Right or wrong thing to do - thoughts?

[lauraw1983]

My morning readings are just getting worse, occasionally it will be near 7 but most often it is 9-10 at least, this morning it's 13.8! 😡

Last night I did have a 2.4 hypo before bed though but treated it with jelly babies - had a biscuit too though because I am often alone with my children overnight (OH works shifts as a firefighter) so there is no option to call him back from work, and it scares me having a night hypo so much. To my knowledge I have never had one and when I have done 3am testing my levels are stable from what I went to bed on.

I don't eat as soon as I rise - because I have two children to get ready, get to the childminders/school and get myself to work by 8.30am. That aside, I have never been able to eat first thing anyway.

This morning when I saw the reading above at about 7.15am, I decided to inject 4u humalog - my correction dose is normally approx 1u for 2mmol drop so in theory it should take me down to about 5mmol.

I'll eat breakfast about 10am this morning so almost 3 hours after injecting.

Is this a bad idea or does it make sense to do? when I start off high in the mornings, I end up spending all day chasing my blood sugar to come down to acceptable levels. My life is so busy that I just want to be able to get on with it with minimum interruption please!!!

The only time I don't wake up high usually is if I have partaken in some alcohol the night before....but that's maybe 1 or 2 nights a week at most!

Thoughts please? Am I at risk of stacking insulin doing this?

In other good news, I will be doing DAFNE 10-14th September which I am really looking forward to doing ad hoping I might pick up some tips there - think my Lantus will be getting switched for Levemir too. Ultimately though, even my DSN has said the only way to fully keep those morning levels in control is a pump, which I am hoping I can get within 3 years at the most...watch this space....! 🙄

 

[lauraw1983]

Update....just tested before eating my toast - perfect 5.7!

Hmmmmmmm.

Now having 2 slices S&L burgen and peanut butter (carbs 29g), have injected 4u (ratio 1:7)

Sooo is there a reason I shouldn't be doing this I wonder??

 

[Ellie Jones]

My consultant would say, there isn't a right way or wrong way, what works is always the right way...

If my levels are at a certain point, I will always correct first get my levels down before eating, some will say that just add the correction dose into the meal dose.. Which is fine for a small correction but not so good if it's a large correction...

Do you know what caused last nights hypo!

Miss match of quick insulin to your carbs you've eaten perhaps!

Concerning the high's first thing in the morning, there could be several reasons behind this, from incorrect background insulin, to Dawn Pham playing a part.

But without any fasting test being done, including a night time hourly testing it's difficult to determine where the problems may lay,

DAFNE will certainly help you out, but even though this is an excellent course, I still suggest that you invest in a book called 'Using Insulin' by John Walsh as this will give you further explanations and details how to do fasting tests correctly, how to work various dose factors out, with a lot more information.. Which tends not to be covered on the DAFNE course.

 

[Northerner]

I think it's perfectly acceptable Laura, you're just correcting the high - it's as if you had eaten something and then forgotten to inject, that's all. Of course, you do need to bear in mind how much longer your correction insulin might have to run when you inject for your breakfast - if you are at 5.7 at 3 hours then it would most likely continue to fall for another hour or two if you did nothing, so I would personally probably have slightly less insulin for my breakfast and also keep an eye on things by checking over the next hour or two. Once you know what happens when you do this you will be able to be more confident and not have to do so many checks.

Hope everything goes OK! 🙂

 

[PattiEvans]

I think it's perfectly acceptable Laura, you're just correcting the high - it's as if you had eaten something and then forgotten to inject, that's all. Of course, you do need to bear in mind how much longer your correction insulin might have to run when you inject for your breakfast - if you are at 5.7 at 3 hours then it would most likely continue to fall for another hour or two if you did nothing, so I would personally probably have slightly less insulin for my breakfast and also keep an eye on things by checking over the next hour or two. Once you know what happens when you do this you will be able to be more confident and not have to do so many checks.

Hope everything goes OK! 🙂

I'd also correct, but you do have to watch out for "stacking" insulin, cos sometimes it's hard to work out how much insulin you have still on board when you subsequently inject for breakfast. If you can get hold of an Accuchek Expert meter or an Abbot's Insulinx meter they will work this out for you. You'd need to ask your DSN.

I came across this app for mobiles this morning which calculates similar to the smart meters. I've not used it, so I can't say how good it is, but worth a try if you can't get hold of one of the smart meters.

 

[lauraw1983]

My consultant would say, there isn't a right way or wrong way, what works is always the right way...

If my levels are at a certain point, I will always correct first get my levels down before eating, some will say that just add the correction dose into the meal dose.. Which is fine for a small correction but not so good if it's a large correction...

Do you know what caused last nights hypo!

Miss match of quick insulin to your carbs you've eaten perhaps!

Concerning the high's first thing in the morning, there could be several reasons behind this, from incorrect background insulin, to Dawn Pham playing a part.

But without any fasting test being done, including a night time hourly testing it's difficult to determine where the problems may lay,

DAFNE will certainly help you out, but even though this is an excellent course, I still suggest that you invest in a book called 'Using Insulin' by John Walsh as this will give you further explanations and details how to do fasting tests correctly, how to work various dose factors out, with a lot more information.. Which tends not to be covered on the DAFNE course.

Last nights hypos was because I spent the day having a mass tidy/sort of 2 bedrooms and was still doing it later - I took a break to get my dinner, but it's one of those things I didn't think about the fact I was 'active' after dinner to reduce insulin a little for it. Felt shaky when I had a shower and then tested when I got out at 2.4.

