Type 1 conundrum. ??????

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Robster65

Robster65

Senior Member
Relationship to Diabetes
Type 1
Hi again.

For about 4 weeks, we've been recording everything that goes into my body (insulin, carbs) and exercise plus any other relevant details.
Ive been walking daily and last week averaged just over 6 miles per day, although this week things are a bit more laid back.
My bloods were mainly low after a week or 2, so I lowered my lantus by 2 units to 12, which I inject at about 11pm.
We're now finding that the lows have mostly disappeared, with levels staying fairly good post meal and during exercise.
I have breakfast about 8/8.30am. dinner about 12.30pm and tea about 5.30/6pm. I get the normal post-meal rise which is controlled by humalog injected immediately after the meal.
We've found that my blood sugar rises about an hour or 2 after I've been for a walk, despite falling from 7 to 5 during the walk. My BS also rises about 11pm ish even if I go for a walk in the evening.

I realise there are a whole heap of variables that come into play but this seems to happen pretty consistently.
I have considered putting my Lantus back up to 14 units and readusting on the humalog to try and avoid hypos. But this may involve eating extra food which will not help me to lose the few pounds I hope to.
Another thought is about the liver kicking out some glucagon if the humalog has run out during the walk but the Lantus should cover any defecit. :confused:

Your thoughts would be welcomed. 🙂

Rob

ps. I'm seeing nursey tomorrow pm so I could do with a few scenarios to throw at her and mull over.
 
Hi Rob

Your rise about 11 pm could be your lantus running out, so you get a small gap in your basal coverage while the previous dose runs out and before the other one kicks in. You could ask your nurse about switching your lantus to a different time, or maybe splitting the dose to try and counteract this.

If you're going to bed and waking up on the same levels, then I'd say your lantus dose is probably fine, and I'd avoid putting it up to 14 if you were having problems with hypos. If you're rising overnight, then increasing the dose is probably required. Can you increase to 13 units rather than 14? 🙂
 
Hi Ange.

We thought about the gap in the lantus and I'll put that to the nurse as an option, but the afternoon rise made me wonder if there's something else at play.

I'm still having a slight drop overnight, although not always easy to discount other factors. I wondered about raising the Lantus back up, lowering the humalogs and keeping an option open for a snack at suppertime.

ANother variable could be overuse of injection sites which I have had in the past but I think they're ok at the moment. ALso possible is the insulin becoming less effective after a few days in the pen. They're kept at room temperature but it may get too warm.

ROb
 
ps. I use the Autopen24 which only goes up in 2 units so I can't split the difference 🙄

Rob
 
Cheers Northerner. I'll see what she's giving away. I've had this one for about a million years.

Rob
 
Robster65 said:
Cheers Northerner. I'll see what she's giving away. I've had this one for about a million years.

Rob
Click to expand...

You might ask her if she's got a Clickstar - people seem to like it better than autopen http://www.diabetessupport.co.uk/boards/showthread.php?t=8462

As for the levels, it often happens to me that my levels rise in the hours afterwardsIt's possible that your liver (and mine!) is putting out glycogen to replenish that used up by your muscles, but as you say, maybe not enough circulating insulin to 'process' it. Some people advocate having a snack after exercise to stop your liver from doing this - a bit like having a snack at night can help some people overcome their Dawn Phenomenon. Tricky business, and I suspect the best solution is an insulin pump - which might also help you with your injection site problems. Good luck with the visit! 🙂
 
I wondered too about the post-exercise snack. I had a jelly baby after the 7 test halfway and another after the 5 test about 3/4 way round. My thinking was that, if I'd had another snack (JB or 2) afterwards, there still wouldn't be enough insulin in my bloodstream. As you say, it's a very fine balancing act and one that I've only recently become aware of due to LOTS of tests 🙂rolleyes🙂. :D

My post-exercise routine this afternoon consisted of sitting on the sofa reading for an hour or so which I hoped would stop me going hypo. It certainly acheived that aim !!😱

If I'm offered a pump, I believe there's a long waiting list so I'll have lots of time to think about it.

Rob
 
Cant advise as i know nothing lol but wanted to say good luck at the doctors tomorrow Rob.
 
