Struggling to maintain control

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Laura22

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Relationship to Diabetes
Type 1
Hello one and all!

After starting Basal Bolus nearly two years ago, I still have no proper control over my blood sugar levels.

I take 30 units of Levemir twice a day at 8am and 8pm which is fine. I also use Novorapid and generally have 10 units at meal times as well as any extra snacks, I dose according to the carbohydrate value. I am on a 1:10 ratio and most of the time this works well.

Except the SLIGHTEST bit of food will send my BSL to well over 16mmol. Sometimes into the 20's. It really gets me down as I have to do correction doses and wait for 2 hours to see any difference.

My Diabetes doctor keeps telling me to up the doses. Up, up up yet, if I do 10 units as a correction and don't eat anything that adds up to 10g of carbs, I tend to go hypo very quickly. I've been seeing this doctor for quite a few years now and to be honest, I want to try and get a new one. Before I changed to Basal Bolus, I was on NovoMix30. My BSL wouldn't go below 10mmol and he kept telling to me increase my doses until at one point, I was injecting over 120 units of Insulin a day to find nothing had changed. He wanted me to wait until my BSL were down to single digit readings before I started on Basal Bolus. He gave me a prescription for it and after a few days, when the readings still hadn't settled on NovoMix30, I started on it myself and found improvements almost immediately. But it's not settled now yet and I find myself waking up with levels between 10 and 16mmol. I want to keep it down at 7 or 8mmol but again, I struggle.

I'm very interested to read your stories about Basal Bolus and any problems you may/may not have had with your doctors and also any advice you might have about keeping BSL low.

Thank you!

Laura 🙂
 
If you have a correction dose, with no food, you will most likely end up in a hypo.
Eg, i am on a ratio of 0.5unit : 10g carb. but if im doing a correction dose, 1unit brings me down by 3.5MMol.

My only suggestion is to try upping the background insulin?

What are your sugars like before and 2 hours after food?
 
Hi Akasha,

I have just upped my backround insulin to 30units.

Levels vary totally. But normally in the teens :(
 
Laura

How are your levels before meals? If they are ok, it may be that you are getting spikes after eating and need to try changing the timing of your injections - do you inject before or after eating?

Rachel
 
Have you hospital/DSN put you on the carb counting course?
They should beable to help you work out the exact ratios (if you haven't already) Plus point out what has roughly what carbs. i.e Jacket potato has more then mashed. 🙂

You could maybe try changing your ratios. 1unit:15g carb?

I shall leave this to the others to put ideas forward. Im not used to dealing with such high numbers.

Hope you get it sorted. 🙂
 
hi laura

a lot of people find they need different ratios for different times of the day - e.g. for breakfast i take 2u for every 10g, whereas at tea time i'm back down to 1:10. have you had a good look at your ratios?

are you in touch with your team? you can request to see a DSN between appointments which is something i do, that way i can still get medical advice even if i'm not seeing the big guy!
 
rachelha said:
Laura

How are your levels before meals? If they are ok, it may be that you are getting spikes after eating and need to try changing the timing of your injections - do you inject before or after eating?

Rachel
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I always inject before meals.

As I said to Akasha, numbers are normally in the teens reagrdless of the time unless I have done a correction shot.
 
shiv said:
hi laura

a lot of people find they need different ratios for different times of the day - e.g. for breakfast i take 2u for every 10g, whereas at tea time i'm back down to 1:10. have you had a good look at your ratios?

are you in touch with your team? you can request to see a DSN between appointments which is something i do, that way i can still get medical advice even if i'm not seeing the big guy!
Click to expand...


Ahh now that could be something to try!! Afterall, I hear Diabetes control is all about trial and error! I'll look into this tomorrow morning. 🙂
 
It may be your ratios that are wrong. On the Dafne course we were recommended to just change one at a time, and see how that went, rather than changing them all at once.

Another thing to think about might be having a carb free meal at lunch time and seeing what happens to your levels to check if you longlasting insulin dose is working properly.

Alot to think about - poor you
 
rachelha said:
It may be your ratios that are wrong. On the Dafne course we were recommended to just change one at a time, and see how that went, rather than changing them all at once.

