High’s

[Ian67]

Hi all still struggling with highs in the morning. I can go to bed at say 9 o’clock at a seven and when I wake up every morning I will be about a 12 and within a half hour of opening my eyes it will go up to another 2 .
I take 9 units of tresiba on the morning and one metforman and with almost every meal I I will take one and a half units of humalog.
I had a meeting with my dietician and she said they is nothing she could do because I could not cab count with me taking so little humalog .
I stop eating at around 7 before I go to bed but it’s still high on the morning. I eat healthy don’t drink alcohol. Just wondering if anyone has any idea what could be going on .

 

[rebrascora]

Sounds like your basal dose of Tresiba isn't correct if you are rising as much as 5 units during the night. The extra rise of 2 units when you get up is likely what is referred to here as Foot on the Floor syndrome (FOTF), where your liver is pumping out extra glucose to give you energy to start the day. Some of us counteract this by injecting a small amount of fast acting insulin as soon as we wake up. However, it sounds like you are still very early in your journey with diabetes and insulin and perhaps haven't been instructed in the use of doing corrections yet. It also may be the case that your Tresiba dose is being kept a little lower than you need to bring your levels down into range slowly so that there is less strain on the small blood vessels in your eyes and feet etc. The best thing to do is to speak to your DSN and perhaps discuss a possible slight Tresiba increase and ask about using your Humalog for corrections. There is a lot to learn with insulin therapy and you need to accept that it will take time to get reasonably consistent in range results and even then it is much harder for some than others to find the balance. Slow and steady progress is the way to go.

 

[Ian67]

Sounds like your basal dose of Tresiba isn't correct if you are rising as much as 5 units during the night. The extra rise of 2 units when you get up is likely what is referred to here as Foot on the Floor syndrome (FOTF), where your liver is pumping out extra glucose to give you energy to start the day. Some of us counteract this by injecting a small amount of fast acting insulin as soon as we wake up. However, it sounds like you are still very early in your journey with diabetes and insulin and perhaps haven't been instructed in the use of doing corrections yet. It also may be the case that your Tresiba dose is being kept a little lower than you need to bring your levels down into range slowly so that there is less strain on the small blood vessels in your eyes and feet etc. The best thing to do is to speak to your DSN and perhaps discuss a possible slight Tresiba increase and ask about using your Humalog for corrections. There is a lot to learn with insulin therapy and you need to accept that it will take time to get reasonably consistent in range results and even then it is much harder for some than others to find the balance. Slow and steady progress is the way to go.

Hi and thank you for that I have now been type 1 for 1 and a half years they said I was type 2 at first.
Iv tried to speak to my nurse and she just keeps saying it’s trial and error it’s my body and only I know how it works. Whenever I’m really busy I don’t need to take any humalog at all and I can eat what ever I like and my levels will not go above 7 or 8 and my morning level will be the same . But you can not be busy 24 hours a day .

 

[helli]

Do you have a half unit pen for your Humalog?
I understand they do not do half unit reusable pens for Humalog but I think they do single use ones. Just thinking half a unit may help with your foot on the floor rise.
There are other insulins such as NovoRapid which do have reusable half unit pens and are more common.

I am also surprised you are taking Metformin. I am not a doctor or medically trained so I may be wrong but I though metformin was only prescribed for people with Type 1 who experience insulin resistance. Given your sensitivity to Humalog, that seems unlikely. It may be worthwhile asking if you need it given your diagnosis is no longer type 2.

 

[rebrascora]

It is normal for your levels to drop when you are active and one of the problems with Tresiba is that it doesn't give you much flexibility to alter it for those days and increase it for the more sedentary days, because it takes 3 days for any changes to have their full effect, whereas a shorter acting basal insulin like Levemir can be adjusted and get results pretty much within the next 12 hours, so much more responsive.
I would ask to be put forward for an intensive education course like DAFNE or whatever your local equivalent is. You will learn how to adjust your basal and bolus insulin and use it for corrections and they may recommend that you change basal insulin to something more flexible like Levemir which you can then adjust as necessary. The course tutors are DSNs so they have the authority to change your prescription if they feel it may be helpful. They can also recommend half unit pens etc. And you get to spend time with other Type 1s which is a huge benefit in itself as you learn so much from each other.

 

[Lucyr]

Do you have a half unit pen for your Humalog?
I understand they do not do half unit reusable pens for Humalog but I think they do single use ones. Just thinking half a unit may help with your foot on the floor rise.
There are other insulins such as NovoRapid which do have reusable half unit pens and are more common.

I am also surprised you are taking Metformin. I am not a doctor or medically trained so I may be wrong but I though metformin was only prescribed for people with Type 1 who experience insulin resistance. Given your sensitivity to Humalog, that seems unlikely. It may be worthwhile asking if you need it given your diagnosis is no longer type 2.

