Not injecting due to fear of hypos

[clarusblue]

Just signed up, but I've browsed for a while.

I'm 21 and was diagnosed type 1 in August 2010, so it's been about a year and a half. I very rarely will inject fast-acting insulin with meals, although I do inject long-acting insulin every night. I know it's really stupid to not inject properly but on the occasions that I do inject I usually have a hypo around an hour afterwards. It isn't as if I inject loads, if I had a sandwich, crisps and fruit for lunch I would inject 3 units (on the low side because I know I'm prone to hypos), yet without fail have to have some Lucozade or something a few hours later. My morning blood sugars are good, always in the 5s so I'm confident my night-time insulin is the correct dose.

I have heard of the honeymoon period etc but I don't think this is causing the problems as on the rare occasions where I'll eat a really carby meal like a pizza or a pasta bake my blood sugars are 15ish easily.

My HbA1c in December was 5.8 which I understand is good, but I have no idea why because my blood sugars are consistently too high. I've tested 5 times today and it has been over 10 four out of the five times.

I've got a diabetic nurse appointment tomorrow so I'm just going to admit things and ask to be treated as if I've only just been diagnosed, as I feel like I've slipped through the net a bit (I was diagnosed at my home address hospital but am GP registered at a term-time address).

Does anyone have any ideas as to why I seem to get hypos whenever I inject even a small amount? Could it be insulin sensitivity which I've read a bit about?

Thanks to anyone who can reply, and thanks for reading.

 

[Riri]

Hia - I'm sure others will come along soon to comment as well. It sounds to me as if your background insulin is to much or your carb ratio to insulin ratio is to high. Do you carb count? For instance, my breakfast, lunch and supper carb ratios are all different. For breakfast I take 1 unit of insulin per 8.5 grams of carbs, lunch it's 1 unit for 9.5g and then supper it goes up to 1 unit for every 13g of carbs. These ratios have been arrived at through starting at 1 unit for every 10g of carbs and then tweaking up and down after regular testing to see what happens to my blood sugars after each meal. This obviously only works if you are carb counting all your meals.

I think you will be asked to keep a food diary and insulin taken for a period of time and then you can see where you are and whether the hypos happen on specific days/times, after certain foods or if they appear more random. All the best and you're doing the right thing going to see a specials diabetic nurse.

 

[robert72]

Hi clarusblue

That's a good HbA1c and great that you seem to have your basal set right.

So it seems you're having trouble with either carb counting or the timing of injections in relation to eating.

Do you keep records of your BGs, insulin and foods? It really helps to try and figure out what's going on (have to admit I was really bad at record keeping until I got an app for it).

Best thing you can do, as you say, is come clean with your nurse and see if you can get on a carb counting course. If not then have a go at the online version here: http://www.bdec-e-learning.com

Any specific questions you are always welcome to ask here as you've probably already seen.

 

[Elc1112]

I'd take a look at your background insulin. I don't take much insulin during the day, but I know that if I take x units then my sugars will (generally speaking) be stable and I can avoid hypos etc.

Try reducing your background insulin and using your short acting insulin to control your sugars throughout the day.

Good luck with it! Xx

 

[clarusblue]

thank you all for your replies!

I'm looking forward to the appointment tomorrow as I feel I just need to take a grip of things and hopefully I will come out feeling motivated to sort things out! I will mention about my basal insulin level to see if the nurse agrees it might be that.

Hopefully I can post back in this thread tomorrow with some positive news!

 

[thetallerpaul]

Good luck tomorrow. Hope it all starts to make more sense. Nothing worse than feeling like you are not able to influence your BG's for me!

TTP

 

[clarusblue]

Had the appointment first thing and the nurse wasn't even a diabetic nurse! Sent me for the usual bloods and said to make an appointment for a certain GP for a week's time because apparently he's more of a diabetes expert. I'm a bit concerned as when I mentioned my issues to him last September he told me he didn't know about it and to see the nurse so I'm feeling a little fobbed off.

But the nurse said he will probably refer me to the hospital endocrinologist and community diabetic nurses who are the experts.vin the meantime I have to keep very strict records of everything I eat, blood sugars and injections. She also advised me to inject and deal with hypos as they come. So at least something will happen.

It's just annoying, same story as ever today, lovely blood sugar on waking, breakfast, injection, hypo, lunch, injection, hypo, snack, injection, hypo. Dinner and I've run out of lucozade and can't be bothered with another hypo so don't inject.

Half miserable and half optimistic now!

 

[robert72]

Hi clarusblue

Great that you will be referred to see endo.

In the meantime, if you don't inject before meals do you go high?

 

[clarusblue]

Hi clarusblue

Great that you will be referred to see endo.

In the meantime, if you don't inject before meals do you go high?

Yep, will be above 11 each time and depending what I have will be up to 15.

