Hello everyone. Looking for some advice

[FionaK]

Recently I developed inflammatory bowel disease and was prescribed steroids, which I am still taking at a reducing dose.

Without any warning this might happen I suddenly developed diabetes, severe enough to require a second hospital admission. I have been home since 3/9/14 and have to take insulin twice a day, before my breakfast and before my evening meal. I test my blood sugar 4 times per day before meals and before bed. I cannot get it down to my target BG except on very rare occasions and it does not seem to matter what I eat. I cannot see any pattern at all.

I began on doses of insulin of 12 and 8: and I have increased those gradually till now I take 26 and 20. The insulin is humulin M3, which I gather is a mixed long and short acting preparation. I am hesitating about raising these doses any more, especially since it does not seem to be making any difference. Is there an upper limit on the dose one can take? I realise people are all different but I would be grateful for information about any adverse effects of high doses of insulin if there are any. I should perhaps add that I am 5ft 2 and weigh approximately 8 stone 9lb, so not especially overweight

I do have a specialist nurse allocated to me but she is in the middle of a fortnight's holiday so I cannot get advice there at present. Unfortunately this week I have also developed a skin rash on all areas which have been exposed to daylight: is that a known consequence of diabetes, or the insulin or is it more likely to be due to the other medication, including steroids, which I am taking for the IBD? Does anyone else know about this?

A few weeks ago I was perfectly healthy and I now feel quite unwell most of the time. I have no energy and the lack of control is really getting to me. Can anyone help?

Thanks

 

[Bluetit1802]

Hi Fiona and welcome to the forum.

I can't help with the insulin questions, but someone will be along later I expect.

Can you tell us what your diagnostic HbA1c test was, and what sort of blood sugar levels you are now seeing before and after meals?

You may have been told, or may not, but steroids can and do raise blood glucose levels. It is one of the less desirable effects I'm afraid.

 

[mo53]

Hello Fiona. Welcome. You certainly are going through a difficut patch. Im sure someone will be able to help you.

 

[FionaK]

Hello Bluetit. Thank you for your reply

The doctors are quite clear that this is steroid induced, though it is not certain that there was no underlying diabetes and apparently it is impossible to tell. Some people get free of diabetes when the steroids stop, but maybe not the majority.

When diagnosed my test was 36

Since I got home I have tested 4 times a day and have had readings less than 9 on only 5 occasions: more usually I am testing at around 12 -15 with occasional spikes over 20. This does not seem to be related to what I eat, so far as I can tell

 

[jack412]

you are having a rough time, ... these are the things I would ask your Dr, I'm T2 non-insulin. don't act without Dr approval
I think the steroid will mess up blood glucose BG control, till you come off them

some people have good results with low carb diet with irritable bowel and diabetes, read about it next week, you have enough on your plate this week

try and eat the same amount of carbs each meal [maybe less at lunch time]

I would read the http://www.nhslanarkshire.org.uk/Services/Diabetes/Documents/Diabetes - Insulin Adjustment for twice daily mixed insulin.pdf and ask your Dr should you follow this
If the blood glucose level is:
high before lunch and evening meal increase the breakfast insulin dose
high before bed and before breakfast increase the evening meal time insulin dose.

Increase the insulin dose by 2 units at a time. For example if you normally take 20 units of insulin, increase your insulin dose by 2 units to 22 units.
Observe the pattern of your blood glucose for 2-3 days before adjusting again.
Contact your Diabetes Specialist Nurse if you need advice and support

 

[AndBreathe]

Recently I developed inflammatory bowel disease and was prescribed steroids, which I am still taking at a reducing dose.

Without any warning this might happen I suddenly developed diabetes, severe enough to require a second hospital admission. I have been home since 3/9/14 and have to take insulin twice a day, before my breakfast and before my evening meal. I test my blood sugar 4 times per day before meals and before bed. I cannot get it down to my target BG except on very rare occasions and it does not seem to matter what I eat. I cannot see any pattern at all.

