Is it time for Basal/Bolus

[Mervyn]

Hi,
I am due to see my GP on Wednesday as I was "summoned" to discuss my recent blood/urine results.

I am taking, what I consider a large amount of Humalin M3 Insulin ( now on 46 units morning and 39 units evening). My morning BG is sometimes within a decent range between 6.1 and 8ish but at least 3 times a week is a lot higher.

Once I start eating, from breakfast time onwards, my BG is between 11 and 16. I can get my pre-dinner down to about 7-8 but only if I do not eat for about 6hrs before hand!!! Although these readings are a considerable improvement to what they used to be.
Although I still eat carbs in my diet they are certainly a lot less than they used to be.

I have explained numerous times to my DNS about the readings throughout the day but she seems reluctant to change my regime. I am wondering though how much more I should increase my Insulin?? Of course with the increased Insulin comes increased hunger pangs, though I am strict and do not eat any more, and drink coffee and tea to stop feeling hungry.

Should I be more forceful and try for a Insulin change? or persevere and just keep "upping" the Humalin until I get good regular results? or discuss "forcefully" with my GP?? Taking into account that my GP is unable/cannot prescribe Insulin,which is the reason I am under a seperate DNS.

The diabetic clinic at my GP surgery were so good, but now I am under an outside DNS I just do not see the surgery team. I even had to ask for my latest blood/urine tests as the surgery no longer automatically requests them from me!!

I am becoming increasingly depressed and that will not help my BG either. I am getting absolutely desperate to get this sorted.

Sorry for the semi rant tone of my post.

Mervyn

 

[Anonymous]

Morning Mervyn,

As you've probably noticed there's hardly anyone on here at this time of day. I am supposedly on basal/bolus but know nothing about Humalin so may not be much help.

As you're probably aware, you need to get your numbers down in to single figures all the time and to get those post meal readings down then you need to start at a sensible number before the meal.
My prescription (which I am merrily ignoring) says that I should take a basal injection of 30 units of Lantus once per day and then take as much fast acting insulin as I need for each meal. This would then allow me to eat what I like as I just pump in enough insulin to cover the carbs in the meal.
I am type 2, like you, and type 1's have to do this and no-doubt get very used to it - all I can say is that I never did. It was a bit like trying to stand up in a rowing boat - you're always compensating and testing to find out why you feel so awful, because you're high or because you're low.

So now I low carb - pretty strictly - and just use a small dose of the Lantus (long acting) morning and night. I take 5 units before bed and 5 in the morning and then restrict my carbs to get the control I need. My morning numbers ranger from about 4.5 - 6.0 and I have tuned this by adjusting the night-time dose. My pre-meals are pretty good at 4.5-6.5 and I rarely hit a double figure reading unless I've eaten porridge.

You have a choice - eat like a non-diabetic and take lots of insulin or change what you eat and take less. I have tried to get off the insulin altogether but it seems that I don't have the pancreas for it - but I prefer to use as little as possible for as long as I can.

Hope that helps - we all get depressed with this thing and we're allowed the occasional rant.

S

 

[Mervyn]

Hi swimmer,
Thanks for your reply. I certainly am trying to reduce my carb intake. I no longer eat rice which used to put my BG up alarmingly. Simarly with a banana, even half of one. Potatos as well I barely eat,and have upped my protein whilst reducing carbs.
For me carb reduction will be gradual but have cut them by at least 50% I would say.

My BG started rising when two things happened. First I only used to eat twice per day.. a small breakfast/lunch combined and then dinner early evening. But started eating 3 x per day at the DNS request/order :crazy: Then the second I think, the most significant change was that I stopped drinking any alcohol!! I used to be a very heavy drinker of Scotch (at least 1 1/2 Litres per week) and bang my BG went shooting up.

My DNS seems to think that stopping the drinking is the main reason but I would have thought that it would have evened out by now??

Thanks again

Mervyn

 

[Anonymous]

Well the additional meal will have had an effect, as I guess your Humalin is balanced against your food intake (at least in theory).
It's also well documented on here that alcohol reduces your levels (though not beer which as it's own carbs I've found). If I drink wine with a meal then I can eat more carbs as a result.

I find pasta and rice are the worst and I don't eat bananas either. In fact, thinking about it, I rarely have spuds or bread either.. what am I eating I wonder :shock:

 

[Unbeliever]

I feel very sorry for you Mervyn. I am not in the same situation yet but may well be oned day. and it frightens me!

I had a long hard battle to sort out my meds .I have complications because of the meds and although insulin is supposed to be the be all and end all I am not otally sure I have the srength for the battles involved.

I know there must be mant who are happy and feel better but its not the suff itself or the injections which worry me . As ever it is the system!

