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Type 3c diagnosed some months ago

I have read ur post a few times and it all makes such good sense and I am aware of most of what u have said..in answer I have had my Lantus reduced from 20 to now being 15 units in the morning and my target range is between 6 and 10 which is on track so far this morning ...I have an appt to see my Diabetic nurse on 2nd January so have noted down some of the points u mentioned to talk to her about these. My bsugars ended up around 18 last night so I decided to give myself 1 unit of NR which brought them down to around 13 before I went to sleep. This morning they are around 7/8 which is fine. I have the carbs and cals book which I use and will look at the other author u mentioned. I very much read all the Nutrition labels on food etc to calculate carbs. Could I ask if I'm going to eat 40g carbs meal at lunchtime instead of 30g light lunch should I swop my insulin from 3units to 4units NR.
 
cherryvalley said:
I have read ur post a few times and it all makes such good sense and I am aware of most of what u have said..in answer I have had my Lantus reduced from 20 to now being 15 units in the morning and my target range is between 6 and 10 which is on track so far this morning ...
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Great response, thanks. It helps me to have a sense of what you are already comfortable with and what is very new for you. When did you reduce your Lantus, ie how many days has the morning dose been 15, rather than 20?
cherryvalley said:
I have an appt to see my Diabetic nurse on 2nd January so have noted down some of the points u mentioned to talk to her about these. My bsugars ended up around 18 last night so I decided to give myself 1 unit of NR which brought them down to around 13 before I went to sleep. This morning they are around 7/8 which is fine.
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Well done with taking that correction. The drop from 18 to 13 is an indicator that leads to 1 unit of insulin created a drop of 5 mmol/L, ie a correction ratio of 1:5. However don't accept that as a definitive ratio on the basis of just one event; there could have been other factors in play at the same time. But 1:5 is a starting point for correction and can be refined after other corrections confirm or are different that isolated result.

I'd like to understand your timings for yesterday eve:
What time did you take your bolus for your dinner?​
How many units of bolus?​
What time did you start eating?​
How many carbs (your best guess, if you aren't sure) and what was that meal?​
What time did you reach 18?​
Was that 1 unit correction at roughly the same time as reaching 18?​
What time this morning did you see you were at 7/8?​
Is your Libre graph for this morning fairly flat, or did you get a rise of BG on waking which took you up to 7/8 from something much lowering the small hours or at dawn?​
​
The answers to these questions will help me to see the slightly bigger picture of how your BG behaved overnight.

Are you aware of something called Dawn Phenomenon (DP) which can start as early as 4am, or the Foot on the Floor (FOTF) (or FotF) Phenomenon? This is when your liver releases glucose from its store to help you get the day started and (not so helpfully for those of us with D) causes a noticeable increase in BG first thing in the morning. DP or FOTF doesn't happen every day, nor does it happen for everyone; as ever with Diabetes, we are all different. But these glucose surges add to the confusion of working out what is going on ["Diabetes is Confusing", ref Gary Scheiner]. Here on the Forum we jokingly refer to visits by the Dawn Fairy, when either of these Phenomena have happened.
cherryvalley said:
I have the carbs and cals book which I use and will look at the other author u mentioned. I very much read all the Nutrition labels on food etc to calculate carbs. Could I ask if I'm going to eat 40g carbs meal at lunchtime instead of 30g light lunch should I swop my insulin from 3units to 4units NR.
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Regarding insulin to food ratios these are something that have to be worked out specifically for you, essentially using the process of trial and learning. It is very normal for people new to Diabetes to be started on a ratio of 1:10 - as an initial first guess. Many of us find our ratio changes as the day progresses, so - just as an example - someone might need 1:10 at breakfast time, 1:8 at lunchtime and 1:12 for dinner. I used to do that, but these days I've gone full circle and use 1:10 for all my meals. However I now know, from my trial and learning, that certain meals need a bit more insulin and other meals need a bit less. Also I invariably have to take account of how active I've been yesterday (perhaps the day before as well), how active I'm going to be today and possibly going to be tomorrow. Did I mention ["Diabetes is Complicated" Gary Scheiner]?

Once again don't panic about this complexity, what seems desperately confusing right now becomes fairly routine with time and experience.

My answer to your question "should I swop my insulin from 3units to 4units NR" is that this is what I would do and use that as a trial and learning exercise.

The useful thing at present is to keep a record of things you are doing, including such a change of NR dosing. The Libre notebook is really good for logging such stuff and it allows you to look back at the notes you make. I used to log things under ther short heading on a note as "TRIED" and that key word allowed me to find such trials in my Libre notes. I spent my 1st year after my Whipples with no CGM, only finger pricking. I kept notes, hand written on scraps of paper, backs of envelopes and bits of cardboard packaging. All very efficient, each day worked brilliantly for that day - but a couple of days later was just a dreadful mess of rubbish. So I don't recommend my hand written system. If you don't like using Libre notes dedicate a notebook specifically for your D management. Use it as if a diary, recording chronologically. Anything that clearly didn't work for you, or anything that leaves you asking yourself WHY(?) enter into your manuscript note book at the back. Those queries and comments at tge back should give you things to ask your DSN on the 2 Jan when you meet, or earlier if you need to leave a phone message.

