Reddit reviews Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin--Completely Revised and Updated (Marlowe Diabetes Library)

This is from "Think Like A Pancreas":

"Without dietary carbohydrate to provide glucose for meeting the body's energy needs, the liver begins to convert some dietary protein to glucose."
"Roughly 50 percent of protein can be converted to glucose if there is no other source of sugar in the meal"
He suggests that for a no carb meal, bolus for half of the protein as if it were carbs. He also says that for a low carb meal, the math gets trickier, but that there is still an effect, if carbs are below a certain level.

I loved Think Like a Pancreas.

You'll be fine.

It's going to be a bit of a life change but it's totally manageable. The best thing you can do is learn as much about your condition as you can because you're going to be the one managing it day-to-day.

Start by learning to carb count so you can match your insulin dose to what you're eating. There's info on the internet but the book Think Like A Pancreas was a godsend to me when I was diagnosed and I recommend it. https://www.amazon.co.uk/d/cka/Think-Like-Pancreas-Practical-Managing-Diabetes-Insulin-Completely/0738215147

Hypos can be very scary but as long as you have good hypo awareness (i.e. you start to feel like crap when your blood sugar is low!) they're nothing to be afraid of. Find a hypo treatment that works for you and make sure you always have it with you. I find running gel works for me.

Alcohol can mess up your blood sugar levels overnight but you can still drink alcohol. Maybe take it easy until you get the hang of managing your blood sugar.

There's a lot of bad information about diabetes on the internet. This sub is one of the good places to learn :-)

Best of luck!

As a person with a newly diagnosed kid, I can agree that everything is super overwhelming in the beginning and help from friends is welcome. The thing we needed most was the space to learn about our new life, and someone to just talk to about everything. Seems contradictory, but I would reach out with no expectations and wait to hear back.

In terms of more tangible things, you could pitch in to hire a temporary cleaning service, even if only once during the 1st couple weeks. or help buy some of the items they will need such as a quality digital food scale, Frio insuling cooling case, or books. The two books I've found to be the most helpful are Think Like a Pancreas, and Sugar Surfing.

Also the JuiceBox Podcast is really wonderful, and I highly recommend it.

Yeah, she was "in DKA." That's what we say. Tough few days I'm sure, but I hope you have been able to take a deep breath and see that as nuts as this all probably seems right now, you'll learn to live with this and it will be ok.

I was also 6 when I was diagnosed, and almost 32 years later I am doing just fine. I identify as a person with diabetes--that's part of my identity--but it is just one aspect of who I am. Everyone has their struggles, and this happens to be ours, but it certainly didn't ruin my childhood or anything. The technology is so much better now too.

One thing to keep in mind is that you and she have plenty of time to learn how to get this under control. Until you have a feel for it, her control is not going to look like the superstars with the A1c's in the 4's and 5's that you sometimes see on here, and that is totally, perfectly ok. Insulin needs may also change a lot in the first year or two as she exits the honeymoon phase. Obviously you'll want to do what the doctors say, but in the near future there is no need to beat yourself up at all over BG control that isn't quite dialed in yet. Focus on getting used to T1D and integrating the treatment into your lives. That mindset sort of continues into the long term too: there are tons of things that impact BG, and there are going to be days that look really ugly control-wise. That's totally fine. The key is to focus on average BG and time in range over weeks and months, and not to get too hung up on the individual days. This is really hard, but just try to keep celebrating the good days and approaching the bad days with a sense of curiosity about how to do things differently next time, never with any blame or guilt.

I think the single most important thing for me early on was developing a great relationship with my endocrinologist and especially my diabetes nurse educator. I stayed with them for 25 years--grade school, high school, college, graduation and my first job... if it's good, that relationship can be hugely impactful.

Inevitably you'll have some thinking to do about CGM and insulin pumps at some point. I personally love my pump and CGM and wish that I had access to them (particularly the CGM) 31+ years ago. At the same time, I think it would have been very difficult for me to have my parents remotely monitoring my BGs all the time, especially as I got older. I don't know the answer for that situation, but something to keep in the back of your mind. As far as having a thing attached to me with a tube, it's part of my life. I don't really notice it that much. It beats having to carry around an insulin pen.

