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Back ground insulin - advice please

-Artemis-

-Artemis-

Well-Known Member
Messages
533
Type of diabetes
Type 1
Treatment type
Other
Hi there, I'm new to the forum and would really appreciate some advice/insights.

I have been diagnosed t1 (I think what's known as t1.5 on this forum - though my consultant tells me this doesn't exist) and in the honeymoon phase. So far I've not needed any medications, but recently my fasting blood sugar readings are creeping up - currently in the 9s.
Though my blood sugars do not continue to rise in the day (they go down to about 7ish), what I've found is that if I start a day with a high reading, it's very difficult to lower it enough to start the next day at a 'good' reading; thus each day it gets slightly worse. IE previously my fasting readings were 6ish, then throughout the day 5ish, meaning I might go to bed at, say 5/6 and wake up at 6ish again. But now what's happening is I'm waking at 9ish, then at 7/8ish throughout the day, then going to bed at 8ish and waking at 9ish again...

What I don't understand is why my fasting a don't come down, but my daytimes do?

My consultant has recommended I start background insulin overnight (sorry if this isn't the correct terminology - it's all quite new to me and I was a bit upset when he explained it).

Can people who have already had experience of this tell me what it's like to start it? I'm frightened of my blood sugars dropping in the night (I live alone).

Also, I'm worried if I start it, it will make me need to go onto insulin injections in the daytime more quickly too - I have to confess I don't fully understand the difference so realise this might seem a very ignorant thing to say.

Also, much more frivolous, but I'm worried about weight gain... As I've read others have experienced this when they start insulin. Silly I know - but on top of everything else I don't now want to feel nothing fits me too.

If I did go on the overnight insulin, what are all the different types? Are some thought to be better than others?

Worried and uncertain at the mo, so thanks for any advice.
 
Hi again Artemis, I has missed this sorry (I said to start another thread because I could see what you said getting lost)


Basically out livers are continually releasing glucose for energy. Insulin acts with another hormone glucagon to regulate this. If the glucose goes up then insulin is released and it stops the liver from putting more glucose into the blood stream. If we don't produce any/enough of our own the regulation won't be efficient and the liver will release more glucose than we want.
The diagram here explains better .
http://science.howstuffworks.com/life/h ... betes1.htm

In the middle of the night your body doesn't need much glucose but just before waking the body gets ready for the day releasing stress hormones which then 'tell' the liver to release some glucose so that you can get up full of the joys of spring!

In the day you aren't resting, much of the time you are moving.
Muscle cells actually have 2 ways of taking in the glucose they need. One way uses insulin , the other way is through the muscle movement itself . if you move they will be able to take in some glucose with very little insulin and so your levels will normally drop . (I need almost no insulin when I'm running because the glucose can get into my cells)
If you lounged on the settee all day without moving then your glucose levels would go up.

Background insulins are used to give us a constant low level supply of insulin.

The two used normally are lantus usually used once daily and levimir often used twice daily .
The advantage of twice daily background insulin is that someone might need less during the day than the night.
At the moment that's probably not a consideration for you.

You should be started on a very low dose with the dose moved upwards as needed.

When you start it is a good idea to set the alarm clock for 2-3am for a few nights to check your glucose. When I was diagnosed in hospital they did that every night (and first thing at 6am :( ) You won't have to do this forever, though most people do it every now and then if they're worried or if they were a bit low at bedtime .
I'm happy to be in the house on my own but I can understand that you might be worried at first. One lady I know who does worry, gets neighbour to ring her if she hasn't opened her curtains by a certain time on work mornings.

Don't worry, its the thought of injecting that is much worse than the reality. The needles are tiny and very thin, you normally feel it less than a finger prick.
 
Hi Phoenix & Noblehead - thanks so much both for you replies; I'm going to read through the links now.

My consultant said it was up to me if I wanted to start the background insulin now or not - but as I was pretty upset at the time, I didn't ask him much more about what this meant as I said I wanted to go away and think about things... since then I have managed to keep my blood sugar readings relatively stable, but only though eating a *very* restrictive diet - which honestly I'm finding pretty distressing all by itself.

I do a moderate amount of brisk walking for an hour each day (I look after / walk two very enthusiastic black labs!) - but I've tried harder exercise and it just makes me feel worse.

My energy levels are pretty low at the moment - did you (anyone) find your energy changed for the better or worse on no change post insulin...?

Thanks for your kind words re the needles; I'm not scared of them - more of the lows and living alone. Actually I'm petrified of this; its the reason I'm eating such crazy foods - if it wasn't for that fear I probably would have said yes to my consultant there and then.... I realise that many people had to go straight on because their blood sugars were super high at diagnosis, but for the "slower progressing" people, at what numbers did you start insulin?
 
