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Anyone else think that a post breakfast reading of up to 16 is nothing to worry about?

B

Binky21

Active Member
Messages
32
Type of diabetes
Treatment type
Insulin
I dont know what is going on with diabetes management these days - have had it for 20yrs, but it seems like everything is so wierd at the moment. I am very obese and have a pronounced dawn phenomenon as well. Been fighting with GP to get more insulin. Sometimes I eat bad but it really is a case of massive insulin resistance. Anyway I need more insulin, also take met and trulicity) and find short acting works better for me than long acting which I take at 40U/day and I dont get lows as I have highs in the morning, very slow settling and lows in the afternoon. GP said you cant have any more insulin as I needed to up my dosage by abut 40U a day from 120 a day. She talked to the diabetes nurse and decided instead to make sure I lowered my insulin by 20% -c ninety 5U a day and not to be concerned if my after meal readings were 11 or 12 or if my morning after breakfast is 15 or 16? My HBA1C is forty nine and I work hard to keep my readings below ten, ideally below nine.

If I was stricter with food, I could probably get down to around 7.8 - 8.2 in 2 hours and had been feeling guilty I'd been hitting nines and tens so regularly.

Any thoughts? I think I'd have neuropathy and all sorts of issues if I do what they say.
 
I can't exactly say what your GP's reasoning is, but if I can hazard a guess: Insulin resistance is a result of your insensitivity to insulin. You become insensitive because there's so much in your system, it doesn't work/register anymore... So at a guess, they want to reduce insulin so your sensitivity improves? But if that leaves you with massively high blood sugars... They can't expect you to wade through double digits with no help whatsoever, to actually improve anything. If that makes any sense at all.

Anyway, yes... Going low carb would in all likelihood help your situation. It'd lower your blood sugars, reduce your insulin needs, but as long as you're injecting, do be careful, because a low carb diet can (and likely will) make you go hypo. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some with the basics.

Good luck,
Jo
 
You say you are very obese , is that something new or have you always been that way ? if not surely that will be having an impact on your insulin requirements .
 
 
Not an expert on Diabetes or have any real Medical knowledge but have been a Diabetic Type 1 for 50 years now.
Most of my working life I've not had a good diet but now semi retired I have out of boredom been monitoring my Glucose levels more closely and recording everything on an Excel sheet. For some years's now I've been using NovoRapid (Short Acting) and Abasaglar (Long Acting) insulin pens. My weight is a little over the top being 90kg at 1.73m tall and 62 years old now.

I have noticed taking the NovoRapid takes approximately 2 hours to fully kick into action but more recently it seems to be taking longer and longer to the point of it not working at all sometimes. The Abasaglar works all the time and I'm getting to believe my Glucose is being controlled more with that than the NovoRapid. We've tried using a different short acting insulin called Fiasp but that seems to have the same affect. Also there seems to be all sorts of Supply issues with Fiasp, but that's a different issue.

I'm not sure if the issues I'm having are Insulin Resistance or Injection sites. I'm thinking it's more to do with injection sites as it does seem to work well in some areas and not in others. Could this be the problem you are having?
 
That's interesting. Maybe age has sme effect - I am 63. But yes I am finding the same thing. It just seems I pump in more Lantus and r Humalog and there is no tangible effect. The Dr originally said she thought I needed to lower Humalog and increase Lantus. So I dropped the Humalog by 10% and pushed the Lantus up by 40Us and there was no effect except some lows mid afternoon. The reduced humalog just resulted in higher BG numbers after meals as I was expecting. Lantus has never seemed to lower anything as far as I can tell.

What do you mean about injection sites? I have never heard anything about that. Because it doesn't hurt I tend to choose fatty places to inject such as stomach and thighs - is this not a good idea? I do sometimes have problems with insulin pooling on the top of the fat
 
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Binky21 said:
What do you mean about injection sites? I have never heard anything about that. Because it doesn't hurt I tend to choose fatty places to inject such as stomach and thighs - is this not a good idea?
Click to expand...
I was advised by hospital staff to rotate my injection sites. I use thighs for long term and belly for short term, but try not to go in the exact same place each time. Evidently it can cause scarring and means the insulin will not be absorbed properly. Maybe see if you can get an appointment with a diabetic nurse so she can explain it to you.
 
I will start with the huge caveat that I am not a health care professional and my views are best on my experience as learnings as someone with Type 1.
There are a couple of things that are unexpected if you are suggesting you need more insulin
- A HBA1C of 49 suggests that your diabetes management is pretty good and would suggest your total injected insulin for your lifestyle (food, exercise, stress, etc.) is not far off
- Increasing your basal insulin by a third sounds like a large increase.

Apologies for asking more questions
- do you have a Libre (or other CGM) to enable you to prove the DP?
- how have you worked out that you need 40U more basal a day? Have you done a basal test recently to check that your BG remains (reasonably) flat in the absence of food and exercise? This would show whether you need to increase (or decrease) your basal as the purpose of the long acting insulin is to maintain a steady BG from the glucose which is constantly dripped from your liver.
- have you tried using a completely different area for your injecting (e.g. of you inject in your abdomen, could you inject your basal in your bottom or thighs?)?
 
