Is this normal?

[tracey w]

Hi all,

Just wondering if it is a normal pattern for bs to drop around tea time? I have noticed that the time I am most likely to go low is between 5 - 7 pm, regardless if i have snacked before tea.

Just wondering if my liver may be recouping or something around this time? Or and I know this sounds bizarre, is my basal peaking then ( I take my humulin I at 11pm?) so around 18 hours later.

I always find that I can drop around 4 - 8 in less than an hour in this period. For example was 7.1 at 5.54pm, tested before drive home, had a biscuit 1 hour earlier, arrived home at 6.40 was 3.3.

just hoping you guys can shed some light on this and if anyone else experiences this at this time of day?

 

[Viki]

Hi Tracey,

Do you carb count? could be your lunchtime ratio is slightly high?

 

[tracey w]

Hi Tracey,

Do you carb count? could be your lunchtime ratio is slightly high?

Well not been taught how to yet, been put on list for daphne, but dsn not been much help when I changed to basal/bolus regime about 8 weeks ago. They never get back to me and make me feel like an inconvenience when I do get through so been doing it on my own to be honest. I try to carb count in the fact that I read how to work it out on a website that was recommended on here. Seems according to my basal i am approx 1 unit to 15g of carbs. But seem to find i need 1:10. However i dont understand how it changes between breakfast, lunch, dinner etc. Sorry to waffle, long and short is I guess how many units i need to approx amount of carbs.

normally take between 4-6 units depending on what im eating and my reading. But find i can go too high if I only take 4 at lunch.

 

[Adrienne]

Hi Tracey

Once you get the hang of carb counting it really is easy but it is the initial getting your head around it.

You don't actually need a Dphne course, you are doing ok, you just need the understanding of why you are doing it.

You have started perfectly fine, 1 unit to 15 carbs is great as a starting point. You will find that for breakfast you will need more insulin and it will change. This is because in the morning you are a lot more resistant to insulin and a lot more sensitive in the evening.

My daughter's ratios (she is pumping though) are 1 to 10 cho for breakfast, 1 unit to 18 cho for lunch and 1 unit to 26 cho for tea time so it really is a huge difference.

There are a couple of good books out there for carb counting which you can get on Amazon. This is my favourite book and it is 1p from Amazon

http://www.amazon.co.uk/Carbohydrat...=sr_1_1?ie=UTF8&s=books&qid=1234381186&sr=1-1

or there is this one which most of my friends use

http://www.amazon.co.uk/Carb-Counte...r_1_14?ie=UTF8&s=books&qid=1234381140&sr=1-14


To check to see if you have the ratio of insulin to carb right you need to test before eating and give insulin, then you need to test after 2 hours. Your reading should be near enough the same as it was before eating. If it isn't then the ratio is probably a bit out. However do you figure in corrections when you do your food bolus? Have you worked out your correction amount? This is a bit harder. I have a friend who knows that 1 unit brings her son down by 3 mmol but another friend says 1 unit brings her daughter down by 8 mmols. That bit is trial and error.

I hope I have helped a bit and am always happy to help with carb counting or whatever.

Adrienne 🙂

 

[tracey w]

Adrienne thank you so much, it makes so much sense when explained. why has no one ever explained this to me before? I go really high after breakfast and now i know why. Seem to be ok after lunch, but think i need a higher ratio for tea as i can go high before bed too. If only i was explained all this i would know what i was doing much better. I do correct but again not been told how to, am working on 1 unit per 3mmol at moment, as what i have reqd on this site! and seeing how that goes.

thanks so much, will try those websites also.

thought i was experiencing tea time phenomenom lol !!!

 

[Adrienne]

No problem.

However you have now mentioned the dreaded mid morning spike. Unless you pump, it is very very difficult for most to get rid of the mid morning spike without going hypo by lunch.

Just as an example on a pump for my daughter, she has to have a huge increase in insulin at 6 am to combat the spike at 10.15 am. with a pump you have a bit trickling in for 24 hours on an hourly basis. It is novorapid but on MDI it is the equivalent of Lantus/Levemir. The difference with a pump is you can change the amount going in on an hourly basis. So regardless of the breakfast insulin, so stop the spike she needs a huge amount of NR on the background rate at 6 am. Then at 10 am we have to drop the back ground rate to nothing at all to stop the hypo at lunch time.

