Hello

[Mycob]

I was diagnosed as type 2 in November (2020) after some years as pre-diabetic. I had developed a full catalogue of symtoms over a relatively short period (significant weight loss, urinary frequency, raging thirst). I am now on insulin (3 Novorapid doses daily - 8,4,6 units, and 1 Toujeo glARGine long lasting - 18 units- at night). My initial blood glucose on diagnosis was in the high 20's but within a week this was down to low teens and within 2 weeks down to single figures, where its been ever since. I have had two clinical reviews with the specialist nurse practitioners and my GP and I are BFFs - so I feel well supported. I am learning some do's and dont's and gaining confidence with minor adjustments where needed (e.g. for Sunday Lunch).

I have one pressing question: I have it stuck in my mind that a reading of 7.0+ is best before bed and if lower (its often 6.2-6.6) I should take action (Toast) to protect against night-time hypo's. Does this seem reasonable to those with more experience than me?

 

[Kaylz]

I don't mean to question you but are you sure it was a Type 2 diagnosis? It's just highly unusual to have sudden weight loss with Type 2 and is more commonly seen in an undiagnosed Type 1, it's also quite unusual for insulin to be introduced to Type 2 after such a short period of time

The question you are asking totally depends on the individual, if basal is as spot on as it can be then it shouldn't drop you so people would go to bed even in the 5's, others have something if they are below 8 whereas me needs something even in the 12's as my basal insulin isn't flexible and I clearly need far less of it during the night so there isn't a right or wrong answer to your question and you just have to do what is right for you xx

 

[goodybags]

I was diagnosed as type 2 in November (2020) after some years as pre-diabetic. I had developed a full catalogue of symtoms over a relatively short period (significant weight loss, urinary frequency, raging thirst). I am now on insulin (3 Novorapid doses daily - 8,4,6 units, and 1 Toujeo glARGine long lasting - 18 units- at night). My initial blood glucose on diagnosis was in the high 20's but within a week this was down to low teens and within 2 weeks down to single figures, where its been ever since. I have had two clinical reviews with the specialist nurse practitioners and my GP and I are BFFs - so I feel well supported. I am learning some do's and dont's and gaining confidence with minor adjustments where needed (e.g. for Sunday Lunch).

I have one pressing question: I have it stuck in my mind that a reading of 7.0+ is best before bed and if lower (its often 6.2-6.6) I should take action (Toast) to protect against night-time hypo's. Does this seem reasonable to those with more experience than me?

Hi @Mycob welcome to the forum,
It sounds like your doing well in reducing down to single figures,
the positive of a T2 being on insulin (where it’s needed) is obviously you get the strips on prescription for self testing.

I’m no expert on the insulin you take, as m on a mixed,
but like you I’m T2 and since I’ve been taking insulin to help get me under control (NovaMix)

I wouldn’t personally worry about raising levels if they were in the 6’s (prior to going to sleep)
previously as my levels came down I did suffer some night time hypos but it always woke me up, then reached for the glucose chews
and as required (after seeking advice from HCP dosage was redused)
I always keep the lift glucose chews and a testing kit bedside.

 

[Mycob]

I don't mean to question you but are you sure it was a Type 2 diagnosis? It's just highly unusual to have sudden weight loss with Type 2 and is more commonly seen in an undiagnosed Type 1, it's also quite unusual for insulin to be introduced to Type 2 after such a short period of time

The question you are asking totally depends on the individual, if basal is as spot on as it can be then it shouldn't drop you so people would go to bed even in the 5's, others have something if they are below 8 whereas me needs something even in the 12's as my basal insulin isn't flexible and I clearly need far less of it during the night so there isn't a right or wrong answer to your question and you just have to do what is right for you xx

Hi Kaylz
Perhaps a little more information:
I have been under GP observation for 6 years due to "pre-diabetes". This was due to an Hba1c of 48 initially and rising to 50. Control was by diet alone but a full regime of check-ups with retinal screening and podiatry. Shortly after my 71st birthday in 2019, I became ill with a particularly nasty urinary tract infection which required prolonged but ultimately successful antibiotic treatment. The infection recurred in late August of 2021 and again a long period of antibiotics was needed. This probably led me to discount urinary frequency as a symptom of something else. I have been trying to shed some weight for a long time, with marginal success. However, throughout the autumn I began to steadily lose weight. At my regular annual review in November a dramatically increased Hba1c was detected and the diagnosis made.

 

[everydayupsanddowns]

Welcome to the forum @Mycob

It is possible, with the timeline you have had, that you may have a slow developing form of T1, known as LADA. It certainly seems like your system reached something of a ‘tipping point’ and your BG levels rose rapidly. The prolonged infection could also have put extra strain on things (illness and injury tend to increase BG levels).

You may decide that since you are already on a flexible ‘basal bolus’ insulin regimen, it makes little difference which box your tick is in, but there are some treatment and management options (eg sensors and insulin pumps) which are not indicated in T2 but can be available to T1. You could ask about GAD antibody and cPeptide testing to investigate whether your diabetes might have an autoimmune route, and to check how much insulin you are still producing.

In terms of bedtime levels… Lantus does have a bit of a ‘kick’ at 5hours, which can coincide with the naturally lowest point of glucose release overnight - which may mean that a bedtime snack is a reasonable precaution. Alternatively you might ask your surgery about shifting your Lantus to breakfast time, so that the dose is waning overnight rather than ramping up to full strength?

Setting an overnight alarm for 2-3am to check your BG might help put your mind at rest.

 

[Mycob]

Welcome to the forum @Mycob

It is possible, with the timeline you have had, that you may have a slow developing form of T1, known as LADA. It certainly seems like your system reached something of a ‘tipping point’ and your BG levels rose rapidly. The prolonged infection could also have put extra strain on things (illness and injury tend to increase BG levels).

You may decide that since you are already on a flexible ‘basal bolus’ insulin regimen, it makes little difference which box your tick is in, but there are some treatment and management options (eg sensors and insulin pumps) which are not indicated in T2 but can be available to T1. You could ask about GAD antibody and cPeptide testing to investigate whether your diabetes might have an autoimmune route, and to check how much insulin you are still producing.

In terms of bedtime levels… Lantus does have a bit of a ‘kick’ at 5hours, which can coincide with the naturally lowest point of glucose release overnight - which may mean that a bedtime snack is a reasonable precaution. Alternatively you might ask your surgery about shifting your Lantus to breakfast time, so that the dose is waning overnight rather than ramping up to full strength?

Setting an overnight alarm for 2-3am to check your BG might help put your mind at rest.

Thank you. You have given me something to think about and more importantly to discuss with my GP/nurse team. I am due for more blood work next week with a review meeting the week after so I will open a discussion.