Frustrated

NikC

Newbie
Messages
4
Type of diabetes
LADA
Treatment type
Insulin
Hi

I was diagnosed LADA in June 2018, started Levemir twice daily in September 2018 and Novarapid in December 2018.

I ate a relatively low carb diet until recently when I was advised to introduce more to my diet. I have been having a sandwich at lunch time (granary seeded bread) and having pasta/ potatoes with my evening meal. I always weigh and check carb content.

My doses are: Levemir 14 at night 4 in the morning. Novarapid 1 unit per 10g but do round down rather than up as I think I do still have a little insulin production.

The issue I am having is, i check my blood 4 hours after my evening meal and insulin and it is often okish, ranging from 5-8. But on occasions I take bloods after 6 hours they are considerably higher e.g. last night 4hours = 7.8 6 hours 12.1. My morning reading was 8.9.

Im really confused about which insulin I should be altering to try and sort this out. Any guidance or info on similar experiences would be appreciated.
 
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K

Knikki

Guest
First off hello and welcome to the forum.

Ok let's see.

When your bloods were up at 12.1 what had you eaten?

Reason I ask is things like pasta usually take a fair while to digest, like me for example, have a pasta meal, calculate amount of short acting insulin I need to cover the carbs and within 2-3 I can be in hypo but some 6 hours later Im running way higher.

It might be the Nova you need to watch HOWEVER I'm no medical expert, personally I would stick to the 1 to 10 ratio especially if your not dropping down to hypo territory.

I would certainly contact your DSN or medical team and ask for advise
 
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karen8967

Master
Messages
10,330
Type of diabetes
Type 1
Treatment type
Insulin
i find if i have rice pasta ,or potatoes with my evening meal i have to spit my doses say i have 60g of carbs il do 4 units b4 then the other 2 about an hour an a half later this tends to work for me but may not work for everyone :)
 

NikC

Newbie
Messages
4
Type of diabetes
LADA
Treatment type
Insulin
Hi guys thanks for replying.

I did have pasta so it does look like I'm similar in terms of reacting later and I didn't think of splitting the dose. Thank you I will try that.
 
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Scott-C

Well-Known Member
Messages
2,474
Type of diabetes
Type 1
Hi, @NikC , I agree with the above comments re considering split doses for pasta etc., but another thing to consider is whether your basal slow acting insulin dose is right. Google "basal testing".

Basal is meant to hold you steady between meals after the carbs from your last meal have been absorbed and the last bolus shot has worn out. It deals with the steady trickle of glucose from the liver which keeps us going between meals.

I sometimes just have a long lie in on a Saturday, watch a couple of movies and see whether I hold steady.

If basal isn't set right, it's a house built on sand. You'll either be having to bolus to bring down persistent rises if basal is set too low, or snack a lot if set too high.

I'd also recommend seeing if you can get yourself on freestyle libre, a sort of cgm, continuous glucose monitor, so you can see a continuous real time graph of how levels are moving. The prescribing rules are loosening up a bit from April 19.

It gives a much deeper insight into what's going on.

The "old" rules were along the lines of "don't test between meals unless you feel hypo and save corrections till meals."

The "new" rules with cgm, are that if you see a post-pasta unexpected rise appearing on your cgm graph, pin it with an extra unit or two at 7 to 8, long before it gets anywhere near 12.

Stephen Ponder's book Sugar Surfing (om kindle) is a good introduction to this sort of stuff.

He takes the view that because there are so many unpredictable variables in T1/LADA, while we can and should have a go at bolusing correctly for each meal, we should also accept that there is a fair chance of getting it "wrong", so shouldn't be shy of adding in a corrective dose between meals if the cgm trace is telling us we underbolused.

HCPs are terrified of the idea of us "insulin-stacking" through injecting between meals, but used sensibly with devices like libre which keep track of active insulin on board it is a perfectly sensible and safe way of steering bg into line in complex pasta situations. Ponder's book even has a chapter devoted to stacking for burritos!
 
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NikC

Newbie
Messages
4
Type of diabetes
LADA
Treatment type
Insulin
Thank you for this. Lots of info I wasn't really aware of. I do think I currently have my basal not quite right as well as my bolus. I tried a split dose last night after my evening meal and wanted to take my bg 5 hours after to see if it was better but as that was midnight I didn't wake up!!! Rubbish, I know! I'll try again tonight. However I think that taking my Levemir at 10.30pm ish may also be a little late as I have a period late in the evening when both sets of insulin have worn off/wearing off.

I will ask about a libre. I like the idea of spotting the rises and correcting before they get so high.

I will also look for Stephen Ponders book.

Thank you for replying.