This community is extremely supportive, as are r/diabetes_t1 and r/diabetes. As far as books, lots of people recommend Think Like a Pancreas, and I think Bright Spots & Landmines is a good one too. Good luck, and hopefully we'll continue to see you around as questions come up.

• Figure out whether you can acquire a Dexcom sooner than later. (For a 3-year-old, don't bother considering the Libre or the Guardian — what's really going to make a difference for you is the remote monitoring, which only Dexcom fully supports.)
  
• Also start looking into the Omnipod — this is going to be your ideal pump, mostly due to the remote dosing.
  
• Think Like a Pancreas is a great management overview book.
  
• Get a small kitchen scale if you don't already have one.
  
• Use a notes app of some sort to keep track of common carb counts for things, like the stuff you're going to put in lunches. AnyList on iOS is great for this.
  
• Keep reading and listening, but try not to overwhelm yourself; it'll all be fine. :)

I constantly recommend Think Like a Pancreas to my family and friends who ask to learn more about diabetes. It's a great book written by Gary Scheiner. He also writes with a very conversational tone, jokes, and is honest with how he handles type 1 for himself and recommendations for his patients.

First of all, good on you for finding a new doctor. I know way too many people who blindly listen to what the first guy told them even if their gut tells them not to.

It looks like both his basal insulin isn't cutting it and his mealtime boluses are off. I'd strongly recommend the book Think Like a Pancreas.

The bolus problem might be his ratios, or it might be incorrect carb counting. If you don't have a food scale, you should consider getting a cheap one and using it for a bit. I still get mine out every few months and measure out what I think is X amount, check with the scale, and correct the amount so that I can actually see hw much dry pasta is 20 g of carbs or what a "medium" banana actually looks like.

The basal problem is more complicated, and is really the thing you're going to need to tackle first. If he doesn't start from a good point pre-meal, or if his spike after a meal is caused by a combination of not enough bolus AND not enough basal, it's going to be incredibly hard to nail down his bolus ratios. The nice thing about Lantus is that it has really steady absorption for about 24 hours, but for a growing kid, that's probably not quite what he needs. I don't know if you and your ex have considered trying to get him a pump once you find a new provider, but being able to set a variable basal rate would help with things like the drops that are happening at around midnight, and the bumps that happen pretty consistently between midnight and 3 am.


This could also be a somogyi rebound where he's going low and his body stresses out and dumps adrenaline and stored glucose, but it looks like there's only one night with a low that could cause it and that bump is more likely due to overcorrecting because middle of the night lows are freakin' scary.

Hi, T1 here. Look up typeonegrit on facebook. Also the Dr Bernstein group too. Every T1 has their own way of managing things though, and it can depend on other health factors. Low carb or keto, varies per person. Also, if she is recently diagnosed and could be still in the honeymoon phase, things can be quite volatile, as in bg changes rapidly, I:C ratios and correction factors can change a lot too, as do insulin requirements. If low carb is a big dietary change for her, she needs good resources.

Look up Dr Bernstein Diabetes Solution--he is an octogenarian type 1 who has zero complications. Was an engineer who became an endo after diagnosis in middle age, helped get blood meters into common use and much more. I can't recommend his work and book enough. Look up the book Think Like a Pancreas for general type 1 info, and also Sugar Surfing (Dr. Stephen Ponder--not low carb but has great resources and a good book) too.

