Novorapid and Lantus - Perfect morning sugar level rising

[iHs]

I had a fairly low carb (80 carb grams) dinner last night when I was 8.1 pre-eating, took my regular 14 units with the meal and was back up to 20.9 when I went to bed, took a correction dose of 6 units, and was 3. 8 when I woke up.

80g carb for a meal is not really low carb.... the more carb that you eat.... the more bolus you will need and then the more you will struggle with getting your bg levels to balance ok. I normall eat about 30-40g carb for my eve meal so dont eat too many spuds and try and bulk up my dinnerplate with loads of green type veg. Occasionally, if I go out for a meal etc, I eat more carb so need more bolus and I then have to careful to keep eye on bg so that insulin doesn't make me drop too low.

When your bg was on 8.1 pre eating, did you calculate a 0.5u correction in your bolus to make your bg drop to 7mmol and then add on the bolus for the food. If you just bolus 14u for 80g carb and you get a bg level of 20.9 about 3-4hrs later.... then that tells you that you need more insulin. Tonight try to inject 14u but eat just 50g carb and then test 2hrs after eating to see what bg is and then hopefully before bed your bg level will be lower than 20.9mmmol and you won't need to do a correction unless it is above 10mmol. This will be another way to establish what your insulin to carb ratios will need to be by just changing the amount of carb that you eat at any one time during the day. The fact that youve gone a bit low when you woke up in the morning is because of the big bolus correction at bedtime working in combination with the Lantus so you should have got up in the night and tested about 2am ish to find out how low the correction had made you go. The 6u bolus correction lowered you a lot more than 2.5mmol per unit. Overnight bg levels sometimes lower for a lot of diabetics naturally due to the way the liver and pancreas work although some find that their bg levels elevate..... It is, like I said before .... all trial and error doing loads of bg tests to work out what bolus insulin will do to your bg levels..

[Homer]

I wish you would listen to carbsRok you are going about this in totally the wrong way. Sorry to be so blunt

[Wizadora87]

I wish you would listen to carbsRok you are going about this in totally the wrong way. Sorry to be so blunt

I get the part about the Lantus testing, and regardless, I go up real high in the mornings (mostly) before I even consider eating any carbs - So I know already something needs to change about it, but I'm not going to start playing with double doses of Lantus without discussing it with someone as I've never ever EVER done that before. Always had one dose, and generally hbA1c's have been fine.

I don't know what was going on yesterday, usually with my evening meal I have more carbs by far than I do with my lunch, and always have good results after I eat and before I go to bed. Good to know I need less of a correction dose if I am high before bed though. The fact I am taking as much as 14 units for 80g carbs is surprising people, and usually this works out fine without a high result later, but it would appear I am taking way above the average per carb-portion. The nurse I spoke to most recently told me on average, people take 1 unit per carb portion. I'm around 4 times above that.

Hormones could be playing a role in everything, obviously. My body does not produce any estrogen. and my brain is working overtime with a super high FSH. I am taking pills but I have no idea whether my estrogen levels are "normal" now, they haven't tested since I was diagnosed. Just had tests for my AMH levels.


I am very grateful to all of you for your input, it's giving me more questions to ask and suggestions to changing doses at the hospital when I go again soon. Normally I would totally do my own thing, but right now I want to let them help me and see if they can do so. So don't be mad at me for not following a particular piece of advice. I've been told to keep doing what I'm doing so they can see the patterns too. And I'm writing down all the carbs I eat along with any novorapid I take, and testing, testing, testing.. Eventhough my fingers are numb.

[CarbsRok]

The fact I am taking as much as 14 units for 80g carbs is surprising people, and usually this works out fine without a high result later, but it would appear I am taking way above the average per carb-portion. The nurse I spoke to most recently told me on average, people take 1 unit per carb portion. I'm around 4 times above that.

