.

Fruits Vs smoothies & juiced fruit :

Let's take some fruits as an example : 

1 orange 7gms carbs

1 Apple 20 gms carbs

2 pineapple rings 8gms carbs 

All containing fibre when eaten whole and much needed nutrients, the fibre content will slow down the impact of the sugar that the fruit contains, if I​ inject as instructed then im​ sorted.

Now pulp, mash, liquidise those same fruits, 

​Iv​ taken out the fibre, Iv​ still got the nutrients, but because of the lack of fibre ​Iv​ now got high speed sugar, coursing through my veins before 

​my​ insulin gets a chance to cop on.

Potatoes, 

• Eaten whole, are high fibre and impact our BG, on a sort of normal time frame.
• Eaten mashed they become a quicker carb hit, rising ​my​ BG faster than the whole potato.
• Eaten fried / chipped become high fat, impacting my​ BG a lot slower than the whole potato.

Basically ​im​ eating the same potato, so the same carbs, but in different forms, all having a different impact on your blood glucose, over different time fames.

Ice cream. 

Now this I can eat with out any rise in BG, and without insulin, BUT 2-3 hours later my BG will start a steady climb because of the fat content.

Chocolate. 

Ah yes chocolate. Now and then at 8pm watching the soaps. Now here's a real sneaky one, choose the bar. Inject the insulin dose, eat the chocolate. Delicious ...... And everything seems to be going to plan. 

2am and your awake to use the loo, you'v maybe got a headache and you test your BG. It's in the teens and I​ was 8ish going to bed, I would​
be fairly safe to blame the chocolate this time, it's because of the high fat content.

Infection / Illness / stress

Sometimes when Iv​ got an unusually high BG with nothing obvious to blame, it could be my​ first warning to an infection, a 24 hour bug, or an oncoming illness of some kind.Stress because of work, exams or just everyday life stresses.

Treatments

Even a dental local anesthetic can effect my​ BG. To either rise it or more usually drop it.I ​need to allow for this one when undergoing treatment. The dentist is guided by the diabetic, they rightly presume you know your stuff, so please​.......​ know your stuff !

Heat and Cold weather

Yes the weather eff​ect'​s my BG, but people react differently to this one. I would run low in the heat having to keep an extra vigilant eye on my BG in case of hypos.

I would run high in the cold weather, needing a little extra insulin to meet my chosen target.

Exercise

Remember when you exercise you burn off sugar first, to continue that exercise you need to compensate by replacing that sugar, which is why type 1, exercising and weight loss  can be a fruitless challenge. Special care and training is needed for marathons etc.

Hoovering, window cleaning, children running around playing all qualify as exercise.

Foot tips

Check feet daily for blisters, cuts etc daily,  keep feet clean and dry. Never moisturise between the toes. Wear socks inside out to avoid the seam rubbing the toes. (a chiropodist who is also a type 1 told me this) 

​I ​Wear 2 pairs of socks in my trainers to reduce the risk of blistering. If you notice cracks, cuts, blisters or anything else unusual seek medical advice and don't be tempted to stick on a plaster and ignore it.Take professional advice on nail cutting and removing hard skin.

Skin

Skin problems and slow healing is quite common in people with diabetes of any type.

Alcohol

Now here's a tricky one, yes there's carbs in alcohol, but we don't count them, why ? Because the day after drinking, the alcohol can drop your BG and leave you prone to hypos. It's advisable to eat a carb before going to bed after drinking alcohol. 3 alcohol free days a week is what I was advised on diagnosis and iv stuck to it.

Coffee

Now here's a dark horse if ever I found one, I get up in the morning, With a BG of maybe 5-6, I have a coffee, just a regular black instant coffee, with a small drop of low fat milk. (no insulin I hear you say) well you'd be wrong. Coffee acts like speed, stimulating the body, or more precisely the liver. 

Just over a 1/2 hour after drinking my morning fix I'd have a BG of at least 9-10 if I'm lucky (that's without injecting insulin) so my morning cuppa is always accompanied by a little insulin unless of course I start off low. If your a coffee drinker you may know what I mean.

Hormones

Hormones Of the general teenage, menopause, puberty, post natal varieties can all effect your BG. So either speak to your diabetes team or T1 people experienced in this area. I'm also pretty sure pregnancy and childbirth take their toll but likewise speak to someone who knows about these things.

Lack of sleep, trauma, worry, exhaustion the list of what effects a diabetic, ( particularly a type 1 ) is endless. Basically every part of our lives and our very being, whether it be emotionally or physically has an impact on how your body copes, therefore can have an effect on your blood glucose.

Treating Hypos - lows - hypoglycemia

We all have our favorite hypo treatment, yes you heard me our favorite treatment. Lucazade is not your only option. This is my big chance to have something I wouldn't normally get to eat, so for me it's jelly beans or jelly babies. Some use fruit juice, full sugar soda, or glucose tablets there are no hard and fast rules to which high sugar treatment you prefer to use to get those blood glucose numbers back up fast. Your diabetes team will advice you about how much of your chosen hypo fix to take, or check out the carbs and cals app or book.

WE DONT TREAT A HYPO WITH CHOCOLATE BECAUSE IT WONT IMPACT ON YOUR BLOOD GLUCOSE FAST ENOUGH TO FIX IT 

( REMEMBER CHOCOLATE IS HIGH FAT ) & TREATING LOWS NEEDS HIGH SUGAR.

Finally.

It was my Diabetes Team who said NEVER go to bed with a BG below 8, and that's something iv never forgotten and stick with to this day. 

After doing research of my own I started a lower carb diet than the diet I was previously on, substituting some of my foods for a lower carb alternative. I did this to reduce the weight I'd gained after diagnosis, to gain a tighter more manageable control, and to reduce my HBA1C.

I achieved these things and have chosen to continue with this lifestyle, feeling generally healthier with more energy.

Write out your questions so you won't forget them. Bring them to you next diabetes clinic and discuss and question those things you may not understand right now. Education and learning is the key to living at ease with your Type 1 Diabetes. 

Lack of knowledge NEVER EVER takes away the facts, the risks, or the disease.

EVERY DIABETIC IS DIFFERENT SO WHAT WORKS FOR ME OR YOU MAY NOT WORK FOR OTHERS.

SEEK - QUESTION - IMPROVE are 3 very important words when you have any type of diabetes.

• SEEK : More information than you may already have, and support from others living with type 1.
• QUESTION : Everything you don't understand.
• IMPROVE : Your knowledge, your management and your understanding of type 1 diabetes in order to improve your life.

Davina 

A Type 1 Diabetic 

​

See us on face book https://www.facebook.com/DiabetesT1Ireland?ref=hl

Co-Founder of http://www.diabetestone.com/

Follow us on twitter @T1Ireland