BS disastorous results - looking for some comments / help please

[mum2westiesGill]

Friday 13/10/2012
00:19 Bed - 16.5 (28u)

Saturday 14/10/2012
11:32 Bfast - 8.9 (4CP = 4u)
19:53 Dinnr - 14.8 (estimated CPs as went out for indian = 8u+2u corr)
00:31 Bed - 23.1 (28)

Sunday 14/10/2012
15:30 Lunch - 5.6 (5CP - 6u)
19:23 Dinnr - 20.7 (4CP - 4u +6u corr)

Monday 15/10/2012
11:23 Bfast - 9.5 (4CP = 4u)
16:14 Lunch - 12.8 (5CP = 6u +2u corr)
20:20 Dinnr - 4.8 (3CP - 4u)
22:44 Bed - 5.6 (28)

Tuesday 16/10/2012
10:42 Bfast - 13.6 (4CP = 4u)
16:34 Lunch - 8.7 (4CP = 4u)
20:41 Dinnr - 8.3 (4CP = 4u)
23:08 Bed - 8.3 (28)

Wednesday 17/10/2012
11:24 Bfast - 8.8 (3CP = 4u)
13:53 Lunch - 12.4 (4CP = 4u +2u corr)
19:02 Dinnr - 8.7 (5CP - 4u)
23:56 Bed - no test (30)

Thursday 18/10/2012
11:06 Bfast - 8.3 (2CP = 4u) (should've done 2u)
20:30 Dinnr - 10.5 (4CP = 4u)
23:56 Bed - 18.0 (30)

Friday 19/10/2012
11:16 Bfast - 14.8 (2CP - 4u +2u corr) (should've done 2u+2u corr)
15:59 Lunch - 11.9 (4CP = 6u)
20:32 Dinnr - 12.2 (4CP = 4u +2u corr)
23:46 Bed - 11.4 (30)

Saturday 20/10/2012
14:43 Lunch - 16.7 (4CP = 4u +4u corr)
01:00 Bed - no test (30)

Sunday 21/10/2012
14:50 Lunch - 20.4 (4CP = 4u +6u corr)
19:12 Dinnr - 16.5 (4CP = 4u +4u corr)
22:49 Bed - 16.5 (30)

Monday 22/10/2012
11:31 Bfast - 22.4 (4CP = 4u +6u corr)


As you can see my results are disastrous! My HB1AC was 9.6% in August 2011 then it went to 6.8% in December 2011. I've got an app on my smartphone called 'On Track' which is near enough with HB1AC results and it's currently showing my HB1AC as 8.2%!! Not as high as the 9.6% but still high enough. I'm not doing anything or eating anything different. Does anyone have any ideas as to what I can do to try to put this right? I currently don't need jelly babies but my poor OH (who's not diabetic) does!

 

[Northerner]

I'd say that all those high numbers and corrections mean that your meal/insulin ratios are way out, so you need to reestablish how much insulin you need per CP for different meals during the day. I think you also need to look at increasing your basal insulin. In fact, I would look at the basal first because you can't really establish your meal ratios if your basal is not right. Lots of basal testing required I think, either skipping meals or having no-carb meals (although some people find even protein will affect their blood sugar levels in the absence of any carbs).

I don't think there is a quick fix for this, it will have to be a careful and methodical testing regime as you establish each change in requirement - only change one thing at a time.

 

[Urbansoulpie]

I would have to agree with Northerner, looks like both your basal and bolus ratios need increasing, I would also start with your basal and test, test, test.

Lots of testing will help establish patterns and gives your DSN lots to work on when you next see them.

Keep going, you'll get there and soon be feeling lots better.

 

[randomange]

Hello! Sorry, this turned into a bit of a long one...

I think the short answer is that you need to test more! 🙂 I know DAFNE only suggests testing at particular times, but sometimes the only way to see where you need to change things is to gather information, and to get that you need to test. Then it's just a case of going through things piece by piece.

If it were me, I would start by testing to see if my basal is correct. If you are high at bedtime, do you correct? From your logs, it looks like you don't, but there are several occasions where you drop quite a lot overnight. If you are not correcting, then that would suggest to me that your basal is way too high. Start by testing before bed (and naughty you - there are several times where you don't test before bed!), then see what you are in the morning. If it's quite different, then repeat, but test at 3 am to see what is going on during the night. I would then tweak my basal until I was remaining as steady as possible overnight.

When you know your basal is ok, then you should start looking at your ratios.

