Diabetes and travelling overseas.....

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ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/7/2008 4:46 PM (GMT -7)   
Hello evey one.Im new to the board.Seems there is a lot of Knowledge around here.I am 31 years old and was diagnosed with Type II the back end of last year which quickly progressed to Type I
 
I take Lantus at night and Novorapid with meals.I usually go with 1iu per 10g carbs and that keeps me under 7mmol.This is the thing.Everytime i go on holiday when there is a time zone change,,my bloodsugar does all over the place ! I went to Florida earlier in the year and my fasting levels where as high as 16mmol ! Really struggled keeping my numbers down,even using much more insulin than usual.Things calmed down a couple of weeks after i got back.Just been on holiday to vegas,so another tine zone shift.BG allover again ! I have been back 2 days and my number are high still.Im hoping they will come down like last time.I eat a low carb.high protein ( i weight train ) and also do cardio every morning.I can go to bed normal and wake up high.I even set my clock to go off every hour to check BG during the night to see if i was having an untreated hypo or if it was dewn phenomenon,I woke up in range though.Probaly as i was up every hour it isnt the same scenario as sleeping right through.I was thinking of asking my gp for a continuous glucose monitor for through the night.Tomorrow i am going to increae my Lantus by 4iu and calculate my insulin 2iu per 10g of carbs to see if that helps.Anyone else have problems when travelling abroad.Thanks in advance for any input.My eyes are suffering thts week with the high readings :(
 

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 8/7/2008 6:14 PM (GMT -7)   
Oh Anthony!! Do NOT double your insulin to carb ratio!!! I can guarantee you a severe hypo for sure!

Hi! and Welcome :-)

When making adjustments to insulin...

1) make one change at a time. You can't accurately know what what's going on when you play with both your short and long acting insulin at the same time.
2) changes are made in increments NOT multiples. I.e. insulin to carb ratio may go from 1U:10 grams carbs to 1U:8 grams carbs but, you would never just double your insulin units. Who said to do this?
3) changes to insulin regimen should be done under the guidance of your Diabetes Team - your Endo, GP, Diabetic Nurse/Educator, whomever is your primary person you work with to manage your Diabetes. Intensive Therapy usually involves a lot of education (carb classes, etc), as well as close contact with one of the aforementioned. Do you work with someone or are you on your own?
4) if it's not measured, it's not managed. Meaning: if you aren't documenting everything, especially when you're about to make changes to your regimen, then you're flying blind (and headed for big trouble).

There are so many possible influences that can affect blood sugar: stress, activity level, food, hormones (women's monthly friend for some :-), excitement, air temperature, (de)hydration, barometric pressure, altitude, planetary alignments... no seriously, everything.

The key is to get your basal insulin dose under control, then get your insulin to carb ratios sorted out (FYI, with Rapid I do 1:10 breaky, 1:12 lunch, 1:8 dindin), once you get this down, you'll know how many units of insulin to correct with at the 2hour post prandial test. It may sound complicated but it's not when you address it as the process it is. Basal first (Lantus), then Bolus (NovoRapid), then correction ratios. You're only a few months new to this, and I won't kid you... if you want to do it right, there is a lot to learn but, you can do it. It also takes time. Most changes to regimen are monitored over a few days, done one at a time...it just takes time but, well worth the effort :-)

Cheers,

p.s. Type2 does not progress to Type1. You were misdiagnosed as Type2. Sometimes the progression of Type1 can be slow enough that we don't need insulin for a while but, ultimately... our pancreases are under attack and it's only a matter of time before our Beta cells get wiped out. Type2s are always Type2s even if they are using insulin (usually only long-acting).
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/8/2008 2:32 AM (GMT -7)   
Thanks for the input.My GP said i had progressed from Type II to Type I,so just quoting what he said.To be honest,i have had little help from my GP.I havent even seen an Endo.All my GP/Diabetic nurse did was start me on "4iu per meal" even though they didnt know what i was eating.And started me off on 16iu of Lantus at night.Luckily,through my previous background in Bodybuilding,i have lots of Knowledge about nutrition etc,so i have been working this out myself.Like i stated earlier,i had my Diabetes well controlled.All of my readings where under 7mmol and my Fasting usually 5mmol.Usually 16iu Lantus at night and 1iu per 10g carbs of Novorapid with meals keeps me in range.All of a sudden i have went haywire :( Fasting readings of 14mmol some mornings.Also,i usually do 30 mins of Cardio in the AM,which usually brings my BG down a couple of digits.I woke up with a fasting reading of 10mmol today,and after excercise it was 14mmol ! I know excercise can raise BG,but it used to be the opposite for me.I definatly think i have a case of Dawn Phenomenon going on,as my BG keeps raising in the AM.I test myself before meals,but atm im tesing before and 2 hours later.MY GP complains that i use too many test strips so i end up buying them myself ! He told me to test myself TWICE PER WEEK ! I appreciate the help.I feel a bit lost atm.Today my eyes are very blurry as i type this :(

ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/8/2008 2:41 AM (GMT -7)   
Also,the correction ratio that USUALLY works for me is 1iu per mmol.So if im running at 10mmol i would take 5iu Novorapid to bring me back down to 5mmol,then account for any carbs i eat.So if i was running at 10mmol and was going to eat 50g of carbs i would take 10iu ( 5 to bring me down and 5 for the carbs i ate )

My Diet is as follows :

(I eat a little more than most,as i still weight train)

M1
50g Oatmeal with skim Milk
10 Egg Whites
Protein Shake ( No Carbs )

M2

Chicken Breast
Vegetables

M3
Chicken Breast
250g Brown Rice ( Cooked Weight )

M4
Protein Shake ( No Carbs )

M5
Chicken Breast or Fillet Steak
Green Salad
Tablespoon Peanut Butter

I rarely deviate from this plan.I might eat some fruit now and again,but always take insulin to cover it.My carbs are around 100 - 150g per day.I weight train 4 days per week and do 30mins Cardio AM and PM 5 days per week.I might have Sunday Lunch or eat out with my Girlfriend once per week,but always eat something reasonable.Ie Steak/Potato/Broccoli.Things where going great,until the vacation(s) / Now......

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 8/8/2008 7:23 PM (GMT -7)   
Hi Anthony - Seems like you've got a stable handle on one of the most important aspects of managing an intensive insulin regimen: nutrition and exercise (OK, two). May be that your insulin regimen needs to be adjusted? You may be correct about the dawn phenomenon. Try checking your blood between 3:00-4:00am and compare it with the fasting level. Sometimes when you go low at night, your liver kicks out some glucose resulting in a rebound high fasting number.

It's possible that you are in what they call the "honeymoon" phase. It's the period of time before the ultimate last breath of your last dying beta cell. Your pancreas is still making some last-ditch efforts to keep working and might still be capable of producing some insulin, usually erratically/ inconsistently. This period lasts differently for everyone and makes trying to establish a suitable regimen most difficult (mine lasted years).
OR... It's possible that you've even ended this phase and now have to rely on insulin 100%. When my phase was over it became pretty evident.

You definitely need to get an Endo/DE that understands Type1. Saying that two strips a week is sufficient, should be enough to have their licence taken away. On your regimen you should be testing minimum 4xday. I test at least 5-7xday and more often when going though a regimen adjustment. I hope you can contact your DE (not your GP), or get an Endo referral (even better), especially if your GP IS your DE :-) You need someone available to work with you through this - by looking more closely at all your data and making appropriate recommendations.

Do you have lows? How often? The blurry eyesight is often a sign of high blood sugar. Do you take the Lantus at the same time every night (even in a different time zone)? That can make a difference. Just trying to help if I can.

Cheers,
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/9/2008 12:59 AM (GMT -7)   
Phishbowl,thanks again for your input.........

Like you say.Telling me to test 2 x per day is a joke.I know the strips dont come cheap,but what would my GP rather do ? Not control my Diabetes and end up with Kidney problems etc ! That would cost the NHS a lot more ( Im from the UK ) A friend of mine has to have Dialysis and it costs between £500 - £800 GBP per week ! Plus the price of his other meds ! I get an ear bashing for using 5 test strips per day :( I had a bad day yesterday.Eyesight bad and sweating heavily all day ! Just kept with it.Ate low carbs,took my insulin.Things seemed to calm down later in the day.Last night i increased my Lantus from 20iu - 24iu.My friends fiancee is a Diabetic nurse who i get a chance to speak to now and again.I remember her telling me if my moring reading was over 7mmol incease Lantus by 2iu every 2 days.If over 10mmol increase by 4mmol.The increase of 4mmol gave me a fasting BG of 7.2 :) So im headed in the right direction ! I will do the same tonight.If it still isnt under 7mmol then i will increase it by another 2iu.I remember her saying only increase every 2 days,at Lantus adjustments take a couple of days to even out......

