Type 1 Why is increasing my insulin dose at breakfast not making a difference?

[Ross94]

Hi All,

I'm newly diagnosed with type 1 as of the 25th of May 2020. I've been told to test my blood sugar only before meals and before bed. Since diagnosis I've been having boiled eggs and wholemeal toast for breakfast to keep the carbs to a minimum. This was working for me in terms of keeping my blood sugar below 7 before lunch. However, the last three days I've had plain Cheerios with milk. This is about 30g of carbohydrate.

The first day I took 5 units of insulin. Before breakfast my blood sugar was 6.7, before lunch it was 8.8.
The next day I took 6 units of insulin. Before breakfast my blood sugar was 6.5, before lunch it was 8.7.
The next day I took 6 units of insulin again. Before breakfast my blood sugar was 5.6, before lunch it was 8.0.
Today I took 7 units of insulin. Before breakfast my blood sugar was 6.7, before lunch it was 8.8.

I'm not snacking in between meals, and I'm eating at the same times each day.

Why is my blood sugar over 8 when I'm eating the same breakfast (weighed correctly), despite increasing the units of insulin?

 

[Jaylee]

Hi @Ross94 ,

Welcome to the forum.

My guess it the milk with the cereal could be having a sort of "pizza effect?"

Though to be fair, your numbers are looking reasonably consistent over the last 3 days.
What are your BGs 2 hours after breakfast?

 

[Ross94]

Hi @Ross94 ,

Welcome to the forum.

My guess it the milk with the cereal could be having a sort of "pizza effect?"

Though to be fair, your numbers are looking reasonably consistent over the last 3 days.
What are your BGs 2 hours after breakfast?

Hi, thanks for replying. I've been told to only test before meals at the moment, so I'm not sure.

 

[Jaylee]

Hi, thanks for replying. I've been told to only test before meals at the moment, so I'm not sure.

You would be surprised how BGs can fluctuate in between meals.

The numbers you have, I don't feel are terrible to be honest. If you're new to this.
It is interesting that you had to increase your bolus to get the same sort of result over 3 days?

What type of insulins are you prescribed? (Short & long acting.)

 

[Ross94]

You would be surprised how BGs can fluctuate in between meals.

The numbers you have, I don't feel are terrible to be honest. If you're new to this.
It is interesting that you had to increase your bolus to get the same sort of result over 3 days?

What type of insulins are you prescribed? (Short & long acting.)

Yes, I can't understand it myself. It's only since I started eating cereal. I'm on Novorapid with meals and 13 units of Lantus at night.

 

[Jaylee]

Yes, I can't understand it myself. It's only since I started eating cereal. I'm on Novorapid with meals and 13 units of Lantus at night.

I just seen your profile. Lantus. (Use the stuff myself.)

I feel you will need to speak with your diabetic team on this.

I would be inclined to look at what the background insulin level is doing? You seem to be increasing your novorapid for the same breakfast which could also be compensating for your basal (Lantus?)

More testing is needed. This may explain. https://www.mysugr.com/en/blog/basal-rate-testing/

 

[Ross94]

I just seen your profile. Lantus. (Use the stuff myself.)

I feel you will need to speak with your diabetic team on this.

I would be inclined to look at what the background insulin level is doing? You seem to be increasing your novorapid for the same breakfast which could also be compensating for your basal (Lantus?)

Ok, thanks for the info. The diabetes nurse is ringing me on Thursday, so I will ask her then.

 

[Jaylee]

Ok, thanks for the info. The diabetes nurse is ringing me on Thursday, so I will ask her then.

Here's wishing you the best of luck!

Let us know how you get on..

& don't be afraid to use that meter a little more. In my experience DSNs get stunned by too much data?
Do it for your own management.

 

[Ross94]

Here's wishing you the best of luck!

Let us know how you get on..

& don't be afraid to use that meter a little more. In my experience DSNs get stunned by too much data?
Do it for your own management.

