Help evening bg going up after 4hour

[Littleburger]

If you are using the correct amount of insulin for your supper then mostly it shouldn't happen but some foods are tricky. Xmas pud is just usually once a year so it's OK to accept that it happens with that and not worry too much about it, but things like pizza or pasta with a creamy sauce are notorious for delayed digestion and causing a much later spike and a split dose of insulin is the general tactic to deal with it.... so injecting some before the meal and then the rest 1-2 hours later.
In an ideal world it is best to eat 4 hours before you intend to go to bed so that the insulin you inject for your meal is near enough spent before you go to sleep, so having a low carb supper is a safer option that having something that needs insulin near bedtime because that active meal time insulin increases the risk of a nocturnal hypo, if we miscalculate or we had a particularly active day and our body becomes more sensitive to that insulin.... or we engage in activity after we get into bed. There are lots of things to think about with insulin use. The important thing is to err on the side of caution and accept that sometimes we just don't get it right despite our best efforts.

your right there. I find I don't need any fast acting insulin if I'm out on mountain bike for the day or tackling a mountain walk. Just take it in evening with meal.

 

[rebrascora]

My diabetic team is made up of 2 DSNs and a dietitian. They sit there discussing what should be done. Last time I took my husband along hoping he might pick more out of the meeting. He certainly wasn't made welcome. No seat for him and the DSN actually said "It's Rather crowded in here". After I was told to get rid of my food diary, I came out feeling close to tears. This is the info they give me. I still had to email them to explain the 10%adjustment which cannot be done on a 1 -5 unit shot. It actually meant put it up or down 1 unit.

Goodness, that is shocking! My sister came along with me to my first couple of appointments with the consultant because it is really overwhelming and intimidating and a second person can be really helpful to take in some of the stuff that goes in one ear and out the other. To be fair, I had a separate appointment with the dietician and went on my own to that and the only time I had an appointment with a DSN was at my GP surgery the day I was started on insulin and it was just the Diabetes nurse from the practice and the DSN form the hospital clinic and myself. They were both absolutely lovely but I still had a cry in the car park when I came out. It is very emotional getting that diagnosis and learning to come to terms with it.

You need to ask for a half unit pen so that you can make finer adjustments. Many of us here have them and love them. They are reusable pens and take cartridges of insulin similar to how old fountain pens used to take a cartridge and the cartridges take up much less space in the fridge as well as being more environmentally friendly. Unfortunately with diabetes management you have to push for what you need and be quite assertive (politely pushy) in order to get it. I found that really hard, but once they realise that you know what you are talking about, they tend to be more accommodating, so it pays to do your homework before an appointment and make a list of questions and things you would like and go through that list, because it is easy to get distracted and come out with several key questions unanswered. Sometimes you have to ask for something at several different appointments before you get it, but if you are persistent you will get there.

 

[rebrascora]

your right there. I find I don't need any fast acting insulin if I'm out on mountain bike for the day or tackling a mountain walk. Just take it in evening with meal.

Do be aware that that exercise during the day will continue to impact your insulin sensitivity for at least 24 hours and up to 48hrs. For me my muscles start sucking the glucose out of my blood to replenish their stones as soon as I go to sleep, so I need to reduce my evening doses, particularly my evening basal insulin to try to prevent nocturnal hypos.

 

[Inka]

That chart is like something out of the 1980s! Very strange! I agree that you need a half unit pen. You’re also making a very good move educating yourself. With Type 1, we have to educate ourselves in order to get the best results, I’ve found. Also, this forum is great for getting advice, asking questions, and finding out what others do. It’s also just nice to chat here with people who understand.

 

[Littleburger]

Goodness, that is shocking! My sister came along with me to my first couple of appointments with the consultant because it is really overwhelming and intimidating and a second person can be really helpful to take in some of the stuff that goes in one ear and out the other. To be fair, I had a separate appointment with the dietician and went on my own to that and the only time I had an appointment with a DSN was at my GP surgery the day I was started on insulin and it was just the Diabetes nurse from the practice and the DSN form the hospital clinic and myself. They were both absolutely lovely but I still had a cry in the car park when I came out. It is very emotional getting that diagnosis and learning to come to terms with it.

