Diabetes Community

Sounds like you're caught between a rock and a hard place. Persistent high blood glucose can itself lead to mental fogginess and confusion ... thus compounding the problems of getting back on track. A forum is really not the place to seek advice and you should be consulting with a medical professional. Although I won't attempt to provide you with any medical advice (which is against forum rules), I can relate how I would personally go about getting back in balance. I am an insulin-dependent Type 1.5 which is not that far removed from Type 1. In the more than three years that I have been using insulin, I have made reasonably consistent determinations of how carbs and insulin affect me personally. I know that one gram of carb is going to jack up my blood glucose levels approximately 5 points and 20 grams will shoot me up 100 points (i.e., without insulin or exercise). On the other side of the coin, one unit of regular insulin will drop my blood glucose approximately twenty points if I'm sedentary and approximately 25 points with modest activity. More intensive exercise will drive my blood glucose even lower.

Those figures are how carbs and insulin affect my body and may or may not be applicable to you or your situation. If you haven't already, you must develop your own cause-and-effect record of how carbs and insulin affect your body. For you to be so far out of whack (A1c >12), you probably need to completely overhaul your dietary intake. A good place to start is to eliminate all wheat and potato containing foods initially from your diet until you get back into balance. That will remove the lion's share of starches from your diet and give you a fighting chance to get back on track. It's past my bedtime but I'll post back with an illustration of how I would personally handle a high blood glucose reading in order to get myself back down into the "normal sugar" range using the info provided above.

Are you using insulin right now?

Hi Jashy. What is it that "there is so much going on?" I feel your pain. My first A1C was 13.2. Yep, consistent high blood sugars. I don't know about you, but I felt terrible. Persistent fatigue because my blood sugars were so out of control. I'm a Type 2, insulin-dependent. Kind of out of the box for most T2's.

I followed my doctor's and dietician's orders to the "T." You need to in order to feel better and get your sugars down. My next A1C was 8. In three months, it came down to a little over 5 points. My next one was 6.2. Then 6.0, then 5.8...

You get the picture. The less carbs I ate, the less insulin I needed to use. My "problem" is that I require a lot of basal insulin, 38U at this point and my Humalog is dosed according to how many carbs I eat. I started out at a small dose of Lantus at 15U but that didn't touch my blood sugar.

It is a delicate balance between eating, using insulin and exercising. If you have too much stress going on, this is going to raise your numbers.

Is there anyone you can talk to? You might ask your doctor. I know you know that your A1C isn't much too good after going through this for eight years.

Trying to get control requires a lot of diligence with your eating, the types of foods you eat and physical activity.

What does your doctor say? You do need to get better control, otherwise you are damaging all of your organs and you don't want to do that. You are much too young to do that.

Do you inject or use a pump? Is the insulin helping? Is your eating out of control?

Jashy is a Type 1 so I have assumed that he is on insulin but to be so far off track indicates that he has not fully learned how food and insulin affect him personally.

Jashy, sorry for the delayed posting but I've had a pretty full plate. Dr. Dansinger has 3 Tips and 4 Resources linked on the upper right side of the page. You should read those to get a refresher on the disease. The most critical step will be an overhaul of your diet. Diabetes is a cause-and-effect disease as I mentioned previously. Your ingestion of carbohydrate-containing foods will drive your blood glucose UP and the injection/production) of insulin will drive it DOWN. Think of diabetes as a carbohydrate-intolerant disease. Getting the two factors (grams of carbs and units of insulin) in balance what you must do. It's really basic commonsense but in actual practice, very, very difficult for many insulin users to achieve. That's why it is vital that you develop a track record or history of understanding how these two key components (carbs and insulin) affect you personally. Each of us is genetically and metabolically different to some degree so what works for me or someone else may be different for you. The bottom line is that it will require modifications to your dietary intake.

