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

Mrs of type 1 said:
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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Sounds good. I think breaded mushrooms are around 20g of carbs per 100g weight so he could inject before or wait till the main arrives (depending on portion size of the breaded mushrooms of course).

If the mushrooms are deep fried they'll contain a fair amount of fat which won't raise bg too fast.... so personally I'd wait for the main course to arrive before injecting, just remember if he's not certain of the carb count for his food he's better giving a little less insulin and correcting later than giving himself too much and going hypo and spoiling the night.

Enjoy the meal:)
 
kkkk said:
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!)
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I think the trouble is if you bolus with the main taking into account your dessert you don't know if your going to be too full to eat it after the main course, I've seen myself order a main and struggle to finish it and couldn't possibly face a dessert, however there are times when the main course is like a children's portion and I could eat a scabby horse afterwards :)
 
Ii use my Levemir at 9pm, but I was told it didn't matter what time I picked as long as it was before bedtime and at the same time every day
 
If your husband still has problems with the diabetes nurse not allowing him to increase his Lantus at least then I think it may be time to ask for a second opinion because increasing my Levemir (and NovoRapid) have brought down my b.g from high 20's to low teens in a matter of a couple of weeks. At the end of the day the longer your husbands glucose levels remain high the more damage it is slowly doing to his body and of course nobody wants that to happen. I am really struggling to understand why the diabetes nurse is unwilling to even try increasing at this moment in time, to me that is rather worrying when his levels aren't improving. I do hope that things start to improve with or without the teams help
 
your husband need to wake up and do a test at 2am and one at 4am. he is either going hypo in his sleep or has dawn phenomenon.
If he has dawn phenomenon..... the way i got around this when I was on MDI was... My dr changed me to a new background insulin called Tressiba. It a peakless insulin and lasts alot longer than Lantus. I started taking my Tressiba at 1pm everyday which then had its best effect on my blood sugar levels in the early hours so I started waking up with readings of 4-8.
This was a solution which took years of trial and error for me. I then went on the pump as I could set the pump to deliver more insulin in the early hours.

Dawn Phenomenon is when your body starts releasing hormones to wake you which also causes your blood sugar to rise.

Do some research into Dawn phenomenon and Somogyi Effect. When you understand these two, you will be better geared to test which you have.
 
This isn't hypo rebound or Somogyi as they tested every 2 hours throughout the night and there was no hypo. This is insufficient basal.
 
you say that but without a CGM you cannot guarantee this. I been through this myself. Even tho I tested every few hours in the night, I missed a hypo at midnight. I dropped really fast directly after going to bed and woke up to test after i went hypo. i had this and then dawn phenomenon in the early hours. This is why I recommend doing research into both situations and having CGM. Like me, Lantus may not be the right long acting insulin.
Lantus isnt all that its cracked out to be. Tressiba is a much more effective and newer long acting insulin. The reason why they dont offer it to everyone is due to price. After 4 years of dealing with the same issues, I was one of the first to go on Tressiba and it changed my life. My HBA1C dropped from 12% to 8.4%.
 
SamJB said:
This isn't hypo rebound or Somogyi as they tested every 2 hours throughout the night and there was no hypo. This is insufficient basal.
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How can you be so sure?

I've often tested and had a good reading, only to be feeling the warning signs of a hypo or of going hyper. When I've re-tested 15-30 minutes later guess what? You got it, I've gone low or high!

BG tests and readings give a reasonably accurate reading at the time they were done - give or take a 15-30 minute window owing to blood flow, etc.

What your body is going through at that specific moment in time is neither considered, calculated or hypothesised by the meter**. Therefore, Mrs. Type 1's husband may have tested at 02.00 and been high, but then at 02.30 he drops off the scale and goes through a rebound bringing his levels up even higher.

I don't discount that his Lantus dose may be wrong, but I also believe - from long standing personal experience - that one should not presume to discount other factors at the same time. Keeping an open mind is essential to developing good control, otherwise you come to rely upon the very things that only treat the symptoms rather than the causes.

**One of the key benefits of CGM is that it can collate data on a continuous basis and not occasional tests, this data can then be analysed (manually at present) to discover trends, etc. Once the closed-loop system is perfected we will have a much more 'human' method of treating our condition. In the meantime, much of our personal treatment is based upon 'guestimates' - albeit, if done properly, based upon the evidence supplied through our meters and HbA1c's etc.
 
kerrygrant26 said:
If your husband still has problems with the diabetes nurse not allowing him to increase his Lantus at least then I think it may be time to ask for a second opinion because increasing my Levemir (and NovoRapid) have brought down my b.g from high 20's to low teens in a matter of a couple of weeks. At the end of the day the longer your husbands glucose levels remain high the more damage it is slowly doing to his body and of course nobody wants that to happen. I am really struggling to understand why the diabetes nurse is unwilling to even try increasing at this moment in time, to me that is rather worrying when his levels aren't improving. I do hope that things start to improve with or without the teams help
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I agree, both the nurses he speaks to want him to increase very slowly, we think when they first decided to his dose they got it totally wrong at 16 units a day, it was so much less than he was taking on the old system. We have noticed the last couple of days he is still high but not in the 20's maybe another unit may get him nearer.
 
