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Sugars not dropping on insulin!! Advice needed.

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Suzy52

New Member
Relationship to Diabetes
Type 2
What's the highest dose of lantus insulin that people are on please? ‍♀️ I'm on 26 units plus tablets but sugars are between 15-19 after eating.
I feel like I'm never going to get it down
My hba1c was just done and its 78.
I don't know what to do.
 
How long have you been on the Lantus? What’s your blood sugar before eating? How many carbs a day/each meal are you eating? What tablets are you taking?

People take varying amounts of insulin. There’s no maximum dose really. Do you have a diabetes nurse to call for advice?
 
I've got a hospital appointment in May for the diabetes clinic, I'm on 4 metformin, 2 80mg gliclazide, 1 linagliptin a day, 26 units of lantus insulin.
I don't measure carbs, my readings are always high even when I've not eaten anything, morning is about 9-10 then meals they go through the toof tonight 19.3.
 
I've got a hospital appointment in May for the diabetes clinic, I'm on 4 metformin, 2 80mg gliclazide, 1 linagliptin a day, 26 units of lantus insulin.
I don't measure carbs, my readings are always high even when I've not eaten anything, morning is about 9-10 then meals they go through the toof tonight 19.3.
You are on quite a lot of medication but if you are having more carbohydrates in your diet than your body can cope with despite the medication then your blood glucose will still be high.
Do you have a means of testing for ketones, urine Ketosticks then it would be wise to get some and test if your blood glucose is consistently in the high teens and do so if you feel unwell and be aware of the symptoms of DKA.
I wonder if you may actually be Type 1 or LADA rather than Type 2 if the medications are not working.
It would be worth keeping an open mind and mentioning to your diabetic nurse asap. Waiting until May seems too far away given your high blood glucose level.
 
26 units of Lantus is not a huge amount, particularly if you are Type 2, so there is definitely room for increasing it, but Lantus is only supposed to deal with the glucose released by your liver and not the glucose from your food which is why your levels are going high after meals.

Can you give us an idea of the sort of things you typically eat for breakfast, lunch and evening meal?

Rather than injecting more insulin, it might be worth experimenting with making some dietary changes to reduce the amount of carbohydrate you are eating, as that will help reduce the increase in BG every time you eat.

If you wake up every morning with levels about 9-10 and your evening readings are near 20 then that suggests that you probably should not be taking any more Lantus as it is already dropping your levels overnight rather than holding them steady. The right dose of Lantus would be a one that kept your levels reasonably steady overnight. Your Lantus dose looks to be dropping you almost 10mmols from 19 at night to 9-10mmols in the morning. That is a big drop. and whilst it is a positive thing at the moment because you want your evening levels to come down from being so high, it is not the job of Lantus to correct high levels but to hold you steady.

If you can give us an idea of what you currently eat, we can perhaps suggest some alternatives that might stop your levels rising so much.
 
26 units of Lantus is not a huge amount, particularly if you are Type 2, so there is definitely room for increasing it, but Lantus is only supposed to deal with the glucose released by your liver and not the glucose from your food which is why your levels are going high after meals.

Can you give us an idea of the sort of things you typically eat for breakfast, lunch and evening meal?

Rather than injecting more insulin, it might be worth experimenting with making some dietary changes to reduce the amount of carbohydrate you are eating, as that will help reduce the increase in BG every time you eat.

If you wake up every morning with levels about 9-10 and your evening readings are near 20 then that suggests that you probably should not be taking any more Lantus as it is already dropping your levels overnight rather than holding them steady. The right dose of Lantus would be a one that kept your levels reasonably steady overnight. Your Lantus dose looks to be dropping you almost 10mmols from 19 at night to 9-10mmols in the morning. That is a big drop. and whilst it is a positive thing at the moment because you want your evening levels to come down from being so high, it is not the job of Lantus to correct high levels but to hold you steady.