Since your particular situation is particularly dire, drastic situations call for relatively drastic measures. For a trial adjustment period of ten days, I would strongly urge you to eliminate all wheat, rice and potato-containing products from your meals. That means no bread, bagels, pastries, pasta, fries, hash browns and all pre-packaged and prepared foods containing them as food ingredients (you will have to be a strict label-reader when shopping for items in the supermarket). What can you eat? Lots and lots of above-ground vegetables (avoid those that grow underground such as carrots and beets during the adjustment period). You can also include eggs, nuts & seeds (raw almonds and walnuts are the best choices; cashews have a much higher carb content), chicken, fish, (beef, pork and lamb also, if you're so inclined), cheeses and other low carb foods during this period. If you want a carb-like meal without the carbs, consider Shirataki noodles . Shiratki noodles (only 3g per serving; one of which is fiber) is made by several different companies and are available from Whole Foods and many other non-traditional supermarkets, health food stores, and even Amazon.com (link provided). Limit beverages to plain filtered water or black coffee or unadulterated tea. Hard boiled eggs make an especially convenient, ready-to-eat meal supplement or snack (I pre-boil a dozen at a time and keep them handy in the fridge). Eggs, string cheese sticks and nuts offer portability without refrigeration and can easily be carried with you as snacks or meal substitutes. Adding some nutritional supplements such as a good multivitamin and whey protein might also be a prudent idea during the adjustment period.

IMPORTANT CAUTION: The elimination of the "demon carbs" from your meals will require major modifications in your insulin doses and you are well advised to check with your doctor before adopting such a low carb diet and before making the resulting adjustments to your insulin doses. Frequent BG testing is a must during the ten day adjustment period and keeping a written log of your food intake (both food types and portion sizes), amount of insulin units administered, and blood glucose readings (before each meal/snack and two hours after taking the first bite of the food consumed) is essential. After the ten day adjustment period, analyze your logs and evaluate the trend in your blood glucose control. Then decide for yourself whether you want to continue the dietary restrictions or simply incorporate the basic principles involved and adapt it to whatever meal plan you ultimately adopt.

I'll explore insulin use in a subsequent post to avoid overrunning the character limitation of the forum's software.

. If you use an insulin pump, you should have already discovered that smaller multiple doses are often far more effective in maintaining blood glucose levels closer to normal than a single large dose with a significantly lower risk of hypoglycemia. If you use vial insulin or pen insulin, then the multiple doses will require multiple injections. The efficacy of an injected dose of insulin can be influenced by many factors including depth of the injection, volume and speed of the injection, and the injection site itself. It is not uncommon for a given dose of insulin to vary (in terms of its efficacy) by up to 29% from one dose to another (usually, it's not that drastic but actual tests in human subjects have shown that efficacy has varied by up to that percentage). Miscalculations in doses occur often enough that by using smaller, multiple doses, any errors can easily be corrected or adjusted. An essential prerequisite is that you must know how carbs and insulin affect you personally. In Dr. Bernstein's words (from his book, Diabetes Solution ):

The name of the game for the diabetic in achieving blood sugar normalization is predictability. It's very difficult to use medications safely unless you can predict the effect they'll have. Nor can you normalize blood sugar unless you can predict the effects of what you're eating. If you can't accurately predict your blood sugar levels, then you can't accurately predict your needs for insulin or oral blood sugar—lowering agents. If the kinds of foods you're eating give you consistently unpredictable blood sugar levels, then it will be impossible to normalize blood sugars.

Originally, I was going to relate the process or procedure that I personally employ to achieve close-to-normal blood sugar levels; that process is still ongoing and continues to change and improve with experience/experimentation. For those who may be skeptical, my current A1c is 5.0 and I have had ZERO catastrophic hypoglycemic episodes. However, after giving the matter considerable thought, I decided that posting what I personally do might be too alien in concept to what the majority follow. Also, if you aren't able to accurately predict the effects of insulin and food in your body, it might endanger your health if you miscalculate your insulin requirements. Instead, I will point you in the general direction of existing material that dovetails with my own beliefs and you can make up your own mind in adopting (or rejecting) the concept of "small numbers" and dietary starch restriction to your own situation.

There are three books that I consider essential reading for anyone experiencing difficulty in making the requisite adjustment in their diets or continue to have A1c readings above 5.8:
Dr. Bernstein's Diabetes Solution, 2011 Edition (Richard K. Bernstein, M.D.)
The Low-Starch Diabetes Solution (Rob Thompson, M.D.)
Wheat Belly (William Davis, M.D.)
The links provided are on Amazon.com but it is NOT an endorsement or recommendation for you to purchase books from that vendor. I only reference Amazon.com's website because they provide free preview chapters, eReader editions, as well as reader reviews that may prove useful to you.

You can also read some chapters of Dr. Bernstein's Diabetes Solution book online for free (2009 updated edition) by clicking on the link provided.

