Blood glucose when new to insulin

[markpj31]

Hi,

Long story short, I had covid (delta) which was fairly mild (mostly had a rapid heart beat). Got over that within a week but noticed glucose was running high (I was on Metformin for 10 years, as well as glicazide and sitagliptin). Was referred to hospital where they did ketones and glucose and was borderline ketoacidosis. They took me off Metformin immediately and put me on 12 units of Lantus insulin (slow release, one injection in the morning).

Well, since then my blood glucose has been a bit all over the place really. I wake up with 7-11 blood glucose, eat breakfast and it for the most part drops to 5.5-8 on average before midday (although sometimes up to 12, but not often). After dinner later in the evening it sits around 8-9 2 hours after a meal. I typically go out and pace walk for an hour (4 miles) per day.

The thing is, during this whole experimentation stage I have been eating the same thing everyday with only 20-30g of carbs or so per day. I was told that I needed to eat more carbs as I was on a ketogenic diet beforehand and weigh 11 stone/72 kilos. I noticed that on the day I was really stressed, the numbers were in the 10's throughout that day.

Any ideas, or do I just need to wait for the community diabetic nurses to get back to me to look at the insulin dose? Thank you.

 

[Jaylee]

Hi,

Welcome to the forum.

Lantus is a basal insulin. Primarily not designed to deal with meals. It just works in the background. (So to speak.)
I use Lantus, but I am also T1. I tends to inject in the evening around 10pm.
I also use a fast acting insulin for the meals & any tweaks in correction.

Increasing the carbs & expecting the basal insulin to deal with any spikes or plataus from it, don't sound right.
But your pancreas may well be producing its own insulin too..?

However, if you are out for exercise. Carry some carbs (fast acting.) with you. Lantus hypos can be a slow creeper for me.

By all means talk with your nurse.
I'm personally interested in what she has to say..

 

[markpj31]

Hi,

Welcome to the forum.

Lantus is a basal insulin. Primarily not designed to deal with meals. It just works in the background. (So to speak.)
I use Lantus, but I am also T1. I tends to inject in the evening around 10pm.
I also use a fast acting insulin for the meals & any tweaks in correction.

Increasing the carbs & expecting the basal insulin to deal with any spikes or plataus from it, don't sound right.
But your pancreas may well be producing its own insulin too..?

However, if you are out for exercise. Carry some carbs (fast acting.) with you. Lantus hypos can be a slow creeper for me.

By all means talk with your nurse.
I'm personally interested in what she has to say..

Thank you for your reply.

It is interesting you mentioned hypos because I had my very first one on insulin today! Just after I went out at about 3pm. I was shopping and suddenly felt weak and sweaty, I knew it was a hypo. The interesting thing was that my blood glucose was 12 just before I went out (ouch!) so I decided not to have lunch (before insulin I never really ate lunch). Anyway, I couldn't measure my blood glucose when I was out, but knew, so I ate a toffee crisp bar. Sat down for 10mins and then decided to walk home (about 2.29 miles). I then noticed 5 mins before getting home that I felt weak again and sweaty. Got home and my Blood glucose was 5! Even half an hour/40mins after the chocolate bar.

I'll keep you posted about what the nurses say, I have been waiting 3 weeks so far, so hopefully the team will see me soon and make me a little more stable.

Thanks again for your reply! Take care.

 

[EllieM]

@markpj31 I believe Abbott had/have a free trial of their continuous glucose monitor available. It might be worth taking it up so that you can tell what is happening at night. (Be aware it's not accurate for everyone so you may want to cross check it against a glucometer).

Both @Jaylee and I are T1s, so we produce no insulin at all, so we absolutely need both long acting insulin (eg your lantus) together with a short acting insulin for meals. If I was a T2 getting diabetic ketoacidosis on a very low carb diet then I'd want to know how much insulin I was still producing. though I know that T2s can get DKAs and I guess it's possible your DKA was a side effect of your medications. Do you know if the hospital did a cpeptide test to see how much insulin you were still producing?

AS for the not eating lunch thing, this is where it might help to be on a basal/bolus regime, because you'd have the basal at a level to keep your blood sugars normal when you weren't eating, and you'd inject bolus (fast acting insulin) when you are eating carbs or as a correction dose if running very high. Definitely tell your nurse about the hypos.


Good luck. Push to get in contact with your nurse, as a new insulin user really needs advice on how to alter their dose.

