Confused what to do when this happens?

[botleydogman]

Hi there

thought someone might have some advice. I have been diagnosed type 2 since dec 29 and I am on novarapid and lantus. Getting on ok with it and seem to have some sort of control except somedays I have breakfast (porridge or oats + browntoast or rye toast)folowed by jab. By lunch time when I am due to have lunch I am on the verge of going hypo so once Ieat I take another jab which seems to bring me down to hypo levels by four/five oclock - should I be snacking more or reducing insulin or.....????? Well any advice would be appreciated.

regards


BDG

 

[hanadr]

I'm not on insulin, but I would guess a lower intake of both carbs and insulin might be your answer. Is this "straight on to insulin" approach, an attempt to put the T2 into remission? Were you offered, diet only or oral medication control?

 

[nativenewyorker]

Hi, I also take Lantus and Apridra with at least one meal a day. If I run a bit low I reduce the amount of fast acting insulin with meals. If it is still a problem, I would reduce the Lantus by 2 units every 3 days until they are more stable.

Hope you are soon sorted!

Sally

 

[totsy]

hya,
ive been on basal bolus for a few mnths now and its a matter of carb counting and finding your ratio, if i was you i would cut back on carbs and lower your insulin by a small amount of 1 or 2 units and test and see what happens, then after a few days lower again if needs be, im am not a medic but this is what i myself have done until i got the right dose

 

[fergus]

If you are eating enough to not be hungry between meals then you're taking too much insulin. You shouldn't have to snack purely to cover your insulin.
Reduce your Novorapid if you're going low within a couple of hours of eating. If you blood sugar is dropping 4 or 5 hours after eating, then your Lantus dose is too high.
Reduce them gradually until your blood sugars are within a stable range at all times, if you can ( ideally between the low 4's and 7).
Your diet might need some thought if you still find big changes in blood sugar.

All the best

 

[anne 37]

hi im type 1 diabetic and take lantus and novorapid ,its strange for type 2 to be on insulin as they usually treat with tablets or diet controlled ,l take novorapid in morning just before breakfast and again at lunchtime .my employers are really good l get for my lunch about noon .can you not ask your employers to let you away on time for lunch,the dose l take at lunchtime keeps me fine til my evening meal and then l take lantus and novorapid again ,

 

[tyroneshoelaces]

I'm interested in this stuff because I'm a notional type 2 and started off on diet and oral medication, but I'm now on one shot of long-acting insulin plus one shot of the faster reacting stuff (name escapes me) with my evening meal. I'm also still on glucophage twice a day. The thing for me is that I puzzle my doctor, she says, because I don't fit any of the preconceived notions of someone at risk from diabetes: no family history; I'm not overweight; I don't smoke; I get plenty of exercise; as a vegetarian I have got used to eating pretty healthy meals. The only thing that fits is that I'm over 40. My doctor always says 'beware the slim type 2' as a joke and describes me as a type 1.5 (also as a joke). Anyway, I can assure you that some people diagnosed as type 2 will find they need to be on insulin - I took the diet and medication thing very seriously, and it helped at first, but my numbers were on the rise after six months or so (I was diagnosed in May 2007). Having diabetes and dealing with it is a learning curve for everyone, and everyone finds their own best way. With insulin jabs it can be a matter of perpetual trial and error, and sometimes there seems no sense to it - I've overindulged in carbs sometimes, but found it makes no difference, only for my numbers to get strangely high for no apparent reason. In the main, of course, the numbers reflect the carbs and the measures taken to keep them within 'normal' bounds. One thing I've got used to doing is letting my specialist know how I've been feeling and wondering what she can suggest: I'm lucky to have someone very good, but I also feel that we can't all be left on our own - no matter how much our heads are screwed on or how much we swot up on it - to do our own treatment schedules. Sorry to witter on, but good luck.

 

[jetsue]

Hi my son is a diabetic (type 1) I know a bit about diabetes type 2 and some requiring insulin and, on reading your post would suggest you need to contact your GP or, Diabetes specialist to advise.

It sounds as if you need more information on Carb counting and insulin adjustment so speaking to your healthcare professional is really the best option.

Getting the balance right is very important and, I'm not going to say it's easy so many other factors to take into account 'confused' is a word I often link with Diabetes! :?

 

[Dennis]

Hi tyroneshoelaces (clever name - took me a while to work it out!)

It is quite possible that you never were type-2 at all. When presented with new onset diabetes doctors often make a judgment on which type based entirely on the patient's age, which has led to many misdiagnoses of late-onset type-1s (LADA). It is perfectly possible that you were always type-1 but with a pancreas that hadn't quite given up the ghost so was able to continue producing insulin for 6 months, but not enough insulin for the oral meds to prevent your BS from steadily climbing. Gradually as the honeymoon period diminishes, the pancreas is able to produce less and less so insulin injections becomes inevitable. The only way to be absolutely sure of your type would have been a C-peptide test.

 

[Stuboy]

i agree with fergus on the reducing insulin front!

 

[chocoholic]

This sounds very familiar. My strapline says it all.Like you I was not overweight,was only 45 and with no family history of diabetes. I should ask for a referral to a diabetes specialist.

 

[tyroneshoelaces]

As I said, I have a very good specialist. I think you're right - I may be late-onset type 1. The most important thing, to my mind, is that I'm controlling it.

 

[type2andnew]

Hi -really interesting to see your messages. I was diagnosed as type 2 last year - I am over 50, slim (have lost loads more weight) and no family history. Doc can't figure it out. Also have very healthy diet and did not eat much sugar. On 2 850gm Metformin but still B.S goes up way too high, even several hours after eating - sometimes as high as 12-14. (After a Thai meal once it went up to 21 - I had to run round the block and on the spot which brought it down a bit!) My last HbA1C was 7.8 - but how relevant is that if daily ups and downs are so drastic?

