Controlling blood sugars- advice needed!

[crazyfool46]

Hi there,

I am new to the form- this is my first post, although I have read lots of handy tips and advice in the past. I feel compelled to post as I am having a hard time at the moment controlling my blood sugar levels and I wanted to seek the wisdom of the diabetes.co.uk forum!

I am a 37 year old male and I was diagnosed with type 1 5 years ago. I live a fairly health life and after getting to grips with being diagnosed for a few years, I have been a regular gym goer for the last 2 years. I go to the gym 3 times a week and tend to stick to a set programme so that I know what I am doing and so that I can with a little bit of experimentation get good control over my blood glucose. I have always gone to the gym at 5am in the morning (before the rush and the kids waking up!) and exercised on an empty stomach through predominantly weight training.

I am in decent shape but want to improve that further and drop body fat/get really lean. About 3 weeks ago I changed my exercise routine to include 20 minute sessions of high intensity cardio on top of my weight training. I have also adapted my diet reducing carb intake, increasing protein and sticking to a fairly rigid calorie regime. I tend to eat the same thing every day (during the week up until dinner and so I can control my blood sugars pretty well during the day. However, I am finding that after a low carb dinner and good blood sugar levels in the evening (5-8), before bed my levels begin to rise (8-14) and that after taking a corrective dose 9which I know from experience is the right amount to bring me back to normal) I am having hypos in the early hours (2-5am typically). I have tried leaving my levels as they are before bed (8-14), and sometimes I do not have a hypo in the early hours, and my levels on waking are back to normalish. This doesn't always work and sometimes I still have the hypo in the early hours and sometimes on waking my levels have remained high (8-14).

I was initially taking on 28 units of lantus long acting taken at 10pm, but I have reduced this to 26 and now to 24 and I am still getting the hypos. Not only are the early morning hypos exhausting and making it hard to work and continue my exercise regime, they also make controlling my levels during the rest of the day a real challenge.

Has anybody got some advice for me? Do I continue to reduce my lantus until no more early morning hypos? If so, what about the rising levels in the late evening- doesn't that imply that I am not taking enough long acting? I am very confused... What about splitting my lantus dose- why do people do that and what effect would it have re my early morning exercise etc?

So many questions- any advice would be gratefully received!!

Thanks

Luke

 

[Juicyj]

Hi @crazyfool46 Welcome to the forum

I'm also 5 years in now too

It sounds like you have answered your own question in regards to your lantus, if you're hypo-ing 2-5am then your quick acting is non existent so you need to adjust your lantus. However in regards to the rising BG levels in the evening my suggestion would be to look at doing some basal testing, have you ever done this ? It's pretty straight forward but will determine if your background is supporting you i.e. keeping you in range or if you need to adjust your quick acting ratio for evening meals, basal testing can be found here:

The guidelines from Salford Diabetes Care (http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007) gives the following information:

Evaluating the results and Suggested Changes

For each time period:

• Compare the BG readings for the three times you have tested a particular time period and look for a pattern
• BG changes of more than 2.0mmol/l between readings indicate the need to adjust the basal rate
• Make basal rate changes in small increments, typically 10%
• The basal rate should be increased 1-2 hours before the BG begins its rise or the basal rate needs to be decreased 1-2 hours before the BG begins its fall
• Make one change at a time
• Re-evaluate that time frame after any changes to the basal rate are made
• Then move on to the next time period

Please also contact your diabetes nurse to confirm any adjustments with them also - I would also see if they can lend you a continuous glucose monitor, most trusts keep 1 or 2 available for patients to try, which is a great way to see a pattern forming over a 24 hour period, useful for times like these when you have an anomaly to sort

 

[Just_Me_Rachel]

Hi, I'm not sure I can help but I'll share what I've done and heard throughout the years... firstly exercise effects people differently, some people go high after exercise, I always go low. Also, exercise can have the effect of making you go low only a few hours later.
Re lantus, my understanding is that lantus works strongest after you take it and then as you come to the end of the lantus period, it slows down. this may be explaining your evenings highs which is just before your next due dose. This is also why people split the insulin , like I did, to avoid these peak and fall times. Because as one dose trails off , the other one is still working fine, and so the cycle continues.
Additionally, if you find you go low in the night, splitting would help you be able to significantly lower your evening lantus dose whilst your morning one can stay like regular (or half of regular as the other half is going at night). Of course the morning one will have some affect at night still but not half as much.
Another consideration is to switch your insulin time from night to one time full dose in the morning. I've done this too, to avoid lows morning hours.
Good luck!