Struggling to stay in range

[GBS_82_]

Hello everyone!

Would appreciate some advice.

Recently I have been REALLY struggling to stay in range. A few weeks back I was hypo-ing too much so started to lower my doses, realising that I have become more insulin sensitive since my diagnosis in February (I'm not 5'8 and 9 stone so not the biggest chap in the world. I was 10 and half ish stone at diagnosis - maybe more like 10).

However, now I am struggling to stay in range. Typically I will take a low dose per g of carb (I carb count) and then be rather high three hours after eating - maybe 12 or 13. However I then take a correction dose of one unit and two hours later am plunging toward a hypo. I have a free style libre so can usually head it off without getting the pain, but it's still annoying.

My nurse is trying to sort me a half units pen which I think will help but it seems to be taking a while. I also believe (thanks to the Libre) that Novo Rapid peaks a little later in my system then its meant to as my levels sometimes drop quite a bit between hours 3 and 4 (i.e. I may be correcting too early).

I am also worried that I'm secretly a misdiagnosed type 2. When I was diagnosed it was off the back of very bad DKA (i.e. quite close to a comma or worse) and was in hospital for two weeks. But when I asked how they knew I was type 1 rather than type 2 they simply said that I "wasn't fat" and "probably a bit too young for type 2" (I was 33) which didn't seem the most scientific approach. They never did a blood test. I've read subsequently online that if I was older and non-white they may have done a blood test to be sure. Could it be that I am still producing lots of insulin and that's why I'm having problems (my weight was quite up and down in my twenties and I briefly peaked at 13.5 stone).

Would appreciate any advice / thoughts.

Thanks again!

Gareth

 

[noblehead]

The first rule on MDI is to basal test, if you know your bg levels are holding steady in the absence of food (and bolus doses) then you can start to look at bolus timings if you think there's a delay in your Novorapid peaking @GBS_82_

A Dr can confirm your diagnosis using a GAD Test (Google for more info).

 

[azure]

I'd suggest very carefully trying moving your bolus more in advance. That should help the spike. You may have to adjust the timing for each meal (eg more in advance for breakfast).

You could ask your GP to prescribe the half unit pen. I gave up waiting for my clinic to get one in and just had my GP prescribe it for me.

 

[Kristin251]

I find a half unit pen invaluable. I use it for all meals and corrections but I am VLC and don't eat lots of food.

I would ask for a GAD ( antibody ) and c peptide teat which shows how much insulin you are producing on your own. I was told I couldn't be type 1 because I wasn't fat. In fact I almost died from too much weight loss. I was skin and bones. Having those tests will answer a lot of questions. For some reason Drs don't want to do them and you might have to put up a fight.

I agree bolus timing especially in the morning is important. I'm in the process now and testing every ten minutes to see when I start dropping. It's about 25 min so far but it only on day two. We are typically most insulin resistant in the morning but I still bolus 8 min prior to lunch and dinner but I eat the same meals everyday basically and again VLC . Morning is always a **** shoot.

 

[jharding]

I am probably not a million miles away from your situation; I am 34 and was diagnosed as type 1 in July. I was told I was "too old for type 1 and too young for type 2." My father is T2 and my daughter is T1 and I went with an inkling I was the latter. On an off-chance almost I found my blood sugars in the 20s one Saturday and ate no carbs until Monday; I pretty much followed the Atkins Diet and my sugars were still in the high teens. This sounded more T1 behaviour than T2. The diabetic consultant agreed.

Ultimately, it doesn't matter right now. I have a regime that keeps my sugars at around 6.0, varying from 4.0 to 7.5. This is not far from where i need to be.

If you want to see if your basal is right, then have a carb-less day. Kippers or eggs for breakfast, chicken and bacon salad for lunch and tea. If your sugars are fine then your basal is spot on; if not then you'll know what you need to adjust. You didn't say if you were on Lantus or Levemir; the former works for around 20-24 hours, the latter is around 12 hours. All dependent on the dose and the person. If you are on Levemir (like my friend) then you can have different doses at night and daytime if your basal needs fluctuate during the day.

Also you may still have some "honeymoon period" variance going on. After diagnosis, you may still have some beta cells still producing insulin in your pancreas; they don't necessarily all stop at once. When my daughter was diagnosed we would have random lows and we suspected it was her pancreas firing some insulin for a short period of time. That went after a few months.

As for the half-unit pen, I got mine by ringing my GP and asking them to prescribe it. I had to argue why I wanted it, and I was clear about the half-unit doses giving better control. They checked that the Novopen Echo gives that (I think it was originally designed for kids) and I collected it 48 hours later with cartridges of NovoRapid from the pharmacy.

