Fluctuating Blood Sugar

[Trixy83]

Hi, apologies now for all the numbers! I was just wondering what is a normal level of fluctuation for blood sugars? I've been fighting with this since diagnosed 5 weeks ago and still unsure how it all works. So this is my day today, any thoughts, comments, advice would be much appreciated!!

Breakfast (7.30am) - 12.7mmol - 14 units levemir, 14 units novorapid
9.20 - 17.5mmol
10.20 - 11.3 mmol
11.00 - 11.2 mmol
11.51 - 11.6 mmol
12.41 - 17.5 mmol - 14 units novorapid and lunch - one of those microwave rice packets and turkey chunks
13.44 - 5.9 mmol
14.20 - 3.1 mmol
14.40 - 5.6 mmol
15.20 - 7.1 mmol
16.15 - 9.2 mmol

I'm confused how I can rise during the morning like that, then after lunch dip so low then start to rise again. It just seems really up and down! (also I know thats a lot of testing but I want to monitor it closely, and this is my second day back at work since diagnosed so really wanting to keep an eye on whats going on)

Thanks

 

[donnellysdogs]

Generally the rule of thimb is if you have a food bolus or correction bolus and your levels go either too high or too low 2-3 hours after a meal then ratio is wrong.

Have you been informed how to check your background rate is correct with basal testing?

Its good to do that amount of testing when you are recently diagnosed or starting to do something different.

 

[donnellysdogs]

Aldo depends on when you take your basal injection(s).

Did you have any breakfast or snack at all prior to lunch?

 

[himtoo]

hi trixy
that is a great post with lots of info( so please don't be apologising ) but perhaps if we could know what and how much you had for breakfast as well as the brand and type of microwave rice packet you had please. ( This to look at carb values versus insulin dose for me )

you have said it yourself though -- it is only 5 weeks and right now you must be doing your utmost to get to grips with it but not really understanding all that is happening.
try not to worry in these early weeks too much but keep records of your insulin doses and what you eat, as well as any exercise.
this information will help your care team to make adjustments to your doses as needed over the next few months.

once you have settled down some you should get your DAFNE course too which will help a lot.

 

[Trixy83]

I've been told that to check my background I should have a day where I start 'normal' then have breakfast and fast until dinner. So far I've not had a day like that! Everytime I see my specialist I just get told to up my dose by 2 units, and use a correction of 1 extra unit if over 12 and 2 is over 16. To be honest I'm a bit confused by it all! I feel like I'm taking all this insulin without fully understanding why or how much I really need and unsure how to adjust to be able to stay flat throughout the day. It's getting really frustrating

 

[Trixy83]

Breakfast was apple muesli with semi skin milk at 7.30am, I had a banana about half 10. Lunch was uncle Bens 2 minute tomato and basil rice pouch with bernard matthews turkey chunks mixed in. No other snacks.

 

[donnellysdogs]

Did you bolus for your banana?

 

[Trixy83]

I sounds silly but I have no idea what that means!! At the moment I take levemir when I get up along with novorapid, then have my breakfast, more novorapid with lunch and dinner then levemir again about 9.

 

[donnellysdogs]

I would personally try a breakfast and cut the banana out too. Both of those can give higher levels.

Your drop this afternoon was probably due to too much insulin at lunch time.

If you were to get in to being able to basal test... You would either skip your breakfast and snack... So this would show what your basal rates do in the morning.
Or you would have breakfast and then skip eating anymore food until tea time.
If your levels go to 4.0 or under whilst basal testing then you should eat and stop the testing. If they go above 12.0 then you should stop testing and inject a correction. However with this if you had to correct you could carry on testing for another 5 hours as it would show whether your correction amount is correct.

By way. Dorry that you joined the exclusive diabetic club but it does get easier. Honest.

 

[Trixy83]

Thank you. I'm a pretty impatient person and very much like right ok I have this so let's get it under control and sorted quickly! It probably doens't help that I also have an over active thyroid which apparently messes with things. It's just all so confusing. I just want a guide that says if you eat this, then iject this! Oh if only it was that simple haha

 

[Heathenlass]

Welcome !

It's very early days, and I can understand your confusion, the terminology alone is hard to get your hea around

So, I'm going to tag @jack412 to ask, pretty please , can we have the links to BDEC and the Scottish I info leaflets ? Yeah, I know I'm rubbish at saving sites !

Also @noblehead for the very good glossary list, please ?

And don't worry, it will sorta fall in to place eventually

Signy

 

[himtoo]

Breakfast was apple muesli with semi skin milk at 7.30am, I had a banana about half 10. Lunch was uncle Bens 2 minute tomato and basil rice pouch with bernard matthews turkey chunks mixed in. No other snacks.

ok so apple muesli has about 65-70 grams carbohydrate per 100 grams weight of cereal - so quantity you had is important..
also the quantity of milk is important too 4.7 carbs per 100ml.
an average banana is about 17-19 carbs

looking at the totals and guesstimating i reckon you have had about 55-60 grams of carb this morning.

your team have obviously given you a target of 10 if your correction doses are as you have listed

my ratios and dose would work like this on your starting blood glucose of 12.7
correction of 4 units plus ( 6 X 2.5 units per 10 carb ) so 14 units -- total 18


but you have only just begun and your team are trying to keep it simple for you to start.
there is trial and error of course.

you really need to just slow yourself down and take it a day at a time.

your basal ( long acting insulin - levemir) does not really appear to be high enough yet -- can you get up and test and just take your levemir in the morning and test every hour but not eat at all ?? this will give an idea of how well your basal is doing at keeping you steady.
maybe do this on a day off from work.