I'm curious as to what your ratios and correction factors are? It looks like you're on a blanket 1:1, but then there are times when you do something different (14/10 lunch - BG ok, 5CP but 6u?) Is there a reason for this? And your corrections - sometimes you correct at breakfast and sometimes not - again, is there a reason? Not trying to criticise , just aware that I sometimes change things for reasons that aren't always obvious!

There are also quite large gaps between testing on some days. I know that DAFNE tells you only to test and correct with meals, but I think if your BGs are misbehaving, I would be testing in between meals to see what is going on - e.g. are you coming down in between meals and then rising, or are you still high after a meal and then staying the same? Also, if you have many hours in between meals, then a correction after one meal may have you in range for the next one.

Again, sorry, this became a bit of a long ramble! This is just what I would do, and you can always get in touch with your DSN. I think when your BGs start going out of whack it can be a bit hard to see the wood for the trees, and I've found that the best way to deal with it is to take a deep breath, and then essentially start from scratch and be quite systematic about testing things.

I hope some of this helps! 🙂

 

[mum2westiesGill]

Thank you all so far for all your comments / help.

I'm going to start by doing a few 3am basal tests for the next 2/3 nights and let you all know results etc. I'll have to maybe set a reminder on my meter when i do my bedtime test tonight.

 

[everydayupsanddowns]

+1 for suggestions about basal test.

Detaile here if you've not done it before: http://www.diabetes-support.org.uk/info/?page_id=120

My meal ratios and corrections rarely play nicely if my basal is even slightly out - and while I can firefight for a while long term it's just way too stressful.

As soon as you have your basal tested and holding you steady-ish then you can tweak meal ratios knowing that you are doing so from a firm footing rather than trying to hit one moving target from another.

On the plus side though... it looks like you aren't yoyoing right down into hypos so pat yourself on the back for that.

How 'boring' have your meals been? I wonder if at least some of the difficulty might be carb estimation - it often is with me.

 

[lauraw1983]

First thing that jumped out at me is you are not testing enough - do you drive?

I know until I got my basal right, which involved switching to Levemir from Lantus too, and even then it was a horrid switchover at first (I posted on here!) - but finally now it is giving me MUCH better coverage and actually does cover my basal needs and holds me steady overnight! Amazing for me, the only time I wake up high is if I have maybe had a high carb/fat meal as I just cannot get the timing right for splitting boluses.

Before I did the above I thought I was on a 1:7 carb ratio for all meals (or on DAFNE terms 1:1.5) I definitely am not, in the mornings I am less active (at work, at a desk!) I am 1:1.5 but then always 1:1 for other meals! On days I am more active (days off work, weekends etc) then I am 1:1 for all meals! Oh and on non work days/weekends I also drop my daytime basal by just 1 unit from 17u to 16u as I was having some hypos when at 17u!

Basal testing is a total PITA but so worth it, it gets things on a much steadier footing for you to know what to do for mealtimes. The 3am tests are very useful too, and a must in order to know what is going on overnight.

If you have done DAFNE, do you have their login and phone app to keep a note of BG results? I have found it one of the best things ever, shows patterns etc and you can share it on the DAFNE forum too for others who have done the course to see and help spot what is going on too.

 

[paul.johnson]

What time do you have your injections ? as you seem to be running out of Basal (long acting) or incorrect dosages as others have indicated..good luck

 

[mum2westiesGill]

What time do you have your injections ? as you seem to be running out of Basal (long acting) or incorrect dosages as others have indicated..good luck

I have my basal (BI) usually around 22:00 - 23:00.....

Thank you for wishing me good luck in getting BS levels back on track again.

 

[mum2westiesGill]

Monday 22/10/2012 (cont)
16:14 Lunch - 19.6 (7CP = 8u +4u corr)
19:59 Dinnr - 14.8 (5CP = 6u +2u corr)
23:53 Bed - 12.6 (30u)

Tuesday 23/10/2012
04:05 Night (basal test) - 14.2 ( I know this should be done at 3am but alarm didn't wake me up)
11:27 Bfast - 30.0 (4CP = 4u +6u corr) 😡 😱

 

[Northerner]

Monday 22/10/2012 (cont)
16:14 Lunch - 19.6 (7CP = 8u +4u corr)
19:59 Dinnr - 14.8 (5CP = 6u +2u corr)
23:53 Bed - 12.6 (30u)

Tuesday 23/10/2012
04:05 Night (basal test) - 14.2 ( I know this should be done at 3am but alarm didn't wake me up)
11:27 Bfast - 30.0 (4CP = 4u +6u corr) 😡 😱

Looks like some significant Dawn Phenomenon going on there Gill - do you test as soon as you wake or after you've been up, had a coffee etc. ?