If you can give us an idea of what you currently eat, we can perhaps suggest some alternatives that might stop your levels rising so much.
Thank you so much for your reply it was very helpful and I wasn't aware of the way lantus works.
I have to admit my diet is pretty poor I do eat some high carbs which I'm aware are wrong, I don't eat lots but mostly the wrong food.
I've had toast for breakfast, 3x biscuits and a slice of fruit cake, for tea 2 thin slices of small white bread with sausage on.
 
I was started on 26 units of Lantus (daily) in an evening when I came out of hospital last July, but increased gradually when my finger prick test was always higher last thing, anything from 12-16. The maximum I got to was 38 units in December, but now I walk 5 miles a day I have reduced it to 32 (I also take NovoRapid for short-term with meals). Maybe adjust your units gradually on a week-by-week basis if you feel comfortable doing so.

I also reduce my carbs for tea/evening meal - chicken, tuna etc which helps keep the sugars down.
 
I was started on 26 units of Lantus (daily) in an evening when I came out of hospital last July, but increased gradually when my finger prick test was always higher last thing, anything from 12-16. The maximum I got to was 38 units in December, but now I walk 5 miles a day I have reduced it to 32 (I also take NovoRapid for short-term with meals). Maybe adjust your units gradually on a week-by-week basis if you feel comfortable doing so.

I also reduce my carbs for tea/evening meal - chicken, tuna etc which helps keep the sugars down.
Thank you I've got to try something I'm really struggling at the moment x
 
All the foods you mention are carbohydrates, not that you can't have some but you are not having a very balanced diet including meat, fish, eggs, cheese, vegetables.
It maybe that you need to be discussing also having a bolus insulin to take with meals so you can eat more normally.
 
Thank you I've got to try something I'm really struggling at the moment x
I know it's horrible having to give up on the food we've spent a lifetime enjoying, but with some self-discipline now in relation to carbs, as type 2, maybe you have the chance of reversing your diabetes in the future.

I would also recommend asking a friend to go with you for a walk in the evening, now the nights are drawing out. This will reduce your bedtime BG reading, so long as you avoid eating when you get home.

Good luck
 
I've had toast for breakfast, 3x biscuits and a slice of fruit cake, for tea 2 thin slices of small white bread with sausage on.
There are no fruit or vegetables in this, not really any protein just the processed sausage, and mainly sugary carbohydrates. Changing your diet to be based on veg and protein with some carbohydrates would be a good start, aim for your plate being 50% vegetables
 
Sorry to hear how difficult you are finding things @Suzy52 :(

Hope you can find a new balance between your menu and your meds. And like others say, I wonder if it might be worth talking to your clinic about the possibility of adding a mealtime insulin?
 
There are no fruit or vegetables in this, not really any protein just the processed sausage, and mainly sugary carbohydrates. Changing your diet to be based on veg and protein with some carbohydrates would be a good start, aim for your plate being 50% vegetables
Have you tried porridge? I have Quaker's 'Big Bowl' (other brands are available) with golden syrup flavour for my sweet tooth. It also acts as a slow release sugar.
 
Have you tried porridge? I have Quaker's 'Big Bowl' (other brands are available) with golden syrup flavour for my sweet tooth. It also acts as a slow release sugar.

Porridge is a bit controversial. It is a high carb food because it is made from grain but it has a reputation for being slow release. Unfortunately, that is not the case for everyone and a big bowl of porridge or even a small bowl, could spike someone's levels higher than toast and just as quickly as toast. Sadly, I am one of those people, so I steer clear of porridge now.... and bread/toast. Not sure about the Golden syrup flavour you mention either. Is that one of these sugar free flavourings that you get in squeezy bottles? It is important to be clear because it might lead to original poster to believe that regular Golden Syrup is OK, when it is probably worse than granular sugar.

A low carb breakfast would be eggs, however you like them. Personally I find them quick and easy scrambled in the microwave and nice with mushrooms and cheese and served on a slice of ham with some slices of tomato, or a large omelette which can have a whole variety of fillings and I serve it with a large side salad and cheese coleslaw .... yes salad for breakfast! Or mostly I have creamy Greek natural yoghurt with a few berries and mixed seeds and chopped nuts and a sprinkle of cinnamon.

