Diabetes Greeting

[Damaris]

Sounds like you are off to a great start!

Has your Dr given you ketone strips (either blood or urine?). I’ve generally been advised to check for ketones after a reading or two in the teens. I think I’m lucky in that I don’t seem to produce ketones very readily - but Your Diabetes May Vary!

Yes I have the ketone strips but haven’t used them much.

 

[Lily123]

I tend to get high blood sugars so I wasn’t sure if that was normal.

It’s normal to test for ketones after a few high readings

 

[Inka]

I tend to get high blood sugars so I wasn’t sure if that was normal.

How high are your blood sugars? Do they just spike a bit high then come down or do they stay high?

 

[Ditto]

Hello and welcome. 🙂

 

[Damaris]

How high are your blood sugars? Do they just spike a bit high then come down or do they stay high?

Can be as high as 14 or 16 but then it will go down to 12 after a while. My alarm didn’t go off last night so I got a good night sleep.

 

[Inka]

Can be as high as 14 or 16 but then it will go down to 12 after a while. My alarm didn’t go off last night so I got a good night sleep.

Ok, a little high (the 14-16). Is 12 around where your blood sugar normally is, or is it lower than that? It might be that your insulin(s) need a small adjustment. There are various ways to gauge what you might need, but you’ll pick that up gradually 🙂

I do recommend the two books I mentioned in an earlier post. Type 1 is a condition where the patient has to do a lot of the managing themselves. I found it very helpful to have a book to dip into when I had questions or didn’t quite get what was going on. I know we have the internet now, but I find something calming about consulting a book.

 

[Damaris]

Ok, a little high (the 14-16). Is 12 around where your blood sugar normally is, or is it lower than that? It might be that your insulin(s) need a small adjustment. There are various ways to gauge what you might need, but you’ll pick that up gradually 🙂

I do recommend the two books I mentioned in an earlier post. Type 1 is a condition where the patient has to do a lot of the managing themselves. I found it very helpful to have a book to dip into when I had questions or didn’t quite get what was going on. I know we have the internet now, but I find something calming about consulting a book.

I might need to see what the diabetic nurses say when I go to them next but I’ll check out the books that you mentioned as I only have the Carbs and Cals book. I think my portion sizes might need to be adjusted as well as that might have an impact as why my blood sugars are so high at times.

 

[Inka]

Unless you’re eating enormous portions, it will be your insulin that just needs adjusting slightly. It’s very common to start people on less insulin than they need (for safety reasons) and then increase it gradually as needed.

Type 1 is about fitting your insulin to your food not the other way round. I eat pretty much exactly as I would if I didn’t have Type 1 🙂 The recommended diet for Type 1 is a normal diet and the only reason we count carbs is for our insulin doses.

I appreciate your on fixed doses of Novorapid but they can be increased if they’re not covering your food. I’d also ask if your basal dose is right as you suggest above you’re a bit high overnight.

I know it probably all sounds a bit overwhelming, things chopping and changing all the time, but that’s the nature of Type 1 - lots of tweaking of things our own pancreas used to do automatically. Clever pancreas!

 

[rebrascora]

Are these 14s and 16s Libre readings because Libre does often exaggerate highs and lows to some extent. Also going up into mid teens occasionally happens despite our best efforts and when you are newly diagnosed will happen a lot more frequently than when you become more experienced at timing your insulin. I used to spike up to 15 every morning after breakfast, even eating a low carb breakfast, and the be back down to about 5 again by lunchtime. It made me feel pretty rough. Once I learned that I needed to inject my breakfast insulin significantly earlier before I ate breakfast, I ironed it out. I still very occasionally hit mid teens like the other night when I shared a fish and chip supper with my partner and didn't prebolus soon enough before eating. I am disappointed when it happens but I had a choice on that occasion of sitting and letting my fish and chips get cold whilst my insulin kicked in or just eat it and deal with the consequences. I waited 5-10 mins whilst he tucked into his portion and then I caved in and started eating. I usually need 20-30 mins for my insulin to get a head start before I eat lunch and evening meal but I need 45 mins at breakfast, so I have to be quite organized which doesn't come naturally to be and sometimes I get it wrong.

I think it is easy to forget pre Libre that many people will have spiked up to mid teens on a daily basis and not even been aware of it because we were only told to test before each meal, by which time levels had likely come back down into range again. Libre shows us the ugly truth sometimes, but it also gives us the opportunity to play around with the bolus timing and reduce the spikes as a result.

