Sugar spike

[vicky1974]

Hi everyone, recent type 1 diagnosis. Currently on 20 units lantus OD and then 8 units of novorapid 3 x a day. Since having my Libre sensor I have noticed a trend. I get up and sugars around 13 mark. Have Lantus and novorapid. Around 12pm my sugars are between 19-21 and then seem to spend the day trying to get them down. Have tried different breakfasts, porridge, Greek yoghurt, slice of brown toast but always the same. Any advice please?

 

[Inka]

@vicky1974 Are you around 13 all night or do they just shoot up when you get up? It’s not about the food with Type 1 - it’s about the insulin: wrong amount, wrong time, etc. It’s the Lantus and Novorapid you need to be looking at not your breakfast or lunch.

When were you diagnosed? Do you know how to do correction doses?

 

[vicky1974]

Hi thank you for the reply 🙂 yes around 13 at night although a couple of times in the night has gone down to around 7 and then shot back up. I was diagnosed about 4 weeks ago. I have been told about correction doses and have at times had an additional 2 units of Novorapid but it makes no difference. I don’t know if I need more novorapid in the morning or even twice a day lantus (or equivalent) diabetic nurses have been great but just keep advising me to put lantus up 2 units (gone from 14 to 20 so far)

 

[Inka]

Ok, so very early days for you. It sounds like your Lantus isn’t sufficient for your needs. Continue increasing it as necessary as directed by your nurses. If in any doubt, check with them before increasing. You can also err on the side of caution and increase by 1 unit rather than 2 units.

Once your Lantus is at the right dose for you, you should find things easier.

 

[vicky1974]

Thank you, I just needed some reassurance. I agree my lantus does need to be higher. Fingers crossed with time I’ll get this right!

 

[SB2015]

Great that you have good support from your DSN @vicky1974

In the early days they will want to bring your glucose levels down gradually, and they will have started with a conservative dose for both Bolus (Novorapid) and Basal (Lantus) As @Inka has said just keep working your way up with the basal as advised by your DSN as they will want to get that right and keeping you stable overnight before working with you in your carb ratios to enable you to adjust your meal bolus according to what you want to eat.

Your correction doses of Novorapid will take some time to react. Before we had sensors we didn’t know what was happening between meals and just retested with a fingerprick before the next meal. The insights that we get from sensors help us but I find I can also get impatient with the changes I want to see.

One thing that you could try to help you is to keep to the same breakfast for now with the same portion size. This will help you and the DSN work out your appropriate ratio in the future. Also a chance for you to start looking at the carbs in what you are eating. Another thing for meal boluses is to start looking at the timing of your insulin. We are often told to inject 15 min before we eat. Some of us find that we need a bit of a bigger gap between the bolus and eating, especially in the morning. Worth talking to your DSN about this

Keep the questions coming. No one minds and there is loads of experience to tap into.

 

[vicky1974]

Great that you have good support from your DSN @vicky1974

In the early days they will want to bring your glucose levels down gradually, and they will have started with a conservative dose for both Bolus (Novorapid) and Basal (Lantus) As @Inka has said just keep working your way up with the basal as advised by your DSN as they will want to get that right and keeping you stable overnight before working with you in your carb ratios to enable you to adjust your meal bolus according to what you want to eat.

Your correction doses of Novorapid will take some time to react. Before we had sensors we didn’t know what was happening between meals and just retested with a fingerprick before the next meal. The insights that we get from sensors help us but I find I can also get impatient with the changes I want to see.

One thing that you could try to help you is to keep to the same breakfast for now with the same portion size. This will help you and the DSN work out your appropriate ratio in the future. Also a chance for you to start looking at the carbs in what you are eating. Another thing for meal boluses is to start looking at the timing of your insulin. We are often told to inject 15 min before we eat. Some of us find that we need a bit of a bigger gap between the bolus and eating, especially in the morning. Worth talking to your DSN about this

Keep the questions coming. No one minds and there is loads of experience to tap into.

Thank you for the reply, all very good advice. I hadn’t thought of keeping to the same breakfast. That’s a good idea and would give me a more accurate picture. I’m amazed with the Libre sensor, the information it gives you is brilliant. Never knew if would constantly record. I do sometimes eat about 10 mins after my Novorapid so will try to leave a longer gap and see if this makes a difference.

 

[Proud to be erratic]

Hi @vicky1974,
You are already getting great responses from @Inka and @SB2015.

Because there are already 2 variables by virtue of your 2x insulin meds and several more variables from daily living, ie food, activity/ exercise, everyday hormones, emotions, weather - to name a few - there is a general principle of get your basal as close to correct as possible, then look to bolus ratios for food and overarching corrections. Otherwise your basal is constantly trying to compensate not just for background life sustaining functions, but also for bolus or food circumstances. In a way this is always a chicken and egg question, but most of us find the basal must be sorted first.

