Treated with distain again

[tizzy]

I really don't know who to ask anymore as I keep getting treated with total distain from medicall staff diagnosed type 2about 6 years ago I think black wee sticks and the the comment sugars will be in the 20s. So pills didn't work the twice daily insulin then onto novo rapid and levimir no instruction apart from 4 4and8 units with food 8 levimir at bed time went to hospital eventually told to carb count great .could be good the blood tests came back not auto immune cpeptide in the middle of what I don't know so if I am so in the middle of normal why do I have blood sugars in the high teens later in the day I eat bfast. In the evening sometimes and whilst in the morning it's great bgs fine the evening 16 17 I asked about splitting the levimir and was told that was only for diabetics who'd had it for many years I asked for an appointment to be brought forward as I didn't want to wait another 3 months to be told I worried to much about my bgs and felt so stupid un fortunately she wasn't the first to be like this with me to be honest unjustly I'm not actually obsessed as I have a lot of other things going on at the moment but I know it's not good control and naively thought somebody would guide me a little I have given up asking for help I know this post is very random and rambling my husband thinks that's probably why the treat me like s,,,ti many thanks for reading

 

[jack412]

sounds like normal concern when you are getting readings of 20's and it doesn't matter even if you're a complete lunatic in a nut house. You still need you BG within range. someone from UK will advise but I've read about going to a hospital consultant diabetic person with good results

 

[tizzy]

Many thanks for your reply I did have a chuckle but yes you are so right maybe get someone to come with me next time ta

 

[donnellysdogs]

Take somebody with you that knows how important it is to keep your levels within normal range. Somebody that is willing to back you up....


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[Daibell]

You are quite right to try to keep your blood sugar below around 10 mmol and the HCPs are wrong to dis-courage you. Are you overweight? If so it sounds like you may be an advanced T2 with some islet cell failure or even just a T2 with insulin resistance. Do ensure your weight is in the normal range by low-carbing if needed to remove excess weight. With any weight loss your insulin needs will reduce so watch-out for hypos. My understanding is that splitting Levemir can be done at any stage, but my DN added my NovRapid instead of splitting my Levemir. If you think about it, if taken once at night, Levemir peaks in the morning and if you have a small breakfast you don't need the rapid at breakfast. That means only three injections a day instead of 4 or 5. I therefore prefer the single Levemir. BTW, your morning fasting sugar should be between 5 - 7 mmol so adjust the Levemir a little bit at a time over several days to get it in range if needed and do check before driving etc and watch out for hypos whilst making any changes

 

[tizzy]

Many thanks I m not over weight and apparently not insulin resistant my husband pointed out the obvious to after blood test results the diabetic helpline also said not resistant according to results I only take small doses and in the morning they work really well so far I my result for c peptide was in the middle of the range so not type one I don't understand any of it but I do know when the result came back they seemed to become indifferent to me not that they were interested before apart from telling me to stop eating and exercise more at that point I was unable to eat a lot without high bgs and feeling ill apparently I'm on good insulin just need to know how to make the best of it

 

[jack412]

this gives a simple overview
endodiab.bcchildrens.ca/pdf/basalbolus.htm
a bit more detail but US numbers
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[Daibell]

Hi. Thanks for the reply. Whatever your exact diagnosis is, carrying on with the insulin with the right number of units should keep your blood sugar under control. It may be your diabetes progresses in which case you may need more injected units, but that isn't a problem. I would just keep monitoring your blood sugar and tweaking the number of units if needed. Do discuss what you are doing with the hospital or DN if they will listen but it sounds like you know much of what to do anyway

 

[tizzy]

Thank you both for your replies I am rubbish at understanding things so will get hubby to help he makes it seem so simple diabetes and probably add is not a good combination lol

 

[Scandichic]

You sound like you've had a really hard time! You shouldn't be treated rudely by your HCP. The clue is in the title - professional! Or not as the case may be. I ramble all the time - that's not unique! Ramble away and keep posting!

 

[Spiker]

That does sound really horrible.

