Questions....and more questions!

[jalapino]

Good evening everyone....I need to clear up a few questions that have been rattling around my head for a few days, I'm sorter anxious over increasing my humulin m3 every 3 days, so at the moment it is 14 units in the morning and evening, tomorrow been told to increase another 2 units which will bring me up to 16 units a day, the thing is I have had single numbers the other day which I was so chuffed at but now having high numbers in the evening and waking up around 12ish, I'm starting to worry because I don't want to keep increasing dose if for say today I go to bed with a low number then end really low at night, I guess what I'm saying I'm scared of having a hypo, because my levels are so up and down I'm thinking if one day I have low bs then the next high bs and I'm told to increase then surely my chance of having a hypo is more likely, so confusing!! am I making sense? it's just one day its low then the next day high no difference in carb intake, is it because one day my pancreas kicks out more insulin than other days?
and does this meen I should take less insulin?
At the moment just feel like I'm not in-control, i no this is long winded but am finding it hard as levels are all over the place
I feel happy in my self...just lost and confused 🙂
I am still taking metformin as well max dose....i have probably made no sence if so ignore me 🙄

 

[Northerner]

All makes perfect sense to me Ant. The difficulty seems to be achieving some consistency in levels. When you say 16 units a day, do you mean in total, or 16 units in the morning and 16 at night, totalling 32 units? People tend to need more or less insulin at different times of the day - in my case I need more in the mornings due to increased insulin resistance at that time of day, plus my liver seems more active at putting out glucose. As the day progresses I need less insulin for the same amount of carbs.

I would suggest you try having meals with exactly the same amount of carbs in for a few days so that food does not add a complicating factor. As you are on fixed doses of a mixed insulin the you need to find out when your peaks and troughs are for the same food against the insulin, so plenty of pre and post meal tests required. Might be boring, but worth it in the long run - like a lot of things to do with diabetes, if you can simplify things whilst you are trying to work things out, it will usually help (I won't say always! 🙄).

What and when were your single figure readings?

 

[jalapino]

All makes perfect sense to me Ant. The difficulty seems to be achieving some consistency in levels. When you say 16 units a day, do you mean in total, or 16 units in the morning and 16 at night, totaling 32 units? People tend to need more or less insulin at different times of the day - in my case I need more in the mornings due to increased insulin resistance at that time of day, plus my liver seems more active at putting out glucose. As the day progresses I need less insulin for the same amount of carbs.

I would suggest you try having meals with exactly the same amount of carbs in for a few days so that food does not add a complicating factor. As you are on fixed doses of a mixed insulin the you need to find out when your peaks and troughs are for the same food against the insulin, so plenty of pre and post meal tests required. Might be boring, but worth it in the long run - like a lot of things to do with diabetes, if you can simplify things whilst you are trying to work things out, it will usually help (I won't say always! 🙄).

What and when were your single figure readings?

Well Friday night I went to bed and it was 9.3
woke up Saturday morning it was 8.1
But now for example last night high 26.2
this morning 12.2
Now I have made sure I have had the same amount of carb intake every night and pretty much the same time everyday.
So I am taking 16 units in the morning then 16 units in the evening so yes totaling at 32 units each day.
I also spoke to my dn on Friday night as she will ring me twice a week to see how I am doing, and i said I need more strips to keep an eye on my bs but was told 50 a month as I only need to check morning and evening and if I feel odd.....well rang again today and she said we do not mind giving you more but only short term, so I will only get 50 strips a month.

 

[Northerner]

50 a month whilst you are trying to work this out? What nonsense! 😱 You are on insulin, and new to it at that, so you need to be testing a LOT! I would say you need at least 50 a week. Doctors have all received a letter from the government saying that CCGs and GPs (or nurses) should not impose restrictions on strips for people on insulin - regardless of type of diabetes:

http://www.diabetessupport.co.uk/boards/showthread.php?t=39097

I'm afraid you seem to have come up against someone who really does need their skills and knowledge updating I remember how you had to fight to get some proper treatment, and that levels in the 20s were considered nothing to worry about (the occasional one maybe, but certainly not long-term). Just because you are on two injections a day does not mean that you only need to do two tests - you need to find patterns and two tests a day are totally inadequate to spot them.

Going back to the tests you have done, it's possible the big variations in values, despite having the same carbs, is because your insulin is peaking at different times to your food. This is what is especially awkward about mixes, I think - the insulin will generally peak at the same times, but the food may not - sometimes it may coincide with the insulin peaks meaning your levels are good, sometimes not, leaving you high.

I really hate it when people are placed in such a difficult situation due to penny-pinching I think you need to get your 'determined' head on and demand more strips and explaining why, I'm afraid, or find another doctor.

 

[Northerner]

Also, are you testing before your evening meal as well as bedtime? You may already be high before eating sometimes.

 

[jalapino]

Also, are you testing before your evening meal as well as bedtime? You may already be high before eating sometimes.

For me I peak in the evening, but I'm trying to test less often due to lack of strips even tho I'm told to increase my units every 3 days...I have my m.o.t this Wednesday so I will be intrested to see what my HbA1c is.....all in all I feel more lost and confused than ever since injecting

 

[Aoife]

Don't expect any great improvements in your HbA1c! It's a kind of average from the last 8-12 weeks (and doesn't really give you any indication of control as hypos can cancel out the higher numbers but that rant is for a different post!)

Also don't get despondent about everything, NO ONE "gets" it at the beginning, it takes time to work out dosages and a lot of getting it wrong before things start to click into place

 

[Pumper_Sue]

Ant, if you drive it is law you test before you drive to nurse or GP will have to increase your test strips.
If you are worried about going low in the night then set your alarm so you test at about 2 AM.

