Insulin & low blood sugar

[CESM]

I’m newly diagnosed, just as lockdown was beginning so I haven’t had all the guidance I should have had. My HbA1c shot up from 57 to 135 so my GP assumed that I was type 1 (later blood tests confirmed that my pancreas is still working & I’m definitely type 2). I was put straight onto insulin - NovoRapid 3 times a day and Abasaglar at night. My daytime readings can be quite low. This lunchtime I was 3.6. Most days I’m within my target range of 5 to 7.9, so I’m doing really well and my latest HbA1c was down to “just’ 85. I haven’t yet had any advice on diet so I’m experimenting with low carb & also with eating carbs to see what the difference is.

My question is, why does my blood sugar drop between meals? I don’t feel I’ll, though I sometimes feel a bit hungry (I eat at regular intervals). Should I be reducing my insulin doses? I’m waiting to get a phone call that I’ve requested from my diabetes nurse, but I’d really like to get an understanding of how to manage my insulin. Hope some of you can help.

 

[JMK1954]

Welcome to the forum, CESM,
Was it a consultant at a hospital who decided to start you on these insulins ? Those are pretty standard treatment for a type 1. If you were given insulin, you should also have been told that you need to eat some fast-acting carbohydrate if your blood sugar level drops below 4.0 mml. This is vital. You can drink about 100 ml of any non-diet Coke or Pepsi for example or eat two or three jelly babies. You can buy glucose tablets called Dextrosol or Glucotabs in most pharmacies, which are handy to carry when you are out. Were you told any of this ?

 

[JMK1954]

Secondly, however much insulin you have been advised to take, this decision was made without knowing that you were going to start going lo-carb. If you eat fewer carbs, you need less insulin. It is as simple as that. How much less insulin you require is not something we can advise you about. You need to speak to your nurse about this very urgently.

 

[Brunneria]

I’m newly diagnosed, just as lockdown was beginning so I haven’t had all the guidance I should have had. My HbA1c shot up from 57 to 135 so my GP assumed that I was type 1 (later blood tests confirmed that my pancreas is still working & I’m definitely type 2). I was put straight onto insulin - NovoRapid 3 times a day and Abasaglar at night. My daytime readings can be quite low. This lunchtime I was 3.6. Most days I’m within my target range of 5 to 7.9, so I’m doing really well and my latest HbA1c was down to “just’ 85. I haven’t yet had any advice on diet so I’m experimenting with low carb & also with eating carbs to see what the difference is.

My question is, why does my blood sugar drop between meals? I don’t feel I’ll, though I sometimes feel a bit hungry (I eat at regular intervals). Should I be reducing my insulin doses? I’m waiting to get a phone call that I’ve requested from my diabetes nurse, but I’d really like to get an understanding of how to manage my insulin. Hope some of you can help.

Hi and welcome,

How much are you testing your blood glucose, and at what times? Are you confident that you are catching your lowest readings?

If you are confirmed as a type 2, then your treatment may be changed in future, but if you are on insulin at the moment then that is obviously the way to go for now.

You mention NovoRapid. Have you been told to take fixed doses three times a day? Or do you count your carb intake and then adjust your insulin dose accordingly? Responses to your questions will vary depending on whether you are on fixed doses, or not.

Also, what are your numbers when you do test? And what is the target range you have been told to aim for?

Sorry you have been left without all the information you need! But getting a diagnosis, and then Lockdown, and having to get to grips with insulin as well... rather a challenge. Do you know when to expect the phonecall from your nurse? If they don't ring in the next day or so I would chase them.

Experimenting with Low Carb is something you may want to put off until you are confident about carb counting and adjusting your insulin doses.

Have you been told about hypos, and how to avoid/treat them?

 

[Daibell]

Hi. If you go low between meals it's possible your Abasaglar shots are too high. The job of this daily insulin is to balance the background continuous glucose output from the liver. You do need to adjust the NovoRapid to suit the carbs in the meal. Many GPs/DNs fail to give that advice and hence risk hypos or high BS. Low-carbing is a good thing but the insulin needs to be adjusted to match.

 

[CESM]

Hi. If you go low between meals it's possible your Abasaglar shots are too high. The job of this daily insulin is to balance the background continuous glucose output from the liver. You do need to adjust the NovoRapid to suit the carbs in the meal. Many GPs/DNs fail to give that advice and hence risk hypos or high BS. Low-carbing is a good thing but the insulin needs to be adjusted to match.

Thank you for this. I wasn’t aware that the Abasaglar was to balance the background glucose output, I was just told it was a nighttime dose that lasts 24 hours. I was started on 16 units, a week later up to 20 units, a week later to 24 units then a week later to 26 units, but on 26 units I was waking up at night feeling funny - clammy even though I wasn’t sweating so I reduced it to 25 and that’s where I am now. My morning readings are now between 5 & 6. I’m not carb counting, I’ve been told by my diabetes nurse not to worry about this for now. If I’m reducing my carbs, do I need to reduce my insulin dose before a meal?

