For me, time in range suggested is 75% and Glucose average is 10mmol/L.
Is that what you are achieving or your target.... or both?
This brings me to 2 questions - what to do when spike is 5.4mmol/L or 6.4mmol/L?
What do you mean by a spike? Do you mean an increase between your premeal reading and your 2 hour post meal reading? If so, thinking in these terms with insulin use is not helpful. Novorapid takes about 4-5 hours to totally work, so you are not really interested in doing anything about an increase of 5 or 6 except maybe prebolus a bit earlier so that the insulin has the chance to get absorbed and working as the food is digested and releasing the glucose. This timing is different for everyone and will depend on the time of day and the type of food and is very much a question of trial and error, but at this stage timing of your bolus and/or an increase of 6mmols is not something to be concerned about as long as it goes back down by the next meal.
You seem to be trying to control your diabetes through diet and trying to follow the advice for that when you are insulin dependent and therefore that doesn't apply. Your levels are far too high and you are losing weight and hungry because you are not eating enough and not giving yourself the insulin to cover it.
How many extra units you would suggest? How many units of NR can be increased in one go?
If this is just the rise after a meal then I would not suggest any extra units until the next meal and assess then if a correction is needed and then work out how many correction units you need with your 2mmol correction factor, you need to bring you back into range.
So if you start the day on 6 then spike up to 12 and come back down to about 6 by lunchtime then that was really good and you don't need to take any action, but if you went up to 12 and stayed there or went up to 15 or16 and then came down to 12 by lunchtime then you are about 6 units higher than ideal, so with your correction factor of 2, you would add 3 correction units to your lunchtime meal bolus (12-6=6 and you would need 3 units of NR to drop your levels 6mmols with a correction factor of 2 ie 3x2=6) , even if you were only having 10g carbs and therefore 1 unit of NR (with a 1:10g ratio) for the meal, so you would give yourself 4 units total in that scenario. If your levels were 20 at lunchtime and you were just going to have 10g carbs then 20-6=14 and 7X2=14.... so you would need 7 units for the correction and 1 for the food. It doesn't matter that the correction of 7 is much bigger than 1, you need that extra insulin to bring your levels down. If you were going to have 80g of carbs for lunch with a meal ratio of 1:10 then you would add the correction to that 8 units for the meal and that would be 15units of insulin (8 for the meal+7 for the correction if your BG was 20 for your premeal reading) to bring your levels down into range again.
More over how much insulin is too much?
Too much insulin is when you hypo....simple as! It happens to the best of us for a variety of reasons. Miscalculation, increased activity, honeymoon period when own pancreas chucks some insulin into our blood stream after we have injected the correct amount, hot weather making us more insulin sensitive, hormones.... loads of reasons....
No one said it was easy
🙄
During the last heat wave I had 4 days in a row when I had 2-4 hypos each day despite reducing my basal insulin by 2-3 units each day to try to prevent them. Hypos happen sometimes despite our best efforts and whilst it is not ideal, accepting that hypos are part of insulin usage and it isn't necessarily a failure on your part is important. I naively thought that 1 or 2 hypos a year was what I might expect and panicked when I had 2 in a fortnight in the first few months of using insulin. A very kind member of this forum said that she regularly had 2 hypos a day. That really put things into perspective for me. Having realistic expectations is important. I consider I have good diabetes management but I have 3-4 hypos a week of 7-10 if you believe Libre
🙄. It is a very fine balance and sometimes we don't get it quite right.
How long is the proverbial honeymoon period?
Can be a few weeks or months up to several years. It is very individual. I had 3 distinct stages to my honeymoon period where it was obvious that I needed more basal insulin. The first was about 6months from diagnosis, then about a year and then what I think was the final stage was after my first Covid vaccine and my insulin needs almost doubled over the 3 months following that vaccine..... then it levelled out and has been more or less the same since then apart from needing to reduce by 9 units over that last hot spell but now back up to full dose again.
Which insulin covers the mid morning and late afternoon snacks?
At this stage it would be best to eat bigger meals and not snack between meals until you have more experience at managing your levels with insulin..... or stick to low carb snacks like a chunk of cheese or a boiled egg. Once you get confident using your bolus insulin you can inject extra insulin to cover snacks between meals but it can be confusing until you get the hang of managing main meals so try to have bigger meals and no or low carb snacks for now.
There is no need to go hungry so make some nice big meals, count the carbs, inject your insulin to cover them and fill yourself up on them so that you don't need snacks between meals.
My summer hols finished a week ago. In 5 working days, I took 4 hypos. First 2 days it was around mid day. On the third day, I took a slow releasing carb snack. It worked but only till 3:00pm. Same happened on Friday. I finger pricked to double check. To my utter astonishment, it was showing 6.2mmol/L. I had all the symptoms of a hypo such as feeling hollow, shaking and dizzy. Many times I do wonder if I am even normal or one of a kind, strange specimen? Why nothing is simple, straight forward when it comes to me?
If this was during the very hot spell then many of us had problems with hypos as I have mentioned above. I reduced my Levemir by 2-3 units each day to try to prevent them but it still wasn't enough and I hypoed multiple times each day. That is not a failing on my part. I took the right action and I am sure if would have been a lot worse if I hadn't done that, but it was quite extreme heat and I was out in it a lot of the time.
Feeling hypo at 6.2 could be because your levels had been quite high and came crashing down very quickly so that even though you weren't actually hypo, your body can sense BG dropping fast and gets twitchy and releases hormones to rectify the problem. Or the other option may be that you were actually hypo but you had something on your fingers which contaminated the blood.... This has happened to me on one occasion when I had been chopping onions, but also fruit or even just handling a jam jar that might have a tiny smear down the side.... If your test doesn't correspond with how you feel, you should always retest.
I used to feel exactly like you, that my diabetes didn't make sense and I wasn't normal like other people, but what you have to understand is that there is a very broad spectrum of what is normal. It takes time to understand how your body works with food and insulin and none of us are the same. You will eventually find some sort of balance and a way to make your insulins work for you (hopefully with some more support and guidance from the nurse and dietician later today and you will be able to eat more or less what you want and when you want and get reasonable results afterwards once you get more experience, but the two things I would say are..... don't be frightened to use your insulin (calculate how much you need, double check and then inject it without worrying how much it is more than usual, if your levels are high or you are having a big meal, then you will need it.....and don't be put off by making mistakes or having hypos. You learn more from mistakes than you do from success and hypos are just a part of diabetes management. The more you have the more confident you get at managing them and whilst of course you try to avoid them, don't feel you are doing anything wrong when they happen.