So on MDI sometimes there is no chance. The only way around it, is injecting your NR before you eat breakfast and play around with how much but you will no doubt need a snack mid morning of about 15 carbs.

Not sure I have explained that very clearly!

Adrienne 🙂

 

[tracey w]

No problem.

However you have now mentioned the dreaded mid morning spike. Unless you pump, it is very very difficult for most to get rid of the mid morning spike without going hypo by lunch.

Just as an example on a pump for my daughter, she has to have a huge increase in insulin at 6 am to combat the spike at 10.15 am. with a pump you have a bit trickling in for 24 hours on an hourly basis. It is novorapid but on MDI it is the equivalent of Lantus/Levemir. The difference with a pump is you can change the amount going in on an hourly basis. So regardless of the breakfast insulin, so stop the spike she needs a huge amount of NR on the background rate at 6 am. Then at 10 am we have to drop the back ground rate to nothing at all to stop the hypo at lunch time.

So on MDI sometimes there is no chance. The only way around it, is injecting your NR before you eat breakfast and play around with how much but you will no doubt need a snack mid morning of about 15 carbs.

Not sure I have explained that very clearly!

Adrienne 🙂

yes, i think i know what you mean, i can go hypo if i only increase by 1 or 2 units at breakfast, when i drop down again i can be 20 2 hours in, or not, today i was 10 2 hours after breakfast on only 4 units, normal reading to start with. Is very tricky? I always snack if im in normal range before lunch, but always check bs, must check around 10 times a day now.

would love to be on a pump, but dont think i qualify. which does annoy me, i think if you are diabetic and want to pump that should be qualification enough. I am dedicated enough to testing and monitoring food etc, i just want to be healthy. thanks again.

 

[Adrienne]

Hi Tracey

Don't be too quick to write off a pump just because you don't think you will qualify. You probably do. The NICE guidelines changed in July last year and it is not that hard to qualify for one. One of the criteria for over 12's (and under) is if you have an HbA1c over 8.5%, another is if you have disabling hypos (sounds like you do), it says you have to have tried MDI, which you are and it is not perfect. Take a look at the INPUT website :

www.input.me.uk

I have taken this from the INPUT website :

"In order to receive a pump and pump supplies bought by the NHS, patients must meet certain criteria. The 2008 National Institute for Health and Clinical Excellence (NICE) technology appraisal on insulin pump therapy says:

Continuous subcutaneous insulin infusion or "insulin pump" therapy is recommended as a possible treatment for adults and children 12 years and over with type 1 diabetes mellitus if:

- attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDI) result in the person having "disabling hypoglycaemia". For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life.

OR

- HbA1c levels have remained high (8.5% or above) with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to manage their diabetes.

The NICE guidance does not mean that a person"s HbA1C must be higher than 8.5% in order to have a pump. It mentions 8.5% because when person has an HbA1C level of 8.5% or higher, he or she is likely to require much more care from the NHS than is usually needed by someone with an HbA1C below 8.5%. Based on the results of the DCCT, most doctors now agree that it is best for all people with diabetes to keep an A1C level below 7% to prevent or delay complications of diabetes."


Are you over 8.5% and you do have hypos. If you qualify then you can have a pump. If your clinic do not do pumps you can transfer. I have loads of friends who have had to transfer, my daughter is one of them. Your GP can do a referral letter for you to the hospital that you find that does pumps.

Adrienne🙂

 

[tracey w]

Hi Tracey

Don't be too quick to write off a pump just because you don't think you will qualify. You probably do. The NICE guidelines changed in July last year and it is not that hard to qualify for one. One of the criteria for over 12's (and under) is if you have an HbA1c over 8.5%, another is if you have disabling hypos (sounds like you do), it says you have to have tried MDI, which you are and it is not perfect. Take a look at the INPUT website :

www.input.me.uk

I have taken this from the INPUT website :

"In order to receive a pump and pump supplies bought by the NHS, patients must meet certain criteria. The 2008 National Institute for Health and Clinical Excellence (NICE) technology appraisal on insulin pump therapy says:

Continuous subcutaneous insulin infusion or "insulin pump" therapy is recommended as a possible treatment for adults and children 12 years and over with type 1 diabetes mellitus if:

- attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections (MDI) result in the person having "disabling hypoglycaemia". For the purpose of this guidance, disabling hypoglycaemia is defined as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life.

