HELP! bloods make no sense

[imtrying]

Ok, so as most of you know, I'm now 2 weeks into my 4 week carb-counting course.

Things have been really bad this week and I'm absolutely shattered. I just don't know what I'm doing wrong. I know I've written a lot, but if anyone can shed any light, that would be great as I can't see anything for frustration.

just as an eg. this was how Sunday went.....

9.10 - 3.3 took 3 glucose tabs as per guidelines
9.20 - retested 10 mins later as per guidelines
- 3.1 😱
- took another 3 glucose tablets (that's 6 now!)
9.30 - retested 10 mins later as per guidelines
- 3.1 (seriously????)
- refused to take anymore glucose tablets!
9.40 - waited 10 mins with no treatment
- 3.6
- took 2 more glucose tablets on the excitment of having actually gone up!
9.50 - retested
- 4.7 RESULT!
- ate 1 weetabix with a tiny bit of milk
12.15 - lunch time
- 16.6!!!!!!!!!!!!!!!!!!!
- adj ratio is 1:2 so 5 units to bring me down to 6mmols
- bacon sandwich - carbs in the bread were 53g so 5 CP
- ratio is 1:1.5 so 5 x 1.5 = 7.5 units
- total taken 13 units
2.45pm - 20.2 (defeated wasn't the feeling)
- took 7 units
3.15pm - 14.7
3.30pm - took my neices and nephews to the park as this weekends homework from BERTIE was seeing affects of exercise
- 12.3 on starting
- i was only walking around with them
4.30pm - 2.2
- 3 glucose tablets
- 1 finger of a twix (didn't bother waiting the 10 minutes this time)
6.00pm - 4.7

Monday was a day of being low - hypo when I woke up and one during the afternoon. Went to bed at 13.3, woke up at 3am, having a hypo and then was sick....painfully I then had to eat MORE glucose tablets and carbs, which I really didn't want to.

Yesterday
- woke up 11.9,
- 3 hours later was 13.3, carb-counting and took adjustment dose but
- 2 hours later was still 12.8.
- ate lunch, carb-counted, injected - no adjustment dose taken.
- 2 hours later - 7.4 🙂
- test before dinner (with nothing in between) 18.1!!!!!
- adjustment dose taken, carbs for dinner counted and injected for
- 2.5 hours later - 13.5
(lantus reduced to 28 after advice from diabetes team)

and yet still woke up with a hypo this morning!!!!!! had carton of OJ, got up to 5.8, had 2 biscuits (as had to drive) and by the time I got to work I was up to 14, and then by 10am I was 19!!!!!!!!!!!!!!!!

somebody please offer me a lifeline somewhere

 

[Caroline]

It would be nice to have a magic wand and magic the dreaded D away. Can't offer any solutions or ideas, but I hope you are feeling Ok and not suffering any ill effects from your roller coaster ride.

 

[AJLang]

You poor thing. You probably overcorrected when your
BG was 20.2 and you had seven units of insulinn. My understanding is "normally" 1 unit of insulin reduces the BG by 3. So if you wanted to reduce your BG from 20 to 5 you would need 5 units of insulin. The bolus would have been near it's peak when you went for your walk so it would probably have been best to test after 30 minutes walking to see if your BG was going down too fast. That's what I do for an hours dog walk but I also try to avoid exercise within two hours of bolus or if I'm going to exercise then reduce bolus and/or have extra cabs

 

[Robster65]

Hi katie.

Obviously you're swinging from hypo to hyper all day, with not much in between. I've not had a long look at your figures but you seem to be correcting the highs, then going low, which iplies at first thought that you may be over correcting at times, especially when you had that walk in the park at the peak of your insulin's action.

If you could manage to get yourself to a safe level, maybe 7 or 8 and stabilise for a while, you might be able to adjust your corrections to maintain you there. It could well be a basal problem which would need a closer examination of what you're eating, when and another look at your bolus ratios.

When do you do your basal ? And how much fo you give ?

Rob

 

[imtrying]

Hi katie.

Obviously you're swinging from hypo to hyper all day, with not much in between. I've not had a long look at your figures but you seem to be correcting the highs, then going low, which iplies at first thought that you may be over correcting at times, especially when you had that walk in the park at the peak of your insulin's action.