We test, before meals and 2-2.5h afterwards, before bedtime, before driving (and every 2h), before and during strenuous exercise and at the spa on holiday. If you are testing your bloods before 2-2.5h has elapsed after a meal you will be higher as your body may have digested the carbs but the insulin hasn't finished working. Correcting here would send you low as you've been double-bolused. My meter (Accuchek) maintains a track of "active insulin" which is just it factoring in that there is insulin in my body and adjusts accordingly. It also has an alarm function to remind me to test 2.5h after a meal (and 15m after a low and 2h after a high, etc). Your DSN/consutlant should be able to give you a fancy meter.

If you are worried about going high, even after you've adjusted your bolus ratios, then injecting 10-15 minutes before the meal or changing to foods with a low GI Index will not see such a large spike

Obviously this is just my experience of managing myself for six weeks and my daughter for three years. Everyone is different so best of luck

John

 

[jharding]

I find a half unit pen invaluable. I use it for all meals and corrections but I am VLC and don't eat lots of food.

I would ask for a GAD ( antibody ) and c peptide teat which shows how much insulin you are producing on your own. I was told I couldn't be type 1 because I wasn't fat. In fact I almost died from too much weight loss. I was skin and bones. Having those tests will answer a lot of questions. For some reason Drs don't want to do them and you might have to put up a fight.

I agree bolus timing especially in the morning is important. I'm in the process now and testing every ten minutes to see when I start dropping. It's about 25 min so far but it only on day two. We are typically most insulin resistant in the morning but I still bolus 8 min prior to lunch and dinner but I eat the same meals everyday basically and again VLC . Morning is always a **** shoot.

I've just had (as in yesterday) the GAD antibody test; awaiting results. My consultant said that if she waited, she couldn't get it, so she's asked for it knowing that they'll do it for me!

 

[noblehead]

If you want to see if your basal is right, then have a carb-less day. Kippers or eggs for breakfast, chicken and bacon salad for lunch and tea. If your sugars are fine then your basal is spot on; if not then you'll know what you need to adjust.

A basal test has to be a fasting one, meaning no food @jharding

Food like kippers, eggs, chicken and bacon will all impact on bg levels and will give a false readings, meaning the OP may see a bg rise if they followed your advice and increase their basal dose when there's no need to.

An example, a breakfast of eggs (say an omelette or scrambled eggs) I need to bolus around 4u of insulin otherwise my bg levels will be in double figures postprandial, the type 1's on here who follow a very low-carb diet will tell you they still need to bolus for meals that contain none or very few carbs.

 

[jharding]

A basal test has to be a fasting one, meaning no food @jharding

Food like kippers, eggs, chicken and bacon will all impact on bg levels and will give a false readings, meaning the OP may see a bg rise if they followed your advice and increase their basal dose when there's no need to.

An example, a breakfast of eggs (say an omelette or scrambled eggs) I need to bolus around 4u of insulin otherwise my bg levels will be in double figures postprandial, the type 1's on here who follow a very low-carb diet will tell you they still need to bolus for meals that contain none or very few carbs.

Apologies then. The advice we were given many moons ago was to validate basal rate was in the right ballpark was to have a low-calorie zero-carb meals for a day. We've done it with my daughter a couple of times and she stayed reasonably steady but obviously, as I said, that post contained just my experience and knowledge.

 

[GBS_82_]

I'm really grateful to everyone for their advice, which was very helpful. Both my nurse and GP seem to think I'm a very clear type 1, so I'll let my type 2 worries go for now. However, I will conduct some basal tests and gather more data and if I still have concerns, push for a GAD test.

@noblehead - sorry for such an ignorant question, but I know very little about science - do antibodies stick around for ever? I.e. if I delayed getting a test for another few months, would the results be very different?

THANKS GUYS - stay safe, happy and in range!

Gareth x

 

[noblehead]

if I delayed getting a test for another few months, would the results be very different?

Not sure, but reading about the GAD Test on the DCUK community pages it says the test should be done before insulin commences:

http://www.diabetes.co.uk/gad-antibody-test.html

Maybe others may chip-in and comment.

Apologies then. The advice we were given many moons ago was to validate basal rate was in the right ballpark was to have a low-calorie zero-carb meals for a day. We've done it with my daughter a couple of times and she stayed reasonably steady but obviously, as I said, that post contained just my experience and knowledge.

No need to apologise, if that is what you were told and it works then that is great.

Probably the advice years ago was to eat a low-carb snack/meal to prevent hunger pangs, but times have moved on and the experts now know that both fat & protein can impact on bg levels in type 1's............hence why the current advice is to fast whilst doing a basal test.