Doctors appointment (call) tomorrow am - help with prepping

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I am going to take the time in the next two weeks to observe how my body responds to the insulin.

I just have a question. 2 hours after breakfast I checked and was at 9.5 (i was 8.5 before the meal) and then two hours later when I was thinking of lunch I checked and I'd gone up to 14. This would mean that the bolus insulin worked to bring down my bg after breakfast but then stopped. So I'm just about to have lunch and will be starting from 14 in the future, am I right in assuming I'd need more insulin if I was to have the exact same thing I had for breakfast. I'm assumed logically I would need more because I'm starting off from 14 while in the morning I was starting off from 8.5. Also is th rising bg probably a sign that the basal may not be quite covering it through the day. It is ll so interesting. I know this is a super long thread and I appreciate any response anyone might have the time to make.
 
Yes, if you started at 8.5 and were 14 by the next meal, then either
You need more bols insulin for that meal, OR
Your basal insulin is incorrect OR
Both.

When you have your cgm, a good rule of thumb, for a 24 hr basal, is 'is it keeping me level overnight'? If mot, adjust an see how tge vhange pans outvover a couple of nihts ( unless that means you run too low)
Once you are happy with your basal, then you can ine tune your bolus.
In the meantime next time you have that meal, you can take a little bit more insulin to cover the carbs.
And if you are a bit high before you eat, you can take a little bit extra insulin to account for that fact
 
I’d guess it was more of a basal issue @Mbabazi but remember you’re bringing your blood sugars down gradually so don’t be too bothered about being a bit high now. Once things are more sorted, yes, if you were 14 before lunch you’d use a correction factor to add a little extra insulin to your the calculation result of your lunch ratio (the ratio of insulin to carbs you use for lunch, eg 1:10g carbs, 1:14g or whatever).

See how much the insulin is helping your blood sugars even in these very early days 😎
 
Tdm said:
Yes, if you started at 8.5 and were 14 by the next meal, then either
You need more bols insulin for that meal, OR
Your basal insulin is incorrect OR
Both.
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I would agree with that basic analysis from @Tdm. But @Mbabazi what was that breakfast meal that appears on the surface to have taken you from 8.5 to 14? Is that breakfast likely to become your standard breakfast - or just a one off?

Also have you been particularly active or sedentary today, in relation to any other day?

Well done @Mbabazi in taking a before eating and 2 hrs later readings. NovoRapid might typically last 4-5 hrs, so as @Inka has just said (and @ Inka is the guru here not me) it does sound like your basal could be too low.

If you take a modest NovoRapid (bolus) correction before your next meal then that will help you return towards more reasonable levels. But keep a note of what you have done, because that correction plus your 4 unit bolus will now slightly confuse the detective work, since we don't know yet what your correction ratio is (learnt by trial and learning) nor whether your breakfast has simply overwhelmed your first bolus of 4 units for food. This is all doable and can be sorted, but will need some mild "interrogation"!
Tdm said:
When you have your cgm, a good rule of thumb, for a 24 hr basal, is 'is it keeping me level overnight'?
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Would your budget allow you to self-fund a 2nd Libre? I'm assuming you had one before from their free trial. This monitoring and general reviewing of BGs is viable from finger pricks only, (indeed was the only way before CGM). CGM would make this easier. But if you haven't had a Libre before you'll either need a seperate Reader or a compatible phone.
 
The two hour result was 9.5, Proud. Unless it was an unusual breakfast then that suggests the bolus is probably ok. That’s why I said it was more likely the basal. But really, I wouldn’t be paying too much attention to this. We know @Mbabazi has been told to bring their sugars down slowly, so 12s and 14s are ok. The insulin has only just been started and there’ll be plenty of tweaks to come.

It’s hardly ever the food and almost always the insulin. I really cringe when comments are made that might imply the fault is the food. No wonder so many Type 1s have eating disorders.
 
I was thinking the same as most of you and will continue to observe my numbers. My breakfast was oats with milk mixed with chia seed to lower the sugar absorption and it is an easy go-to breakfast now that I have the insulin to correct any spoke. Either that or 2 eggs on 1 slice of toast is what I usually have. I will have to see about self-funding the cgm, it really does sound worth it. thank you all so much. I am going to keep a food and activity log as I think that based on your feedback, it would be helpful to know and also discuss with the nurse and doctor.
 
Hey everyone.
I hope everyone is having a good week.
It's been a week now on the insulin and I'm so happy to share that I haven't seen any numbers in the 20s. They're still some high teens but I'm able to see why, low insulin dose for the carbs in the meal or something like that. I'm learning my response to insulin.

IVe suffered some hypos though in the night more than day and was glad that I had my hypo treatments on stand by.

I had a call with the nurse today and she told me my A1C was 85. That really surprised me because that's higher than when I was diagnosed last year but also that I deteriorated so fast from the A1C when I was starving myself just in November (53) about two month ago. We are still waiting on the second GAD and other antibody test but im hoping they will help the doctors give me a good treatment plan.

My question on A1c and perhaps this will be covered with the doctor is on targets. I really would love to bring that down and I see that insulin can help me stay in range. Are there any other things type 1s or those on insulin do to help with this?

I also saw that the gp requested an appointment for Monday (same one I had to ask for glicazide when my numbers were desperately high and metformin wasn't bringing them down). I kinda feel bad because I didn't feel heard in our interactions and had to get worse before she took things seriously. If I hadnt begged for glicazide she was happy for me to continue on metformin and not test daily and wait for the next A1C. Anyway, I have another appointment with the diabetic clinic doctor for the 26th So maybe she just wants to check in. For the 26th, I'd like to ask for a cgm because the hypos are really scary and I had one where I was at 3.1 in a meeting and all I felt was hunger. I've had shaky ones at 2.8 too. I don't know of I qualify but I read somehwere that if you're using insulin you might. Is a cgm something I might be able to ask the gp and maybe get that earlier than waiting for the 26th?

