How can I control my levels?

[Shazia555]

How do I get my fasting sugars to decrease? I've been on insulin for two months now. My insulin has steadily been increasing as my nurse didn't want to suddenly increase the insulin.

I am now taking 18 units of novo rapid before breakfast and lunch. 25 units of novorapid before evening meal. 25 units of levemir at night

My fasting sugars always seem to be 13-15. Throughout the days my levels are between 7-9.

How can I reduce my fasting sugars. I've tried eating no carbs at evening and has resulted in the similar readings

I know my job has a big impact as I'm a driving instructor and its a very stressful job but I simply can't get it in control

 

[noblehead]

You need to speak with your diabetes nurse and explain to them about your high fasting bg levels, they will probably ask you to increase your levemir dose to bring your morning levels down.

 

[donnellysdogs]

As a general guideline only... Not for you to change any dosing....without speaking to your dsn etc...this is how generally doses work.. Some people vary.....

Generally total bolus for the day and total basal for the day would be fairly equal.. Ie if you take 50 units of basal insulin (generally) you would find that your bolus would equate to the same-(ish) amount.
This is called a 50/50 ratio.
Some people run on a 60/40 ratio and a few run on a 70/30 ratio.
We are all individual and it all depends on our individual lifestyles.

It seems that you are having significantly more novorapid than your basal insulin.
So your nurse may well raise your basal more.

As you are a driving instructor it us imperative that you are not at risk of hypo's whilst fine tuning your needs.

By the looks of the levels you have stated and the timings and ratios you are currently on I personally would have thought that your bolus may need to be reduced and your basal to be increased. However you must speak to your DSN.

Due to your job it is sensible to balance your changes sliwly rather than put you at risk of hypo. I cannot emphasise that enough...

 

[Daibell]

Hi. Can you let us know your BMI as excess weight can make it difficult to stabilise insulin due to insulin resistance. Do continue keeping the carbs down but for all meals.

 

[Shazia555]

I'm still trying to adjust the units. I did go up to 30 on levemir but that brought on night sweats but I will try to slowly increase again

My nurse has said to adjust and see if it improves. Has also told me to add correction doses at the night after evening meal to help bring the level down

I'm a bit cautious as the insulin has increased my weight by 5kg in two months which is a lot!

I'm now 85kg! Im 5'6" so have a high bmi

 

[donnellysdogs]

Hi
When having night sweats did you actually test yourself?
Have you done any night time time tests?

Are you testing pre eating and 2 hes after? How much are you raising (or dropping after meals?)

How are you working out how much correction to give yourself?

Sorry for asking so many questions....

 

[donnellysdogs]

Welcome to the elite club by the way!

 

[Shazia555]

Thank you.
No I dontvmond the questions

I've been told to only test before meals at the min as before insulin my habc1 was 116 and the last one was 83 so has been significantly reduced

I only noticed my body drenched in sweat in the morning as I awoke and when checking was between 8-13.

Due to the nature of the job I finish at 9 so by the time I eat it's quite late and testing before bed my levels have almost doubled despite what I eat

I last corrected by 6 units when before bed my level was 17 but still in the morning my level was 13.1

My nurse told me for every 1 unit it would decrease 1.5 so I'm basing it on that

 

[Shazia555]

Hi I awoke this morning to a bf level at 7.4.

I followed your advice guys and lowered the novorapid and increased my levemir and that seemed to have made some effect. Thank you so much for the advice guys. I m ow it's early days but it certainly has made a difference.

Fingers crossed x

 

[donnellysdogs]

Hi
Well that was a better reading to wake up to.
Will you do a 3am check please? It is important that if you change your basal rate that you do a check during the night. Best to do this before you suddenltly have a bad hypo one night!!
Do test before meals and 2 hours after meals. This is important to see the effects of the bolus change.
Glad that your morning level was improved...

 

[Shazia555]

Thank you

Yes I will do. I think the nurse wanted me to only check before meals but I will start checking after meals now
And also at night.

I was so confused as my dn was saying how the higher levels could be down to stress sleep illness which appreciate is the case as I get a max 5 hours sleep and am stressed due to the nature of the job but I was sure it may mean adjustments to the insulin I was taking

I'm glad I posted on here
Thank you for your help x

 

[donnellysdogs]

I generally like you get limited sleep. Going to bed most nights about 11.30 ish and up again at 4.50 with testing during the night as well.

Unless you can see the rises 2 hours after your food (which really need to be less than 2.7bg rise or drop) then how the heck does your DSN know whether it is your bolus or basal that needs to be changed. Gggggggrrrrrrr!!!

