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Deleted member 45091
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Thinking of going back to just two injections a day again. All over the place. Any ideas? Just today this afternoon had just 3 units of nova rapid. Ate a sandwich. 3 packets of crisps, a Banana. Biscuit. And sugars dropped of a cliff on 3 units and my sugars were in the mid teens to start with. Needless to say dropping like that now had a bottle of lucazade. But it didn't happen yesterday etc. Unsure just really tired. Don't seem to get access to the pumps etc and didn't really want to go back to just two injections a day either. But getting just a little fed up of the erratic sugars and how fast they come down sometimes on little insulin. Thinking not really getting any control on this regime either. Any ideas and yep diabetes is rough on some of us.
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Deleted member 45091
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Don't worry just ranting. Can't delete post IL sort it.
T1Dscientist
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I suppose everyone has different insulin to carb ratios but my understanding is that most people have around 1 unit of rapid-acting insulin e.g. NovoRapid for 10g of carbohydrates.
So I would estimate based on what you ate that you’d probably would’ve had to do somewhere around 10 units but it seems like 3 units did the job and you claim that it brought you low but low-teens are quite high in my standards.
The aim should be between 4-8 ideally. If your blood sugar is dropping more than you’d expect it after a bolus then it might suggest that your basal insulin is too high which is causing you to take less bolus and also have unexpected drops in blood sugar.
You should test out your basal insulin by doing a carb-free day or two and see how your blood sugars are. If you’re finding that your blood sugars are decreasing, to the point of breaching the 4 mark then it may suggest basal adjustment.
So I would estimate based on what you ate that you’d probably would’ve had to do somewhere around 10 units but it seems like 3 units did the job and you claim that it brought you low but low-teens are quite high in my standards.
The aim should be between 4-8 ideally. If your blood sugar is dropping more than you’d expect it after a bolus then it might suggest that your basal insulin is too high which is causing you to take less bolus and also have unexpected drops in blood sugar.
You should test out your basal insulin by doing a carb-free day or two and see how your blood sugars are. If you’re finding that your blood sugars are decreasing, to the point of breaching the 4 mark then it may suggest basal adjustment.
Rokaab
Well-Known Member
I'm not surprised you're feeling tired (and a selection of other things as well)
Though do remember that the libre is not considered to be accurate at higher levels, so you need to see how high you actually at when its at the top (as the libre cannot display above 21 mmol/L) to be able to calculate your correction - for instance if you're at 26 youll def need more than you would at 21, also above about 15 it can be horribly wrong.
Do note that it insulin can suddenly kick in especially if you hit a blood vessel, but when you're still above what you really want to aim for please try not to over-react, just keep a good eye on it, it may just be taking you down to a more reasonable level
It could be your basal rate is wrong, it could be your carb ratios are off, but at high levels it can be tricky to work everything out especially if basing it on possibly not quite correct data.
Can you talk to your diabetes team as a matter of urgency, averaging 15+ will be making you feeling poop if nothing else, they need to help you get it down to a more reasonable level to begin with, if you start off on a more reasonable level its a lot easier to work things out like carb ratios, correctional doses, basal rates etc
Though do remember that the libre is not considered to be accurate at higher levels, so you need to see how high you actually at when its at the top (as the libre cannot display above 21 mmol/L) to be able to calculate your correction - for instance if you're at 26 youll def need more than you would at 21, also above about 15 it can be horribly wrong.
Do note that it insulin can suddenly kick in especially if you hit a blood vessel, but when you're still above what you really want to aim for please try not to over-react, just keep a good eye on it, it may just be taking you down to a more reasonable level
It could be your basal rate is wrong, it could be your carb ratios are off, but at high levels it can be tricky to work everything out especially if basing it on possibly not quite correct data.
Can you talk to your diabetes team as a matter of urgency, averaging 15+ will be making you feeling poop if nothing else, they need to help you get it down to a more reasonable level to begin with, if you start off on a more reasonable level its a lot easier to work things out like carb ratios, correctional doses, basal rates etc
- Messages
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Hi Danny,
Insulin can sometimes pool below the skin and that's why the drop off the cliff happens - has anyone checked your insulin sites recently ?
