Can't control Blood Sugar Levels

[Mrs of type 1]

My husband who's been type 1 for 30+ years is having real difficulty in controlling his blood sugar. It seems to be most evenings around 9-12pm his blood sugar drops, the lowest was 1.3! often between 5-2. He then has 1 or 2 glucose tablets, a banana and a scone to get back to 6-7. The next morning he wakes up at 7am and his sugars are anything between 15-20. the rest of the day he constantly tests and doesn't eat until it's lower than 10. It doesn't seem to matter what we try different it happens the same every night, he has a good evening meal at 6pm with plenty of carbs, and takes his insulin at that time. 15 quick reacting and 15 long reacting. Has anyone got any idea what we can try ??

 

[mo1905]

Try reducing insulin amount with evening meal. This should avoid the hypo. Make reductions 1 unit at a time and monitor closely. Also, you seem to me treating the late hypo with too many carbs, leading to high morning levels. Speak to your nurse as well to get advice. I'm no doc ! Just advice. Good luck !
Mo


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[Mrs of type 1]

Did think about reducing the quick reacting insulin, it's knowing what to eat when he has the hypo as we want to get the sugar back up to a normal level as quickly as possible. He also becomes very hungry and wants to eat bread. Thanks for your reply.

 

[sheil19]

In relation to the hypo treat it straight away with fast acting glucose ie lucozade, 5 glucose sweets, jelly babies etc!! The problem with using fruit and scones is that they are slow releasing carbs and when you're hypo you need to treat it straight away. Scones have huge amounts of carbs as well so that might be a factor in the high early morning readings!! Hope this is of some help.


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[Mrs of type 1]

Back in the 1980's when he first became diabetic he was always told to eat plenty of carbs when sugar is low and to avoid glucose unless in a bad hypo and even now he hates taking the anything with glucose in it. Will have to try to cut the amount of carbs in his diet. Thanks for your reply

 

[AndyS]

Try talking to Dr / Nurse and see if your husband can get onto a DAFNE course. That will really help.

Additionally this is quite a useful site: http://www.bdec-e-learning.com/ you can set up a free account and it has a ton of useful information and exercises to try out

Good luck.

A

 

[HarriP2]

Hi . Is he on a slow release insulin too? What time of day does he take this?


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[Mrs of type 1]

Yes he is on slow release and quick release insulin, he takes 15 of both around 7am and 15 of both around 6pm when he gets in from work and has dinner. We have been wondering for a while now about going on a different system as he's been on this system for over 30 years now. We have an appointment in January to see a consultant. These highs and bad lows have been going on now since the summer. The DAFNE course is for a week and he will have trouble getting the time off work, But we may have to go down that route. Thanks for your replies.

 

[noblehead]

What insulin's does your husband use?

 

[Mrs of type 1]

He takes Hypurin Porcine Neutral and Hypurin Porcine Isophane 15 of each twice a day.

 

[noblehead]

He takes Hypurin Porcine Neutral and Hypurin Porcine Isophane 15 of each twice a day.

Thanks. I couldn't possibly say how to adjust the doses for both these insulins as its so long ago that I used them, I would ask his DSN for that advice explaining that your husband is having frequent hypo's later in the evening, mind with twice daily doses you do need to snack more and eat some supper before bed.

I do wonder though if your husband would be better off on basal/bolus so that he can adjust his insulin to the food that he eats instead of the other-way round, basal/bolus is more flexible in that it allows you to eat when you want with the option of skipping meals should you choose.

 

[mentat]

While the DAFNE courses are great, there are PLENTY of other ways to learn how to use a modern basal/bolus regime. Think Like a Pancreas is a great book to get; and you can get plenty of information on the internet, or even Youtube videos if he's resistant to reading things.

I do highly recommend switching to a modern basal/bolus regime; even without a good grasp of carb counting it allows for a more flexible way of life. And if he really dislikes it he can always go back to the old regime.

 

[Mrs of type 1]

Thanks for all your replies, we have asked a few times about going onto the basal/bolus regime, but the doctors have always said he manages well enough with what he's been doing, although this is not the case anymore. We will mention it again when we see the consultant in January. Last night he took 3 units less insulin and had a couple of small pieces of grannery French stick for supper, all was well and he was 4.9 at 11.45, but by 12.30 he was down to 2.0, he had a couple of glucose tabs and was OK throughout the night, although I didn't sleep a wink!!! This morning he was 13.5 which is slightly better but still no where near what we would like it to be.

