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Problem with dsn????

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G

Ginnie

Active Member
Relationship to Diabetes
Type 1
Hey,
I have finally got through to my dsn after a few difficult days of trying and iv come.away confused and upset I hope someone can offer me better advice.. Generally I have sugar readings between 5-9 with the odd double figure iv been great over the last few weeks with no hypos apart from this week iv had two half an hour after my evening.meal dropping to 2 but im eating the right carbs and not doing any more exercise than.usual so the dsn has said my insulin may need adjusting seems straight forward enough but her next sentence was my levels are too high so surely if I reduced my insulin my levels would be higher??? One hypo this week I didnt notice but lucky tested my sugar due to driving she has said I could have my licence taken off me??? She also thinks im having night time hypos so I have the pleasure of waking up at 2am for the next couple of nights. The main concern is when im in that lovely time of the month us.girls have I feel.shocking with extremely bad moods, skin, eyes and feel like im constantly on the edge of a hypo the dsn said she doesnt know..... Any help, opinion and advice would be amazing 🙂
 
Hi Ginnie, we can't offer medical advice, but if my levels were generally between 5 and 9 I wouldn't consider them to be too high :confused: Certainly if you run your levels too low then you will only experience symptoms at very low levels - it's a difficult tightrope to walk. It doesn't sound like you got a great deal out of the appt. Hopefully the 2 am checks will give you some more information so you can see whether you are having night hypos or not, although it is generally my experience that I know when something isn't right in the night. What sort of levels do you normally wake to? Often, people who are having night hypos will wake with very high levels. If your waking levels are good then it seems less likely you are going hypo as you sleep.
 
Hi Ginnie. For what its worth i think those results are pretty good. I think your dsn has been reading to many "text " books. It is hard to keep figers right. She might mean well but dont give yourself a hard time over it. 🙂
 
Im having problems with the dsn anyway she is so difficult to get hold of and seems insensitive I asked her about any suggestions with me struggling and she kept redirecting the conversation. Iv been waking up to levels around 7 or 8 which I thought were good, she also said even if I eat the same at breakfast and lunch with the same insulin i.could still have a hypo at lunch is this right? How do you know if your having a hypo in the night? I thought she might of had a bad day but the text book thing.sounds right which is annoying nothing is ever that black and white.....
 
I would doubt that you are having a night hypo if you are waking at those levels. For me, I know if I'm having a night hypo if I feel hotter than normal, so I always test if I wake feeling like this - keep your meter by your bed 🙂 Your waking levels are a little on the high side, but at this stage since your diagnosis I think they are very good 🙂 Her advice doesn't sound very coherent, I'm afraid. There are many factors which might result in you going low, even if you are eating the same food with the same insulin, in particular your activity levels during the morning. In time you will build up knowledge that will help you to decide if you need to make adjustments to your food or insulin - just keep those jelly babies handy! 🙂
 
Well iv set my alarm so ill be testing my levels tonight and over the next few nights to.see if I am or not. Yeah im not sure where shes coming from its definitely making me considering moving hospital im not being very patient with it all as it is never mind with advice like im getting. Thank you so much for your help 🙂 I always have my jelly babies and stashes of food around the house now. Yeah iv already.learnt I cant have porridge on 12 units but everything else has veen ok.so far I suppose things change though!!
 
It does sound like there are communication problems, but remember that adjusting insulin can include changing timings of injections, both long and short acting (eg relative time between short acting and eating, time of day / night for long acting etc), perhaps splitting long acting into 2 injections within a 24 hour period, changing to different insulins with different profiles etc - all of which can only be done in consultation with your DSN and a prescriber if you DSN can not prescribe.

Hope things begin to make more sense when you make contact at a different time of the month.
 
Well her suggestions were to reduce my tea time insulin by 1.5 and look into reducing my lantus at night??? At 2.30am I was 8.1 and 7.8 this morning but I had a hypo yesterday.at 20.00 so could this effect my readings? My next appointment is at the beginning of december so hopefully ill have a better idea of whats going on 🙂
 
If you were at 8.1 at 2.30 am and it was more than 4 hours since you injected rapid acting, and you woke at 7.8 then your overnight basal looks spot on. You may want to think about increasing your bolus at your evening meal, I can't think why she'd tell you to reduce it by 1.5 if you were 8.1 several hours later. Do you carb count and match doses of rapid acting or are you on set doses?
 
I have no idea half the stuff shes telling me to do it doesnt seem to add up! Iv only done the night time.reading once so going to get a few more and see if theres a pattern.... I have set amounts but I was told they think im on a 2:1 ratio so I try and make sure I have around 60gs of carbs for my 12 units to avoid any high or low readings 🙂
 
Ginnie said:
I have no idea half the stuff shes telling me to do it doesnt seem to add up! Iv only done the night time.reading once so going to get a few more and see if theres a pattern.... I have set amounts but I was told they think im on a 2:1 ratio so I try and make sure I have around 60gs of carbs for my 12 units to avoid any high or low readings 🙂
Click to expand...

Aww Hon that's a horrid way around to be doing things. If I ate 60g carb per meal I'd be the size of a house! Think about this in reverse.... if you only want to eat 30g carb, you could inject only 6u insulin. you need carb counting education. Ask for it. If you can't get it then you can do it online here http://www.bdec-e-learning.com/
 
Well I was glad at first I needed to put in the weight id lost so much I looked ill but im now at a healthy weight plus im eating food when im not hungry which isnt great but I will do that have 30gs and half the amount of insulin the dsn is always telling me off so it can just add to her list if shes not happy 🙂. I was told im not allowed on any course until iv had diabetes for 6-12 months??? Iv got a book thats great and kind of know what to do I can carb count most of my meals with the odd double checking. Thank you for your suggestion im always a bit nervous about changing things but for some reason knowing you live with it helps..... Funny how we think ay 🙂
 
The reason why courses are not offered until 6 - 12 months after diagnosis is due to honeymoon period, when insulin:CHO ratios are a bit, well, variable. So, the thinking is that people get more value from working out their ratios when physiology has calmed down a bit.
 
Just wondering if this DSN is actually that or maybe a practice nurse who deals with Diabetes? I don't feel you are getting good advice from her but agree with what others have said on here.

The other part of your question about the time of the month - yep I get lots of hypos and some days I struggle to keep above hypo level regardless of what I eat or inject so you are quite normal there (although being the same as me may not be normal!!) The DSN I saw recently said that is very common and hormones mess sugar levels up enormously. Wish you well with all this and if she is a practice nurse then definitely ask to see a "proper" DSN. xx
 
Well I saw her when I was in hospital and she said she was a dsn but ill double check it wont do any harm. Yeah I was told I needed to get my head around having diabetes before going in the course but the honey moon period makes alot of sense. Im pretty jealous of everyone saying your dsn is important and good support but then again this forum has filled that gap 🙂 the dsn seems to dismiss anything I say because im new to it all but I know my body! Yeah the time of the month is so bad I dread it my skin becomes dry and itchy along with really low levels but its how I cant control any emotion that worries me so I shut down from everything other wise im that angry haha it must be like living with the devil.... My poor other half! Well it makes me feel better its common the fact the dsn said she needed to.look into it because she didnt know anything about it didnt fill me with confidence 🙂
 
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