Some advice please

[Spiker]

You need to teach yourself basal-bolus, do a fasting test to establish your basal dose, then do some carb tests to get your carb ratio and correction ratio. Jeez did they just kick you out the door with some novorapid and some Lantus to get on with it? Not even a leaflet?

Summoning: @jack412 for his basket of links please, Maestro!

 

[Spiker]

You can adjust your basal without fasting just by looking at the difference between your bedtime value and your waking value. So your data are +4 last night from sleeping to waking. If that's consistent over 3 days, increase Lantus.

In the meantime you can correct the highs with novorapid and that will teach you your correction ratio. Did they give you a starting point? A very conservative (safe) starting point is 1u drops you 3 mmol/L. In practice it will probably drop you less than that but test and see how you go.

Unfortunately you are flying blind at the moment with all 3 factors (basal, carb ratio, correction ratio) all just guesses. Try to nail these numbers down one at a time. It will be iterative - make a first pass at them, then refine them again later. Also, as you are newly diagnosed, the actual ratios will change quite rapidly as your body climbs out of its undiagnosed hell-hole and adapts to functioning normally again on adequate amounts of insulin.

 

[nivenj]

Yeah, feeling a little lost. Was meant to have an appointmemt set up for yesterday at the clinic but that never materialised, and when i call the clinic its an answering service that says if its urgent contact your GP otherwise leave a message but please allow several days for a response. I'm going to be writing to my PCT when the dust has settled, its pretty shocking.

 

[Spiker]

I don't know if they gave you a starting point for novorapid but a typical starter is 1u per 10g of carbs. You might be safer starting on 1 per 15g or even 1 per 20g and working up from there based on +4 hr post meal testing.

 

[Spiker]

As you are in Kent, get seen by KCH in Denmark Hill not UCH. KCH have taken over UCH now anyway, they are the Daddy. More to the point KCH is a world class centre for T1 care and research, UCH is a world class healthcare privatisation screwup (with pretty buildings).

 

[nivenj]

so my sliding scale on intravenous over 18 hours measured every 2 hours was roughly (mmol/hr), 6,6,6,5,3,3,2,5,3 they then took me off iv and put me on 12u Lantus, and 6u Novorapid x 3. GP upped my Lantus to 15u when i phoned him yesterday with my 27 morning reading.

TBH, i dont feel as though the Novorapid has much effect. Took 6u when i woke up around 10 (was up a lot during the night), then my midday 6u before i had something to eat, after an hour my BG had risen nearly 6mmol.

 

[noblehead]

so my sliding scale on intravenous over 18 hours measured every 2 hours was roughly (mmol/hr), 6,6,6,5,3,3,2,5,3 they then took me off iv and put me on 12u Lantus, and 6u Novorapid x 3. GP upped my Lantus to 15u when i phoned him yesterday with my 27 morning reading.

TBH, i dont feel as though the Novorapid has much effect. Took 6u when i woke up around 10 (was up a lot during the night), then my midday 6u before i had something to eat, after an hour my BG had risen nearly 6mmol.

Register with the following site, it's a carb counting course for those who are on basal/bolus and is similar to what is taught on the DAFNE course:

http://www.bdec-e-learning.com/

edit: Try ringing the diabetes consultants secretary if the clinic are not responding to your calls, they are normally very good at pushing matters forward, at this moment in time you do need some professional input.

 

[Spiker]

TBH, i dont feel as though the Novorapid has much effect. Took 6u when i woke up around 10 (was up a lot during the night), then my midday 6u before i had something to eat, after an hour my BG had risen nearly 6mmol.

It's very hard to say whether this is due to too little Novorapid per meal or too little Lantus overall. It needs a more detailed look at the patterns. What time of day do you take the Lantus? It seems likely the Lantus is still too low, but you want to adjust it slowly, typically no more than once every 3 days, though in your case I can see the temptation to adjust more quickly at first.

 

[Spiker]

One thing that probably hasn't been explained is that if you have 6u at each meal you need to have the same carbs at each meal. Which most people don't do. So way back when I was on a fixed bolus dose like they have given you, it was 8u for breakfast, 12u for lunch, 16u for dinner. Don't adopt these doses, they are just for illustration.

 

[nivenj]

i take the Lantus at midday Spiker.

premeal 10 / +1hr 15.7 / +2hr 14.8 / +3.5hr 16

is the dip likely to be an erroneous reading, or does this suggest all active insulin has been used up in bringing it down, and therefore it started to rise again (suggesting i need larger Bolus?)