Edited to add. I believe that lots of T2s start out on basal alone, mainly because they are still producing some of their own insulin, so their own insulin production can cope with their meals.

 

[Jaylee]

Thank you for your reply.

It is interesting you mentioned hypos because I had my very first one on insulin today! Just after I went out at about 3pm. I was shopping and suddenly felt weak and sweaty, I knew it was a hypo. The interesting thing was that my blood glucose was 12 just before I went out (ouch!) so I decided not to have lunch (before insulin I never really ate lunch). Anyway, I couldn't measure my blood glucose when I was out, but knew, so I ate a toffee crisp bar. Sat down for 10mins and then decided to walk home (about 2.29 miles). I then noticed 5 mins before getting home that I felt weak again and sweaty. Got home and my Blood glucose was 5! Even half an hour/40mins after the chocolate bar.

I'll keep you posted about what the nurses say, I have been waiting 3 weeks so far, so hopefully the team will see me soon and make me a little more stable.

Thanks again for your reply! Take care.

Hi,

OK? I certainly wouldn't undermine or discount your symptoms as a hypo. Testing during the "episode" would be preferable?
By all means treat it first. Make sure the finger used to test is clear of any food residue... & test whilst chewing on something. (Preferably something quicker acting to start. As a quick nudge.
5mmol is not classed as a hypo. However it might feel strange in that range after prolonged high BGs.?

I'm certainly not suggesting you may have dropped lower. Hence logging these events with the meter at the time.
(For your HCPs to help advise.)

My personal experience using Lantus for me, is a low can recur about an hour later just hitting it with an appropriate amount of sweets if the dose is wrong. (& possibly again.)

Deciding not to have your lunch may not have helped? The "toffee crisp" may well have helped another drop later,

I do manual labour on this stuff. & after years of use. Found proficient experience to alter the dose for the following days projected activity? Temprature (climate.) can also affect insulin sensitivity for me..

Be safe, yourself.. Carry something in your pocket to treat. Never rely when out shopping on a short queue purchase.

 

[markpj31]

@EllieM Thank you for the info. I take two glicazide with breakfast and 2 for dinner and one sitagliptin on top of the insulin in the morning (I aim for the same time everyday). I have no idea what tests the hospital did, I assume that they did something to come to the conclusion to take me off Metformin (which they believe was no longer working and causing the ketoacidosis) but who knows? I guess I could request the latest blood test results from my GP, as well as whether or not they tested to see how much insulin I was/or am not producing. I've been waiting 3 weeks so hopefully something comes up this week.

To be honest the hospital food was diabolical. Well, in my opinion anyway, which is why my sugars were high there. The choice of breakfast was two slices of toast with butter or jam best option for lunch was a cheese and pickle sandwich (at 53g of carb that was the lowest carb on offer) and dinner was macaroni cheese, chicken and mushroom pie or a chicken/veg soup. Along those lines - I went with the chicken/veg soup and it turned out to be a cup-a-soup laced with glucose, cornflower, croutons and whatever other junk they put in those things - it went down the sink.

@Jaylee Again thank you. Yep, I didn't eat lunch because of the 12 blood sugar reading (which makes no sense because I ate the same thing as I did the day before and it was 6ish midday). I bought the chocolate bar in the shop because I could feel the hypo coming on - it had 19g of sugar in it and I ate about 70% of the bar. Because I was out, I could not do a reading and didn't really expect a hypo on a slow release insulin, especially considering that it was 12 just before I went out! After the 16g of sugar I consumed (40mins later), it was still only 5 so I don't know what it could have been when out (3-4?). I normally take jelly beans out with me, but changed some stuff in my bag to clean it out and forgot to put them back in

 

[EllieM]

Ouch, @markpj31 .

To be honest, it sounds to me that you are a lot more clued up than your nurse, who sounds to be telling you to eat for your insulin rather than inject for your food, advice that was outdated for T1s about 40 years ago but I guess may still be OK for T2s. (Reminding myself that T2s on insulin are not the same as T1s on insulin.)


Has he/she at least advised you on how to adjust your lantus if you get lots of lows or highs?

 

[markpj31]

Ouch, @markpj31 .

To be honest, it sounds to me that you are a lot more clued up than your nurse, who sounds to be telling you to eat for your insulin rather than inject for your food, advice that was outdated for T1s about 40 years ago but I guess may still be OK for T2s. (Reminding myself that T2s on insulin are not the same as T1s on insulin.)