If you could manage to get yourself to a safe level, maybe 7 or 8 and stabilise for a while, you might be able to adjust your corrections to maintain you there. It could well be a basal problem which would need a closer examination of what you're eating, when and another look at your bolus ratios.

When do you do your basal ? And how much fo you give ?

Rob

Thanks Rob, Yes the theory I came to was probably overlaps with my bolus, BUT yesterday for example, my correction doses just taken with my meals seemed to have barely any affect. I correct to take me to 6mmols and clearly that didn't work at all.

My basal I take before I go to bed, about 10.30 and I was on 32 units. On Friday BERTIE told me to reduce to 30, which I did. Then I spoke to the team yesterday and they told me to reduce again to 28.

I know its really hard looking at other people's results and try and make sense of them so appreciate everyone taking a look and trying to help.

re: eating, I've stopped all snacks as I'm scared to do any more injections for fear of overlap so my eating is just as I put down - breakfast, lunch and dinner and all carbs are exactly worked out and calculated and I inject exactly what I should for my ratio, plus any correction dose needed....

I'm becoming a bit stuck now.

 

[imtrying]

It would be nice to have a magic wand and magic the dreaded D away. Can't offer any solutions or ideas, but I hope you are feeling Ok and not suffering any ill effects from your roller coaster ride.

ah thanks Caroline. normally I'm ok, it's just so frustrating when it doesn't seem to make ANY sense!! I'm physically drained from all the highs and lows, but mentally drained too with all the carb-counting, injection ratios and trying to make sense of it all. I'm sure I'll be right as rain in no time though - I get bored dwelling too much!! lol

You poor thing. You probably overcorrected when your
BG was 20.2 and you had seven units of insulinn. My understanding is "normally" 1 unit of insulin reduces the BG by 3. So if you wanted to reduce your BG from 20 to 5 you would need 5 units of insulin. The bolus would have been near it's peak when you went for your walk so it would probably have been best to test after 30 minutes walking to see if your BG was going down too fast. That's what I do for an hours dog walk but I also try to avoid exercise within two hours of bolus or if I'm going to exercise then reduce bolus and/or have extra cabs

yep i agree I think I did. my ratio is different to yours though - I use 1 unit to bring my blood down by 2mmol. so to get from 20 to 6, I'd inject 7 units.

I'll try your idea about the exercise though...think it was a major case of overlap.

thank you

 

[everydayupsanddowns]

Just looking at these to start with:

Sunday
9.10 3.3 (+15g CHO)
9.20 3.1 (+15g CHO)
9.30 3.1
9.40 3.6 (+10g CHO
9.50 4.7 (+15g CHO) - Weetabix
12.15 16.6 7.5u +5u correction
2.45pm 20.2 +7u
3.15pm 14.7
3.30pm 12.3 Walk
4.30pm - 2.2 +25g CHO
6.00pm - 4.7

I think it looks like a combination of several factors all messing you about at once. Between 9am and 10am my guess is that your basal is too high (your team seem to be reducing this). Despite the best efforts of your glucotabs your BG was being pulled relentlessly back. I've also seen this pattern, and overtreatment is very hard to avoid, because something seems to delay the rapidity of the glucotab/lucozade treatment.

From your stated ratios it looks like 10g CHO should raise your BG (eventually) by approx 3.1mmol/L. Your total hypo treatment was 55g CHO = a potential rise of 16.5mmol/L, so your lunchtime 16.6 was pretty much as expected, but just a bit late 🙄 In fact you might have gone higher, if your basal was not still pulling back on your BGs.

For lunchtime, I suspect timing issues. You don't say whether you left much/any time after injecting for your bacon sarnie and the correction dose before you ate. At that level I would need to leave a LONG time for the correction to start working before I ate lunch. Perhaps an hour, maybe even longer. Waiting to eat is a bit 'high risk' and you need to go carefully and test frequently until you are fairly confident of when, and how rapidly your BGs might be exected to come down. By waiting until I'm more like 7-8 before eating I can (sometimes) prevent the meal pushing me even higher and that high level causing its own problems. I know that an hour's wait is not practical for everyone.

At 2.45 you still had a significant amount of active insulin, though I completely understand your frustration. The rise itself post-meal is around 3.5mmol/L at 2.5 hours, so not brilliant, but not a rise you'd have worried about if you'd started at 5.5.

