Hyper advise please

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CoventryTrev

CoventryTrev

Well-Known Member
Relationship to Diabetes
Type 3c
My numbers have been going up since 7pm tonight. They were sitting on 10 most of the day then jumped to 15 at 7pm, 19 at 8.30pm and are now sitting on 20.
I gave myself 5 units at 7.15pm, 10 units at 8.45pm but the numbers are still.going up.
How often can I give myself insulin or is everyone different?
 
CoventryTrev said:
My numbers have been going up since 7pm tonight. They were sitting on 10 most of the day then jumped to 15 at 7pm, 19 at 8.30pm and are now sitting on 20.
I gave myself 5 units at 7.15pm, 10 units at 8.45pm but the numbers are still.going up.
How often can I give myself insulin or is everyone different?
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Did you inject the correct insulin.
Do you have means of testing for ketones in your urine with ketosticks as your level is quite high.
You could call 111 for advice if it stays high.
 
Are you giving yourself correction doses of fast acting insulin? If so, please do not inject any more just yet. 15 correction units stacked like that is a lot! Have you been given a correction factor? ie 1 unit drops your levels 3 mmols or something similar. 3 is usually the starting point for corrections.
You need to give the corrections time to work and when levels are that high, you become insulin resistant, so it takes longer for them to work.
What did you have for your evening meal and when did you inject for that? I am worried that you might now have 3 lots of fast acting (bolus) insulin in your system which could cause a nasty hypo later.
 
Also, are you relying on Libre for your readings or have you double checked these high readings with a finger prick?
Libre often over estimates high levels and is slow to show your levels changing course and coming down so always important to double check with a finger prick before calculating corrections or injecting more insulin.
 
rebrascora said:
Are you giving yourself correction doses of fast acting insulin? If so, please do not inject any more just yet. 15 correction units stacked like that is a lot! Have you been given a correction factor? ie 1 unit drops your levels 3 mmols or something similar. 3 is usually the starting point for corrections.
You need to give the corrections time to work and when levels are that high, you become insulin resistant, so it takes longer for them to work.
What did you have for your evening meal and when did you inject for that? I am worried that you might now have 3 lots of fast acting (bolus) insulin in your system which could cause a nasty hypo later.
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Hi Barbara.
I've not been given any correction factors, still in waiting for my first appointment with the hospital diabetes team in November. Had dinner around 6pm which was lasagne and gave myself 5 units just before.
 
rebrascora said:
Also, are you relying on Libre for your readings or have you double checked these high readings with a finger prick?
Libre often over estimates high levels and is slow to show your levels changing course and coming down so always important to double check with a finger prick before calculating corrections or injecting more insulin.
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First reading of 19 on Libre was backed up by a finger prick test and they was a 0.1 difference between the two.
 
CoventryTrev said:
Hi Barbara.
I've not been given any correction factors, still in waiting for my first appointment with the hospital diabetes team in November. Had dinner around 6pm which was lasagne and gave myself 5 units just before.
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Ok so your BG was about 10 before you ate the lasagne and you injected 5 units for that.... How long before you ate the lasagne did you inject the NovoRapid?
 
rebrascora said:
Ok so your BG was about 10 before you ate the lasagne and you injected 5 units for that.... How long before you ate the lasagne did you inject the NovoRapid?
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I've been told to inject 5 units just before a meal so it would have been a matter of a couple of minutes.
 
Ok, so the insulin didn't really have time to start working and the carbs hit your system first and your levels were already a bit high at 10 so it is unlikely that there is anything too untoward going on and it is just a question of not enough prebolus time and not enough bolus insulin for your meal.

Did you have anything else with or after the lasagne? Salad, garlic bread, chips... any dessert?
What sort of size portion was the lasagne?.... Just trying to calculate roughly how much it might have needed and how much you now have in your system....
 
Was it a ready meal lasagne or home cooked? Just wondering if you can check the packaging info if it was a ready meal.
 
rebrascora said:
Was it a ready meal lasagne or home cooked? Just wondering if you can check the packaging info if it was a ready meal.
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It was a supermarket premade one so not a massive portion plus half a garlic bread.
Sorry to be a pain in the a#@e but I'm still learning and appreciate your help.
 
CoventryTrev said:
It was a supermarket premade one so not a massive portion plus half a garlic bread.
Sorry to be a pain in the a#@e but I'm still learning and appreciate your help.
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No problem. I appreciate you are working in the dark.