Has he/she at least advised you on how to adjust your lantus if you get lots of lows or highs?

Nope No mention of adjusting anything, just inject 12 units per day in the morning. I think what I am going to do is cut down on the carbs to under 20g again until I can get some actual help and guidance. I already have damage to my left eye because I had no eye screening for 2 years because 'of the pandemic' and I had to wait 8 months for the laser which she said was going to be done over two sessions (one now and one in 3 months).. I then waited 5 months and had to call asking what was happening.

 

[Jaylee]

Hi again @markpj31 ,

You mentioned in your first post about borderline ketoacidosis & being tested?

What were your BGs at that time..? you also mentioned doing a Keto diet. There is such a thing as "nutritional ketosis." but that is all pending on what your BG levels were too?

We need some insulin using T2s here, i would agree.

 

[EllieM]

Nope No mention of adjusting anything, just inject 12 units per day in the morning. I think what I am going to do is cut down on the carbs to under 20g again until I can get some actual help and guidance.

Just be aware that if you take more insulin than you need then you will hypo. We're not allowed to advise on doses here but I feel it's irresponsible of your nurse to leave you with no advice about dose adjustment.

One reason why T1s often get recommended not to go keto (though some do anyway) is that it can be hard to differentiate between the dietary ketosis from a keto diet and a DKA caused by lack of insulin. In T1s, that is accompanied by high blood sugars, but if your DKA was medication induced that may or may not be the case. (I freely admit to lack on knowledge on medication induced DKA).

 

[markpj31]

Hi again @markpj31 ,

You mentioned in your first post about borderline ketoacidosis & being tested?

What were your BGs at that time..? you also mentioned doing a Keto diet. There is such a thing as "nutritional ketosis." but that is all pending on what your BG levels were too?

We need some insulin using T2s here, i would agree.

Sorry for the delay in getting back to you. Yep. I was borderline Ketoacidosis.
When I was admitted with 15 BSG and ketones were very high. Then again, I was 12 days in to and getting over a covid. I was eating around 10-15g of carbs per day (no grains, rice, breads, fruit)... Just food pretty much as it comes out of the ground.. I guess you could call it a caveman diet.

 

[markpj31]

Just be aware that if you take more insulin than you need then you will hypo. We're not allowed to advise on doses here but I feel it's irresponsible of your nurse to leave you with no advice about dose adjustment.

One reason why T1s often get recommended not to go keto (though some do anyway) is that it can be hard to differentiate between the dietary ketosis from a keto diet and a DKA caused by lack of insulin. In T1s, that is accompanied by high blood sugars, but if your DKA was medication induced that may or may not be the case. (I freely admit to lack on knowledge on medication induced DKA).

Sorry for the delay. I just take/was prescribed 12 units of Lantus insulin per day, and two oral meds per breakfast and dinner. Yeh, I thought that myself regarding the ketones. Maybe it looks worse than what it was because I followed a keto diet and covid was the thing pushing my sugars up.

I tried to chase up my blood results from the hospital but GP said they don't have any.. I would have thought they were shared, or maybe I need to contact the hospital directly(?).

I contacted the Diabetic specialist nursing team I have been waiting to see and they said I have been missed somehow and they will call me next week.

 

[jonathan183]

I think you need to adjust the insulin dose and you need advice on that. Being new to insulin and left without advice is unacceptable - were you given a 24 hour contact number ?

 

[markpj31]

I think you need to adjust the insulin dose and you need advice on that. Being new to insulin and left without advice is unacceptable - were you given a 24 hour contact number ?

No, no number - I was told to wait for the Diabetic nurses to contact me within 3 weeks, but I didn't hear anything so had to chase it up. Apparently they are calling me next week and I guess then they can look at the diary I have been making (testing myself 4 times a day and noting numbers).

I've been experimenting myself really, starting off with eating the same thing everyday for 3 weeks and adding bits and pieces to that meal to see what happens. I exercise a lot (5 mile walk daily) which brings it down by a good margin (although sometimes it doesn't, oddly).. The time I am mostly seeing highs 9 and up to 11 BG is morning and before bed. However, this seems to be changing lately for some odd reason. Despite eating the same thing the bloods can vary massively. For example, I went to bed last night at a high 11, and woke up 7 hours later and it was 5. My new blood glucose machine seems to be averaging out (based on 4 times testing per day) at 7.2-8.2 average blood glucose per day. I'm guessing 5.5-6.1 or something along those lines would be the best number to aim for?