 

[ConradJ]

Yeah, feeling a little lost. Was meant to have an appointmemt set up for yesterday at the clinic but that never materialised, and when i call the clinic its an answering service that says if its urgent contact your GP otherwise leave a message but please allow several days for a response. I'm going to be writing to my PCT when the dust has settled, its pretty shocking.

Copy in your MP and the Sec. of State for Health - oh, and the local press, they'll all soon start jumping for the "JC, we've f.....d up here" button.

It's incredible really, when you think about it.

 

[ConradJ]

i take the Lantus at midday Spiker.

premeal 10 / +1hr 15.7 / +2hr 14.8 / +3.5hr 16

is the dip likely to be an erroneous reading, or does this suggest all active insulin has been used up in bringing it down, and therefore it started to rise again (suggesting i need larger Bolus?)

That's an odd time to take Lantus - did they tell you to inject it then? Lantus takes several hours before 'peak performance' sets in, and then it lasts from 16-28 hours depending on the individual. It could be that you're running out of Lantus by mid-morning or it could be that you're going hypo in the early hours and your rising levels are a result of a rebound. Or it could be that your body just doesn't like Lantus - I had a terrible time on it.

Also, as your BG levels were very high for several weeks, I wouldn't be surprised if your hypo levels are sitting at around 8 or 9 mmol rather than the '4.4' they like to say it is.

As @Spiker says, don't rush it - despite the temptation to do so, sign up for the e-course @noblehead has linked, and contact the DSN team asap.

Good luck.

 

[Spiker]

i take the Lantus at midday Spiker.

premeal 10 / +1hr 15.7 / +2hr 14.8 / +3.5hr 16

is the dip likely to be an erroneous reading, or does this suggest all active insulin has been used up in bringing it down, and therefore it started to rise again (suggesting i need larger Bolus?)

Yes you definitely need a bigger bolus dose. At this stage of the game all that matters is your score 4/5 hours after injecting the Novorapid and how that compares to the immediate pre meal score. You want it back to the pre-meal level after 4-5 hours.

But what you need to find is the insulin to carb ratio that works for you, not a fixed amount of insulin for a meal.

 

[nivenj]

Thanks guys, bear with me, am i right in assuming then that a larger bolus counteracts a larger swing from pre to post meal. ie if with a 6u bolus i go from 10 to 16 in 2hrs, a larger dose (say 8u) would produce something like 10 to 14 in 2hrs, and the purpose of the bolus is to keep. BG effectively neutral?

ive signed up for the online training thing, just working my way through it.

 

[Spiker]

Thanks guys, bear with me, am i right in assuming then that a larger bolus counteracts a larger swing from pre to post meal. ie if with a 6u bolus i go from 10 to 16 in 2hrs, a larger dose (say 8u) would produce something like 10 to 14 in 2hrs, and the purpose of the bolus is to keep. BG effectively neutral?

ive signed up for the online training thing, just working my way through it.

Yep you've got it.

But don't worry about the effect at +2 hrs for now. Just worry about +4 hrs. +4 hrs after injection is when 80-90% of the BG lowering action of Novorapid is completed.

 

[donnellysdogs]

What are your unit sizes you are taking for your insulins and what time are you taking your lantus injection

If it was me I would raise my basal injection qty, but by how much depends on how much You are taking and what time..

 

[Spiker]

What are your unit sizes you are taking for your insulins and what time are you taking your lantus injection

If it was me I would raise my basal injection qty, but by how much depends on how much You are taking and what time..

It's all up above in the thread. He's on 6u Novorapid each meal, 15u Lantus at noon.

 

[donnellysdogs]

It's all up above in the thread. He's on 6u Novorapid each meal, 15u Lantus at noon.

Sorry, didnt see that... Oops!! Only got to page 4.

 

[nivenj]

unconfirmed, but seems my Carb ratio is 5.5 and insulin sensitivity is 1.3 :-S

 

[Spiker]

unconfirmed, but seems my Carb ratio is 5.5 and insulin sensitivity is 1.3 :-S

It's great to have some numbers, and work to refine them from there.

So is that 5.5g CH = 1 unit of Novorapid (quite high insulin need!), and 1 unit of insulin drops you 1.3 mmol/L? Or have I got that the wrong way round?

Your basal may still need to go up. Or it could just be the crazy adaptation as your body gets used to running on insulin again.