consistent highs....

[megan]

its me back again...not been here for a while i know...got my new insulin...the bovine hypurin isophane.....seemed to take some effect after a week....brought my sugars to more of the 9's to 11's........

but then every other week it seemed it just went crazy and i had to learn that there was nothing i could do about it and had to just ride it out...knackering and upsetting of course...i'd stay up in the 17's plus and feel awful

so having consistent highs every morning, I decided to increase my night time slow acting....now i am on 24 in the morning and 24 at night....
1.5 units to 2 units per 10 g cho on the daphne and max metformin...


so i spend the first 3/4 of the day walking round like a zombie and then the bloods improve a little and then go up again at night


i do not believe i am hypo-ing over night.....i have tried reducing the insulin as has been advised to see if i am over insulin-atised!

i am 5ft 6" and on approx 60 - 75 units total of insulin a day


what on earth do i do next???

 

[janabelle]

Hi Megan
Sorry you're still having probs
I read in another post that you're still on Novorapid and it doesn't seem to be working. Maybe that's at the root of this; if it's not working for you it may explain why your BG is remaining high. While the high Blood sugar levels can make you feel like ****, that could also be down to Novorapid as many people suffer such side-effects on analogue insulins. Metformin also has side-effects, and I would be questioning why you are still being prescribed metformin. Insulin and metformin in type-1s is not a good mx. Metformin works by quashing glucose production from the lliver, however there are times when us type-1s rely on that very function.
Hang in there and don't give up on the animal insulin yet.
Are you doing any physical exercise,and wot's ur diet like?
All can play a part as you know, and your thyroid problem, if not being treated appropriately will also affect control. If you can give us some more current info about your daily diet/routine we may come up with some answers-fingers crossed xxx
Jus

 

[megan]

thanks.

well...

yesterday got up 7.45 am ( very difficult to get up)
blood sugar.................17.6
took 24 bovine isophane hypurin
5 correctional and 6 bolus novorapid total 11 units....
then 8.45 ...................16.9
had breakfast at 8.45. .....2 toast and cup of tea 2 metformin 200thyroxine and 1 prozac

went to work cycled
cycled home at lunch

blood sugar ................13,7
took 6 novorapid
salad sandwich + coffee

cycled and did big grocery shop and carried on bike, collected kids, delivery some shopping, then cycled home
6pm blood sugar 14.4
took 10 novorapid
had steamed veg on puff pastry with cheese
stewed fruit with a crumble top
tea
bovine isophane 24 units

about 9pm blood sugar.....15.5
about 9.30pm sat down from house work and had two glasses of wine
11pm blood sugar 14.8
took 3 units novorapid to help reduce levels ( have tried this and have left it before, doesn't seem to make much difference)
went to bed

same time this morning blood sugar 18.7
one hour later 13.2
breakfast
mid morning blood sugar 13.1

lunch blood sugar 10.1 took 6 novorapid for a chicken sandwich and coffee

I cylce everywhere, or walk, I did try kickboxing and yoga recently but have had to stop because my sugars have got so high I find it makes me feel very ill.....and off course its not good to exercise on high sugars either.

a fairly typical day......I am sleepy all morning.....and then most of the rest of the day. I may get a small break from this just before lunch or occasionally just before dinner....

it is miserable and now one of my toes has started to feel a bit numb.....I want to be able to keep my health, I don't know what to do or where to turn next

 

[iHs]

thanks.

well...

yesterday got up 7.45 am ( very difficult to get up)
blood sugar.................17.6
took 24 bovine isophane hypurin
5 correctional and 6 bolus novorapid total 11 units....
then 8.45 ...................16.9
had breakfast at 8.45. .....2 toast and cup of tea 2 metformin 200thyroxine and 1 prozac
Dont know what the exact carb content is of yr bread but presume its about 15g carb per slice so yr insulin to carb ratio at breakfast is 1:5?

went to work cycled
cycled home at lunch

blood sugar ................13,7
took 6 novorapid
salad sandwich + coffee

cycled and did big grocery shop and carried on bike, collected kids, delivery some shopping, then cycled home
6pm blood sugar 14.4
took 10 novorapid
had steamed veg on puff pastry with cheese
Sorry but do you know what the carb content of the veg on puff pastry is???
stewed fruit with a crumble top
Also this is fairly high in carb???
tea
bovine isophane 24 units

about 9pm blood sugar.....15.5
about 9.30pm sat down from house work and had two glasses of wine
Unless you are drinking red wine, most of the other white wines except dry will definately make yr bg levels go up fairly high.
11pm blood sugar 14.8
took 3 units novorapid to help reduce levels ( have tried this and have left it before, doesn't seem to make much difference)
went to bed

same time this morning blood sugar 18.7
one hour later 13.2
breakfast
mid morning blood sugar 13.1

lunch blood sugar 10.1 took 6 novorapid for a chicken sandwich and coffee

I cylce everywhere, or walk, I did try kickboxing and yoga recently but have had to stop because my sugars have got so high I find it makes me feel very ill.....and off course its not good to exercise on high sugars either.