Interesting. No I did a meter two week trial but found that with 1 exception my predicted results and dosing was spot on so didnt see the point in it but this was when I had only 20U Lantus daily Re: DP, it is consistent. I do before bed and upon waking. Before bed fairly consistent in the mid high 7s. Waking usually nine.5 - 10's. If its in the nines before bed it can go as high as 12 in the morning. Also if I sleep for 10+ hours, it can go up really high as well.
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I take enzymes on an empty stomach when I first get up and I will see a rise in BG then as well most days. As to needing 40U more short acting insulin. Having been diabetic for a long while, I had extra backlog of insulin in the fridge. I noticed an increase in usage from about the beginning of the year and then it seemed to get worse. Long story short, to get the same results after meals, I was pumping more short acting insulin. Eventually I ran out about 3 + weeks out of my script because it wasnt being replaced at the rate it was been consumed. I measure my blood between 5 and 7 times a day so I mostly know what is happening. This is what kicked the conversation off with the GP.

No I have never done a basal test so what is that exactly? Fasting for a period? If so, how is it done? Yes, I'm going to change up my injection sites as I hadnt been doing this.
 
I should also have mentioned that without the increased insulin, HBA1C went from 50 to 55.
 
Wow lol My knowledge of Terms used in Diabetes is extremely poor.
Reading up a little on Basal Insulin, not sure if I'm correct here, is the Long Lasting Insulin. In my case this is Abasaglar. I would assume Basal testing is Fasting using only the Long Lasting insulin to determine if the Long Lasting insulin is working correctly due to the normal addition of Carbs from the Liver and the body using Fats. I would think this is an important test but to be honest I've just learnt to work out my Long Lasting insulin intake through Trial and Error. My diet is pretty poor in that I mostly eat protein rich food like Meat. Never really had a sweet tooth so not a problem for me. I take Abasaglar twice a day 30 units in the morning and 20 units at night. Seems to work well for me. I don't normally inject short acting during the day but my BG does go down mid afternoon so tend to eat some carbs during that time. The NovoRapid I usually take twice a day, depending on my BG when I wake up and prior to dinner in the evening. I usually work the amount out by Carbs of the food I'm going to eat. But usually if my BG is around the 8 mark and I'm going to eat a regular meal I will inject 8 units or if higher I will add to this the amount it is over 8. i.e. if my BG is 12 I will inject 12 units of the NovoRapid. This has worked for me over many years but Please understand that we are all different so will be different for everyone. My Excel Sheet I created using some VBA and Drop Down lists for BG readings, Insulin Intake and Carbs intake showing the times taken, time since last readings and Average BG for the day and also selecting Average for Days Weeks or Months etc. So have a good analysis of what is going on. My 3 monthly Average is steady at around 8 so happy so far.
 
This is normally different for everyone but I have a number of Injecting areas. For Long Lasting Insulin I use 4 different areas on each outer thigh. For my Short Acting insulin I have 8 different areas on my Stomach and 2 different areas on my inner thigh of both legs. They don't like you using your inner thigh as there is a big artery that runs in that part of your leg and injecting insulin directly into your artery is not a good thing as it will react very quickly. This is also true of injecting to deep into Muscle which has a much larger Blood flow than your normal flesh hence why they prefer you to use the 4mm needles and it will also causes trauma to your muscle. I'm not to worried about that happening every so often as I normally have to wait 2 hours after injecting before eating and monitoring my sugar, if it starts to come down fast I know to eat sooner.

But it is important to keep changing places you inject each time. It was described to me by the Diabetic nurses, that even the New 4mm very thin needles will cause some trauma to the Flesh which will over time cause your flesh to stop absorbing the insulin. When I first started injecting lol the only needles available were those terrible Dagger size needles they now only use for drawing blood. So learnt very quickly to keep changing places due to the pain injecting into the previous place. Again my Excel sheet has a place for me to put the areas I have inject so I know where next to inject. Also the same with the Finger Prick BG spots. I now have Callouses growing on my fingers due to pricking the same spot all the time.

FYI until recently I only injected in the lower part of my stomach, basically only 4 points. But the issue I'm now having with the Short Acting insulin I have narrowed down to using just those parts. Started using the top half above my belly button and it seemed to work well. But even that is now starting to give very random results so moved to the Inner Thigh which for the time being is working very well. Now waiting for the stomach areas to calm back down and will regularly change to all 8 parts on my stomach and also my inner thigh.

I'm not suggesting this is your problem but worth thinking about and as suggested by someone else above, it might be worth asking the Diabetic nurses about it.
 
Actually I think you're onto something, I have tidied up my diet to shave off about 30carbs a day 13% less) and I have rotated the sites and dropped all my insulin by 20% and unbelievably, I am getting lower readings than I have been for quite a while. So I am thinking the insulin sites were part of the problem and the food certainly also. So its looking good. I know you are a type 1 but I just cant get over the fact that you only need to inject 8 units for a meal. Out of interest, what kind of meals do you have? If I have 2 rashers of bacon and 2 eggs and coffee with milk say a late lunch - my best time of day, I'd still be dialling up 15U if I was in the 6's or 20U if I was in the 7s. The joy of having too many fat cells and or not enough exercise I suspect.

Yep, we have had the dagger needles here for years too and have only had the new ones for 12 - 18 months - what a difference they make.
 
Great to hear mate.
My diet is fairly low carb so it's probably why I don't need much quick acting insulin. But in my Carb sheet from some Diabetic Association site, Bacon and Eggs is negligible so I tend to eat that a lot lol. Its only when you start adding bread etc that the Carbs go up. Normally for Breakfast I have 2 weetabix with sugar and T-Spoon of sugar. Taking 8 units of NovoRapid seems to take care of that. After calculating the Carbs for Weetabix, Milk and T-Spoon of sugar the Carbs are 38.2g. A T-Spoon of sugar is ~5g of Carbs and I tend to have that with Coffee maybe 8 times a day.

Keep up the good work
 
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