T1D, hypos and insulin

[PeteM2020]

Newly diagnosed T1D in March this year. I mentioned in my previous post this morning that consultant is sending me for cortisol blood tests in connection with the frequency of low BG readings in having (about 20% of my time is spent below 3.9mmol/l at the moment - overnight and day time). My work is highly physical and we have adjusted insulin doses accordingly. I eat like a horse when working.

As it's a day off today I thought I'd try something. I've done my basal insulin as normal. Breakfast was just 3 biscuits and cup of tea. I didn't take my bolus insulin. My Libre reading indicate BG rose from 5.9 at 8am to 9.0 over about half an hour. I lazed around just reading, and by 10am it was back down to 5.8.

It's hovered between 5.8 and 6.1 for the past few hours. Half an hour ago (1pm) I had 2 slices of egg and cheese on toast. Just waiting to see how BG responds.

Am I likely to have any problem if I stay off bolus insulin (Novorapid) all day, and am I likely to learn anything?

 

[Pumper_Sue]

You are in what is known as the honeymoon period, which basically means your pancreas is having it's final fling by pumping out insulin before it pops it's clogs. So whilst your blood sugars indicate not needing either both basal or bolus then go with it. Your meter will soon tell you when you need some insulin.

 

[PeteM2020]

You are in what is known as the honeymoon period, which basically means your pancreas is having it's final fling by pumping out insulin before it pops it's clogs. So whilst your blood sugars indicate not needing either both basal or bolus then go with it. Your meter will soon tell you when you need some insulin.

This is so strange. Look at my readings today after just having my Levemir. Cheese and egg on toast seems to have peaked and already on way back down.

 

[PeteM2020]

These are what I've been contending with the past few days while working. Keep crashing, getting confused and having to have glucose/maltodextrin gels as well as my food!

 

[DaveB]

Hi. You don't have to take the Bolus if you don't need it to keep the BS right.

 

[Kaylz]

Have you been comparing the Libre readings to a BG finger prick test?

I was on very low doses of both insulins (just 1 unit of my basal and 1U:20-25g carbs) for the first 2 years of my diabetes journey, I had quite a long honeymoon due to also being severely underweight, if your not needing bolus insulin then don't use it but I wouldn't cut basal off completely just yet, how much basal are you on at the moment?
xx

 

[PeteM2020]

Hi. You don't have to take the Bolus if you don't need it to keep the BS right.

I need to remember that. Just lately I seem to have gone all over the place and it seems I'm fighting to keep glucose where it should. Work has been full on and pretty stressful which hasn't helped.

 

[PeteM2020]

Have you been comparing the Libre readings to a BG finger prick test?

I was on very low doses of both insulins (just 1 unit of my basal and 1U:20-25g carbs) for the first 2 years of my diabetes journey, I had quite a long honeymoon due to also being severely underweight, if your not needing bolus insulin then don't use it but I wouldn't cut basal off completely just yet, how much basal are you on at the moment?
xx

I'm on 10 units Levemir in morning, and was on 15 units Levemir in evening, which I have just reduced to 7. Novorapid recently had been 8, 6, 8 (, breakfast, lunch and dinner), recently reduced from 8, 8 10.
I'm doing finger pricks when I can, and these are generally close to Libre readings except when very low.
After my cheese and egg on toast at lunchtime today, I eventually peaked at just over 10 and it's properly coming down now.
Libre just now was 8.4 with downward trend showing,and finger prick at exactly same time was 7.9.
I'm pretty sure my basal dose is right now, but my bolus maybe needs to come down a lot, and maybe to nothing when I'm sweating buckets at work!
Thank you!

 

[Kaylz]

Ah so your problem seems to be that you look like your on set units rather than carb counting and adjusting insulin based on carbs going to be consumed and where your bloods are at that given time, have you spoken about carb counting? It makes things more manageable, I'm self taught less than a month after my diagnosis but many go on courses xx

 

[leonS]

Two things ro remember:
You need to inject the amount of insulin that you need, If that turns out to be zero then that is the amount that you should inject.

When you are using your own insulin (not injected) things work like this: you eat - BG goes up - insulin is produced - then BG goed down. It is obvious that you will get a rise in BG it is just the way that things work, but may be disconserting when you hoped for a flat line.

You can teduce the hight of the peak by eating less carb and the speed at which it occurs by eating moe complex carns, but you will get a spike. As long as BG goes down in a rew hours everything is fine.
.

