Insulin use

[ivygirl]

I have been type 2 for many years now but have only recently been put on insulin. I have been trying so hard to get a grip but I’m failing miserably. I’m waiting for an operation and have been told to keep levels consistently below 10. Before bed I was 5.7 but this morning was 11.9! How is that when I have had nothing to eat or drink through the night? I have come down a bit, when I started the insulin I was 19.4 just not enough to have this op (incisional hernia) Be grateful for advice.

 

[Inka]

When did you start the insulin exactly @ivygirl and what insulin are you taking (full name) and when?

 

[ivygirl]

Insuman Basal solar star. I started 30 December. 16 units a day.

 

[rebrascora]

Hi. Sorry to hear you are struggling. Knowing the insulin(s) you are using and when you use it might help us to understand your situation a bit better. Are you on any other medication to manage your diabetes?
Also what did you have for your evening meal and when did you eat it? Your overnight rise could be due to slow release carbs raising your levels whilst you sleep. Things like pizza and pasta with creamy sauces and Chinese or Indian meals can be notorious for that and high fibre foods with lentils and beans can also release their glucose whilst you sleep.
Alternatively it could be the release of glucose from your liver which has raised your BG levels. The liver trickles out glucose in the absence of food (like when we are sleeping/fasting) to ensure a steady supply of energy for our vital organs, to keep our lungs breathing and our heart pumping and our brains alive and any regeneration of the body. If you are not producing enough insulin or have the right dose or combination of insulin to match your liver output then your levels will rise even if you didn't eat at all the previous day. I think of my liver as my back up battery for when the mains power goes out. usually we have a long acting insulin which is injected to utilize that glucose trickled out by the liver. Sometimes this is a separate injection and sometimes the long acting insulin is mixed with a quicker acting insulin which works on the food you eat, so knowing the name of the insulins you are using will help us to figure out what is going wrong and how you might be able to tackle it.
It is also helpful to understand that the liver pumps out a lot more glucose as we start to wake up and get up out of bed. This is called Dawn Phenomenon or more colloquially as "Foot on the Floor" syndrome. That in itself can raise my BG levels by as much as 6 whole mmols in a matter of an hour, so it can be quite significant. I therefore always check my BG before I set foot out of bed and inject my insulin at the same time to counteract it. Depending on which insulins you have this may help for you too. If you are typically getting up and going to the loo and getting washed and dressed and sitting down with a cup of coffee before you test then your reading is likely to be inflated.

 

[rebrascora]

Insuman Basal solar star. I started 30 December. 16 units a day.

Solo star is usually Lantus I believe otherwise known as Glargine? Can you see than written anywhere?

Do you just inject it once a day and if so, when?

 

[Lucyr]

Solo star is usually Lantus I believe otherwise known as Glargine? Can you see than written anywhere?

Do you just inject it once a day and if so, when?

Solostar is just the name Sanofi give to their disposable pens. Insuman is the name of the insulin, it’s made by Sanofi hence the solostar

 

[rebrascora]

Solostar is just the name Sanofi give to their disposable pens. Insuman is the name of the insulin, it’s made by Sanofi hence the solostar

Thanks for that Lucy. Will now Google Insuman as never heard of it but guessing perhaps similar to Insulatard...

 

[Inka]

Thanks @ivygirl Insuman is an isophane insulin and although it can last for up to 24 hrs, it usually lasts closer to 12 hours. What time of day do you take it? Perhaps it’s not lasting hence the highs.

I use isophane as a basal when I take a pump break, and I take it twice a day.

 

[Inka]

It’s still early days for you and it’s possible your dose might be tweaked slightly. However, you could also ask if twice a day might work better.

 

[ivygirl]

I have been having the injection around 9.30 am. I will give it a try to Inject before getting out of bed!

 

[rebrascora]

That definitely should help. I actually set my alarm for an hour before I am going to get up and inject and go back to sleep and let the insulin start doing it's magic for an hour before I get up. I keep my insulin and glucose monitor under my pillow and jelly babies and glucose tablets on the bedside table in case of overnight hypos, so everything is very close to hand when I need it. I can even inject without putting the light on now..... just dial up the air shot, tap the pen across the back of my hand to feel that insulin is emerging, then count the clicks up for my dose and inject and go back to sleep. If you have a new needle fitted when you go to sleep you don't need to faff on changing needles and can dispose of the used one when you get up and prime it with a new one ready for the next morning. Minimum fuss and no light means that I barely wake up and drop straight off again. Obviously I have been injecting for a while so it is a bit second nature and you will need to take more trouble initially.

 

[Inka]

I have been having the injection around 9.30 am. I will give it a try to Inject before getting out of bed!

That might work but might not. My thought is that your insulin is running out overnight. If you have it earlier in the day, and that’s the case, it will just run out earlier in the night and you’ll still be high in the morning.

See how it goes.

 

[rebrascora]

That might work but might not. My thought is that your insulin is running out overnight. If you have it earlier in the day, and that’s the case, it will just run out earlier in the night and you’ll still be high in the morning.

See how it goes.

Depends when levels start to rise. I think you agree that most people need much less through the night and needs tend to increase in the morning. It is worth a try as a first option but if this insulin is one which can be split into 2 doses then that would be the next thing to explore certainly but may need some discussion with your HCP (Health Care Professional) before implementing, whereas moving the dose forward by a couple of hours or so shouldn't need any authorization.

 

[Inka]

Yes, we won’t know for sure until @ivygirl tries for a few days. For me, the ending of isophane is usually quite obvious. It kind of grinds to a halt quite abruptly. I have to watch the timing of my dose at night because if I have it too early it will run out rather than deal with my Dawn phenomenon. Too late and I’ll have risen because my morning dose has worn off.

 

[trophywench]

Sorry to slightly sidetrack but I thought I needed less insulin at night for years. However once I started pumping and hence could have up to 24 different base rates I discovered I need a pretty huge amount between c.10pm and 2am ish, then lower again for a few hours, bit more until I get out of bed, then increases a bit till lunchtime then drops again for part of the afternoon ....

Anyway that's immaterial when the problem is Insuman isophane by pen injection. Old isophanes were always twice a day. There isn't the expertise these days in most of the medical profession re using older types of insulin I'm afraid and I reckon they just play it by ear - that means guesswork. So @ivygirl - ring whoever's put you on the insulin and tell them that the people on the DUK forum reckon it ought to be twice a day, and that this is borne out by the BG testing you've been doing, it obviously needs changing, so how much of it do they suggest you have and at which times of day?