DKA!???

[donnellysdogs]

I use Toujeo and Novorapid. Switching from Toujeo to Tresiba this week. I do not have a half unit pen, but it would be really convenient if there even is a half unit pen with novorapid? I do use a CGM, the Dexcom G5, so I know what`s going on. I just can`t correct it, because every time I do 1 unit drops me 15 points. Double the points if I actually go out walking or shopping for one day. I do feel like **** all the time, but it is so normal to me now that when I don`t it`s not normal. I don`t care how I feel anymore physically, just care about the risks.

Do you basal test at all? If you can, this would help as the basic starting point.

If high after eating and it needs a correction then it may well be that you need to see if you need to check the time of your injections before eating...

1/2 unit pens are available for novorapid and tresiba.

 

[Elise Broenlund]

My advice is to go back to basics. That is, start from the beginning and don't assume that anything is right. Obviously, get help from your DSN and do tjings gradually as it's sensible to be cautious and to change one thing at a time.

I'd also suggest considering whether a change of insulin might be something that would help.

And do ask for a half unit pen. They're incredible useful, and available for most insulins. Your DSN should have some or you can just get your GP to prescribe the correct one(s).

Don't despair. There's an answer out there for you You just need to find it - with the help of your team and hopefully the many Type 1s here, some of whom will have had similar problems.

If you don't already have it, get the book Think Like A Pancreas. It's fantastic for Type 1.

Tagging some helpful Type 1s for you : ) @noblehead @himtoo @catapillar @GrantGam @EllsKBells @tim2000s and there are many more : )

Thank you so much for the support, but it is really urgent. In 3 weeks time I am going to the US for a worklacement as kitchen worker in Marina Cay Resort, Montana. I will be on my feet all day and it will be twice as hot as I am used to. Therefore, I am pretty sure my insulin needs will be far less than they are now.

 

[Elise Broenlund]

My doctor has always told me to inject right before I eat. I do see with my readings I could benefit from having the insulin on board 1 hour before I eat, but that is physically not possible as it would cause me to have massive hypos before the food kicks in. Once I did 1 unit bolus, my bg was 7 and turns out I did`nt need that 1 unit, cuz 20 minutes later my bg was 5 and kept going dow. I will ask for half increment pens, but are those profiled pens? I have always used profiled pens that I just throw away when I`ve used them up. I am switching my long acting insulin to Tresiba. The only thing I am wondering is if I would benefit from switching from novorapid to homolog. However I am not nearly confident enough to change EVERYTHING right now

 

[azure]

My doctor has always told me to inject right before I eat. I do see with my readings I could benefit from having the insulin on board 1 hour before I eat, but that is physically not possible as it would cause me to have massive hypos before the food kicks in. Once I did 1 unit bolus, my bg was 7 and turns out I did`nt need that 1 unit, cuz 20 minutes later my bg was 5 and kept going dow. I will ask for half increment pens, but are those profiled pens? I have always used profiled pens that I just throw away when I`ve used them up. I am switching my long acting insulin to Tresiba. The only thing I am wondering is if I would benefit from switching from novorapid to homolog. However I am not nearly confident enough to change EVERYTHING right now

Then I suggest two things only to prioritise - firstly, half unit pens; secondly, having your bolus at the appropriate time, which may allow you to reduce the amount of insulin you have and so avoid that drop after two hours.

You don't need to bolus an hour in advance. You should proceed with caution and gradually move your bolus forward eg try it 5 mins in advance for a few days and then increase to 10 mins. Very fast acting insulin isn't as fast acting as was originally thought, and most Type 1s need to bolus around 15-20 mins in advance of eating.

It sounds like you're having quite a few issues with your blood sugar. Can you also call your DSN for help?

P.S - I'm notbsure if they make half unit disposable pens but you don't need disposable pens. Re-useable pens are better, in my opinion - more robust, better mechanism, more environmentally friendly - and less bulky when travelling : )

P.P.S - you could try Humalog if you want. Not every insulin suits every person and it's worth a try.

