I was diagnosed back in March as type 2 no medication. May was admitted to hospital very high sugars. I also have cancer and am on immunotherapy. Which seems to have made diabetes worse. I'm on Novarapid and Lantus and metformin. My problem is very high sugars through the night. Any ideas welcome
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Hello Im Moi new here.
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42istheanswer
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Hi and welcome!
If sugars are high overnight, then that would suggest either that you aren't having enough fast acting insulin (the Novarapid) with your evening meal (if they are high after your meal and stay at that level all night), or that you aren't having enough basal insulin (the lantus) for overnight - I think in this case they would probably be rising overnight from the post-tea BG reading.
If sugars are high overnight, then that would suggest either that you aren't having enough fast acting insulin (the Novarapid) with your evening meal (if they are high after your meal and stay at that level all night), or that you aren't having enough basal insulin (the lantus) for overnight - I think in this case they would probably be rising overnight from the post-tea BG reading.
rebrascora
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Hi and welcome.
Sorry to hear you are going through such a tough time with your health at the moment, but pleased you have come to the forum for diabetes support. Hopefully we can give you some pointers to help improve things.
Do you have Freestyle Libre to see what your levels are doing overnight or are you basing your statement about levels going high overnight on your morning finger prick? The reason I ask is that it is normal for levels to rise in the morning to give us energy for the day ahead. This is caused by the liver dumping glucose into the blood stream, sometimes before we wake up but often more so once we get out of bed. This is referred to as Dawn Phenomenon or Foot on the Floor Syndrome. What I am wondering is whether your levels are steady or even dip overnight and then rise in the morning in which case a basal insulin (Lantus) increase could drop you too low, or if your levels are genuinely climbing overnight which might suggest an increase in Lantus, or could it be slow release carbs from a meal before bed..... Fatty foods like pizza and creamy pasta dishes can do that.
If you have Libre, can you post a photo of your graph so that we can see the problem?
Of course the best thing to do is to discuss any problems with your nurse but I know it can be difficult to get hold of them. Are you under the care of a diabetes specialist clinic with Diabetes Specialist Nurses and a Consultant or is it just a practice nurse at your GP surgery?
Are you carb counting your meals or just using fixed doses of Novorapid at each meal time?
What sort of doses have they advised for NR and Lantus and how long have you been using these insulins?
What sort of high BG readings are you getting? It can be subjective. Some people consider 10 high and others 20 or 30, so it helps to know the scale of the problem and how urgent attention to it needs to be. With cancer I believe it is important to have as good control as you can, but I appreciate both the cancer and the treatment can inflate levels which is why I am so pleased you have insulin, but you also need lots of support to adjust doses and use it correctly and there is usually a lot of adjustment needed in the early stages to bring levels down slowly and steadily. If you have been struggling with high levels since starting on insulin in May then I would be more concerned than if this is just a recent problem that has surfaced in the last week....
The ore info you can give us, the better we can understand your situation and make more appropriate suggestions to help you. We are not able to give individual dosing advice but we can tell you what we would do in that situation and explain why and what the risks might be of that action and what we might do to mitigate them..... So for instance, if we decided to increase our basal insulin dose, then setting an alarm and testing our BG levels through the night maybe 2am for the first couple of nights would be advisable and obviously eating some carbs if it was dropping a bit low. If you have Libre then setting the alarm, so that it warned you that you were dropping low.
Hope to hear more from you soon and if you have any questions yourself do feel free to ask. Trying to balance your Blood Glucose levels with insulin is really, really tricky ..... it makes you appreciate how wonderfully clever a fully functioning pancreas really is..... but I am pretty sure we can help you to improve your current situation.
Sorry to hear you are going through such a tough time with your health at the moment, but pleased you have come to the forum for diabetes support. Hopefully we can give you some pointers to help improve things.
Do you have Freestyle Libre to see what your levels are doing overnight or are you basing your statement about levels going high overnight on your morning finger prick? The reason I ask is that it is normal for levels to rise in the morning to give us energy for the day ahead. This is caused by the liver dumping glucose into the blood stream, sometimes before we wake up but often more so once we get out of bed. This is referred to as Dawn Phenomenon or Foot on the Floor Syndrome. What I am wondering is whether your levels are steady or even dip overnight and then rise in the morning in which case a basal insulin (Lantus) increase could drop you too low, or if your levels are genuinely climbing overnight which might suggest an increase in Lantus, or could it be slow release carbs from a meal before bed..... Fatty foods like pizza and creamy pasta dishes can do that.
