very confusing blood sugars...

[Rachel_1989]

im at a total loss at the moment guys...

i was taking 38units of lantus in evening but started hypo-ing every morning so lowered it to 36 units...was waking around 8.0 but then by lunch time it is high

i stuck to the 36 units and then this morning i woke up with a 3.6 and had 4 jelly babys and before lunch im 17.9. Or another example is on saturday i woke up 5.6 and ended up 22.8 at lunch time.

i just dont know what to do...any suggestions? im back at hospital next month but cant carry on like this all month

 

[AlisonM]

I would suggest you call your DSN as a matter of urgency and ask her advice on what to do. But no doubt there'll be a T1 along soon who may have some idea what's going on.

 

[Ellie Jones]

As said you need to call your dsn..

It does sound as though you need to split your lantus into 2 jabs a day, so that it give better and more controlable coverage..

What seems to be going on is two things, firstly it's not lasting the 24 hours it should do in the system, and then your needs overnight is a lot different to that of latter in the day..

By splitting the dose, you can then adjust your night time injections to match your needs overnight, and then your morning Jab can be adjusted to suit the rest of the day and ensure that you are getting coverage for 24 hours a day and not falling short

 

[Robster65]

Hi Rachel

Obviously, it's impossible to say what's happening but a few things might give clues.

Firstly, are you getting plenty of exercise ?

Also, are you keeping a food diary to keep a check on your ratios and your actual food intake ?

Waking at 3.6, I would have had 1 jelly baby and then had breakfast. The 4 JBs you had would, for me and Im sure others, be way too much. It's about 20g of fast carbs.

As an example, if you're in the 1s or 2s, you should only have 15g and wait 15 minutes to retest. It would normally bring you up to normal levels.

Rob

 

[Rachel_1989]

Thanks for the replies. I was told not to split lantus :/ .. but i may give my dsn a ring and see if i can split it because seems most logical thing to do..because cant remember the reasons.

definatly my need in the night is different for the morning. I always have 3-4 jelly babies .. oops lol!

I have been exercising but not for the last few week because hurt my knee. but ive lost 22.5lb in last 3 months with Slimming World 🙂 so i kind of have a food diary but its not for my diabetes its for SW..so i might start writing one so i can send it to my dsn too.

xx

 

[Robster65]

Congrats on the weight loss. Extra weight will not help with insulin resistance and the exercise itself improves insulin sensitivity. If there's any sort of cardio-vascular you can manage, it will help no end.

I would certainly keep a diary for carbs, insulin, BGs and exercise as well.

I'm assuming you're following portion control and low GI through SW as a matter of course but it's not my area of expertise ! 😱

As for splitting lantus, I do it successfully and don't know of any reason not to but you'd need to ask your DSN why not.

Over treatign hypos is a common problem. I did it for decades and it causes a spike later. Much better now I've got the hang of it.🙂

Rob

 

[novorapidboi26]

Splitting Lantus is possible as others will tell you, but because it takes 2-3 days for any dose change to take effect, keeping down to one dose is easier.........

It basically means in theory making changes, if done by the book, would take a long time as you would need to wait 2-3 days for both your AM and PM Lantus changes......

Definitely worth having a chat with your team, the easiest thing to do is to go to Levemir or similar [Humilin I], but this changeover can bring new problems on top of your existing one............

Good luck..........

 

[everydayupsanddowns]

Hi Rachel

Chaotic BGs are no fun at all, sorry you are having to go through it.

Over treatign hypos is a common problem. I did it for decades and it causes a spike later. Much better now I've got the hang of it.🙂

I agree with Rob. Overtreating is all too easy to do and very frustrating. No one wants a ride on the hypo-high gluco-coaster

Have you ever systematically tested your basal level? It can be very hard to get meal doses right if your basal is off, and while basal testing is assumed to be a 'given' for people on pumps, inexplicably, DSNs rarely seem to advocate it for T1s on MDI. There are instructions on how to test your basal here.

It is possible that you need 37u (you can get a 1u version of the Autopen24 to fit Lantus).

I am just wondering, although it's a bit counter-intuitive, whether your basal may still be too high. You might be dropping low overnight and your rapid rise during the morning could be your liver wading in to 'help out' by dumping glucose from its stores.

Hope you make some progress with this over the next week or so.

 

[randomange]

Waking at 3.6, I would have had 1 jelly baby and then had breakfast. The 4 JBs you had would, for me and Im sure others, be way too much. It's about 20g of fast carbs.

As an example, if you're in the 1s or 2s, you should only have 15g and wait 15 minutes to retest. It would normally bring you up to normal levels.

Rob

Just as an aside, I'd disagree with this - I'd probably have 2 JBs at 3.6, because after a hypo I aim to be around 5 or 6 and I tend to find JB puts me up about 1 mmol/l. If I was in the 1s or 2s, I'd certainly have more - if in the 2's I have 20g, and if in the 1's I'd have at least 30g, but then IMO if your BG is in the 1's then getting it up is the most important thing! 😱

As ever, YMMV and others may not find this works for them, but I just wanted to put in my tuppence worth! 😛

 

[novorapidboi26]

Just as an aside, I'd disagree with this - I'd probably have 2 JBs at 3.6, because after a hypo I aim to be around 5 or 6 and I tend to find JB puts me up about 1 mmol/l. If I was in the 1s or 2s, I'd certainly have more - if in the 2's I have 20g, and if in the 1's I'd have at least 30g, but then IMO if your BG is in the 1's then getting it up is the most important thing! 😱

As ever, YMMV and others may not find this works for them, but I just wanted to put in my tuppence worth! 😛

My preference is to treat any hypo with 10-20g of quick acting, no matter what, then check again if I still feel off.........

