Diabetic nurse doesn't know what to do, help needed please.

[kerrygrant26]

Keep going with the increasing by 1 unit every 72 hours it really will help get his fasting levels down, I haven't had this long at all but if there is anything I can help with please feel free to message me or any of the others for that matter

 

[Mrs of type 1]

mrs of type 1.... I really recomend that your husband try the dexcom CGM system and either change his Lantus to tressiba or go on a pump. The highs will cause complications so please dont delay..
If your husband has a serious dawn phenomenon (which I presume), then that is very hard or impossible to control with injections.
Read the NICE guidelines for a pump and make your case for funding. If you do decide on a pump, I really recomend the Omnipod tubeless pump. I am on this pump and I love it. It has given me my life back and my diabetes is now easily managed without any tubing!!!

Hi there, We have asked about a pump but as he's only been on this system 3 weeks his consultant wouldn't consider a pump for a while yet. We have decided to start increasing the Lantus a unit every 3 days to see if this will help. We are finding all this waiting for the nurse to ring and "give him permission" too slow, as you said everyday with high blood sugars is more damage to his body, it's all very well the nurses saying don't do nothing until we phone and then they forget to phone, it's not their bodies that are being damaged. Lets hope we see an improvement soon.

 

[Omnipod]

dont wait for the nurse....diabetes is a disease where you have to treat yourself. Carry on increasing the lantus by a unit each day. You may want to consider this.... Lantus stays in the body for about 18 hours. If your husbands sugar levels are increasing in the early hours, perhaps he wants to take his lantus a bit later in the day so that while he is asleep, he is not running out of background insulin. I always took my lantus at about 8am each day and woke up with higher readings. I then forgot to take my lantus 1 morning and then realised at about 2pm. I took my lantus at 2pm. The following morning I woke up with much lower levels. I then carried on taking my lantus at 2pm each day and this pattern continued.

Most cases you will find more usefull advice off this forum.

 

[smidge]

Hello Smidge,

I do wonder if they are against often blood testing as the NHS want to cut the cost of blood testing strips!
What doesn't make sense is if the Lantus doesn't last the full 24 hours, surely his blood sugar would be high in the evening rather than in the morning when the Lantus hasn't been in his system long? As it is now, he takes his Lantus at 11.30pm, when he gets up his sugar is in the teens and continues to rise until around 6pm when he starts to go down, you would think it would be the other way round if it was running out before the 24 hours were up. He should be speaking to his nurse today, hopefully she will have an idea what to do next.

Yes, I do see where you're coming from on that. I just think that basal is easier to troubleshoot taken in two smaller doses as you can adjust them independently and see the results much sooner. I certainly wouldn't wait for the DSN. You just need to have the confidence to adjust and monitor until you find the dose and timing that works best.

Smidge

 

[Omnipod]

I never saw the post saying your husband takes his Lantus at 11:30pm. In this case he should not be running out by 6am as Lantus stays in the body for 18 hours. Go up 10% each night until he wakes up with a more normal reading. I know of some diabetics who also have serious dawn phenomenon who wake up at 3 am each morning and take a correction shot.

I do believe your husband is a candidate for a pump even tho he is a new diabetic. My levels start rising at 3am each morning and then from about 6am, they stop rising. My pump is set to deliver 1.5 units per hour from 3am to 6am. Before the pump, I always woke up with readings between 10 and 15. Now I wake up between 4 and 9. At all other times of the day, my pump delivers .7 units of insulin per hour.
Dealing with dawn phenomenon on injections is very hard. At the same time..... he should not allow himself to have these high readings too long. It will start affecting his vision, nerves etc.
Try get onto a DAFNE course ASAP and push for a pump. The proces can take a while and your husband does have a choice in his treatment. If the diabetic dr gives excuses... then move to a new clinic. Some clinics are pro pump and some arent.

i have been a T1 for 13 years now. I battled with multiple injections. I changed to a pro pump clinic and was given the Omnipod. Since then, I have never looked back. My diabetes management is so easy and for the first time, I have stable, controllable blood sugars. My life has completely changed. I have stamina, energy.... I feel healthy. Ive not been sick or seen my GP since Sept. Even my vision has improved. I can read the TV menu without glasses. My HBA1C is down from 13% to 7%. I have even put on 5 killos of weight - Could never put on 1 killo when I was on MDI.
Just before going on the pump, my eyes deteriorated so fast. I was diagnosed with retinopathy and M1 maculopathy which required me to see the opthalmologist every few weeks. Each time I went, they could see further deterioration.
Now that Im on the pump, its all stabilised and yesterday I was told that I only need to have my opthalmology scan every 6 months so theres been improvement.

