Really struggling

[Tanikitsky]

I am a type 1 diabetic and have been for 22 years so you would think I would be able to do a better job than I seem to be doing. I am on multiple daily injections but have been referred to a new doctor in the hopes that I can get a pump - this requires a lot of paper work and training and hope that the medical aid will agree to pay as I do not have enough money to buy my own machine.

In the meantime I am without a doctor (long medical aid story about switching doctors) and really would like to get things right. Despite testing 6-8 times a day my sugars are still wildly erratic (anything from 2.2 to 20.0). My HbA1c has been rising since I gave up breastfeeding a number of months ago - it was reasonable during pregnancy (7.0) but I was told not to allow it to go lower since in order to get it that low I was often comatose and was having up to 6 lows a day to achieve that - probably due to overcompensation of lows it never went lower. It is now at 9.3 and not getting better despite trying hard.

I think it is the long acting insulin that is not cooperating - I have enormous increases in my blood glucose between 03:00am and 07:00am when I get up. I am on protophane at night and take it at about 06:00pm - it seems it does not last into the morning. Even taking short acting insulin at 02:00am does not seem to fix those morning highs and if I start the day high then it will take til before supper to get it all right again only to start again. I take protophane in the morning too and humalog before meals.

I have in despair tried taking two doses of protophane at night - the usual at 06:00pm and then a very small dose at 10:00pm - this usually gives a slightly better reading in the morning but I risk going low at the 02:00am reading with a rebound high instead. I have also tried taking the protophane only late at night (around 10:00pm) but that has not worked either as then I am high by 10pm before taking it even despite having the short acting at meal times.

I am at the moment testing as much as I can and writing everything I eat down as well to see if there is any pattern. I find PMS knocks my sugars so high for about 5 days before my period starts and if I raise the insulin before this to try to get it under control then once it starts I drop severley low (in the 2s) before I have a chance to sort it all out again.

I have never struggled so much to get things under control - especially all these highs - I have had issues when pregnant with very bad lows, but even then I felt they were more predictable than this lot. Is there anything else I can try that I have not yet tried - my appointment is on 7 August so it is still a way to go.

 

[Redkite]

Hi and welcome to the forum. 🙂 Whereabouts in the world are you? (Seeing as you mention medical aid, I'm guessing not UK and therefore not NHS funded for a pump?). I think an insulin pump would really help you with many of the issues you have. Certainly, many people experience a sharp rise in their BG levels around 3-7am, known as the "dawn phenomenon" - and with an insulin pump you can programme a much higher basal rate at that time of day to counteract this rise. Starting the day in range is half the challenge I find!

While I'm not diabetic myself (my son is T1), I can say that when I stopped breastfeeding I failed to adjust my diet and consequently put on quite a lot of weight! Not saying it's the same for you, but obviously breastfeeding draws on your body's resources and when you stop you need a reduced calorie intake, to include reduced carbs. Hormones take a while to settle back into their old rhythms too, which can all have an effect on your BGs.

Good luck with your pump quest! 🙂

 

[Copepod]

Welcome to the forum, Tanistsky, wherever you are.
Members will try to help, but most of us live in UK, and use NHS.
There are several members with type 1 diabetes and insulin pumps, but I'm not one of them.

 

[everydayupsanddowns]

It's a long time since I used protaphane. Unfortunate that you are without a Dr as it would be good to get their advice about how long the insulin is likely to last, and how to balance its activity with meal doses and/or snacks.

Sounds like you may have quite marked 'Dawn Phenomenon' pushing your BG up in the early hours too which is tricky to manage on MDI.

From what I remember protaphane has a fairly long tail and a mid-length peak of activity so in terms of giving you basal cover you would probably need 2 doses perhaps 12 hours apart but with some caution (and possible snack) in the period soon after midnight as the peak of activity may cause hypos overnight.

Would it be possible to try one of the more 'peakless' long acting analogues where you are? Lantus or Levemir. Most basals seem to work best 2x a day, but Lantus works OK for some people 1x a day.

Hope you get somewhere with your pump funding/training soon.