A few questions please...

[lauraw1983]

I have had a few things in my head but not had a minute the past few days to get on to ask...

My levels are STILL too high most of the time, waking levels of 8, 9 or 10 generally.

I started basal insulin at bedtime last week. Initially DSN said to do 5u. didnt seem to do much, on Monday she said to try 8u. Last night I did 9u.

Still woke up at 10. 😡

How do they normally calulate basal insulins for people? Is it based on height/weight/age/gender of people?

My DSN keeps saying 'a few days' (its been longer than that now) of being a bit high won't do any damage etc - is this even correct? Even if it is, it's making me anxious

I also don't really know anything about counting carbs correctly...they say it's still too early days for that still?

Also something else I dont understand fully....I keep seeing things on here referencing spikes after certain foods...I don't understand why, if carbs are correctly counted and covered by insulin, why is this bad?? Is it not what could/does happen in non diabetics too if they ate something high in carbs or sugarry etc...? As long as it returns to normal within the 4-5 hours of the dosage....?

And I am confused about snacking...if its within 4-5 hour of the last dose of humalog do you still inject for it, or not? What is insulin stacking, is this not a risk with doing that?? I don't always eat at regular times at all and I can see this being a problem? 🙄

Thank you in advance for any help with this you can give! x

 

[shiv]

Hi Laura

- basal insulin - is this Lantus/Levemir? Lantus is notorious for taking 2 or 3 days to 'kick in' properly, so it's common to see no change in the first day of increasing/decreasing the dose. I believe Levemir works slightly faster but I haven't used it myself.

- there are various ways they work out a background dose using various formulas etc. What's important to remember is that everyone needs a starting point, which is why they do this - and then you can work from that starting point to find out what you actually need.

- in the long run yes your DSN is right, a few days right now of running a little bit high probably isn't going to cause long term damage - however, if it goes on longer than a few days, then action needs to be taken to get those numbers down.

- carb counting is used as part of multiple daily injections or insulin pump therapy. It allows you to match the amount of fast-acting insulin you take against the carbs you are eating (for example, 1u of insulin for me covers 10g of carbs). From what I understand, it can be tougher to carb count in the early days of diagnosis as your body is probably still spitting out bits of insulin as and when it wants to, but I really don't think there's any harm in you knowing about it or understanding it!

- if a non diabetic eats something that would spike a diabetic (hope that makes sense!!), then their body would respond and kick out the insulin to stop them spiking. So no, non diabetics don't get high BG levels after certain foods - they are lucky to stay in range pretty much all the time 🙂 the reason it is important to try and minimise spikes is to try and always keep BG levels in the 'safe' range - if you are spending 4 - 5 hours high after each meal before coming down, and you're eating 3 times a day, that's up to 15 hours a day you are spending out of the 'safe' range. So keeping those spikes down is really important to overall control. Of course - this isn't as prescriptive as it sounds and we ALL get spikes every now and again. It's just important to recognise them as something that is acceptable every now and again, rather than the norm. Hope that makes sense!

- insulin stacking is taking several doses of insulin close together. The best example I can think of is at a buffet, where you might be grazing for 2 - 3 hours, and injecting separately for everything. Eventually, there is a risk that all the 'peaks' of the insulin may collide and end up sending you low.

- when it comes to snacking, generally yes it will need extra insulin to cover it. If you had humalog with your last meal, that humalog will be used to sort out the food you ate at the meal - if you are taking on extra carbs, more than likely you'll need the appropriate amount of insulin to cover them. However, some people on MDI find that they can 'get away' with some small snacks without insulin - this comes down to trial and error for most people.

- I don't eat at regular times either! That is the good thing about MDI - you take insulin when you need it, ie with food, not at set times.

 

[novorapidboi26]

Everyone's basal needs are different down to I suppose many factors, gender, weight, muscle mass etc..........you can be given a rough dose to start with but you will always need to fine tune it, and it will change many times throughout life..........