They do make half unit humalog pens. I have one from when there was an apidra shortage and I had to switch.

 

[JJay]

They do make half unit humalog pens. I have one from when there was an apidra shortage and I had to switch.

Would that be the Humapen Luxura HD? Unfortunately they have now been discontinued and there is no indication of a replacement.

 

[Ian67]

Do you have a half unit pen for your Humalog?
I understand they do not do half unit reusable pens for Humalog but I think they do single use ones. Just thinking half a unit may help with your foot on the floor rise.
There are other insulins such as NovoRapid which do have reusable half unit pens and are more common.

I am also surprised you are taking Metformin. I am not a doctor or medically trained so I may be wrong but I though metformin was only prescribed for people with Type 1 who experience insulin resistance. Given your sensitivity to Humalog, that seems unlikely. It may be worthwhile asking if you need it given your diagnosis is no longer type 2.

Yes I have half units on my humalog pen they have put me a child’s one I know this seems silly but humalog seems not to work very good.

 

[Ian67]

It is normal for your levels to drop when you are active and one of the problems with Tresiba is that it doesn't give you much flexibility to alter it for those days and increase it for the more sedentary days, because it takes 3 days for any changes to have their full effect, whereas a shorter acting basal insulin like Levemir can be adjusted and get results pretty much within the next 12 hours, so much more responsive.
I would ask to be put forward for an intensive education course like DAFNE or whatever your local equivalent is. You will learn how to adjust your basal and bolus insulin and use it for corrections and they may recommend that you change basal insulin to something more flexible like Levemir which you can then adjust as necessary. The course tutors are DSNs so they have the authority to change your prescription if they feel it may be helpful. They can also recommend half unit pens etc. And you get to spend time with other Type 1s which is a huge benefit in itself as you learn so much from each other.

Thank you for your reply I will make enquiries on Monday hopefully I can contact someone.

 

[Inka]

Yes I have half units on my humalog pen they have put me a child’s one I know this seems silly but humalog seems not to work very good.

If you’re on fixed doses of Humalog you’ll probably have to limit your carbs according to what works for your blood sugar eg you might find your 1 and 1/2 units only works for a max of 50g carbs for lunch (just made up figure) and for other meals you might find you need different carb amounts for your 1 and 1/2 units. You also need to make sure you’re injecting the Humalog far enough in advance of your meal.

But - these highs sound like a basal problem as others have said. You’d find a twice a day basal more flexible and you could then have enough to keep your steady at night in your evening dose, and whatever you need to keep you on track during the day in your morning dose. So much better IMO.

 

[Ian67]

If you’re on fixed doses of Humalog you’ll probably have to limit your carbs according to what works for your blood sugar eg you might find your 1 and 1/2 units only works for a max of 50g carbs for lunch (just made up figure) and for other meals you might find you need different carb amounts for your 1 and 1/2 units. You also need to make sure you’re injecting the Humalog far enough in advance of your meal.

But - these highs sound like a basal problem as others have said. You’d find a twice a day basal more flexible and you could then have enough to keep your steady at night in your evening dose, and whatever you need to keep you on track during the day in your morning dose. So much better IMO.

Thank you I have tried to carb count and it never works iv had high carb food Been at 8 had a Chinese prawn curry rice chips prawn crackers it was just to see what would happen and I plummeted and I only took 1.5 units of humalog. It seems the more I eat the less fast acting I need .

 

[Inka]

Interesting @Ian67 I wonder if you might be able to find a ‘happy medium’ of carbs - ie don’t have too few but also don’t have too many so you can avoid that plunge. Another option is to have a small carb snack to ward off the plunge. It’s probably caused by some of your own insulin coming in too late and too much.

 

[everydayupsanddowns]

Sorry to hear you are having such a confusing time @Ian67

It does sound like your diabetes is behaving in a very strange and atypical way, which must make it really hard for you. It also doesn’t sound like you are getting much in the way of actionable suggestions from your appointments either.

Have you considered a fasting basal check, to see what happens when you only have basal active at various sections of the day?

How To Successfully Test Your Basal Rate

Are you looking for basal rate information and testing instructions? Perfect! You're in the right place!

www.mysugr.com

I wonder if you might still have some beta cells ‘helping out’ but not necessarily consistently or reliably?

Might be interesting to ask for a cPeptide test to see how much home grown insulin production you still have?

 

[rebrascora]

Thank you I have tried to carb count and it never works iv had high carb food Been at 8 had a Chinese prawn curry rice chips prawn crackers it was just to see what would happen and I plummeted and I only took 1.5 units of humalog. It seems the more I eat the less fast acting I need .

It might be that the fats in that meal delayed the glucose release and your insulin kicked inand caused you to hypo before they were digested. Can you remember if your levels went high afterwards?
The other possible cause is as @everydayupsanddowns suggested that you own pancreas is still generating some insulin in unpredictable fits and spurts.