The 7u at 2.45 then proceeds to weigh in with your insulin already on board (lunchtime dose/correction likely to be running until, say 5.15pm?) and, combined with the exercise crashes you into a hypo

Much of this is just my own guesswork, based on similar days I've had. I'm not saying this is how it happened for you, but if those were my numbers I'd be reducing basal and trying not to 'stack' corrections until things settle.

Sorry you had such a rough time of it. Hope you get some good support from your next BERTIE session.

 

[Robster65]

Sensible advice from Mike. Lots of different issues causing confusion probably.🙂

When you reduced your basal, did they suggest raising your bolus at all ?

Your basal does sound high but maybe your resistance is high, so everything is a bit up. My ratios and basal have all gone up recently.

If you could try and have a couple of days of evenly spaced meals without too much happening in between, it might show patterns clearer. Hard to do but would help in the long run.🙂

Rob

 

[margie]

When I did the carb counting course - they wanted us to forget about correction doses until we had the ratios correct. The theory being that the correction doses would just confuse the picture of what was happening. They said it doesn't matter if you are high for a few days.

I think that correcting at 20 was a bit excessive as you had already included a correction as part of your bolus. Your 16 at lunch could well have been due to your liver chucking out glucose because of being stuck at 3 for a while.

Hope that you make a breakthrough and get somewhere soon.

 

[novorapidboi26]

All this confusion is bound to happen when starting out with the carb counting/ratios/corrections..........

How is your background dose or doses? I can assume these are correct or nearly, as if there not, making sense of the rest is near impossible..........

As mentioned by others, its OK to go high for a few days, and at the very least in between meals, as then when you get to the next meal, you can evaluate the results and come up with a solution, only after a pattern has emerged remember...........

Stick at it, it takes time for it all to come together.............

 

[Ellie Jones]

It also sounds as your basal is out?

And if your basal is out, every other calculation you make will be as well...

My guess you are injecting once a day more than likely in the evening at some point..

So in the morning you got too much basal floating around, then in the afternoon you've got one of/and two things happen you background insulin may start burning out the system and falling short and/or it may not be enough to cover your basal needs..

Option that can be used to improve is.. Either swapp your timeing of the injections and/or splitting your injection into 2 to adjust so that it can be adjust to suit the different parts of the day...

A couple rule of thumb that you might find helpful

As said, the starting point for correction is 1 unit of insulin will drop your BG by 3mmol/l but do remember it's a starting guide though mine is 1u=7mmol/l drop!

The guide profile for quick acting insulin is, it starts to kick in after 10-15 mins, reaches it's peak at 2 hours, then tails off over the next 2 hours.. At the 2 hour peak 80% of the does has been used, the remaining 20% will work it's way off over the next 2 hours..

Remembering the profile, and 80% will help to avoid the stacking of insulin if you are making a correcting, as it gives you some idea how much to take off if needs be your correction dose...

I would also invest in 'Using Insulin' by John Walsh as this will further expand your knowledge of the bolus/basal regime, expanding on things like fasting testing, working our how long quick acting insulin last in you, working out carb/ratio's and corrections etc..

Carb counting/DAFNE course are very good and worthwhile but does need to be underpinned and expanded on with books such as the on above.

 

[everydayupsanddowns]

The guide profile for quick acting insulin is, it starts to kick in after 10-15 mins, reaches it's peak at 2 hours, then tails off over the next 2 hours.. At the 2 hour peak 80% of the does has been used, the remaining 20% will work it's way off over the next 2 hours

Where did you get that 80% from Ellie? I'm pretty sure John Walsh says 50% at 2 hours and a likely overall duration of between 4-6 hours. Is that from 'Think like a pancreas' or one of the others?

Obviously all depends on the individual, but I'm pretty sure I have more than 20% of a dose working between hours 2 and 5...

 

[imtrying]

I think it looks like a combination of several factors all messing you about at once. Between 9am and 10am my guess is that your basal is too high (your team seem to be reducing this). Despite the best efforts of your glucotabs your BG was being pulled relentlessly back. I've also seen this pattern, and overtreatment is very hard to avoid, because something seems to delay the rapidity of the glucotab/lucozade treatment.

From your stated ratios it looks like 10g CHO should raise your BG (eventually) by approx 3.1mmol/L. Your total hypo treatment was 55g CHO = a potential rise of 16.5mmol/L, so your lunchtime 16.6 was pretty much as expected, but just a bit late 🙄 In fact you might have gone higher, if your basal was not still pulling back on your BGs.

