Struggling

[Pearsall85]

Hey all I'm jus about at the end of my wits I just can't seem to get decent control from evening to morning. Throughout the day I can carb count and adjust my bolus quite well but when it comes to my basal I'm at the stage where I'm not even sure what its meant typo be doing! Here are some readings this week.

Morning. Evening
Monday. 11.4. 15.9
Tuesday. 3.3. 14.7
Wednesday. 12.7. 14.2
Thursday. 3.4. 10.6
Friday. 13.5

I go to the gym on a Monday, Wednesday and Friday which could explain the lows the day after? But last night I had my dinner at 5.30 and 2 hours later I was 4.5 so I had a little snack to stop me going too low. I was 10.5 at bed then I woke at 6am and it was 14.7 then when I got up at 9am it was 13.5. I was only diagnosed in August so I don know enough myself to work out how to fix it. I'm currently on 14 units of lantus which I take before bed. Any help would be great!

Stu.

 

[the_exile]

Hi Stu,

First of all, those readings, although high, are not as bad as mine were 6 months after diagnosis so you're doing not too badly.

Do you have a ratio of carbs to insulin? For example for every 10 grams of carbs you take 1 unit of insulin? Would probably have to have more results over the entire day as a dose you took at lunchtime might affect late ron in the day etc.

What I was advised when I was going through something similar was to have a carb free day, ie getting your morning glucose levels down to normal, having meals with no carbs in them (salads, some soups, steak and mushroom with onions was my weapon of choice for evening meal!!), that way you see only what your background (lantus) insulin is doing and whether that needs adjusted, if you're still experiencing highs, then the background would need increasing, 2 units increase at a time is the general advice. Alternatively, if you find your background is ok and keeping you level throughout the day then it'll be your bolus ratio you take with your meals that needs increasing. For example instead of 1 unit for ever 10 grams, you would increase it to 1.5 units for every 10 grams, and keep going up in half units until you hit the sweet spot. It's common for people to have different ratios for different times of the day, i personally used to bolus 1.5 for every 10 grams in the morning and at lunchtime, and 1 unit for every 10 grams at evening meal and supper.

It's important to not make too many changes at once, as one small change in the morning may also have a knock on effect during the rest of the day.

Anyway, hope that wasn't overkill, there's so much info to get your head around when you're newly diagnosed, if you haven't been on a DAFNE (stands for 'Dose adjustment for normal eating') ask your specialist for a referal as it does straighten out a lot of the myths and helps you get on your feet with regards to not only carb counting and dosing the correct amounts but correct insulin ratios etc you should be on.

 

[SamJB]

Hi Stu,
Defintely looks like there's a pattern there with the exercise and waking up low. I personally drop my lantus on days of exercising. The affect of exercise on glucose levels lasts 24-48 hours, which is why you are not dropping on Tuesday and Thursday nights.

So you could try 12 units on Monday, 14 on Tuesday, 12 Wednesday, 14 Thursay, 12 Friday, 14 Sat & Sun.

The way to calculate Lantus is that if you change by 1.6 mmol/l overnight then change your Lantus by 10% (from Gary Scheiner's book).

Also you meter has about 10-15% error margin, so 14.7 and 13.5 are broadly consistent with each other.

Some people are a bit scared of being dynamic with their Lantus, which is totally fair enough. I know I need to be though, i change it on a daily basis. If I'm going hypo after exercise I know my body needs less insulin. I'd reccommend Gary Scheiner's Think Like a Pancreas book. It details adjusting Lantus levels in there.

 

[iHs]

Hi

Another way of adjusting insulin to carb ratios is to adjust the carb and not the insulin. There are many people who will find that 1u to 10g carb is not enough but altering the bolus to 1.5u to 10g is too much. If this ends up being the case for you, adjust the carb and use 1u to 9, 8,7 carb for example if bg levels are too high which will equal more insulin or adjust the ratio the other way and use 1u to 11,12,13g carb if bg levels are too low which will then give you less insulin. As long as you know your 'times tables' ok adjusting the ratio using carb might give you fairly ok control.

Frequent bg testing will play a real big part in how you get the control you want......

 

[Pearsall85]

Thank you for the replies, my ratio is about 1u to 15carbs for my novarapid which works well, I have to take a couple of units off on the days I exercise. I will try 12units tonight and see what I am in the morning, I've also been meaning to set an alarm in the night to see what my levels are doing. My control throughout the day is fairly good but If I start high I tend to stay high.

Stu.