Thanks Steffie. We've got 20 minutes and a whole file full of charts, graphs and statistics to show her where we've been having problems and she'll probably ignore it all and come up with a simple solution.

But at least she can see where her test strips have been going !

Rob
 
What confuses me is that some people on pumps (and some on injections) idon't need any insulin when exercising - they switch off their pumps or don't inject! Blooming diabetes!
 
I used to work in the control systems industry where you have varying inputs which are monitored, software that tries to acheive what you want, and outputs that make the changes necessary.

I try to view my diabetes in a similar way. Cause > effect.
But when you try to list all the variables and how they might affect the way the body functions, you end up going ever so slightly mad.

The best one for me has always been the liver's effect. Just when you think you're doing well, it squirts some glycogen into your bloodstream and you start again. :D

I've been for another stroll btw because BS was up to 11.2 and now it's down at 4.2 so I've had a jelly baby and will test and adjust all evening until we reach equilibrium. Or until my BS climbs of its own accord. 🙄

Rob
 
Brief update.

I had a good low GI tea and tested 11.2 at 7.20pm so we went for a short 15 minute walk. When I got back I was 4.2, so waited to see what would happen, tested again at 9.36pm, was 3.7, had a jelly baby, tested again at 10.56pm and was 4.3, so had a hob-nob. Tested again at 11.26 because I was still feeling low and was 3.3. Had a jelly baby again. Half an hour later was 3.7 so had 2 hob nobs to see me through the night.
At 2.15am I woke up feeling low, tested at 1.9 so went into emergency mode and had 150ml of coke, 2 jelly babies and then an alpen bar half an hour later to see me through. Tested at 8.15am and I was 12.6.

All extreme ups and downs. I don't like it.

Rob
 
What a pain in the neck Rob. Maybe all the lows contributed to the overnight extreme low? They do say that you are more likely to have onother within 24 hours. Seemed like you were doing your best to stay in range and don't blame you for the overtreatment of the 1.9 - it's extrmely difficult not to when you are that low at night. Sounds like you may need to start lowering your basal.
 
Rob - sorry to hear you're finding this tough! I'm only just getting into this notion of 'exercise' haha so I can't really comment on that, but Northe's suggestion of all the little lows combining into one big one sounds about right - it's almost as if this time when you went walking the scales tipped over to the low side and you were playing catch up all night.

On the 2 occasions I've successfully been running (I did attempt a 3rd one but hypo'd straight away so gave up on that), one time I found myself hypo half way through and hypo most of that evening, the other I found myself shooting into the 12s and then hypo about 12 hours after. Fun and ruddy games.
 
Trouble is, I lowered the basal a 10 days ago and we've been adjusting to the new levels but we're still getting these odd spikes.
I'm hoping the nurse can give some ideas because I can't see any consistent logical cause for what's happening.

I did wonder with the low GI food, whether it's trickling into the bloodstream at a steady rate but the humalog has more of a spiked response and is not there for the tail end of the food absorption. My knowledge of digestion is sadly limited.

Rob
 
>Shiv.

Lol. Ain't it just !

I wouldn't mind but we're doing everything we're supposed to and, like you, some of it is a bit new to me and still the BS goes up and down like a yo-yo instead of the smoothed response they suggest for low GI and exercise.

I was no worse off when I used to sit on my bum most of the time and have sausage and mash and a slice of cheesecake for pudding 😱

I can feel the self-pity gland starting to inflame so I'll stop there ! 😉

Rob
 
Robster65 said:
I was no worse off when I used to sit on my bum most of the time and have sausage and mash and a slice of cheesecake for pudding
Click to expand...

Had to laugh at this. I'm hoping over time I'll see some actually patterns in terms of what happens after I go for a run (and bear in mind I'm running at most 1 - 2 miles at the moment - I've never run before, so I plan to start small and build up over time).
 
You can run a mile ???? 😱

I've had to build up the walking (albeit 3-4 mph with some serious hills) from about 1.5 miles to about 3 or 4.

As for patterns, I'm still looking. I'd love an off switch for glycogen. It's like an interfering colleague who messes with your work when your back's turned.
Is there a clinical name for a pathological hatred of one your own (perfectly functioning) organs ? :confused:

Rob
 
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