Any help again please

[Deleted member 45091]

Hi said wouldn't post again, but got no where to turn to and believe it not I wouldn't mind trying to live a little longer at age 41. IAM on levinir 16 units in morning and 18 at night I have sometimes several correctional doses through the night but only ever 2/3 units as I don't know what's it going to do, basically any advice on how to set my background insulin, I've noticed in the afternoons I sometimes eat more carbs than I inject nova rapid and it can still come down. My sugars are in the twenty's around at least 80 percent of the time, how do you know if your insulin resistant? I seem to be more sensitive in the afternoon. Is nova rapid and levimir good for everyone? Alot of the times at night the corrections do not do alot. Then sometimes they crash, like yesterday said went from 20 to 11 in 15 minutes on glucose meter, only had around 4 units of Nova rapid and had food too, how do you know if you have lumps under skin where insulin can pool and release at random times? When I do nova rapid I don't usually have more than 6/7 units in one go, and then probably have around 40/50 grams of carbs so alot of the times I am just having an extra couple of units, iam like this as it's crashed fast a few times and can't explain it. Do different foods digest differently, all I know I feel a lot more sensitive in the afternoon as too morning and evening, does lack of sleep effect blood sugar as I am up all night scanning and doing correctional doses. Is it normal to feel starving at sugars of 15/16. Does different sites effect the insulin absorbtion? I currently inject in my legs stomach and bum, can you use the libre sensor anywhere else apart from the top out side arm? What glucose meters are most accurate tested earlier on a 4sure glucose meter one saidn11.2 then I did it again and said 17.5 then I scanned on liber said 18 and just changed batteries so may look at changing glucose meter. As someone said on one of the earlier post moving onto this regime one of the first things I should of been shown is how to set your background insulin, what I've had is cos sugars are high just up it a couple units and see how you get on. I am on certain medications eye drops etc while the keep doing stuff on it to try and save any sight in the right eye, iam not sure if this is having any effect on my diabetes, I try and eat well, 5.10 and weigh just over 12 and a half stone, but I find whatever IAM doing is very unpredictable, and what to eventually get my sugars down and feel safe and comfortable at normal levels. So any tips I could try or advice would be so helpful. IAM willing to try most things and I know they say speak to your doctors for advice but that's left me with a hba1c over 100 on around 8 injections a day and feels like my body is rotting from the inside out, iam willing to start from scratch, keep posting everything I eat and inject, and see if any of you people can have an idea what's going off. I don't drink no alcohol, smoke, Ive even quit coffee 6 months ago. Sorry for long post, but decided if I can wouldn't mind squeezing just abit more out of life, instead of waiting for the help from the so called specialists or when I've met the so called criteria...any help iam willing to listen to many thanks Dan

 

[Yaya10_10]

Hi Dan, thank for posting again.


I am not a native speaker so mind my poor english.

I will try to answer what I know from your questions:


Different food have also different digestion.
when you eat only carb, it is different when you eat something like chicken or egg with it.

Another thing is
Yes it is normal that different insulin injection sites have different effects.

For example when I inject on my leg my insulin will be slow.
My insulin is working fast when I go for my stomach area.

The thing is or my advice is ( I am not an expert) try fixing your meal or at least your breakfast
for example eat similar thing everyday and try to see how your bg reacts.

I know, it is kinda boring to eat same thing but what can we do if we try to sort things out.

How to set your background insulin here is a link but I have similar problem tbh,


Thanks to @Marie 2 for sending it to me

https://integrateddiabetes.com/basal-testing/?amp
good luck and please keep posting

 

[EllieM]

Hi @DannyH
I am so glad that you are not giving up.

We have to be very careful what we say here because forum rules don't allow us to give specific dosage advice, but hopefully we can still give you some help.

It sounds to me that one of your issues is that you are getting false hypo symptoms at high blood sugars, because they are lower than the ones that your body is used to. This is something that should pass once your body gets used to normal levels.

Here is the link to basal rate testing that @Fairygodmother supplied before
How To Successfully Test Your Basal Rate (mysugr.com)

(I see @Yaya10_10 has given you another link for this, that will work too)


An issue here is that the instructions want you to start with a bg between 5 and 10 and a level arrow on your libre.

