Good morning all I’m hoping that I might get some help today on this very confusing subject. I was diagnosed as a type 2 last year after the doctor missed my symptoms from a number of time visiting doctors. He eventually did a test for diabetes after losing 3 stone and looking like death when I turned up at his surgery. The finger prick showed 15 and I had 3.5 ketone I done a blood sample next day I got called in and my bloods was showing 135 high . The Same day he put me on metforman and glictiside and sent me home . A month later I was called in to hospital to see the consultant and I was given the dreaded news I was a type 1 not a type 2 and I was put on 2.5 units of humalog 4 x a day and 7 units of tresiba once a day and 2x 500 mg metforman . And my sugar levels was dropping really quickly when I was taking the humalog after food sometime even down to 2 and I was showing no symptoms of a low that was the scary part . The consultant advised me to run at about a 10 due to my job being very active and to eat more carbs . My diet consists of porridge on the morning with my 7 units of tresiba and 2.5 of humalog and 1 metforman then salmon broccoli and some new potatoes for dinner and maybe boiled egg and toast for tea at round about 7 at night so I will go to bed at about a 7-10 but wake up as a 13 and even sometime 15 this has got me really confused as I’m doing my hardest to keep in line with everything but then it feels like it’s a waste of time struggling during the day to keep my levels right . I don’t drink alcohol I do smoke and very active 54 years old on some days I could eat what I wanted and take no insulin due to my job . But I always need to keep a eye on my level because when they start to drop they don’t stop . I would be very grateful if anyone out there could give me some advice on waking up to high level and any other advice on the subject. Thank you
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New type one
- Thread starter Ian67
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Pumper_Sue
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- Type 1
Hello and welcome to the forum.
Can I ask you please to break down your post as it's very difficult to read as it it 🙂
One of the bits I picked up was the fact you take your bolus after you have eaten this is not correct it needs to be taken 15mins before you eat.
As you are waking up so high it means you do not have enough background insulin. So you need to ring your nurse and ask about increases this if you are not confident in doing so yourself.
Why are you taking Metformin? It's not type 1 med unless you have insulin resistance, which you obviously don't have.
If you are having so many lows with using the bolus insulin then consider stopping it until your pancreas decides you need the extra help.
Also consider looking at the type of carbs you are eating and perhaps add some extra protein to your meals as this will help the drop in levels.
The fact that you have no symptoms of low blood sugars also means you are not legally allowed to drive either.
Can I ask you please to break down your post as it's very difficult to read as it it 🙂
One of the bits I picked up was the fact you take your bolus after you have eaten this is not correct it needs to be taken 15mins before you eat.
As you are waking up so high it means you do not have enough background insulin. So you need to ring your nurse and ask about increases this if you are not confident in doing so yourself.
Why are you taking Metformin? It's not type 1 med unless you have insulin resistance, which you obviously don't have.
If you are having so many lows with using the bolus insulin then consider stopping it until your pancreas decides you need the extra help.
Also consider looking at the type of carbs you are eating and perhaps add some extra protein to your meals as this will help the drop in levels.
The fact that you have no symptoms of low blood sugars also means you are not legally allowed to drive either.
stephknits
Well-Known Member
- Relationship to Diabetes
- Type 1
Welcome to the forum Ian67. Forgive me if I have the wrong end of the stick but it looks like you are taking fixed doses of short acting insulin for your meals, rather than carb counting and adjusting the amount of insulin each time? If that is the case, it would be really worth your while enquiring about carb counting, as this will mean you can adjust your insulin to suit your meals rather than eat for your insulin.
If your levels are going up by more than 2-3 regularly in the night then your trepidation needs adjusting.
Sorry if all obvious and you do this already!
If your levels are going up by more than 2-3 regularly in the night then your trepidation needs adjusting.
Sorry if all obvious and you do this already!
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
I agree with both the above @Ian67 If you’re waking high, that’s your Tresiba not being enough. However, I’d also suggest you consider changing to Levemir or another twice daily basal insulin as that way you can adjust your day and night amounts separately eg have a tiny amount in the morning to cover the day, and a larger amount at night to stop your night rise.
I’d ask why you were on the Metformin too. It’s for insulin resistance - but you’re clearly not resistant.
Just read your fish and chips post - again, I’d be changing your basal insulin.
I’d ask why you were on the Metformin too. It’s for insulin resistance - but you’re clearly not resistant.