Also I have a question about when to place the order for the insulin renewal.and testing suppllies. Like how many days prior to needing the insulin. The one I have now runs out on the 26th.

Thanks again everyone.
 
Don’t worry about the HbA1C @Mbabazi Thats high because you were in the 20s so much. The insulin will bring that down (remember that it’s best if it comes down slowly rather than quickly as that can cause damage to the eyes).

Re your nighttime hypos - what’s your blood sugar before bed and what do you wake up on?

Don’tfeel bad about the doctor - you were treated very poorly. It was clear you needed insulin and that you’d previously suffered DKA and could be Type 1.

Ask for a CGM. You’re on insulin and possibly Type 1. You should have one.

Requesting a new prescription depends on how long your surgery takes to sort it. I’d request it in plenty of time the first time, eg 7-10 days ahead of when you need it.
 
Mbabazi said:
Back from the doctors,

She says that because of my normal insulin levels, they are going to treat me as a type 2 and then since metformin is not working, they have added a prescription for Glicazide 2 tablets a day. They said that I have the GAD antibody but it is not high enough so they will repeat the GAD and also do another anti body test to rule out type 1 completely. For now, I am a type two. I don't know what to make of it all but I guess I should just accept it. When I weighed myself, Id lost more weight and it must be from all the fasting. On this new treatment plan, I am going to eat normal and take those meds. I don't know now whether to try and reverse my diabetes or not. Also, why do I have the anti-bodies in the first place if I am a type 2, why? The doctor could not answer than but said that they make a decision based on reviewing everything. I do not think they have taken into consideration my DKA and how I presented on admission because that did not happen here or is not in their records. I also tried to show them the detoriation of the c peptide level even if it is still higher than usual. Anyway I am not sure how to proceed. I will take the meds because they should help bring my numbers into normal range. this morning's was 13.4 even though i skipped dinner.

i asked if I could show my paper work to the diabetic clinic and the doctor said she will write me a referral and it will be the clinic to write me a letter to give me an appointment. I suppose this is how it works? They did give me a metre and a prescription for strips so I am glad for that. I will reschedule my anti-body test and based on those results will see someone at the diabetic clinic. I am happy to accept the type 2 diagnosis if they can explain why I have antibodies and why metformin or all the dieting and fasting would not work. I actually teared up in the appointment because all of it does not make sense.
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Hi I was on the same 2 tablets having been diagnosed as Type2. I was eating normally but losing so much weight people thought I was dying. Eventually got them to give me insulin. Whilst mt blood glucose is not stable at least I have put weight on and can take some control back.
 
AS58 said:
Hi I was on the same 2 tablets having been diagnosed as Type2. I was eating normally but losing so much weight people thought I was dying. Eventually got them to give me insulin. Whilst mt blood glucose is not stable at least I have put weight on and can take some control ba
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Inka said:
Don’t worry about the HbA1C @Mbabazi Thats high because you were in the 20s so much. The insulin will bring that down (remember that it’s best if it comes down slowly rather than quickly as that can cause damage to the eyes).

Re your nighttime hypos - what’s your blood sugar before bed and what do you wake up on?

Don’tfeel bad about the doctor - you were treated very poorly. It was clear you needed insulin and that you’d previously suffered DKA and could be Type 1.

Ask for a CGM. You’re on insulin and possibly Type 1. You should have one.

Requesting a new prescription depends on how long your surgery takes to sort it. I’d request it in plenty of time the first time, eg 7-10 days ahead of when you need it.
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Thank you for being ever so reliable with the advice. My waking numbers are a mixed bag. I have had some low teens but I have also had 8 and 7s so I am really happy with it. I did wake in hypos too, twice so right now it does not seem consistent. I know that I initially was taking my basal in the middle of the day and the advice was to move that towards bedtime, but tat along with my dinner units seemed to give me hypos, so then I decided to move it to the beginning of the day. In all of this, I am optimistic that Insulin can get my numbers in range and that feels so good for me. I will surely ask for a cgm from the GP on Monday as that will really help with seeing how the insulin is working and avoiding the lows. I found this calculator online for determining how much insulin and also downloaded carbs and cals app for checking how many carbs are in a meal. https://perinatology.com/calculators/Insulin Correction Dose.htm .
 
Hi all. Just a quick update - the doctor at the diabetes clinic thinks I am a type one, based on the blood work from when I went into A&E and is happy to treat me as such. They gave me a cgm which has been really fun to see my blood sugars through the day and how they respond to different things I eat and do. For sure, going into the hospital then was a life saver and I am grateful for all the encouragement I got from so many people here. I am doing ok on the insulin, seeing my numbers coming down and feeling like I have more control of my diabetes. Mentally, it is such a relief. Thanks again everyone.
 
That’s great news @Mbabazi At least you’re getting the correct treatment - and a CGM - now. It was awful how messes around you were and how your very high sugars were ignored. I know Type 1 is a pain, but I hope knowing what you have has brought you some relief and mental peace x
 
Inka said:
That’s great news @Mbabazi At least you’re getting the correct treatment - and a CGM - now. It was awful how messes around you were and how your very high sugars were ignored. I know Type 1 is a pain, but I hope knowing what you have has brought you some relief and mental peace x
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Hugs Inka, thank you for all the hand holding. 🙂
 
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