For lunchtime, I suspect timing issues. You don't say whether you left much/any time after injecting for your bacon sarnie and the correction dose before you ate. At that level I would need to leave a LONG time for the correction to start working before I ate lunch. Perhaps an hour, maybe even longer. Waiting to eat is a bit 'high risk' and you need to go carefully and test frequently until you are fairly confident of when, and how rapidly your BGs might be exected to come down. By waiting until I'm more like 7-8 before eating I can (sometimes) prevent the meal pushing me even higher and that high level causing its own problems. I know that an hour's wait is not practical for everyone.

At 2.45 you still had a significant amount of active insulin, though I completely understand your frustration. The rise itself post-meal is around 3.5mmol/L at 2.5 hours, so not brilliant, but not a rise you'd have worried about if you'd started at 5.5.

The 7u at 2.45 then proceeds to weigh in with your insulin already on board (lunchtime dose/correction likely to be running until, say 5.15pm?) and, combined with the exercise crashes you into a hypo

Much of this is just my own guesswork, based on similar days I've had. I'm not saying this is how it happened for you, but if those were my numbers I'd be reducing basal and trying not to 'stack' corrections until things settle.

Sorry you had such a rough time of it. Hope you get some good support from your next BERTIE session.

Wow, Mike, you are amazing! everything you've written does make sense - I'm going to print this (and everyone elses answers) out and carry them round with me!

re: lunch, I injected immediately before eating so no time delays there, which included added units for correction. we've been told to only inject correction doses with a meal injection, so I didn't inject twice. (I did 2 hours later but i felt so rubbish I couldn't stay like that).

I've done a little test today, and at 10am (just before I ate breakfast) I was 19.4 following the morning hypo. I ate crumpets and dose adjusted just before eating (both at the same time). 2.5 hours later I was 13.9, but nearly 4 hours after injecting I was down to 8.8! I've just eaten lunch and injected so will see what I am before I leave to go home.

thank you again for taking the time to look at my results, and reply. so much appreciated.

 

[imtrying]

Sensible advice from Mike. Lots of different issues causing confusion probably.🙂

When you reduced your basal, did they suggest raising your bolus at all ?

Your basal does sound high but maybe your resistance is high, so everything is a bit up. My ratios and basal have all gone up recently.

If you could try and have a couple of days of evenly spaced meals without too much happening in between, it might show patterns clearer. Hard to do but would help in the long run.🙂

Rob

Hi Rob, It's never easy is it?!

No they didn't suggest that, but I think they wanted to stop me from hypoing first as they did say we may need to look at my bolus ratios on Friday.

Historically I've always been on high amounts of insulin so was pleased that I'm now starting to get them down.

and yep, that's what I've tried doing today (and what I did try yesterday) - just 3 meals and no snacking inbetween to see what happens. that and I've been too scared to do anything else!

thanks so much for replying, really appreciated.

 

[imtrying]

When I did the carb counting course - they wanted us to forget about correction doses until we had the ratios correct. The theory being that the correction doses would just confuse the picture of what was happening. They said it doesn't matter if you are high for a few days.

I think that correcting at 20 was a bit excessive as you had already included a correction as part of your bolus. Your 16 at lunch could well have been due to your liver chucking out glucose because of being stuck at 3 for a while.

Hope that you make a breakthrough and get somewhere soon.

Thanks very much Margie. We're only supposed to inject correction doses with our meal injections, but by the time I'd hit 20 I'd had enough! Felt like total c**p and just wanted it to stop....looking back at it now I should have just waited.

we live and learn hey! Thanks very much for replying, very appreciated.

 

[imtrying]

All this confusion is bound to happen when starting out with the carb counting/ratios/corrections..........

How is your background dose or doses? I can assume these are correct or nearly, as if there not, making sense of the rest is near impossible..........

As mentioned by others, its OK to go high for a few days, and at the very least in between meals, as then when you get to the next meal, you can evaluate the results and come up with a solution, only after a pattern has emerged remember...........

Stick at it, it takes time for it all to come together.............

haha I'm so confused I don't even know what confusion is any more!!

my background is being reduced at the moment - last week (Friday) they wanted me to reduce it, and when I spoke to them yesterday about all my hypos etc, they've got me to reduce it by another 2 units last night.

hopefully it will all settle down for the rest of the week and give my body, and brain, a break!

thanks for taking the time to reply, it's much appreciated.