 

[Mrs of type 1]

I never saw the post saying your husband takes his Lantus at 11:30pm. In this case he should not be running out by 6am as Lantus stays in the body for 18 hours. Go up 10% each night until he wakes up with a more normal reading. I know of some diabetics who also have serious dawn phenomenon who wake up at 3 am each morning and take a correction shot.

I do believe your husband is a candidate for a pump even tho he is a new diabetic. My levels start rising at 3am each morning and then from about 6am, they stop rising. My pump is set to deliver 1.5 units per hour from 3am to 6am. Before the pump, I always woke up with readings between 10 and 15. Now I wake up between 4 and 9. At all other times of the day, my pump delivers .7 units of insulin per hour.
Dealing with dawn phenomenon on injections is very hard. At the same time..... he should not allow himself to have these high readings too long. It will start affecting his vision, nerves etc.
Try get onto a DAFNE course ASAP and push for a pump. The proces can take a while and your husband does have a choice in his treatment. If the diabetic dr gives excuses... then move to a new clinic. Some clinics are pro pump and some arent.

i have been a T1 for 13 years now. I battled with multiple injections. I changed to a pro pump clinic and was given the Omnipod. Since then, I have never looked back. My diabetes management is so easy and for the first time, I have stable, controllable blood sugars. My life has completely changed. I have stamina, energy.... I feel healthy. Ive not been sick or seen my GP since Sept. Even my vision has improved. I can read the TV menu without glasses. My HBA1C is down from 13% to 7%. I have even put on 5 killos of weight - Could never put on 1 killo when I was on MDI.
Just before going on the pump, my eyes deteriorated so fast. I was diagnosed with retinopathy and M1 maculopathy which required me to see the opthalmologist every few weeks. Each time I went, they could see further deterioration.
Now that Im on the pump, its all stabilised and yesterday I was told that I only need to have my opthalmology scan every 6 months so theres been improvement.

Thanks for your reply, actually my husband has been a type 1 for over 30 years, he's only been on this carb counting Novarapid/Lantus system 3 weeks, before it was the old fashioned method of pork insulin twice a day. He has done the DAFNE course, his clinic did say the pump is a possibility if he carries on with the high morning sugars, but he needs to be on this method for 6 months first. We have given up waiting for the DN and he has started to take 20 units of Lantus at night now. His blood sugars aren't so high as they were but it seems he's got a cold now so this might be throwing the levels out slightly. Time should tell.

I am really pleased the pump has worked wonders for you, your eye sight is so important, my poor mother suffered for years with eye problems, she wasn't Diabetic. I'm so glad you have a vast improvement in your eyes. Funny enough even after 30 years of fluctuating sugar levels, my husband has excellent eye sight, and has only had lazar once nearly 10 years ago, but he does have Neuropathy which causes pain. Diabetes can be cruel.

 

[Mrs of type 1]

Yes, I do see where you're coming from on that. I just think that basal is easier to troubleshoot taken in two smaller doses as you can adjust them independently and see the results much sooner. I certainly wouldn't wait for the DSN. You just need to have the confidence to adjust and monitor until you find the dose and timing that works best.

Smidge

We haven't waited for the DN, he has increased the Basal dose and isn't quite so high, but he seems to have a cold at the moment so we will know more when he gets over this, typical!! It is all about having the confidence to change doses, this insulin is different to the old pork inulin he used to take as he only needs a very small amount of food to come out of hypo where as before he would need loads of carb and sugar. Goes the other way too, one biscuit can give him high sugar. It's going to take a bit of getting used to.

 

[donnellysdogs]

Agree up the basal!! If it was me I would up it 1 unit every 3rd day by 1 unit..... But you must get hubby to test, test, test. If this doesn't work do speak to nurse and consider a pump. I used to get DP... Not linked to a night hypo and my pump is amazing at keeping me absolutely good..


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[Mrs of type 1]

Hi there,

Just a quick up date. After hubby started to take 20 units of Lantus at night he was hypo every single evening for a week with his BG dropping rapidly after his evening meal. He started to take less Novarapid but still he was going hypo. He was waking up in the mornings with his BG at anything between 9-18. For the past 3 days he has stopped one of the unit's of Lantus and isn't hypo in the evening, BG are around the 5-9 range which we are happy with. He is still very high in the morning. We have managed to get an appointment with the consultant for 2 weeks today. We feel the Lantus does not suit him, do any of you know of better baseline insulin?? Many thanks for reading this.

