Totally had enough

[MeganN]

I've taken on board all of the advice from here. you guys have been fab, but....


I still can't work out what's going on. My overnight basal tests run steady all night, I pretty much wake up to the same reading I went to bed on. Also my evening readings and bolus ratio are spot on.
My problem is the mornings. I eat the same thing every morning but it doesn't seem to matter what bolus ratio I use nothing works.
It doesn't matter what reading I wake up on I always am about 11.5 at around midday. I've left each bolus fiddle a few days to see what happens but it still appears useless.

The only explanation I can come up with is that my liver kicks out from breakfast time onwards until about mid-morning. sending my readings high and making my lunch time readings high.

For example his morning i woke up to a 7.5. took 7.5 units of insulin working to 2.5:1 carb ratio. 2 hrs later i was at 11.2 and then another 3 hours later at lunch time I've dropped back down to 7.0. From 11-7 seems like a big drop considering my rapid would have peaked and be coming back down at this point.


I'm sooooooooo fed up this week. Feel miserable

 

[bennyg70]

Sounds like its what your eating as opposed to wht your insulin requirments are. In my opinion if I start on number A, and finish 4 or 5 hours later on number A then im happy my ratio is right.

There certain things which will effect whats going on inbetween. Ie - In the morning, I need to take my insulin about an hour before I eat - Hopefully this will match the peak better of the food.

So do you take your insulin for breakfast at a time before you eat.

And second what is it your eating? Some foods I just cant have because they spike me too much, I dont know whether they delay the insulin or what because in theory the insulin should be spent (The majority of anyway) at 2 hours however I still return to where I should be. So thats a bit of trial and error. A lot of people wont eat cerals because they have such a spike. I found I can eat cereals If i mix in nuts as the fat in the nuts helps delay and flatten out that spike.

So what is it you are eating for breakfast and is it the same most days?

 

[trophywench]

Feet Hit The Floor syndrome.

That's like DP but happens AFTER your feet hit the floor - ie after you get out of bed.

What do your basal tests between 'fasting' and 'pre-lunch' say?

 

[MeganN]

I'm eating brown seeded bread with ham and tiny squirt of BBQ sauce. total of 25g max

I know that I can't touch cereal.

Have to admit i haven't done a basal test by not having breakfast as if I do this I tend to feel completely awful.

I am however, doing a lunch fasting basal today.

Coz I felt too rubbish with myself to want to eat lunch

 

[bennyg70]

If I were to have that it would do the same to me. It would shoot me up at 1 and 2 hours and then come down by lunch Id say. If you like nuts just an experiment try some mixed nuts say 25g's (Total weight) worth and see if it helps. Also what TW said, get a basal test done.

Just too note, what I find happens when I have nuts with my breakfast what ever my BS is at 2 hrs I expect it to be the same at 4 and 5 hours as the slow release of the food after 2 hours matches the insulin thats left.

seems to work for me anyway. But you certainly need that confidence in your basal first and thats there no DP at this time.

 

[MeganN]

I'm hopefully seeing a hospital nurse tomorrow to discuss splitting my basal into 2 doses instead of just at night.

Do you mean eat nuts with my sandwich or just nuts on their own for breakfast?

I do like peanuts 🙂

 

[Northerner]

Well, I suffer a LOT from FHTF syndrome! In the mornings I test on waking. Currently, I then immediately inject 7 units of novorapid. 30-45 minutes later (after my first mug of tea!) I have my breakfast which for the past year or so has been a single slice of Burgen S&L, toasted. 30-60 mins later I go for a run. By lunchtime my level will be upper 6s, even if I woke on 4.5, and despite all that insulin for a measly 12g carbs! I then have lunch, which is usually around 30-45g carbs and inject around 6 units!

So there is a HUGE difference in my requirements to cover whatever my liver is up to in the mornings, which has almost completely switched off by lunchtime. If I only injected for the toast, even with a generous ratio, then I would be double figures every lunchtime. Just a thought! 🙂

 

[trophywench]

Sorry Megan, you cannot HOPE to get your carb ratio battened down without FIRST KNOWING what your basal insulin is doing.