You need to ask for a half unit pen so that you can make finer adjustments. Many of us here have them and love them. They are reusable pens and take cartridges of insulin similar to how old fountain pens used to take a cartridge and the cartridges take up much less space in the fridge as well as being more environmentally friendly. Unfortunately with diabetes management you have to push for what you need and be quite assertive (politely pushy) in order to get it. I found that really hard, but once they realise that you know what you are talking about, they tend to be more accommodating, so it pays to do your homework before an appointment and make a list of questions and things you would like and go through that list, because it is easy to get distracted and come out with several key questions unanswered. Sometimes you have to ask for something at several different appointments before you get it, but if you are persistent you will get there.

Thank you for your encouragement. I'll be ready next time.

 

[Tdm]

That chart is like something out of the 1980s! Very strange! I agree that you need a half unit pen. You’re also making a very good move educating yourself. With Type 1, we have to educate ourselves in order to get the best results, I’ve found. Also, this forum is great for getting advice, asking questions, and finding out what others do. It’s also just nice to chat here with people who understand.

I agree about needing to educate yourself...at first i was reluctant to take control, but when i did my blood glucose management improved greatly.
Keep that meal diary...it will help you note trends and take appropriate action

 

[Littleburger]

That chart is like something out of the 1980s! Very strange! I agree that you need a half unit pen. You’re also making a very good move educating yourself. With Type 1, we have to educate ourselves in order to get the best results, I’ve found. Also, this forum is great for getting advice, asking questions, and finding out what others do. It’s also just nice to chat here with people who understand.

Thank you. I feel s lot more confident and have started the BERTIE education course. Feeling positive

 

[everydayupsanddowns]

Thank you. I feel s lot more confident and have started the BERTIE education course. Feeling positive

That’s great to hear @Littleburger

Sounds like your clinic is a little stuck in its ways, and doesn’t encourage a carb-counting approach where each dose is tailored to match the meal that is eaten. I have never understood this reluctance. I started on fixed doses way back in the mists of time, but was also given a fixed carb amount for each meal. To my mind you simply can!t have an “eat what you like” approach without meal-by-meal dose adjustment, or you risk someone using the same dose for omelette and salad (no carbs) to a blowout from the chippy (potentially more than a hundred of grams of carbs, and fat to complicate things further!). Which would be disastrous!

In the end, we all have to become experts in our own diabetes - which will have unique foibles and eccentricities. It sounds like you are well on the way to that.

You could teach your DSNs a thing or two!

 

[Littleburger]

That’s great to hear @Littleburger

Sounds like your clinic is a little stuck in its ways, and doesn’t encourage a carb-counting approach where each dose is tailored to match the meal that is eaten. I have never understood this reluctance. I started on fixed doses way back in the mists of time, but was also given a fixed carb amount for each meal. To my mind you simply can!t have an “eat what you like” approach without meal-by-meal dose adjustment, or you risk someone using the same dose for omelette and salad (no carbs) to a blowout from the chippy (potentially more than a hundred of grams of carbs, and fat to complicate things further!). Which would be disastrous!

In the end, we all have to become experts in our own diabetes - which will have unique foibles and eccentricities. It sounds like you are well on the way to that.

You could teach your DSNs a thing or two!

Thanks for all your help. I started adjusting my insulin myself not long after I started on insulin. My teams weren't very pleased about that and give me these sheets. Today I've done what I usually do when hill walking. Took 1unit of levemir 8am porridge for breakfast and done a 7 mile hill walk with one cheese and chutney sandwich half way. Got home at 3pm bg 7.5 took my morning dose of rapid insulin and had poached egg on 2slices of toast and tin spaghetti followed by a satsuma. Will be checking bg regularly and having dinner at 6pm. Will adjust insulin accordingly. Gonna have to discuss all this with DSN on 31 Jan next appointment. Thanks again