a fairly typical day......I am sleepy all morning.....and then most of the rest of the day. I may get a small break from this just before lunch or occasionally just before dinner....

it is miserable and now one of my toes has started to feel a bit numb.....I want to be able to keep my health, I don't know what to do or where to turn next

I think Megan if you want to carry on eating the food listed above then you've either got to increase yr basal insulin up a bit more to see what that does or increase your insulin to carb ratios for yr bolus. The other way is to cut out the pastry and crumble stuff and possibly the wine.

 

[janabelle]

God Megan, I'm not surprised you're sleepy with your sugars running so high and I'm amazed your managing to cycle and keep active through it-well done for that!
Definately looks like your isophane dose needs to be increased. Try increasing it by 2 units and see if it makes any difference. It doesn't seem like Novorapid is doing much for you, and you need to speak to your doc about an alternative. I agree with previous poster, that your diet is quite carby, but with the abount of activity you're doing and novorapid you're taking(if it were working) that would be enough to keep your levels ok, i would have thought.
Do you drink a lot of water through the day? You should be drinking at least a litre of water a day, as the high sugars will dehydrate your body. Keeping your body hydrated can also help keep BG levels down.
Dry white-wine in moderation
I hope things improve soon,. You can't let your levels stay this high indefinately, you will suffer probs. Your doc must be concerned, has he/she offered any suggestions? I hope you feel better-keep us updated
Jus x

 

[josie38]

Hi megan,

Could you possibly be having 'rebound' sugar levels in the morning, where you are having night hypos but don't realise it. I have suffered this on/off for 13 years and i have to juggle my insulins around a lot.

It would seem that you are only using one correction a day (in the am) depending on what your target bs is i would suggest correcting for any or even slightly high. As my consult is fond of telling me that when you start hi in am 'you are constanly chasing your tail for rest of day'. it could be that you need more comprehensive carb counting advice over what target bs you would like to be and getting a carb ratio and correction doses.

i know how you feel about being constantly high as i have periods like that and nothing you do seems to change it.

Hope you find a solution soon!!!! :wink:

 

[iHs]

i do not believe i am hypo-ing over night.....i have tried reducing the insulin as has been advised to see if i am over insulin-atised!

i am 5ft 6" and on approx 60 - 75 units total of insulin a day


what on earth do i do next???

Hi again Megan

If you are using 60-75 units insulin per day then it looks like your correction factor is incorrect. From what you have stated 1 unit of bolus is not making yr bg level drop by 2mmol. Try using 1 unit to make bg level drop by 1mmol to see what happens. Novorapid is ok for most carbohydrates that are low to moderately high but anything really high like pizzas (very fatty) etc, it is going to struggle. The stuff that you are eating contains a fair amount of fat so that is going to keep your bg elevated for longer along with the carb content.

I know very much that DAFNE should mean that people should be able to enjoy whatever food they wish to eat but sometimes a change in the type of food is needed. Just have the pastry type stuff every now and again.

 

[badmedisin]

Hi megan,
I've recently switched to porcine hypurin isophane and also having a massive problem with morning levels. This week I'm using the continuous glucose monitor from the hospital so I can see if I'm having night hypos, but I don't think I am.

So I can't really offer advice on the background insulin cos I'm a bit **** at that! But quick acting makes more sense to me. I think you need to do more of it. You don't say how much carbohydrate you're having at meals, and that's the important thing to be exact about if you're using the dafne method. My breakfast ratio is 2 units to 1 cp, so 2 slices of toast is about 3cp (30g) and 6 units would be about right. But your lunch and dinner ratios obviously could be different to your breakfast ratios, so you'd need to be exact about your carbs and adjust your ratios. I find I need 2:1 at lunch, 2.5:1 at dinner and 1.5:1 if I have something like a latte separate from meals.

Also it doesn't look like you're doing any correction doses at lunch and dinner. If my bg is above 7-8 before a meal, I would do a correction dose on top of whatever I need to account for my carbs. The general rule is that 1 extra unit should lower bg by 2-3 mmol, but once your bg us above 11 this is a bit unpredictable, so it all gets a bit trial and error.

My morning levels are tending to be around 18 recently, so I'm working on the background thing. I'm wondering whether the time I do my background injections could be a factor too, since the isophane has peaks rather than the flat profile lantus has. But I'm managing to get my bg down during the day, despite my carb addiction, by being exact with the carb counting, adjusting my ratios, and doing correction doses when necessary.
As for the background, we'll get there eventually
hope you feel better soon.