 

[Damaris]

Yes 14-16 but when first got diagnoses my blood sugar was in the 40s so they weren’t sure if I was going to make it. I remember in hospital that my blood sugar was high in the morning but then lower by lunch time but since being out of hospital I am trying to have my meals every day at the same time so I get into a routine. I tend to prefer to do my insulin if it is around the 10 blood glucose reading. I was at a yoga class this morning and my sensor didn’t even go off and I was out ten pin bowling this evening and my blood glucose was in the green through each game which doesn’t always happen.

 

[Inka]

I tend to prefer to do my insulin if it is around the 10 blood glucose reading

Do you mean you correct at 10 @Damaris ? Or are you saying you don’t feel well if your blood sugar is under 10? Apologies - I don’t quite understand what you’re referring to. Can you explain a little more?

 

[Damaris]

I tend to prefer to do my insulin if it is around the 10 blood glucose reading

Do you mean you correct at 10 @Damaris ? Or are you saying you don’t feel well if your blood sugar is under 10? Apologies - I don’t quite understand what you’re referring to. Can you explain a little more?

I don’t feel comfortable doing my insulin when it’s at like say 7. Something I prefer it to be at least 10 or just slightly above as I know the insulin brings the blood sugar down. I have done my insulin before when it was at 7.2 and it brought my blood sugar levels down so low it was nearly at a hypo stage.

 

[Leadinglights]

I don’t feel comfortable doing my insulin when it’s at like say 7. Something I prefer it to be at least 10 or just slightly above as I know the insulin brings the blood sugar down. I have done my insulin before when it was at 7.2 and it brought my blood sugar levels down so low it was nearly at a hypo stage.

Can you clarify what your exact insulin regime is, which insulin are you injecting when as what you say is a bit confusing.
Normally basal insulin is taken once or twice a day depending on which basal insulin it is and the bolus insulin taken before eating your meals. If you are not eating then you would not normally inject but those people with experience may to correct a high level but if you are on fixed doses that is not as flexible.

 

[Damaris]

So I get up at 9am and I inject the 18 units of the grey pen (lantus) and then inject the 6 units of the orange pen (NovoRapid) then I have my breakfast. Normally about half an hour to a hour afterwards my blood sugar reading tends to be quite high in the 13s but I don’t take anymore insulin until before lunch which tends to be about half 1 with the orange pen. I tend to have the odd snack in between the day and then I take my insulin again before dinner around 6:30 to 7pm again using the orange pen. Some nights I have a few crackers and cheese with a cup of tea before bed just to get me through the night.

 

[Leadinglights]

So I get up at 9am and I inject the 18 units of the grey pen (lantus) and then inject the 6 units of the orange pen (NovoRapid) then I have my breakfast. Normally about half an hour to a hour afterwards my blood sugar reading tends to be quite high in the 13s but I don’t take anymore insulin until before lunch which tends to be about half 1 with the orange pen. I tend to have the odd snack in between the day and then I take my insulin again before dinner around 6:30 to 7pm again using the orange pen. Some nights I have a few crackers and cheese with a cup of tea before bed just to get me through the night.

That is much clearer now but have you been given any guidance about a carb to insulin ratio, that is how many grams carbs you should have for your meal to balance the 6 units of rapid insulin. Don't forget the insulin doesn't work instantly so depending on what you have for breakfast the carbs may be hitting your system before the insulin works. But even so one of the important things is that your blood glucose level comes down before your next meal and that is when people would check if they are finger pricking.
I know it is early days but you may need a more flexible regime especially if you are also having snacks as well.
Hopefully those with some 'insulin' experience will be along to offer some words of wisdom.

 

[Inka]

I don’t feel comfortable doing my insulin when it’s at like say 7. Something I prefer it to be at least 10 or just slightly above as I know the insulin brings the blood sugar down. I have done my insulin before when it was at 7.2 and it brought my blood sugar levels down so low it was nearly at a hypo stage.

That’s understandable @Damaris Hypos can be frightening, especially in the early months after diagnosis. You’re wise to be wary of them (although everyone gets hypos sometimes - it’s not a sign of failure or anything). The Libre should help you avoid hypos by alerting you. I set my Low Alarm in the 5s so I have plenty of warning. This has really helped.

However, if you look at the Type 1 targets below you’ll see that if somebody met those targets 100% of the time (no-one does - don’t worry if you’re not):

If you’re an adult with type 1 diabetes​

• when you wake up and before meals: 5 to 7mmol/l
• before meals at other times of the day: 4 to 7mmol/l

They would, rightly, always be injecting with a blood sugar lower than 10. That’s normal. To reassure you, your Lantus is a slow-acting background insulin which releases slowly over the day and night. It’s job is to keep your blood sugar steady in the absence of food. Your Novorapid works much quicker but you only take it when you’re about to see a rise in blood sugar because you’re about to eat carbs. You take it before the meal to offset the rise. You don’t need to be at 10 to take it, if your insulin and carbs are correct.