I hope your GP can help. Maybe you could explain your feelings about the system? I think that they are still learning about T"s on insulin and I am no at all surprised that they just expect them to react in the same way as T1s.
I epect that many, like swimmer find their own way hrough it as I have with the meds but it is depressing.
I hope you get it sorted soon.
Please let us know how you get on.

 

[Mervyn]

Hi Unbeliever,
Thanks for your reply and encouragement. I will hope that my GP will certainly do something.
Maybe he may even suggest seeing an endrocrinologist ( I have not seen one since 20001) and we can get some sort of care plan.

Take care

Mervyn

 

[Mervyn]

Apologies and a big,big oops!!!!!

I have just remembered something!!!! oops double oops!!

I had a neck tumour removed in hospital in Feb 2011. Before this I was not allowed any test strips etc but whilst in hosp my BG went through the roof!!

Sometime afterwards a boil/abscess formed on one of my bum cheeks :shock: which was over a year a go. I have been home treating, and I regularly (sorry if you are squeamish) get loads of bloody stuff out of it, but it will not go away. I have never had a fever etc with it!!

Now my wife insisted that when I see the GP this week, for blood results, I see him for this as well :roll: so she made a double appt!!! I know that an infection can cause raised BG but surely not by such an amount that means I have to have such a large amount of Insulin??? It is on the biggish side( about 2in diameter) and not looking forward to an operation or on the spot lancing Sorry that I forgot about this before!!

Mervyn

 

[anna29]

Hi mervyn...
Sounds like you could suggest and request ? to see an endo specialist, I did and got it...
The boil in your bum - with inflammation from it - could be pushing up your blood sugars.
Remember illness,stress,pain,inflammation,worry,anxiousness plus steroids and antibiotics can push up your blood sugar levels.
So much can.... and does affect them !!! :thumbdown:
With your insulin being a largish dose, am inclined to suggest you request a specialists clinic to take closer look at this for yourself. Also a new therapy careplan in place could be beneficial here for you too.
Worth asking for and about ??? When you see your GP at the double appt.
I only do a basal only plus victoza regime, due to my medical conditions / intolerances.
Apparantly its the bolus that will swallow up the calories eaten and fat stores!!!
Having had heart surgery and am tiny in frame plus weight gain phobic it was agreed this was the best plan for me.
We are all individual and have specific needs and critereas to be taken on board.
Do let us know how you get on.
It isnt easy I know , and even harder when you get down with things am sure... [[[[hug]]]]
Keep pushing onwards mervyn and get the help you truly need.
Much love n thoughts.
Anna.

 

[Mervyn]

Hi Anna,
Thanks a lot for your help and understanding. With my lump/abscess/boil I am wondering how much that would really increase my BG. I know it is like how long is a piece of string!! :? At the mo I am not taking antibiotics only my "normal" plentiful meds.
Although I am unfortunately allergic to all the penicillins on top of everything else.

I will indeed try and have a full conversation with my GP. I wonder whether my DNS suspects trouble as she mentioned to me that she would attach a note to my online notes!! Covering her backside springs to minde :twisted: or am I being too cynical.

To top everything off...I have a fresh 10 pack of Insulin and the b----y fridge has just packed up!! :evil:

Thanks for the hugs x

 

[Unbeliever]

I really do hope you can get a referral to an endo Mervyn but I do have o wonder why this hasn't been suggested to you before because of all your health problems.

If the GPs etc are not going to take some sort of an overview of patients' health then what are they for? {sigh}

Why do WE have to suggest a course of action to our highly paid GPs?

Good luck! I was plagued by bolis everywhere one year so I sympathise. Yet anoher symptom that wasn't picked up.
All my fault. I had he temerity not o be overweigh so I couldn't possibly be diabetic could I?

Hope you get it all sorted and you are a little more comfortable !

 

[Mervyn]

Thanks Unbeliever,
Yes I think you are spot on. What really irks me is that the Diabetic clinic run by our GP surgery was very good...apart from the fact they only did an HbA1c on a yearly basis.

My GP HAD to refer me to the outside DNS, for insulin, run by a community hopital about 15 miles away. We have a local hospital with it's own endocrine dept only five miles away!! :roll: :crazy:

Since I have been speaking to the DNS ( have only actually seen her once) my GP surgery do not even remind me for my blood tests. I have to request them myself. I have not even had my yearly Diabetic clinic at the surgery.

I am hoping that my GP will start to take a more proactive role in my care.

Thanks again

Mervyn

 

[anna29]

Hi mervyn...
Hope you can get your fridge working again??? If not ?
Ask a neighbour or family member to store your insulin for you till you get it sorted or a new one in ...
Try mentioning to your GP you do know you are entitled to yearly tests and screening, this might just make
things progress forward for you.
I find at my surgery if dont ask - you dont get !!! If I do ask - I do get .... :thumbup:
It can be easy for somethings to slip the net if not talked through .
Maybe writing a short list of bullet points to go through with your GP , could make this easier for you, this is usually seen as positive and HCP's are happy to answer. Always works with me... :thumbup:
Do you know what is causing your boil ?
With levemir insulin I used to get mouth ulcers, never had these since using the porcine animal insulin.
Anna.x

 

[Mervyn]

Thanks Anna,
I do not know what caused the boil!! it appeared not long after my stay in hosp for the tumour removal (from my neck). I did not start Insulin until after my incarceration in hosp. Unfortunately the Insulin was above the optimum temp for several hours. But I will have used most of it by the 28 days allowed out of the fridge.