Im just off to do my 30 mins cardio now.Hopefully i wont get a BG spike from the excercise.I like to do my Cardio on an empty stomach before breakfast ( Better for fat burning ) If i keep getting a spike i may try a small amount of Carbs before my AM cardio ( 20g ) with a little insulin.Do you think that would help ? A few weeks back,my AM reading was always 4 - 6 mmol fasting,and i was sometimes having lows during the day.I was also only on 16iu Lantus at night and 1iu per 10g carbs of Novorapid with meals.Maybe you are right and i was in the Honeymoon phase.......

Regarding the timezone issue.I did keep my watch on UK time when i travelled to the USA and took my Lantus at the same time i would back home,but that didnt work.I tried splitting my dose into 2 doses,and that didnt work either :( Thing is i am due to travel agin in 7 weeks.I will probably/hopefully get my readings down by then,only to get them messed up again.Really frustrating ! Makes me not want to go on Vacation :(

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 8/9/2008 9:20 AM (GMT -7)   
I was wondering about the lows you might have because it seems to be that you're on a pretty aggressive I:C ratio for meals and your correction of 1U:1mmol over a BG of 10 is really aggressive for a 2hr PP. If it weren't for the high protein part of your diet, I would think you would be going low (under 4 mmol/L), quite often.

You say you were sweating a lot - did you test to see if you were maybe going hypo? Your DN friend is correct about the Lantus changes - it could take up to a few days to see results of the changes you made. I'm on Levemir now but, when I was on Lantus I had a lot more BG fluctuations and also crashed about 4-8 hours after my Lantus shot. This often gave me the high fasting numbers 'cause I was actually going low while sleeping. Levemir seems to much more agreeable and certainly doesn't sting like Lantus did :-) I also tried splitting my Lantus and it just caused me more problems.

You may want to have an under 30 gram carb snack before your morning exercise, without insulin. This often prevents your liver from kicking out glucose, which often happens if you don't already have some food in ya, especially after 8-10 hours without food. Your body will go to your stomach and small intestine first to get it's sugar. Your liver acts as a backup/emergency sugar store and errs on the side of caution usually sending out a lot more glucose than what's needed. Also, sometimes when you test after exercise it's high because your body is still working on getting all that sugar in your blood into your cells. Many will test high after exercise but will test normal (or even low, as is my case if I don't eat something before I start), within a few hours.

However far we've come with these great new insulins, they still don't quite work in the "real time" we need them to. Watch the correction doses you do with the Rapid insulin. With your aggressive correction factor, that might be causing your lows. Also, at night... have a small snack (under 30 gr of carbs) without any insulin and see if that helps your DP. If you go low at night, the bit of food should prevent your liver from kicking in.

I understand your frustration with the all-over BGLs. I've been on the roller coaster for 3.5 years now :-) I say roller coaster because it is sometimes. You can do all the right things but for some reason, who knows, maybe the moon's orbit? you just don't get the results you're expecting. I've come to expect that this D will throw me for a loop on a regular basis. All you can do is manage what it throws at you.

Get your eyes checked out, too. It's an important part of your diabetes management (eyes are one of the first organs affected by BGLs). I've wore glasses for years and found that since getting D, I've have my prescription slightly change every year. Lately, I've noticed it's changed again and read things better further away than up close. Time for my appointment anyway.

Cheers,
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 8/9/2008 4:27 PM (GMT -7)   
Just to add....two great books to read that I highly recommend are:

1) Think Like A Pancreas by Gary Scheiner
2) Using Insulin by John Walsh

They really give one an understanding of just how the body works, particularly how food, exercise, insulin, etc all work together in one's metabolism. They are real eye-openers to the "timing" of everything (when you eat and how much vs when you inject insulin and where... all matter if you want to fine tune your management/control).