 

[azure]

@Elise Broenlund Just realised that I'm assuming you're counting carbs - are you?

 

[Elise Broenlund]

Then I suggest two things only to prioritise - firstly, half unit pens; secondly, having your bolus at the appropriate time, which may allow you to reduce the amount of insulin you have and so avoid that drop after two hours.

You don't need to bolus an hour in advance. You should proceed with caution and gradually move your bolus forward eg try it 5 mins in advance for a few days and then increase to 10 mins. Very fast acting insulin isn't as fast acting as was originally thought, and most Type 1s need to bolus around 15-20 mins in advance of eating.

It sounds like you're having quite a few issues with your blood sugar. Can you also call your DSN for help?

P.S - I'm notbsure if they make half unit disposable pens but you don't need disposable pens. Re-useable pens are better, in my opinion - more robust, better mechanism, more environmentally friendly - and less bulky when travelling : )

P.P.S - you could try Humalog if you want. Not every insulin suits every person and it's worth a try.

I think blousing 5 or 10 minutes before eating sounds like something that could help me. My only concern with doing so, is some foods tend to not spike my blood sugar until an hour after eating, so I could go low before the food kicks in. I feel like it`s a greater chance of going low before the food kicks in as my bg will not go up and then down, but down and then up if that makes sense. That could also get worse if I`m having a busy day and have been out before eating, been walking a lot. I do notice if I go out walking right after eating, my bg just stays there - a flat line for 2 hours, no ups, no downs and then after 2 hours it goes dramatically down. If I am just home relaxing it goes up for 2 hours and then down. I am having a lot of issues with my blood sugar, recently I have felt great as I felt like I finally got it stable, but then the last couple of days I have gone from needing 30 units a day to almost surviving on my basal only which is 13 units, because of the hot weather and I live a more active lifestyle as a student in Chester than I do home in Norway.

I have considered trying humalog. I know a girl who had better effect of homolog than novorapid. I have done some research and read online, most websites say novorapid kicks in faster and peaks faster than humalog? You have any experience with both? Half unit pens, if they have to be non-disposable, heck I`ll take it. I am at the point where I am willing to try anything! Are those harder to use or just the simple, put on the needle, the number of units and inject? How often do you switch the insulin in those pens? How many units in one pen? I am used to Novorapid Flexpen 100 u/ml (300 units).

I asked for a urgent doctor appointment so I can make the adjustments right now and have a while to see how it goes before my placement as more adjustments will have to made when I go, because of the weather and the busy days, but they are not willing to see me until Friday 1st of June, next week! I am leaving around the 15th of June. It takes my body 2 weeks to completely adjust to a new insulin....so not very convenient, but they have agreed to switch me from Toujeo to Tresiba. However, I feel like I should stick with novorapid and do half unit pens for now, as I have very little time to fix this.

PS: I was not actually going to bolus an hour in advance, I just feel like if my pancreas worked that`s what it would have done

 

[azure]

Excuse the quick reply for now @Elise Broenlund

You'll probably find you can bolus at different times in advance depending on the meal (ie breakfast, lunch, etc) On pens I bolused with Humalog 30mins in advance of breakfast, 10 mins in advance of lunch usually, but could often get away with bolusing just 5 mins before my evening meal.

You've mentioned dropping before the food puts you up - have you asked about your digestion to make sure there are no issues with that that are affecting your control? What kind of things do you eat?

What you've said about the affect of walking (staying flat for 2 hrs then dropping) suggests your basal may be a bit high.

The re-usable pens are easy to,use : ) You just drop in a cartridge (like an ink pen) and screw a needle on. Each cartridge has 300 units so can last days. When it runs out you simply put a new one in. It takes seconds (literally).

 

[Elise Broenlund]

Excuse the quick reply for now @Elise Broenlund

You'll probably find you can bolus at different times in advance depending on the meal (ie breakfast, lunch, etc) On pens I bolused with Humalog 30mins in advance of breakfast, 10 mins in advance of lunch usually, but could often get away with bolusing just 5 mins before my evening meal.