Will do, thanks a lot!

 

[KK123]

Ok, thanks for the info. The diabetes nurse is ringing me on Thursday, so I will ask her then.

Hi Ross, I can pretty much guarantee that your Diabetes Nurse will be ecstatic when you quote those numbers, especially given you are newly diagnosed, 2 weeks???. Your glucose levels will fluctuate 24/7 no matter how much you try to control them, your levels after your meals are very good and the differences in the numbers are hardly worth mentioning given the numerous factors that come into all this, ie, the honeymoon period/time of day/exercise/walking about/stress levels and on and on and on. For the first 6 months or so for me I was having to alter my doses (for the same meals) regularly, it was all about learning how it all works and this takes time. Many people believe that if you have '30' carbs you simply have '3 units' of insulin (or whatever your ratio) and your numbers will be exactly 'this or that', erm no. Be patient, don't get disheartened, your numbers seem good. What were they on diagnosis? Also, IF you are still producing some insulin of your own that can kick in as and when making it even more unpredictable. x

 

[Ross94]

Hi Ross, I can pretty much guarantee that your Diabetes Nurse will be ecstatic when you quote those numbers, especially given you are newly diagnosed. Your glucose levels will fluctuate 24/7 no matter how much you try to control them, your levels after your meals are very good and the differences in the numbers are hardly worth mentioning given the numerous factors that come into all this, ie, the honeymoon period/time of day/exercise/walking about/stress levels and on and on and on. For the first 6 months or so for me I was having to alter my doses (for the same meals) regularly, it was all about learning how it all works and this takes time. Many people believe that if you have '30' carbs you simply have '3 units' of insulin (or whatever your ratio) and your numbers will be exactly 'this or that', erm no. Be patient, don't get disheartened, your numbers seem good. What were they on diagnosis? Also, IF you are still producing some insulin of your own that can kick in as and when making it even more unpredictable. x

Thanks for your reply, that makes me feel better about where i'm at. I'm generally happy with my numbers, the mornings seem to be the most problematic for some reason.

I was diagnosed about two weeks ago in A&E, I was suffering from DKA at the time. My blood sugar was over 20, they got it down gradually over about 4 days. It was still in the low teens when I left hospital. I've been adjusting my rapid acting doses very gradually, and I've had no double digit readings (pre-meals) for the last 5 days now.

 

[Daibell]

Hi and welcome. Those numbers are quite good so don't worry. It may be that your Basal needs tweaking up a bit; talk to the nurse. The Basal should keep your BS steady when fasting for a good few hours. I'm surprised you have only been told to test before meals. Many of us will test 2 hours or so after a meal to check all is OK. Testing before and after occasionally will also guide you as to how different foods affect your BS

 

[Ross94]

Hi and welcome. Those numbers are quite good so don't worry. It may be that your Basal needs tweaking up a bit; talk to the nurse. The Basal should keep your BS steady when fasting for a good few hours. I'm surprised you have only been told to test before meals. Many of us will test 2 hours or so after a meal to check all is OK. Testing before and after occasionally will also guide you as to how different foods affect your BS

Thank you. I think I will be testing after meals soon, the nurse is just starting me out slowly. Especially with all the information I've been given to digest.

 

[Jaylee]

Thank you. I think I will be testing after meals soon, the nurse is just starting me out slowly. Especially with all the information I've been given to digest.

Hi again,

You may find some interesting numbers on waking, then just before you do breakfast? (If you have a bit of a morning routine inbetween rallying for work.)
Then before & 2 hours after each meal & before bed. (Especially if you dose Lantus in the evening?)

Now, you may find testing whilst low & after treating it, you may appear to go lower still if you test within 10 minutes of the last test. BG meters tend to have a 15/20 minute lag. Like a snapshot in time,? So try not to panic be patient.

A BG sensor or flash monitor is revealing still..

Take your time taking this all in. It's your condition you are working with.

Best wishes.