I hope I can include this web site (it doesn't sell anything, guys :-):

www.insulin-pumpers.org/howto.shtml

It's a great site to check out if you want to really understand how to manage your insulin regimen. The "blood sugar howto's" section is a definite read, IMHO :-)

NEWSFLASH**
The province of Ontario (Canada) just funded a new program last month that will cover the cost of an insulin pump for Type1 adults. The program started a couple of years ago for kids and everyone (i.e. insurance companies, gov't assistance programs, etc.) are starting to realize that kids grow up to be adults. They still require insulin to live, and in the long run, it will be far cheaper to get a Type1 onto the best managed care than to pay out so much more for dialysis, prosthetics, seeing eye dogs, etc. They've woken up and smelled the coffee :-)

Cheers,
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5394
   Posted 8/9/2008 6:42 PM (GMT -7)   
Kris, you're a gem.  You're so knowledgeable about type 1.  Thanks so much for all your help!

Lanie
forum moderator - diabetes
diabetes controlled so far by low/no carb diet and exercise; no meds


ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/10/2008 10:47 AM (GMT -7)   
Things are starting to calm down,thank the lord :) My readings ahve been better ( 5.9 this morning ) Eyes are not as blurry and not sweating as much.I think the timezone change ( 8 hours ) just messes my body up ! The sweating i get when im high is a different kind of sweating when i get hypo.I get a hot sweat on my ches/face when high and kind of a cold sweat on my back when low.I had my eyes checked around 6 months ago.No sign of Retinopathy.Also had my feet checked,which where fine.I dont usually eat before cardio as i do cardio for 3 reasons :

1 - To help with Cholesterol/Cardiovascular System
2 - To help keep my Bodyfat in check
3 - Your insulin Sensitivity increases with excercise

If you eat before cardio,your body basically burns the food,instead of stored bodyfat.But,if i have to eat a snack before cardio to keep my BG from climbing then so be it.I like my 6 pack though and would like to keep it :) Im back to my regular routine tomorrow ( Work etc ) so hopefully things will get back on track !

I might try 0.5iu per mmol over for my correction dose and see if it prevents the lows.

Thanks again for your help,i will keep you upto date.Thanks Lanie for the books,ill look them up.

Post Edited (ANTHONY8677) : 8/10/2008 4:16:54 PM (GMT-6)


LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5394
   Posted 8/10/2008 11:35 AM (GMT -7)   
Hi Anthony, that was Kris (Phishbowl) who gave you the book titles, by the way.  :)  Anthony, I'm not type 1 or a body builder but I also do weight training and cardio about 5 or 6 days a week.  This is exactly for the reasons you stated.  I'm much stronger than 18 months ago and have lost 35 pounds.  This has helped me control my type 2 diabetes immensely.  I wish I had started this years and years ago but still am thankful I can do this now at age 59.   Never too late as they say.

Lanie
forum moderator - diabetes
diabetes controlled so far by low/no carb diet and exercise; no meds


ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/10/2008 3:16 PM (GMT -7)   
Ooops ! Thank you to Kris then lol :) All the help is much appreciated........

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 8/10/2008 7:02 PM (GMT -7)   
Glad to hear that you seem to be on top of everything (getting your eyes checked out), despite not having much help from your diabetic team. You can count yourself miles ahead of most in the nutritional understanding and exercise areas - some folks never get or try to understand the biggest impact to their management.

Glad to hear, too, that things seem to be calming down now. I hate to say expect this to happen again but, well, expect the unexpected 'cause it happens :-) Your 5.9 fasting is actually a fantastic morning level. A wee snack before your exercise might just help you stay level as I mentioned and I hope you try it. You never know until you try. Also, just as a rule of thumb, Type1 diabetics are advised to eat a 15-30 gram snack before exercise (unless the exercise follows a meal), in preparation for how the metabolism works.

Trust me on this one, too.... when you get the sweats, feel light-headed, get emotional (angry, tired, sad), and there are some other "signs".... please test. You CANNOT guess, especially when you're trying to figure out your regimen. I have typical signs for both lows and highs and I can't tell you how many times I tested and was surprised to learn my BG was the opposite of what I thought. I thought I was high one time and waited a while to test, only to find I was the lowest I'd ever been. There is no guessing with diabetes (if it's not measured, it's not managed :-)

One last thing... climate/geography changes can play chaos with BGLs. It's a known fact that many Type1s have to adjust insulin regimens when both summer and winter hit (especially in the northern climates that see a greater variance in temps). I'm not surprised that your UK to Florida/Vegas trips had your BGs outta whack. Different climate, food, body clock, routine, etc. are all things that might require an insulin adjustment. And you thought I was kidding about the planetary alignments... :-)

Glad to be of help if I can.

