Hi everyone. I'm a newbie looking for some guidance and help with BG levels please

[Libby45]

Hello 🙂

Four weeks ago l was diagnosed Type 1.

The hospital issued me with Novorapid, Tresiba, BG tester and strips. I was
told to take Tresiba in the morning with a dosage of 12 units and Novorapid to be taken three times a day with a dosage of 4 units. My original target set by the hospital was to get my blood sugars down to between 11-15 mmols. (Apparently my levels were through the roof when admitted to hospital however l don't have any info / figures at the moment as to what they actually were.)

As l am currently forloughed from work, l have been using my time to try and research as much as possible about diabetes, discover forums like this and also to do plenty of BG testing and keep a food diary.

Within approx two weeks of being diagnosed l have got my levels down so l have now been told by the hospital to try and get my blood sugar readings between 5 -10 mmols. Hospital instructed me to change my dose of Novorapid to 4 units at BF and then 3 units at lunch and 3 units at evening meal. I currently range now on a typical day between 5 and 8.

About a week or so ago I started to get hypos in the morning, approx one and a half hours after having my insulin and eating breakfast. This happened consecutively across three or four days. Spoke to the hospital and said l felt that my insulin dose was possibly to high in the morning (Been trying to learn all this with research etc 😱 ). They agreed and have now told me to reduce my insulin in the morning and take 3 units before breakfast.

I have now also just got a App on my phone to help me work out my BG reads v carb intake v exercise which then works out how much insulin l should take. It has been a fantastic tool for me. I was still getting some hypos in the morning so i decided to follow the App, and if it said take 2 units of insulin (based on info l had entered) l have been. I feel this is working better for me and the dosage is more inline and hypos reduced.

However....the last couple of days, l have had hypos again in the morning, again aprox one and a half hours after breakfast.
Today, first BG read of the day was 7.2 .Entered into App: Breakfast 52g of carbs, exercise 30 mins of walking. App calculated that l needed 2 units of insulin which l took before eating and exercising.
My next BG read was 3.2 (approx hour and a half later). I knew the signs so had some jelly babies and then had a couple of crackers about 20 mins later. Did another BG check and it was 7.8.

I would be very grateful for any suggestions / advice / comments as to where l might be going wrong please. I know hypos will happen however l feel like these morning ones could be avoided due to me eating wrong food for BF (do l need to remove carbs from BF?), Insulin dose not correct, not eating enough at BF etc.

Thanks 🙂

 

[Inka]

Hi @Libby45 Carbs are fine for breakfast if you’re Type 1. It’s Type 2s who often need to watch the amount of carbs (although obviously we need to be mindful of them) What are you eating? I’m presuming it’s something normal like cereal, etc.

What app are you using? Are you carb counting and adjusting your mealtime doses according to the carbs? Do you know your insulin to carb ratio for breakfast and other meals? If not, how does the app know what to recommend to you?

Have you done a basal test to make sure you’re not having too much basal? It’s always best to check that first as if your basal dose is out, it can make it harder to get everything else right.

Do you have a half unit pen for your mealtime insulin? They’re very useful if you’re only on small doses of insulin.

 

[SB2015]

Welcome to the forum @Libby45 . Sorry to hear of your diagnosis but pleased that you have found us. Well done on getting your levels down already, and starting to carb count and adjust doses already. There is a lot to learn very quickly at diagnosis, but you are clearly getting your head round it.

The best analogy I was given was that it is like learning to drive. It all seems very complex at the start but then quite quickly becomes automatic and you are just watching out for detours, and bumps in the road.

We each have to find out what our carb ratios are for the meals we eat. Mine change through the day and It has just been a case of testing, alongside good records for the carbs that I am eating, to gradually adjust the amounts of insulin that I need.

In the early stages the DSNs often suggest fixed doses which is just a starting point from which you can go up and down to get to what you need. Also you will no doubt be in the ‘honeymoon period’ (a ridiculous name for it!) during which the few beta cells that you have left, having had a bit of a rest now that you are injecting insulin, then decide that they will join in again, without any warning, and cause unexpected hypos. Eventually things settle down so just be as patient s you can.