****************
In an ideal world, you'd have
1) basal amounts of insulin that hold you steady when you don't eat and don't have any bolus in your system
2) an insulin ratio of insulin to carbs so that you can carb count your meals and dose for them (this may be different at different times of day) say X units per 10g of carb
3) a correction ratio of insulin to bg levels that tells you how much 1 unit of insulin will pull down your levels. Say Y mmol per unit

So, suppose your ideal target blood sugar before meals was 5, and your blood sugar before the meal was 9, and the carbs in the meal were 45, you'd inject bolus
X * 45/10 + (9-5) /Y = 4.5*X + 4/Y

Hopefully you already know this stuff - I actually only learnt this formalism including correction doses relatively recently after decades of diabetes - it seems that long term T1s can slip through the education net sometimes

So have your team given you any starting ratios?

****************
As for glucometers, they are all required to be pretty accurate (to within +-15%) but will occasionally give off readings - I'd suggest you repeat the test if it's drastically different to your libre reading.

Medications can affect bgs (eg oral steroids are notorious) but as there's nothing you can do about that at the moment I personally would try not to worry about it.

And I'm going to send you this fascinating link that @NicoleC1971 posted earlier
What type of type 1 diabetes do you have? - The Glucose Never Lies
which may (or may not) give you a reason why some T1s find it more difficult to balance their levels than others.

I'm going to stop now before this wall of text becomes too overwhelming.

Good luck, please keep posting and don't give up.

 

[JAT1]

Different foods do digest differently. Food combinations also affect carb absorption. For example, if I eat a carrot on its own, the carbs are reflected in about 20 minutes in my blood sugar reading. However if I eat a carrot with a chicken leg, the carbs won't show up for an hour or two. Fat and protein slow absorption of carbs down. Lack of sleep does affect blood sugar readings. I agree with Yaya10_10 about eating the same things every day at the same times until you have sorted this out. Recording in a journal what and how much you ate (weigh the food for accuracy), also recording when you took insulin and how much, as well as how well you slept, stress level and exercise will show you how your blood sugar levels react. Over time, you will see patterns and this will give you stability. If you are hungry, eat foods without carbs or that are very low in carbs and absorb slowly - for me, that would be cheese and chicken legs. The ratio of one unit of rapid-acting insulin (Novorapid) to 10 carbs is a good starting point. You may also inadvertently be 'stacking' insulin with correction doses which results in rapid blood sugar drops. Certain foods for me create chaos with my blood sugar readings and so I avoid them completely, such as, grains, rice, potatoes, take-out, premade food, all sauces, and of course sugar and all sweeteners. I hope this helps and I hope you keep the journal. My journal was a life-saver for me. Have faith and patience and you may yet live to see 90.

 

[Marie 2]

Hi @DannyH

Do a basal test first. As stated you should stay fairly even keel without eating if your basal is set right. A slight variation of about 1 point can happen. Sometimes you might set a basal dose a little lower than needed if you are on MDI because you want to prevent going too low at any point. If you are dropping too low, your bolus dosing is too high or your basal is too high.............it can be tricky to figure out which is why you need to start with getting your basal set fairly accurately because everything else will be off if it's not right.

Remember insulin works from maybe a slight amount at 30 minutes up to 6 hours after you take it. With probably the peak time of it working between 1-2 hours. So if you correct at night and 2-3 hours you wake up still too high and give another dose it is considered stacking. You haven't actually needed that second correction because the first hasn't completely been used up yet. I'm not saying you didn't need that second correction, I have no idea, but people notoriously "stack" doses during the day. And then you need to eat something or crash later. You are not the only one to do it , we all do at some point.

Personally 20 is too high.I would do a basal test first. Going too high for me takes extra insulin for it to come down. I prefer preventing it, prevention of too high for me means better timing of my prebolus. A standard meal I prebolus half , a half hour before I eat and the other half when I know what I actually ate. But for some prebolusing 20 minutes a third of the dose works. It takes some trial and error to know what works for you. And then of course higher fat delays carb absorption, higher protein sometimes hits hours later. I can not eat a high protein snack for the 3-4 hours before bed because I guarantee I will have a BG rise a couple of hours after I am asleep.

I have a pump and my sensitivity is adjusted for different times of the day. I am more sensitive in the evening and at night. I am strongly insulin resistant in the morning........I generally avoid eating in the am because of it. You could be more insulin sensitive in the afternoon, or it could be because you are more active, or it could be the morning dose is still working some with the lunch dose you took.

PS: Medication like steroids can cause higher BG levels and stubborn ones too.........even if it's localized eye drops. I've had steroid cream on my skin raise my BG level. We all can react differently to medications. It's not to say you don't need the eye drops, but sometimes adjustments need to be made.

 

[Marie 2]

Thanks @EllieM fixed.