 

[robert72]

If you're happy with basal as you say, then you need to recalculate your fast acting ratio. And because your on such small amounts, it might also be worth seeing if you can get a half-unit pen.

I was also getting too many lows yesterday which I'm blaming on the suddenly hotter weather.

 

[clarusblue]

If you're happy with basal as you say, then you need to recalculate your fast acting ratio. And because your on such small amounts, it might also be worth seeing if you can get a half-unit pen.

I was also getting too many lows yesterday which I'm blaming on the suddenly hotter weather.

i hadn't thought of temperature actually! The area I was working in yesterday was boiling hot inside, never mind what it was like outside! I'm shutting myself away to do an essay (allegedly...) so will be cooler, it'll be interesting to see what hypos I have.

As for the half-unit pen, I will definitely ask the GP when I see him.

I think I'm going to set alarms through tonight to check levels as I always have headaches on waking, I'm thinking it's best to just check if I'm having night-time hypos just in case.

 

[iHs]

Hi

Yes, Robert is correct........ for many people using insulin, hot weather does tend to make bg levels drop, usually quickly instead of slowly.

Are you counting the carbohydrate that you are about to eat before you calculate a bolus dose of insulin? Do you know how much carb was in your lunchtime meal that you mentioned in this thread? For you to just inject 3u of bolus for that meal and then find that you are going hypo within 2hrs leaves me to think that maybe you are using way too much basal. Can you tell us how much basal you are injecting per day and also on average, how much bolus per day as well?

 

[robert72]

It would be interesting to know how many units of basal you take. The rule of thumb is that it would be about 50% of your total daily insulin - at least that's a good starting point before making adjustments. It's difficult to get the fast acting right without setting the basal first.

 

[clarusblue]

I currently inject 16 units basal at bedtime, which is way more than half (I would say on average I inject 10-12 units fast acting per day). That basal is something that needed to be increased, as I began on 10 when I was first diagnosed and was needing more because of morning blood sugars. Although it is seeming quite a likely culprit for my difficulties! I'm wondering what you guys think, shall I stick to what I always have done to present the numbers to the doctor, or try going down a few units to see what happens?

In terms of carb counting, yes, I have read that 1 unit = 10g. However I will always knock a couple of units off to be on the safe side! My lunch yesterday was 50g carb and I injected 3 units. The concept is something I understand and would love to stick to rigidly but I'm aware that I need to get the numbers right.

Thankyou for your thoughts on this!

 

[robert72]

It does seem high compared to total. See what's happening with the night testing.

If you feel comfortable about adjusting your basal then you could try reducing it by 2u and see how you get on. Leave it for 3 days before making any further changes as it takes a little while to stabilise.

 

[clarusblue]

I think I'll have tonight injecting normal amounts but measuring every few hours and see, and take it from there.

 

[iHs]

Hi

It is thought that most people will need approx 0.7u of insulin per kg of body weight ( some will need less and some will need more though), so whatever your body weight is, multiply by 0.7 to work out how much insulin units (approx) you will need and then divide that amount by 2 - 50% basal and then the other 50% divided up over 3 injections of bolus. That will get you somewhere near being correct as a starting guide..... but working out exact insulin to carb ratios from testing bg levels every 2-3 hrs is better (look at NICE bg targets as the guide). Hope this helps you out a bit.

Also do you inject your basal insulin before bed and is your bg level always the same before bed or does it fluctuate? If it fluctuates, then you need to try and work out a ratio for eve meal that gives you the same bg level when going to bed. It's then easier to adjust the basal so that your overnight and fasting bg level starts to be ok. It will be from your fasting bg that you can then will be able to use a correct insulin to carb ratio and also a correction factor (100 rule).

 

[onlytwintip]

Hi,

If I was to bet I would say you are still on your honeymoon phase. I had a long honeymoon phase (over a year) in which I hardly had to inject and still had descent hbac1. Your sugar level spyking after a pizza doesn't necessarily mean your honeymoon is over. It could mean you over-did the carbs and your "still working a bit" pancreas is struggling with the huge demand of insulin. Just thoughts...

All the best.

Harry

 

[clarusblue]

so the latest is that despite having had my blood tests a week ago, with HbA1c printed on the request form it hasn't been done :roll:

no doctors in the surgery all week. so that's my waiting to try and get an appointment next wednesday!

i've reduced my basal and found things a little better. had a horrible hypo that woke me at 6am though which is odd, as i don't get like that normally with the higher basal!

 

[robert72]

Are you able to call your DSN at your home time clinic for advice? Also, if you're away for a few years it might be worth asking them to refer you to a term-time clinic for the duration. Your local GP doesn't sound too competent and you need support for your diabetes.

It's interesting that reducing your basal has helped a little, but the 6am hypo is not so good. Is it a regular thing or a one-off?