A book that I found very useful, even in these days of internet etc, was Type1 Diabetes in Children Adolescents and Young Adults by Ragnar Hanas. Ignore the age reference. I was 53 at diagnosis. It clearly explains all that is T1, and is relevant to us at any age (apart from the bit about going to school. Just think of that as going to work but without a form tutor to help)

Keep in touch and keep firing questions at us as they arise. Plenty of people here happy to help.

 

[SB2015]

Ps
I quickly asked for a half unit pen, which made a big difference as I was able to adjust my doses by smaller increments. Well worth asking about these. It makes it a lot easier especially in the early stages when you need so little insulin (or 12 years in when I still need very little)

 

[everydayupsanddowns]

Welcome to the forum @Libby45

It sounds like you are getting on brilliantly for someone newly diagnosed, and your analytical and experimental approach will serve you really well in the years ahead.

I notice you are only talking about reducing your meal doses - have you adjusted your background (or basal) insulin at all?

it would be interesting to see what happened if you ate no breakfast and took no breakfast insulin. That way only your Tresiba would be active and you could see whether it was doing its job of ‘holding you steady’ between meals correctly.

The full process is called ‘basal testing’ and breaks the whole day/night into sections to check the full 24 hours, but sometimes just skipping one meal give a useful clue as to what’s going on underneath the meal doses.

I also thoroughly recommend a half unit pen - on your tiny doses you’ve not got much wiggle room left!

 

[Amity Island]

Hello 🙂

Four weeks ago l was diagnosed Type 1.

The hospital issued me with Novorapid, Tresiba, BG tester and strips. I was
told to take Tresiba in the morning with a dosage of 12 units and Novorapid to be taken three times a day with a dosage of 4 units. My original target set by the hospital was to get my blood sugars down to between 11-15 mmols. (Apparently my levels were through the roof when admitted to hospital however l don't have any info / figures at the moment as to what they actually were.)

As l am currently forloughed from work, l have been using my time to try and research as much as possible about diabetes, discover forums like this and also to do plenty of BG testing and keep a food diary.

Within approx two weeks of being diagnosed l have got my levels down so l have now been told by the hospital to try and get my blood sugar readings between 5 -10 mmols. Hospital instructed me to change my dose of Novorapid to 4 units at BF and then 3 units at lunch and 3 units at evening meal. I currently range now on a typical day between 5 and 8.

About a week or so ago I started to get hypos in the morning, approx one and a half hours after having my insulin and eating breakfast. This happened consecutively across three or four days. Spoke to the hospital and said l felt that my insulin dose was possibly to high in the morning (Been trying to learn all this with research etc 😱 ). They agreed and have now told me to reduce my insulin in the morning and take 3 units before breakfast.

I have now also just got a App on my phone to help me work out my BG reads v carb intake v exercise which then works out how much insulin l should take. It has been a fantastic tool for me. I was still getting some hypos in the morning so i decided to follow the App, and if it said take 2 units of insulin (based on info l had entered) l have been. I feel this is working better for me and the dosage is more inline and hypos reduced.

However....the last couple of days, l have had hypos again in the morning, again aprox one and a half hours after breakfast.
Today, first BG read of the day was 7.2 .Entered into App: Breakfast 52g of carbs, exercise 30 mins of walking. App calculated that l needed 2 units of insulin which l took before eating and exercising.
My next BG read was 3.2 (approx hour and a half later). I knew the signs so had some jelly babies and then had a couple of crackers about 20 mins later. Did another BG check and it was 7.8.

I would be very grateful for any suggestions / advice / comments as to where l might be going wrong please. I know hypos will happen however l feel like these morning ones could be avoided due to me eating wrong food for BF (do l need to remove carbs from BF?), Insulin dose not correct, not eating enough at BF etc.

Thanks 🙂

Hi Libby,

It sounds like you are doing very well indeed, considering a recent diagnosis.