Let us know how your readings pan out today.... It needs to be monitored like this for when you are working and days when you don't... As there may well be a difference that would show...

Don't rush in to changes...test to see what occurs today....until your basal is balanced with your bolus you may have slightly higher readings during the day....

We're not medics... We aren't professionals but we have experience of what works for us. We are all individuals though. So we are just letting you know what we would do in your situation....sometimes as well different members suggest different things... Thats only because our bodies all react differently.

Hiwever, basics of testing pre meal, 2hours after meal, nught time testing are pretty much standard to us all.

Have a good day. Don't stress if you see raises...they can be sorted...

 

[Shazia555]

My dn told me to increase my novorapid as before evening meals my level was 7-9 and it doubled after meals which is why she recommended correction dose but I was thinking if my fasting level was lower maybe that would help the level throughout the day?

I will be monitoring pre and post meals a day night too

Thank you for your advice xx

 

[donnellysdogs]

It may well be that you need more insulin with your evening meal than you would during the day...that wouldn't be odd.

However it is your basal rate that you have to check. This is to allow you flexibility around your eating times and activities.

For example if family are with me at breakfast time.. I eat. Uf they aren't I don't eat at all until my evening meal. If I did not have my basal rates right I wouldn't be able to do this. It applies whether you are on MDI or a pump. You need your basals right first....then this helps to get your bolus ratios right.

You'll get there. No fears...don't worry, honest.

To do a basal test.. You need to have a meal and bolus as usual. Then don't eat another meal for 10 hours and try tontest every two hours. If you go low, then you must treat the hypo and stop testing.
If you go high, use it as a test for a correction bolus... Treat the high with the dose that you would normally and carry on testing every 1-2hours. If your dose is correct you will be back to your target figure of say 6.0 bg by 5 hours after the correction bolus.. Do not eat for 5 hours. If you get to normal target figure before 5 hours your correction insulin would be too much.
If you don't hit your target level by 5 hours you aren't having enough correction insulin.

Hope that helps.

Let us know how you get on....
Best wishes...

 

[Daibell]

Hi. Thanks for the reply on BMI. I suspect your excess weight is a big part of your problems. Taking insulin when you have excess weight can be problematic as you are adding insulin to your blood when it may already have too much due to insulin resistance. You must seriously reduce the carbs in your diet if you haven't already done so. I would target 100gm/day or less until things stabilise. Insulin doesn't cause weight gain but it enables the body to make more use of the carbs you eat and store excess as fat. I'm assuming you don't have any other medical condition that could also be part of the problem?

 

[donnellysdogs]

Hi Shazia555

How have you got on today?

 

[Shazia555]

Hi

I have increased my levemir at night to 40 and have found my fasting levels have dropped to 7/8 which is really good and as a consequence my levels before meals is around the same

I am doing my best to reduce my carb intake

I have always been around 80kg since I can remember. (I'm big boned) but have noticed my belly growing since I started insulin and my dn did mention it would be a side effect but I have started the gym to try and maintain the weight but it's so difficult especially when I'm working 8am straight through till 9pm so I'm sitting all day in a car with very little exercise.

I have just checked my level now before lunch and it was 5.8. Morning level was 8 which means I can now decrease my novorapid as my levels are getting nearer to how they should be?

Thank you guys

 

[Shazia555]

Hi. Thanks for the reply on BMI. I suspect your excess weight is a big part of your problems. Taking insulin when you have excess weight can be problematic as you are adding insulin to your blood when it may already have too much due to insulin resistance. You must seriously reduce the carbs in your diet if you haven't already done so. I would target 100gm/day or less until things stabilise. Insulin doesn't cause weight gain but it enables the body to make more use of the carbs you eat and store excess as fat. I'm assuming you don't have any other medical condition that could also be part of the problem?

Hi

No other condition that I know of. My weight has always been an issue and I have always been around the 80kg mark. In fact the only time it's been less was when I had been diagnosed with lung cancer and was on chemo at 17 then my weight dropped down to 9kg

 

[jack412]

I think carbs for weight loss, gym for general fitness, which makes you hungry and you eat more

 

[donnellysdogs]

If you had breakfast and bolus and then dropped by lunch to 5.8 that could warrant less bolus.. Yes, as if you had been 5.8 to start off with you would have been hypo...
Have you got 1/2 unit bolus pens? It may need a full unit decrease but may only need 1/2 unit....depends upon your ratio's..

So lovely to see that you have improved your levels. Well done. Goid result. Keep testing. I hope dinners and teas etc will work out good too!!