Sadly a pump isn't the magic wand either, it's not an easy switch if you're already struggling with injections and your team would be less inclined to give you access until your control is in range. It's a good idea to try low carb/carb free to see what is really going on with your control though and a good starting point for you for a few days at least, can you give that a go ?
Insulin can sometimes pool below the skin and that's why the drop off the cliff happens - has anyone checked your insulin sites recently ?
Sadly a pump isn't the magic wand either, it's not an easy switch if you're already struggling with injections and your team would be less inclined to give you access until your control is in range. It's a good idea to try low carb/carb free to see what is really going on with your control though and a good starting point for you for a few days at least, can you give that a go ?
RobertJ
Well-Known Member
You mention having a bottle of Lucozade when it dropped, but from the graph it only dropped to about 9.
I don't worry about going low unless my Libre goes below 5.5 and the arrow is going straight down. Even when I'm below 4.5, as long as it's stable I leave it alone.
The objective is to be between 4 and 8, so I think it was a mistake to have a Lucozade just because it was dropping. Dropping is a good thing if you are starting on 16mmol.
A big thing I put into practice now is to always start a meal at a good level. I really try not to be above 7mmol at the start of a meal if possible. If you're high and you start eating, it will go even higher before it gets better.
I don't worry about going low unless my Libre goes below 5.5 and the arrow is going straight down. Even when I'm below 4.5, as long as it's stable I leave it alone.
The objective is to be between 4 and 8, so I think it was a mistake to have a Lucozade just because it was dropping. Dropping is a good thing if you are starting on 16mmol.
A big thing I put into practice now is to always start a meal at a good level. I really try not to be above 7mmol at the start of a meal if possible. If you're high and you start eating, it will go even higher before it gets better.
D
Deleted member 45091
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Hi cheers for replys, just haven't a clue what's happening. I know what saying but like yesterday although not low I was around 19/20 only had 3 units of nova rapid and it came down to 8/9 within less than an hour as it was crashing so fast I ate a good 60/70 grams of carbs within the hour. It was still crashing and as it wasn't leveling out I then drank lucazade. But thinking surely just 3 units shouldn't do that with food. And starting that high too. But as this happens IAM reluctant to do proper correctional doses etc, so il only do a couple of units correction at a time. Then I get ABIT bothered thinking if I am in normal range and get crashes like that I'd be all over the place. Then I get frustrated as it doesn't happen all the time. I low carb etc probably around 30 grams per meal. Have 16 and 20 units of levemir. Nova rapid usually is around 3,4,5 per meal. I usually find iam more sensitive in the after noon, than evening and often have 2/3 corrections before bed of just 1/2 units at a time. As iam bothered about the crashes and when it will stop. Often I over treat it when I see it coming down fast then usually treat highs alot. It's like being at the races, when I do my nova rapid I think and we are off as haven't a clue where its going to end up. I count all carbs and stuff but no two days are the same. I can have exactly the same food and insulin and different results. But do have other issues with vision etc, diabetic kidney disease etc so Ian not sure if these are having an impact. Just be nice however to get some stability and predictability. But I am trying to what I can, just not working at the minute. But cheers for the messages anyway.
D
Deleted member 527103
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Hi @DannyH, Sorry to read how you are struggling
A few things come to mind
- Do you check all high Libre readings with finger pricks. It is common that it over-reports when higher than about 10 mmol/l. This is because they are calibrated to be most accurate at "normal levels". Correction doses should always be taken based on finer prick readings
- Are you considering Insulin On Board (IOB) when dosing? IOB is the "unused" fast acting insulin which typically remains active for about 4 hours. A safe approximation is our body uses the fast acting insulin evenly throughout the 4 hours*. So, if you take a dose of 4 units, after 1 hour, 3 units are still active, after 2 hours 2 units are still active and after 3 hours, you still have 1 unit. If make a correction after 2 hours and do not take IOB into consideration, you will go too low.
- Do you increase your correction dose when your levels are high? I find I need 1.5 as much insulin when my levles are above 12 and 2x when my levels are above 16. This is because we become insulin resistant when our levels are high. The other thing to consider is that our bodies become resistant to all insulin so we may find our levels rise when high because our usual basal dose is not enough due to the insulin resistance.