All for now. Keep asking questions as necessary. Others will pitch in with answers, as well as me.
 
Sorry @cherryvalley, I should have asked if you have disposable insulin pens or refillable ones? If refillable do you have half unit pens?
 
Proud to be erratic said:
Sorry @cherryvalley, I should have asked if you have disposable insulin pens or refillable ones? If refillable do you have half unit pens?
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I have disposable pens. I am now going to attempt to answer your questions...my Lantus has been reduced from 20 to 15 over two months. I took 3 units of NR last evening at 5 30pm and had my dinner just before 6pm. I had 40g of carbs working that out as best I could and my meal was scampi chips peas abd tomato. My bsugars rose to 18 around 8 30/9pm when I decided to take 1 unit of NR to bring bs down..I was quite anxious as before I have always double checked anything "unusual" with my daughter who has been very helpful and supportive through this journey. I have heard of the dawn phenomenon. My bs on waking was 7.8. I do keep a notebook for my visits to the hospital but on your advice will start recording more info. I really appreciate your advice. I'm now leaving home to drive and do some shopping and then collect my grandchildren from school. That definitely has an effect on my bs..they drop quite a bit usually.
 
What was your BG (Blood Glucose) level before the meal? I am wondering if you were above range before eating and that is why your levels went so high?

I would be surprised if scampi and chips was just 40g carbs unless it was quite a small portion because there will be quite a bit of bread crumb coating on each piece of scampi, but it isn't something I eat, so maybe I am wrong and of course it will depend on the number and size of the chips you had.
 
I'm grateful for ur comments but I haven't noted what my bs were before I ate my dinner !! The same thing happened yesterday evening..I had a pasta dish with Meatballs.. at 4pm my blood sugars were 12.2 and at 5.30 I took 3 units of NR which is a set amount of carbs but took a correction dose of 2 extra units..by 7.30pm my bs were 4.3 and I had a round of toast. They then went down to 4 so I took rapilose gel. At 9pm they were 13. I also had a small amount of plain greek yoghurt. On waking this morning bs were 7.3...I find it very confusing and bs very up and down.
 
Reading your post above, I wonder if you are perhaps being tempted into chasing the readings your Libre gives you, rather than waiting for things to settle and run their course before you respond again. Like when you took your Rapilose because the Libre showed your levels continuing to drop after your round of toast. In that situation on 4.3 I would have eaten something a bit faster acting but smaller than a round of toast.... If the arrow was level, I might have apiece of dried fruit like a fig or date or maybe a couple of prunes or apricots. If it was a downward arrow I would have 1-2 well chewed jelly babies (glucose will absorb through the cells inside your mouth quicker than in your stomach and the glucose will get to your brain quicker to always important to chew any solid hypo treatment well before you swallow, particularly if you have recently eaten a meal because the meal will slow the absorption of the hypo treatment in your stomach.

It is important to know that Libre will usually continue to show your levels dropping for up to half an hour after a hypo treatment even though your BG (Blood Glucose) will actually usually be coming back up, so you should not rely on it after taking carbs to stop a drop or you will end up over treating and going high.
So in this case, the Libre showed your levels continuing to drop after you had the toast, so you had your Rapilose which may not have actually been necessary. If you had done a finger prick test before taking the Rapilose you might have found your BG was higher than 4 and you didn't need it and the food from your meal was likely still digesting and this is why you you ended up at 13. You ate some Greek yoghurt and then woke up on 7.9 which suggests that your Lantus dose may well be still too high.

Can I just clarify.... You say that you tested at 4pm and you were at 12.2 and then at 5.30pm you injected 3 units. Did you not check your levels at that time before you injected the insulin? This would be an important reading, so if you are not testing before you inject then presumably you are basing decisions about your dose on that previous 12.2 which may well be very different an hour and a half later. Am I right in thinking you injected 3 units for the food and a further 2 units as a correction for that 12.2, so you injected 5 units in total, half an hour before eating? What correction factor are you using. ie. How many mmols does 1 unit drop your levels? I am guessing 3mmols if you were correction from 12.2 which would get you down to about 6.2mmols. Was that 12.2 a Libre reading or a finger prick. Libre is not always accurate above range ie above 10mmols so, firstly it takes nothing to get a new Libre reading before injecting for your meal but also, if it is above range (10mmols) you need to finger prick to get a better idea of your BG before calculating a correction...... Whilst writing this I am now also wondering if perhaps you injected those 2 correction unit at 4pm when you were 12.2.... Is that the case? If so, you might have been better leaving it a bit longer until your premeal bolus and correcting it then when perhaps it may have come down a bit on it's own.

