HELP! bloods make no sense

[imtrying]

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

ok from that 19 yesterday,
- I managed to get down to 8.8 by 1.45pm.
- then immediately injected and ate lunch. I only injected for my carbs, no correction and
- by 3.50pm I was 3.3. ate 3 flumps (lol they were just in the office!) but
- 15 mins later 2.6. ate 3 glucose tablets
- 10 minutes later 3.3 again. ate 2 more glucose tablets
- 10 minutes later - 4.6. desparate not to spike again post hypo, I had 2 rich tea biscuits and nothing more (by now it's 4.30pm ish)
- 5.30pm I was up to 14.9. drove home
- tested before dinner, 23.7 😱 felt like death. injected for dinner and included adjustment dose that should have taken me down to 5/6
- 10.00pm 13.9

what the hell am I doing wrong????????????

 

[novorapidboi26]

ok from that 19 yesterday,
- I managed to get down to 8.8 by 1.45pm.
- then immediately injected and ate lunch. I only injected for my carbs, no correction and
- by 3.50pm I was 3.3. ate 3 flumps (lol they were just in the office!) but
- 15 mins later 2.6. ate 3 glucose tablets
- 10 minutes later 3.3 again. ate 2 more glucose tablets
- 10 minutes later - 4.6. desparate not to spike again post hypo, I had 2 rich tea biscuits and nothing more (by now it's 4.30pm ish)
- 5.30pm I was up to 14.9. drove home
- tested before dinner, 23.7 😱 felt like death. injected for dinner and included adjustment dose that should have taken me down to 5/6
- 10.00pm 13.9

what the hell am I doing wrong????????????

Nothing at all...................its becoming more likely that your Lantus dose is way too high, and would benefit from a split........

 

[everydayupsanddowns]

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!

Sorry Katie - that bit went a bit 'off topic' about the finer intricacies of the Roche Accu-Chek bolus wizard's inner workings!

Really sorry you are haing such a tough time on the gluco-coaster at the moment.

Have you run any fasting basal tests? ie Missing a meal and not taking a bolus when your last rapid acting dose was 5 hours previous then testing every hour to see what happens with your BG levels on just basal alone.

Until you have your basal keeping you as steady as possible (and doing no more than that) it's very hard to get meal doses and corrections working reliably. Basal should keep you within 1-2 mmol/L of wherever you start.

 

[Ellie Jones]

The Off Set does takes a bit of work to get your head around..

My wizard I think is slightly different, I get both a read out of the off set insulin at the top, and at the very bottom Active Insulin this can give two different figures...

My old pump didn't have any wizard's so had to mentally calculate everything, and this is the information I set up the wizard of my meter to begin with, I did try to see if I could fine tune my wizard settings to improve control but my original settings are the best ones so far...

But saying about setting on the basal rate adjustments, the rule of thumb is you make the rate adjustment 2 hours before the time you want it to take effect but I find for me adjustments work better if I adjust an hour before..

 

[imtrying]

Nothing at all...................its becoming more likely that your Lantus dose is way too high, and would benefit from a split........

thanks NRB - sometimes it's nice to know it's not only you that can't see what's going wrong!! I was wondering if they're going to change me to take my lantus in the morning instead of at night, but maybe they might suggest a split. will keep you updated...hopefully with some answers!

Really sorry you are haing such a tough time on the gluco-coaster at the moment.

Have you run any fasting basal tests? ie Missing a meal and not taking a bolus when your last rapid acting dose was 5 hours previous then testing every hour to see what happens with your BG levels on just basal alone.

Until you have your basal keeping you as steady as possible (and doing no more than that) it's very hard to get meal doses and corrections working reliably. Basal should keep you within 1-2 mmol/L of wherever you start.

hey Mike. no worries...even when you explained it I still don't get it lol baby steps 😎

no I haven't. this is something I've NEVER done, nor been asked to do, or even been spoken to about. I've only heard about this from here. I did start wondering if they were going to get me to do this, but they haven't suggested it yet. when you put it like that, really I should have done this when I first put my dose down - otherwise how else am I going to know what's going on in the background??

but wow...missing out a whole meal.... 😱 haha I do think this will be the next thing, but will speak to my diabetes team tomorrow when I see them. If they don't have any answers, I might show them this thread!! lol

 

[everydayupsanddowns]

My experience was that stumbling across the idea of basal testing online was a complete 'lightbulb' moment.

