Can't get lower then 7

[Maple]

Hi... I'm type one, diagnosed around 9 months ago. Overall, I feel I have decent control over my BG. It ranges from 4.5 to 6(ish) before meals and I have got it down from 12 before bed to 8-9. I've been told that a fasting BG should be 5-6 but I can't get below 7? I'm on 20u of Lantus taken in the evening and a 10:1 ratio of humalog (was on epidra until the supply issues...)

Any suggestions?

-Andrew

 

[mrburden]

Hi,
Can you clarify what the problem is, I might be mis-reading your post. You say that you can't seem to get fasting BS below 7, but your pre-meal levels are between 4.5-6? Pre breakfast would be counted as fasting, so you seem to be within the target you are hoping to achieve.

 

[Maple]

Hi... pre meals are fine, it's the 'first thing in the morning' figure that I can't get below 7.

 

[mrburden]

Hi... pre meals are fine, it's the 'first thing in the morning' figure that I can't get below 7.

In my experience, early morning highs are because I need more long acting insulin (I'm on Levemir) at night. Just a couple of units make a difference. It may be worth trying to increase your long acting insulin. I would only add a couple of units, then leave it for maybe 2 or 3 days to see how it affects your AM readings. If they are still too high, do the same again, always leave a few days for a pattern to emerge rather than increasing day after day.

 

[Anonymous]

Have you ever tested at night? Do this at least once before adjusting your basal. Morning highs could be a rebound from night-time lows, if that's the case you might actually have to lower your dose to have better morning readings.

 

[Maple]

Thanks both... will try testing at night. Really appreciate the advice!

-Andrew

 

[smaynard]

One further thought Andrew, do you test immediately you wake? I used to do this with my daughter and would frequently have numbers a bit higher than desirable which I would correct and she'd then hypo. Then we started using CGMS and we observed that my daughter's blood sugar goes up my a couple of mmol immediately on waking and then drops again (without correction) within 30 mins (it appears to be a bit like an adrenalin response). We therefore now don't test until she's been awake for c. 30 mins. This might be something very individual to my daughter but I thought I'd mention in case useful.

 

[noblehead]

Have you ever tested at night? Do this at least once before adjusting your basal. Morning highs could be a rebound from night-time lows, if that's the case you might actually have to lower your dose to have better morning readings.

Good advice, it's inconvenient but testing during the night gives you a bigger picture of what your bg is doing. Should you decide that your lantus needs increasing do it by just 1 unit at a time then leave it for 2-3 days before adjusting again, lantus takes 2-3 days before changes are noticed (check patient information) so do keep this in mind.

Good luck!

 

[Maple]

One further thought Andrew, do you test immediately you wake? I used to do this with my daughter and would frequently have numbers a bit higher than desirable which I would correct and she'd then hypo. Then we started using CGMS and we observed that my daughter's blood sugar goes up my a couple of mmol immediately on waking and then drops again (without correction) within 30 mins (it appears to be a bit like an adrenalin response). We therefore now don't test until she's been awake for c. 30 mins. This might be something very individual to my daughter but I thought I'd mention in case useful.

Thanks, will try that too!!

 

[Maple]

One further thought Andrew, do you test immediately you wake? I used to do this with my daughter and would frequently have numbers a bit higher than desirable which I would correct and she'd then hypo. Then we started using CGMS and we observed that my daughter's blood sugar goes up my a couple of mmol immediately on waking and then drops again (without correction) within 30 mins (it appears to be a bit like an adrenalin response). We therefore now don't test until she's been awake for c. 30 mins. This might be something very individual to my daughter but I thought I'd mention in case useful.

Thanks, will try that too!!

Tried waiting 20 minutes today before testing, reading was 5.1! Once is not enough to say 'that was it!' but I'm going to try that for a few days.... cheers

 

[smaynard]

As you say, once isn't enough to be sure but I do hope this is the answer to your morning anomaly. I know you are also trying night time testing too.... for my daughter, night time wakings cause the exact same affect. On the CGMS you can see the pattern very clearly.