BS Suddenly gone sky high - help please....

[Paulaah]

Good morning all,

I just wondered if someone could give me a helping hand. I'm a relative newbie - one year diagnosed. I'm on split Levemir 4/6 and Humalog. I've had good control right up until the week before last and now it's all just gone out of the window, with pre meal readings being 11. Morning ones particularly high, so I did some overnight tests and rang my Diabetes team for some advice. They advised me to increase Levemir, which I did last night. But of course I will have to wait a few days to see if it works. Although i did wake up in single figures this morning for the first time in a week.

My question is this... My ratios also seem to have changed. So when my basal dose, and my ratios are all over the place, what do i tackle first? Obviously, when I'm correcting, I don't know what my ratio is and therefore how much correction i need. So every tme i test i get that awful sinking feeling because it feels like its a constantly moving goalpost. 2 hrs after breakfast today I was 16.6, but i thought i'd built in a good correction.

I'm starting to panic a bit. Do I concentrate on getting my basal right first? How do I do carb free testing to check it when i'm starting on such high numbers which are unsafe to leave uncorrected.

Please help :? :? :? :?

 

[noblehead]

Checking your basal doses are correct is where I would start Paula. I was just saying the other day that it would be wrong to assume that basal doses stay static throughout the year, mine can change 4/5 times in a year.

In theory if your doing a fasting check and your bg is say 9 then it should stay around this figure throughout the fast, if it goes up then your basal needs increasing, if it drops then you have too much basal on board.

 

[Paulaah]

Thanks, Noblehead.

When your basal changes, do your bolus ratios too? Or is it just that your basal need is greater so you are taking more bolus to compensate until you get your background sorted out. At such time, does your bolus go back to your normal ratio?.

I know that might sound like a daft question, but I'm just wondering what to expect.

Many thanks

 

[robert72]

Hi Paulaah

First you need to sort out your basal as advised.

You can work out your 'correctional' dose by adding together the total number basal and bolus units that you take in one day and dividing that number into 100. In my case it's 34 units so 100/34 = 3. Therefore 1 unit of Humalog or Novorapid will bring my BG down by 3 mmol/l.

Once you have sorted your basal, keep an eye on your post meal BGs. If you consistently need to take correctional doses then you probably need to change your bolus/carb ratios. Best to talk to your team about this.

 

[noblehead]

When your basal changes, do your bolus ratios too? Or is it just that your basal need is greater so you are taking more bolus to compensate until you get your background sorted out. At such time, does your bolus go back to your normal ratio?

Of course, if your high bg is down to you not injecting enough basal insulin then your bolus doses should reduce when you get your levemir dose correct.

Ask your DSN if they do a DAFNE (Dose Adjustment for Normal Eating) course in your area, this is an excellent course that teaches patients to carb-count correctly and to work out their insulin to carb ratio's, they also cover basal insulin, exercise and sick-day rules to name a few. A very worthwhile course for type 1 diabetics!

 

[Paulaah]

Thanks for your replies.

I'm booked in for DAFNE in June....can't wait!

In the meantime I'm going to concentrate on getting basal right again as a first step. I really do hate this feeling of not being in control. Onwards and upwards" :wave:

 

[noblehead]

I'm booked in for DAFNE in June....can't wait!

Excellent stuff, let's know how you get on