 

[Omnipod]

Yes... there is a new insulin. Its peakless and you take it once a day. Its called Tressiba / Degludec. I had a very bad dawn phenomenon like your husband. I switched to degludac at 1pm each day and within a week my morning readings dropped from 15- 20 to 8!
Its the most expensive insulin on the market but it really works well. Hypos are less intense on tressiba too. Easier to treat. Ask for it..and let me know how you get on

 

[SamJB]

Hi there,

Just a quick up date. After hubby started to take 20 units of Lantus at night he was hypo every single evening for a week with his BG dropping rapidly after his evening meal. He started to take less Novarapid but still he was going hypo. He was waking up in the mornings with his BG at anything between 9-18. For the past 3 days he has stopped one of the unit's of Lantus and isn't hypo in the evening, BG are around the 5-9 range which we are happy with. He is still very high in the morning. We have managed to get an appointment with the consultant for 2 weeks today. We feel the Lantus does not suit him, do any of you know of better baseline insulin?? Many thanks for reading this.

You need to get your Lantus dose right before you can think about getting your fast acting dose correct. When Lantus is injected, it crystallises and slowly disolves throughout the day. Let's say, for example, your husband is on 24 units of Lantus (it makes the example easier to understand). This means he will be getting 1 unit of Lantus per hour. If he tests before eating and two hours after eating, not only would he have consumed his fast acting insulin, but also 2 units of his Lantus; and 1 unit of Lantus has the same BG-lowering power as 1 unit of fast acting insulin.

So if you try to figure out your fast acting dose (I.e. carb ratios) before Lantus, then you can't know if your pre-meal and post-meal readings are down to fast acting or basal insulin. Therefore, if you calculate your fast acting dose, then try to increase your basal, you may well go hypo after eating and blame the basal, when it could be your fast acting dose that was too high.

Try testing throughout the night again. If there is no sign of hypo and a steady BG increase then I'd suggest your basal is too low. Figure your basal before your fast acting, there is little chance of any decent level of control unless it is done in this order.

For every 1.6mmol/l change in overnight levels, adjust the basal by 10%.

My money is still firmly in the basal being too low.

 

[Mrs of type 1]

Yes... there is a new insulin. Its peakless and you take it once a day. Its called Tressiba / Degludec. I had a very bad dawn phenomenon like your husband. I switched to degludac at 1pm each day and within a week my morning readings dropped from 15- 20 to 8!
Its the most expensive insulin on the market but it really works well. Hypos are less intense on tressiba too. Easier to treat. Ask for it..and let me know how you get on

Thanks for your reply, we will definitely ask about this insulin when we go to see the consultant, I read that Lantus can cause morning highs and evening hypos.

 

[Mrs of type 1]

You need to get your Lantus dose right before you can think about getting your fast acting dose correct. When Lantus is injected, it crystallises and slowly disolves throughout the day. Let's say, for example, your husband is on 24 units of Lantus (it makes the example easier to understand). This means he will be getting 1 unit of Lantus per hour. If he tests before eating and two hours after eating, not only would he have consumed his fast acting insulin, but also 2 units of his Lantus; and 1 unit of Lantus has the same BG-lowering power as 1 unit of fast acting insulin.

So if you try to figure out your fast acting dose (I.e. carb ratios) before Lantus, then you can't know if your pre-meal and post-meal readings are down to fast acting or basal insulin. Therefore, if you calculate your fast acting dose, then try to increase your basal, you may well go hypo after eating and blame the basal, when it could be your fast acting dose that was too high.

Try testing throughout the night again. If there is no sign of hypo and a steady BG increase then I'd suggest your basal is too low. Figure your basal before your fast acting, there is little chance of any decent level of control unless it is done in this order.

For every 1.6mmol/l change in overnight levels, adjust the basal by 10%.

My money is still firmly in the basal being too low.

Thanks for your reply Sam, the consultant told us that the Lantus would keep the BG level, e.g. if taken when BG is 7, it would remain at 7 for 24 hours, if no exercise was taken or food was eaten. When his BG is very high in the morning he takes a ratio of 3:1 and some corrections, but the BG remains high until after his evening meal at 6pm when he has a ratio of 1:1 and no corrections as we know if he has a more he will become hypo within 2 hours. Last night for example his BG was 14.5 before his meal, he had a meal of 100g carbs, so 10 unit's of Novarapid, 2 hours later his BG was 5.1, yet in the day his BG can be 16, he can take 10 units of Novarapid for a 3 unit sandwich and end up with BG's of 20+ it is all so complicated. Yet 1 extra unit of Lantus seemed to be dropping the BG so rapidly in the evening ( luckily we caught them before he went into a really bad hypo) None of it makes any sense!!!!