If you are just injecting Levemir once a day in the morning then that's why you are going high in the evening. It really only lasts 12 hours. Once a day Levemir is not a good plan. To be honest you probably need to up the total dose if you are going into the 20s, as well as splitting it to twice a day. You may also need to take more novorapid with your food. Now your carb counting, do you check blood sugar right before and then 2 and 4 hours after? If you do that you can figure out if you need more novorapid for your carbs, to increase your 'carb ratio'. It may be that you need to up the total Levemir, split it to twice a day (that's normal for Levemir), and also increase your carb ratio with the Novorapid. But - change one thing at a time.

It will not take long to get it under control and we here will support you with advice and cheeky comments.

 

[tizzy]

Many thanks I am going to ask my husband pathetic I know to read through the link and help me also can I just grange the levimir myself or do I need the dn to give the ok

 

[jack412]

Many thanks I am going to ask my husband pathetic I know to read through the link and help me also can I just grange the levimir myself or do I need the dn to give the ok

I wouldn't do any adjustments yourself without the dn's OK, the link was an overview for down the road to give you an idea

 

[Giverny]

Many thanks I am going to ask my husband pathetic I know to read through the link and help me also can I just grange the levimir myself or do I need the dn to give the ok

Getting help from anyone isn't pathetic! Pretty much everyone on this forum is here because they need help

To address your question, it's probably best to talk it over with the DN just so you can avoid doing anything that might harm you. It might also be worth asking if there's any courses they can send you on that will help you out.

 

[tizzy]

Hi thank you again I haven't the confidence to change things myself I have 2 appointments coming up so hopefully get more info I hadn't thought about it but on another thread it says 2 doses of levimir a day may cause hypos with overlapping doses nothing is as simple as I thought I have asked to go on a course but they said type 2 course wouldn't help me and not allowed on type 1 as I said nothing is ever simple lol there must be others in my position as next year yeh they may set up a course just hope I can keep my limb and kidneys oh and eyes healthy should it really be this hard

 

[Spiker]

There is no way that splitting the same dose of Levemir (or anything else) in two, and taking it 12 hours apart, will cause hypos due to the overlap. The overlap is very minimal anyway as Levemir doesn't last much more than 12 hours in any strength, and even at the point of greatest overlap, the overlap between 6 old units and 6 new units is never going to be as strong a concentration as 12 new units. If 12 Levemir isn't giving you hypos, then overlapping 2 x 6 units of Levemir twice a day is not going to give you hypos. Not from the overlap effect, anyway.

But if you are worried it's definitely right to wait until you talk to your DSN. You should only make changes yourself if you are confident. Confidence comes from experience, with time.

 

[Spiker]

Actually as you are ok in the mornings but very high in the evenings (16-17) what you might need is an additional dose of Levemir around lunch time, in addition to your 8u of Levemir at bedtime. Talk it through with your DSN. But don't walk out of there unless they give you some kind of solution for these high values in the evening and bedtime.

Have you been taught how to do correction doses with Novorapid, to reduce high blood sugar even when you are not eating a meal? Do you do a correction dose at bed time when you see those results of 16-17?

 

[donnellysdogs]

Very high in the evenings can also depend on your last meal times and what the meals consist of. With exact times and doses of novorapid and what is ate it should be able to eliminate whether this is a factor or not..


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[donnellysdogs]

When you go for your appt have your record books with every detail wriiten down, times and what the foods are that have been ate etc. the whole point of being on basal / bolus is to be able to adjust your doses as and when necessary to keep your bg's normal. Your dsn needs to go through this with you.


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[Spiker]

Very high in the evenings can also depend on your last meal times and what the meals consist of. With exact times and doses of novorapid and what is ate it should be able to eliminate whether this is a factor or not..


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Good point, but in the chicken and egg question of whether a consistent high is due to insufficient basal or due to insufficient bolus insulin, it is usually a good idea to look at basal first, at least to eliminate that first. Particularly in this case when the high is coming 20 odd hours after a smallish Levemir injection as the last basal dose.

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