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[Purls of Wisdom]

 

[Inka]

When did you eat and bolus on that chart? Did you do any corrections @Purls of Wisdom ?

 

[Leadinglights]

I wonder if because you are still producing some of your own insulin but in a very erratic way that is what is making it very hard to get things right with your insulin dosing.
I think you should be pushing for those two tests, the c-peptide and GAD antibodies. or at the very least ask the consultant to explain why he thinks it is too soon.

 

[Purls of Wisdom]

I wonder if because you are still producing some of your own insulin but in a very erratic way that is what is making it very hard to get things right with your insulin dosing.
I think you should be pushing for those two tests, the c-peptide and GAD antibodies. or at the very least ask the consultant to explain why he thinks it is too soon.

The Consultant explained that 7 months into the diagnosis is not long enough duration to expect a correct c-peptide result. I am not aware of GAD antibodies test.

Personally speaking, my head was so wrapped around the readings that I had no chance of paying attention to the bigger picture.

 

[Purls of Wisdom]

When did you eat and bolus on that chart? Did you do any corrections @Purls of Wisdom ?

I ate at 9:00pm and took Levemir about 10:30ish or so. Usually I eat between 7:30 and 8:00 with basal insulin around 10:30.

 

[rebrascora]

View attachment 23142

So, you ate at 9pm and I think you said you injected 9 units and that insulin is active for about 5 hours so at 2am you weren't far off your starting point, so it looks like the insulin dose for the food was probably about right, but you could have done with injecting the insulin earlier in advance of the meal, because the carbs hit your blood stream before the insulin which is almost certainly why you went so high. In that situation, I would have injected my bolus insulin and then watched my Libre and waited until the insulin kicked in and brought me down into range before eating. I have a rule where I don't eat if my levels are above 8 because otherwise my levels will go a lot higher before they come down and it will need more insulin to bring them down. I might have to wait an hour or more if my levels are as high as 12 before my meal, but waiting is the best policy for me. I think of it like a race and my insulin is a lot slower than my digestive system, so it needs a head start. If my levels are high to start with, it needs an even bigger head start. If I don't allow for that then the carbs from my food will hit the finish line well before my insulin and my levels will spike high. My job is to work out how much of a head start the insulin needs in different circumstances and watching my Libre (scanning regularly after I have injected) really helps me to fine tune that timing. This takes time and experience to get good at but I think you can take comfort from your bolus dose being about right for that meal. The timing is just fine tuning..... It is sort of advanced diabetics if you like.
Obviously your premeal reading in the 12s was too high and it would be useful to know if you have been given any advice on correction doses? ie 1 unit of insulin will drop you so many mmols?

Eating at 9pm is not ideal of course and if your levels were more in range then it would potentially put you at higher risk of nocturnal hypos, so it is best to eat earlier if at all possible.

 

[Inka]

I ate at 9:00pm and took Levemir about 10:30ish or so. Usually I eat between 7:30 and 8:00 with basal insulin around 10:30.

Ok, and when did you eat the following day - ie breakfast and lunch? You’ve explained the reasons for your high overnight, but I’m looking at the following day.

 

[Purls of Wisdom]

Hi,

My guess was you started waking around 6am, ate around 9am, but had either too much insulin on board from breakfast onwards or you did some exercise, which caused a continuous drop from 10am through to 3pm.

I wake up at 6:00 but only to go back in bed for another hour or half before taking both insulins with in 15 mins at opposite sites.

Then I eat breakfast after a quick shower. With in 20mins, I leave to catch the bus for work. From 8;45, there is no stopping for me, working with young children.

11:00 is the coffee break. I eat an apple or a banana with a semi milky drink of Barley Cup. Back on feet again.

I scan around 12:15 before going out in the playground. This definitely is a stumbling point. If going low, I will eat a slow release snack or if hypo then 2 or 3 Dextro Tablets. Not 6 tabs so it does not go too high. I could be very wrong with this mindset.

Lunch is at 1:15. I eat a sensible lunch. Brown bread with cheese or beans or eggs or any left over soup. A piece of fruit and few unsalted nuts. Back on my feet again.