I began on doses of insulin of 12 and 8: and I have increased those gradually till now I take 26 and 20. The insulin is humulin M3, which I gather is a mixed long and short acting preparation. I am hesitating about raising these doses any more, especially since it does not seem to be making any difference. Is there an upper limit on the dose one can take? I realise people are all different but I would be grateful for information about any adverse effects of high doses of insulin if there are any. I should perhaps add that I am 5ft 2 and weigh approximately 8 stone 9lb, so not especially overweight

I do have a specialist nurse allocated to me but she is in the middle of a fortnight's holiday so I cannot get advice there at present. Unfortunately this week I have also developed a skin rash on all areas which have been exposed to daylight: is that a known consequence of diabetes, or the insulin or is it more likely to be due to the other medication, including steroids, which I am taking for the IBD? Does anyone else know about this?

A few weeks ago I was perfectly healthy and I now feel quite unwell most of the time. I have no energy and the lack of control is really getting to me. Can anyone help?

Thanks

It seems likely that your specialist nurse will have someone picking up her ad-hoc enquiries whilst she's on holiday. Assuming she's hospital based, it could be a decent idea to call the clinic/unit and ask who you can talk to. Alternatively, I don't know if all areas have a community diabetes team who might be able to help. But, I'm sure if you can keep looking in, there'll be someone around in a while who will be better equipped than me to try to help.

 

[donnellysdogs]

There are no upper limits to taking doses of insulin. You take what is needed to bring your levels down.

Incidentally. What are your readings 2 hours after you have ate? Are they going up hugely from pre meal readings. You need to test pre meal and 2hours after a meal.

If you are going up hugely after the meals (by more than 2.8 units) I would suggest that you would be better off on a basal / bolus regime.

The initial workings out nurses suggest are based upon weight, height etc and I would have hoped that they took in to account your eating patterns too. So basicaly it was an educated guess..so now comes the harder work, as you are finding out of getting the right dose.

Was any consideration given to basal / bolus regime?

 

[FionaK]

@ Jack 412

That explanation is helpful. I have been increasing my dose every couple of days which seems to be in line with the advice in your link.

@ Andbreathe

Thanks for your answer. I did phone the clinic yesterday and today but it was an answering machine and they have not yet returned my calls.

@donnellysdogs

Thanks to you too.

I was not told to test two hours after meals: only before them. So that is what I have been doing. I have checked it within two hours of eating a couple of times just because I have been worried: but as I said, it seems to me to be completely random. For example on one of those occasions I had a small bowl of cornflakes for breakfast (which I now realise is not ideal) and the reading went from one of my best that morning 5.6 to 8.7 within two hours. On another occasion I had two boiled eggs for breakfast after a reading of 8.3, and the next reading, within two hours, was 19.1

I have no idea if consideration was given to a basal/bolus regime. I do not actually know what that means.

If there is no upper limit can anyone tell me what kind of dose of humulin M3 they are taking regularly? I am conscious how much I have increased since the outset and although the early increases were based on advice from the nurse the more recent ones I have done on my own initiative and that is why I am anxious in case I overdo it

 

[ribbit]

I take M3 twice a day, 50 units each time. My consultant told me as basic guideline that I would need possibly 1 unit per Kg of body weight. Even on what I am on now I still have quite high readings. On days I can get down to approx 8 then I get blinding headaches and as a migraine sufferer find I have to be careful.

At a recent appointment we decided to keep the levels as they are and see if my HBA1C level comes down - was 107 and now down to 84 - but have a long way to go. Things are complicated by a range of other medication & conditions.

 

[jack412]

@ribbit are you under the care of the specialist hospital clinic?

 

[donnellysdogs]

@ribbit have you or your team ruled out basal / bolus. Med complications or not your hba high...
I know of a gentleman that is undergoing chemo and steroid treatment for blood cancer and the medics went from nowt, tablets, mixtard to basal bolus very quickly sorting him out. Getting him to jab himself and not his wife doing it is another story... But having high bloods due to meds is a bit of a lame excuse when I think of this gentleman and the full on efforts to control his levels.

