Any advice with Insulatard

[freddddy]

Hi, I am T1 since 09/22/2011, on 3x8 units Actrapid (8 a.m., 1 p.m., 8 p.m.) and 8 units Insulatard (11 p.m.) I have a big problem for the last month with insulatard, always in the morning BG is in 6's and 7's. The first two months was good in the morning BG in 5's. I try with 9 units and nothing ( result is 7,9 in the morning), tray with 7 units( first morning in 5's but the next mornings again 7's), try with 6 units (the same like 7 units). The food is same every night. Before I go to bet in 0:30 a.m. is into 5's and 6's; I woke up in 2 a.m to see my BG and it is again OK - 5-6). The problem is in the morning. My endo was told me to eat something small with Insulatard ( one slice of bread) and for the first two months always eat that slice of bread. Could be this the problem? Any advice?
Last week check my Hab1c - 6,5% , is it good?



Sorry for my English, Thank you

 

[Snodger]

Your HbA1c and readings sound very good indeed. What sort of targets have you been told to aim for? Or are you trying to get non-diabetic blood sugars? Don't forget that for those of us on insulin, it's important to avoid very low blood sugars as well as very high. That balance is incredibly hard to do. Just to put it in context - about 3/4 of people on insulin have an HbA1c above 7.5. So if yours in 6.5 you are doing incredibly well.

 

[freddddy]

Yes, my target is to get non-diabetic BS and HbA1c. Thanks for your reply

 

[Snodger]

I wish you all the best with it, but please don't forget about the low blood sugar side as well. Hypos are dangerous too. And you don't want to run so low (or have so many mild hypos) that you lose your hypo warning symptoms.
Also, it's a long-haul disease, and it's a difficult disease. I set myself similar targets when I was newly diagnosed (my first HbA1c after diagnosis was 4.8%!), and I wish now I could go back and tell my younger self to be a bit kinder and a bit less upset when things went wrong - it's not always going to be possible to get it 'right', and it's also important to congratulate yourself for the hard work you've already done.
I don't mean to be discouraging, quite the opposite, I want to tell you to be proud and happy with what you've achieved and not worry too much.

 

[freddddy]

Yes, I'm aware of hypos. Two months ago I wake up in 2 a.m. one night and in 1 a.m. another night with hypo, and because of that, I think i have hypos all these nights (this month) and that's way in the morning my BG is high. I test it last two nights and everything was OK, but in the morning readings was bad for me.

 

[Snodger]

That suggests to me that your insulatard dose may be too high. If you are having any night hypos at all you must take it very seriously and reduce your dose. Having lots of hypos like that may well cause you to lose your hypo symptoms in the longer term.
As you yourself suggest, this could well be why your readings are a little higher in the morning too. You may find that avoiding the night hypos with a lower insulatard dose might solve both problems.
What time do you inject your insulatard, and what time do you inject your actrapid for your evening meal? Could they be working together to peak in the middle of the night perhaps?

 

[freddddy]

I write about them in my first post:
8:00 a.m. Actrapid 8u
01:00 p.m. Actrapid 8u
8:00 p.m. Actrapid 8u
11:00 p.m. Insulatard 8u
I already try with small dose 6u and 7u and the result is the same: for the first morning after reducing dose, BG was in 5's but the next morning again in 7's. BTW I use the same vial Insulatard for 32 days now, could it be the problem? In general my problems with morning BG started with that vial Insulatard, but Exp. date is 2013 so...

 

[noblehead]

I write about them in my first post:
8:00 a.m. Actrapid 8u
01:00 p.m. Actrapid 8u
8:00 p.m. Actrapid 8u
11:00 p.m. Insulatard 8u
I already try with small dose 6u and 7u and the result is the same: for the first morning after reducing dose, BG was in 5's but the next morning again in 7's. BTW I use the same vial Insulatard for 32 days now, could it be the problem? In general my problems with morning BG started with that vial Insulatard, but Exp. date is 2013 so...

Try changing the vial and carry out some night-time testing over the next few nights to see what's happening, just don't beat yourself about fluctuations of 1-2mmol as you'll find most people never wake up with the same fasting readings for consecutive days.

Nigel

 

[sugar2]

I write about them in my first post:
8:00 a.m. Actrapid 8u
01:00 p.m. Actrapid 8u
8:00 p.m. Actrapid 8u
11:00 p.m. Insulatard 8u
I already try with small dose 6u and 7u and the result is the same: for the first morning after reducing dose, BG was in 5's but the next morning again in 7's. BTW I use the same vial Insulatard for 32 days now, could it be the problem? In general my problems with morning BG started with that vial Insulatard, but Exp. date is 2013 so...

Try changing the vial and carry out some night-time testing over the next few nights to see what's happening, just don't beat yourself about fluctuations of 1-2mmol as you'll find most people never wake up with the same fasting readings for consecutive days.

Nigel

Also, the meter accuracy isn't that great...so you BG may be exactly the same, but becasue ofthe 10% variation in the monitor reading, you may not be aware of it.

 

[swordy]

With you being newly diagnosed with T1 I am really surprised that you have not been placed on a DAFNE Course which is a far better way of controlling your diabetes, I think you are doing really well getting the results you are getting and you need to avoid the hypo's during the night. Are you eating enough with your 8pm insulin.
Having been T1 diabetic for 40 years I would be over the moon if I could have got the results you have been getting. My results have never been better since I attended the DAFNE Course and my consultant is delighted with my kind of steady 7's.
Please ask about the course the next time you attend the clinic.

 

[freddddy]

Yes I eat enough, 60-70 g carbs, depends on the food. One night before 4 weeks I try with only 5 units Insulatard and in the morning BG was 5,6. If these morning results (6's and 7's and very rear 8's) was 1 or 2 or 3 days OK, but this lasts 3 weeks, and that is why I'm worried.
I'm not from UK, and in my country we don't have DAFNE course. In fact I haven't seen my endo since I get out from the hospital, that's about 3 months. And my GP is not very good with diabetes so everything I know is from internet and forums like this one.
Thank you all for your replies and sorry for my English again.