I will certainly take a tick sheet with me when I see the GP. Hope I have enough time in the allotted double appt for everthing including my boil. I have a vision of the GP looking at the boil saying oh yea!! me turning round and seeing him with a blooming great scalpel in his hands. :lol:

thanks for your help.

Mervyn x

 

[Mervyn]

Update,
Just got back from GP for results of bloods and to discuss my abscess!! Firstly would not discuss my Diabetes. Insulin regime HbA1c, endo or anything to do with my Diabetes!! I have speak to the DSN even to change from pre-filled pens to pen and cartridges. He was very nice about it though :lol:

Now to the serious stuff!! He wanted to see me about my liver...I have always had a fatty liver but something has changed and he has ordered more substantial tests (how long do the path lab keep the bloods??) the blood was taken 4 weeks ago. He did look a tad concerned about my liver. The new tests will take at least two weeks!!

He said the abscess was huge. I told him he should have seen it a few days ago before I squeezed :crazy: :crazy: He has put me on a twoo week course of a strong antibiotic of 2 x 500mg of Clarithromycin and if it does not clear up it will be an op.

I have to see him in 3 weeks.
A question tho....does liver probs and diabetes go hand in hand? I am going to be a bit stressed waiting 3 weeks to hear the results.

Thanks

Mervyn

 

[anna29]

Hi mervyn.
Thanks for the update, sounds like your doc is passing you over to the diabetes nurse for all diabetes issues and carrying on treating you for all your other medical issues. Some practices do - do this, sounds like your's does!
Yes -fatty livers are indeed connected with raised cholestrol levels and diabetes..
Hope you dont worry yourself unduly, whilst you are waiting till the results come, try and relax think positive,nice things...
Am sure things will not be as bad as you may fear ...
Worry and stressing yourself will only send your blood sugar levels UP !!!
Am glad you are on a course of antibiotics to clear up the boil for you. [ antibiotics can raise the blood sugars too!]
So do keep eye on yourself , try doing some nice things with your family in the next few days, this will help you along. :thumbup:
How is your insulin regime suiting you now? I remember it has taken you some time to adapt and find the routine and levels to suit you.
It does take time, and never is a quick fix with diabetes/insulin regime ...
Getting easier with time to settle into a fixed suited to the individual regime/routine.
Anna.x

 

[Mervyn]

Hi Anna,
Yes I am trying not to worry....still I will get the results in two weeks and if the abscess does not retreat with this course of antibiotics then it has to be cut out.

My BG is now good most of the time first thing in the morning and before my evening meal...but even the before evening there is a gap of 6hrs since I last eat. The post prandial have improved but they are still between 12 and 15 so even though I am taking 46 units morning and 39 units at night, the morning dose does not seem sufficient.

I am going to reduce my evening one by 2 units for a while as my fasting has dropped to 5.2 and the antibiotic comes with a warning that it can cause a hypo. Normally I would be ecstatic at a 5.2 reading but whilst on the antibiotic it seems sensible to reduce a bit.

Thanks for your comments

Mervyn x

 

[hanadr]

Mervyn
It seems you are not getting the care you should be. Certainly get the "boil" attended to and download the list of monitoring factors you should be getting from the Diabetes UK website [there are about 15 points on it!] Show it to your doctor. Some medical practices have to be kicked in the rear to make them get their act together.
Hana

 

[Mervyn]

Hi Hana,
Thanks...my GP surgery used to be so very good. They have their own Diabetic clinic. But the PCT decided that anyone needing to go onto Insulin has to have this Diabetic service from a Community Hospital at least 10 miles away.

They do hold a clinic in a local building that is used also for baby clinics and childrens speech therapy. I have mind you, only had one face to face meeting with my allocated DNS since September 2011.

Since the PCT made that decision my surgery has all but abandoned my Diabetic needs!!

Thanks

Mervyn

 

[tesswarwick]

Hi Mervyn,
It sounds as if you are floundering a bit by yourself. You are entitled to see a specialist and I suggest that you insist that your doc or your nurse refers you to an endocrinologist. I'm sure that your 'extra' things going on are probably connected to your diabetes. I hgave T1 and I'm convinced that it's easier to manage than T2 ...
Stamp your foot if needs be.
Hugs to you,
Tess

 

[Mervyn]

Deleted...Posted twice!!

Deleted....Double Post.