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Erratic readings

M

Mel98

Member
Messages
11
Hi all

Need some advice - can't seem to control this blasted thing, despite talks with dieticians, nurses and endos. I'm tempted to go on the pump but i've been advised to try and stabilise things as best I can with injections and re-adjusting Lantus dosage. Nothing seems to be helping.

Brief history - 2 years diagnosed. HBA1c post honyemoon period was 6.3 but I was having multiple hypos a day. So not really 'controlled'. Then started to experience hypo unawareness. Had to raise sugars for a period of time to get the warning signs back. Next HBA1C was 7.5%. Awareness came back so I tried to get those decent numbers once more with more conservative insulin:carb ratios but started suffering hypos again - followed by a second round of unawareness. Now my HBA1cs cant get below 7.8% and I'm freaking out. I believe my fasting readings are what are causing me problems with my HBA1cs. I'm scared to go to bed on a reading below 7 because of nightime hypo fears (especially since I can't feel them anymore - had a nasty rebound one morning), so i'll always snack and wake up much higher. I've tried reducing carbs in my evening meals and reducing need for insulin, going to bed on reasonable readings of 6-8 but still waking up in the 9-10s. I just can't understand why my sugars are rising in the night (i'm not having hypos) Not sure if this is to do with hormonal factors (being a woman, i experience a lot of PMS symptoms throughout the month - no gynae can find reasons for it), Lantus coverage not working, Lantus dosage too low, or my body just doing weird things for the sake of it.

Any advice on how to achieve better control through the night on injections? I'm stumped.
 
Not sure when you take your Lantus, but when I first went onto it I took it before bed and used to go low during the night, so was advised to take it in the morning and that fixed it.

It has a very flat profile but seems to have a slight peak and tail, so best not to have the peak during the night.
 
I started taking Lantus in mornings to reduce hypo fears at night. But morning usage is causing my sugars to go higher in the night and by the time I wake up. So i'm tempted to start switching it back to evening coverage - perhaps the slight 'peak' will cover me better during the night whilst hopefully avoiding hypos while asleep. I don't know. I'm just at a loss with it all.
 
For me it was impossible to get good control on Lantus.
Have you considered using twice daily Insulatard as your long acting Insulin? You might find it works better for you.

I would urge you to try a pump if you get the opportunity. It sounds as if you would definitely fit the criteria. I had a horrible time on Lantus and the pump transformed my life.
 
I guess I have my own fears with the pump - it's a machine that could malfunction - i'm more afraid of it overdosing me on insulin rather than not working at all and putting me in DKA. At least with injections I know I'm the one administering. What's your take on the pump?

My medical team seem hesitant for me to try it as they think it will force me to micromanage more than I already do and given my personality i might overstress about it but to be honest, I'd be happier for the machine to do its thing if it actually stabilises my sugars. I'm thinking of family planning next year so its imperative i get good control.
 
You need to carry out some fasting basal tests to get your dose right, unless your basal insulin is right everything else is pointless IMHO, once your basal is steady then your 50% there!

Not sure if your diabetes team have recommended DAFNE or indeed you have done the course already, if not I would highly recommend the course and that you inquire about it asap.
 
cally said:
For me it was impossible to get good control on Lantus.
Have you considered using twice daily Insulatard as your long acting Insulin? You might find it works better for you.
Click to expand...

I've actually never heard of Insulatard. Only Lantus and Levemir?!

Lantus used to work well for me on my honeymoon period but now my pancreas has well and truly shut shop, I can't work out what my levels should be, how effective the coverage is or when I should take it. Totally ridiculous.
 
noblehead said:
You need to carry out some fasting basal tests to get your dose right, unless your basal insulin is right everything else is pointless IMHO, once your basal is steady then your 50% there!

Not sure if your diabetes team have recommended DAFNE or indeed you have done the course already, if not I would highly recommend the course and that you inquire about it asap.
Click to expand...

How do I do a fasting basal? Not eat carbs for certain periods? I've not eaten carbs and had readings of 7 average. But other times I won't eat carbs and it will be high protein meal and my sugars will be 9. I just feel there is no way of telling what is right for my body.

I've been on a NHS version of DAFNE at my local hospital. Still hasn't helped. :oops:
 
Mel98 said:
noblehead said:
You need to carry out some fasting basal tests to get your dose right, unless your basal insulin is right everything else is pointless IMHO, once your basal is steady then your 50% there!

Not sure if your diabetes team have recommended DAFNE or indeed you have done the course already, if not I would highly recommend the course and that you inquire about it asap.
Click to expand...

