Get a good control! Diabetes type 1.

If you want to have a good control, you must control your diabetes. It's all about taking control of diabetes and not let the diabetes control you! If you need to control diabetes, you must have full control. This means that you need to know:

a. What is your blood glucose level (BG)?
b. What is your carbohydrate / insulin ratio?
c. How many carbs / meal you eat.
d. How many carbohydrates various foods contain.
e. How your body responds to the insulin.
f. How your body responds to food (with and without fibers) (proteins and fats).
g. How your body reacts to stress (including anxiety or excitement).
h. How your body responds to exercise.
i. How your body reacts to insulin due to the time of the day.

 a) + c) + d) + e) + g) + h) + i) Measure your blood glucose level (BG) often - Laura measuring  5-10 times / day. You need to know where you are so that you can act by it; either take some NovoLog (NL) or eat some food. Especially in the early diagnosis while still in the remission phase, it is important to measure often, as it is this which gives you a greater understanding of how various foods works, and how to respond to insulin and exercise.

b) + c) The best thing for us was to find Laura's carbohydrate / insulin ratio, ie. the number of carbohydrates that  1 unit of insulin (NL) consume. We found the ratio by over a very long time (and still do) to write all the BG numbers down and the food that Laura consumes each day. See an example of our schedule here, where Laura is six months after diabetes diagnose (still in the remission phase):

 

Date	Saturday 22/6
Time	7.00 am	11.15 am	2.15 pm	5.50 pm	6.40 pm	8.50 pm	11.00 pm
BG	7,4	5,8	5,3	4,4	5,2	8,9	5,8
Insulin	9 Lantus + 2,5 NL				1,5 NL	2 NL
Food/Sport	Yoghurt + musli = 6g + 12g carb.	1 bun with ham + avocado + vegetables = 29g carb.   -Go for a walk  15min	1 rye bread with tuna = 15g carb. + 1. peach = 6g carb.	50ml milk = 2,5g carb.	Chicken + 120g potatoes + vegetables = 30g carb.	2 scoops icecream = 25g carb.

 

Bolus and correction insulin: When you eat, you can take both bolus and correction insulin ie. insulin for both food (= bolus) and correction insulin (= to correct for a high BG). It is therefore important to know what BS is before you eat, so you can take corrective insulin if so, that's a bit too high.
You can post-process a high BG by taking correction insulin if you after dinner (2-4 hours) have a high BG (> 9). You just have to be sure that the first dose of insulin is close to be out of the body, otherwise you´ll  suddenly go too low if you take extra insulin. You have to know your insulin sensitivity, meaning that you need to know how many jumps down the BG-ladder by 1 ie NL. If you know that, you can better deal without being afraid to go too low. If you take extra insulin you MUST be measured (BG) after 1 ½ hours. Laura's insulin sensitivity is currently 33 meaning that Laura jumps 100/33 = 3 hops per insulin unit.  

d)On almost all food producs is applied, how many carbohydrates found per. 100g or 100ml. You can weigh the required quantity and figure out how many carbohydrates pr. gram or volume by taking the product carbohydrate-number and divide it by 100 and multiply by your balanced grams. eg:

The product carbohydrate in gram/100g	Your balance / weighted out	Carbohydrate in your balanced grams?
61 grams	24 grams
61/100 = 0.61 g carbohydrate in 1 gram of the product.		0.61g x 24g = 14.64g carb. in the balanced quantity.

On the internet there are lists of many foods and their carbohydrate content.

e + i) The body can respond differently to insulin depending on what time of the day it is and what kind of exercise you have been doing as well as heating / cooling effects, and of course on what you have eaten.   In the morning, you are much less sensitive to insulin because you do not have much insulin left in the body from the previous day. This means that your carbohydrate / insulin ratio is lower than the rest of the day. Laura's morning-carbohydrate/insulin ratio is = 8 - 12g carbohydrate, while for lunch called 22g carbohydrate and night = 10 - 14g carbohydrate. Do you exercise regularly, you are more sensitive to insulin than if you're not doing anything ie. that you need less insulin when playing sports. Are you in the sun a lot you should be aware that you may need less insulin or more food.
Do you have a fever, you might need more insulin.

f) Most foods contain carbohydrates except fish, meat, poultry, eggs and cheese meaning they do not affect BG. There are fast and slow carbohydrates and this is very important to know. It's all about knowing what you should / can eat if you are very low in BG or if you just need to eat normally or if you have to exercise.

Simple - and fast carbs are: sugar, juice, milk, fruit, white bread and sugar-sweetened beverages.            

