First Post,,,Help Needed,,

docvern

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Diabetes
What a welcome to find a forum for a forgotten people.....
First of all let me introduce myself,,,,I am a 38 year old front line police officer diagnosed with type 1 diabetes when I was 21..initially I had a bit of denial towards diabetes and tried to lead a normal life,,,,my HBA1C has never been in single figures with my normal being in or around 11. Eventually my Diabetic doctor got me on a DAFNE course as I am now starting to get minor complications eg burning feet. I finished the course 2 weeks ago and I believe it has given me the wake up call I needed and the knowledge to improve my general diabetes health. My problem is I do shift work and I know I could get put on day shift but for other reasons that really does not suit. My BG when I am on rest days I am very pleased with, with readings of between 5 and 9. But I am now sitting at 3.30 am with a BG of 16.0. My last meal was at 11 p.m. and comprised of chicken salad which I did not take any QA for ( my BG prior to eating was 9.4). Tomorrow I know I will wake at 11.30 with a BG around 3-4. What the heck am I doing wrong? Why is my BG creeping up in middle of night and then dropping so low during the day when I sleep???? I take 30 units of lantus at 10 p.m. and am completely baffled…..any help much appreciated….My DAFNE tutor is also baffled…
 

cugila

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Hi docvern.

Welcome to the forum.
Hopefully there will be a T1 around soon who may well be able to advise you better than I.

Ken.
 

Dennis

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Type 2
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Hi docvern and welcome,

I'm not a type 1 either so not an expert on injected insulin, but I suspect that your problem is not taking a bolus dose with your meal. Even a chicken saled will have contained some carbohydrate which you would need insulin to deal with.
 

phoenix

Expert
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5,671
Type of diabetes
Type 1
Treatment type
Pump
Hi,
Some speculation :!:
I too think that the meal would account for the rise. Firstly you were at 9.4 before the meal. At this level I would include a small amount of correction with my mealtime insulin. Secondly I find that a low carb meal containing a fair amount of protein needs some insulin. (protein also converts to glucose)To be honest I haven't worked out an exact ratio and tend to use a bit of trial and error but (and this is personal) I would probably use 1 unit for correction (1 unit reduces levels by an average of 2,7mmol) + 2- 3 for the meal so I 'd use 3-4 in total.
(edited to add that I rarely eat very low carb meals and they're usually English breakfasts when travelling so I might use a bit more than if active afterwards)

Another possibility is that your basal is wrongly calculated. It shouldn't be reducing your levels at all and if you do indeed go from 16 at 3am to 3 at 11 it is doing that. You probably need to test your basal dose and perhaps consider splitting it, maybe using an uneven split to cover night and day rather than a one dose. Your DAFNE trainer should help you do this and see here:http://www.diabetesdaily.com/forum/articles/16675-basal-testing-multiple-daily-injections

Your work perhaps produces high intermittant stress/adrenalin levels and consequent rises in glucose levels. Is it possible that the very high jump between your meal and 3.30 was caused by this? It would be useful to know what your levels were like at 1.30am. Also at 4 hours later If you knew that you had a stable basal you would be able to give a small correction without fear of a hypo later.
Another thing that occurs is that you have very different insulin requirements for working days and rest days and probably that your job varies from day to day. You may require different ratio of insulin to food and a different correction factor on work days. It maybe that you also need a different basal for work days, though this is more problematic on MDI. This is where a pump would be useful if you were allowed to have one.

Can I suggest a couple of books ? Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin by Gary Scheiner and Using Insulin by John Walsh ( both from the US and to a certain extent cover similar material but some prefer one over the other)
 

Dennis

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Thanks Phoenix!
 

yipster29

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200
Hi Dennis

I'm a newly diagnosed type 1 so by no means the oracle on all things insulin but I would completely back up what Pheonix said.

At 9 before a meal I would add a unit of insulin as a correction and even a low carb meal I would need a couple of units.

I use Levirmir overnight so don't split although a lot of people on here do seem to need to, I was running higher than I should have been between meals and found adjustments led to dropping too low so DN swapped me to half unit pens which has made surprisingly large difference.. may be worth considering.

Also agree re work / rest days... I def need less insulin on day off as more active. Stick at it you'll get there!
 

docvern

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Diabetes
May I start by saying thanks to folks for responding it’s certainly give me food (sugar-free) to think about. As I have said in another post I would love to get put on a pump but for some reason they seem to be like hens teeth here in N Ireland unless you are a health worker!!! I am for clinic on Thursday so I will be obviously voicing my desire to have one, whether it works or not I shall have to wait and see.

Another confusion/ problem is when I respond to incidents I think I get an adrenaline rush which often I confuse with hypos so I pop a few extra strong mints and off I go. I hope with a bit more confidence and knowledge I will be able to knock that on the head.

Again many thanks it certainly seems the best tutors of diabetes are diabetics!!!
 

emma1972

Newbie
Messages
1
Hi

Only just read your post, I am a 36year old front line police officer with type 1 diabetes. I was diagnosed at 36years old. I am a traffic officer and have retained my duties after some initial resistance.
I used to take my Lantus at 10pm everynight as it fits with my shift pattern, however I had noticed that about 4 - 6 hours after taking it my levels used to drop before levelling out. I now take mine at 6pm every night so that if I do misjudge evening meal the lantus kicks in before bed and takes the edge off the high. I don't get many lows and am stable during the day without eating if necessary so I know I have the basal right. This may be happening to you as you wake up low, perhaps you could put it back a few hours so the low times in with your night time snack.

I low carb and often eat protein rich meals. Meals that are high in lean proteins can trigger a response from your body to produce glucose, I don't know how it works but it does happen. It is best to take in some dietry fat with the protein (not too much) and the body does not respond in this way.

Dont know if any of this is what you were looking for or is any use . Good luck.

Emma
 

Trinkwasser

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2,468
emma1972 said:
I low carb and often eat protein rich meals. Meals that are high in lean proteins can trigger a response from your body to produce glucose, I don't know how it works but it does happen. It is best to take in some dietry fat with the protein (not too much) and the body does not respond in this way.

Dont know if any of this is what you were looking for or is any use . Good luck.

Emma

Yes, in a normie carbs produce the most insulin release, protein will produce a lesser amount, fat none at all. Some Type 1s need to bolus for protein for this reason (a much lower ratio than for carbs).

The body (principally the liver) is pretty good at turning stuff into other stuff. If you eat carbs it will whoosh these into glucose, often more and faster than you need. If you cut the carbs below this level it will generate all the glucose you actually require from protein, which especially for us Type 2s is a much smoother and less peaky process, but it may still require more insulin than your basal provides to deal with it. Some individuals prefer R to the faster acting logs to cope with a high protein meal.