What basal insulin are you on? Lantus takes a few days to work, Levemir straight way!!

Increasing 1 unit at a time is safe I suppose but some people need more to see an effect, you will get to know how you react as time goes on.....

Spikes are normal and are as a result of human error I suppose. Matching the profile of the insulin to the profile of your food [sometimes made up of multiple items] is needed to minimize spikes and can be achieved by timing your injection............non diabetic will get small spikes but their own insulin is being secreted form the pancreas, an organ evolved over million of years, so you cant get better than that really....

you would still inject for snacks, sometimes you can wait till the next meal if its within an hour etc.........insulin on board/active insulin should be considered though and can be difficult to take into account without some kind of meter.......

stacking insulin will result in low blood sugar, even if you have considered insulin on board..........so the more injections you do, the worse it would get, sorry its not a more technical explanation.............

 

[pgcity]

I have had a few things in my head but not had a minute the past few days to get on to ask...

My levels are STILL too high most of the time, waking levels of 8, 9 or 10 generally.

I started basal insulin at bedtime last week. Initially DSN said to do 5u. didnt seem to do much, on Monday she said to try 8u. Last night I did 9u.

Still woke up at 10. 😡

How do they normally calulate basal insulins for people? Is it based on height/weight/age/gender of people?

My DSN keeps saying 'a few days' (its been longer than that now) of being a bit high won't do any damage etc - is this even correct? Even if it is, it's making me anxious

I also don't really know anything about counting carbs correctly...they say it's still too early days for that still?

Also something else I dont understand fully....I keep seeing things on here referencing spikes after certain foods...I don't understand why, if carbs are correctly counted and covered by insulin, why is this bad?? Is it not what could/does happen in non diabetics too if they ate something high in carbs or sugarry etc...? As long as it returns to normal within the 4-5 hours of the dosage....?

And I am confused about snacking...if its within 4-5 hour of the last dose of humalog do you still inject for it, or not? What is insulin stacking, is this not a risk with doing that?? I don't always eat at regular times at all and I can see this being a problem? 🙄

Thank you in advance for any help with this you can give! x

You need to try and start estimating the carbs in your meals and seeing if there is any reltionship between your pre and 2 hour post meal readings. I too was told there was no point carb counting but I managed to identify the ratios on my own and becasue i had good records and a diary that recorded meals, readings, activity, stress, hormones etc I could persuade my DSN that it mostly worked. Get some scales and a notebook and give it a go.

I have only been diagnosed for 5 months and I have similar norning readings to yours but my HBA1c has fallen from 8.8 to 6.8 as I have got rid of higher readings after meals. I was told that the morning levels need to come down slowly as you can end up chasing lows all day if your pancreas produces insulin which it may do.

I haven't got the hang of snacking yet so try to stick to 1-2g of carbs. I like to have cheese and nuts or if really naughty I have double cream with vanilla essence. I'm a veggie so you can eat meat.

I only have a very small amont of time with my DSN so it is a big ask to expect her to teach me all about fine tuning. Have you read any books yet? There are lots of good one's. I have read Using Insulin by John Walsh.

Hope this helps

 

[everydayupsanddowns]

Good advice already so won't repeat it.

pg's advice about keeping good records is very worthwhile. Can seem like a bit of a faff to begin with, but it can help enormously to have earlier readings to look back on and say, "Ah... on day x I had blah food with y insulin and went high afterwards".

If you have a smartphone there are usually a few free apps to choose from to help take the grunt out of recording (though for many years I used a pen/notebook which does just as well).

Once you have a basic idea of how your body will usually react in different circumstances you can ease off the logging. At a certain point though the ole D gremlins are likely to move the goalposts (eg your basal insulin needs or ratios will change) and you'll have to start up again until you've got your head around the new 'normal' 😉

 

[trophywench]

Laura

Obviously you weren't happy with 10 this morning but - what was it at bedtime? You can never look at one BG reading and know what's happening. You were eg 12 after a meal. What were you before the meal? See what I mean?

