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Diabetic nurse doesn't know what to do, help needed please.



When you do basal testing you should fast completely and avoid food altogether and just drink water, Gary Scheiner mentions this in his book Think Like a Pancreas. Salad contains carbs and protein (in a meal with no carbs or very few) will convert to glucose by around 50%.
 
Have to (100%) agree with Sam and Noblehead. It sounds as if his basal is too low. My Lantus lasts me the full 24 hours, It's mainly Levemir that needs to be split.
 
My son as the opposite he is normal in the morning always around 6 and then slowly creeps up through out the day ending up in the 20's at evening, but always back to normal by the next morning.

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Shows how amazingly different all our bodies are Nothing like making it easy for us!

Gemma88 - if he gradually rises in the day - is that because he doesn't have enough insulin for the meals that he eats, or if you give extra does he hypo after the meal? Have you tried a basal test where he doesn't have any carbs for lunch and seen whether his sugar rises with that (the DSNs will be able to give extra advice on day time basal testing)….'cos in my mind the fact that he can drop from 20 down to 6 in the morning suggests that he is probably having too much long term overnight (if he isn't blousing for the high blood sugar) so if you do do any adjustments and get him lower before he goes to bed be really careful of night hypos. When I was on one injection of levemir I found that it had run out by tea time and that I would have to have a significantly bigger doses of short acting insulin with tea to keep my blood sugar down which is why I went onto a split dose of levemir some in the morning and some in the evening - but speak to your DSNs about it and they should be able to help and advise.
 
Can I ask whether your husband's weight is within a reasonable range? If overweight you can have insulin resistance and that can make getting the balance quite difficult. The number of insulin units is quite high anyway which suggests some insulin resistance. If there is a weight problem then reducing this thru low-carbing should help. It may not solve the problem but may help. Apologies if I've guessed wrongly!
 
Mrs of type 1 said:
We think he needs a larger dose of Lantus but his DN is very reluctant.
Click to expand...

I realise the DAFNE course is different across the country and people come away with different levels of understanding, but he should be able to follow the steps taught in DAFNE to adjust his own doses without the help of the nurses.....

Is that possible at the moment.......?
 

As, Lantus is supposed to last better than most (although, as per many previous posts, it doesn't seem to go the whole 24 hrs) then surely - if it's taken around 9-10pm the dose will at least last until 6am the next morning!?! Furthermore, evidence suggests that if you don't eat then the body will begin to produce glucagon to dump sugar from the liver and ketones turn body fat into glucose. So, his morning highs could be the result of his body's own mechanisms - see this link: http://www.diabetes-support.org.uk/info/?page_id=143

As Mrs of Type 1 replied, his morning BG's continued to rise when he did the fasting / basal testing - as the article in the link states (under "Dealing with Dawn Phenonenon"): "5. Lastly, EAT BREAKFAST. The resulting increase in blood glucose from food will often turn off the continued rise. If you don’t, some diabetics will continue to rise until 10-11 am."

Interestingly, that article then talks about the "SOMOGYI EFFECT" (severe hypos in the middle of the night and subsequent early morning highs).

One has to consider injection sites and absorption ratios (i.e. different parts of the body will result in differing speeds of insulin release), food types eaten at tea time and the insulin given to compensate, as well as the possibility that he may have gone low in between blood tests and is already on a rebound when testing before bed. (Depending on his thresholds and his recent run of high BGs, his body could have reset its hypo triggers to a higher level - say 6mmol instead of 4.5 or lower.)

[quote="Mrs of type 1, post: 481632, member: 84279"Last night he done something he was told never to do, he took 2 unit's of Novarapid before bed, he was 14 due to not enough Novarapid when he ate crackers and cheese ( can't believe how much carb is in a cracker) Well it worked because this morning he was at 9 which is so much better than the usual 16+[/quote]

As Novorapid starts working from around 20minutes after dose for up to 5 hours after, it is quite possible this 'special' dose contributed towards curbing a rebound... but it may also be compensating for insufficient basal / shorter life cycle of lantus in him. Who's to know for certain? Only time and testing will tell.