 

[Deleted member 45091]

Morning everyone, thanks for replys went to bed last night at 10pm my sugars were 20.4 then woke up and there 21.4 and didn't do no correctional doses, although high and feel rubbish does that mean my basal insulin is about right at night as it's not moved much. What was thinking of doing is having cereals every morning but using a cup etc so I am having the same amount exactly every day and see what's happening. Il be checking ketones soon there usually ok even with high sugars. At these levels would people recomend low carb breakfast then add some basal insulin...I think it's called, to try and lower sugars more? I am on medication for my eye one is called dexafree I have 8 times a day and that has steroids in but it's eye drops and not sure how much gets into the system, also on eye drops called timilol X2, monopost x1, iopidine X 2 and take a tablet called diamox two half a tablets a day, all designed to lower eye pressure etc, and to take as I've had various operations on my eye, Hopefully if the op went well coming off some of the medication soon.

 

[Draco16]

Hi @DannyH

Well done for keeping going and asking for support. I read a few of your posts and a few suggestions.

Pre-bolus - do you inject a short time before eating? This allows the insulin to get a headstart and so better match up with the digestion of the food. It'll stop you going so high after eating and then rapidly dropping later.

Exercise - you don't want to be doing anything strenuous with such high sugars, but you mentioned mostly staying at home. Even if you can get out of the house a couple of times a day for a 15 minute walk down the road that's great. It gets the body's systems working overall, it lifts the mood. Very gradually try and increase this in the coming weeks

Treating 'hypos' - you mention treating at 12/13, which is understandable if you're used to being at 20+. But again very gradually start treating them at 11/12, then the next week 10/11 and so on.

Don't try for normal levels now. You want to very gradually edge things down over time. If your average reading is low 20s now, then try and get that to the high teens in the next month or so.

Levimir - I wasn't sure if you meant you gave correctional doses of Levimir during the night? You shouldn't do this. The impact it will be having is many hours later and confusing things during the next day. Just stick to 2 injections per day of levimir. Yes you can gradualy change the amount of levimir over the long term, but not hour to hour. You correct high sugars with short acting insulin (bolus).

OK, NOW THIS IS THE KEY BIT!

Blood sugar is driven mainly by 3 things:

a)Activity
b) Food
c) Insulin

We're all trying to balance these 3 moving parts. They're all constantly changing.

But when you're in a crisis, you need to make things simple, by making them as fixed as possible.

a) Activity - this already sounds fixed for you at close to zero, but at least it is consistent day to day. But if you could get out for those couple of walks that would be great (but keep it consistent day to day, very gradually look to increase the time)
b) Food - eat exactly the same meals (and same quantities) every day for the next 2 weeks
c) Insulin - as you have now locked down Activity and Food as fixed constants, this means that you can just focus on insulin as your blood sugar numbers will be changing in the main because of what you do with insulin: how much you take, the sites you use, how far ahead you pre bolus, how much long acting insulin you take, how sensitive you are at different times of the day, etc

This is tough, but you need to understand how insulin affects you. If you are doing different amounts of activity, eating different things then there is too much other noise and it is too difficult to try and figure out what is happening and why.

You really need to understand how insulin affects you. If your food and activity is the same everyday then what you do with the insulin is the main thing that is driving your blood sugar numbers.

 

[becca59]

Hi DannyH have you ever read a book called, ‘Think Like a Pancreas’ by Gary Steiner? If not it’s worth a read. He is a diabetic himself and it helps a lot with basal testing and bolus testing.
It sounds like you are more insulin resistant in the morning so yes I would ditch things like toast and cereal in the mornings. I now eat a small amount of raspberries an full fat Greek yoghurt. 10 carbs in total. I also weigh EVERYTHING to ensure carb counting is exact. It’s not the same as a bowl of lovely Shredded Wheat (my past favourite), but it helps me with the days levels as I go forward. You could also have some bacon, eggs etc. In the evening try and avoid eating for 5 hours before bed. By that time bolus insulin should have just about finished working. And you should be able to gauge if the basal you took with your food was correct. Plus you will then know if you need to correct before sleep. As long as you had had no basal insulin in the previous 5 hours I would not go to bed on a 20. It needs to be nearer 8.
As others have said, try eating similar things to try and work out if what you are doing is correct. Also consider eating less carbs and the carbs you do eat be very strict over weighing and calculations.

 

[Zhnyaka]

I adjusted my basal rate by comparing my BG in the evening and in the morning (those without food). As soon as they were about the same, it meant that the basal insulin was sufficient. Bolus insulin may work differently depending on your BG. It is best absorbed when injected into the stomach, but if administered in the same place all the time, you get lumps under skin (it do not contain insulin and it interfere with its absorption) .