It is a fact that low carb can help with the roller coaster of type 1. There are over 42 factors affecting blood glucose levels, with only about 3 that one can control (food, medication, exercise). The rest are often a surprise. Eventually, she may find she needs to bolus for protein but that can take a good while to figure out as that ratio is absolutely not the same as a carb ratio (mine, for example, is 30% of my bolus). Many endos don't even know this because they usually do not treat low carb type 1's. It will take a lot of trial and error again, especially if she is in the honeymoon phase. Also if she's a woman, her cycle will greatly affect her insulin sensitivity and resistance throughout her cycle, depending on what the progesterone is doing in the body. So leading up to her period, she can experience extreme highs, or low, depending on the day. So you can feel like your i:c ratio is not correct, but it's just our other hormones messing things up. Most type 1 info seems to be geared towards the male body, and a high carb diet. It's a bit harder for women to get the correct info. Also, most people will have different IC ratios for different times of the day, but not all people. Is she pumping yet or on MDI?

One more thing: https://diatribe.org/42factors

There's also a couple type 1 specific subs on reddit if she's not there already--check out diabetes_t1, although not specifically low carb, some of us there are.

I cannot state this enough--if she's honeymooning things can be tough and change a lot.

Hope this helps!

Edit: some endos will think you're nuts or mostly not be supportive if you go low carb and many dietitians will push high carbs--mine wanted me to eat more carbs than I ever have in my life sometimes smiling and nodding helps, then confound them with good results and say "hmmm, lucky I guess?"? so...keep reading and finding the resources you need and a good endo/team.

Edit 1: yes, she should talk to her endo in case there are other concerns and massive dietary changes need to be done slowly and carefully. Anything weird happening, talk to the endo asap.

Edit 2: she needs to basal test regularly--carb reduction can result in a need to lower basal rates, even if its 1 unit for example, so basal tests are an absolute must.

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PS: https://www.bookdepository.com/The-Ketogenic-Diet-for-Type-1-Diabetes-Ellen-Davis/9781943721054?redirected=true&utm_medium=Google&utm_campaign=Base1&utm_source=CA&utm_content=The-Ketogenic-Diet-for-Type-1-Diabetes&selectCurrency=CAD&w=AF4BAU9603F04YA80TR7&pdg=kwd-309174813119:cmp-710395099:adg-40837325721:crv-163852249878:pid-9781943721054:dev-c&gclid=Cj0KCQjw3JXtBRC8ARIsAEBHg4mj7BkbBFvRSpL-223vh1ZXz745TrN_FsxICdkmwtRopsy6vVhuG6saAt9BEALw_wcB

http://www.diabetes-book.com/

http://www.diabetes-book.com/about/

https://www.sugarsurfing.com/

https://www.amazon.ca/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147

https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag

My wife was diagnosed at 25. It was a drastic change. No one at the hospital or the first couple doctors was useful. We would not have had a hope had someone not recommended (and lent us) "Think Like a Pancreas" by Gary Scheiner. It's $10 on Amazon. [link] (https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147/ref=sr_1_1?hvadid=77859218195798&hvbmt=be&hvdev=c&hvqmt=e&keywords=think+like+a+pancreas&qid=1558460097&s=gateway&sr=8-1)

Just another note, don't let anyone tell you bullshit like you can only have sugar free or you'll never eat bread again. (both of these things the nurse in the emergency room told us). It sucks, it's a big change, it will make you cry at times, but you will make it. Get a pump and CGM as soon as you can.

1 - 8.6 while not great, is really not that bad. Small improvements can probably make a HUGE difference for you. Read Think like a Pancreas and then maybe Pumping Insulin. Sugar Surfing is also another good one but that method requires CGM usage.

2 - getting a CGM and seeing the impact that things have on your BG, from food, to activity, to even things like stress, can help you have better strategies to manage things.

3 - good diabetes management is primarily about taking action when necessary, and far less about being compliant and doing what your doctor told you to do. You need to learn to be the one in charge and take control and direct your own management.

Absolutely. "Think Like a Pancreas" was essential reading for me when I was first diagnosed. http://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147

Using Insulin by John Walsh has a great section on carb counting and a good carb factor list.

Pumping Insulin also by Walsh.

Think Like a Pancreas by Gary Scheiner will help you wrap your head around how insulin works and what you need to do as your own external pancreas.

Scheiner also wrote: The Ultimate Guide to Accurate Carb Counting.