 

[CESM]

Hi and welcome,

How much are you testing your blood glucose, and at what times? Are you confident that you are catching your lowest readings?

If you are confirmed as a type 2, then your treatment may be changed in future, but if you are on insulin at the moment then that is obviously the way to go for now.

You mention NovoRapid. Have you been told to take fixed doses three times a day? Or do you count your carb intake and then adjust your insulin dose accordingly? Responses to your questions will vary depending on whether you are on fixed doses, or not.

Also, what are your numbers when you do test? And what is the target range you have been told to aim for?

Sorry you have been left without all the information you need! But getting a diagnosis, and then Lockdown, and having to get to grips with insulin as well... rather a challenge. Do you know when to expect the phonecall from your nurse? If they don't ring in the next day or so I would chase them.

Experimenting with Low Carb is something you may want to put off until you are confident about carb counting and adjusting your insulin doses.

Have you been told about hypos, and how to avoid/treat them?

 

[CESM]

Hi, and thank you for the welcome. I’m hoping to learn a lot.

I test my blood three times a day, immediately before meals, and I’ve started to test when I’m feeling hungry or light-headed between meals. I’ve been told to not yet test 2 hours after eating, not sure why. I’ve also been told not to carb count yet, but I’ve bought the Diabetes UK book on carbs.

The diabetes nurse increased my 3 NovoRapid doses from 6 units 3 times a day to 14 units 3 x a day, but I’ve reduced these to 11 units. I’m a bit concerned that I’m being left alone to make adjustments without understanding the reasons for what’s happening.

My target range is 5 to 7.9. I’ve been within this range since mid April, but quite a number of readings between 4 & 5 and several below 4.

Re hypos, I’m not sure what I’m supposed to feel like. I don’t think I’ve had one yet, just sometimes feeling lightheaded and a bit hungry. I know if I do get one to eat some dextrose tablets and then a snack or a meal.

I have to confess, I’m feeling pretty low about all of this at the moment and somewhat abandoned by the medics because of Covid. My retinography was cancelled, so too the course I was meant to attend to explain diabetes, and the hospital hasn’t seen me. Hey ho.

 

[CESM]

Welcome to the forum, CESM,
Was it a consultant at a hospital who decided to start you on these insulins ? Those are pretty standard treatment for a type 1. If you were given insulin, you should also have been told that you need to eat some fast-acting carbohydrate if your blood sugar level drops below 4.0 mml. This is vital. You can drink about 100 ml of any non-diet Coke or Pepsi for example or eat two or three jelly babies. You can buy glucose tablets called Dextrosol or Glucotabs in most pharmacies, which are handy to carry when you are out. Were you told any of this ?

 

[CESM]

Hi and thank you for your reply. I’ve only seen my diabetes nurse once since they thought I was type 1. I haven’t seen a doctor. I was supposed to see a specialist at the hospital but this hasn’t happened because of Covid. I only had a brief face to face meeting, since then it’s brief phone calls when I feel I need them. I was given an information pack to read, and all that I’ve learned so far has come from this pack and what I’m finding out online. It’s frustrating.

 

[CESM]

Secondly, however much insulin you have been advised to take, this decision was made without knowing that you were going to start going lo-carb. If you eat fewer carbs, you need less insulin. It is as simple as that. How much less insulin you require is not something we can advise you about. You need to speak to your nurse about this very urgently.

 

[CESM]

I have told my diabetes nurse that I’m reducing my carbs (I’m not going completely low-carb at the moment).

And you’ve given me the answer I needed - if I eat fewer carbs I need less insulin! Thank you!! That just goes to show how little I understand about this. I wondered if that might be the answer, but didn’t dare reduce my insulin in case it was the wrong thing to do.

 

[Brunneria]

It looks to me as if you are raring to go and ready to take the next step.

I have no intention of contradicting the advice you have been given already from your health team - but in all honesty it looks as if that advice has been inadequate.

Have a look at this link. It is an NHS link and talks about carb counting and adjusting insulin to carb intake.
Once again, I want to stress that you need the advice and support of your nurse, so that phone call is still important, but you could look on this link, and the carb counting as research to prep you for when you start that part of your diabetes management.

https://www.nhs.uk/conditions/type-1-diabetes/counting-carbohydrates/

 

[CESM]

It looks to me as if you are raring to go and ready to take the next step.

I have no intention of contradicting the advice you have been given already from your health team - but in all honesty it looks as if that advice has been inadequate.

Have a look at this link. It is an NHS link and talks about carb counting and adjusting insulin to carb intake.
Once again, I want to stress that you need the advice and support of your nurse, so that phone call is still important, but you could look on this link, and the carb counting as research to prep you for when you start that part of your diabetes management.

https://www.nhs.uk/conditions/type-1-diabetes/counting-carbohydrates/

 

[CESM]

Thank you for the link, I’ll do my research before I speak to the nurse. Very helpful.