To help answer your queries and shed some light, I can give my typical daily routine and perhaps that might be quicker than trying to answer everything in one go.

I too am using the basal insulin Tresiba Degludec (runs up to 48hrs). I take 19 units every day, usually around same time about 8am. No need to worry about taking it exactly the same time (unlike other insulins) I can take it earlier or later in the day, even by several hours and it still work very well as designed.

I use a Freestyle Libre (to manage glucose readings) with a sensor attached to my arm, giving continuous readings whenever I want to scan/swipe it.

For meals (bolus) I take Humalog insulin. The amount of insulin I take is adjusted to each meal and the carbohydrates I wish to eat -- I see you are currently trying fixed doses 3 times a day, (fixed carbs too?) which I assume is to give you time to get used to everything and simplify your day.

My quick acting insulin (humalog) for mealtimes varies because in the morning not only do I need to take it 20 mins before I eat (to avoid spikes), I need 2 x the amount of insulin for the carbs e.g for 40g of carbs I need not 4 units but 8 units of insulin. For lunch time, I need 1.5 x the amount of insulin for the carbs e.g for 80g carbs I need not 8 units of insulin but 12 units. By the evening it's straight conversion of 1unit to 10g of carbs, e.g 60g carbs needs 6 units of humalog insulin. Everybody has their own requirements and ratios and need for pre-bolusing. You will get the hang of your own insulin needs and timings through regular testing and consultations with your nurses and doctors, your requirements at the moment seem quite light compared to mine.

b.t.w I avoid quick breakfast cereals (as do many other diabetics) because they spike blood sugars very quickly. I tend to eat all bran, whole rolled oats or sour dough bread toasted.

 

[Libby45]

Hi @Libby45 Carbs are fine for breakfast if you’re Type 1. It’s Type 2s who often need to watch the amount of carbs (although obviously we need to be mindful of them) What are you eating? I’m presuming it’s something normal like cereal, etc.

What app are you using? Are you carb counting and adjusting your mealtime doses according to the carbs? Do you know your insulin to carb ratio for breakfast and other meals? If not, how does the app know what to recommend to you?

Have you done a basal test to make sure you’re not having too much basal? It’s always best to check that first as if your basal dose is out, it can make it harder to get everything else right.

Do you have a half unit pen for your mealtime insulin? They’re very useful if you’re only on small doses of insulin.

Hi. Thanks for your response.
Each day l'm learning more about carbs and ratio to insulin. I am now just reading up on basal testing.....think your right....this sounds like it will give me a better insight! 🙂

 

[Libby45]

Welcome to the forum @Libby45 . Sorry to hear of your diagnosis but pleased that you have found us. Well done on getting your levels down already, and starting to carb count and adjust doses already. There is a lot to learn very quickly at diagnosis, but you are clearly getting your head round it.

The best analogy I was given was that it is like learning to drive. It all seems very complex at the start but then quite quickly becomes automatic and you are just watching out for detours, and bumps in the road.

We each have to find out what our carb ratios are for the meals we eat. Mine change through the day and It has just been a case of testing, alongside good records for the carbs that I am eating, to gradually adjust the amounts of insulin that I need.

In the early stages the DSNs often suggest fixed doses which is just a starting point from which you can go up and down to get to what you need. Also you will no doubt be in the ‘honeymoon period’ (a ridiculous name for it!) during which the few beta cells that you have left, having had a bit of a rest now that you are injecting insulin, then decide that they will join in again, without any warning, and cause unexpected hypos. Eventually things settle down so just be as patient s you can.

A book that I found very useful, even in these days of internet etc, was Type1 Diabetes in Children Adolescents and Young Adults by Ragnar Hanas. Ignore the age reference. I was 53 at diagnosis. It clearly explains all that is T1, and is relevant to us at any age (apart from the bit about going to school. Just think of that as going to work but without a form tutor to help)

Keep in touch and keep firing questions at us as they arise. Plenty of people here happy to help.