Generally, between bedtime and waking, the difference should be no more than 2 either way. Preferably, closer. Specifically 1.7.

Before meals- range of 4.5 to 7.0. 2 hours after meals - no more than plus 2 or 3.

Nobody scores 100% on this. It's just what to aim for.

 

[everydayupsanddowns]

Nobody scores 100% on this. It's just what to aim for.

You got that right!

Occasionally it feels like my 'aim' is standing with my back to the target lobbing things over my shoulder. Meanwhile the D-gremlins are joyfully running backwards and forwards with the target held sideways on

 

[lauraw1983]

Thank you all! That's helped me understand things a bit more re; spikes etc. Sodding pancreases eh?

It's Humulin 1 I am on as basal. I have no idea how they decide what to put people on either!? Lantus and Levemir seem much more common on here??

Trophywench, it was only about 10.5 before bed, then 10 on waking. Sorry I should have mentioned that! I'm wary of correction doses too late at night (worrying about hypos) and last night I was too tired/confused to do much about it - having a bit of a stressful time about something else too.

So it's holding steady over night for certain....it's just not as low as it needs to be for the 'starting point' of the day iyswim?

I took 6u humalog with my breakfast (2 slice burgen and peanut butter - was hungry today!) and tea.

Before lunch I was 6.6 and had a mackerel & salad sandwich and a mullerlight & a funsize twirl (first choc in ages, would be today when I am posting about it - lol!) Took 6u then too. Before dinner I was 7.9. Have just had pork and apple sauce, mashed potato and carrots. Took 6u for it too.

Before bed, who knows?! If I want a cuppa and some chocolate later, would I inject humalog for it seperately before having it, even if it's not long before I would take the Humulin 1??

Thanks for all replies x

 

[lauraw1983]

You got that right!

Occasionally it feels like my 'aim' is standing with my back to the target lobbing things over my shoulder. Meanwhile the D-gremlins are joyfully running backwards and forwards with the target held sideways on

Stupid gremlins!!!!!!!!! Did make me LOL a bit though

 

[lauraw1983]

Good advice already so won't repeat it.

pg's advice about keeping good records is very worthwhile. Can seem like a bit of a faff to begin with, but it can help enormously to have earlier readings to look back on and say, "Ah... on day x I had blah food with y insulin and went high afterwards".

If you have a smartphone there are usually a few free apps to choose from to help take the grunt out of recording (though for many years I used a pen/notebook which does just as well).

Once you have a basic idea of how your body will usually react in different circumstances you can ease off the logging. At a certain point though the ole D gremlins are likely to move the goalposts (eg your basal insulin needs or ratios will change) and you'll have to start up again until you've got your head around the new 'normal' 😉

Yeah pizza sent me really high, hours after. DSN says I should inject half an hour after starting my meal for that, or in split doses but she's still to tell me more about it when I see her! Is that right?

Do you know the names of any good apps? I do have an iphone and would much prefer to keep it on there than pen and paper!!

 

[everydayupsanddowns]

My App of choice on iPhone/Touch is DiabetesDiary by FridayForward. Easy data entry/editing, good views/averages, graphs and averaged (trend) graphs and easy export via Email.

 

[trophywench]

Yup - inject with a snack if it's more than approx 10g carb. Of course if you have a high bolus insulin to carb ratio then you would have to inject anyway, but I don't think you have at the moment, have you? (mine happens to be 1u to 10g, so with that I'd only have one unit so .. but that carb would also raise my BG by a whole 3.0 so it really depneds on what my BG is before the snack ... all these things for each person become apparent in time......)

Your Basal insulin has nowt at all to do with food or drink Laura - see

http://www.diabetes-support.org.uk/info/?page_id=120

 

[trophywench]

PS I haven't the foggiest clue why they've put you on Humulin I. You should enquire 'Why?' if it hasn't been explained !