 

[PeteM2020]

Ah so your problem seems to be that you look like your on set units rather than carb counting and adjusting insulin based on carbs going to be consumed and where your bloods are at that given time, have you spoken about carb counting? It makes things more manageable, I'm self taught less than a month after my diagnosis but many go on courses xx

Yeah. I think you're right. I don't carb count at present. My bolus insulin units were based on the sort of meals I generally eat, and these vary quite a lot in terms of carbs and timing because of the work I do which is very messy borehole drilling, and I have to grab food when I can!
I've been waiting for a proper appointment with diabetes dietician but Covid has scuppered that at the moment, and I'm almost permanently working away from home which makes things harder. I might just try using smaller number of bolus units before eating and see what happens. If levels go up and don't come down again then I can add another couple of units, being careful to avoid insulin stacking so keeping units low.

 

[PeteM2020]

The only thought troubling me is this: if I don't inject my bolus insulin during the day then how does glucose get into my cells to provide their energy requirement? Can I safely assume that if my glucose levels rise and then fall within a couple of hours of eating then that glucose has been taken up by my cells as it should be, and that my injected basal insulin units have been sufficient to enable this to happen?

 

[Pumper_Sue]

The only thought troubling me is this: if I don't inject my bolus insulin during the day then how does glucose get into my cells to provide their energy requirement? Can I safely assume that if my glucose levels rise and then fall within a couple of hours of eating then that glucose has been taken up by my cells as it should be, and that my injected basal insulin units have been sufficient to enable this to happen?

Basically your basal insulin is doing all the work.
As you can eat all those carbs and stay very well in range then you are having the insulin you require. As you do not eat during the night except when hypo it just proves you are having too much basal insulin hence it's been cut in half.

Just go with the flow as they say. There is no exact science to diabetes. If you know for sure you will be doing extra manual work then cut your insulin a tad more or have some extra carbs so you do not go hypo.

 

[PeteM2020]

In case anyone is remotely interested, I had fish and chips from the chippy last night at 630pm.
s expected my glucose levels crept up to about 10.5mmol/l and then, without any Novorapid they slowly started to come down. I hada acan of beer at about 900pm. At 1000pm bed time glucose was still just above 9mmol/l so I injected 2 units Novorapid.
The only insulin I had yesterday was my Levemir (10 units in morning and 7 in evening), and the 2 units of Novorapid before bed and my Libre graph looks like this...
d

 

[Pumper_Sue]

If it were me Pete I would be looking at halving my basal on working days to stop the hypos. If you are getting those numbers when not working, it's no wonder you are so hypo when using all that energy at work.

 

[PeteM2020]

If it were me Pete I would be looking at halving my basal on working days to stop the hypos. If you are getting those numbers when not working, it's no wonder you are so hypo when using all that energy at work.

Or should I go lower on Novorapid based on fact I'll be eating a lot more on work days and will need to compensate for that?

 

[Pumper_Sue]

Or should I go lower on Novorapid based on fact I'll be eating a lot more on work days and will need to compensate for that?

well if you are not injecting novo on your day off why would you inject on a working day when burning off carbs?

 

[PeteM2020]

well if you are not injecting novo on your day off why would you inject on a working day when burning off carbs?

Now that's a good question! I had in my mind that I'm eating a whole lot more when working and that I would need the Novorapid to enable glucose to get into my muscle and brain cells to provide the every they need to function properly. But maybe the Levemir is sufficient for that, and I might just be better off not eating too much and letting my body convert fat to energy.

I actually think the Novorapid when I'm working makes me really hungry and in response I eat more than I need. This might explain why my fat store around my waist has expanded!

 

[Robin]

I actually think the Novorapid when I'm working makes me really hungry and in response I eat more than I need. This might explain why my fat store around my waist has expanded!

When you are expending energy, insulin sensitivity increases greatly, which means the body needs far less insulin to enable enough glucose to enter the muscle cells. If you take the same amount of short acting insulin, it won’t all be needed, so your body will call for more food intake to ‘mop up' the insulin which hasn’t been needed.

 

[rebrascora]

I tend to think of exercise and activity as the muscles sucking the glucose out of the blood without the need for much insulin.... maybe a bit like osmosis.... the exercise uses up what is in the cells so there is an imbalance between what is in the blood and the cells and this sucks the glucose through the cell walls more easily, whereas if they are both at the same sort of levels and you are sedentary, it needs the insulin to push it out of the blood stream and into the cells. That may not be biologically correct but it seems to explain how it works for me.... Exercise/exertive activity seems to sort of do some of the insulin's work, so you don't necessarily need as much insulin to effect the transport of glucose into the cells when you are physically active.