We are reluctant at the moment to talk to any of his health care team as he has just applied to renew his driving licence and although none of his hypos have happened while driving (we are very careful) or have required outside help we are worried if his doctors tell DVLA that he's having trouble with his sugar levels they will stop him from driving and he can't do his job without a driving licence.

 

[noblehead]

Appreciate that your reluctant to talk to his HCP's because of his licence renewal but frequent hypo's can lead to reduced or complete loss of hypo awareness symptoms, should this be the case then it's inevitable that he'd lose his licence as he'd be no longer be safe to drive.

Perhaps (as the Dr's said) your husband did manage well at one time but this isn't the case at the moment, as I said before you need to speak with his DSN and ask about adjusting his insulin doses to prevent these hypo's occurring, better still would be to make the change over to basal/bolus which is far better IMHO.

 

[lisa mcaneny]

Hi,my blood sugar level is very high it goes up to 33.2 I'm on 90mls of lantus.2 times day. Plus rap 60mls 3times a day and 80mls at nite.plus metforming.so i know what it feels like when you can't control bloods sugar

 

[mentat]

Thanks for all your replies, we have asked a few times about going onto the basal/bolus regime, but the doctors have always said he manages well enough with what he's been doing

A big advantage of basal/bolus is improved lifestyle and greater flexibility, not just better diabetes management. Plus you mentioned in another post that your husband has "many complications" - if doctors consider that situation "well enough" then maybe you should ask yourself whether you agree.

Yes, to make the most of basal/bolus there is a bit of learning to do - but as long as you have the enthusiasm, you're never too old for that! Besides, keeping your brain active helps ward off mental decline.

 

[Mrs of type 1]

Thanks for all your replies,
To Lisa, wow, that is very high sugar levels, I wonder do you get the lows to go with it?

Well last night hubby had a good dinner with potatoes and veg's, he had 2 crumpets, 2 biscuits, and a yoghurt. His sugar was 4.0 when he went to bed. This morning at 7am his sugar was only 3.7!! We can't understand why, he had far more supper than usual, took less insulin and still had low sugar, when other mornings it's been 12+ I am going to post a new question about Brittle Diabetes as we have been wondering for a while if he has this.

 

[iHs]

A bg level in the 4's before going to bed will usually cause a hypo in the night unless some food is eaten earlier to prevent them but loads of diabetics find that their bg levels change in the night even without insulin's action due to DP. Some people need to eat a higher carb snack and some need to eat less and some don't need to eat anything at all. Very hard at times to balance up insulin correctly and often people can prevent a hypo coming on if they get up and test about 1hr before the hypo starts and use the bg level to determine whether more or less of a carb snack needs to be eaten before retiring as a way to prevent.

I always eat a carb snack before going to bed on twice daily insulin and bolus/basal because if I didn't, I would be in hypo land around the 2-3am mark but that was a compromise that I was willing to make in order to be ok.

 

[Mrs of type 1]

Thanks for your reply iHs, what we can't understand is why he can eat the exact same food and have the same insulin one night and end up with sugars of 18 in the morning and a couple of days later have 3.7 in the morning, this has never happened before. He's at work and his sugar is 2.5 at this very moment, I'm hoping he will be OK.

 

[iHs]

Thanks for your reply iHs, what we can't understand is why he can eat the exact same food and have the same insulin one night and end up with sugars of 18 in the morning and a couple of days later have 3.7 in the morning, this has never happened before. He's at work and his sugar is 2.5 at this very moment, I'm hoping he will be OK.

When your husband eats his evening meal are his bg levels the same or do they differ and are a bit low some nights and a bit higher on others? Does your husband adjust the amount of carb that he eats to deal with being low or being higher? As he injects the same quantities of insulin twice per day, he needs to alter the amounts of carb that he eats so that his bg levels stay at some kind of order. Testing blood glucose levels every 2 or 2.5hrs and writing down the amounts of carb that is eaten for each meal will him to adjust the carb if need be rather than adjust the insulin.

Regarding the night time problem...... get your husband to get up in the night and test his bg levels about 2am and then again at 5am and then that will paint a better picture of what happens overnight to the bg. The cause of the high bg in the morning might be that some time during the night, he is having a hypo in his sleep and the liver is maybe coming to his rescue and releasing some glucose even though he has not woken up to swallow any. Some times this happens for diabetics and some times it just doesn't and that is why some need help from a relative/friend etc because the liver has gone on strike. The human body can behave weirdly..
but by testing bg levels frequently and adjusting the carb, should enable better control unless something else is at play and further medical tests need to be done.