You've mentioned dropping before the food puts you up - have you asked about your digestion to make sure there are no issues with that that are affecting your control? What kind of things do you eat?

What you've said about the affect of walking (staying flat for 2 hrs then dropping) suggests your basal may be a bit high.

The re-usable pens are easy to,use : ) You just drop in a cartridge (like an ink pen) and screw a needle on. Each cartridge has 300 units so can last days. When it runs out you simply put a new one in. It takes seconds (literally).

Quick reply is absolutely perfect! Not a whole lot to read haha. I have not asked about my digestion yet, but I have had stomach pain for quite some time now so I can ask for an ultrasound to check my organs as I`ve had high bg`s for so long. I do not feel comfortable with blousing 30 minutes before eating, but I could try 10 or 15 Because of the drops after 2 hours, I have to eat every 3 hours and I am thinking maybe that is why it takes an hour for the food to spike my bg?

This is what I eat:
Breakfast: 2 slices of bread (with or without milk) or oatmeal
Lunch: Soups with 1 bread roll
Dinner: Fish / meat with 2 potatoes or rice
Evening meal: 2 slices of bread / oatmeal / omelettes

Pretty simple normal food, I don´t eat a lot of quick carbs either.

 

[Elise Broenlund]

Do you think switching from Novorapid to Fiasp would help solve my problems?
It is an even faster acting insulin that would be out of my body 3 hours after eating, might minimise my drops.
It is considered to be twice as fast as Novorapid, so I may need less of it and a lower basal, but what do you think?

 

[azure]

Do you think switching from Novorapid to Fiasp would help solve my problems?
It is an even faster acting insulin that would be out of my body 3 hours after eating, might minimise my drops.
It is considered to be twice as fast as Novorapid, so I may need less of it and a lower basal, but what do you think?

I haven't used Fiasp, but @tim2000s uses it. @tim2000s perhaps you could have a read through of this thread and give your experienced opinion about what's going on and whether Fiasp might help at all?

@Elise Broenlund The reason I suggested asking about tummy issues is that occasionally people with diabetes get an issue with stomach-emptying and digestion. This can cause a problem with hypos and erratic sugars. It's worth mentioning to your team so it can be ruled out. Also mention your stomach pain so that can be checked out too.

Personally, if it was me, I'd experiment a little with insulin doses and timing - but only if you're confident doing so. I'd take my most difficult meal (eg breakfast, etc) and eat exactly the same thing a few days in a row and experiment with bolus dose and timing carefully. Reading your problems, this is the first thing that occurred to me. As I say, a carefully timed bolus can mean you can reduce your bolus amount and get smoother sugars after meals.

That's a simple way to try to improve things. Another simple thing is simply to have a small snack between meals when needed. Some people do need to do this. It's a quick answer. You can always eat a slightly smaller meal and then top up your sugar with a little snack when needed. I've found this works well.

However, getting your basal sorted is also important so if your insulin change doesn't work, don't panic. There are other basal insulins you can try : ) And if it does work, then you may find that smooths things out : )

 

[tim2000s]

If I'm honest @Elise Broenlund I think your basal probably needs to be modified first up as what you're describing doesn't sound like it's set right. Then you never answered whether you were carb counting, and if you're thinking of Fiasp, that's even more important than Novorapid or Humalog, as it acts that much faster, having the dose wrong has a much quicker impact.

Personally, before looking at Fiasp, I'd try and sort out Basal and Insulin Carb ratio, and count carbs properly.

I also would consider waiting for FIAsp until you are back from the US as it isn't available in the states.

Just my twopenneth.

 

[Elise Broenlund]

If I'm honest @Elise Broenlund I think your basal probably needs to be modified first up as what you're describing doesn't sound like it's set right. Then you never answered whether you were carb counting, and if you're thinking of Fiasp, that's even more important than Novorapid or Humalog, as it acts that much faster, having the dose wrong has a much quicker impact.

Personally, before looking at Fiasp, I'd try and sort out Basal and Insulin Carb ratio, and count carbs properly.