So, as your basal dosing gets "in tune" with your daily circumstances - your bolus requirements can alter. Don't be surprised, or phased, if that occurs.

Also, I certainly find that my corrections can be remarkably slow in providing a visible response (from looking at my CGM) and certainly don't give me any respite in a 15 minute period, sometimes corrections from extra bolus can take 2 or more hours. In general, many people learn that when our BG is in the teens or higher our bodies seem to have increased insulin resistance and thus any correction becomes less effective when BG is higher.

Trial and learning is a necessity for better management of blood glucose (I dislike trial and error as a mindset; I don't set out to deliberately make errors, but am happy to learn when something tried dows or doesn't give the expected result), particularly because we are all different and thus what works for me could be the same for you, or a little different or even doesn't work at all for you.

I can't see anyone mentioning a book that I found really helpful shortly after my diagnosis. It is "Think Like a Pancreas" by Gary Scheiner; he is in the US and has been T1 since his late teens, now a provider of support and advice about Diabetes as his profession. Another book is "Type 1 Diabetes in children, adolescents and young adults" by Dr Ragnar Hanas; don't be misled by the young adults part of the title, it is fine for all ages. It is perhaps a drier read and slightly more of a reference source, than Scheiner's "bouncy" style; but both very useful in a different way.

Early on in his book Gary Scheiner remarks that "Diabetes is Complicated, Confusing and Contradictory". I think this is so true and perhaps early on after my diagnosis I would add Frightening. But now the fear aspect is no longer the case. It takes time, but we find knowledge dispels fear with understanding and while still very complicated, confusing and contradictory we innately acquire a sense of how to manage. [Just as I did after passing my driving test, until I now (too complacency sometimes) slide into the driving seat and drive for hours, barely thinking about the fine details of the processes of that drive.]

 

[vicky1974]

Hi thanks for the great advice. This forum really is brilliant, everyone is so helpful. I can see what you’re saying about needing to get my bolus insulin sorted out first. I think it should be much higher but understand this is going to take some time.

I will order the books, I had looked online but only really found recipe ones so it’s great to hear of some that will give me more advice.

“Diabetes is Complicated, Confusing and Contradictory" is so true! It’s just how I feel at the moment. Every day I think I’ve got better at things but then something changes and I realise what a huge learning curve this is.

I’m sure with time it will get easier, I hope so anyway. Thanks again 🙂

 

[janedent]

Hi @vicky1974,
You are already getting great responses from @Inka and @SB2015.

Because there are already 2 variables by virtue of your 2x insulin meds and several more variables from daily living, ie food, activity/ exercise, everyday hormones, emotions, weather - to name a few - there is a general principle of get your basal as close to correct as possible, then look to bolus ratios for food and overarching corrections. Otherwise your basal is constantly trying to compensate not just for background life sustaining functions, but also for bolus or food circumstances. In a way this is always a chicken and egg question, but most of us find the basal must be sorted first.

So, as your basal dosing gets "in tune" with your daily circumstances - your bolus requirements can alter. Don't be surprised, or phased, if that occurs.

Also, I certainly find that my corrections can be remarkably slow in providing a visible response (from looking at my CGM) and certainly don't give me any respite in a 15 minute period, sometimes corrections from extra bolus can take 2 or more hours. In general, many people learn that when our BG is in the teens or higher our bodies seem to have increased insulin resistance and thus any correction becomes less effective when BG is higher.

Trial and learning is a necessity for better management of blood glucose (I dislike trial and error as a mindset; I don't set out to deliberately make errors, but am happy to learn when something tried dows or doesn't give the expected result), particularly because we are all different and thus what works for me could be the same for you, or a little different or even doesn't work at all for you.

I can't see anyone mentioning a book that I found really helpful shortly after my diagnosis. It is "Think Like a Pancreas" by Gary Scheiner; he is in the US and has been T1 since his late teens, now a provider of support and advice about Diabetes as his profession. Another book is "Type 1 Diabetes in children, adolescents and young adults" by Dr Ragnar Hanas; don't be misled by the young adults part of the title, it is fine for all ages. It is perhaps a drier read and slightly more of a reference source, than Scheiner's "bouncy" style; but both very useful in a different way.

Early on in his book Gary Scheiner remarks that "Diabetes is Complicated, Confusing and Contradictory". I think this is so true and perhaps early on after my diagnosis I would add Frightening. But now the fear aspect is no longer the case. It takes time, but we find knowledge dispels fear with understanding and while still very complicated, confusing and contradictory we innately acquire a sense of how to manage. [Just as I did after passing my driving test, until I now (too complacency sometimes) slide into the driving seat and drive for hours, barely thinking about the fine details of the processes of that drive.]

I second the recommendation for Think Like A Pancreas. I'm reading it now and finding it really useful and, yeah, bouncy. I like his style. If you buy it, be sure to get Edition 3. Thanks for the recommendation for the Ragnar Hana book too, Proud To Be Erratic.