I am in need of answers to some questions i have, mainly to do with going to bed with high blood sugar levels, to scared to take humalog at that time of night, i am being talked to by a diabetic nurse over the phone but im not getting anywhere at the moment.
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- Thread starter Jaffs
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Inka
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It’s wise to be cautious at night @Jaffs I take half my normal correction dose if I need to correct at night. Ideally you wouldn’t be too high before bed but just high enough to be safe. Some people, for example, like to be 8 before bed.
Do you have a Libre? How high are you before bed? Does that drop overnight? What basal do you take?
And welcome 🙂
Do you have a Libre? How high are you before bed? Does that drop overnight? What basal do you take?
And welcome 🙂
Hi,i do have a libre which my nurses can see when i talk to them, i takeToujeo as my long acting insulin, i am going to bed as high as 16,17 and wake at 14 so my long acting is working and my nurse has just put it up by 4 units, i take humalog first thing in the morning 4 units to bring my levels down but i have no food so its insulin only which i dont like , i do not have any confidence taking more insulin even tho my diabetic nurse is instructing me what to take, living on your own does not help, any help would be great.thanks
trophywench
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Jaffs - how much, on your meter, does 1u of your faster acting insulin (you haven't told us the name of that one) reduce your BG meter result by? - or indeed if it comes in a pen that dispenses half units, does half a unit reduce it by?
Inka
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How long have you had Type 1 @Jaffs ? Is it still early days for you? It sounds like your nurse is helping you gradually get the Toujeo at the right dose for you. Although it’s frustrating to be high, it’s better to gradually and carefully increase the dose.
What’s your blood sugar before your evening meal? If it’s normal and then goes high after you’ve eaten and stays high until bed, you could look at the amount of Humalog you’re taking with your evening meal and what you’re eating.
rebrascora
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I agree with what @trophywench is suggesting. You need to gain confidence in your correction factor. Once you know how many mmols 1 unit of Humalog drops your levels you can inject a correction at bedtime that will bring you down to say 10 if you start on 16 and still be safe through the night. It is just a question of building up your confidence to do that slowly. Certainly 1 unit of Humalog if you are on 16 at bedtime is not likely to cause you any risk of hypo or half a unit if you have a half unit pen. Once you do this a few times and get a feel for how little it brings you down and that it is reasonably reliable and safe, you can inject a little more if you need to. Until you are confident that what you are doing is not putting you at risk and you know how much you need to perhaps keep you between 8 and 10 overnight, rather than being above 10 all night. It takes time to build up that confidence, so start very small and see how it goes.
Hi Inka. You wont believe ive had diabetes for 44 years and never had this problem before, i know after my evening meal i am high but my nurse tells me what to take and she can see what it is doing before bed ,to be honest Inka i am worried about changing my insulin unless the nurse says so, it all seems a problem now when before i just coped with it , thanks for your words of help .
Bye
Hi Jenny, my fast acting insulin is called humalog,it is in a pen i use , i dont know what you mean about how much 1 unit reduces my bgd metre by please explain.
Rob Oldfield
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Hi Rob, i have libre 2 and yes i ve got my alarms on
rebrascora
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Injecting insulin at times other than at meal times is called "a correction" although corrections can be done at meal times too. You should have been given what is called a "correction factor" by the nurse which is the number of mmols 1 unit of Humalog will reduce your BG by over the course of it's activity. Say it is 3mmols, then if your levels are at 16 at bedtime and you want to bring them down to about 10, then you want to drop your BG from 16 to 10 which is 6mmols. So if each unit of Humalog drops your levels by 3 units, then 2 units will drop you the 6 mmols that you want to get you down to 10.
If you don't know your correction factor, then when your levels are steady on a higher number than you would like (say 10mmols) and there is no active Humalog in your system (5 hours since last injection), then inject 1 unit of Humalog and see how much it lowers your BG levels over the course of the next few hours. This will give you a good idea of your correction factor. So if it just drops you 2 units then your correction factor is 2 or if it drops you nearer 4 units, then it is 4. This is usually a consistent factor give or take a few decimal places, so you can be reasonably confident of relying on it.
It sounds like you may never have had an intensive education course like DAFNE or BERT1E if you are relying on your nurse to tell you your doses. These courses can really help you to understand how your insulin works and give you the framework and confidence to identify when your doses need changing and how to do that. It gives you much more control over your own diabetes management, although of course the nurses are still there to contact if you need extra input. Personally I would trust my own knowledge and judgement over that of a nurse or doctor or even consultant because I live with my diabetes day by day and meal by meal and night by night so I have a much better idea of how my body responds than they do from looking at a few numbers or a graph once every 6 months or year. The DAFNE course and this forum, gave me the knowledge and confidence to do that. I have become the expert in my own personal diabetes management. I might need to talk over a few concerns with my consultant or ask to change to a different insulin every once in a blue moon but otherwise I am very independent with it.