Thank you for comments 🙂

 

[Libby45]

Welcome to the forum @Libby45

It sounds like you are getting on brilliantly for someone newly diagnosed, and your analytical and experimental approach will serve you really well in the years ahead.

I notice you are only talking about reducing your meal doses - have you adjusted your background (or basal) insulin at all?

it would be interesting to see what happened if you ate no breakfast and took no breakfast insulin. That way only your Tresiba would be active and you could see whether it was doing its job of ‘holding you steady’ between meals correctly.

The full process is called ‘basal testing’ and breaks the whole day/night into sections to check the full 24 hours, but sometimes just skipping one meal give a useful clue as to what’s going on underneath the meal doses.

I also thoroughly recommend a half unit pen - on your tiny doses you’ve not got much wiggle room left!

Hi. Thanks for the feedback. I'm reading up on basal testing..... think this is something i need to do 🙂

 

[Libby45]

Hi Libby,

It sounds like you are doing very well indeed, considering a recent diagnosis.

To help answer your queries and shed some light, I can give my typical daily routine and perhaps that might be quicker than trying to answer everything in one go.

I too am using the basal insulin Tresiba Degludec (runs up to 48hrs). I take 19 units every day, usually around same time about 8am. No need to worry about taking it exactly the same time (unlike other insulins) I can take it earlier or later in the day, even by several hours and it still work very well as designed.

I use a Freestyle Libre (to manage glucose readings) with a sensor attached to my arm, giving continuous readings whenever I want to scan/swipe it.

For meals (bolus) I take Humalog insulin. The amount of insulin I take is adjusted to each meal and the carbohydrates I wish to eat -- I see you are currently trying fixed doses 3 times a day, (fixed carbs too?) which I assume is to give you time to get used to everything and simplify your day.

My quick acting insulin (humalog) for mealtimes varies because in the morning not only do I need to take it 20 mins before I eat (to avoid spikes), I need 2 x the amount of insulin for the carbs e.g for 40g of carbs I need not 4 units but 8 units of insulin. For lunch time, I need 1.5 x the amount of insulin for the carbs e.g for 80g carbs I need not 8 units of insulin but 12 units. By the evening it's straight conversion of 1unit to 10g of carbs, e.g 60g carbs needs 6 units of humalog insulin. Everybody has their own requirements and ratios and need for pre-bolusing. You will get the hang of your own insulin needs and timings through regular testing and consultations with your nurses and doctors, your requirements at the moment seem quite light compared to mine.

b.t.w I avoid quick breakfast cereals (as do many other diabetics) because they spike blood sugars very quickly. I tend to eat all bran, whole rolled oats or sour dough bread toasted.

Thanks for the feedback. I have started to try different breakfast options to see if that helps with my levels mid morning. Interesting to read about your insulin dosage for mealtimes......i still have a lot to learn

 

[rebrascora]

The timing of the bolus injection on a morning particularly can also be another factor to consider and experiment with. I find that I have to inject NovoRapid an hour before I eat breakfast (Fiasp is about 45mins) otherwise the glucose from my breakfast hits my blood stream long before the insulin kicks in and I get a big BG spike and then a drop and that is with slower release foods like low carb granola with creamy Greek yoghurt. Obviously if you decide to extend the time between your injection and eating, then do it in 5 min increments each day and test frequently to be safe. I tend to wait until my meter shows that my BG is falling before I eat, as I seem to digest carbs very quickly, so the glucose hits the blood stream about 10 mins later and starts balancing out the insulin activity.

There is a huge amount to take in but don't feel you have to do everything all at once. Basal testing and getting that dose right is probably the most important thing as without that holding you steady it is the difference between shooting at a fixed target or a randomly moving object.... trying to get your meal bolusses right.

 

[trophywench]

OTOH Novorapid gets going within 10 minutes for me, hence I try and jab when it's on the plate in front of me, unless we're needing to say grace, which since I haven't been to a formal dinner with anyone 'important' at the head of the top table or even a formal wedding (or a wedding at all come to think) I can't say it's a problem.