I also would consider waiting for FIAsp until you are back from the US as it isn't available in the states.

Just my twopenneth.

If I'm honest @Elise Broenlund I think your basal probably needs to be modified first up as what you're describing doesn't sound like it's set right. Then you never answered whether you were carb counting, and if you're thinking of Fiasp, that's even more important than Novorapid or Humalog, as it acts that much faster, having the dose wrong has a much quicker impact.

Personally, before looking at Fiasp, I'd try and sort out Basal and Insulin Carb ratio, and count carbs properly.

I also would consider waiting for FIAsp until you are back from the US as it isn't available in the states.

Just my twopenneth.

I was on Levemir for 5 months, then a failed attempt to make an insulin pump wok for 2 months. Then 2 months on Toujeo which I think is giving me horrible side affects. So Tresiba and Lantus are the only other options that are available in Norway. Insulin carb ratio does`nt work for everyone and unfortunately it does`nt work for me. I could easily do the same dose for 2 tacos as I do for 2 potatoes....just how my body works. Thank you for the advice I will try to get my basal sorted. It very
well may be that I just don`t need basal during the night or I need far less than during the day.

 

[tim2000s]

I know this might sound quite blunt, but unfortunately, you get out what you put in. Given the description of your symptoms, I'm really surprised a pump didn't work for you as it sounds like the ideal solution to your issues given the much smaller doses that can be taken.

Your description of "I could easily do the same dose for 2 tacos as 2 potatoes" just adds to the impression that your basal is not set up correctly.

Whilst you say that insulin carb ratio doesn't work for everyone, you are the first person I've come across to say that. Like I said before, that's also usually a symptom of not having Basal set up correctly.

As others have said, I think you need to go right back to the start and act like you're newly diagnosed, and work everything out from there. You may be surprised at what you find!

 

[LittleGreyCat]

As a T2 I will stay away from insulin issues, but I would believe a blood ketone test over a urine test every time.

I've used Ketostix to check that I am producing ketones as part of LCHF and switching to fat burning instead of carbohydrate burning. My quick test was in the "walk don't run to A&E" range for a T1 but there was no way I was anywhere near ketoacidosis. I was (presumably) just producing more ketones than my body could burn for energy. The Ketostix just measure how much your body is throwing away and from my limited reading it is not uncommon to have a high Ketostix reading with low blood ketones.

Not much help to you in the short term, but I wonder if LCHF might help in the longer term? I know some T1s are following it and I think it helps iron out the ups and downs everyone (diabetic and non-diabetic alike) can get trying to balance carbohydrates with insulin.

 

[Elise Broenlund]

I know this might sound quite blunt, but unfortunately, you get out what you put in. Given the description of your symptoms, I'm really surprised a pump didn't work for you as it sounds like the ideal solution to your issues given the much smaller doses that can be taken.

Your description of "I could easily do the same dose for 2 tacos as 2 potatoes" just adds to the impression that your basal is not set up correctly.

Whilst you say that insulin carb ratio doesn't work for everyone, you are the first person I've come across to say that. Like I said before, that's also usually a symptom of not having Basal set up correctly.

As others have said, I think you need to go right back to the start and act like you're newly diagnosed, and work everything out from there. You may be surprised at what you find!

You may be right, but if I got what I put in I would not be struggling this much. There is nothing I haven`t tried and I don`t feel like a newly diagnosed type 1, I feel a 100 times worse than that. Newly diagnosed, it was super easy. It`s the experiences I got with the pump that caused all of this. I know it is surprising and yes it sounds ridiculous, but I don`t know why nothing works for me. The pump caused me 1 episode of DKA and 3 seizures from low blood sugars, so no I do not want to put my life on the line again any more than I have to to survive. I do realise a pump is the only thing that could fix this, but to me it was super complicated to get my basal right and I tried for a long time, but eventually I had to realise it`s not for me. Not now anyway. Maybe in the future, but if I do decide to go on a pump again it will be the Medtronic Minimed 670g or the Omnipod Horizon Hybrid Loop System with the dexcom sensors. I really love that the omnipod is tubeless, but I have also dreamed of the 670g for as long as I can remember. I probably have to wait another year or two before it`s released in Norway. My only concern about automated basal insulin delivery is, how do you know which bolus works with the basal the pump figures out for you? Are there truly no settings your endo puts in for you? Does it just learn your basal as you go along?

