Hello and a brief introduction

[Eternal422]

Hello and welcome,

My position is the same - type 2 on insulin for many years but my GP practice seem very uninterested in my care. I think they don't have the correct resources in place as my last visit earlier this month ended up with me explaining about dosage and carb counting. This visit didn't end well as I got quite annoyed - I have significant peripheral neuropathy in my feet which they hadn't even logged - seemed to want to bat it back to podiatry. This is a very useful forum and answers many questions.

Hi Robert, sorry to hear what happened with you at your GP. When I started on basal bolus as a (then) diagnosed T2, they did refer me to the hospital where I got a brilliant grounding in how to self manage. Having moved house 4 years ago, my new GP just kept things ticking over until this year when they told me that they didn’t really look after insulin treated patients, having them under the care of the local hospital instead. However, that was a great step for me as I now have access to a great DSN, diagnosis changed to T1 (admittedly not something I particularly welcomed, but best to know where I stand) and been started on the Freestyle Libre.

Maybe, like me, you could ask your GP to refer you to the local hospital diabetic team to help you?

Like you, I’m so glad that I’ve found this forum and can hear other’s experiences and thoughts. Let us know how you get on.

 

[everydayupsanddowns]

Just a quick follow on question about this if I may? New Libre sensor is behaving beautifully, now I can see clear patterns but do not know how to treat them!

Typically my overnight drops from around 8 to 5, than after breakfast it picks up to about 8 again despite covering the carbs with Novorapid. It remains there until lunch, again covering the carbs, peaks at about 10 and drops back to 8 where it stubbornly sticks for the rest of the day. Same thing for my evening meal. From this I’m guessing that my carb counting and ratio stop the peaks, but although BG is level, it is a bit higher than I wanted. I am presuming this is down to the basal, keeping things nice and steady, so I have just increased from 28 to 30 (still doing one shot at bedtime for now).

I’m probably answering myself here and need to look at splitting the Levemir dose? I think maybe I need to speak to my DSN now rather than waiting until the end of November for my next appointment, but I’d be really interested to hear any other opinions on what has worked?

I can’t give you advice, as I have absolutely no medical qualifications, so all I can do is reflect what some of my thinking would be if those were my numbers…

Firstly - the role of my basal is to keep my levels chugging along steadily when I’m between meals (or miss or delay a meal) and when I’m only averagely active. ‘Steadily’ for me would mean staying within +/-1.5 to 2 of my previous reading overnight, or if no meal/dose is happening. So if my BG was dropping 8-5 overnight I’d be thinking my basal is too high.

In the morning, as soon as I get out of bed, my BG begins to rise (because my caveman hormones kick in to fire up the burners). Some people get this in the early hours, often called Dawn Phenomenon. So some of the rise might be related to other factors than food/insulin?

Have you been advised to take ‘correction doses’? This is where you add a little extra insulin when your BG is above range with the intention of getting you back to mid-range by your next meal. If you’ve not been advised about this it might be worth a conversation with your DSN?

Steady readings are my preference, even if they are a little above range to a rollercoaster of highs and lows… but even better if I can gently nudge the steady high level into range 🙂

And I’d be really interested to hear how you got on with a split basal - spreading the coverage out more evenly over the 24 hours.

 

[PattiEvans]

Hi from me

I too was diagnosed as T2 in 2003. I was on insulin very quickly as levels were so high (in the 30+ range consistently) but it took me 8 years to get a final diagnosis of T1 (rather than my previous diagnosis of T2 on insulin - a subtle difference, but huge in terms of treatment and attitudes). In my experience the new diagnosis was amazing in that it opened so many doors regarding modern treatment. I am now on a pump with Libre 2 on prescription and I am one of those who finds it exceedingly accurate. So that's more or less my background.

The link Mike gave you mentions the book "Think like a Pancreas" by Gary Scheiner and I would highly recommend it. As I highly recommend basal testing... with the caveat that from time to time our basal needs change, even if only a little, with the weather and numerous other factors, so you will need to do the basal testing all over again if things start to go a little wonky.

You mention that drinking alcohol lowers your numbers, despite the carbs in it. Yes, it does, because it keeps Mr Liver busy processing the alcohol so poor Mr Liver is far too busy to emit his normal output of glycogen into the blood stream.

For your information I attach a chart of the action of Levemir. Across the bottom you can see how long Levemir will last according to the amount per kilo of body weight you are injecting. So say you weighed 65 kilos and you use 25u levemir then divide 25 by 65 and you come to .38 - call it 0.4u and follow the horizontal line across... you will see that the Levemir will most likely last 22 - 24 hours for you. However, I suspect you are currently not taking .4u per kilo. I can however, see why your DSN is upping the Levemir. If she goes by that chart then perhaps she is hoping that the increased amount of levemir per kilo of body weight may make it last the full 24 hours.

 

[Eternal422]

Thanks for the comments Mike, much appreciated. I did wonder if the morning rise was the dawn phenomenon albeit occurring only when I have breakfast, but maybe that is just timing and a coincidence. I do take correction doses when needed before meals, but somehow this isn’t helping now. I love the BG being pretty stable rather than bouncing all over the place, just want to bring the level down a bit.