If you have Libre, can you post a photo of your graph so that we can see the problem?
Of course the best thing to do is to discuss any problems with your nurse but I know it can be difficult to get hold of them. Are you under the care of a diabetes specialist clinic with Diabetes Specialist Nurses and a Consultant or is it just a practice nurse at your GP surgery?
Are you carb counting your meals or just using fixed doses of Novorapid at each meal time?
What sort of doses have they advised for NR and Lantus and how long have you been using these insulins?
What sort of high BG readings are you getting? It can be subjective. Some people consider 10 high and others 20 or 30, so it helps to know the scale of the problem and how urgent attention to it needs to be. With cancer I believe it is important to have as good control as you can, but I appreciate both the cancer and the treatment can inflate levels which is why I am so pleased you have insulin, but you also need lots of support to adjust doses and use it correctly and there is usually a lot of adjustment needed in the early stages to bring levels down slowly and steadily. If you have been struggling with high levels since starting on insulin in May then I would be more concerned than if this is just a recent problem that has surfaced in the last week....
The ore info you can give us, the better we can understand your situation and make more appropriate suggestions to help you. We are not able to give individual dosing advice but we can tell you what we would do in that situation and explain why and what the risks might be of that action and what we might do to mitigate them..... So for instance, if we decided to increase our basal insulin dose, then setting an alarm and testing our BG levels through the night maybe 2am for the first couple of nights would be advisable and obviously eating some carbs if it was dropping a bit low. If you have Libre then setting the alarm, so that it warned you that you were dropping low.
Hope to hear more from you soon and if you have any questions yourself do feel free to ask. Trying to balance your Blood Glucose levels with insulin is really, really tricky ..... it makes you appreciate how wonderfully clever a fully functioning pancreas really is..... but I am pretty sure we can help you to improve your current situation.
Thank you both for uour replies. I am on Libra free style. Have been woke up quit a few times in the night mostly for high sugars.
I'm on 26 of Lantus 8am. Novarapid if bloods are 10 and under take 8. If 11 or over tale 10. I'm under the hospital and have a consultant and a nurse. Tried to do a snap shot of Libra reading but it wouldn't work. Last night it started to rise about 1am at 7am which it was13.5 12 pm it had gone up to 18 only went down after doing some walking at present it's 6.9 after evening meal, had 8m and 2 metformin, so I'll see how I go.
rebrascora
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Sounds like your Lantus might be tailing off at 1am which is why your levels are rising then, if you are seeing a regular pattern of this, but it could be your meal last night... What did you have and what time did you eat?
The higher readings in the morning are likely not enough basal insulin. I wonder if you might be better taking the Lantus when you go to bed so that the peak of activity is acting in the morning when most people need it most. It depends how your body absorbs it and how your liver works. Whilst they are higher than you would like, at least they aren't dangerously high in the short term but obviously you want them to be more in range for long term management.
When do you inject your NR for breakfast? Many of us find that injecting our fast acting insulin before we get out of bed helps to control that foot on the floor rise a bit and whilst the recommended prebolus time for NR is usually 15-20 mins, most of us need longer at breakfast time. I myself found I needed to inject my NR as much as 75mins before eating breakfast to prevent my levels spiking up to mid teens each day. Many people would hypo injecting that long before food but I seem to be quite slow to absorb insulin but very quick to digest carbs, so my meal time insulin needs a good head start. I use a slightly faster insulin now but still find it best to inject it for my breakfast before I set foot out of bed and then give it about 45 mins before I eat. At other times of the day I usually just need 15-20mins, but because of that Foot on the Floor Syndrome I need to get that fast acting insulin in early to deal with it and I usually give it 1-1.5 units more than my breakfast should need. 45mins would still be too long for some people so you need to start with the length of time you inject it now in advance of food and then increase it by 5 mins each day until it stops that rise but doesn't cause you to hypo.
I would encourage you to discuss changing the time you take your Lantus to the evening first and experimenting with giving your breakfast insulin a bit longer to work before you eat breakfast and see how you get on with those 2 things and then maybe discuss an increase in basal dose if that doesn't fix it. It is recommended to only make one change to your insulin regime at a time and then wait for a few days to see the full impact of that change before you try something else and just make slow and steady changes. It is great that you have Libre so do make use of that to keep yourself safe, particularly after any increases in insulin, but also increasing the prebolus time ie how long you take the NovoRapid in advance of food. Don't get distracted an end up hypo.