 

[azure]

I understand your feelings about a pump but my pump was and is an absolute godsend. No basal worked for me but my pump has the perfect basal for my body and the difference in how I feel is enormous. It gave me my life back.

However, the pump is only as good as it's user. My pump was set up by the company rep and then I altered the basal myself. I never use my pump to 'decide' what I need. I decide myself. That way I get the best control.

I know you've said you can't do a basal test having tried previously, but did you try doing it gradually by taking a segment of the day/night at a time? If your basal is wrong, it makes control hard.

If you're feeling so bad - and I truly understand why, as it sounds awful and incredibly frustrating - could you consider moving to a different hospital or consultant? Perhaps you might get more/better input then.

 

[donnellysdogs]

.. a pump is not the right tool for everybody... you are right.

I had a pump (brilluant for 5 years) but all of a sudden cannulas wouldnt work...took 5 horrid hospital emergencies to find out exactly the cause of probs... so I completely empathise with you...
Totally.

However, there isnt a magic answer of one size fits all.. but your basal being correct is a must...
And to be honest - there are ways to get better responses with your eating and bolus's.

I have to have a strange mixture of two basal background insulins and its taken 3 hospitals and extensive monitoring to establish what routine has been necessary to get numbers better since I had to come off the pump..
3 years down the line now and I'm not totally happy with levels but there isnt one single person I know that has to wake at 4am (or 4hours before waking for first basal and again another correction bolus before feet on floor etc..

We aree all individual ...BUT there are ways for you to get better levels and your acceptance and commitment to keep trying things like carb counting and basal testing is hugely important...

I have also had chronic digestive issues... I also have some screwy results for different foods etc or the same food according to how my stomach and colon is working.
However, carb counting is vital... it maybe that it teaches you that rather than just ditching the carb counting.. that it is identifying foods that react well and those that dont.

I do not eat bread, pasta, rice or meat. Or leafy veg and too many foods to list.

With you, you need to eat lower carbs and 5 hours apart.. and to watch exactly...keep each meal under 30g initially of carb.. keep to 30g for every meal.. (or 20 or 10, but no more than 30g) for a month.
This will allow you to see if its actually that mornings.. have a different bolus ratio to evenings.

I really think you have chosen to give up carb counting rather than using it to give you basics...

 

[donnellysdogs]

You have to be able to manage own ratio's etc on mdi and pumps. Endo's only give you the basic set up....they cannot live your life. They see each patient for 15 mins a year-honestly how can they know you as well as you are hoping..??

Please go back to carb counting..

I dont know your reasons for not being able to basal test-Unless its due to being tube fed etc.. I cannot fathom reasons for no basal Testing to be honest but this just makes it more necessary for carb counting.

 

[MelissaC]

Hi @Elise Broenlund Just wanted to quickly say that I use a NovoRapid half unit pen and it's great so would recommend trying to get one of those if you can. Basically you'll get given cartridges of NovoRapid which you insert into a re-usable insulin pen. Once the cartridge is empty you just pop in a new one

 

[Elise Broenlund]

Hi @Elise Broenlund Just wanted to quickly say that I use a NovoRapid half unit pen and it's great so would recommend trying to get one of those if you can. Basically you'll get given cartridges of NovoRapid which you insert into a re-usable insulin pen. Once the cartridge is empty you just pop in a new one

Thank you for the input everyone. Part of why I am going to the US this summer even though I´m in no condition to do so is because I feel like it is the only way I`ll get past this horrible time in my life, by focusing on something I actually enjoy. I explained the situation in more detail to my doctor today, so I got an appointment in 2 hours! Definitely asking for novorapid in half dose pens, thank you Melissa C