Finish work at 3:30. Rush to catch the bus. This is another stumbling point. L2 will alert of BG going low. I eat 2 biscuits and sometimes 2 Dextro Tablets too. Walk home. Rescan. Drink cup of tea with a small snack if readings are low, otherwise nothing. Prepare dinner for extended family.

Dinner around 7:30. Scan, bolus, wait and eat. Watch TV for an hour or so. Tidy up and off to bed. Scan again and take levemir. A drink of hot milk. Time spent on mobile. Sleep.
I usually find that mid night is the time for a sure hyper.

As @Inka suggested, if you can let us know your insulin timings, amounts, carbs and exercise etc. We can probably make some suggestions.

It may be a matter of adjusting basal and or bolus mealtime insulins.

 

[Purls of Wisdom]

Ok, and when did you eat the following day - ie breakfast

at 8:30am.

and lunch?

At 1:30pm.

You’ve explained the reasons for your high overnight, but I’m looking at the following day.

Dinner at 8:00pm.

 

[Purls of Wisdom]

So, you ate at 9pm and I think you said you injected 9 units and that insulin is active for about 5 hours so at 2am you weren't far off your starting point, so it looks like the insulin dose for the food was probably about right, but you could have done with injecting the insulin earlier in advance of the meal,

how long in advance? I can see where you are coming from.

because the carbs hit your blood stream before the insulin which is almost certainly why you went so high. In that situation, I would have injected my bolus insulin and then watched my Libre and waited until the insulin kicked in and brought me down into range before eating. I have a rule where I don't eat if my levels are above 8 because otherwise my levels will go a lot higher before they come down and it will need more insulin to bring them down.

I read about this theory and practiced it too. When i caually mentioned it to DSN, her response was that i only have to wait for 15mins and no more.

I might have to wait an hour or more if my levels are as high as 12 before my meal, but waiting is the best policy for me. I think of it like a race and my insulin is a lot slower than my digestive system, so it needs a head start. If my levels are high to start with, it needs an even bigger head start. If I don't allow for that then the carbs from my food will hit the finish line well before my insulin and my levels will spike high.

i fully understand the reasoning and you ve explained it well too.

My job is to work out how much of a head start the insulin needs in different circumstances and watching my Libre (scanning regularly after I have injected) really helps me to fine tune that timing. This takes time and experience to get good at but I think you can take comfort from your bolus dose being about right for that meal. The timing is just fine tuning..... It is sort of advanced diabetics if you like.

If you ve asked me a couple of weeks before, I rarely saw my readings as low as 8mmol/L. At times the readings were as high as 19!

Obviously your premeal reading in the 12s was too high and it would be useful to know if you have been given any advice on correction doses? ie 1 unit of insulin will drop you so many mmols?

Yes, I ve been told of correction dose but only pre bolus, not afterwards, in the case of seeing an extra high readings after eating.

1 extra unit will drop me by 3.0 mmol/L. Also advised only increase by a unit or 2 at a time for no less than 3 consecutive days.

Please confirm that any time I am over 10.0; I should go ahead and take extra insulin and either bolus earlier and wait for longer until it has decreased back to 10.0mmol/L.

The DSN has also pointed out that may be I am over scanning and keep fretting at the hyper readings. She has repeatedly said that in pre CGM times, people only tested twice a day and got on with their lives!

Eating at 9pm is not ideal of course and if your levels were more in range then it would

I reckon that is my one of the major downfalls. What time would you say is ideal for dinner? Specially if I am going to have a hot drink before bedtime.

potentially put you at higher risk of nocturnal hypos, so it is best to eat earlier if at all possible.

Must mend my ways with the expection of once in a blue moon.

 

[Bruce Stephens]

What time would you say is ideal for dinner?

That's very much a personal choice. Personally I like 6-7pm, which means the Novorapid is mostly gone by 11pm. But it's a choice, and I'm sure if we were an Italian forum people would tend to prefer eating much later.

 

[Purls of Wisdom]

That's very much a personal choice. Personally I like 6-7pm, which means the Novorapid is mostly gone by 11pm. But it's a choice, and I'm sure if we were an Italian forum people would tend to prefer eating much later.