 

[iHs]

For twice daily insulins to work ok, its important to eat carbohydrate in little but often amounts.. this is not as bad as it might seem as most people can eat substantial amounts like 20-30g carb for breakfast, a biscuit mid morning, 30g carb lunch, biscuit or peace of fruit mid afternoon and then eve meal which the eve injection will cover and will cope with carb of about 30-40g ok and a biscuit before going to bed to make sure that bg levels dont go too low whilst asleep. So in other words, twice daily insulin means eating to the action of the insulin's effect on controlling bg ok, that's why the need to eat little and often works ok and adjusting the carbohydrate and bg testing to get the balance of carbohydrate correct. But once the balance of carb is found, apart from dealing with the odd hypo now and again, life can be fairly good.

 

[FionaK]

Thanks to all for your responses. It occurs to me that I do not know much about the carb content of food. Is there a handy list somewhere? Most prepared food like cornflakes shows the quantity, but things like bread and rice etc don't. How long does it take to stabilise, generally? I don't feel I am making any progress at all, at present.

 

[iHs]

The carb content of most food that comes tinned or packaged will have the nutrician data listed on it. Look for the carb value per item or per 100g weight. A pair of weighing scales, a table, desert, teaspoon is good for transferring weighed food to spoon quantities. Start counting the carb (not the sugar) and then you'll be able to adjust the carb up or down in qty to get yr bg levels better balanced.

 

[jack412]

this is for basal bolus, but the carb counting is the same

Workbook 1http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb listhttp://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diaryhttp://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Basal testinghttp://www.diabetes-support.org.uk/info/?page_id=120

Sick day ruleshttp://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowcharthttp://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf

 

[FionaK]

Thank you both for that information

 

[ribbit]

@ribbit are you under the care of the specialist hospital clinic?

Sorry I get side tracked easily and don't get to come back as often as I should. Yes I see my consultant every 3 months and have access to the Nurse at any time.

 

[ribbit]

@ribbit have you or your team ruled out basal / bolus. Med complications or not your hba high...
I know of a gentleman that is undergoing chemo and steroid treatment for blood cancer and the medics went from nowt, tablets, mixtard to basal bolus very quickly sorting him out. Getting him to jab himself and not his wife doing it is another story... But having high bloods due to meds is a bit of a lame excuse when I think of this gentleman and the full on efforts to control his levels.

Have to confess know nothing about bolus/basal - be interested to find out. Don't doubt other meds have a lot to do with interfering with readings at times. Had 4 x CABG some 15 years ago & still on beta blockers now, also being treated for Barrats, Thyroid, Chlorestorol, Arthritis - breakfast is a cocktail of some 15 different pills + insulin.

 

[jack412]

I put that basal bolus up mainly for the carb counting, so you can have a stable carb intake per day, this will help keep your BG level.
you are taking a mixed basal [long acting] and bolus [short acting ] insulin in one injection twice a day. when it is separate, you can take the basal once a day and the bolus with each meal

this might help with your carb diet, cholesterol and arthritis ...

if you do reduce your carbs, you will need to reduce your insulin too, I would reduce my carbs slowly because you are on a mixed insulin seek advice from your nurse

http://www.dietdoctor.com/lchf it’s a long page and a video
http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm For me, the more carbs we eat the more carbs we want. they don’t give up easy.
http://lowcarbdiets.about.com/od/lowcarb101/a/firstweek.htm

blood testing
http://www.phlaunt.com/diabetes/14045524.php
food counting
http://www.myfitnesspal.com/

more diet plans
http://diabeticmediterraneandiet.com/low-carb-mediterranean-diet/
http://www.lowcarbdietitian.com/blog/carbohydrate-restriction-an-option-for-diabetes-management