How high is high, and how do the risks increase?

[sw11bloke]

Em

Having regular hypos' in the early hours definately means you are taking too much background insulin especially if your going to bed in the 12's or 14's.
Dropping to 1.6 is VERY dangerous. How much background Insulin do you take a day and at what times of the day or night? And if you dont mind giving me your body weight, I can perhaps do a calculation for you and see what your dose should be. PM me if you prefer.

"I have no idea what I'm doing. I take a whack of insulin and hope for the best. At my last app the doc said he was happy with my HbA1c (7.2). Just to keep doing what I was doing! Can't go the dafne course as I have 2 small children and finding someone to look after them that long is impossible"

You have 2 small children and you need to have an idea how to manage your diabetes without these dangerous hypos. Sorry if i sound a bit harsh. Its my caring side - I promise.

Perhaps google DAFNE (Dose adjusting for normal eating) and do some reseach into basal rate calculations. Also anything youd like to know.... just ask.

Anyway.... PM me and lets start off looking at your background insulin.

 

[Embabe25]

Hey I don't mind saying maybe others are similar and could use the advice too.

I am 5'6" and I weight 18 stone :-(

I am very insulin resistant and I know I've made it worse!

I take 40 units of lantus In the morning and 40 at night.

I take between 20 and 30 units of humilin S at each meal.

God writing it down makes me see how mad it is!

I'm constantly hungry! Going to see a doc about getting some appetite suppressants on Wednesday. Fingers crossed. I've always been a tubby girl but never as big as this!

I also have an under active thyroid which I take 200mcg of thyroxine per day for.

I tried metformin but they made me ill.

Thank you xx


Em x

 

[sw11bloke]

Em

Wow. Thats a huge amount of background insulin. According to DAFNE, your total daily background insulin should only be about 46 units in total. According to Dr Bernstein, your total dialy dose of BI should be 22 units. (But thats if you cut your carb intake to less than 20grams per meal)

To fine tune you basal Insulin (BI)
Have a healthy dinner without any fat (Do that at about 6pm)
3 hours after dinner test
BG should be between under 13. (and at a safe level to go to bed.)
Take your BI insulin (about 9pm)
Go to bed without snacking.
Wake up at 3am and test.
Your BG should remain within 1.6mmols from your bed time reading (lower or higher)
If its more than 1.6mmols higher, then take 10% more background the next day and repeat the test again.
If your BG drops more than 1.6, then reduce your insulin by 10% etc etc.

Concentrate on your nighttime dose first.Perhaps drop your evening BI from 40 to say 20 units and then start this process and gradually go up 10% a day till your BG stays within 1.6mmols of your bed time reading. Its imprtant not to snack after dinner and pre bed when carrying out this test.

I used to take a high dose too but after doing DAFNE, my BI dropped by more than half.

Hope that helps you a bit.

 

[the_anticarb]

I believe it is consistent highs that cause damage, the odd spike is unlikely to cause damage so long as readings have returned to normal by the next meal.
I also think that a few days high are unlikely to cause a lot of damage, eg at Christmas or something, it's consistent highs over a long period of time which really do you in.
Agree that hypos can be bad if they cause a rebound high due to over treatment (very easy when you're having a bad one and carbs are calling) and liver dump. But again, the odd one is unlikely to be a massive problem, only if you were having them regularly.
My ophthalmologist says 7 is the magic number in terms of hba1c to avoid eye damage. I think above 7.5 it really starts to cause damage but they say aim for below 7 to have a little leeway.
Personally so long as my hba1c is below 7 and I'm not having too many hypos I think I am doing ok.
Being pregnant I currently test post-meal but this is for the baby's health rather than mine and after I've delivered I will prob stop doing this.

 

[Thommothebear]

The targets I was given were <7 before a meal, <10 +2hours after. I consider these too high and I tend to aim for <6 before eating and < 7.5 2 hours after. I usually manage stay within those targets, mostly through an aggressive exercise regime and lowish carbs.

 

[barrym]

The targets I was given were <7 before a meal, <10 +2hours after. I consider these too high and I tend to aim for <6 before eating and < 7.5 2 hours after. I usually manage stay within those targets, mostly through an aggressive exercise regime and lowish carbs.

So could you quantify that a bit for me? How lowish is your daily carb intake? What is the exercise regime?

Until recently I was doing 2-3 hours a day of quite strenuous exercise, either cycling or an a cross trainer, plus addition walking with the dog. I found this quite demoralising knowing that I had to get through this each day. It certainly worked in so much as I could eat a meal, of reasonable carbs and have sub 5 readings by the next meal. This was fine during the morning or afternoon, but I never felt much like it after my evening meal, and I wasn't going to get up in the night to get a low morning reading and so my fasting and bedtime readings were always well over the limits, usually in the 8s often higher.

My consultant has suggested I go onto a low Lantus (still playing with dose, but 6-10) which has certainly levelled out things, but still not perfect. I took Lantus 2 years ago when first diagnosed, but was getting lots of hypos and the dose was reduced to the point that it wasn't doing anything. So for the past 18 months I've taken Gliclazide in varying amounts and done the exercise, and kept carbs to varying levels of 100-130 per day, and lately a bit more relaxed at 150-160 per day. Trying to get a more normal existence eating and exercise.

Sorry to blabber on, but I'd be interested to know a bit more about how you make it work.

TIA