But as I stated before - and others have also related in this (and many other threads), each one of us IS different and none of us should assume to know anothers body with any degree of certainty - suggesting possibilties is one thing, but certainty???

Well, put it this way, when I went through severe problems, my lantus basal dose went up to 36 units (I'm 181cm and was 72kg at the time), yet my BG's would hit 33.1mmol during the day and the only symptom I would have is anger! My body's hypo warnings were triggered at 13-14mmol and only constant bolusing during the day would keep me down. Was there something wrong with the Lantus? No, it was just that my body was not suited to it and the stress of everything made it all worse.

I wish Mrs of type 1 and Mr type 1 the very best of luck and patience, because when you're stuck in that cycle it is hard to see the wood for the trees.
 
My morning levels are also very high and I wouldn't want to take you away from medicine advice but I was told that if my morning test was still high to increase my Lantus (now on Levemir but still the same advice) by 1 unit and if that didn't work to keep increasing by 1 unit every 72 hours and slowly but surely my morning readings are coming down and this is always my worst time. I currently take 25units at night time which is still to low for me. It takes time but by doing this I am seeing big a big difference x
 
Wow, what a lot of replies, thanks so very much to you all for all the info you have given me. To answer a few questions that were asked, my hubby is 6 foot 2 and 14 stone 8, he has lost almost a stone in weight and last week alone he lost 4 lbs., he used to have to eat a lot of carb to keep his blood sugar high enough on the old system, this is why he changed to this and also why he was over weight. His DN doesn't want him to change any of his doses without her say so at the moment, we are abiding by the rules but we both think it really is worth changing the dose of the Lantus by a unit and seeing if this works. He should be speaking to her tomorrow and he is going to ask if he can put up the dose. We think it sounds like the Dawn Phenomenon.

On a slightly different subject, for the first time since the insulin change we are eating out on Saturday evening, it is at a friends house and they are doing a 3 course meal, there will be gaps between each course as it is a Murder Mystery evening ( Got no idea what to expect) We are not sure when he should take his insulin, as he is only supposed to have his Novarapid every 4 hours, any advice? Thanks again everyone.
 
I agree with increasing the Lantus by 1 unit every few days. It may be your husband's weight is still going down and therefore still has some insulin resistance. This will require more insulin than would otherwise be the case. I can't understand why your DN says don't change any of the insulin doses. With NovoRapid you should really be carb-counting. My DN from Day 1 gave me a Roche leaflet with pictures of typical foods and their carb level; she also said to look at the web. She told me to adjust my Rapid as needed to control after meal sugars. She also said to adjust my Levemir by a unit at a time and let it settle for 3 days to maintain a fasting level of 5 - 7mmol. So, keep the carbs down and say to your DN you wish to take control of your insulin units, measuring regularly of course.
 


We are carb counting and he can change the Novarapid as he sees fit, it's just the Lantus that the nurse doesn't want to him to change yet.
 


A tricky one if you don't know what courses are being served, if it's a friends house ask in advance what the courses are.

If the starter is low(ish) in carbs then he can just inject for the main meal when it arrives, tell him not to inject in advance unless he's sure what is going to be on the plate and certain when it will be served, for desert just give another injection according to how many carbs are there.
 

I tend to do the same - if the starter is fairly carb free - so melon and palma ham or salmon or something like that I just eat it and then inject at the main meal….this is just me but if it is getting quite late - i.e. post 8pm then I would ask to have dessert a little earlier as ideally I like to have my nova rapid through my system before I go to bed (again to avoid night time lows)….and I don't eat huge portions of dessert either I would eat the bulk of my carbs in the main meal - but I like the idea of bolusing for the dessert after (not tried that - (I'm just awkward and can't be bothered with the hassle of changing stuff too much as invariably it upsets the apple cart for me!)
 
Agree with novorapidboi, the Lantus should be the first thing to change. You can't get your ratios correct if your Lantus isn't. it's wrong that the DSN is saying you should get the Novorapid right first.
 

We have heard that the starter is breaded mushrooms, and the main is chicken in a sauce and roast potatoes, no idea on desert. Think one injection for starter and main (as long as there isn't a massive gap between them) then one for desert, if he wants it of course, sounds like a good idea
 
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