@Suzy52 Just making a simple change like trying a different low carb breakfast could make a significant difference to your levels for the rest of the day.
To my way of thinking, adding a meal time insulin to your regime and continuing with your current diet is unlikely to be beneficial in the long run. If you can make just one small change every few weeks to form new better eating habits, that will benefit your general health, not just your diabetes management. I know it isn't easy because I was essentially a sugar addict pre-diagnosis, but I can tell you that I feel so much better now that I have kicked the habit and the majority of the time I don't even crave that sweet stuff now. I am not saying that I couldn't easily slip back to the way I was because I could, much like a recovering alcoholic.... and I had a rare wobble day last week which made me feel physically unwell for several days afterwards (and I have insulin to cover what I eat), but I am back in control again now and happy to be eating healthily again. That old way of eating was killing me and since changing to a low carb way of eating, it has improved lots of other health conditions like migraine and joint pain and reduced cholesterol and I sleep really soundly.

Getting some exercise like a walk particularly after a meal, is an extremely good suggestion by @kit.kendal.

Hopefully you can find a way to improve your eating habits and your diabetes management, but sometimes increasing doses of insulin or adding different insulin can make things worse instead of better in the long run, if you don't address your diet because it will cause you to put on weight. Just to be clear, it isn't the insulin which causes weight gain, but the food you eat. The insulin just allows your body to store that food as fat if you don't burn it off, whereas now the glucose from that food is sitting in your blood stream. The key thing is to put less glucose into your blood stream in the first place by eating less carbs.

With you being on insulin and Gliclazide, you need to make slow sustainable changes to your diet otherwise you risk going hypo. So just take it one meal at a time and make small changes and form new healthier habits.
 
Thank you so much for your reply it was very helpful and I wasn't aware of the way lantus works.
I have to admit my diet is pretty poor I do eat some high carbs which I'm aware are wrong, I don't eat lots but mostly the wrong food.
I've had toast for breakfast, 3x biscuits and a slice of fruit cake, for tea 2 thin slices of small white bread with sausage on.

I’d reduce your carbs gradually so you can make adjustments to the Lantus as and when needed. It’s far better to bring them down a gentle slope than change your diet massively overnight.
 
Have you tried porridge? I have Quaker's 'Big Bowl' (other brands are available) with golden syrup flavour for my sweet tooth. It also acts as a slow release sugar.
Lots of people will tell you that porridge is bad @Suzy52 but I would try it, as @kit.kendal suggests

For me, it doesn't cause a spike in blood sugar and keeps me full until lunch time, so there is no wanting to snack mid-morning either. I understand that this is not true for everyone and some people do spike, but it's always worth trying out different foods to find the things that work for you
 
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Hi. It sounds like you have far too many carbs overall in your meals. Try to set yourself a daily limit of perhaps 130gm or less. Also Lantus is a long-acting insulin and is usually but not always used with fast-acting insulin such as NovoRapid (the Basal/Bolus regime). If you have any excess weight then any insulin may not have much effect due to insulin resistance where your body may already have too much insulin.
 
Lots of people will tell you that porridge is bad@Suzy52 but I would try it, as@kit.kendal suggests

For me, it doesn't cause a spike in blood sugar and keeps me full until lunch time, so there is no wanting to snack mid-morning either. I understand that this is not true for everyone and some people do spike, but it's always worth trying out different foods to find the things that work for you

Same here, have porridge most mornings & doesn't cause spike with a prebolus.
 
Same here, have porridge most mornings & doesn't cause spike with a prebolus.
But the OP is not using bolus insulin and has high BG levels, so porridge is probably not a good option for them.
 
But the OP is not using bolus insulin and has high BG levels, so porridge is probably not a good option for them.

Wasn't suggesting it to OP, quoted LancashireLass as also find porridge doesn't spike & keeps me going all morning.
 
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