Just to clarify, you now have 20 units of NovoRapid in your system. 5u just before the meal and then another 5u at 7.15pm followed by a further 10u at 8.45pm?

Can you dig the packaging out of the bin and look at the nutritional info box on it. It will usually be on the side or back/bottom. It will include info on protein and fat and carbohydrate and it will say "of which sugars" under the carbohydrate. It will then give a couple of numbers. The first will be g/100g of product and the second will be per portion. It is the number of carbs in the portion which is required. Also was the garlic bread a french stick style that you had half of?
 
I took the rubbish bag down to the communal bins earlier, I don't fancy jumping into that lol
The garlic bread was one of those small French stick ones from Aldi.
Yes, 20 units between 6pm and 8.45pm.
Just checked again and now it's down to 17.0 and just have a nice headache with it.
 
I am going to guess about 50g carbs in the lasagne and another 40 in the garlic bread. If you work on a ratio of 1:10 which we probably don't know but it is a ball park figure, then those last 10 units you injected may become slightly problematic. The fact that your levels were high to start will soak up some of the excess though due to insulin resistance.

NovoRapid acts over a period of 5 hours so you are going to need to keep an eye on your levels into the small hours to keep yourself safe as it may well drop you too low.

Is Libre showing your levels coming down at all yet?
 
So just to recap, I am estimating that there were about 90g carbs in your meal. If you were using a 1:10 ratio which is a standard starting point for assessing carb to insulin ratios, ie 1 unit for every 10g carbs you eat, then 9 units would have been about right for that meal, so your first and second injections should have covered it. The problem was that your levels were already a bit high to start with at 10 and you didn't give the insulin a head start by injecting it in advance (for me I would have probably needed to inject the insulin nearly an hour before eating to prevent that spike up to 20 because NovoRapid is a misnoma. It's actually quite slow in comparison to home produced insulin, so you need to give it a head start on the food. Ordinarily 15-20 mins in advance of your meal, but with your levels already being high it will take longer, which is why I would need to inject it about an hour before eating. You might have got away with 30 mins. We are all a bit different in that respect, but injecting just before you eat is always going to lead to a spike and my levels would have done exactly as yours have so there isn't anything sinister going on, it's just that you don't have enough information to manage it and the Libre data is panicking you into action that might be unnecessary..... in particular that extra 10u of NR at 8.45pm.
If you were only relying on finger pricks you would be unlikely to know that your levels had gone so high and have reacted by injecting more. This is a real temptation with Libre and I occasionally do it myself sometimes. You have to be a bit patient and give the insulin you have injected time to work (ie 5 hours).

How are your levels now? Do you have a downward sloping arrow?
 
It was 17.0 ten minutes ago now its 17.8 with a straight arrow.
Tomorrow I'm going to try and do my meal insulin half hour before eating.
 
Don't be fooled by that leveling out, I am pretty certain it will start to drop again soon. Probably as that last 10 units gets into full swing.

Prebolusing is one of the most important tricks for reducing spikes but you need to be cautious with it and take into account your BG levels before you inject. So if your BG is at 4.5 when you start thinking about your meal, then you might only need 5 or 10 mins and if it is say 7 then you might need 20-30 mins. If it is 10 you will probably need a bit longer (for me it would be about an hour) but the important thing is to start experimenting with it carefully and increase the time by 5 mins each day until you find the perfect timing for you and your body. So start with maybe just 10 mins prebolus time tomorrow and then if you still spike badly, give it 15 mins the next night and so on. We are all different in our sensitivity to insulin and it is important not to be too Gung Ho with it and end up hypo.... which is what I am concerned about tonight with that last 10 units you injected. That insulin will not be finished working until about 1.45am which I am guessing will be after your bedtime, so do be well prepared to treat a hypo tonight and keep treatment and testing kit by your bed and maybe set an alarm for 1am to wake up and check levels..... or you may find that they start to drop dramatically before bedtime and you need to take on some more carbs before you go to bed. Please keep a close eye on your Libre and if you get to 7 with a vertical downward arrow, start with a couple of JBs (jelly babies) or whatever you use and use them to slow the drop. I don't think you will have a full 10units of insulin to mop up but there might be 4 or 5units spare which could be about 10JBs or 2 JBs and 3-4 digestive biscuits but that is very much guess work, so best to watch your Libre and slowly feed in a few carbs at a time IF you get to 7 or 8 and dropping fast in the next hour.
 
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