If you identify your BG goes up masses just because of lack of basal then you need to address that by either changing your basal (the dose, the timing, the brand of insulin - whatever it takes) and in the meantime - inject sufficient fast-acting to cover the gap. This is NOT your carb ratio for brekkie. It's just X units of Novorapid you have to inject to cover the lack of basal.

Why are you on Insulatard?

 

[MeganN]

I'm on insulatard because it was the basal from the mix I was on before. I refused lantus do to being sensitive to the sting so was given insulatard.

If I do a fasting breakfast basal test do I eat nothing until lunch??
Or is it just 12hrs from when your last bolus wore off??

 

[everydayupsanddowns]

You have my sympathies with FHTF Megan - I need an artificially skewed breakfast dose (weekdays only - weekends are weird/more active) to keep mid-morning and lunchtime readings in check.

Like you I have ended up just eating the same thing every day (to remove one of the variables!) and also I find, like Alan, that I need to leave extra-long between injecting and eating to give the insulin a proper headstart (or at least to delay the hit of carbs so it only has the liver splurge to deal with). So typically I will wake, test, bolus. Then 45 minutes later (or more if I wake high) I will eat my 2 slices or Burgen toast.

And yes, testing basal in the morning means eating nothing from the noght before and skipping breakfast (or depending on your school of thought just having a chunk of cheese or protein to stop your liver going 'starvation mental' on rising) and hanging on until lunchtime.

Keep plugging away - you *will* work out a method that works for you.

 

[trophywench]

Well if you want to split your basal dose, you might do better with 2 x Levemir. Doesn't hang around as long as I. and you can generally see what it's doing within 12 hours! 24hrs at the outside.

Doesn't sting like Lantus or behave like it either. I know quite a few people who do far better on it than they did on Lantus - as I did - but other than yourself, I'm afraid I don't know anyone on Insulatard now.

I mean that's not to say it isn't brilliant Megan - but we could do with someone who could tell us the actual CURVE of it's activity.

 

[megga]

I always peak, from 13 to 15, now i have started taking my insulin 1/2 hour before eating. It was a big step for me as i was scared of hypo's. But doing it has reduced the spikes down to single figures. It may be worth just giving it a go and see how you get on.

 

[DeusXM]

Do a basal test for dinner - when you get up, test. Then don't eat for the morning and test every hour until lunch. I found my BG goes up of its own accord by 3 mmol/l in the morning and so factor this in to my morning boluses.

Are you also splitting your insulatard?

 

[MeganN]

Insulatard is in one dose of 26u in the evening

 

[Lizzzie]

Hmmm... Sounds as though it's your basal but think you're right about a carb free breakfast just to check!

 

[Pigeon]

Please excuse my ignorance... have to confess I have never done a basal test. Is there any point to doing a basal test if you're not on a pump? Surely if your BG rises naturally between breakfast and lunch all you can do is take more rapid acting insulin at breakfast to counter act it? There's nothing to change in your levemir/lantus if your BG is about steady through the rest of the day, I would think I just had to increase breakfast insulin?

 

[trophywench]

Of course you need to basal test on MDI. How else do you know for a fact that your basal is correct?

If you are eating breakfast, how much of the rise is caused by carbs, and how much by your body itself? Despite the remedy being as you say just take more fast acting - if you change your breakfast - how much insulin are you going to take that day???

Anyway you can have the X units to stop the rise, the moment you wake up, or whilst you sit on the loo. Then go through your normal routine and what ever time you are ready to eat, inject your bolus insulin for the meal.

I mean I used to have my morning Levemir, then test my blood, then wash, dress etc, and then have my brekkie Novorapid and eat. You don't wait to test and jab your basal until brekkie. Esp if your BG rises in a morning, why waste another half hour without insulin to address it? So you'd have your 'BG rise' insulin same time as your morning basal - ie asap.