 

[Inka]

@Leadinglights The OP has already explained what insulins they’re using and that they’re on fixed doses. You’re not an insulin user so I wouldn’t want you to inadvertently mislead or confuse the OP. Best to tag a Type 1.

 

[Leadinglights]

@Leadinglights The OP has already explained what insulins they’re using and that they’re on fixed doses. You’re not an insulin user so I wouldn’t want you to inadvertently mislead or confuse the OP. Best to tag a Type 1.

If you could point out what I said that was misleading I would appreciate it, that is the last thing I would want to do. Agreed about the tag.

 

[Inka]

If you could point out what I said that was misleading I would appreciate it, that is the last thing I would want to do. Agreed about the tag.

You give half-explained explanations relying on what you’ve read here that Type 1s say, which is potentially risky. As you don’t use insulin, you understandably won’t know about it, which is totally fine. I’ve seen other threads where the OP has latched on to you as an expert and I feel that’s putting yourself at risk of being misinterpreted or responding to questions which you’re better not answering and just tagging a Type 1 instead.

I think/do the same for myself about Type 2 drugs like Ozempic, etc. I try to respond with a minimal comment and tag a Type 2 who uses the medication if I remember one who does.

 

[Spathiphyllum]

That is much clearer now but have you been given any guidance about a carb to insulin ratio, that is how many grams carbs you should have for your meal to balance the 6 units of rapid insulin.

I agree; it sounds like you haven't had guidance on this, and unfortunately this is quite common! When I was diagnosed, 5 months ago now, I was first put on a basal with no bolus, and then put on a fixed bolus; no one told me about insulin-to-carbs ratio (ICR), I had to find out myself!

What I found out, from the online BERTIE course, was that an ICR of 10-- 1 unit of insulin to 10g of carbs-- was a reasonable starting point, and that one should try that, see what happens, and adjust accordingly, until you find the ICR that's right for you.

Note that your own personal ICR may vary depending on the time of day! For example, many people find that they need more insulin for the same amount of carbs for breakfast than they would at dinner.

If you've been put on a dose of 6 units of NovoRapid per meal: Try eating meals with 60g of carbohydrates, and then see what your BG levels are before your next meal. Keep a record, and look for patterns.

If for example you notice that your Libre readings before lunch are usually higher than your Libre readings before breakfast-- that probably means you need more insulin for the same amount of carbs at breakfast; try 1 unit of insulin for every 9g of carbs. Or, if you notice that your Libre readings before dinner are usually lower than they were before lunch-- that probably means you need less insulin for the same amount of carbs at lunchtime; try 1 unit of insulin for every 11g of carbs.

(If I recall correctly, this is actually the basis of one of the quizzes in BERTIE! Looking at a fictional logbook.)

Don't forget the insulin doesn't work instantly so depending on what you have for breakfast the carbs may be hitting your system before the insulin works.

Again, agreed! And, again, nobody explained 'pre-bolusing' to me; I had to find out myself (first of all, I think, by reading on this forum!).

Rebrascora (Barbara) is right about the importance of "timing your insulin", especially with NovoRapid, and possibly particularly with breakfast. Try injecting 15 minutes before you start breakfast and see whether that helps.

But even so one of the important things is that your blood glucose level comes down before your next meal and that is when people would check if they are finger pricking.

Agreed-- see above.

I know it is early days but you may need a more flexible regime especially if you are also having snacks as well.

Agreed. Personally-- I've said this before, but I'll say it again!-- I think it's crazy that they don't explain carb counting and ICR straightaway, from the get-go. It's not rocket science!

I discovered the online BERTIE course via this forum, within about a week of diagnosis-- did the course-- told my DSN I'd done it, and I was thinking of experimenting, starting with an ICR of 10, and she said 'ok'. And off we went, and I no longer had to try to work around a fixed bolus dose.

Regarding snacks, though: For the time being, you should probably avoid carbohydrate snacks, except of course when needed to avert a hypo. It's difficult enough working out what your personal ICR is, for each of three meals; snacks just muddy the waters. So, for example, if you really feel peckish before bed, rather than having crackers and cheese, just have the cheese.

I know this is all an awful lot to take in! But things do get better; and we are all of us happy to try to help. Wishing you all the best!