Bloods Spiking

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My whole bodily skin covering is pretty lumpy - frequently commented on when having breast examinations!

As nobody ever checked my jab sites for the first 40 odd years I had diabetes however would anyone be able to guess whether they're puddles of insulin or not? (except that obviously the knots detectable in my boob won't be - whilst on MDI I did ONCE wonder if you could inject into boob tissue, so tried inserting a needle - violently painful and only got it in about one millimetre. Ergo, no at least I, definitely cannot!) I've had a number of ops and procedures done on my tum - laparascopic sterilisation, total hysterectomy, where extensive endometriosis was also found and removed, HRT implants for a few years, removal of numerous seborrheic keratoses. Would any of those have caused any damage preventing absorption of insulin? Or caused the knots I can always feel myself? There's no-one to ask these sorts of Qs.
 
I honestly don't know, except over on DSF yonks ago - more people using Lantus reported it than other insulin users, though sometimes, they did. When I had mine let go, early noughties, left work early to get to Friday afternoon, 4.00 ish D. appointment - I was actually still in the D clinic having finished my review that day - I sat down back in the waiting room thereof to test my BG prior to walking back to my car to drive home, discovered I was under 4, drank some Lucozade (the old fashioned full glucose sort, waited, tested, still hypo, finished the (new) bottle I had in my bag) a DSN was about to go home and lock up, aaargh, didn't have the keys to the cupboard with their bottles of Lucozade in, but found a packet of custard creams in someone's unlocked drawer fortunately - I hated them before that, and still do 'oddly enough'. Had to force em down so I could get my BG up before I dare risk driving 2 junctions along the M6 in Friday rush hour. It absolutely wasn't possible with what I'd eaten or injected either that day or the day before.

Hence both she and I (plus her assistant DSN and my own and other consultants there) concluded it must have been a ruddy 'pocket' releasing. Scary stuff and one of the things that decided for me I really ought to try Levemir instead of Lantus as basal.
What was your reason to change Lantus with Levemir?
Is that what you are achieving or your target.... or both?

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.



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.

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.

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.

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.

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.
Barbara, my claim to knowledge did not come to anything. I am going to present you with a scenario and would love to read your response.

I woke up late and was feeling sorry for myself. Decided to give breakfast a miss. No NR. Wake up reading was 8.7mmol/L

In can't be bothered state of mind, I decided to have weetabix for lunch as opposed to breakfast time. Weetabix + SM milk and a banana.

Quite happy at the fact that I ve finally solve the mystery. Feeling full too.

Suddenly the alert sounded. High glucose.
Scanner read 21.0mmolL. Finger pricked and
GLuco Meter read 20.5mmol/L.

My ratio for breakfast is 1:5g and lunch 1:10g. Because I ate Breakfast at lunch time, I took lunch time ratio hence the sharp rise I guess?

I will love to hear your advance. Thanks.
 
That's the leading question, DSNs and consultants have consistently told me ever since they told me it could be that some 20 or so years ago - that there's no way of predicting whether anyone has them or where they might be. Lantus was always a leading supplier of these, but everyone thinks that's because of the crystalline properties of it. Very very unusual to have it happen in anyone so very newly diagnosed though, don't think I've heard it mentioned by anyone this new before. Blooming things have always been a random possibility even with the animal insulins but that was really mega rare in those days.

Anyone know if they've revised what they used to say, ie that they could hang round for up to 12 years before they decided to release and send you mega hypo? - or might not ever release and just stay there gradully becoming less effective with age!
Thanks Jenny, could it be nuggets of fat in my case?
 
Why I changed Lantus for Levemir?

Hope the ques is for me. The simplest answer is DSN told me. I was taking 12u of Lantus at night. In order to give me better coverage, Levemir was given to be used twice a day, 14u at a time. I used to go in hypos, 2-3 hours in the early hours of the morning while sleeping. So Levemir was reduced by 1u at night time.
 
My whole bodily skin covering is pretty lumpy - frequently commented on when having breast examinations!

As nobody ever checked my jab sites for the first 40 odd years I had diabetes however would anyone be able to guess whether they're puddles of insulin or not? (except that obviously the knots detectable in my boob won't be - whilst on MDI I did ONCE wonder if you could inject into boob tissue, so tried inserting a needle - violently painful and only got it in about one millimetre. Ergo, no at least I, definitely cannot!) I've had a number of ops and procedures done on my tum - laparascopic sterilisation, total hysterectomy, where extensive endometriosis was also found and removed, HRT implants for a few years, removal of numerous seborrheic keratoses. Would any of those have caused any damage preventing absorption of insulin? Or caused the knots I can always feel myself? There's no-one to ask these sorts of Qs.
Jenny, do not be afraid of asking questions. As I was told in the very beginning that no question is silly. There is so much knowledge and expertise on this forum. Moreover by asking questions you might be helping someone else too.

OMG! If I could only hear myself dishing out advice.
 
What was your reason to change Lantus with Levemir?

Barbara, my claim to knowledge did not come to anything. I am going to present you with a scenario and would love to read your response.

I woke up late and was feeling sorry for myself. Decided to give breakfast a miss. No NR. Wake up reading was 8.7mmol/L

In can't be bothered state of mind, I decided to have weetabix for lunch as opposed to breakfast time. Weetabix + SM milk and a banana.

Quite happy at the fact that I ve finally solve the mystery. Feeling full too.

Suddenly the alert sounded. High glucose.
Scanner read 21.0mmolL. Finger pricked and
GLuco Meter read 20.5mmol/L.

My ratio for breakfast is 1:5g and lunch 1:10g. Because I ate Breakfast at lunch time, I took lunch time ratio hence the sharp rise I guess?

I will love to hear your advance. Thanks.
Without knowing more information it is really hard to make comment and sometimes you talk in riddles....
For instance what do you mean by "Quite happy at the fact that I ve finally solve the mystery. Feeling full too."

So...info which would help make sense of your situation at lunch today....
1. Did you take your morning Levemir as you make no mention of it?
2. What was your pre-meal reading?
3. How many carbs and how much NR did you inject?
4. How far in advance of the meal did you inject?
5. How long after eating did you get the high BG alert and find the reading of 21?

Your body doesn't know that you are having a breakfast cereal for lunch so the ratio is for the time of day and not the food you eat so a 1:10 ratio for that meal at lunchtime would be fine, but if you didn't eat any breakfast then your liver will likely have been chucking glucose into your blood all morning (Dawn Phenomenon/Foot on the |Floor syndrome) to give you energy because you didn't eat anything and there is no additional insulin in your system to deal with that glucose so I am going to guess that your pre meal reading was probably already pretty high.... and then you maybe didn't prebolus far enough in advance and probably didn't do a correction with the meal bolus so your levels sky rocketed.....

If you can supply the information to the 5 questions above then it will shine a lot more light on the situation and I can tell you what I would have done in that situation.
 
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