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robofski

robofski

Well-Known Member
Relationship to Diabetes
Type 1
I got to thinking today, One blood test 6 years ago diagnosed me as diabetic, a GTT the results of which labelled me 'Type 2 Diabetic'.

6 years on and I'm now on insulin and no matter what I've tried today can't seem to bring my BG down to single digits, supposed to be doing one unit of Novorapid to 10g of carb but today I was almost doubling that to see the effect and it just hasn't really done much, infant I'd say the results are the same!

So i was wondering how much of a role insulin resistance plays in the whole saga? Why does my DSN now think I'm not producing enough insulin and not that I've just become more insulin resistant? I've never had any tests to confirm what insulin is being produced and it's always surprised me that this isn't something that was done.

I'm sure my DSN knows what she's doing but it just got me wondering!

Community thoughts and experiences if you would be so kind 🙂

Dan
 
You will find that most T2s are insulin resistant and take much larger doses of insulin to T1s. Are you not on a basal insulin as well (like Levemir/Lantus)? How much of that are you on and when do you test? What is your fasting test in the morning?
 
Vicsetter said:
You will find that most T2s are insulin resistant and take much larger doses of insulin to T1s. Are you not on a basal insulin as well (like Levemir/Lantus)? How much of that are you on and when do you test? What is your fasting test in the morning?
Click to expand...

Sorry, neglected to mention the Levemir, 24 units, 16 when I get up and 8 before bed. Here's my readings for the last 3 days (before meal readings)
Mon
Wake 9.4
Lunch 9.5
Dinner 6.7
Bed 11.4
Tue
Wake 9.8
Lunch 10.3
Dinner 8.3
Bed 11.0
Wed
Wake 8.5
Lunch 9.6
Dinner 11.0
Bed TBD!
 
Robofski here's a really stuid question for you then ......

do you ever test your basal insulin like we type 1's do?

Or indeed, how did YOU get to that carb ratio? - 1u to 10g isn't a magic bullet - it's just the starting point for Type 1's to have a go at, then adjust that up or down as necessary to them personally.

But if your basal isn't right
(so in your case that's your basal Levemir plus what? - Metformin? (not Gliclazide, if you take that you actually take it with meals and it does help lower your BG, so you'd consider that with the fast acting , not the basal bit. ie if you don't eat, you don't take the Glic but you's still take the Metformin)

then your bolus will never be right.

If you have IR, it doesn't only work against naturally produced insulin, it works against insulin; period.

Final question - when you say DSN - is she at the hospital? - or the surgery nurse who isn't a proper DSN?
 
I haven't done any proper testing of my basel I've done some reading about it (in fact I think it was you that pointed me to the material) and hope to get a chance to have the required parameters next week.

The carb ratio is just a starting point for me too but I'm surprised that doubling the insulin (i.e. 1u to 5g) still doesn't seem to have an effect (pointing probably to basal being incorrect)

I don't take anything else with my basal, I tried Metformin years ago and it brought me out in rash so I was put on to Gliclazide which is now ineffective and has been stopped, this is what lead to the insulin.

I see my DSN at my GP surgery but she is not part of the practice, she travels around various GP's, I guess she's a PCT resource or communal type DSN but don't know if she is associated with a hospital but she does only deal with Diabetes.
 
All the numbers you quote would suggest too little basal insulin to me. Do you space your meals at least 5 hours apart and have no snacks in between? I find that novorapid lasts 5 hours in me so my reading at, say, 4 hours, will usually be lower at 5 hours.
 
Yes, usually meals are around 5 hours apart and I don't snack during the day, (evenings are when I liked to snack and it's a killer not being able to grab a packet of salted crisps whenever I feel like one!)

What kind of increment would you suggest changing my basal by? Last week (Mon) I accidently did 16u at night instead of 8, the following day, nothing had changed! I got a low reading at dinner time (Tue) but only becuase I skipped lunch as I was travelling.
 
robofski said:
What kind of increment would you suggest changing my basal by? Last week (Mon) I accidently did 16u at night instead of 8, the following day, nothing had changed! I got a low reading at dinner time (Tue) but only becuase I skipped lunch as I was travelling.
Click to expand...

I guess that would depend on the results of the basal test (the sort of BG movement you are seeing over 4-5 hours when doing a fasting basal test). Ideally basal should be holding your BGs within 1.7mmol/L up or down with no food/bolus active. In general I seem to find an adjustment of 10% up or down is a good first step for me. But that's just the general 2-3 monthly changes that seem to happen to mine after I'd got it sorted.
 
Last edited:
robofski said:
Yes, usually meals are around 5 hours apart and I don't snack during the day, (evenings are when I liked to snack and it's a killer not being able to grab a packet of salted crisps whenever I feel like one!)

What kind of increment would you suggest changing my basal by? Last week (Mon) I accidently did 16u at night instead of 8, the following day, nothing had changed! I got a low reading at dinner time (Tue) but only becuase I skipped lunch as I was travelling.
Click to expand...

I'm afraid we can't give advice on the amount to change it by - you need to discuss that with your DSN, but the general rule of thumb is to make a small adjustment and monitor the effect, slowly fine-tuning things rather than going for a big change all at once. Levemir changes are generally seen more quickly than with lantus, but you would need to wait a couple of days to see the effect of a change before making another.
 
Thanks Robofski - yes sounds like a community DSN I agree.

Yes - one change at a time. It's like a lot of things - if you do it just a bit at a time, you usually get there quicker in the end.

Sor the basal first!

At whatever time of day you aren't testing basal that day, if you need it you could always try a small corretion dose of fast acting - and there the 'starting point' (much like the 1u to 10g thing) is the hypothesis that 1u reduces your BG by 2.5 to 3.0 on the meter. There's no point in trying to pin down the carb ratio OR the correction rate precisely until you know your basal is right ..... Just kinda firefight for now, until you've done that and made the adjustments you need.
 
Thanks all, basal testing it is!! Oh joy 2 hourly testing through the night, wonder how many alarm clocks I'll need to set for that, I need 3 to get me up in the morning!!! I think the spare room for me when I do this, my wife is very supportive but I think she'd kill me if she was woken up every two hours :D
 
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