 

[imtrying]

It also sounds as your basal is out? And if your basal is out, every other calculation you make will be as well...

My guess you are injecting once a day more than likely in the evening at some point..

So in the morning you got too much basal floating around, then in the afternoon you've got one of/and two things happen you background insulin may start burning out the system and falling short and/or it may not be enough to cover your basal needs..

Option that can be used to improve is.. Either swapp your timeing of the injections and/or splitting your injection into 2 to adjust so that it can be adjust to suit the different parts of the day...

A couple rule of thumb that you might find helpful

As said, the starting point for correction is 1 unit of insulin will drop your BG by 3mmol/l but do remember it's a starting guide though mine is 1u=7mmol/l drop!

The guide profile for quick acting insulin is, it starts to kick in after 10-15 mins, reaches it's peak at 2 hours, then tails off over the next 2 hours.. At the 2 hour peak 80% of the does has been used, the remaining 20% will work it's way off over the next 2 hours..

Remembering the profile, and 80% will help to avoid the stacking of insulin if you are making a correcting, as it gives you some idea how much to take off if needs be your correction dose...

I would also invest in 'Using Insulin' by John Walsh as this will further expand your knowledge of the bolus/basal regime, expanding on things like fasting testing, working our how long quick acting insulin last in you, working out carb/ratio's and corrections etc..

Carb counting/DAFNE course are very good and worthwhile but does need to be underpinned and expanded on with books such as the on above.

thanks so much Ellie.

Yes I was starting to think I wonder if they'll get me to inject my lantus in the morning...then any hypos would be covered by dinner!

Now I'm starting to monitor things a lot more closely, there's a huge amount of other things I need to learn to help me get better results.

Thanks very much for all the info and advice, really appreciated.

 

[Ellie Jones]

Couldn't tell you the exact source of the 80% information I've used this for so long now in my calculations...

My burn out for bolus insulin is just over the 4 hour mark, from about 2 hours I don't get the hit off the insulin that I get in the first two hours, over the last 2 hours I wouldn't expect to drop more than 2mmol/l...

On my pump it has IOB (insulin that is still active) so when I use my bolus wizard it will tell me how much active insulin I still have... My bolus wizard is set to alarm at 2 hours after a meal/snack and my duration time my insulin is 4 hours... So using your 50% figure if I did a straigt bolus of 4 units, at the 2 hour mark the wizard should tell me that I have 2 units of active insulin on board... Considering most of my bolus's are duel wave I still get a figure which is still a lot less some where under 1 unit of active insulin! But I will check with my next bolus to see what the percentage is..


But as anything diabetic it's all ever a guideline rule of thumb, and you got to work out the finer details that suits as an individual...

 

[everydayupsanddowns]

On my pump it has IOB (insulin that is still active) so when I use my bolus wizard it will tell me how much active insulin I still have... My bolus wizard is set to alarm at 2 hours after a meal/snack and my duration time my insulin is 4 hours... So using your 50% figure if I did a straigt bolus of 4 units, at the 2 hour mark the wizard should tell me that I have 2 units of active insulin on board... Considering most of my bolus's are duel wave I still get a figure which is still a lot less some where under 1 unit of active insulin! But I will check with my next bolus to see what the percentage is..

You are on the Accu-Chek pump aren't you? I wonder if the IOB/Active Insulin shown on that is the same as on the Expert meter (makes sense as they are so similar in other ways) in which case it will only be showing you active *correction* rather than any insulin known to be active but allocated against carbs entered into the wizard. It does track the whole dose internally, but only for use against Meal Rise and Offset Time to prevent bolus advice suggesting extra corrections between meals where things are on track.

On the Expert I can have a dose of 6u and only show, say, 0.4u active at 2hours because for 'Active Insulin' the Expert is tracking the 0.8u of correction it allowed and ignoring the 5.2u that are supposed to be dealing with the meal I just ate.

I found that so confusing at first I had to phone the lovely folks at the Scandinavian helpline to get them to explain it to me.

 

[imtrying]

I found that so confusing at first I had to phone the lovely folks at the Scandinavian helpline to get them to explain it to me.

I'm very confused!!! All of that went straight over my head, but I'm not panicking...I'm guessing I don't need to worry about that bit yet!