Insulin help ...

[Mad76]

Hi guys,
Hoping someone can help me

Bit of background. I'm t1 diagnosed April 2019. Im on lantus at night novorapid in day as and when I need it. I have a libre. My consultant and nurse are happy with me adjusting doses myself.

So, last few days my sugars have just not gone below 10. At all really. They're pretty much between 11 and 15, and higher after food. I keep having novorapid, but its hardly having any effect. Usually 1 unit will bring me down 2mmol . So its very frustrating. I'm having huge doses to eat. Double what I usually have.

I dont feel sick. Don't think I have an infection.
I've checked ketone. Thankfully don't have any
I've changed to new pens of novorapid and a new pen of lantus
I've changed injection sites
None of the above have helped

So my next plan as of tonight is increase lantus. One unit . Then wait 2 days. Then repeat. Until I see a change


Couple of questions

1. Does this seem like a good next step?
2. Any one have any insight on why and if basal needs can just change like that ? For no obvious reason ??


Thanks if you have even read all the above . And thanks in advance for any advice

 

[EllieM]

So my next plan as of tonight is increase lantus. One unit . Then wait 2 days. Then repeat. Until I see a change

What's your morning blood sugar compared to your night time one? If it is still the same I wouldn't expect you to need to increase your lantus.

Any one have any insight on why and if basal needs can just change like that ? For no obvious reason ??

Mine can change for all sorts of reasons: illness (maybe asymptomatic), different exercise, stress, and some people find time of year makes a difference.

But given that you were only diagnosed in 2019 could it be that your honeymoon period is finishing?

 

[himtoo]

Hi @Mad76
from everything you have described your plan of action sounds reasonable and what i would do if i were in your position.
not sure if you are aware of this handy chart but maybe something else is going on that the 42 factors chart might help to explain
i find my basal needs change with the seasons and another factor that can sort of be hidden is if you have stressful events happening in your life ( work , relationship , money issues , etc etc ) ...hope you get yourself sorted and back in range soon xx

 

[Mad76]

What's your morning blood sugar compared to your night time one? If it is still the same I wouldn't expect you to need to increase your lantus.



Mine can change for all sorts of reasons: illness (maybe asymptomatic), different exercise, stress, and some people find time of year makes a difference.

But given that you were only diagnosed in 2019 could it be that your honeymoon period is finishing?

Thanks for the reply. My morning bloods are not massively different from when I sleep. Maybe a unit or so higher. Its hard to tell though as the minute I get up my sugars increase. I have the dawn phenomena most mornings.

 

[Mad76]

What's your morning blood sugar compared to your night time one? If it is still the same I wouldn't expect you to need to increase your lantus.



Mine can change for all sorts of reasons: illness (maybe asymptomatic), different exercise, stress, and some people find time of year makes a difference.

But given that you were only diagnosed in 2019 could it be that your honeymoon period is finishing?

As for it being the end of my honeymoon period. Not sure. Does it usually end this way with the doses of insulin needing to increase so much ?

 

[Mad76]

Hi @Mad76
from everything you have described your plan of action sounds reasonable and what i would do if i were in your position.
not sure if you are aware of this handy chart but maybe something else is going on that the 42 factors chart might help to explain
i find my basal needs change with the seasons and another factor that can sort of be hidden is if you have stressful events happening in your life ( work , relationship , money issues , etc etc ) ...hope you get yourself sorted and back in range soon xx

View attachment 54053

Thanks. I've not seen this chart before. We have had builders for a week which is Massively stressful. But they're finished now and my sugars are still like this.
Its really getting me down to be honest. I used to have ok control, and when it wasn't ok I knew why. Right now I just feel lost.

 

[himtoo]

Thanks. I've not seen this chart before. We have had builders for a week which is Massively stressful. But they're finished now and my sugars are still like this.
Its really getting me down to be honest. I used to have ok control, and when it wasn't ok I knew why. Right now I just feel lost.

sometimes the shoogs don't behave and we can't always get to the bottom of it. it can be so frustrating at times. ......the most important thing is that you are actively attempting to manage.

 

[JAT1]

It could take more than a few days to get back on track. My insulin needs change when I don't sleep well enough and am tired during the day. Fighting some kind of bug and not be having any outward symptoms will also affect your blood sugar. Keep watching your blood sugar and adjust your insulin to carb ratio accordingly. Then continue to watch in case your ratio returns to what you were used to. There are so very many factors involved, all we can do is keep trying our best and not stress about it.

 

[EllieM]

As for it being the end of my honeymoon period. Not sure. Does it usually end this way with the doses of insulin needing to increase so much ?

I'm not the right person to ask (diagnosed pre glucometers in 1970) but I would guess that it is another thing that varies very much from person to person...

 

[Doug88]

Hi guys,
Hoping someone can help me

Thanks if you have even read all the above . And thanks in advance for any advice

Hi, its so handy that you're on a libre as that makes testing a bit easier. Its seems that your insulin requirements have changed (doesn't really matter why - could be honeymoon, stress, sleep or well pretty much anything). I've found that instead of trying to work out why, its easier to just to adjust the insulin dosing and move on. In adjusting, you want to fix basal first and then bolus.

Adjust Basal
The first thing to do is get the basal right - that means do some testing. You can just google how to run a test, they're all kinda similar involving missing meals and looking at your libre graph, but here's a link to one: https://integrateddiabetes.com/basal-testing. Probably do it a couple times till you're convinced that its in the ball park.

Adjust Bolus
After that's done, you might still need to adjust you carb-ratio. One easy way to do it is...
1. make a meal in which you can count the carbs accurately (might be easiest to get some packaged food with the carbs on the label).
2. record your BG before starting
3. bolus your normal amount using your normal carb ratio
4a. if you go low - correct any lows with a food you know the carb content of
4b. if you don't go low - wait for 3-4 hours and see if you BG is high and needs correcting back to the starting point. Record the ammount required to correct.
5. Add up all the carbs you had to eat in that 4 hours. Add up all the insulin you had to take in that 4 hours. Divide the total carbs by the total insulin. That's what your carb ratio should have been. Probably best to do that test a few times until your confident.

Pre-Bolus
For bonus points, try to pre-bolus your food to reduce post meal spikes in the 0-2hour range post meal. here's another link: https://www.mysugr.com/en/blog/pre-bolus-to-stop-high-blood-sugars/

One thing to remember is that things might change again (that just happens) and the purpose of reducing highs, is to avoid long term complications. This kind of damage is hardly affected by a couple of days of being high whilst you fix things....so...try not to let it stress you out. Good luck.