ConradJ said:
How can you be so sure?

I've often tested and had a good reading, only to be feeling the warning signs of a hypo or of going hyper. When I've re-tested 15-30 minutes later guess what? You got it, I've gone low or high!

BG tests and readings give a reasonably accurate reading at the time they were done - give or take a 15-30 minute window owing to blood flow, etc.

What your body is going through at that specific moment in time is neither considered, calculated or hypothesised by the meter**. Therefore, Mrs. Type 1's husband may have tested at 02.00 and been high, but then at 02.30 he drops off the scale and goes through a rebound bringing his levels up even higher.

I don't discount that his Lantus dose may be wrong, but I also believe - from long standing personal experience - that one should not presume to discount other factors at the same time. Keeping an open mind is essential to developing good control, otherwise you come to rely upon the very things that only treat the symptoms rather than the causes.

**One of the key benefits of CGM is that it can collate data on a continuous basis and not occasional tests, this data can then be analysed (manually at present) to discover trends, etc. Once the closed-loop system is perfected we will have a much more 'human' method of treating our condition. In the meantime, much of our personal treatment is based upon 'guestimates' - albeit, if done properly, based upon the evidence supplied through our meters and HbA1c's etc.
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That is very interesting, I feel very overwhelmed by all the things that could be causing the high sugars, also I don't know if I said but once he gets up in the morning the sugars keep on rising all morning and don't start to come down until tea time despite all the corrections he takes, in the evening we have to be very careful as he goes low if he has more than a 1:1 for his evening meal. It would be good to have the use of a continuous monitor as then we would know for sure what was really happening. On the DAFNE course he was told he was testing his blood too much and should only test before meals, which we totally disagree with, they didn't seem to be in the slightest concerned about the high sugars just lows when he didn't go under 10 for the whole week!!! Sometimes I think it was easier not doing the carb counting and the Novarapid/Lantus.
 
If, as the OP has said, there is a steady gradient of increased BGs throughout the night and an increase during fasting then it is almost certainly down to insufficient basal.

It could be down to a hypo, but it's much more likely to be down to insufficient basal.

It's going to be difficult for the OP to get a CGM to prove otherwise, so the best they can go on is that there IS a steady rise in BG throughout the night and not a rebound from plummeting BGs between their 2-hourly readings.
 
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Mrs of type 1 said:
It would be good to have the use of a continuous monitor as then we would know for sure what was really happening. On the DAFNE course he was told he was testing his blood too much and should only test before meals, which we totally disagree with, they didn't seem to be in the slightest concerned about the high sugars just lows when he didn't go under 10 for the whole week!!!
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Hi Mrs of Type1!

That was also my experience of the DAFNE course. He absolutely must test before and 2 hours after each meal and before bed.

Personally, I also think his basal dose is too low, but I also wonder whether his basal isn't lasting the full 24 hours, so for part of the day he has no or insufficient basal. In that situation, splitting the dose to take some in the morning and some in the evening can be better - it's an extra jab, but might give him a solution. If it continues, it might be that Lantus just doesn't suit him and a swap to levemir might help.

Smidge
 
I take my lantus am instead of pm and it has helped balance things out for me I'm on 40 units with 1.3 ratio of humalog fast acting during the day !!!!


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smidge said:
Hi Mrs of Type1!

That was also my experience of the DAFNE course. He absolutely must test before and 2 hours after each meal and before bed.

Personally, I also think his basal dose is too low, but I also wonder whether his basal isn't lasting the full 24 hours, so for part of the day he has no or insufficient basal. In that situation, splitting the dose to take some in the morning and some in the evening can be better - it's an extra jab, but might give him a solution. If it continues, it might be that Lantus just doesn't suit him and a swap to levemir might help.

Smidge
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Hello Smidge,

I do wonder if they are against often blood testing as the NHS want to cut the cost of blood testing strips!
What doesn't make sense is if the Lantus doesn't last the full 24 hours, surely his blood sugar would be high in the evening rather than in the morning when the Lantus hasn't been in his system long? As it is now, he takes his Lantus at 11.30pm, when he gets up his sugar is in the teens and continues to rise until around 6pm when he starts to go down, you would think it would be the other way round if it was running out before the 24 hours were up. He should be speaking to his nurse today, hopefully she will have an idea what to do next.
 
mrs of type 1.... I really recomend that your husband try the dexcom CGM system and either change his Lantus to tressiba or go on a pump. The highs will cause complications so please dont delay..
If your husband has a serious dawn phenomenon (which I presume), then that is very hard or impossible to control with injections.
Read the NICE guidelines for a pump and make your case for funding. If you do decide on a pump, I really recomend the Omnipod tubeless pump. I am on this pump and I love it. It has given me my life back and my diabetes is now easily managed without any tubing!!!
 
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