I'm afraid i may be needing more medication or an additonal tab or even heading towards taking insulin, which scares me no end. I too have heard about type 2 people becoming type 1 -is that me?? It's already complicated enough with trying to eat the right things. Funny thing is, I already seem to go low and need to eat every 3 hours so I don't get feint. Also feel sick a lot especially in mornings. I take houmous and oatcakes to work and stink the office out!!

I think I need to see a specialist as so far it's just my GP - the diabetic nurse didn't seem to have much idea about diet, but this forum has helped a lot and I am doing the low carbs.

Lots of questions and wonderings here? Has anyone got any thoughts? Many thanks

 

[HLW]

Hba1c is just an average, so as you say it doesn't tell you that much. If you notice your blood sugar is going high after eating certain things, don't eat those things so much.

Feeling sick could be the metformin maybe? it can cause stomach problems, it did with me at first, so I assume it can make you feel sick? I feel sick if I eat in the mornings, but I don't think that is the metformin, I think my body still thinks it should be asleep.

Eating more small meals can be good to keep blood sugar levels stable, so don't worry about eating every 3 hours. Though you shouldn't really be having low blood sugar like that, maybe it's not really that low, it just feels like it because it's so high the other times?

That's not the max dose of metformin, plus there are other medications which aren't insulin that can be used, so even if that dose of metformin isn't enough there are things that can be done before you need insulin.

Type 2 can't develop into type 1, but it can be misdiagnosed as type 1, and it can get worse so you can start to need insulin.

You could ask to see a specialist, yes that might be a good idea.

 

[botleydogman]

Thanks for all the posts and tips - found this place is really heplful and appreciate your time.i'm seeing the dietician tomorrow so that may help!!! I was put on metaforim first off (when diagnosed at the walk in centre on the saturday) Went to the GP on monday following (2 days later) and they said metaformin was n't working so up to the hospital for insulin. The consultant said I would be on it for life ( so assumed Type 1) but transpire I'm t2. I started on 10 units of both went up to 14 and now down to 8 across the board altough have tried dropping to 6 on occassion. Last time I went to the GPhe said that maybe i could come off it at some time if I get control and loose weight. trying to control carbs but having this crisp and peperami snack thing (normally about 4/5 o'clock!!) I seem to show signs of hypo at around 4.4 or lower - but if i get those signs at that level I start to correct. My job is outside and quite physical so its all just trial and error really. Got a mate who has been diabetic for 14 years and he says he still does 't get it some days - it certainly has been interesting so far though!! thanks again any way

BDM

 

[type2andnew]

Thanks HLW
I really appreciate support - it's all so confusing. Good advice.This site is so encouraging and good to be able to have a moan too with people who understand - i find it hard explaining things to my friends.To you who are confused, I wish you good luck and hope things settle a bit

 

[phoenix]

Type one is far more prevelent at older ages then most doctors realise. It maybe that 10% of people diagnosed as type 2 actually have LADA or another form of diabetes. Thats a lot of people.
The trouble is the onset is not necessarily sudden, it may be spasmodic , followed by partial regeneration and be over a period of time.The graph below is from a model of LADA progression suggested by Pozzilli and Di Mario
(Autoimmune Diabetes Not Requiring Insulin at Diagnosis (Latent Autoimmune Diabetes of the Adult)
Definition, characterization, and potential prevention
Paolo Pozzilli, MD1 and Umberto Di Mario, Diabetes Care 24:1460-1467, 2001)



Personally I lost huge amounts of weight three years before developing DKA, and official diagnosis I had self treated with diet and exercise during the intervening period. When 'officially' diagnosed my Hb A1c was still only in the low 7s, yet my fasting glucose was more than 20mmol. I suspect that at the first weight loss my insulin levels might have been at the position marked with a red mark, 3 years later, they were low enough to make injected insulin inevitable.

 

[tyroneshoelaces]

type2andnew: don't be scared of insulin injections; I've had a lifelong phobia of needles, but the pen-like things they give you these days do not hurt in the slightest. It's really easy to do. And it's certainly better than feeling like ****.

 

[tyroneshoelaces]

I think the thing everyone has to remember is that we're diabetic - that means our body doesn't naturally control our blood sugar levels well. Which means that we're going to go below and above 'normal' BS levels at times, sometimes for obvious reasons, sometimes not. Obviously, the ideal way to be is within 'normal' parameters at all times, but that's unlikely isn't it? We're going to get some high and low readings, and part of our regime involves what we do to counteract those situations. As for the hba1c: surely it's highly important that our average BS level is within the right parameters - to me it's a way of showing whether our everyday attempts to control our condition are working, and we wouldn't know that without this test.

 

[Trinkwasser]

IMO there are fewer variants on Type 1 but there are a whole load of different diseases which fit under the Type 2 umbrella. Then there are the MODYs

http://projects.exeter.ac.uk/diabetesgenes/index.htm

which may be diagnosed as either type initially

Our family history is of insulin resistance in otherwise slim and healthy individuals, and the actual diabetics also seem to have a problem with the control system rather than insulin production as such. I know someone elsewhere who is MODY and while her initial presentation is similar (slim, fit, diabetic) the details are substantially different (no IR and problems with insulin production)

Sorting out these atypical cases is often above the competence of a GP and sometimes even an Endo considering some of the horror stories from LADAs misdiagnosed as Type 2