Another thing to think about might be having a carb free meal at lunch time and seeing what happens to your levels to check if you longlasting insulin dose is working properly.

Alot to think about - poor you
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It's easier said that done to have a totally carb free meal these days! Especially in my house! lol. I only work part time so am at home alot.

I've been recommened a DAFNE course. Another interesting thing to look into.

The Levemir is a pickle insulin. The other day I woke up at 10mmol, yesterday at 8.......... I can't win!
 
the DAFNE course is fab, i did it in 2008 and i would really recommend it. it helped me so much, and i learnt more on that course than i had in my whole [diabetic] life.

low carb mea ideas: omelette, cottage cheese, meat eg bacon, eggs...?

basal testing could also be a good idea, although i don't know a great deal about it - maybe one of the guys on levemir could help with that, i'm on lantus and the profiles are slightly different.
 
shiv said:
the DAFNE course is fab, i did it in 2008 and i would really recommend it. it helped me so much, and i learnt more on that course than i had in my whole [diabetic] life.

low carb mea ideas: omelette, cottage cheese, meat eg bacon, eggs...?

basal testing could also be a good idea, although i don't know a great deal about it - maybe one of the guys on levemir could help with that, i'm on lantus and the profiles are slightly different.
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Haha- you are talking to quite possibly one of THE fussiest eaters on this forum!

I don't like eggs, mushrooms, cottage cheese, spicy foods or casseroles.

But I do love fish! 🙂
 
shiv said:
then grab the tuna and munch away 😉
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Hmm- could do but I bet it'll add to carb value if I put sweetcorn in :(
 
shiv said:
check the can of sweetcorn!
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Just had a look. Went to the cupboard, cupboard is empty. Cue me looking like this: -----> :(
 
Hi Laura

Everyone's already given some really good ideas! :D I'd definitely try getting on a DAFNE course if you can, in the meantime there's a pretty good online carb counting programme here: http://www.bdec-e-learning.com/ I'd also suggest maybe trying to pick up some books on basal bolus - Think like a pancreas by Gary Scheiner and Using Insulin by John Walsh are two I particularly like. They can help with all the niggly things about basal/bolus, and I found them really helpful while I was waiting to get on a DAFNE course.

The only other thing I can think of suggesting is have you considered using lantus instead of levemir? The reason I ask is that I had much better control on lantus than levemir, and with much lower insulin doses. When I was on levemir I had to take far more levemir (three times as much as lantus), and I had to take much more insulin with food as well, and I was still waking with high levels. This might not be the case with you, but it could be worth bringing up with your doctor or DSN. 🙂
 
randomange said:
Hi Laura

Everyone's already given some really good ideas! :D I'd definitely try getting on a DAFNE course if you can, in the meantime there's a pretty good online carb counting programme here: http://www.bdec-e-learning.com/ I'd also suggest maybe trying to pick up some books on basal bolus - Think like a pancreas by Gary Scheiner and Using Insulin by John Walsh are two I particularly like. They can help with all the niggly things about basal/bolus, and I found them really helpful while I was waiting to get on a DAFNE course.

The only other thing I can think of suggesting is have you considered using lantus instead of levemir? The reason I ask is that I had much better control on lantus than levemir, and with much lower insulin doses. When I was on levemir I had to take far more levemir (three times as much as lantus), and I had to take much more insulin with food as well, and I was still waking with high levels. This might not be the case with you, but it could be worth bringing up with your doctor or DSN. 🙂
Click to expand...

Hi there,

I am already one step ahead! lol I have the "Think Like A Pancreas" book but struggle to understand it.

I'll defiantely talk to my doctor about Lantus!!
 
I've just checked my levels now and they're at 18.3mmol :(
 
Laura22 said:
Hi there,

I am already one step ahead! lol I have the "Think Like A Pancreas" book but struggle to understand it.

I'll defiantely talk to my doctor about Lantus!!
Click to expand...

I have both, and I prefer Using Insulin, because it's more like a step by step guide at the beginning, and then explains the more complicated stuff later, but everyone's different! 😛 And of course, you can always ask here, there are plenty of people who can answer any questions you might have. 🙂
 
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