Just read your fish and chips post - again, I’d be changing your basal insulin.
Thank you for your reply I do eat a lot of chicken I always take my insulin with food not before thank you for that . I will try that the next time.Hello and welcome to the forum.
Can I ask you please to break down your post as it's very difficult to read as it it 🙂
One of the bits I picked up was the fact you take your bolus after you have eaten this is not correct it needs to be taken 15mins before you eat.
As you are waking up so high it means you do not have enough background insulin. So you need to ring your nurse and ask about increases this if you are not confident in doing so yourself.
Why are you taking Metformin? It's not type 1 med unless you have insulin resistance, which you obviously don't have.
If you are having so many lows with using the bolus insulin then consider stopping it until your pancreas decides you need the extra help.
Also consider looking at the type of carbs you are eating and perhaps add some extra protein to your meals as this will help the drop in levels.
The fact that you have no symptoms of low blood sugars also means you are not legally allowed to drive either.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Also, if you’re going low, so increase your meal carbs but then also increase your Humalog, you’ll still go low! You need to find the right ratio for you eg 1 unit of insulin covers 25g carbs or whatever. Ratios aren’t fixed - they vary per person and per meal. Some have a 1:10 ratio, some 1:7, some 1:20, etc.
But first get your basal sorted as if that’s wrong it will mess everything else up.
But first get your basal sorted as if that’s wrong it will mess everything else up.
But I was told I could only take my long active insulin once a day
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Yes - Tresiba is once a day but there are other basal insulins that can be taken twice a day eg Levemir as I mentioned in my post.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
@Ian67 There are a couple of excellent books that might help you: Think Like A Pancreas by Gary Scheiner, and Type 1 Diabetes in Children Adolescents and Young Adults by Ragnar Hanas. Ignore the title - it’s informative for older adults too.
Type 1 is a condition where we really need to ‘be our own experts’.
Type 1 is a condition where we really need to ‘be our own experts’.
Thank you to everyone on hear for the helpful advice I’m sorry if I did not explain myself correct it’s my first time I have ever been on a forum. I will just plod on for now and see if I can get a appointment to see my nurse at my local hospital. But could anyone recommend what is the best to eat and best time for last food before bed time .
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
It was just the lack of paragraphs @Ian67 Your problems came across ok 🙂 No need to apologise.
For a bedtime snack, it depends on the individual. You should have been given a bedtime minimum blood sugar eg “Don’t go to bed below 10” or whatever.
So, you could choose a snack where you can easily vary the amount of carbs eg oatcakes and peanut butter. One oatcake is approx 5G carbs so you can have as many as you need in increments of 5gs eg 10g total, 15g total, etc.
When you see the nurse, do ask about your basal. It seems your Tresiba is possibly too much during the day and not enough at night. As the Tresiba lasts a whole 24 hours you can’t vary the dose just for nighttime because that bigger dose will still be working through the day too. Levemir or similar will allow you to have more at night (to stop going high) but less for the daytime (to stop you going low and because you have an active job).
I’ll tag @rebrascora as I know she uses Levemir and is pleased with it.
For a bedtime snack, it depends on the individual. You should have been given a bedtime minimum blood sugar eg “Don’t go to bed below 10” or whatever.
So, you could choose a snack where you can easily vary the amount of carbs eg oatcakes and peanut butter. One oatcake is approx 5G carbs so you can have as many as you need in increments of 5gs eg 10g total, 15g total, etc.
When you see the nurse, do ask about your basal. It seems your Tresiba is possibly too much during the day and not enough at night. As the Tresiba lasts a whole 24 hours you can’t vary the dose just for nighttime because that bigger dose will still be working through the day too. Levemir or similar will allow you to have more at night (to stop going high) but less for the daytime (to stop you going low and because you have an active job).
I’ll tag @rebrascora as I know she uses Levemir and is pleased with it.
Hi. I don't want to possibly confuse you further but you've had a lot of good advice so far on these posts. The NHS for some strange reason delays providing carb-counting advice until a course months later. This does risk hypos. Do ask (insist even) that you are given carb counting advice for your Bolus. It'd dead simple. My lovely DN instructed me when I started insulin so I was fortunate. My db consultant recently considered moving me to Tresiba from Levemir as it lasts more than a day but does make it more difficult to adjust dosage. I inject my Levemir twice a day as it only lasts 15 hours or so. Yes, Tresiba is once a day only; they are both excellent Basals. I must challenge the medics advice to increase the carbs. It's much better to carb count and over time reduce your insulin to match the carbs that are right for you. Too many carbs can cause weight gain and larger BS swings. Find out what is right for you.
