at last! someone like me??!

[everydayupsanddowns]

Hi ST

Many of your questions are completely beyond me (Addisons etc) but I'll offer what I have...

MDI just stands for Multiple Daily Injections, (basal/bolus) I think you might be in this already. Two different insulins, one long-acting (often either Lantus or Levemir) and a short acting to deal with meals/snacks.

CGM is a Continuous Glucose Monitor, a device that measures the glucose level in interstitial fluid (lags approx 15 mins behind Blood glucose level) every few minutes. Some are linked to pumps and can warn if too high or too low levels are recorded. Brilliant, but expensive.

If you are often waking up hypo then I suspect your basal insulin needs a bit of work. I spent several years just assuming this was how things were, but have been amazed at the difference some adjustments can make over the last 18 months.

Some basic pointers I wish I'd known earlier: neither Lantus or levemir are really 'peakless', nor do they necessarily last 24 hours (or anything close to it as far as Lev goes). Smaller doses tend to last less time. Different people find that either injecting at a different time of day (eg morning or lunchtime) work better, others find it better to split the basal into two injections to vary the amount of basal active at different times. I was in your position and found injecting at breakfast worked well.

Details of basal testing here: Basal driving me bonkers

 

[Pumper_Sue]

Dont think i have Addisons as my consultant has i think checked for this. We talked about it at my last appt but dont really understand - except that all the steroids i've had to take have depressed my cortisol levels (details in my last post so wont repeat). A few people mentioned interactions between medications too + consultants meetings re same - is this what a CGM is?

When you say you checked for this what was done for the checking?
The fact you say you are or have been on loads of steroids would dampen your adrenal glands and could give you secondary addison's. So if you have not been given the specific tests for it, then they need to be done.

Looking at the amount of insulin you are taking for food coverage is 😱 compared to your basal needs.
So this needs to be looked at very carefully. Carb counting is def the way to go 🙂

If you are not always on the steroids then think about how to aproach your basal needs to cover this.
IE a lot more insulin needed for steroid use than not.
Waking up hypo means way to much basal overnight. So as Mike above says do some basal testing and see what is happening.
Glad the forum members have been able to help with ideas and give you some light at the end of the tunnel.

 

[AJLang]

But was wondering if i have gastroparesis. Thank u too ajlang for taking the time to give me some support despite all your own problems by the way + all the best for your eye surgery next week. I guess u wont have time to go thru this with me right now but is there a good website i could get some more info from. I do have long-standing acid indigestion which has become very severe the last few years + i've also had nausea/vomiting the last 6 years but this has usually been associated with my periods.


Thanks very much for wish me all the best with the eye surgery tomorrow. With regard to gastroparesis it took a long time for me to realise that there was actually a condition causing the problem so I didn't want to bother the doctor. My symptoms were increasing heartburn (despite being on lansaprazole), constant nausea, bloating in my upper stomach that felt like I had a football in there, loss of appetite and blood sugars that made absolutely no sense whatsoever - particularly with them going high several hours I had eaten. It reached the stage where I was feeling quite ill with the bloating/nausea after just a sandwich - which wasn't much fun when I was about to spend three hours in a class teaching postgraduate students! (Fortunately I rarely suffer from it but another common symptom of gastroparesis is vomiting) I saw the DSN several times about the erratic sugars - it made no sense because we kept increasing and increasing the levemir, as well as the carb counting, but the night BGs kept going very high. I also saw my GP two or three times who gave me some domperidone but no diagnosis. I then did some internet searching - guessed that it was gastroparesis - but instead of telling my diabetic consultant this I just explained EVERY symptom and he said that he thought that it was gastroparesis. This was confirmed as being severe by having a painless gastric emptying test. Gastroparesis is not curable - the aim is to keep you as comfortable as possible - but I am able to work in a demanding job with the treatment that I am on. They tried me on domperidone and metroclopramide but the metroclopramide made me VERY sleep (for some people it works, for others it can have a sedative affect). I'm now on domperidone and erythromycin four times a day (including one dose at 5am). I have to do many blood tests during the day and night and often inject humalog at 1.30am, 5.30am and possibly 7.30am to reduce the BGs (in addition to "normal" corrections and pre-meal injections). It is best to eat six small meals a day but this isn't always possible (or desirable) so I tend to have three small meals/snacks during the day plus a more "normal" meal in the evening. You should also inject after the meal because it takes the food longer to digest. I still feel nauseous some of the time, and the BGs are erratic, but it is manageable. My recent HBA1C was 7.8 and my consultant said that this was the best that he had ever seen for someone with gastroparesis. Be careful when looking at websites because some of the treatments can be extreme and do look scary (e.g. tube feeding) but I would emphasise the small meals/regular injections, blood tests/medications can help and may be the only treatment that is needed although there are other options if these don't work, such as botox injections into the stomach. Sorry that this is rather longer but I hope it helps. Please do not hesitate to let me know if you need further information.