I can't believe it isn't taught as a basic part of ongoing MDI maintenance, but whenever I've mentioned it at annual review there's always been a bit of a surprised look. People who go on pumps get shown how to do this as part of the pump set-up, but for some reason it rarely gets suggested for MDI. Madness!

What I discovered is that my basal requirement changes every so often through the year, with different activity levels and with different seasons. These days I *know* my basal is out when my levels go all over the shop because meal doses/carbs/corrections just stop behaving.

In your shoes that is exactly what I would do.

There's a good set of instructions here: http://www.diabetes-support.org.uk/info/?page_id=120

You don't have to commit to the full 24 hour check straight away, but a few checks over the same 4-5 hour period over a few days will let you know if your BGs are stable without meals confusing the picture...

Testing more periods will help once things have settled and might show that you need to split your dose, or move your basal injection time. Basal on MDI is always a bit of a 'least worst' setup, but by testing at least you'll get an idea of what's going on.

 

[martindt1606]

I have found (in the last 3-4 months) that using GlucoTabs does not have an immediate impact on BS where I am under 3.5, previously it was my go to option if I was between 3 & 4. I now have a glass of orange if I find I am under 3.5 and this brings the BS back over 4 (after 15 minutes) and "usually" doesn't result in too high levels later in the day.

 

[sofaraway]

Seems like it really is all over the place for you at the moment, but from looking at this thread it does look like the basal is out and thats what your team are trying to sort first. It can be frustrating but it's hard to sort everything at once. I'm not sure about BERTIE but overnight hypos are DAFNE's number one thing to sort out so i can see why that is being addressed. I find for myself if I have had a early morning/night hypo then the rest of the day can't be relied on to look at bolus doses.

Out of interest what is the BERTIE rule for correcting after a hypo? DAFNE is not correcting on the back of a hypo, which is designed to stop the swinging. ie. hypo at 10am, blood glucose is high at lunch, so you wouldn't correct, just give insulin for the CP's, then if still above target at evening meal then you are safe to correct at that time.

Hope things start to become clearer as the course goes on.

 

[imtrying]

Thank you everyone soooo much for all your help, support and advice...and putting up with all my moaning 😱

I was dreading going to BERTIE on Friday, but it was actually really good 🙂 I've now had my lantus reduced again, this time down to 24 units. Only had one hypo the whole weekend and I think that was because I over-injected.

I have been running high, around the 12's. so may have to increase Lantus to 26 maybe this Friday, but happy to see how things go this week. Today I managed to get down to 6.3 so here's hoping!

They also said they want me to run a little higher than my aim of 6mmols, about 8/9mmols, to try and get better warning signs of hypos so I can hopefully catch them around 4mmols rather than 3mmols. They thought that although I'm treating my hypos properly, my liver is dumping a whole load of glucose at the same time, which is resulting in the 16-20mmols readings. So I need to be treating before this happens.

We covered sickness and alcohol this week and couldn't believe the amount of stuff I didn't know!!

I think this Friday I'll be in tears as we cover complications, and pregnancy. Two things I panic about all the time. I'll let you all know how it goes! (very sad that this week will be the last week )

 

[novorapidboi26]

Its good the experience has made an impression......................

There will come a time were your Lantus dose will be so close to perfect that even a change of 1 unit either way would have a significant effect, this is actually good, but it means you need to compensate with your bolus ratios....🙂

 

[heasandford]

This is another of those brilliant sets of answers!

There were two significant points for me: you seem to have your bolus insulin 'lasting' longer than medics say - in other words it doesn't run out at 4/5 hours (I think I'm the same) - everyone's metabolism is different. How to handle this - not sure, perhaps someone can clarify?
Second, Mike's suggestion of giving your bolus longer before eating depending on how high your BG is - I am scared to try this, but it really does make sense, AND of course that will mean the bolus ends sooner, less chance of hypo at the end. Bit of a faff, especially if someone's made something for you, but hopefully the learning process will help.

I have days where I feel like I'm on a rollercoaster too and I am going to try some of the suggestions, best of luck, hope things calm down!

 

[heasandford]

oh and third! Once you BG is less than about 3.5 then there is almost certainly glucose chucked in from your liver, messing up all the corrections and readings. It's finding how to know you're going low when your BG is around 4 (PLEASE can I have a CGM???)