 

[lauraw1983]

PS I haven't the foggiest clue why they've put you on Humulin I. You should enquire 'Why?' if it hasn't been explained !

Ooh I don't like the sound of that! Why, is it lots different to levemir/lantus?! I don't have a clue, just took what I was given! :-/

 

[novorapidboi26]

Humilin I is fine, and its a lot similar to Lantus and Levemir, and can be split.......

It has a more noticeable peak in it than Lantus and Levemir, its also referred to as Isophane Insulin which is porcine or human insulin mixed with some other stuff, as opposed to the analogues like Levemir that are grown in a big tub.......

 

[Copepod]

Humalin I is also about half the cost of either Levemir or Lantus - so, to me it seems sensible to start with the cheapest insulin, and change to a more expensive one IF it doesn't suit the person, rather than immediately going for the more expensive. That doesn't mean that cost is the only consideration.

I have used it since starting MDI in 1997, after taking a photocopy of an Australian pharmacists' journal sent to me from Tasmania by the mother of a friend, to my diabetes clinic and suggesting that MDI would suit me far better than the bimodal they'd started me on.

Personally, I find being able to adjust basal dosage twice a day suits me very well, especially when days are so different, with some very physical work days (conservation jobs, chopping wood etc) and some very physical running / long distance hiking / cycling / kayaking etc, and some all night activities eg marshalling on adventure races, interspersed with less active days. Plus the fact that Humalin I and Humalog can both use the same pens, including half unit pens, is a good feature - routinely I use different colours for each, but on mountain marathons, carry just one pen, plus a back up syringe, to reduce weight, and swap over cartridges as necessary.

 

[everydayupsanddowns]

Ooh I don't like the sound of that! Why, is it lots different to levemir/lantus?! I don't have a clue, just took what I was given! :-/

It is designed to have a quite different profile, though I know some here (including Copepod I think?) use it successfully as a basal.

The DUK 'Meds & kit' roundup has Humilin I in the 'medium and long-acting' category, separate from 'long-acting analogue'.

It may well be that your clinic are implementing a new approach following last year's hoo-hah about the use of (expensive) long-acting analogues as default choices. Although that report *did* say that analogues had proven benefits for T1s I think. Your clinic's approach may well now be: "Try Insulatard/Humilin I, if that doesn't work move on to Lantus/Levemir"

From what I can see Humilin I has an onset of around 30 minutes, followed by a peak activity lasting 7-8 hours and then a fade to 18-20 hours.

To me this would suggest that as a basal it would work better in two smaller injections (so that they slightly overlap and you don't get a 'gap' between hours 18-24), but that's something you should discuss with your DSN.

Lantus and levemir are often said to be 'peakless' which is not quite accurate. Both have peaks of activity though these tend to be less marked than Humulin I's would be. Duration is usually slightly longer with Lantus (and may even exceed 24 hours in some people), Levemir tends to be shorter and is generally thought to be well suited to split patterns.

hth
M

EDIT: Ha! Late again. Posted at the same time as NRB and Copepod

 

[lauraw1983]

Oh man, it's still a bit like double Dutch reading that! Basically it doesn't last as long, which might explain numbers creeping up at evenings again...time to phone the dsn again I think! Thank you for replies!

 

[everydayupsanddowns]

Oh man, it's still a bit like double Dutch reading that! Basically it doesn't last as long, which might explain numbers creeping up at evenings again...time to phone the dsn again I think! Thank you for replies!

Sorry Laura! I had a pretty timeline graph thing from the Balance supplement but it sounded a lot more confusing written down than just looking at the coloured bars!

Hope it made some sort of sense 🙂

 

[Copepod]

Oh man, it's still a bit like double Dutch reading that! Basically it doesn't last as long, which might explain numbers creeping up at evenings again...time to phone the dsn again I think! Thank you for replies!

Basically, Laura, Humalin I can suit people very well, but is usually better given as two doses in 24 hours, not just one. So, definitely speak with your DSN.