 

[pav]

I agree with Northerner, 50 test strips a month for some one on insulin is utter rubbish, you need to ask your doctor to increase the amount on a permanent basis. I now have 2 prescriptions for test strips (2 different meters) one is now for 100 and the main one is for 200. I do have to get them re-authorised every 2 prescriptions.

If I did not have access to strips, I would not be able to drive, remember DVLA say test before you drive to confirm you are safe to drive. If you work a 5 day week that's at least 10 strips and if you go out to lunch that's another 5 used, and that's allowing for after meal tests.

Its important at this stage to test before and after your meals to see where you are peaking or getting it right.

I did have to justify my requirements, and once I did, I have not as yet had any problems getting strips.

 

[jalapino]

Don't expect any great improvements in your HbA1c! It's a kind of average from the last 8-12 weeks (and doesn't really give you any indication of control as hypos can cancel out the higher numbers but that rant is for a different post!)

Also don't get despondent about everything, NO ONE "gets" it at the beginning, it takes time to work out dosages and a lot of getting it wrong before things start to click into place

I no...I just can't help but be worried!......im trying my best but i still feel lost in the dark, I no there are worst of but it is all so new and find it tuff, but I no I will get there 🙂

 

[jalapino]

Ant, if you drive it is law you test before you drive to nurse or GP will have to increase your test strips.
If you are worried about going low in the night then set your alarm so you test at about 2 AM.

Good idea sue....I have not notified dvla, from what I have read they can take my licensee?

 

[jalapino]

I agree with Northerner, 50 test strips a month for some one on insulin is utter rubbish, you need to ask your doctor to increase the amount on a permanent basis. I now have 2 prescriptions for test strips (2 different meters) one is now for 100 and the main one is for 200. I do have to get them re-authorised every 2 prescriptions.

If I did not have access to strips, I would not be able to drive, remember DVLA say test before you drive to confirm you are safe to drive. If you work a 5 day week that's at least 10 strips and if you go out to lunch that's another 5 used, and that's allowing for after meal tests.

Its important at this stage to test before and after your meals to see where you are peaking or getting it right.

I did have to justify my requirements, and once I did, I have not as yet had any problems getting strips.

Hmmm....sounds like I have a battle on my hands pav to get more strips

 

[Pumper_Sue]

Good idea sue....I have not notified dvla, from what I have read they can take my licensee?

No they wont take your licence, unless you have 2 hypos needing paramedics or other 3rd party assistance which doesn't include passing some glucose to you. (within 12 months)
You did need to inform DVLA though because it's an offence not to and your licence is non valid as is your insurance.
I've been on insulin for 48 years and have held a full licence for 30 + years with no problems.

 

[Pumper_Sue]

Hmmm....sounds like I have a battle on my hands pav to get more strips

No you wont just tell em you want their medical insurance details as you going to claim taxi fares/loss of earnings etc due to loss of driving licence which is their fault. You wont have a problem.

 

[jalapino]

No you wont just tell em you want their medical insurance details as you going to claim taxi fares/loss of earnings etc due to loss of driving license which is their fault. You wont have a problem.

Wow!!! sue you no so much!!!.....what would I do without this forum and every ones knowledge .....I was reading on a forum that I have to renew my licence every 3 years?

 

[Mark T]

Wow!!! sue you no so much!!!.....what would I do without this forum and every ones knowledge .....I was reading on a forum that I have to renew my licence every 3 years?

In some cases every year (my fathers been on both 1 year and 3 year licenses). But generally it shouldn't be an issue.

 

[Pumper_Sue]

Wow!!! sue you no so much!!!.....what would I do without this forum and every ones knowledge .....I was reading on a forum that I have to renew my licence every 3 years?

Hi Ant, I have learnt an awful lot from other people with diabetes just the same as you are doing. 🙂
I renew my driving licence every 3 years, so far touch wood I haven't had a problem.

Bottom line is your GP owes you a duty of care that care involves keeping you and other road users safe by prescribing test strips as you are on insulin.

 

[trophywench]

Hey Ant, don't stress about a 3 year licence ! I was diabetic when I took driving lessons and passed my test and so was Sue!

It's just so they check up on people every 3 years and now there's a declaration when you get to the signing bit, explaining when you have to test and what to do when and if you are low, and by signing that form you legally agree to do it.

If a doctor KNOWINGLY deprived me of the means to stay within the Law in this or any other respect, I'd threaten to sue, too !

That is to say, I'd need to make sure he knew what the law is now.

So you need to do that with your doctor. Not the ruddy nurse.

Your GP.

Incidentally, my doc explained to me that the prescribing system they use on their puters says that for every single case where they prescribe more than 100 strips a month, they have to justify it or it won't let them. But they don't have to write a diatribe every month, it's done by a code they use when they renew your scrip - you know when it goes from "0 repeats left~ to "6 repeats left" again. Then they can just tick the box to issue another scrip every time you need one until another 6 months pass by.

But where nurses prescribe it may well be that they do not have the authority to override the system in this way without someone with authority giving it the rubber stamp. Just a safety margin, but a lot of nurses and even some deceptionists, think they are God anyway ......

 

[Pumper_Sue]

Just a safety margin, but a lot of nurses and even some deceptionists, think they are God anyway ......

Was that a deliberate typo 😱 Thanks TW I now have coffee all over my keyboard.

 

[Northerner]

Was that a deliberate typo 😱 Thanks TW I now have coffee all over my keyboard.

Made me laugh too!