Cheers,
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/14/2008 10:16 AM (GMT -7)   
Hi Kris,thanks again for the advice.I know a couple of type I and they seem to need less insulin in Hot climates.Seems im the opposite !

I visited the nurse yesterday.Expressed my concerns and told her the problems i was having.High AM reading,blurry vision,elavated Blood Pressure and constantly urinating.Her response was "If you are are doing plenty excercise and eating right i wouldnt worry about it" !!!! Im sorry,but i do worry about it !!!! Made an appointment with my GP for next week.I seem to be on top of things.My AM fasting level went back up after the previous post.I increased my Lantus by another 2iu and it seems to have kept my AM reading in range ( 5.6 today ) My readings have been stable all day follwing my 1iu per 10g carb ratio,so hopefully i can keep it that way.Thanks for the tip on eating/excercise.I used to be able to eat small snacks like a peice of fruit without any insulin and it didnt afftect my BG.Nowdays it does.I had a Cappachino this morning before my Cardio ( 10g carbs ) and after my BG only raised by 1MMOL or so.Im still passing more water then usual ( Very annoying at night ! ) hopefully that will calm down as my BG is kept stable.....

ANTHONY8677
New Member


Date Joined Aug 2008
Total Posts : 8
   Posted 8/14/2008 10:20 AM (GMT -7)   
P.S. I weight train at 5.30pm.I eat a meal at 4.00pm,and take my Novorapid of course.Do you think this meal would be sufficient to cover the excercise,or should i be having a snack right before weight training.I seem to be fine.
 
Also,i read a lot about Caffeine being bad for diabetics.I have at most 1 - 2 cups per day,just for a boost beofre excercise.Is this ok ?

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 8/14/2008 1:08 PM (GMT -7)   
Hi Anthony.... good for you to be on top of things - "You are the most important person in managing your diabetes".

In response to your Nurse's answer I would be tempted to say, "well, you are NOT me. I am worried. And tell me specifically why you think I do NOT have anything to worry about." I don't settle for 'pat' answers anymore; I want the facts/details. Glad to hear you'll bring everything up with your GP who'll hopefully be more informative for you.

It's possible that your BP meds (are you on them?), could be the reason you're friendly with the loo these days. They are known to do that. Also, with the amount of exercise and it being summer at the moment, I would think you would be staying well hydrated and that too, could be the reason for the more frequent bathroom trips. Have you had the micro albumin/urinalysis test yet? It's part of your diabetes management and should be done yearly (pee in a jug over 24 hours and it tests kidney function: protein levels infection, etc.).

The blurry vision is usually a sign of high blood sugar (usually sustained high levels for a period of time). I'm not too familiar with BP issues (I actually have low blood pressure), but maybe that has something to do with the vision?? Having your eyes checked out by an ophthalmologist is the appropriate step (and you've done that since being diagnosed Type1 right?).

You seem to have a handle on the Lantus; you're getting good numbers throughout the day (and not going low, right?). You have to skip some meals and follow a few other minor conditions to really see how your background insulin is performing (if you haven't already, check out the "insulin pumpers" link I mentioned previously - they explain how to do this brilliantly).

The only way to know if you need a snack before your 5:30 training is to test before you start, test during, and test after, then again anywhere from 1-2 hours later and possibly again 3-4 hours later (part of the process that helps you establish some "knowns" about yourself). It all depends on what/how much you ate for din-din, I:C ratio used, how the kind of activity affects you normally, etc. I might suggest that you increase your I:C ratio from 1:10 to 1:12 or 1:13 for that meal in preparation of the activity. You might spike a bit higher than usual but you wouldn't have to snack and should still come out with a decent evening/before bed reading. My biggest concern is that your dinner's Rapid injection peaks shortly after you start your training - you'll want to test during your training to make sure you're not going low. Peaking insulin and exercise are usually a recipe for a crash for me :-)

Caffeine is a drug. Some do OK on it, some have a greater sensitivity to it. It does affect metabolism (it's a stimulant), but again, it just depends on the individual. 1-2 cups/day is OK in my book. I have one cup in the morning just because I like the taste (and hubby makes it for me :-) You can search on caffeine+diabetes and find a lot of info.

Cheers,
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus

Post Edited (Phishbowl) : 8/14/2008 2:13:16 PM (GMT-6)

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