Indians too! But I have been here for too long and have gladly understood and adapted the done things.

 

[Purls of Wisdom]

Someone has mentioned the Nature Valley and Kind nut bars as suitable snacks; can you pls be more specific? Can i eat one a day, every day? Feel free to PM me. I understand that dark chocolate with nuts are fine. Thanking you in advance.

 

[helli]

Someone has mentioned the Nature Valley and Kind nut bars as suitable snacks; can you pls be more specific? Can i eat one a day, every day? Feel free to PM me. I understand that dark chocolate with nuts are fine. Thanking you in advance.

You can eat as many as you want provided you take the appropriate amount of insulin for them.
A healthy diet for someone with Type 1 diabetes is no different to a healthy diet for someone without diabetes.
It is all about learning to use your insulin.

Some things are harder to bolus for so some people with Type 1 chose not to eat them but, if you have the correct basal dose (according to the basal test mentioned earlier), you can learn to bolus for most things.
Including as few or as many nut bars as you want.

 

[gll]

Everyone is giving you amazing advice Purls, you are doing amazing and need to remember you are relearning a whole new way of life.
You WILL wrap your brain around it all and be a pro soon enough. Just allow yourself time and don't be too hard on yourself.
Massive hugs to you xx

 

[Bruce Stephens]

Indians too! But I have been here for too long and have gladly understood and adapted the done things.

When you manage to persuade your local team to follow the NICE guidelines (which recommends offering "a structured education programme of proven benefit, for example, the DAFNE (dose adjustment for normal eating) programme.") you'll find that the goal of such courses is to support you doing what seems right to you (whether that's eating low carb or late in the evening as your friends and family want to do).

(Having said that, you might still choose to eat a bit earlier in the evening because I think it is genuinely a bit easier. But it is a choice.)

 

[rebrascora]

1 extra unit will drop me by 3.0 mmol/L. Also advised only increase by a unit or 2 at a time for no less than 3 consecutive days.

The first sentence above relates to corrections with bolus (meal time) insulin.
Did you apply any correction to your meal the other night when you were 12.8 before your evening meal and if so, how many units did you add for the correction?

The second part of that reply about only increasing by a unit or 2 for no less than 3 days will be referring to basal insulin changes, which sometimes take a few days to show their full effect, so increasing by a unit and waiting 3 days to see how that works out and then if necessary increasing by another unit until you find it is holding you steady.

Putting those 2 sentences together suggests to me that you are a bit confused about when they apply. The first is a correction for a one off high reading and is a short term temporary measure to reduce your levels over the next few hours. Changes to basal insulin (Levemir in your case) are longer term adjustments for when you are repeatedly needing to do those short term corrections day after day often at the same time of day, which tells you that your Levemir is not holding your levels steady. You then look at when the problems are arising and decide if it is the daytime or night time Levemir dose that needs adjusting.

Looking at your graph it seems to me that your morning Levemir dose may be too much if this is a regular pattern of your levels dropping through the day and this would tie in with you being physically more active at work. I also think that your levels would benefit from you injecting your morning Levemir when you wake up at 6am as that insulin could then get going to deal with that dawn phenomenon which shows your levels rising from 6am onwards even though you don't have breakfast until 8.30am. I set an alarm an hour before I get up to inject my morning Levemir to give it a head start.
HOWEVER.... I am basing those thoughts on just looking at one day's graph and with diabetes you look for patterns and do not make basal insulin adjustment off one individual day, but an overall pattern over several days. So if your graph shows that your levels rise every day after 6am, then taking that Levemir at 6am would be a useful strategy to try for a few days and then look at your graphs again and see if it has improved things. That is a relatively simple thing to do if you wake up at the same time every day.

I do think you are right and you need to try to unlearn a lot of the information you have picked up about Type 2 diabetes. I know it is really hard to unlearn stuff but as we are all trying to tell you, Type 1 means you can eat whatever you want. At the moment, until you get experienced, then try to keep it simple.

Keep snacks handy and have one when yopur levels are dropping but before they get too low. Maybe set your Libre low alarm a bit higher, so that you have more warning that you need a snack. What level is your low alarm set at?