Hi again. One extra point about Metformin with insulin. It does no harm and helps BS reduction by a small extra amount. Some GPs/DNs like my DN wanted me to continue with it as Metformin supposedly has some other beneficial effects e.g. rumoured lower cancer risk. So if Metformin isn't giving you any issues then you may want to continue with the marginal benefits.
Thank you but if I do that ( carb counting) and taking the correct amounts per carbs I would be always too low example .
Fish chips peas 1 slice of bread I’m already at 10mmol I take 2.05 units of humalog and am plummeting down and I end up about a 5 mol . But if I have a salad ham sandwich with brown bread and a plain pack of crisps for for dinner and I’m at say a nine mmol and I take two units of humalog I go up to say a 13mmol . It’s seams the more I eat with with insulin the lower my levels. If I take humalog without food to say fetch me down it will not work but if I have it with food to fetch my levels down it will .
Fish chips peas 1 slice of bread I’m already at 10mmol I take 2.05 units of humalog and am plummeting down and I end up about a 5 mol . But if I have a salad ham sandwich with brown bread and a plain pack of crisps for for dinner and I’m at say a nine mmol and I take two units of humalog I go up to say a 13mmol . It’s seams the more I eat with with insulin the lower my levels. If I take humalog without food to say fetch me down it will not work but if I have it with food to fetch my levels down it will .
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Thank you
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Hi and welcome from me too
It is all very confusing at first so don't feel like you are doing anything wrong or failing in any way. There is an immense amount of trial and improvement with diabetes and whilst the learning curve is steepest in the first few months or years, it continues throughout your life but you have to become the expert in how your body and diabetes operates and it will be quite unique to you so whilst the health care professionals (and us) can give you guidance you will need to monitor and adjust for yourself to how your body works.
It sounds to me very much like you are struggling with the honeymoon period. This is where your remaining beta cells in your pancreas are producing insulin. It often happens that they have been stressed and struggling to cope for a while (particularly if you have initially been treated as Type 2) and then insulin being injected takes the strain off them as they are no longer having to work so hard and after a bit of a break they kick back in with renewed vigour, so when you eat a carb heavy meal, they are getting a signal from the liver to produce insulin and they swing into action not realising that you are also going to inject some extraneous fast acting insulin to cover those carbs, so you end up with too much insulin for what you ate. It might be worth discussing with your nurse, not using the Humalog for meals at the moment and perhaps just doing a correction (injecting some Humalog) 2 hours after your meals if your BG has gone too high.
As regards the Tresiba, it does sound like it might not be a suitable basal insulin for you and I would enquire about trying Levemir. I need much more basal insulin during the day than at night and I would hypo every night on Tresiba, because it trickles out a steady amount of insulin over 30+ hours. At the moment I inject 24units of Levemir in the morning even though I am quite active during the day but just 3units at night. I injected 4units last night as I have been waking up a bit high for the last few days but I hypoed last night so I will be back to 3units tonight. Being able to make that adjustment between day and night is essential for me with the way my body works. You would probably be the other way around and need to inject more Levemir at night and less in the morning if you were changed to that instead of Tresiba. You can fine tune Levemir much better to your body's individual needs. I have tried different quick acting insulins for my meals and there isn't a huge difference but I would fight tooth and nail if they ever tried to change my basal insulin as Levemir gives me the ability to tailor my doses to my body's requirements. Getting your basal insulin dose correct makes such a massive difference and everything else starts to make sense after that, so my thoughts are that your basal insulin is probably not suiting you and you are likely suffering from the honeymoon phase which is making things even more confusing. With the latter it is just a question of grin and bear it until your beta cells splutter to a halt but changing your basal should make things easier to cope with in the mean time, so I would definitely ask about that and perhaps ask about doing corrections 2 hours after meals (if necessary) rather than when you eat during this honey moon phase.
You might also want to ask about trialing the Freestyle Libre system as that will give you a much greater insight into what is happening with your BG levels. It involves applying a sensor to your arm which lasts 2 weeks and you can scan it 100+ times a day if you like to get a BG reading rather than finger pricks which are obviously very limiting. If you work in an unsanitary environment where washing hands for finger pricks is not always feasible, that is one of the parameters for prescribing it.... so manual labour on building sites, farm workers etc. Just something else to ask about.