Funny how you can be ok for ages, confident you know what you’re doing and then suddenly you get a curve ball! I guess that’s D all over! Of course, a lot of this was previously hidden to me before the Libre, so some of this may have been happening all along and only now exposed thanks to all the graphs and constant readings!

The overnight drop would suggest actually reducing the basal as you say, but then I don’t know what effect that would have on the rest of the day. Definitely one for the DSN to help me with, I’ve left a message tonight to get a call back to chat it over. The advantage being that she can see the Libre data which will be a big help.

 

[Eternal422]

I too was diagnosed as T2 in 2003. I was on insulin very quickly as levels were so high (in the 30+ range consistently) but it took me 8 years to get a final diagnosis of T1 (rather than my previous diagnosis of T2 on insulin - a subtle difference, but huge in terms of treatment and attitudes). In my experience the new diagnosis was amazing in that it opened so many doors regarding modern treatment.

Hi Patti, very true! The difference now is amazing! Although, to be fair, when originally classed as T2, my GP put me on a twice a day mixed insulin which didn’t work with my irregular eating patterns at the time, so when I suggested trying basal-bolus, he referred me to the hospital team who were great. But then after being discharged back into primary care I was pretty much left to my own devices. I must admit I didn’t do too badly, very few hypos and a good HbA1C for years. But now with a new GP health centre and a referral to hospital to help arrest the slowly increasing HbA1C, they diagnosed me as T1, got me onto the Libre and are being great. Really though this classification between T1 and T2 shouldn’t affect the level of care, only subtle differences in treatments.

It’s great you find the Libre accurate too - my first sensor started failing after just 4 days, read low and then expired altogether. This second one is doing great and seems pretty accurate too.

I had heard of Think Like A Pancreas years ago, maybe I should have a read now to get myself more up to speed with things. I think after all this time I have fallen into the trap of taking things for granted and not paying as much attention as I did initially.

You mention that drinking alcohol lowers your numbers, despite the carbs in it.

Thank you for the explanation - that makes perfect sense now! I always knew that it affected my BG but not the reason why! Not that I’m anything more than an occasional drinker, but even one or two drinks has the effect of lowering my BG.

For your information I attach a chart of the action of Levemir.

Thank you so much for this bit of information! I am 86.4kg and injecting 30U Levemir, so 0.35. Looking at your chart that may only be lasting around 18 hours. So, typically taking it at around 10pm means it would be out by around 4pm on the following day. Interesting.

Lots to ponder about. I should be getting a call back from my DSN in the next day or two, so I’ll discuss a bit more with her as to how to tackle this.

Thank you so much for your comments and info. It’s great to chat over stuff with others going through the same sort of things.

 

[PattiEvans]

Good luck with your chat with the DSN. Let us know what transpires.

 

[Eternal422]

Good luck with your chat with the DSN. Let us know what transpires.

Really impressed as I had a call back yesterday from a DSN from the hospital team in response to the previous night’s voicemail I left with them!

He said that the Libre charts were among the best he had seen and nothing to worry about. However, to lower the steady line a bit more into the middle of my range he suggested taking the Novorapid about 30 mins before eating, that way the insulin peak would better match the BG peak from eating. Taking it at the same time as eating means it is playing catch-up and May be the reason that although I don’t peak much above range, my levels remain at the top end of the range.

He also said that the Levemir dose seemed reasonable and the steady lines means it is working well.

He also talked through correction doses of Novorapid, starting with 1U to bring down BG by 3 (apparently it’s average effect), but only to take a correction 3 hours after the last Novorapid as that dose would be starting to wane by then, I.e. to avoid insulin stacking.

Last night was my first go at taking Novorapid 30 mins before my meal and that worked well with no big peak and levels returning to mid-range. However I’ll need a few days of doing this to see if it works for me ok. Last night was a bit different as it was a 40 minute walk over fields to a local pub for a drink and meal, then the same walk back afterwards. The walk there dropped my BG by about 3, amazing what a difference it makes! Mind you, even a bit of light gardening has the effect of dropping my BG, so it just goes to show how important exercise is for me!

 

[trophywench]

I too successfully used a split dose of Levemir for years. 18u TDD split 14u when I rose at approx 7 to 7.30 ish, 4u at night. The pm dose started at bedtime - 11-ish - but hypo by the early hours - so changed the evening dose to 9.30 to 10 ish and that made a huge difference, no more overnight hypos. (Remembering to do it at that time was the main prob!) Every single one of our bodies has it's own little idiosyncracies - but basal testing is an ongoing feature of most of our lives if we want to achieve decent ongoing BG results!

 

[Eternal422]

@Pattidevans - just received my copy of “think like a pancreas”, looks full of really useful information, looking forward to reading through it and putting it into practice!

 

[Eternal422]

Just got my latest HbA1C result : 58 . However, that would cover June to August and i was only using Libre in August, so I can well believe prior to that things were not good. Hopefully my next test will show an improvement now that I can actually see what is going on and maybe, just maybe, get an HbA1C closer to the current LibreView figure of 47