- Have you tried eating less low carb. I find my body needs more than 30g carbs per meal. If I eat this low, I also need to dose for protein (which my body converts to sugar in the absence of carbs). As I found the insulin to protein ratio was different for different types of protein, I found it too complex and a higher carb level was easier to manage.
We are all different so the numbers I give above are for me so your doses and levels are likely to be different.
*In reality the activation profile is front loaded with a peak after about 30 minutes and trailing to the 4 hours. The approximation above is conservative to minmise risk of overdosing.
A few things come to mind
- Do you check all high Libre readings with finger pricks. It is common that it over-reports when higher than about 10 mmol/l. This is because they are calibrated to be most accurate at "normal levels". Correction doses should always be taken based on finer prick readings
- Are you considering Insulin On Board (IOB) when dosing? IOB is the "unused" fast acting insulin which typically remains active for about 4 hours. A safe approximation is our body uses the fast acting insulin evenly throughout the 4 hours*. So, if you take a dose of 4 units, after 1 hour, 3 units are still active, after 2 hours 2 units are still active and after 3 hours, you still have 1 unit. If make a correction after 2 hours and do not take IOB into consideration, you will go too low.
- Do you increase your correction dose when your levels are high? I find I need 1.5 as much insulin when my levles are above 12 and 2x when my levels are above 16. This is because we become insulin resistant when our levels are high. The other thing to consider is that our bodies become resistant to all insulin so we may find our levels rise when high because our usual basal dose is not enough due to the insulin resistance.
- Have you tried eating less low carb. I find my body needs more than 30g carbs per meal. If I eat this low, I also need to dose for protein (which my body converts to sugar in the absence of carbs). As I found the insulin to protein ratio was different for different types of protein, I found it too complex and a higher carb level was easier to manage.
We are all different so the numbers I give above are for me so your doses and levels are likely to be different.
*In reality the activation profile is front loaded with a peak after about 30 minutes and trailing to the 4 hours. The approximation above is conservative to minmise risk of overdosing.
RobertJ
Well-Known Member
Hi @DannyH, I have been a keen reader of your posts for the last few months. It seems that an ongoing issue is you operate like 8/9 is bad and needs to be treated like a hypo.
If you're high and it starts falling fast to 8 or 9, there is no problem. That is a good thing and it needs to fall further anyway. In a perfect world, everyone's blood glucose would 5.5 all day. Diabetics are basically advised to keep between 4 and 8 and so next time you see it dropping into the 8/9 range, I strongly advise that you leave it alone and try and get it to 5 or 6.
D
Deleted member 45091
Guest
Thanks for replies again. I have been on this regime only a couple years if that. I just thought we injected for carbs not protein IAM still learning. I definitely over treat even none hypos as Iam not sure when these crashes will stop and IAM starting off high so the drops make me feel even worse. As yesterday I only had 3 units my sugars was in late teens and it came down to 8 within less than an hour, and I also ate around 30g of carbs. I would expect this sort of swing if I had nothing to eat at all. So I over did it that batted all last night with highs etc. Think there testing me for gastroperis soon hopefully. As if my sugars are in the normal range I'd be concerned about my sugars dropping before my food digests etc. As I've found sometimes I can inject then sugars drop then hours later have a rebound and shoot up with no extra food on board. Yes I try and follow the insulin on board. I try and inject 1/2 units extra if sugars are high at tea then sometimes 2 hours later have another couple of units if still high. As a rough pattern I find overall IAM just doing 1_10 grams of carbs, I find in the afternoon if my sugars are high and I still do 1_10grams of carbs it can still drop a little. Then at tea it seems to settle down again, Iam not sure if the basal insulin is overlapping in the afternoon. I was trying to a do a basal test but you need to be in range before you do which is pretty much never now. The diabetes team have suggested a different background insulin just once a day, as before I was just on 2 injections a day for years, and sort of ate around it. But over recent years my control got worse so decided to try the basal bolus regime just taking time to understand it ABIT, IAM not used to how fast it can swing. All thought not great control with the 2 injections everything was much slower on humalin M3, I could walk around with blood sugar's at 2/3 and not panic as much. But as these drops can be fast and coming from a high level it can feel more extreme etc. But working out things for injection for protein or insulin resistance at higher levels is new to me. Hopefully it will settle down as I get more used to it.