Hormones could be playing a role in everything, obviously. My body does not produce any estrogen. and my brain is working overtime with a super high FSH. I am taking pills but I have no idea whether my estrogen levels are "normal" now, they haven't tested since I was diagnosed. Just had tests for my AMH levels.

The reason you are taking so much insulin per carb portion is because you are expecting the bolus insulin to do double work. IE it's having to be bolus as well as basal.
I don't produce any estrogen either as have no overies. This means that now I have stopped HRT I need more basal insulin.

Consuming 80 carbs in one meal is a bit silly as well as your blood sugars are all over the place. You would be better off sticking to a smaller amount and the same amount each day for each meal. So if you had 40 carbs for lunch and 60 for evening meal stick to that every day then you have a pattern to follow. Obviously what amount you eat is up to you but IMHO 80 is one hell of a lot esp with the amount of insulin you are using.

[Wizadora87]

I ate a baguette last night (wasn't big or anything, essentially 2 small bread finger rolls), and according to a website I'm using that measures Carb in food (if it doesn't say on that packet) - This was 76 alone. I didn't have anything else with carb with it. Tonight I had mushroom risotto so it was kinda lots of carb from the rice. I'm a good vegetable eater, not too fussed on loads of meat, but like my potatoes too. Guess it's difficult to get a balance sometimes.

I have never been told I need to restrict any carb I eat, just that I need to be aware that if I eat more than usual, I need to compensate when I take my bolus insulin.

I mentioned previously that I figured I was going low before dinner as I was having too much bolus with lunch (30carbs sandwich, 14 units insulin - I only started going low every day before eating since they told me to try increasing the bolus with lunch. They told me to do this as I was going up to around 12mmol 2 hours after eating. So they figured it was the lantus that was making me go low then, but I guess this is not the case? I don't really know. I am low every evening before I eat now though, (after reducing lantus also) and not going up as high as 12mmol after eating, I'm usually pretty good (around 7-8, 2 hours after lunch), but always low 5-6 hours after eating the lunch.

I presume they might check my estrogen levels at some point, but since I'm taking tabs (with higher estrogen than HRT) my levels should be somewhat normal now for a 25 year old.

[robert72]

You won't get any of the figures right until you've sorted the basal - looks like you need a split basal regime. It would be worth getting the Carbs & Cals app for your phone to help you get the carbs right. And if you can get the 2 books that CarbsRok mentioned at the start, they'll really help you understand how everything works. You may not feel confident to change anything yourself right now, but the understanding will be invaluable. Hope you manage to get this sorted out soon

[CarbsRok]

I ate a baguette last night (wasn't big or anything, essentially 2 small bread finger rolls), and according to a website I'm using that measures Carb in food (if it doesn't say on that packet) - This was 76 alone. I didn't have anything else with carb with it. Tonight I had mushroom risotto so it was kinda lots of carb from the rice. I'm a good vegetable eater, not too fussed on loads of meat, but like my potatoes too. Guess it's difficult to get a balance sometimes.

I have never been told I need to restrict any carb I eat, just that I need to be aware that if I eat more than usual, I need to compensate when I take my bolus insulin.

I mentioned previously that I figured I was going low before dinner as I was having too much bolus with lunch (30carbs sandwich, 14 units insulin - I only started going low every day before eating since they told me to try increasing the bolus with lunch. They told me to do this as I was going up to around 12mmol 2 hours after eating. So they figured it was the lantus that was making me go low then, but I guess this is not the case? I don't really know. I am low every evening before I eat now though, (after reducing lantus also) and not going up as high as 12mmol after eating, I'm usually pretty good (around 7-8, 2 hours after lunch), but always low 5-6 hours after eating the lunch.

I presume they might check my estrogen levels at some point, but since I'm taking tabs (with higher estrogen than HRT) my levels should be somewhat normal now for a 25 year old.

Ok let's try once more.
Your Novarapid covers food......... Now if you eat 30 carbs and inject 14 units and the next meal you eat 80 carbs and inject 14 units.......the result would be rather obvious me thinks.
If you have a set amount of insulin you need a set amount of carbs. If you vary your carb intake then you must vary your bolus.