 

[megan]

thanks for all the responses....i didn't explain very well, but i go through different phases of correcting and not. at each meal and then just at one etc etc...

when i have seen a dr i have been constantly told to stop correcting so much..so i did....it didn't work

i was told i was taking too much insulin and to reduce all my doses.....so i did...it didn't work...

there is so much i have tried and do repeatedly every now and again, i just get fed up of writing it all down, so i know what i've done, and the dr (the specialist) and the diabetes nurse had no further information to help me with....they did eventually tell me just to get on with my life and be happy.....

mmmmmm not so ......we all know about the complications...and then when i kept asking for help, i was told i worried too much and and should stop

that was several years ago...i have not been back to them.....i saw them for years and i was just paying to be spoken down to and not really helped that much..

my gp has obviously been in contact earlier this year when i asked for his help...he lectured me for 45 minutes with my mum and husban with me....he spoke over all of us....and told me the facts about myself as he saw it.....bearing in mind i hadn't got to speak or show him what i'd been doing......

and so he told me to go back to what ever i did before and just be happy because diabetes isn't meant to be that hard..

mmmmmmmm......what can i say..

i have picked out so tips from here and there...i have reduced my carbs massively these last 24hours.....

i have got the bloods down, but then last night went from 5.7 to 7.7 to 10 this morning??
sounds like basal? i guess i shall increase tonight...but i am on antibiotics now so i want to be careful

 

[josie38]

Hi megan,

Its not very nice that you keep being told to just get on with it. I'm very lucky that my consultant and dsn(who is a friend) are very patient with me and try to help when i have problems, but i must admit there was a time when i had to go and see them every month because diabetes not going well. I do know how maddening it is when you are constantly changing things and nothing works. :x
When i went to see my GP about my problems he told me to get in touch with the hospital so i dont bother going to him if i have problems with diabetes.

I do hope everything works out for you hun x

If you need to chat anymore send me a private message and we can moan together!!!!!!

Josie

 

[megan]

thank you for the support.....it is very kind

I do not have access to anyone but my gp or i wouldn't have bothered there believe me..

but i am working on that....geographically its not very easy....I have been in touch with a diabetes nurse who was very kindly going to talk to me on the phone but has not be able to return my calls as yet...

so i am still injecting in my arms and for now that seems to be making a difference...but although some of my sugars are better, I have also had some rather nasty hypo's and then hyper's....

but it does come with the territory and I am doing it alone at the moment...so i shall just see what tomorrow bring s for me :roll:

 

[josie38]

Hi megan,

Its good that you sound a bit more positive about things.

Hopefully the diabetic nurse has been in touch and you are getting a bit more help.

Try to positive hunxxxxxxxxxxxxxxxx

Josie

 

[Gjimmy]

I have just seen this post so ignore this if your problem has already been cured satisfactorily.
It seems a strange mix An analogue insulin and animal insulin together ?
There is a simple cure to your problem. The isophane insulin has a peak type profile which confuses some people who do not study the profile properly.
You are taking Novorapid this is an excellent insulin when used in conjunction with Novo Nordisk's other insulin, designed for a basal longer acting approach to diabetic control. This is of course Levemir. Levemir has what is called by experts a flat profile, which means it does not peak throughout the day, it just keeps a steady basal level. You then simply inject the proportional amount of Novorapid to match the carbs in your meal . Take the Novorapid about 15 minutes before you eat, and check your blood sugar level 2 hours later to make sure it is less than 8.
If it isn't then the next time you have a similar meal use more Novorapid.
The combination of Levemir and Novorapid makes diabetic control easy peasy.
To combat the effect of the dawn phenomena of high blood sugars, make sure you use the appropriate dose of Levemir at bedtime . Make sure you are not too low at bedtime otherwise you will hypo in the night, and will have a corresponding liver dump of glycogen in the morning causing a high BG level. Try to start the day with a BG level below 6. If it is higher than 10 then simply use more Levemir at bedtime. This should set you up for the rest of the day. A high BG level in the morning will cause your BG level to remain high for the rest of the day.
Your BG levels are far too high. Levemir should sort this out. Some people take 2 injections per day others take 1 . You will also discover you will have less hypos as your body's sugar levels are more balanced throughout the day. You are not being vigilant enough with your diabetes. Take more care of yourself. Count your carbs. Don't just eat any old stuff without careful thought. Diabetic control has been made a lot easier with the analogue insulins. I can't believe you are using animal insulin at all. Unless you are among the many people who have a lack of tolerance of analogue insulin. This can't be the case because you are using Novorapid.
BTW. Don't use Lantus , it is akin to toxic waste because it has a high affinity to the igf-1 receptor in the bodies cells, 600% or so. Sanofi Aventis shouldn't really be marketing anything with a level above 100%. It is a powerful growth hormone which can promote the growth of dormant cancer cells , which would otherwise not be harmful.
If your problem has already been solved simply ignore this post.