Sugar:	Laura never eats plain sugar, but she gets it in the form of candy or glucose tablets, if she is a little low or if it is included in a meal (dessert).
Juice:	We use juice when Laura is very low. We use either juice or milk to keep BG up 1 - 1 ½ hour before dinner.
Milk:	We use juice or milk to keep BG up 1 - 1 ½ hour before dinner or if Laura is very low (<4) and must have insulin before dinner. The more fat there is in the milk the longer it is to be included and therefore lift BG slower. We have a little trouble with milk because it often teases us with a high rate of BG. Laura gets her calcium from yogurt and cheese instead.
Fruit:	Fruit is good for sports or if you go a little low in BG an hour before dinner. An apple (10g carb.) will keep Laura ongoing for 1-2 hours depending on how much she´ll move around.
White Bread:	White bread can be eaten as a starter if BG is a bit low and before taking NL (insulin) - but remember to include bread in your insulin dose calculation.
Sugar-sweetened beverages:	Laura does not drink sugar-sweetened beverages, but you can use Coca Cola, if you get sick in your stomach and BG is hard to keep up.

The slow carbohydrates are: Fiber-rich bread, legumes, vegetables and high-fiber breakfast cereals.

Fiber-rich bread:	Laura eats fiber-rich bread (bread / buns / toast) every day (for lunch).
Legumes:	Laura eats peas.
Vegetables:	The vegetables are good because they contain very few carbohydrates and they provide a slow rise in BS. Laura will have them in addition for lunch, afternoon and dinner. They keep the carbohydrates that you have eaten along with the vegetables running longer.
High-fiber breakfast cereals:	Laura eats Musli from ISIS (or ISIS Chunch) on Cheasy yogurt 0,1% (low fat/nonfat yoghurt).

 

I will not go into what kind of fat, which is good and which is bad (read more about it on the internet). But too much fat in the diet prolongs the food's "lay" in the stomach, which means that you get a subsequent increase in the blood sugar. Normally, you can measure the effect of food on the blood sugar levels 1 ½ - 2 hours after food is consumed, but have you been eaten a large amounts of fat (like burger and fries (not homemade) or pizza (not homemade)) then it might take up as 4 hours before BG increases. This means that the amount of insulin that has been taken with the food, is no longer working and you´ll go too high in the BG. If you, for example must have 4 ie NL for a burger with fries and take the insulin just before eating, there is a risk that you´ll go too low in BG shortly after the intake of food and insulin - to treat for this, you´ll have to eat some bread and juice - and then after 1 ½ - 2 hours the rise of BG comes from the low BS-treatment-bread and further 2 hours later another rise from burger / french fries – you´ll go very high in BG.                  
To avoid this, one option could be to share insulin contents into 2: If we use the example from before; 4 ie NL: If you take 2 ie NL along with the burger and french fries and 2 ie NL more 3-4 hours later then you should be well off. In all cases, it is advisable to measure BG 1 ½ - 2 hours and again after 3 - 4 hours. It must be tested and not all people reacts the same. Laura has decided not to eat French fries, as it always teases. If you can not completely avoid chips / pizza, you can perhaps do with a little less (2 pieces pizza or 3-4 pcs chips).    

g) Going for the exam or a concert or another thing that excite or stresses you (positively or negatively), you run the risk of going either higher or lower in BG than normal. Whether you go high or low is individually based and you must experiment. Laura always gets a higher BG when she gets excited.

 h) Exercise is a good thing! Exercise will make BG drop and stabilize it. It can be a little difficult to find out how much or how little exercise is needed before one gets too low. It depends on how high your BG is before starting exercise, but also how tough the exercise is and what you have eaten. One thing is certain, you should ALWAYS have some sugar with you when you exercise (even if it is "only" a walk). Some take apple-both when they run, but again it is something you must try out. We were initially a little worried that Laura would go too low when she ran or bicycled, but gradually Laura became more courageous when just some sugar was in her pocket and Laura measured before and after exercise. Laura responds really well to exercise. She jumps for example approx. 3-4 jumps in BG from cycling for 30 minutes at a moderate pace (provided she has eaten food with many fibers). It is conversely also very clear that BG is higher and hard to get down when Laura is lazy for a day or two. After a lazy weekend, it may take 1-3 days for the BG to become normal again.

Laura used especially at the beginning exercise (dance) to get down in BG when she was too high (> 10). Laura produced herself a lot of insulin at the time and got therefore only basic insulin, so that´s why Laura could dance herself to a fine BG in a short time. Even today, where Laura is coming out of the remission phase, she can dance the BG down. If you exercise a lot, you do not need so much insulin as if you do not exercise regularly; this is linked to that one becomes more sensitive to insulin when one have a toned body / toned muscle tissue.