confused

If you are novmix30, this combines a background and a quick acting insulin together, which means that you need to balance out your carbohydrate intake against insulin intake... So you need to eat your meals and/or snack with a set amount of carbs, i,e. 30g of carbs for breakfast, mid morning snack of 20g's, lunch 30g, mid afternoon snack 20g's tea 40g, supper 20g (this is just an off the head example) and every day, you eat that amount of carbs per meal/snack at roughly the same time! Get the balance wrong, miss-timed or miss a meal you end up either high or hypo!

It seems that you do need some form of insulin support, I would ask to go an a multi-daily injections (MDI) also know as a basal/bolus regime... This you inject background separately either once or twice a day, then you use a quick acting insulin to counter react the carbohydrates you eat... This gives you the flexibility to eat what you want (within normal limitations) and you adjust your insulin accordantly... As your other medical conditions seem to lead to pain etc, pain can increase the blood glucose levels, as pain stresses the body.. This method allows you to either use a correction dose either on it's own, or with carbs you are eating, enabling you to maintain better control.

You need to learn carb counting, and learn what foods react in what why, what exercise does and also how your pain effects you so that you can work out your dose adjustments needed and will need to do more blood tests, it does seem quite a high learning curve when you first start, but you soon get used to it and it becomes a lot easier as you go along..

So I would speak to your team, and ask them about the MDI/basa/bolus regime

Hi Julie and welcome to the forum!

I have read your post and agree with Jopar on the issue of which type of insulin regime would be best. In my opinion, bolus/basal is a much more flexible system.

Let me tell you a little about myself and then I'll make a few suggestions for you. I have a condition called LADA (Latent Autoimmune Deficiency in Adulthood). This is often referred to as Type 1.5 diabetes. It is an autoimmune form of the condition like Type 1, but comes on more slowly like Type 2. It is often misdiagnosed as Type 2 and then treated completely inappropriately. I was (mis)diagnosed with type 2 about 3 years ago and had a terrible struggle getting the medical world to see that I was not Type 2 and that I really needed to go on insulin. It took me a year to make them listen and I was very ill by then. So I know how frustrating it is when no-one listens to you!

OK, so firstly, 18 is absolutely NOT OK between meals. 18 is never OK. If you are Type 2, levels that high will be doing long-term damage. If you are type 1/1.5, it can be very dangerous as you can get a condition called ketoacidosis which needs urgent medical attention. So, my first suggestion is to make an appointment with your GP (not the nurse) and ask to be referred to a specialist diabetes clinic for tests to establish what type of diabetes you have. There are two main tests: GAD antibody test looks for a range of antibodies and if they are present that is usually indicative of an autoimmune type of diabetes (1 or 1.5); c-peptide test shows how much insulin you are producing. If you have high levels of insulin and high levels of glucose you are probably Type 2; if you have low levels of insulin and high levels of glucose you are probably Type 1/1.5. There are many reasons why you need to know this, but basically, Type 2s are often insulin resistant (i.e. produce insulin but cannot use it) and so if they inject insulin, often need much higher doses than Type 1/1.5. Type 1/1.5 produce little or no insulin and must inject insulin to cover background (basal) and any food we eat (bolus).

As Jopar said, with the type of insulin you are on, you must inject an amount and then eat the right amount of carbohydrate at the right times to match the insulin. With the bolus/basal regime, you will need to inject 4 or 5 times a day. I inject basal in the morning and evening and bolus with every meal. This means that i can count the carbs in my meals and inject just the right amount of insulin for each meal - this helps to avoid hypos and enables me to get good control of my glucose levels. If my blood glucose does go too high occasionally, I can take a correction injection of bolus and bring them back under control. I would suggest this might be a more suitable insulin regime for you. Counting carbs seems daunting, but it isn't as bad as you might think - it takes a while to get used to, but it becomes secoond nature - there are books you can buy that give you the carb value of almost all the foods you eat.

Make sure you test your blood glucose (BG) at waking, before and 2 hours after each meal. Keep a diary of everything you have eaten (including amounts - weigh your food). Write down all your test results. This is your evidence that your current regime is not working for you - take this diary to your GP, diabetes nurse or any specialist you might see - it will help them decide on an appropriate course of action. I am afraid you need to make a fuss - don't be fobbed off, this is your health we are talking about and your current treatment is not good enough. If your doctor will not refer you to a specalist, call your PALS (Patient Advisory and Liaison Service) and see if they can help.

Take care and ask any questions you need to - there are always some of us Type 1/1.5s around to share our experiences of controlling BG with insulin.

Smidge

Julie you have been give very good advice so I won't add anything else. Just wanted to say though that carb counting and all that can sound very daunting but once you get some practice it isn't really difficult, just seems difficult in the beginning because it's all new and takes a while to get used to.

Good advice from Smidge. You need to get your control sorted Julie as 18 is not really a good level for your glucose to be at. It will, of course, be affected by what you're eating, the insulin that you're producing, the insulin that you're injecting, what else is going into your system and lots of other things besides. As Smidge says, you need to get your GP to refer you to a diabetes specialist to get you stable.

Hello Julie

Due to the way twice daily insulins affect bg levels it is important that you don't eat too much carbohydrate at breakfast as the insulin can take a while to kick in but when it does, down go your bg levels as you have found. Best thing is to test your bg levels before bkfast, mid morning, before lunch, mid afternoon, before eve meal and before going to bed. By doing that you will start to see what happens when you eat carb and by adjusting the carb, your bg levels will be better balanced out..

Blood sugar at 18 between meals is not okay, I'm afraid to say. Did you not try adjusting the dose unit by unit? Maybe you need to pull back to around 4 units in the morning if you're having hypos? It's clear you need the insulin but maybe you only need a bit of it. Maybe keep a diary as well to keep a record of your insulin dosages, if you're not already doing so?

Can you give just one days blood readings and insuiin details? Then we may be able to help liwer those 18 levels downward?? Just one days worth would be something to go on.

Know how you feel with fibro pain, mine inlast few weeks has started to hit me bad again, and it is impacting horribly on my mood and happiness level. , and I too feel less than bothered about my bloods at moment. The words fed up with it all are ringing loud in my ears too..

Don't want to be pushy as totally know the angst you are feeling.. But, 18 is a tad too high after meals, but without seeing 24hrs of detail it is hard to help because we dont know if you then drop to normal levels..

The scales of balance are within grasp though. If like me though, the pain experienced can impact so much that to be honest, I get to point when I cant think about anything else but the pain. So, I'm not going to push.

Great to hear Julie. Lets see what we can do to help. If your levels are more balanced, thats one less thing to worry about.

Hi

Got any readings from today to compare with? Spot trends etc? Looks like you've got a higher insulin:carb ratio in the morning, like a lot of us. Which just means you need more insulin with breakfast.

for example, if you usually use 1u of insulin for every 10g of carbohydrate, your need is more in the morning, you may need 1.5u per 10g or even 2u. So if those were my readings, I'd try an extra unit before breakfast and record numbers for a few days to see if bg was reducing. If they were still too high I'd add another...

The rest of your numbers look great! Good luck and report back!


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Ahh I see. How annoying! Coz all your other numbers are enviable! What about adding a unit to counter the post meal high, then an hour before lunch a little carby snack to prevent the hypo? I appreciate that it's easy to advise...the theory is one thing and the reality another with this condition eh??!


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