But you have to sort your basal first.
You are using the Novarapid to compensate for your lack of basal.
I didn't say you had to restrict your carbs permantly. I suggested to had a set amount at a lower level so you could see where things were going.
Starchy carbs in any quantity will cause havoc with your blood sugars. So restrict them at any meal. This is very basic diabetes knowledge.

As suggested before buy your self the books using insulin and think like a pancreas.
Because until you get even the basic level of insulin use and how food types work and digest then you are on a hiding to nothing.

Just stop messing around chopping and changing everything sort your basal first.

[etmsreec]

Just to throw my £0.02 worth into this thread, having changed my thinking over the past 12 months or so.

The changes that I've been recommended to make are alter the basal until the fasting blood glucose level is right, then change the bolus to take account of meals. (Typical meals for me are anything between 40g carbs and 150g carbs, depending where I am, what I'm eating and drinking etc..)

If you're waking up with a glucose level of 4, that suggests that the basal is about right. More and you'd risk hypos before waking. Less and you'd be rising.

The issue of rising blood glucose during the morning is that the body releases hormones that encourage you to wake up. These have the side effect of raising the blood glucose. Eating something at breakfast time and taking a bolus insulin dose should reduce/eliminate the peak in blood glucose that you're getting because you're taking neither carbs nor insulin in the morning at the moment.

Basal/bolus and dosage adjustment for normal eating (DAFNE) are great but one has to still take account of what you're eating, when you're eating it, and when the body will raise the blood glucose by itself (either through exercise or natural cycles.)

For what it's worth, if you were to eat breakfast and take some insulin, you'd probably eliminate the rapid rise in the morning (it works that way with me, anyway) and that might have an effect on the rest of the day too. Although I appreciate that some people just don't like breakfast (toast and jam is boring, cereal is bland, etc etc), it's also an issue here of attack the problem, not the symptom. I'd say the symptom is the rise in blood glucose, the problem is the missed meal.

Steve

[Wizadora87]

Your Novarapid covers food......... Now if you eat 30 carbs and inject 14 units and the next meal you eat 80 carbs and inject 14 units.......the result would be rather obvious me thinks.
If you have a set amount of insulin you need a set amount of carbs. If you vary your carb intake then you must vary your bolus.

Yep. This is indeed seemingly obvious, and I pointed out to the doctor (when I was taking 12 units per meal) that I thought it was strange to be having the same amount of insulin for a 30carb meal as I was when I was eating double, or more carbs in the evening. His response was that my novorapid should not STILL be working that far along in the day (especially since I was higher than I should be, 2 hours after eating my lunch and taking the 12 with 30carbs) - So he blamed the Lantus for the lows. Saying also that hormones are causing me to need more with a lower carb consumption in the morning.

Steve, you suggest everything I previously have considered and assumed. And mention that if I am 4 in the morning, my Lantus is about right, I've also heard this in the past, that if the morning reading is good, the Lantus is good. I may well need more Lantus (a second dose) but this could ultimately end up making me go lower before the evening meal (if this is what is making me low - and not, indeed, the novorapid.)

I will look out for the books on Amazon and try to get an understanding other than the things I have already been told, which do, in some cases, contradict what people say here.

