DSN maybe having a laugh.

[NaijaChick]

Hello

I am now a T2I. After my first week on insulin, DSN noticed that my BG was as follows

“Fasting” (Told her I take it at 9 when I’m at work, so not sure why she thinks this is fasting)

8.0-11.0 (Humalin S-6 units, increased from 4)

After Breakfast (I always eat Leon kids blueberry porridge)
8.0-12.5

Before Lunch (Humalin S-4 units)

7.0-10.0

After Lunch
4.7 to 7.5 ( I don’t eat carbs)

Before Dinner (Humalin S-6 units, increased from 4)
6.0- 8.0

After Dinner (7.0-10. With carbs 6.0-8.0 without carbs)

As you can see if I stay away from carbs then my BG actually improves. Here is the issue, DNS has insisted that I eat carbs at night to ensure that I don’t hypo in my sleep. Basically she has frightened me as I sometimes stay alone.

Is there an amount of carbohydrates or specific ones that I can eat that won’t raise my BG and I won’t be at risk on a hypo.

Also my real fasting BG before stepping out of bed are normally 10-12, should I ask for something to sort out my BG during the night?

Confused.com

 

[EllieM]

As you can see if I stay away from carbs then my BG actually improves. Here is the issue, DNS has insisted that I eat carbs at night to ensure that I don’t hypo in my sleep. Basically she has frightened me as I sometimes stay alone.

It's a valid point, but it's also a valid point that you should be able to modify your insulin regime so that you inject for your food rather than eating for your insulin. I would work out how you actually want to eat and ask your nurse to put you on an insulin regime that supports this. (You may need to have more injections).

Also, for someone who is relatively low carb you seem to have moved onto insulin quite early. Have you actually been tested to check whether you are T2 or T1/LADA? (An awful lot of the latter folk get initially misdiagnosed as T2.) In particular, have you had a c-peptide test?

Also my real fasting BG before stepping out of bed are normally 10-12, should I ask for something to sort out my BG during the night?

Make sure your DSN knows about this.

Good luck.

Disclaimer: T1 here, so I know about insulin but not necessarily about T2.

 

[NaijaChick]

Thanks for your response. I have a whole range of blood tests booked on Monday and that’s one of them. I think I’m allergic to carbs. A simple sandwich spikes me by 2-3mmol. I will speak to her on Monday.

 

[Seacrow]

You seem to not be understanding the link between carbohydrates and blood glucose. ALL carbohydrates raise your blood glucose when eaten. Ideally, the insulin you take reduces your blood glucose back to a 'normal' range. So if you eat a large amount of carbs, your bg goes up by a large amount, and you need a correspondingly increased insulin dose.

If your DSN is worried about overnight hypos, I am surprised that she has increased your dinner insulin dosage.

 

[NaijaChick]

You seem to not be understanding the link between carbohydrates and blood glucose. ALL carbohydrates raise your blood glucose when eaten. Ideally, the insulin you take reduces your blood glucose back to a 'normal' range. So if you eat a large amount of carbs, your bg goes up by a large amount, and you need a correspondingly increased insulin dose.

If your DSN is worried about overnight hypos, I am surprised that she has increased your dinner insulin dosage.

Yes, you are right but not all carbs spike you in a matter of minutes. Sweet potatoes don’t spike me at all but peas do.

Is she not meant to increase my dinner dose?

 

[MeiChanski]

Hello I think it is important to discuss it with your team about carb counting so you can adjust your insulin for the amount of carbs you are eating.
You will hypo if you take insulin and not eat the appropriate amount of carbs for it. However there are a number of factors to why some have highs and lows, taking into account exercise, weather etc. So this must be addressed with your team.
Are you taking any basal insulin? I know from reading that humulin s has a longer acting profile compared to novorapid/fiasp.

 

[Scott-C]

Yes, you are right but not all carbs spike you in a matter of minutes. Sweet potatoes don’t spike me at all but peas do.

Is she not meant to increase my dinner dose?

Once you get more used to the dynamics of insulin, it's possible to adjust the timing of insulin to accomodate the gi of different carb types.

Although it's true that all carbs turn into glucose, the rate at which they do so is important.

For example, bread can be broken down and absorbed into the bloodstream quite quickly, so I would tend to inject quite far in advance, maybe about 20 to 30 mins, so that the insulin has had time to distribute around my body and get to work so that it will meet the incoming glucose load head on and balance it.

Whereas pulses will tend to break down a lot slower, so if I injected too far in advance, the insulin will be dropping my bg levels too much because the glucose from the still digesting pulses is nowhere near my bloodstream yet, so I might only inject about 5 mins before the meal.

One of the keys to using insulin well is getting an idea of it's "shape" over time - it's not just x units for y carbs: it's thinking about how soon it starts working (typically about 20 mins), when it peaks (usually about 45 to 90 mins), and when it's activity ends (about 3 to 5 hours), and then trying to match that to the expected absorption rate of the type of food you're eating.

Sometimes, some injected insulin gets destroyed by the body before it gets to work at all, so be prepared for unusual and inconsistent results for the same meal eaten on different days.

With time, it's possible to check results in the 1 to 3 hour range after a meal, make a judgment call on whether the dose amount was "right" or "wrong", and then decide on whether an additional correction injection of another few units is required. This is much easier with cgm.

Good luck!