Blood sugars running on the high end.

[Nicola M]

When I last went to hospital for an appointment my HbA1c was at a good 7% according to my doctor although my results don't always reflect that because they can be all over the place. My next appointment is in 2 weeks time and so far looking at all my results they are above 10.0 at least 75% of the time. I do 13 units of lantus in the morning and have a carb ratio of 1:6 in the morning. At lunch time my carb ratio is 1:8. At tea time my carb ratio is at 1:10 and pre-bedtime I do 8 units of lantus. If I have to correct any highs I have a raio of 1:3 my doctor has tried changing that to 1:2 but it sends my sugars low. My sugars are all just a little bit crazy at the moment, in the morning I could be 8.0 but by lunch time it has significantly shot up to around the 20.0 mark. And by tea time it goes down to only around 14.0/15.0 my pre-bed result can vary from anything between 3.0-15.0

I test my sugars before eating and do my insulin 30 minutes before eating anything to give it time to get into my system. I was wondering if any of you wonderful Type 1 diabetic people could help me and give me advice on what I could do to try bring my levels down to a more normal level. Thanks!

 

[tim2000s]

Hi Nicola,

Are you accurately measuring the carbs in your meals as the bg levels you are suggesting look like your bolus is not accounting for the carb content of your food correctly.

Have your basal levels been looked at it either?

 

[Nicola M]

I make sure to weigh up all my meals accurately for carb content, and always have my phone's calculator handy for doing the sums so I know I'm doing it right. Recently I wrote everything down on paper and have emailed it to my nurse to show her what is happening but have yet to receive a reply.

I have recently upped my lantus dose in the morning as I rung my diabetes nurse to ask for some help but she is reluctant to up it any more until she has seen me in clinic in 2 weeks time I'm weary of changing my doses too much because I seem to drop low really easily. It's difficult finding the right balance for me.

 

[noblehead]

Nicola, start with some basal checks first then look at your meal-time ratio's, without getting the basal aspect right in your diabetes management everything else fails, the following explains how a basal check should be carried out:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[Dillinger]

Hello,

With that morning jump to 20.0 what did you have for breakfast and how much insulin did you take?

Your correction dose sounds right if you are hypoing on 1:2 but ok on 1:3

I'm slightly surprised you are splitting Lantus; it's not commonly split; Levemir is more readily split as it has a very flat profile. Perhaps ask to be changed to that?

The general advice I'd give though is the fewer carbs you eat the easier it is to control.

Best

Dillinger

 

[tim2000s]

Hi Dillinger, quite a few of us split lantus. I find it provides a flatter profile than using it in one shot. It does tend to run out at the end of the day if you don't.

 

[Nicola M]

Hello,

With that morning jump to 20.0 what did you have for breakfast and how much insulin did you take?

Your correction dose sounds right if you are hypoing on 1:2 but ok on 1:3

I'm slightly surprised you are splitting Lantus; it's not commonly split; Levemir is more readily split as it has a very flat profile. Perhaps ask to be changed to that?

The general advice I'd give though is the fewer carbs you eat the easier it is to control.

Best

Dillinger

At breakfast I have 1 slice of toast with a bit of margarine. It amounts to 18g of carbs so I do 3 units of insulin.
My doctor suggested to split the lantus because by morning it was running out.

 

[Daibell]

Whilst a lot of people split the Basal particularly Levemir due to it's peaky, short life profile, I don't split mine (Levemir) which saves one injection and also makes getting the right Basal dose easier. I take the daily shot at bedtime and maintain my fasting BS between 5 -7 mmol. I don't normally have Bolus at breakfast as the carbs are low and the Levemir is peaking. I then use the Bolus ratio relevant for lunch and evening meal. Works for me and only 3 shots. Interestingly my DN said not to split but I think that's because she believed the marketing stuff for Levemir which shows it being flat when it isn't.

 

[LucySW]

the general advice I'd give though is the fewer carbs you eat the easier it is to control.

This is really true. The lower the carbs, the smaller the insulin doses, and the smaller the variation, and the smaller the swings. It looks to me from the outside as if lower carbs would scale down your uncertainties and bring you a bit of sanity.

 

[Dillinger]

At breakfast I have 1 slice of toast with a bit of margarine. It amounts to 18g of carbs so I do 3 units of insulin.
My doctor suggested to split the lantus because by morning it was running out.

That's odd isn't it? I think you need to sort out your basal first; here is guide to how to do that

http://www.diabetes-support.org.uk/info/?page_id=120

Essentially, you need to skip meals over a few days and see what happens to your blood sugars; if they are stable then your basal is correct and you need to look at your bolus.

Your morning highs might be the dawn phenomenon going unchecked, but if you try the basal tests you should get a better idea.

Only skip one meal a day; so breakfast one day, lunch the next and supper the next. Don't change your basal dosage whilst testing.

You may want to try and time it so that most of your testing happens over a weekend as it would be useful to know what your blood sugars are doing over night.

What short acting insulin are you on? Some last longer than others; here is rough guide to how long each of the ones available last; you'll see that they have different actions in terms of peaks but most last about 4 hours. For basal testing you want to know what is happening when you only have the Lantus on board and have had nothing to eat so don't need/have any short acting.

http://www.diabetes.org.uk/Documents/Magazines/Insulinwallchart.pdf

You'll get there in the end!

Best

Dillinger

 

[Nicola M]

I will defiantly try out the basal testing, thanks for linking me to that

As for short acting insulin I currently use Novo

That's odd isn't it? I think you need to sort out your basal first; here is guide to how to do that

http://www.diabetes-support.org.uk/info/?page_id=120

Essentially, you need to skip meals over a few days and see what happens to your blood sugars; if they are stable then your basal is correct and you need to look at your bolus.

Your morning highs might be the dawn phenomenon going unchecked, but if you try the basal tests you should get a better idea.

Only skip one meal a day; so breakfast one day, lunch the next and supper the next. Don't change your basal dosage whilst testing.

You may want to try and time it so that most of your testing happens over a weekend as it would be useful to know what your blood sugars are doing over night.

What short acting insulin are you on? Some last longer than others; here is rough guide to how long each of the ones available last; you'll see that they have different actions in terms of peaks but most last about 4 hours. For basal testing you want to know what is happening when you only have the Lantus on board and have had nothing to eat so don't need/have any short acting.

http://www.diabetes.org.uk/Documents/Magazines/Insulinwallchart.pdf

You'll get there in the end!

Best

Dillinger

I will defiantly try out the basal testing, thanks for linking me to that

As for short acting insulin I currently use NovoRapid.

Thanks for the help!