Hope that is of some help to you, but do contact your DSN to discuss the problems you are having and be guided by their advice.
The higher readings in the morning are likely not enough basal insulin. I wonder if you might be better taking the Lantus when you go to bed so that the peak of activity is acting in the morning when most people need it most. It depends how your body absorbs it and how your liver works. Whilst they are higher than you would like, at least they aren't dangerously high in the short term but obviously you want them to be more in range for long term management.
When do you inject your NR for breakfast? Many of us find that injecting our fast acting insulin before we get out of bed helps to control that foot on the floor rise a bit and whilst the recommended prebolus time for NR is usually 15-20 mins, most of us need longer at breakfast time. I myself found I needed to inject my NR as much as 75mins before eating breakfast to prevent my levels spiking up to mid teens each day. Many people would hypo injecting that long before food but I seem to be quite slow to absorb insulin but very quick to digest carbs, so my meal time insulin needs a good head start. I use a slightly faster insulin now but still find it best to inject it for my breakfast before I set foot out of bed and then give it about 45 mins before I eat. At other times of the day I usually just need 15-20mins, but because of that Foot on the Floor Syndrome I need to get that fast acting insulin in early to deal with it and I usually give it 1-1.5 units more than my breakfast should need. 45mins would still be too long for some people so you need to start with the length of time you inject it now in advance of food and then increase it by 5 mins each day until it stops that rise but doesn't cause you to hypo.
I would encourage you to discuss changing the time you take your Lantus to the evening first and experimenting with giving your breakfast insulin a bit longer to work before you eat breakfast and see how you get on with those 2 things and then maybe discuss an increase in basal dose if that doesn't fix it. It is recommended to only make one change to your insulin regime at a time and then wait for a few days to see the full impact of that change before you try something else and just make slow and steady changes. It is great that you have Libre so do make use of that to keep yourself safe, particularly after any increases in insulin, but also increasing the prebolus time ie how long you take the NovoRapid in advance of food. Don't get distracted an end up hypo.
Hope that is of some help to you, but do contact your DSN to discuss the problems you are having and be guided by their advice.
@Moi what time of day do you take your Lantus?
I ask because some people find it does not last a full 24 hours.
If it is holding your levels stable other times of the day and then starts rising, this could be the problem. There are a few ways to address this : split the Lantus into two doses 12 hours apart or change your insulin to a longer lasting one like Tresiba.
I recommend talking to your DSN about this.
I ask because some people find it does not last a full 24 hours.
If it is holding your levels stable other times of the day and then starts rising, this could be the problem. There are a few ways to address this : split the Lantus into two doses 12 hours apart or change your insulin to a longer lasting one like Tresiba.
I recommend talking to your DSN about this.
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Welcome to the forum @Moi
Sorry to hear that you’ve been having a tough time health-wise recently. Must be very difficult for you
It sounds like your doses have been set to respond to your BG levels before meals, but you don’t mention being given advice about a consistent carb target for your different meals? For T1s on fixed doses this would have been a standard, and important, piece of the puzzle. An amount of carbs to aim for at each meal which is meant to balance with your insulin doses at those meals.
Yoir big rises in BG overnight could indicate insufficient basal insulin, but as others have said there can be other complex factors at play (duration of basal insulin action, hormone levels overnight, last bolus dose and various other things).
Hope you manage to get some recommended changes which begin to help stabilise your BG levels overnight.
Over the years I’ve found that getting my basal insulin dose as ‘right’ as it can be seems to be a key part of my meal doses and corrections acting properly.
Sorry to hear that you’ve been having a tough time health-wise recently. Must be very difficult for you
It sounds like your doses have been set to respond to your BG levels before meals, but you don’t mention being given advice about a consistent carb target for your different meals? For T1s on fixed doses this would have been a standard, and important, piece of the puzzle. An amount of carbs to aim for at each meal which is meant to balance with your insulin doses at those meals.
Yoir big rises in BG overnight could indicate insufficient basal insulin, but as others have said there can be other complex factors at play (duration of basal insulin action, hormone levels overnight, last bolus dose and various other things).
Hope you manage to get some recommended changes which begin to help stabilise your BG levels overnight.
Over the years I’ve found that getting my basal insulin dose as ‘right’ as it can be seems to be a key part of my meal doses and corrections acting properly.
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