Hi. First your consultant should be aware that T1.5 is also referred to as LADA Late onset Diabetes in Adults. It is T1 but a slow progression during the middle years typically. I'm surprised he didn't realise this but sadly the 'Establishment' doesn't believe in T1.5 and tends to class most late onset T1s, incorrectly, as T2. When I went onto insulin this year from tablets I started with once-daily Levemir (Basal) with 10 units at bedtime as recommended by my excellent DN. I found 9 units was better to give me fasting reading of around 5mmol. Many find twice a day Levemir is better as it only lasts around 18 hours. My DN suggested adding Rapid (Bolus) insulin instead which gives me real flexibility. Don't worry too much about overnight hypos as long as you start with low units and increase in stages as needed to achieve 5-7 mmol fasting. Allow 3 days between any unit change. I've never had a hypo in 9 months although have come near it (3.6) with 10 units. The starting number of units is usually related to your weight and I'm 61Kg. I'm giving you info from my own experience but you should discuss all of this with the consultant.
 
Daibell, Some researchers use the term but there isn't any official label T1.5. LADA is type 1 according to the 'official' classification. I have LADA but the diagnosis on my notes and other documents says T1.
 
Thanks both. Daibell I think the endocrinologist I saw was a bit 'old school' - he was really quite adamant about there not being a 1.5/LADA as I really resisted his t1 diagnosis.... He just kept saying there is either autoimmune antibodies present which created diabetes, or there aren't - t1's have the antibodies, and you have an extremely elevated level present... I didn't see the point in arguing as, as he said - it wouldn't alter his treatment/care plan...
I have put myself forward for a research thing with a professor of t1 though, so I hope that might help enlighten me further...

Blood sugars 9.1 fasting this morning, but did come down to 6.3 pre-lunch; which was basically what happened yesterday too - I am confused whether I am displaying the dawn phenomena, or it's background insulin related...? Or can someone have both?
 
Hello,
I was diagnosed this year with type one and I was originally told to have my background slow release insulin (levimir) before bed but my readings were so erratic and then I went into the honeymoon stage and my levels were low a lot. I exercise frequently and being a gym instructor and sports therapist, working brought my levels down too so my consultant suggested I split my levimir and have half (I have approx. five units) in the morning and the other five units 12 hours later.....it was the best thing I did! My levels are so much easier to control and I no longer wake up in hypos as when you exercise in the evening, it lowers you sugar levels for up to 8 hours after so levimir needs to be adjusted so halving it and injecting twice a day was so so so much better! Having the levimir twice prevents hypos and means that I don't have to have as much of my novarapid insulin with meals. Having it twice a day for me was so much better.
Hope this helps!
 
Kelsie said:
Hello,
I was diagnosed this year with type one and I was originally told to have my background slow release insulin (levimir) before bed but my readings were so erratic and then I went into the honeymoon stage and my levels were low a lot. I exercise frequently and being a gym instructor and sports therapist, working brought my levels down too so my consultant suggested I split my levimir and have half (I have approx. five units) in the morning and the other five units 12 hours later.....it was the best thing I did! My levels are so much easier to control and I no longer wake up in hypos as when you exercise in the evening, it lowers you sugar levels for up to 8 hours after so levimir needs to be adjusted so halving it and injecting twice a day was so so so much better! Having the levimir twice prevents hypos and means that I don't have to have as much of my novarapid insulin with meals. Having it twice a day for me was so much better.
Hope this helps!
Click to expand...

This is so helpful and helps ease my concerns of, if I start some insulin my blood sugars dropping at home alone at night, thank you Kelsie! :)
 
Hi Kelsie,
Im not going to give you advice, as everyone is different, but I was told to follow some guide lines that worked for me,
I was told that there is a direct relationship between fast and slow insulin, and the slow, will lessen the peaks and troughs created to a small extent by the fast insulin and the carb intake,
I was started on 8 units of slow, per day, Not to be taken at the same time as Fast, and not in the same area of the body. as slow can become fast. so i put slow in my bum cheeks or legs, and fast in my belly,
with STRICT Carb counting, then 1 unit per 10 g carbs of fast, so you need to acuratly prepare and measure food.

Its a huge learning curve and will take a couple of years to get used to, but you must not be phased by the enormity of the task, just take it one day at a time,
keep a diary of food (carb weights) and insulin amounts and times, and test before food, and 2 hours after food, and before bed,
This gave a pattern very quickly, showing large swings , so I was told to increase slow insulin by 2 units every 3 days until i had greater stability,
I'm now on 16 units of slow(levemir) which i take just before bed, and fast insulin when I eat at a rate of abouut 1 unit per 10g(novarapid) carbs in the morning and 1 unit to 12 g carbs at night,

this status quo has been maintained fot 3 years, and im raely below 4 or above 8 at any time, but you must be true to yourself and your meter and diary, there's no cheating on this diet :( , but that doesnt mean you cant have fun sometimes, just watch your carbs and sugars

Hope this helps

Paul :thumbup:
 
Hey Paul - all really useful info - thank you! :)

My blood sugars have stabilised a bit more again now - so I'm hoping to put this all off a little longer - but it's really good to get an idea of what to expect so it's not all massively overwhelming at the time (though I still know I will be! :***: )

Anyway, thanks again, I really appreciate your insights :thumbup:
 
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