(to be continued)

If you prefer to read the free chapters offline at your own leisure, PDF versions of the free chapters are available for download at the links below:
Before_and_After.pdf (14 patients Share Their Experiences) 05-Aug-2009 83K
Diabetes_TheBasics.pdf (Chapter 1) 05-Aug-2009 720K
Chapter7.pdf (The Laws of Small Numbers) 05-Aug-2009 304K
Chapter9.pdf (Basic Food Groups; What You Need To Know About Diet) 05-Aug-2009 603K
Chapter10.pdf (Essential Diet Guidelines) 05-Aug-2009 1.2M
Chapter12.pdf (Weight Loss If You're Overweight) 05-Aug-2009 482K
Chapter14.doc (Using Exercise To Enhance Insulin Sensitivity ) 05-Aug-2009 275K
Chapter15.pdf (Oral Blood Sugar-Lowering Agents) 05-Aug-2009 542K
Chapter24.pdf (What you Can Expect from Normalizing Blood Sugar Levels) 05-Aug-2009 180K
MyLife.pdf (Autobiographical Overview of Dr. Bernstein's 64 years as a Diabetic) 05-Aug-2009 79K
AppendixA.pdf (Commonsense Scientific Analysis of "Good" vs. "Bad" Foods) 05-Aug-2009 782K
AppendixD.pdf (Foot Care for Diabetics) 05-Aug-2009 182K

Chapter 14 is in Word format instead of PDF. It was difficult to locate this link navigating the diabetes-book.com website; perhaps because it is a work still in progress (doubtful) or may be one that is slated for removal soon (more likely). In any event, it is definitely worthwhile reading. All insulin-dependent diabetics will find it beneficial to download and read Chapter 7, The Laws of Small Numbers . Those who do not use insulin can bypass this particular chapter as the information only applies to insulin users.

I purchased the hard copy version of Dr. Bernstein's book when it was first released in November,2011 but it just languished on the shelf gathering dust until a friend asked to borrow it (I had previously read two of Dr. Bernstein's earlier editions). Early this week, after loaning out my hard copy, I decided to purchase the eBook version for my Kindle. Once it was downloaded into the Kindle, I immediately began reading it. Although much of it is a rehash of Dr. Bernstein's previous editions, there is still ample new material to cost-justify the purchase ($14.95 for the Kindle version; $17.23 for the hard copy). I also previously purchased and read copies of the other two book recommendations above. Having read all three books, I can recommend them without hesitation to anyone who suffers from diabetes or is a caregiver to someone who has diabetes. If you can't afford to purchase them due to budgetary restraints, check with your local library to see if they have them available. However, by all means do read the free chapters of the Bernstein book offered online and/or download them using the links provided.

Post back if you have any questions or comments.

I followed my doc and dietitian very close for years. i don't know what happened. I moved from michigan to arizona and i lost control. I am happy here with my family. i have a fiance and 10 year old step daughter. my fiance works at least a 10 hour shift, 6 or 7 days a week. i dont work. i do everything, dont get to see my lady, with her kid more than i am her, i deal with the bills, rent, cleaning, cooking, everything. then on top of it i am supposed to check my bg levels at least 6 times, and at least 4 insulin shots, watch what i eat. its way too much.
I have never had a problem tho. i have had 500 bg level for a long period of time. never had a siezure, nothing has ever happened. its been out of control off and on for 3 or 4 years.
I have a problem eating. i dont! i might snack a little between 7am and 4pm. then i usually make dinner for my step daughter and i. maybe not on the weekends. and its always frozen or canned food. its easier, and cheaper. we live paycheck to paycheck. money is gone when we have it. we cant save a dime. fresh food is more expensive.
i am not a whinner, but i do feel all cloudy, like i have no idea wtf is happening!

Jashy, the fact that you're even here asking for input indicates a self-awareness that you're in deep doo-doo. However, if your blood glucose is in the 500 range and your A1c is nearly 12%, you probably should head to the ER or see a doctor as soon as possible (with double emphasis on ASAP). You're not just "way off track," you're headed for some very serious threats to your health that may be very long term and even permanent; perhaps even life threatening. Not eating and "just snacking" is one of the worst things for a diabetic to do. Not only is it difficult to keep track of your calories and carbs but it is virtually impossible to safely gauge how much insulin you require in order to offset your intake. I also suspect that your snacks are manufactured foods that are laden with carbs and HFCS. I think that you should let your fianc? read this entire thread and assist you in getting back on track. If you continue the way you are, it's going to negatively impact your future in many more very serious ways than you can imagine. I can't stress enough the dire nature of your situation and you need help ASAP from a medical professional because I am not at all confident that you arfe able to DIY (i.e., do-it-yourself) without outside assistance. The situation is much more urgent than you may realize. Best of luck.