I also want to eat when my BG is 15, so it is ok

 

[EllieM]

As long as you had had no basal insulin in the previous 5 hours I would not go to bed on a 20. It needs to be nearer 8.

Do you mean bolus?

I wouldn't be happy about going to bed on a 20 either, but this is where @DannyH is at the moment, and if he does a correction dose he doesn't know whether his basal is correct.

Given the starting value is 20 the basal test may not be very accurate but at least it suggests that his night basal isn't wildly out...

@DannyH, your correction doses are done with bolus (novorapid) not basal (levemir).

 

[Marie 2]

Hi @DannyH It sounds like you stayed stable all night. Too high but stable. I think that means you should work on the dosing of your bolus insulin. I would try eating something you know the exact carbs of and is low fat and protein. Be exact and dose exact. Watch what your blood sugars do over the next at least 3 hours........preferably 3-6 hours without eating or dosing. If you go too high or too low, correct it. Then you can repeat the test with an adjustment needed the next time with the same food. Some people do it 3 times in a row before they use the adjustments. I would also try to take at least some of that dose as a prebolus. But this will tell you if your insulin/carb ratio that you are using is close to what you need.

Your numbers would only change from a 20 to 11 in 15 minutes that you mentioned, if you hit a muscle with a dose or more likely it was leftover from an earlier shot and happened to start working then. While almost all my insulin is used up in 2 hours, I can stay stable for 3 hours straight and get a little "kick" at about 6 hours or sometimes at 3 or 4 hours. You need to be aware that insulin can stick around for up to 6 hours and when we are "too" high a lot of us stay at a very stubborn high. We then end up taking an extra correction because our numbers aren't coming down to have it all decide to finally kick in and cause a sudden crash. It really is easier to not go too high in the first place. Working on timing of prebolusing and how much to prebolus can make it so much easier to not deal with as many "too" high numbers. Prebolusing for me made a huge difference in controlling my levels.

I don't know what you are aiming for BG level wise. But bring it down safely. Keep in mind fats can delay carb digestion, protein can hit later and exercise helps your body use insulin better. So variance can occur. They really recommend for your health much lower numbers so I'm glad you are reaching out and trying.

 

[Deleted member 45091]

Hi yep I do nova rapid through the night sometimes 2/3 units every few hours sometimes it brings it down abit sometimes it doesn't, I know for me after a few hours nothing much seems to happen with the rapid insulin. But what I was wondering is there anyway that insulin I have at night could some how linger in my body and start working throughout the day. As it says the rapid insulin is usually gone in 4 hours. I will try and have a look at the book think like a pancreas, this morning had two toast small ones 10grams each and had 5 units sitting with bs 23 no ketones and feel sick, off to the eye clinic today as eye still red and sore after nearly 2 weeks after my op don't think my control is helping with the healing process. I know exercise is good for me but don't walk no where now, anxiety panick attacks set in alot now, another faulty gene IAM blessed with l. I might invest in a treadmill thing but been told to take it easy after the eye ops I keep having. It's strange even with high sugars when it comes up to the early after noon I feel sort of sensitive and it would crash, iam not sure if my basal is high in the morning and that my bolus needs adjusting, as before I've tried it a few times now having 1 unit per 10g carbs and have the exact carbs to insulin and it still comes down in the afternoon, not to hypo levels but something else seems to be happening, but again is it the medication Iam using, the diabetic person I see said even with steroid eye drops can effect sugar levels etc. Just keep trying having a lot of injections monitor alot, but the unpredictability puts me off doing a lot of things now. Il keep trying with your help and hope things improve even if it's just bit by bit

 

[NicoleC1971]

Hi @DannyH there is so much great info here but if you are feeling overwhelmed then first things first get the basal testing done!
That does mean a day without carbs (the food most likely to jack up your blood sugar) and a day without excessive exercise.
If that is too daunting could you fast until lunchtime (water, black tea and coffee)? then do the same on the following day but stop eating half way through the day?
Ideally your bg would be in a normal range to begin with so you would have to try super hard to get it back into range by bedtime possibly by eating less carb and taking much less bolus.
Go by your meter or libre, not your feelings of being low given that if you spend a lot of time high then you will feel a sensation of low sugar when in normal range but shouldn't treat it as a hypo. You will get used to lower sugars and feel comfortable.
IF your basal isn't right and I don't think yours can be, then you will always be chasing your tail with your novo rapid doses. At least you'll know that this part of the puzzle is solved then be able to problem solve bolus dosing and feel better.
And yes you may well be insulin resistant for now but the danger for now is the high bgs as you know.
I don't think anyone can provide you with a magic bullet of the right doses here or even on your medical team Danny so try to discover more for yourself but 1 step at a time and you haven't given up. You deserve decent blood sugars so please fight for them.