Apologies if that is information overload.... basically 3 things to ask your nurse about....
1. Corrections 2 hours after meals instead of at the time because you are hypoing perhaps due to honeymoon
2. Basal insulin change to Levemir and a split dose (it can sometimes be started as a single dose for the first few months and then split, but that would not help you) because you seem to need much more at night than through the day.
3. Freestyle Libre monitoring system.
It is all very confusing at first so don't feel like you are doing anything wrong or failing in any way. There is an immense amount of trial and improvement with diabetes and whilst the learning curve is steepest in the first few months or years, it continues throughout your life but you have to become the expert in how your body and diabetes operates and it will be quite unique to you so whilst the health care professionals (and us) can give you guidance you will need to monitor and adjust for yourself to how your body works.
It sounds to me very much like you are struggling with the honeymoon period. This is where your remaining beta cells in your pancreas are producing insulin. It often happens that they have been stressed and struggling to cope for a while (particularly if you have initially been treated as Type 2) and then insulin being injected takes the strain off them as they are no longer having to work so hard and after a bit of a break they kick back in with renewed vigour, so when you eat a carb heavy meal, they are getting a signal from the liver to produce insulin and they swing into action not realising that you are also going to inject some extraneous fast acting insulin to cover those carbs, so you end up with too much insulin for what you ate. It might be worth discussing with your nurse, not using the Humalog for meals at the moment and perhaps just doing a correction (injecting some Humalog) 2 hours after your meals if your BG has gone too high.
As regards the Tresiba, it does sound like it might not be a suitable basal insulin for you and I would enquire about trying Levemir. I need much more basal insulin during the day than at night and I would hypo every night on Tresiba, because it trickles out a steady amount of insulin over 30+ hours. At the moment I inject 24units of Levemir in the morning even though I am quite active during the day but just 3units at night. I injected 4units last night as I have been waking up a bit high for the last few days but I hypoed last night so I will be back to 3units tonight. Being able to make that adjustment between day and night is essential for me with the way my body works. You would probably be the other way around and need to inject more Levemir at night and less in the morning if you were changed to that instead of Tresiba. You can fine tune Levemir much better to your body's individual needs. I have tried different quick acting insulins for my meals and there isn't a huge difference but I would fight tooth and nail if they ever tried to change my basal insulin as Levemir gives me the ability to tailor my doses to my body's requirements. Getting your basal insulin dose correct makes such a massive difference and everything else starts to make sense after that, so my thoughts are that your basal insulin is probably not suiting you and you are likely suffering from the honeymoon phase which is making things even more confusing. With the latter it is just a question of grin and bear it until your beta cells splutter to a halt but changing your basal should make things easier to cope with in the mean time, so I would definitely ask about that and perhaps ask about doing corrections 2 hours after meals (if necessary) rather than when you eat during this honey moon phase.
You might also want to ask about trialing the Freestyle Libre system as that will give you a much greater insight into what is happening with your BG levels. It involves applying a sensor to your arm which lasts 2 weeks and you can scan it 100+ times a day if you like to get a BG reading rather than finger pricks which are obviously very limiting. If you work in an unsanitary environment where washing hands for finger pricks is not always feasible, that is one of the parameters for prescribing it.... so manual labour on building sites, farm workers etc. Just something else to ask about.
Apologies if that is information overload.... basically 3 things to ask your nurse about....
1. Corrections 2 hours after meals instead of at the time because you are hypoing perhaps due to honeymoon
2. Basal insulin change to Levemir and a split dose (it can sometimes be started as a single dose for the first few months and then split, but that would not help you) because you seem to need much more at night than through the day.
3. Freestyle Libre monitoring system.
Hi and thank you for that information very helpful my consultant put me on Libre straight away due to my job and the lows I was getting . It’s just so hard trying to get it right and I’m frightened of the highs as well as the lows what it damage it might be doing to my body so sometimes I don’t eat at all and my levels will rocket up so I feel that I can not win at times . Iv cut all sugars out I eat none at all no sweets chocolate alcohol I maybe have a treat Chinese maybe once a week but that will be a stir fry with vegetables small amount and I still struggle with levels.
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