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Argh!!!!

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I

Ivy

Active Member
Relationship to Diabetes
Type 1
I am so fed up with my blood sugars!!! I test constantly (like every 2 hours, every day) but they fluctuate all over the place. My Hba1c isn't *too* bad (8.2% last time) but I have cataracts that just keep getting worse because of the fluctuations. My doctor told me they should settle when my hormones settle down...I thought they would have settled down by age 22??

Night time is the worst. I was on 9 units Levemir (I know it's not a lot but I'm a tiny person, only 4'11 and 105lbs) but whatever my sugars before going to bed, by morning they would creep up to 13+. I increased it to 10 units which makes me go hypo, but when I get up to eat (even a small amount) by morning my sugars have again shot up.

I have random days where I have to take triple the amount of novorapid because my sugars will just not go down. But some days it's not a problem. I don't feel I can increase my Levemir any more because I am so sensitive to hypos. I can never keep my sugars in the ideal 5-6 range because the moment I get up to do something they go shooting down into a hypo.

The people at my clinic didn't have much advice to offer. I am at the end of my tether. Any suggestions?
 
Hi Ivy,
sorry to hear you are having so many problems.
Have you thought about trying or have you tried different insulin's to see if that helps?
 
Ivy said:
I am so fed up with my blood sugars!!! I test constantly (like every 2 hours, every day) but they fluctuate all over the place. My Hba1c isn't *too* bad (8.2% last time) but I have cataracts that just keep getting worse because of the fluctuations. My doctor told me they should settle when my hormones settle down...I thought they would have settled down by age 22??

Night time is the worst. I was on 9 units Levemir (I know it's not a lot but I'm a tiny person, only 4'11 and 105lbs) but whatever my sugars before going to bed, by morning they would creep up to 13+. I increased it to 10 units which makes me go hypo, but when I get up to eat (even a small amount) by morning my sugars have again shot up.

I have random days where I have to take triple the amount of novorapid because my sugars will just not go down. But some days it's not a problem. I don't feel I can increase my Levemir any more because I am so sensitive to hypos. I can never keep my sugars in the ideal 5-6 range because the moment I get up to do something they go shooting down into a hypo.

The people at my clinic didn't have much advice to offer. I am at the end of my tether. Any suggestions?
Click to expand...

Hey - Have you done any proper basal testing - You situation was is very similar to how mine was, and I didnt know which was to turn.

I found that: -

A) Basal test and ensure your basal is working as best it can be - I see this as the back bone to diabetes and until this is in place you will be chasing your tail
B) Work out and fine tune your meal ratios for your meal ratios, also your injection timings
C) Diet and exercise - Work out how exercise effects your levels & What foods do and dont spike your levels

If it were me Id start at the top and work my way down. Have you done any basal testing? Theres plenty of great links on here. Have a look in the pumping section!
 
I agree with Benny, I think basal testing is absolutely key to good control. See http://www.diabetes-support.org.uk/info/?page_id=120 - about 2/3 down the page. However if you test through the night you should see at what point your BG starts to go up and it sounds to me like you have dawn phenomenon. No injected basal insulin can cope with that, so it's either a case of correcting with rapid acting or asking for a pump. I have the same problem and have applied for a pump, just waiting for my appointment with the Endo.
 
To be honest I have been trying to avoid a pump. =/ I just hate the idea of having something attached to my body all the time. I've even tried correcting in the middle of the night but they still stay raised. I will raise the issue again at my clinic appointment next month and make sure they understand how much it's getting me down. Can a certain type of insulin just suddenly stop being effective for someone after years?
 
Ivy said:
Can a certain type of insulin just suddenly stop being effective for someone after years?
Click to expand...

Might be worth asking that question when you see your clinic - ISTR someone on a forum developing antibodies to an insulin, but it was ages ago and I can't remember the details, sorry.

Agree with others about basal testing. It really is the bedrock of your control. It could well be worth experimenting with the timing of your basal too, if you want to keep using Lev. Try taking it in the morning... try taking some at night and some approx 12hrs later (could be half the dose, could be more or less for each 12hr segment).

It's a fair amount of testing, fiddling and tweaking, but once you've worked out the best (usually least worst) basal apporach for you on MDI you should only need to retest and check it periodically when things go out of kilter.

Days when your levels just won't come down could well be your liver kicking off - feeding out way more glucose than normal. There are a number of things that can trigger this, so it's not always easy to spot or explain. Very frustrating though!

Good luck!
 
Ivy said:
To be honest I have been trying to avoid a pump. =/ I just hate the idea of having something attached to my body all the time. I've even tried correcting in the middle of the night but they still stay raised. I will raise the issue again at my clinic appointment next month and make sure they understand how much it's getting me down. Can a certain type of insulin just suddenly stop being effective for someone after years?
Click to expand...

Again the same as you - Im not ready for the pump - Im also on MDI like you.

I was just saying that the guidelines for basal testing on the pump can still be used for us on MDI, and give us real indication and an idea of what our basal is doing. Where it peaks and where it troughs. For eaxample if your have a rise at 4am in the middle on the night. Maybe you could shift your levimir a few hours forward or back so that you could cover it etc Theres alsorts of tips and tricks you can use to get the best possible control.

Like Mike said - Splitting your levimir may work for you also.

It will tell you roughly if the amount of insulin you take is the right amount too.
 
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Just a sec... there could be a very simple answer to this. You're on Levemir yes? One dose a day? If so it may be that Levemir isn't lasting a full 24 hours, it doesn't at smaller doses. See this chart http://www.diabetes-support.org.uk/info/?page_id=428 At lower doses it may only last 16 to 18 hours and if you are taking your dose in the morning that could be the explanation.
 
Pattidevans said:
Just a sec... there could be a very simple answer to this. You're on Levemir yes? One dose a day? If so it may be that Levemir isn't lasting a full 24 hours, it doesn't at smaller doses. See this chart http://www.diabetes-support.org.uk/info/?page_id=428 At lower doses it may only last 16 to 18 hours and if you are taking your dose in the morning that could be the explanation.
Click to expand...

I take it every 12 hours, in the morning and before bed.

Thanks for the replies guys I will maybe try adjusting the times I take my injections and will read up on basal testing.
 
Maybe I will try taking my Levemir earlier but increasing the dose? Because I take it around 9 and it sends me hypo around midnight-1am. So maybe if I take it at 6 or 7 when I come in from work, then it will dip at 10pm when I usually take some pre-bed novorapid, but then maybe I won't need the novorapid anymore.

Does that make sense or am I just confusing myself and talking rubbish? 😛
 
You didn't mention novorapid corrections before. Quite honestly I think under the circumstances it's extremely hard for either you or any of us to draw any conclusions if the waters are being muddied by correction doses. I think if it were me then my first action would most definitely be the basal testing and NO correction doses before bed.

Good luck with the testing.
 
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Sorry, that sounded rather sharp and I didn't intend it to be😉. If you are taking Novorapid at 10pm then it will continue to bring your BG down until possibly 3am or later. It's possibly the Novorapid that's sending you hypo at 1am rather than the Levemir. Of course it's also possible that the levemir that's working after the Novorapid has worn off is insufficient and that's why you start to rise later in the night. So you can't see really what your Levemir is doing unless you drop the 10pm Novorapid.

Hope this helps.
 
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