 

[tim2000s]

This is BDEC:

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

 

[Trixy83]

Thank you for all the advice! I will read over tonight. I'll give the just taking levemir in the morning a go and see how I get on. It's hard, I love to eat! So the 18 units, is it ok to take as much as that? (Is that even that much?)

 

[himtoo]

Thank you for all the advice! I will read over tonight. I'll give the just taking levemir in the morning a go and see how I get on. It's hard, I love to eat! So the 18 units, is it ok to take as much as that? (Is that even that much?)

no trixy -- that is what i would do for myself based on your numbers -- right now 1 day at a time -- go slow -- and keep speaking to your diabetic specialist nurse too

 

[jack412]

this is how to do 'miss a meal' and overnight Basal testing ...as has been said, most think this is the first to get right..ring your nurse with the results
http://www.diabetes-support.org.uk/info/?page_id=120

at heathenlass request...this is a simple set of workbooks,
with BDEC..working out I:C ratios and correction sensitivity...worth reading and practising working examples of carbs and doses and corrections. Don't change dose without nurse approval

Overview of Carbohydrate Counting and Intensive Insulin Therapy for Paediatric Diabetes , An Introduction to Carbohydrate Counting , Carbohydrate Counting – The Next Steps Carbohydrate Tables , Carbohydrate and Blood Glucose Diary

from reading here...the other thing you need is sick day rules..it's best to ask your nurse to set it out for you, than trying to work it out at 3am with your head in a bucket throwing up

 

[noblehead]

I've been told that to check my background I should have a day where I start 'normal' then have breakfast and fast until dinner. So far I've not had a day like that! Everytime I see my specialist I just get told to up my dose by 2 units, and use a correction of 1 extra unit if over 12 and 2 is over 16. To be honest I'm a bit confused by it all! I feel like I'm taking all this insulin without fully understanding why or how much I really need and unsure how to adjust to be able to stay flat throughout the day. It's getting really frustrating

That is right, you miss one meal and check your bg 4 hours after finishing your previous meal which should be low in fat, there's an explanation about it in the following:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[LucySW]

Good luck Trixy. Just put one foot in front of the other and you'll get there.

 

[mikeg1964]

Trixy, I am in the same boat and finding it all a challenge to get to grips with, but I am sure we will get there in the end.

 

[nigelho]

Hi, apologies now for all the numbers! I was just wondering what is a normal level of fluctuation for blood sugars? I've been fighting with this since diagnosed 5 weeks ago and still unsure how it all works. So this is my day today, any thoughts, comments, advice would be much appreciated!!

Breakfast (7.30am) - 12.7mmol - 14 units levemir, 14 units novorapid
9.20 - 17.5mmol
10.20 - 11.3 mmol
11.00 - 11.2 mmol
11.51 - 11.6 mmol
12.41 - 17.5 mmol - 14 units novorapid and lunch - one of those microwave rice packets and turkey chunks
13.44 - 5.9 mmol
14.20 - 3.1 mmol
14.40 - 5.6 mmol
15.20 - 7.1 mmol
16.15 - 9.2 mmol

I'm confused how I can rise during the morning like that, then after lunch dip so low then start to rise again. It just seems really up and down! (also I know thats a lot of testing but I want to monitor it closely, and this is my second day back at work since diagnosed so really wanting to keep an eye on whats going on)

Thanks

Hello, Welcome to the club. There is no need to test on the hour as your GP will soon be onto you for using too many strips. DAFNE recommends to test 4 HOURS AFTER a meal as your body is still absorbing the quick acting insulin. Do not do any corrections if you're high after 2 hours of a meal. Your nurse has probably said do a 2 hour test but in most occasions you'll be more than the 2 mmols. From what you're posted, you were high BEFORE the meal....so you must correct then FIND out what correction ratio you should from your DSN ASAP. I correct using a 1:1 ratio and aim for 5 mmols so if I was 12.7 mmols before a meal I'd correct be 8 mmols therefore 8 units of Apidra. Some folk use a correction ratio of 1:2 THEREFORE WOULD CORRECT BY 4 UNITS QUICK ACTING INSULIN. please ASK TO GO ON THE DAFNE COURSE and ask how to carb coun in the mean time. as insulin works on a specific amount of carbs eaten..If you don't have enough carbs for the amount of insulin injected you will hypo approx 2-4 hours later.....like you showed at 14.20. HOW much carbs in the microwave meal???as at 12.41 you were 17.5 mmol 14 units novorapid then 1 hour later the BSs is 5.9 mmols and hypo at 14.20 mmol then rising. Did you have something for the hypo at 14.20? It is a huge juggling act but you need to get the basis right. DAFNE would show you the WHYs and HOWs to set up your insulins and how activities play a huge part in your BSs. At the moment you seem to on a fixed amount of insulin and this will only work if your BSs were ok before the meal and you happen to eat the correct amount of crabs for the insulin injected. GOOD LUCK. and keep a food diary...ask DSN about this ...they shoulkd know the whys.