 

[mum2westiesGill]

Looks like some significant Dawn Phenomenon going on there Gill - do you test as soon as you wake or after you've been up, had a coffee etc. ?

After I've been up, when I've had a brew. Basically I do my fasting test when I have my breakfast.

 

[lauraw1983]

Monday 22/10/2012 (cont)
16:14 Lunch - 19.6 (7CP = 8u +4u corr)
19:59 Dinnr - 14.8 (5CP = 6u +2u corr)
23:53 Bed - 12.6 (30u)

Tuesday 23/10/2012
04:05 Night (basal test) - 14.2 ( I know this should be done at 3am but alarm didn't wake me up)
11:27 Bfast - 30.0 (4CP = 4u +6u corr) 😡 😱

What is your ratio? Why are you having 8u for 7CP's? And 6u for 5CP's? How much does 1u drop you down by for a correction too?

Would you normally correct any high reading at bedtime - your 12.6?

What was your evening meal last night?

You might have dropped low before 4am, and that was it rising back up if you are? My DSN told me anytime between 2 and 3am is best.

If you are not eating breakfast until 11.30 or so too, I would be testing as soon as you wake for the day before you get up and moving around. Anything could be happening between getting up and eating too. Have you ever tried splitting your dose of lantus?

 

[lauraw1983]

also - what is BG now at, 2 hours after eating breakfast?

 

[mum2westiesGill]

Tuesday 23/10/2012 (cont)
13:41 2 hrs after bfast - 24.6

 

[lauraw1983]

If you answer the other bits up there ^^^ then maybe together we can try to help further too....

Are you planning to eat again before 4 hours is up? (ie before your QA will have fully run out from breakfast?)

 

[Northerner]

After I've been up, when I've had a brew. Basically I do my fasting test when I have my breakfast.

It would be worth testing as soon as you can when you open your eyes. A lot of people find their levels shoot up after waking if they don't inject/eat asap, so testing as soon as you wake will give you a better picture of what happens with your levels through the night. For example, if your numbers are actually quite reasonable overnight, but you react to a big DP rise by increasing your basal, you may end up having night hypos. The DP needs to be considered separately. 🙂

 

[mum2westiesGill]

What is your ratio? Why are you having 8u for 7CP's? And 6u for 5CP's? How much does 1u drop you down by for a correction too?

Would you normally correct any high reading at bedtime - your 12.6?

What was your evening meal last night?

You might have dropped low before 4am, and that was it rising back up if you are? My DSN told me anytime between 2 and 3am is best.

If you are not eating breakfast until 11.30 or so too, I would be testing as soon as you wake for the day before you get up and moving around. Anything could be happening between getting up and eating too. Have you ever tried splitting your dose of lantus?

My ratio is 1:10. So I should really be doing 7u for 7CP's & 5u for 5CPs. My pen goes up in 1u.

I've never corrected at bedtime for fear of going hypo.

My evening meal last night was Asda Lasagne meal deal !/4 of the pack & 2 of those small garlic bread rounds.

I'm usually awake about 7am - 8am ish then go down to do a brew. Also I've never tried splitting my dose of lantus - too scared to do that.

 

[mum2westiesGill]

If you answer the other bits up there ^^^ then maybe together we can try to help further too....

Are you planning to eat again before 4 hours is up? (ie before your QA will have fully run out from breakfast?)

Thank you so much to you and to Northerner also and anybody else 🙂 🙂

The next time I will probably be eating will be about 3pm ish then 7.30pm ish.

Breakfast is usually about 10am - 11am ish, that's because I just can't eat early, I'm just not an early bird 😱

 

[lauraw1983]

My ratio is 1:10. So I should really be doing 7u for 7CP's & 5u for 5CPs. My pen goes up in 1u.

I've never corrected at bedtime for fear of going hypo.

My evening meal last night was Asda Lasagne meal deal !/4 of the pack & 2 of those small garlic bread rounds.

I'm usually awake about 7am - 8am ish then go down to do a brew. Also I've never tried splitting my dose of lantus - too scared to do that.

My first thought would be that certainly for breakfast you need to try 1.5:1 ratio.

But honestly, before ratios are looked at you need to sort the basal out, seems like something is WAY out with it. Don't be afraid of splitting your lantus, at first you could try a 15u/15u split 12 hours apart, as it's well known in many people it does not last 24 hours! however before doing it I think you should seek advice and support from your DSN about it.

Lasagne & garlic bread is quite high carb and fat too, so some of that could be a delayed spike from that too.