 

[StewM]

Hi @DannyH there is so much great info here but if you are feeling overwhelmed then first things first get the basal testing done!
That does mean a day without carbs (the food most likely to jack up your blood sugar) and a day without excessive exercise.
If that is too daunting could you fast until lunchtime (water, black tea and coffee)? then do the same on the following day but stop eating half way through the day?
Ideally your bg would be in a normal range to begin with so you would have to try super hard to get it back into range by bedtime possibly by eating less carb and taking much less bolus.
Go by your meter or libre, not your feelings of being low given that if you spend a lot of time high then you will feel a sensation of low sugar when in normal range but shouldn't treat it as a hypo. You will get used to lower sugars and feel comfortable.
IF your basal isn't right and I don't think yours can be, then you will always be chasing your tail with your novo rapid doses. At least you'll know that this part of the puzzle is solved then be able to problem solve bolus dosing and feel better.
And yes you may well be insulin resistant for now but the danger for now is the high bgs as you know.
I don't think anyone can provide you with a magic bullet of the right doses here or even on your medical team Danny so try to discover more for yourself but 1 step at a time and you haven't given up. You deserve decent blood sugars so please fight for them.

Yeah, it's fairly standard practice to break the day into chunks (in fact most recommend this way as preferrable, except Gary Scheiner, I believe).

And I also agree the test will be somewhat skewed by being out of normal range, as all Basal Testing guidelines recommend being in normal range at the start of the test. Obviously, getting into normal range safely is paramount.

 

[Juicyj]

Tons of great advice given above so can't really add much other than your basal insulin should keep you in your range i.e. 5-9 mmol/l when there is no active quick acting insulin on board and in a fasting state, so if you are running high at night then it's not the job properly as this is a perfect fasting state during the night as we are generally not taking quick acting or eating, as your correction doses aren't working then your correction ratio needs addressing too, so you've got some good pointers to start on, we can't advise on dosing as you or your team should be managing this but basal testing is key.

Keep asking questions Danny, it's work in progress, always, and we need as much support as we can get too - lots of that in supply here.

 

[becca59]

Do you mean bolus?

I wouldn't be happy about going to bed on a 20 either, but this is where @DannyH is at the moment, and if he does a correction dose he doesn't know whether his basal is correct.

Given the starting value is 20 the basal test may not be very accurate but at least it suggests that his night basal isn't wildly out...

@DannyH, your correction doses are done with bolus (novorapid) not basal (levemir).

Yes bolus.

 

[Deleted member 45091]

Hi thanks very much for replies again, as before been to eye clinic today to have it checked as it was hurting abit, apparently it's the stitches that are still in from my last operation just over a week ago but should dissolve soon, I don't know I thought I was made for better things but lying on that table having instruments put in my eye while awake isn't one of my favourite hobbies haha, but the op went well and I can see bits from the eye again but said any recovery will take time, on the diabetes front tonight il have the same background insulin, but maybe just one correctional dose before I go to bed and see what that does over night. Also as I was in the eye clinic today the diabetes specialist rang me to have another oppointment next week to see if I want to try just a once a day background insulin she didn't say the name of it might try it. Sorry if it seems like Iam going on but in life probably abit of a loner and learning new information all the time, back 30 years ago I was in hospital for a few days learnt to inject into an orange and let out, back in them days I used to inject in my calf muscles but think thats stopped now, so you will have to forgive me sounding like a kid just leaning after 30 years of basal bolus, timing of insulin, sensitivity, what exercise etc has effect on the body, how protein and fats can effect how food/insulin works. At 41 I thought the dawn phenomenon was the birds singing outside. So would just like to say again any tips ideas or advice is really welcome, I know we're are all different but it's nice to finally open up abit

 

[NicoleC1971]

Yeah, it's fairly standard practice to break the day into chunks (in fact most recommend this way as preferrable, except Gary Scheiner, I believe).

And I also agree the test will be somewhat skewed by being out of normal range, as all Basal Testing guidelines recommend being in normal range at the start of the test. Obviously, getting into normal range safely is paramount.

I could easily do a whole day without carbs now that I am low carb but back in the day I do recall being outraged at being asked not to eat any for a whole 8 hours!