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constant swings...

A

academicdiabetic

Active Member
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Hi,

I am struggling to find any balance in my blood glucose/insulin. I take levemir (12 units) and novorapid (the latter 1 unit per 10g carbs). I eat a low carb vegetarian diet, exercise daily and weigh about 8 stone. My BGs are constantly spiking (20-35 not at all unusual in response to something heinous - like maybe a slice of brown bread or a yoghurt!), but when I take insulin to match, BGs often shoot down rapidly (e.g. 6 units novorapid can take me from a BG reading of 25+ down to 6 or less, despite carbs to match).

I am becoming increasingly worried about the impact of these wild swings, but the only way I have found to approach any sort of control is eating virtually nothing.. which obviously isn't tenable for that long and leaves me in any case on around 14 mmol....

is anyone else with LADA having the same problem? Any suggestions?

Thanks!
 
If that was my situation I would increase my levimir 1 unit at a time and give less novorapid.

I'm type 1. Have you been on a dafne course or told how to change your doses?


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Hi,

Thanks for your reply. I'll try that. No, I haven't been on a course, I was just told that, basically, all I need to know is to take 1 unit novorapid per 10g carb. Beyond that, the nurse pointed out that the number of factors impacting on blood glucose is too complex to taek into account (exercise, stress, sleep patterns, residual endogenous insulin, sugars in protein etc etc). What other suggestions did they give you on a DAFNE course?

Thanks
 
Hey academicdiabetic!

LADA's a b****r for that! I've had it for nearly 4 years now and I have reached some type of consistency with it but I still get too high highs and too low lows sometimes. In the early stages it was mad because I never knew what my pancreas was going to produce on any given day :roll:

A couple of observations for you that have helped me:

The 1:10 bolus:carb is only a starting point - you will need to adjust that for different meals, especially if you low-carb - the carb ratio doesn't really work for low-carbers. When I eat a no or very low carb meal, I still have to have 1 or 1.5 units Apidra (equivalent of novorapid), so basically, bacon and eggs would still require 1.5 units Apidra. In the absence of carb, about a third of the protein you eat will break down into glucose and will need to be jabbed for. High fat meals can delay the spike and I deal with that by splitting the bolus dose and taking a unit or 2 with the meal and another unit a couple of hours later.

Another starting point - 1 unit bolus will drop your BG by 3mmol. You need to spend some time experimenting and recording and working out how much 1 unit Novo actually drops you by.

For me, 2.5g carb will increase my BG by 1 mmol and 1 unit Apidra will drop my BG by 4.5 mmol. From that knowledge I have managed to bring a bit of consistency to things. (For your info, I am 7 stone and eat about 50g carb a day. I eat no bread, rice, pasta and very little potato and cereal. If I introduce those things into my diet I get the high highs and crashing BGs you are experiencing.)

I calculate every bit of carb I eat and jab for it. That includes vegetables, salad, pulses - the DSNs tend to tell you not to include those things. They are wrong! They also tend to tell you not to jab for anything of 10g carb or less - 10g carb would raise my BG by 4 mmol - I need to jab for it!

Now, your Levemir. I use Levemir as my basal. I take 6 units in the morning and 4.5 units in the evening. I find splitting the dose helps to give me coverage throughout the day and night without causing hypos. Levemir seems to last only for about 14 - 16 hours for me but to taking a bigger dose in one go to make it last longer causes me to hypo. So if you're going to try increasing your Levemir, you might be better reducing the single dose and adding a second dose rather than increasing the single dose.

Anyway, I hope some of that gives you some clues as to what is going on with you. I really do sympathise!

Take care

Smidge
 
Brilliant answer from Smidge.... I also will give myself 2 units for bacon and eggs together...

I also used to weigh and calculate everything... Even lettuce, cucumber , peppers etc....now I know how many carrots, brocolli, leeks I can have without measuring.

In basic terms... Dafne gives you information on how to adjust your insulin for the food you eat.... I'venever beenona course myself... Just taught myself.. And I have a pump as well..

When your levels go too high 2-3 hours after a meal then it may be your bolus insulin that you need more of. Adjusting basal rates on injections.... You really need to take in to account a whole days blood tests....as this can impact at different times according to when you take it....


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Dear Smidge,

Thank you very much for your detailed reply, I think that is the most helpful set of information I have had to date and makes a lot more sense than anything I have had from the nurse. I wasn't aware of the issue with protein if on a low carb diet (but having just started reading a food biochemistry text, it looks as if everything pretty much turns to glucose!). I think you are absolutely right that the only way to go is to evaluate what insulin/food does to oneself, everyone's chemistry seems to respond differently.

Thanks also for your reply Donnellysdogs, it is comforting to know that other people are struggling with the same issues (although ideally it would be better if no-one was!)
 
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