 

[Purls of Wisdom]

The first sentence above relates to corrections with bolus (meal time) insulin.
Did you apply any correction to your meal the other night when you were 12.8 before your evening meal and if so, how many units did you add for the correction?

Thanks Barbara. I surely owe my well being to your solid advice.

It makes sense when you put it like the way you do. How many units of NR can I go up at a time, be it for one meal time only? I will tackle my levemir after having a good read.

The second part of that reply about only increasing by a unit or 2 for no less than 3 days will be referring to basal insulin changes, which sometimes take a few days to show their full effect, so increasing by a unit and waiting 3 days to see how that works out and then if necessary increasing by another unit until you find it is holding you steady.

Levemir was reduced by 1 unit for working days a couple of months ago. Still having hypos, i mean I am due another reduction.

Putting those 2 sentences together suggests to me that you are a bit confused about when they apply. The first is a correction for a one off high reading and is a short term temporary measure to reduce your levels over the next few hours. Changes to basal insulin (Levemir in your case) are longer term adjustments for when you are repeatedly needing to do those short term corrections day after day often at the same time of day, which tells you that your Levemir is not holding your levels steady. You then look at when the problems are arising and decide if it is the daytime or night time Levemir dose that needs adjusting.

Morning Levemir I gather.

Looking at your graph it seems to me that your morning Levemir dose may be too much if this is a regular pattern of your levels dropping through the day and this would tie in with you being physically more active at work. I also think that your levels would benefit from you injecting your morning Levemir when you wake up at 6am as that insulin could then get going to deal with that dawn phenomenon which shows your levels rising from 6am onwards even though you don't have breakfast until 8.30am. I set an alarm an hour before I get up to inject my morning Levemir to give it a head start.

Best advice I must follow.

HOWEVER.... I am basing those thoughts on just looking at one day's graph and with diabetes you look for patterns and do not make basal insulin adjustment off one individual day, but an overall pattern over several days. So if your graph shows that your levels rise every day after 6am, then taking that Levemir at 6am would be a useful strategy to try for a few days and then look at your graphs again and see if it has improved things. That is a relatively simple thing to do if you wake up at the same time every day.

I do think you are right and you need to try to unlearn a lot of the information you have picked up about Type 2 diabetes. I know it is really hard to unlearn stuff but as we are all trying to tell you, Type 1 means you can eat whatever you want. At the moment, until you get experienced, then try to keep it simple.

Keep snacks handy and have one when yopur levels are dropping but before they get too low. Maybe set your Libre low alarm a bit higher, so that you have more warning that you need a snack. What level is your low alarm set at?

My low levels are set at 4.5mmol/L giving me enough time to sit down and treat in case it dips into a hypo (3.9 or lower).

At lunch time today L2 reading was 7.3. I took 3 units of NR for 27g of carbs. Prepared lunch and it took me little longer before I ate. Roughly 30mins. L2 read 4.3 with slanting arrow. I had eaten lunch and hoped it will keep me afloat. Pity it didn't. L2 read 3.7. GM read 4.8 though. Please comment.

 

[Purls of Wisdom]

When you manage to persuade your local team to follow the NICE guidelines (which recommends offering "a structured education programme of proven benefit, for example, the DAFNE (dose adjustment for normal eating) programme.") you'll find that the goal of such courses is to support you doing what seems right to you (whether that's eating low carb or late in the evening as your friends and family want to do).

(Having said that, you might still choose to eat a bit earlier in the evening because I think it is genuinely a bit easier. But it is a choice.)

I know I am entitled to DEFNE within a year since diagnosis. Let us see.

Eating earlier is not a bad idea.

 

[Purls of Wisdom]

Everyone is giving you amazing advice Purls, you are doing amazing and need to remember you are relearning a whole new way of life.
You WILL wrap your brain around it all and be a pro soon enough. Just allow yourself time and don't be too hard on yourself.
Massive hugs to you xx

Thanks for your kind words. I already feel well informed and confident that I can manage this ailment in time with the clear and trusted advice from fellow forum members! So, thank you all. X