[Barrie Smith]

Hi , 1st hope you `re not driving on blood sugars that low , do you eat breakfast ,injectimg at least 1/2 hr before eating , because you should , your Bgs really are a mess your support team are par for the course , useless .
The onset of change in your diabetes is worrying could be you are developing anti-bodies to the G/M insulin , or developing auto -Immune response as I did .
What ever for goodness sake get a 2nd opinion , sooner rather than later you dont need irriversable damage , an insulin change
might help ,but you will need to be strong willed to do that .
Kindest Regards Barrie

[etmsreec]

Re-reading the original post Wizadora87, I'm wondering whether the 14u for 30g carbs includes a correction for your blood glucose going high?
Novorapid has a short onset - about 15 minutes with a peak at about 45 minutes - and a duration of 3 to 5 hours. If you're dipping after the 3 or 4 hours, I'd think that it was the Novorapid causing the hypo.
I think there needs to be several tasks here:
- start eating breakfast and at regular intervals through the day;
- get advice from a diabetes team that has experience with diabetics in pregnancy. This isn't a thing that all diabetologists seem to be able to do, if the pattern in my diabetes clinic is anything to go by;
- try and get onto a DAFNE course (or whatever it's called in your area). this will explain the correction doses, dose versus carbs and such like.

Just as a thought (I'm a sufferer of diabetes, not a consultant) - Could it be that you're about right at breakfast time (maybe a little on the low side), going high because of dawn phenomenon (as cortisol, glucagon and epinephrine are released to wake you up), taking enough insulin to deal with carbs and correction at lunch time, going hypo before evening meal from too much Novorapid?

Remember also that the motto is, "less than 5, don't drive".

[Wizadora87]

So, I have an annoying update. My regular "diabetic nurse" who I really do not get along with (we totally clash!) called me and wanted me to see her this morning. So I did. I brought up the 0-carb to test Basal insulin theory and she said "We don't recommend this, don't do it". Great, thanks. She also told me that I'm not going high in the morning due to kidneys releasing Glucose "No way this is not what happens". Great, thanks. She ALSO said that Lantus works for 24 hours, and I DO NOT NEED ANOTHER DOSE. That's for sure! Oh really?

I told her I'd found this forum and brought up some things people are doing (who live with the condition, unlike her), and that they are getting along fine. She told me "forums are just a bunch of random people - Don't do anything they tell you. They're not professionals." I said, I know they're not docs, but they do live with it and they are advising on alternatives that work for them. I brought up the other Basal insulin (totally forgot the name during this rant) and she said we'll look into it. She said SHE WILL CHANGE MY INSULIN if she thinks it needs changing. Yeah, cause I'm going to see her again.....

<-- A little bit mad at this useless woman who doesn't specialize in Type 1 Diabetes and assumes she knows better than people who DO live with it.

Seeing Dietician at hosp on Thurs, who seems to know a lot more what she's talking about. Hopefully this IS the case. Evil woman today also gave me a flu injection, ouchie.

[Wizadora87]

Oh by the way, I got a DAFNE book telling me all about carb portions in food which is rather useful.

[iHs]

I dont like to say it, but I think you are going to have to do your own thing with adjusting your insulin. We've given you different ways for. you to think about.... you've got the Lantus and you've got the Novorapid. It's up to you to do whatever you need to do to get your bg levels better balanced without too many highs and also without too many lows.. Insulin to carb ratios do work for people and if DUK and BDEC recommend using them with bolus insulin, then this nurse that you have seen needs to be questioned as to how she expects you to achieve good bg levels by keeping bolus dose the same and eat whatever carb you want.????? Good job you haven't got an insulin pump

All I can say is test your bg levels every 2-3hrs and adjust the amount of carb that you eat so that your bg levels are ok. You may be able to eat more carb at lunchtime than you do at breakfast.. It's up to you with the testing to find out how Lantus and the bolus affect you.

[Wizadora87]

then this nurse that you have seen needs to be questioned as to how she expects you to achieve good bg levels by keeping bolus dose the same and eat whatever carb you want.????

She's rubbish. I suspect she doesn't specialize in Type 1 Diabetes, so I have no idea why I need to see her since she is not exactly helpful. I know I shouldn't be taking the same insulin regardless of what I eat, they just wanted me to do it for now to look at my BG patterns I suppose. I did take more insulin last night though as I made a yummy risotto again Seemed to do the trick, and woke up at 4.3mmol

Now they decided to give me the flu, I guess BG will fly