And, he has very affordable online "classes" in T1 management. The link includes a free video on how to dose for pizza :-)

In the meantime, this is a fantastic list of carb factors and an explanation on how to use them.

Get thee a food scale. Nothing fancy required.

edited: formatting

I went to a pump because I have a HUGE Dawn Phenomenon that MDI was unable to address adequately.

That said, in your case, I would hold off on a pump until you get the basics under your belt. Doctors usually start conservatively on insulin dosing and then dial the doses in as things progress, as the number one concern they are going to have is minimizing hypo events.

If you're looking for a good reference for managing insulin, I highly recommend Think Like a Pancreas.

> Jesus 3 hypos a day? Surely that's him having poor control over his diet right?

Not really poor control over his diet - it's more that he's not "feeding the insulin" he has in his system at the right rate. This usually happens if you're on a long acting insulin as it will be constantly supplying the body with insulin regardless of whether you eat or whether your body needs it. If he's late eating something, or eats the right amount of carbohydrate but it's lower-GI than he thought, it will mean the insulin drags his blood glucose down and he has a hypo.

I think some people have greater variations in insulin sensitivity - which also changes depending on the time day, exercise, sickness, medications etc. So whilst he might be struggling to match his food intake to his insulin, he could also be unlucky with how sensitive his body is to it. I know the affect of exercise on glucose levels is quite different between individuals. If he really was having 3 hypos a day then you'd have to think it was more his body's sensitivity to it and the challenge of getting his insulin profile to match his needs from a couple of injections a day. A pump would make a big difference you'd think as he could create a basal insulin delivery profile to match the natural peaks and troughs.

This is a good book on how the pancreas works: http://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147 I'd recommend it to anyone with Type 1 (or their family) so they can understand what's going on.

I have no info for you about rashes, but hopefully someone else will. Ketones are flushed out in urine, so have her drink lots of fluids. If any thing is raising blood sugar and not helping stop using it. High BG slows healing. Read Dr.Bernstiens book and [Think Like a Pancreas] (https://www.amazon.com/gp/aw/ol/0738215147/ref=mw_dp_olp?ie=UTF8&condition=all)

Others have some put some great real world info here. I'd only add that these 2 books were quite helpful.

Think Like a Pancreas

https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147/

Diabetic Athletes Handbook

https://www.amazon.com/Diabetic-Athletes-Handbook-Sheri-Colberg/dp/0736074937

here is a good book

As others have stated, when I started pumping, it took care of this. I could alter the rate of my background insulin to compensate for my morning numbers. But if a pump isn't possible right now or if you have a reason for not wanting to pump, I would suggest you do a basal test to make sure you're taking enough of your basal insulin (lantus or levemir probably) to keep you level minus the variables. Gary Scheiner's book THINK LIKE A PANCREAS does a good job of talk about this too...http://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147

The challenge you'll have is figuring out correct basal patterns for different types of days (work, sick, etc). I highly recommend you get this book: https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147. This new edition has a chapter on basal patterns and how to adjust them.

Here's the book: Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin--Completely Revised and Updated https://www.amazon.com/dp/0738215147/ref=cm_sw_r_other_awd_32I6wb343CAPD

I absolutely love my Dexcom. However I have insurance that pays for all durable medical equipment and I definitely wouldn't be able to afford the sensors otherwise. I do get 10-12 days out of one sensor though so it still may be worth you getting a price estimate from them!

I do have a child! Pregnancy with diabetes is far from trivial, but it is doable. You'd be amazed at the amount of motivation that appears out of nowhere once another life is involved! This is a good intro and reference to pregnancy with diabetes: Balancing Pregnancy with Pre-existing Diabetes: Healthy Mom, Healthy Baby https://www.amazon.com/dp/1932603328/ref=cm_sw_r_other_awd_d7I6wb4NHH7NZ . I also was hugely inspired by Kerry Sparling's blog, SixUntilMe. Look it up, she's amazing (and very real)!

Life will get easier and routine will eventually become second nature. Also I would push your doctor to prescribe a continuous glucose monitor asap as they make managing T1 diabetes so much easier as it gives you your blood sugar and a graph of the trend every 5 minutes.