One of the major benefits of these courses is just spending time with other Type 1 diabetics and learning how different we can all be but also just feeling normal being amongst others who also have to carb count and inject before eating and deal with hypos etc. One of the things that I picked up from the younger girls in my group was being very open about injecting in public. Prior to that I had gone to the toilets to inject if I was out for a meal or in public, but they just lifted up their T-shirts or blouses and jabbed themselves with no fuss or concern. It was a good lesson to learn.
You should ask your nurse about getting put forward for such a course.
trophywench
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Hi,i use to be on lantus and humalog not mixed, they changed the lantus to toujeo, i really dont know why i have lost all my confidence controlling it now, i just worry all the time whats going to happen with my levels its driving me mad
rebrascora
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Do you feel that you would be happier if you were back on Lantus because if you think that would restore your confidence and they haven't given you a good reason why they changed it, then you have every right to insist you go back onto Lantus.
I dont think that would help ,getting my levels right might help my confidence i dont know whats up with me at the moment,thanks for your concern and help
rebrascora
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In that case, I would ask about a structured education course like DAFNE to see if that will restore at least some of your confidence if not make you more confident than you were before. Spending a whole week with a DSN going through your results and the results of the others on the course and learning how to problem solve in a very non-judgemental environment really is helpful.
There was a lady on my course who had been diagnosed 50 years and had been suffering severe nocturnal hypos for many years despite only using tiny amounts of insulin, but her daytime levels were going really high. One of the main things they eventually figured out was that the gun type contraption she used to dose her insulin was no longer accurate in delivering the dose. She had been using it all her life and was loath to use something new as she trusted it, and no one had ever queried how she injected her insulin. We were all quite intrigued by this diabetic antique she was using but it wasn't until towards the end of the week that the DSN had a light bulb moment that perhaps it was no longer accurate. Thanks to the course, not only were her nocturnal hypo and high daytime problems sorted but she is now using an insulin pump, so she has gone from very old fashioned insulin delivery to very modern and coping so much better... and not just her but her close family too who were all really worried about her and no longer having to deal with helping her recover from hypos or call paramedics in the middle of the night. There was a really broad spectrum of people on the course from newly diagnosed teenager to a newly diagnosed 76 yr old and myself at 8 months in and this lady with 50 years and a guy 15 years in. We all learned from each other. It was really good!
There was a lady on my course who had been diagnosed 50 years and had been suffering severe nocturnal hypos for many years despite only using tiny amounts of insulin, but her daytime levels were going really high. One of the main things they eventually figured out was that the gun type contraption she used to dose her insulin was no longer accurate in delivering the dose. She had been using it all her life and was loath to use something new as she trusted it, and no one had ever queried how she injected her insulin. We were all quite intrigued by this diabetic antique she was using but it wasn't until towards the end of the week that the DSN had a light bulb moment that perhaps it was no longer accurate. Thanks to the course, not only were her nocturnal hypo and high daytime problems sorted but she is now using an insulin pump, so she has gone from very old fashioned insulin delivery to very modern and coping so much better... and not just her but her close family too who were all really worried about her and no longer having to deal with helping her recover from hypos or call paramedics in the middle of the night. There was a really broad spectrum of people on the course from newly diagnosed teenager to a newly diagnosed 76 yr old and myself at 8 months in and this lady with 50 years and a guy 15 years in. We all learned from each other. It was really good!
nonethewiser
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- Type 1
Push for insulin pump my friend, you can have multiple basal rates using pump & you should find you have far less hypos & hypers, very reassuring for someone living alone & afraid of night time hypos especially.
I find nowadays hypos are very few & far between, mainly due to combination of pump & libre 2.
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It might help you to check out the ‘basal testing’ guide, which is a systematic way of ensuring that your basal dose is set so that it ONLY holds you level overnight (ideally rising or falling no more than 1.7)
How To Successfully Test Your Basal Rate
Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!
Once you can be fairly confident that you will go to sleep at 16/17 and wake up at the same level, it might make you more confident to try a cautious correction dose (perhaps half of what you might have used during the daytime?). Not sure why your dose has been increased - basal insulin isn’t supposed to reduce your BG as far as I have been told.
Sorry to hear you have lost your confidence adjusting your own doses. Have you had some nasty experiences with doses you have estimated?
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