OR

- HbA1c levels have remained high (8.5% or above) with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to manage their diabetes.

The NICE guidance does not mean that a person"s HbA1C must be higher than 8.5% in order to have a pump. It mentions 8.5% because when person has an HbA1C level of 8.5% or higher, he or she is likely to require much more care from the NHS than is usually needed by someone with an HbA1C below 8.5%. Based on the results of the DCCT, most doctors now agree that it is best for all people with diabetes to keep an A1C level below 7% to prevent or delay complications of diabetes."


Are you over 8.5% and you do have hypos. If you qualify then you can have a pump. If your clinic do not do pumps you can transfer. I have loads of friends who have had to transfer, my daughter is one of them. Your GP can do a referral letter for you to the hospital that you find that does pumps.

Adrienne🙂

Hi, my HbA1c was 8.3 and one before 8.1, both before mdi. My next appont,ent is 2th march, to be honest my control has not been much better since i started this regime.

I do get hypos, not frequently, but dont know what disabling means? I dont have to be helped, I generally feel them starting, but do have to stop and treat them. doe that qualify?

I do try really hard but because i test so frequently i still find no real pattern in my control and its been a year now. I can litterally drop 6 - 8 in half an hour to an hour sometimes, this is what i find most scary. My lowest hypo was 1.9 and that was the one i didnt have any symptoms for???

At this point i dont see that my next result would be much lower. How can i find out if my trust do pumps? I have tried searching the internet but not found out. May just try dsn again and see what they say. Trouble is as ive mentioned they are soo difficult to get a response from.

 

[tracey w]

sorry, just read again, you have explained disabling hypos! Dont think thats me just yet, but I think I may qualify for high HbA1c??😱

 

[Adrienne]

Hi Tracey

I think you do qualify personally. I think certainly come under this bracket :

"......repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life."

If you have having lots of hypos, which you are, they are unpredictable and definitely reaccuring and definitely having an adverse affect on your life.

And also yes your HbA1c whilst not at 8.5 it is on the up and it definitely isn't a good level, under 7.5 would be better and according to INPUT under 7.0% is trying to be achieved.

What people worry about the most is funding. This is the thing that people should worry about the least!! Seriously. If a consultant says you need a pump and this consultant writes to your own PCT (Primary Care Trust), they CANNOT refuse funding. They have to provide the funding. Hospitals work in different ways. My daughter is under the UCLH, one of the top for children and pumps in the UK. They actually buy the pumps themselves and the PCT where I live (not in London) have to pay for the consumables which is the cannulas and tubing etc. Some hospitals make the PCT's pay for the actual pumps. They cannot refuse so you do not need to worry about that and don't let anyone tell you otherwise.

The hardest thing is finding a hospital who does pumps. Does your hospital do pumps for adults? If so then ask them. They will most like tell you that you have to be able to carb count which is fair enough and is not hard to do. They may tell you no you don't qualify. If you want a pump you need to go prepared with an argument that you do qualify and this is why and tell them.

If your hospital doesn't do pumps for adults, there will be one which will be accessible to you and all you need to do is ring them and ask them if you can be referred to them for a pump and then go to your GP. Your GP can refer you. Some GP's try and talk people out of it (this has recently happened to a friend of mine - they persevered and started quoting NICE and other things and bingo got a referral) but stand your ground and ask nicely.

I hope that help a bit more with info.

Adrienne

 

[tracey w]

yes, you are right in everything you say. Although I personally do not feel i have many hypos, the fact im testing so often proves i am anxious about them occurring and if anything staying higher in order to avoid.

I have briefly looked at the input website thanks, it provides good information. I will certainly enquire with my dsn, I am genuinely worried about my future health with my high results and i think they should appreciate that. I will keep you informed.