A couple books that are good resources:
https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147

https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316182699/ref=pd_lpo_sbs_14_t_1?_encoding=UTF8&psc=1&refRID=G1ZBQ2CDMBY71R49W5CN

Sorry about your hubby's dx. I agree with pp...don't throw out food in fridge. I use a food scale with a built in database of food. I weigh out most of the food my t1 kid eats. You can pick up a good scale online or at your a retail store ie target/bed bath beyond. I also will write on packaging what the carb factor is so if my kid wants more or less of a serving size I weigh out times the # of grams (weight) by the carb factor and find out the total carb count. Here is a link on carb factors I have a ton of books on t1...but my favs are Type 1 Diabetes: A Guide for Children, Adolescents, Young Adults--and Their Caregiver and Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin

One more thing....YES being a grump when bs #s are coming back into range is common. Learning what the other symptoms are is important too.

If your insurance will cover...using a CGM has helped me see BS trends.

knowledge and being prepared is power when it comes to managing t1.

Some background: I'm 24 and was diagnosed at age 7. I take one dose of Lantus in the evening, then I use Humalog to cover food / high readings. I'm 6 foot, 230 and am into weight lifting and fitness in general. I'm also in law enforcement and manage my Diabetes well enough to do my job so take that as you will. My last HBA1c was 6.4, up from 6.0.


First, talk to your doctor about this. And please keep in mind that all diabetics are different and experience it differently. A certain dose for me could be way too much or too little for another person.


Now that I've said that, low carb is great for controlling diabetes, and for losing fat (Insulin plays a HUGE role in the storage of fat, from what I've read). I personally TRY to eat relatively low carb, but I still eat my fair share of carbs. You can definitely still get big on a low carb diet, but there are some things you should keep in mind.


I regularly take supplements such as Optimum Nutrition 100% whey protein as well as their casein. Although 1 scoop of 100% whey is only like 3g of carbs (and like 24g of protein), it can still raise your blood glucose way more than 3g of carbs from say, carrots. I've found that certain supplements can jack the hell out of your blood glucose. The worst for me is Muscle Milk. One bottle of that shit is like 9g of carbs, for which I would normally cover with about 1 unit of Humalog. But with Muscle Milk, I need to cover with about 4 units of Humalog. There's just something in it (not fat) that jacks me up. ON 100% Whey doesn't affect my blood glucose that much.


Also, it seems like everyone says to eat a snack before working out or playing sports. I am the exact opposite. Lifting and sports RAISE my blood sugar, at least initially. I usually get 1-2 units of Humalog before I lift, otherwise I can start lifting and be like 120 and by the time I'm done I will be 250. Then, several hours later, I will drop. I believe it is due to adrenaline or some kind of stress-related hormone response.


My suggestions:

Continue your low carb diet, because you are new to Diabetes and low carb is easier to control in my opinion.
Start lifting regularly.
Take a supplement like ON 100% Whey or something similar. Something without all kinds of extra shit (avoid pre-workouts, caffeine can affect your blood glucose in unexpected ways too).
Eat a lot of calories.

GO BUY AND READ SOME BOOKS!

CLICK

I'm not all that familiar with Novalog, but I was under the impression that it is similar to Humalog. You need to experiment when you have some time.
From what I know, Lantus is basically used to match your liver's output of glucose. So Lantus sets the baseline. You need to do some fasting and figure out how much Lantus you need to dose in order to match your liver. Once that's figured out, you can move on to your Novalog. Through experimenting, I've found that 1 unit of Humalog will cover 12g of carbs (FOR ME). 1 unit will also lower my blood glucose roughly 35 points (FOR ME). Once you figure that out, you can use math and everything gets a hell of a lot easier, granted these numbers will sometimes change based on sickness, stress, etc. Before you do any of this experimenting, read that book I linked.

I'm new to this sub, and don't post much on Reddit but if you have any questions, feel free to ask here or send me a message.