Pasta and pizza and sometimes lentil dishes can be a bit awkward to dose for with insulin because they can release their glucose much slower that you expect, so if you inject all your insulin before the meal, you can end up having a hypo after the meal or sometimes even whilst you are eating and then go high a few hours later, often overnight if it was an evening meal. Many people find it helps to split the dose and inject some before the meal and some after. This might explain why your levels dropped at 7.30pm because the insulin is at peak activity but the past isn't releasing all of it's glucose yet. Or it may be that your calculated correction was too much because you based that calculation on out of date info, ie. the reading of 12.2 taken it 4pm, instead of taking a reading at 5.30 when you injected.

My gut feeling is that your Lantus dose may still be too much and I think it is most important to check that first by doing some basal testing. If your Lantus dose is too much or too little, it is a bit like building a house on wonky foundations, it becomes even more wonky the higher you build the walls, and basically, your mealtime doses will not make sense and you will be constantly correcting and fighting your diabetes. I know when my basal insulin dose is not right because my diabetes becomes difficult to manage and once I get that right, everything becomes much easier and more predictable and less frustrating.

Sorry that the above is so involved. I am just trying to work through all the possible scenarios that might be happening and all the things you need to consider when dosing with insulin. It is very complex and you do need to consider lots of different factors before making a decision on a dose. Gradually a lot of it becomes second nature but it takes time to build up that depth of knowledge and experience for that to happen.
 
Thank you very much for such a detailed reply...I do check my blood sugar levels before every snack and meal but just look at my libre reading on my fone. I was told to use that all of the time except when my blood sugars went above 17 when I should use my finger prick meter !! I think as u suggest I am too quick to treat a low blood sugar instead of giving the levels time to rise...but I do use jelly babies at times to help give me a boost. I did check my levels at 5 30pm and they were 12.9 hence me taking my standard 3 units of NR and 2 units of a correction dose which my consultant said would bring the bs down 6 units. My basal insulin is 15 units but as I said I'm not at liberty to change anything unless advised by the Dr or nurse whom I see once a month. I find ur advice very useful and re read the posts often.
 
Do you log all the injections and food you eat on the Libre app? I think this is important particularly if you are relying on others to make decisions about your doses, because without all the information they can't make appropriate decisions and as you have seen from all the questions we have asked you, this information is really important in figuring out what is happening.
I note on my Libre when I inject and how much of which insulin and then how many carbs I am eating when I start eating. I also not when I do exercise or something particularly exertive. I have a Libre reader rather than using the phone app, but I know you can record a lot more info on the phone app.
I scan my Libre an average of 30+ times a day and have done so for the past 4.5 years since I got Libre. I don't do anything with that info most of the time but this regular input of data from the Libre gives me background understanding of how my levels react in a whole host of everyday situations, day in day out, and that helps me to have more confidence to predict what may happen in certain situations and therefore gives me more confidence in how to respond or plan for it or if I need to respond at all but perhaps rather just wait a bit longer and check in 5-10 mins. There is no harm in looking at your levels whenever you want to, as long as you don't panic and do something rash if it gives info that is outside your range. Knowing the limitations of Libre and when to double check levels with a finger prick is really important because it doesn't always give reliable data, particularly when levels are changing direction, so when they are rising and then start to fall or more importantly when they are falling fast and then you have eaten carbs to make them come up, but they don't show your levels coming up. This is when you need to rely on finger pricks, if you are considering taking action, like eating more carbs. If you are not considering taking any action, then you don't need to finger prick to double check. Gradually you get to a stage where you know it is not reliable and you have confidence that the action you have taken will be working and in those situations I often don't test anymore but just wait until the Libre has had time to get back to being reliable again. Usually half an hour to 40 mins in my experience. Libre and other CGMs are really great bits of technology, but you have to know when to trust them and when not to and it can be really tempting to respond to them every time without stopping to consider if they are likely to be correct in that given situation or if you need to get a second opinion from your BG meter. It is also important to know how quickly your body responds to different types of carbs, so that you know which carbs to have when your levels are a bit low and how many. So for me, 4.3 with a downward sloping arrow generally gets 1 jelly baby as does a 3.5-4.0 with a level arrow, but 4.3 with a vertical downward arrow will usually get 2 jelly babies as will a reading below 3.5. I almost never need a full 15g fast acting carbs (3xjelly babies) to treat a hypo otherwise I will end up too high and I almost never need follow up slower carbs but that is because I have my basal insulin adjusted so that it is holding me pretty steady.
 
Gd am....most of what u say makes perfect sense and I follow your suggestions to a certain degree I.e I keep notes at times of bs levels what I have eaten and how many carbs. My Dr has suggested this and at my hospital appts she then adjusts my Lantus accordingly. I only use the bgm if my sugars go over say 18 to get a more correct reading and then if necessary take 1/2 correction dose of NR to lower bs. I would start to get anxious if I see a reading below 5 as I know now the numbers will just keep going down. The nurse tells me to have toast or a banana or nuts to raise this but usually b4 I know it my low alarm which is set at 4.5 goes off and I need oj j babies etc. to start to raise the levels. I definitely need more diabetes education.
 
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