How do I do a fasting basal? Not eat carbs for certain periods? I've not eaten carbs and had readings of 7 average. But other times I won't eat carbs and it will be high protein meal and my sugars will be 9. I just feel there is no way of telling what is right for my body.

I've been on a NHS version of DAFNE at my local hospital. Still hasn't helped. :oops:
Click to expand...


For a night fast you would have your evening meal say 6-7pm and fast thereafter, you should start checking your bg levels from 4-5 hours after you last ate and make a record of them, in theory your bg shouldn't rise or fall much over 1.5 -2mmol and if it does then your basal insulin needs adjusting, you can do the same again in a morning, have breakfast then skip lunch and do as above, likewise eating lunch and skipping your evening meal.

Just make sure when you do eat your meals that they don't contain a lot of fat, fat slows down the absorption of carbs and can have a delayed effect on bg several hours later. Not sure what the NHS version of DAFNE is, however if you put DAFNE into the forum search engine you will find 100's of positive posts talking about the DAFNE course.
 
noblehead said:
For a night fast you would have your evening meal say 6-7pm and fast thereafter, you should start checking your bg levels from 4-5 hours after you last ate and make a record of them, in theory your bg shouldn't rise or fall much over 1.5 -2mmol and if it does then your basal insulin needs adjusting, you can do the same again in a morning, have breakfast then skip lunch and do as above, likewise eating lunch and skipping your evening meal.
Click to expand...

I take 12 units of Lantus in the mornings. I had my evening meal last night at 18.30 and deliberately had less carbs - about 20g and took 2units. Didn't eat thereafter. Checked before bed at 22.30 and it was 8.3. I woke up with 9.7. That's a rise of 1.4mmol but for a fasting reading that's still not good enough. Either the dosage of Lantus is not enough or taking Lantus in the mornings is not working for me?

The course at the NHS was good - similar to DAFNE's. Carb counting and the lot. But i cant get my levels right for whatever reason.
 
Mel98 said:
cally said:
For me it was impossible to get good control on Lantus.
Have you considered using twice daily Insulatard as your long acting Insulin? You might find it works better for you.
Click to expand...

I've actually never heard of Insulatard. Only Lantus and Levemir?!

Lantus used to work well for me on my honeymoon period but now my pancreas has well and truly shut shop, I can't work out what my levels should be, how effective the coverage is or when I should take it. Totally ridiculous.
Click to expand...

Insulatard lasts for about 12 hours so has to be taken twice daily. It's what I was given as a backup in case of pump problems. I did use it in the distant past also before Lantus became available.
I have used it a couple of times recently when I went to a weekend at a spa, and also when I wore a dress to a wedding and couldn't fit the pump in anywhere without an unsightly bulge! My blood sugars were fine both times.
I don't think Lantus is all it is cracked up to be. A lot of people have problems with it.
 
Mel98 said:
I guess I have my own fears with the pump - it's a machine that could malfunction - i'm more afraid of it overdosing me on insulin rather than not working at all and putting me in DKA. At least with injections I know I'm the one administering. What's your take on the pump?

My medical team seem hesitant for me to try it as they think it will force me to micromanage more than I already do and given my personality i might overstress about it but to be honest, I'd be happier for the machine to do its thing if it actually stabilises my sugars. I'm thinking of family planning next year so its imperative i get good control.
Click to expand...

I don't think there is any risk of pump overdosing you with insulin! I have had a couple of minor malfunctions with mine and it just ceases to work at all. Support is fantastic and you are soon up and running again. That's In 5 years of pumping.

I remember when I was on lantus I had all the same problems as you are having and never managed to get it right. I had no hypo awareness. I was always tired as never got a good nights sleep!
When I started on the pump I remember how amazed I was at being able to sleep all night without needing to get up to pee !!
Alright it does take a bit of work to get the Basals right to start with but for me anyway it has been fantastic and has changed my life.



Sent from the Diabetes Forum App
 
Mel98 said:
I take 12 units of Lantus in the mornings. I had my evening meal last night at 18.30 and deliberately had less carbs - about 20g and took 2units. Didn't eat thereafter. Checked before bed at 22.30 and it was 8.3. I woke up with 9.7. That's a rise of 1.4mmol but for a fasting reading that's still not good enough. Either the dosage of Lantus is not enough or taking Lantus in the mornings is not working for me?

The course at the NHS was good - similar to DAFNE's. Carb counting and the lot. But i cant get my levels right for whatever reason.
Click to expand...
If your BG only went up by 1.4mmol overnight then you basal is pretty good. You possibly could have taken another 1u of bolus with your evening meal and you would have been nearer, say, 5.3 at bedtime and 6.7 in the morning. Have you done any 'during the night' testing to see what's happening?
 
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