I am on 12u Lantus at 10.30 at night - when I tried 14u all it did was give me hypos through the day so I stuck with 13u! Any 3am tests I have done have always been almost the same as the figure I went to bed with.

Have never done full fasting tests, when I mentioned it to my DSN she said there was no need for that yet?!

I think I do need to buy some of these recommended books though, am going to see if I can get them on my Kindle 🙂

 

[lauraw1983]

I think it's perfectly acceptable Laura, you're just correcting the high - it's as if you had eaten something and then forgotten to inject, that's all. Of course, you do need to bear in mind how much longer your correction insulin might have to run when you inject for your breakfast - if you are at 5.7 at 3 hours then it would most likely continue to fall for another hour or two if you did nothing, so I would personally probably have slightly less insulin for my breakfast and also keep an eye on things by checking over the next hour or two. Once you know what happens when you do this you will be able to be more confident and not have to do so many checks.

Hope everything goes OK! 🙂

Hmm yes. Testing so far has been this:

7:15am - 13.8
4u humalog

10:00am - 5.7
29g carbs, 4u humalog

13.30pm - 5.7
(Had to go out the office so checked before I drove)

14.15pm - 6.8
75g carbs, 9u humalog


Will see what I am before dinner I guess...

My only worry with taking insulin when I rise and not eating for a while is that I have to drive and am often running around like a blue a****d fly and am worried I overdo it and end up hypo, but I can only trial it. Seeing a DSN on Thurs for my pre-DAFNE baseline HBA1C so will ask her about it too and see what she says...

Thanks all, once again great help so far!

 

[lauraw1983]

I'd also correct, but you do have to watch out for "stacking" insulin, cos sometimes it's hard to work out how much insulin you have still on board when you subsequently inject for breakfast. If you can get hold of an Accuchek Expert meter or an Abbot's Insulinx meter they will work this out for you. You'd need to ask your DSN.

I came across this app for mobiles this morning which calculates similar to the smart meters. I've not used it, so I can't say how good it is, but worth a try if you can't get hold of one of the smart meters.

I use the Abbot Xceed at the moment too, I know my DSN has the Insulinx....I shall ask about the other one too! I didn't realise a BG meter could calculate that for me, that could be very useful indeed! Will also check the app as I have an iPhone. Thanks.

 

[Northerner]

...My only worry with taking insulin when I rise and not eating for a while is that I have to drive and am often running around like a blue a****d fly and am worried I overdo it and end up hypo, but I can only trial it. Seeing a DSN on Thurs for my pre-DAFNE baseline HBA1C so will ask her about it too and see what she says...

Thanks all, once again great help so far!

Yes, I can see how that might be a worry - I don't drive and never have so it tends not to feature in my thinking! I suppose the best thing to do is to be cautious in your correcting, then test regularly to see what effect it has. Might take a bit longer to find the happy medium, but better to err on the safe side 🙂

 

[heasandford]

I'd also correct, but you do have to watch out for "stacking" insulin, cos sometimes it's hard to work out how much insulin you have still on board when you subsequently inject for breakfast. If you can get hold of an Accuchek Expert meter or an Abbot's Insulinx meter they will work this out for you. You'd need to ask your DSN. .

I have an Expert meter, but the calculation doesn't make allowances for insulin previously in use for food on board, so is not exactly foolproof for stacking.

I think you're already responding well, and the responses on here have all supported you, keep it up!

 

[PattiEvans]

I have an Expert meter, but the calculation doesn't make allowances for insulin previously in use for food on board, so is not exactly foolproof for stacking.

Ahhh I didn't realise that and therefore my advice was wrong. Thanks for that info heasandford.
I use the Insulinx and I love the feature that takes IOB into consideration!

Lauralaw, if you don't test before driving, and every 2 hours whilst driving on a long journey, or making several short journeys, you are now breaking the law. It used to be "advisable" but you now have to sign to say you understand about testing and will comply with the law i.e. testing as I said, when applying for your driving licence. I presume you have declared the fact you're on insulin and have the 3 year licence?

 

[lauraw1983]

Ahhh I didn't realise that and therefore my advice was wrong. Thanks for that info heasandford.
I use the Insulinx and I love the feature that takes IOB into consideration!

Lauralaw, if you don't test before driving, and every 2 hours whilst driving on a long journey, or making several short journeys, you are now breaking the law. It used to be "advisable" but you now have to sign to say you understand about testing and will comply with the law i.e. testing as I said, when applying for your driving licence. I presume you have declared the fact you're on insulin and have the 3 year licence?

Of course I have and of course I do - I have my children in the car! My driving licence is extremely important to me, I'd never take a risk with it.

I also live in the real world with two young children and a very busy life. 🙄

 

[PattiEvans]

Sorry, wasn't being judgemental, it was just a comment on strips/number of tests per day/stacking insulin.

 

[robofski]

Laura, fill out the form on Abbotts website and they'll send you an insulinx meter for free! I got one last week (not really had a chance to play with it yet!)

 

[lauraw1983]

I know I could get a free meter but I don't have the strips on prescription...I'll ask my dsn about it compared to the other one mentioned above.

I'll update this further with the rest of my tests last night and today when I get a minute today!

 

[Northerner]

I know I could get a free meter but I don't have the strips on prescription...I'll ask my dsn about it compared to the other one mentioned above.

I'll update this further with the rest of my tests last night and today when I get a minute today!

They often come with a form that you can hand it at your surgery for a change of strips, Laura. It shouldn't need an appointment or anything - if I need anything changing I just put a note on my repeat prescription 🙂