But the reality is for me, if in the 1s or 2s, is minor panic and subsequent stuffing my face with whatever is there, but this rarely happens nowadays.....

 

[trophywench]

LOL @ Mike - some DSN's do teach it to MDI-ers !!! proof is in the article ! ROFL

 

[everydayupsanddowns]

Ha! Well yes I guess some do, but the consultant/registrar I spoke to at my review last week was positively astonished that someone on MDI was basal testing. She had never come across anyone on MDI doing it before.

 

[trophywench]

Ah well at least one if not two (have an idea it was rejigged after the site got hacked!) Type 1's (then) on MDI wrote it!

 

[margie]

Thanks for the replies. I was told not to split lantus :/ .. but i may give my dsn a ring and see if i can split it because seems most logical thing to do..because cant remember the reasons.
xx

About 18 months back I was having real problems with my BMs, if I had my evening meal about 6 they would be fine but if I ate around 8 they would be skyhigh. I worked out it was the basal and asked my DSN about splitting the Lantus. I was told that there was no way it could be running out when I thought it was, and that I could split it if I wanted but it would not make any difference. It did straight away - she said if I was splitting do it morning and evening. Since then I spoke to a consultant who said to try and keep the split at 12 hours if possible.

So you can split your Lantus and it can be of great benefit.

 

[Robster65]

I inject mine around 8am and 5.30pm. Maybe not ideal but doesn't seem to cause me problems once the routine is established.

Rob

 

[Rachel_1989]

Hey, thanks for all your messages...i hardly ever come on this site but i much prefer it to DUK so you will be seeing more of me on here 😛

Well i did some basal testing last night..

had 36units of lantus at 10pm and at 11pm i was 6.3

1:30am-5.6
2:30am-7.2
3:30am-2.9!!

Once i treated my hypo (with JUST 2 JBs haha!) i thought there was no point carrying on the test so turned my alarm off 😛 but this morning at 9am i was 9.1. ive actually had breakfast this morning too so got my alarm set for 2 hours and see what it is then.

tonight i am lowering my lantus by 10% and give it three days and do some more testing. Its gone on to long now because i try really hard then i get bad results and feel c**p about it all but this time im determined. been type 1 for 2 years at the end of the month and its not been a smooth ride at all but ill get there 🙂

Thanks for all your support guys...it means alot x

 

[everydayupsanddowns]

That 3am dip is not uncommon Rachel - the counterregulatory hormones ebb and flow overnight and I think 3am is where many get a drop of cortisol and adrenaline (both of which stimulate the liver into releasing glucose).

Of course in many people this is then followed by a surge in hormones/glucose release around 4am-5am (Dawn Phenomenon) 🙄 so it's no wonder a flattish Lantus profile struggles.

If you have been going low at 3am regularly your FBG highs (and onward through breakfast) could just be liver dumps triggered by the hypo you have been sleeping through.

Good luck with your continued tests 🙂

M

 

[FM001]

Ha! Well yes I guess some do, but the consultant/registrar I spoke to at my review last week was positively astonished that someone on MDI was basal testing. She had never come across anyone on MDI doing it before.

I would love to know their reasoning for this astonishment Without basal testing it's difficult to tell if your insulin is set at the right dose, I'll conduct fasting tests when there is a unexplained pattern emerging in my bg readings, once I'm certain the basal is correct then I'll begin to look at my bolus doses and make adjustments thereafter.

 

[FM001]

Hey, thanks for all your messages...i hardly ever come on this site but i much prefer it to DUK so you will be seeing more of me on here 😛

Well i did some basal testing last night..

had 36units of lantus at 10pm and at 11pm i was 6.3

1:30am-5.6
2:30am-7.2
3:30am-2.9!!

Once i treated my hypo (with JUST 2 JBs haha!) i thought there was no point carrying on the test so turned my alarm off 😛 but this morning at 9am i was 9.1. ive actually had breakfast this morning too so got my alarm set for 2 hours and see what it is then.

tonight i am lowering my lantus by 10% and give it three days and do some more testing. Its gone on to long now because i try really hard then i get bad results and feel c**p about it all but this time im determined. been type 1 for 2 years at the end of the month and its not been a smooth ride at all but ill get there 🙂

Thanks for all your support guys...it means alot x

As a suggestion I would try bringing your lantus back a few hours and inject around 6-7pm, I recommended this to Northerner some time ago when he was experiencing problems with his bolus insulin, he may correct me if I'm wrong but I'm sure it improved matters for him. It's certainly worth a try and it may not work but then again it may help, I experienced similar problems once and this was the advice given by my dsn at that time.

 

[everydayupsanddowns]

As a suggestion I would try bringing your lantus back a few hours and inject around 6-7pm, I recommended this to Northerner some time ago when he was experiencing problems with his bolus insulin, he may correct me if I'm wrong but I'm sure it improved matters for him. It's certainly worth a try and it may not work but then again it may help, I experienced similar problems once and this was the advice given by my dsn at that time.

I agree. I think the timing with Lantus is often overlooked, but it can be very important. Although flat-ish it doesn't have a completely flat profile, aside from the (approx) 1 hr onset, there's a mini-peak often around 5hours (which would coincide with Rachel's overnight dip) and then a gradual tail-off towards the end.

I found splitting didn't work for me at all, but moving Lantus injection from evening to before breakfast worked a treat!

M