Frustrating Week :(

[becky.ford93]

Hi all, looking for some advice, though I'm not sure if anyone will be able to help me. Consistently for the last 7-10 days or so my blood sugar before dinner and bedtime has been raised. I haven't been able to get it below 10 before bed in ages, despite lowering my ratio from 1:10 to 1:9. I've been out for dinner a lot as I've had a lot of social events lately, but even when I've been able to accurately carb count at home I get the same results. For 3 days in a row I went to bed ~13mmol!!
I don't correct at night, as my 6 units of Lantus at 9pm always makes my blood sugar drop to a normal level within a few hours of going to bed. I'm reluctant to take anymore Lantus as I've recently woken up in low 4s twice (for the first time in months).
I'm at my wits end and just don't know what to do anymore, it feels like no matter how much insulin I take with lunch and dinner I'm still way too high afterwards!

 

[catapillar]

I feel like you are crying out for a basal test (sorry, I hate basal tests & im going to have to do some this week, so maybe it's just misery loves company). If you are going to bed at 13 and waking up "normal" (I'm assuming that means less than 7?) what would happen if you went to bed at 7, would you wake up hypo? Is this happening from your basal alone (so how long before bed are you taking your dinner time bolus?)? Your basal is supposed to keep you roughly steady, not drop you by any more than 2mmol. So, longer term I would suggest basal testing.

However, that doesn't really solve your problem at the moment. I would think about when you are blousing, when you are eating and what you are eating. It could be that your pre bed high is the spike from dinner and you might be able to avoid that spike (and therefore possibly adjust your ratio back down) by taking your bolus before you eat the carbs. Same thing with the pre dinner highs, depending on how long before dinner you are having lunch. If you are eating something high fat/protein the spike just happens later than you would expect it to. And then also giving enough time between your meals so you can figure out what is going on with each one.

Argh gosh that's loads of stuff isn't it - don't give up. The answer will be there somewhere. I'm sure others will be along with more sensible/helpful ideas, if you feel like exploring them, pick one (if you think they actually apply to you) at a time and try a bit of trial and error to figure it out.

There's also... are you a lady becky? Because, hormones, some weeks of the month ratios might just change - because what every woman needs to combine with PMT is some unpredictable blood sugar.

 

[himtoo]

Hey becky
ok so you have adjusted the carb ratio and still not getting lowered bloods ---
if it were me i would tweak I:C ratio to 1:8 and test test test all evening
and after a few days if not satisfactory adjust to 1:7
do you have a 1/2 unit fast acting pen -- that could help to tweak doses -- speak to your DSN if you don't !!

( Diabetes doesn't often play fair for very long )

 

[becky.ford93]

If I go to bed at a normal 7-8mmol level I don't seem to have hypos in the morning or overnight (I have on rare occasions checked at 3/4am and never had a low reading). I think my pancreas maybe kicks in at night so it's probably not the Lantus alone.
Hormones may be playing a role, I'm on the pill and have had to run packs so perhaps that's not helping.
I guess I'll have to keep tweaking my ratios, I just get so scared of having a bad hypo! (though there doesn't seem to be any danger of that lately!!! haha)

 

[catapillar]

Sounds like you are doing it really sensibly by making the adjustments slowly/cautiously & testing lots.

 

[himtoo]

it is really difficult to KNOW what to do and in all honesty taking the slow version and making small adjustments is always the best way -- it is just having the patience to do it -- we can only live in real time.

you could be starting to see some changes due to end of honemoon possibly as well -- so your vigilance in your BG's will help keep you safe.

 

[pinewood]

A few thoughts:

1) I also have a tendency to naturally gravitate higher in the evening/before bed and I strongly suspect it is because my Lantus from the previous evening is "running out" (I take it c. 10/11pm). I am able to keep the rises under control because I've now varied my evening bolus ratio. You might need to do the same?

2) If you are still seeing evening rises you might want to speak with your DSN about either moving your Lantus to the AM or split-dosing it between evening and morning.

3) Have you been experiencing the honeymoon period? I am around 18 months post-diagnosis and never used to have this problem as I suspect my pancreas was able to compensate for the Lantus running out; now that my honeymoon period appears to be dwindling away it's far more noticeable as my pancreas is clearly struggling to keep up.

 

[becky.ford93]

Yeah I'm wondering if the timing of my lantus may need some adjustment. I'm actually attending an ERICA (Exeters version of DAFNE) course on Thursday so I might try to speak to someone then. Just a shame that I've had to keep a record of my diet/levels for a week and right now it probably looks like I have no idea what I'm doing! I'm in a similar situation having been diagnosed 16 months ago...perhaps this is the end of the honeymoon!

 

[noblehead]

@becky.ford93, why don't you have a low-fat lunch around 1-2pm and start testing your bg levels four hours after (miss your evening meal and bolus dose), if you find your bg levels starts to increase after the four hours then it's your basal insulin which is causing the evening rise, if it stays pretty flat then you need to look at your I:C ratio for your evening meal.

Hope that makes sense.

 

[iHs]

I think I would be inclined to do the same as @himtoo for a bit and see if bg gets lower.
Sometimes bg can go a bit haywire at different times of the day and then change back again. At the moment my bg levels have gone fairly high between eve meal and bedtime so Ive been trying different ways to get it lower.....alter carb ratio one night to see how bg goes and test, test, test.

If worried about going hypo......set an alarm on mobile to wake you up at a time about an hour before bg starts to go low and eat something

 

[himtoo]

Hey @becky.ford93
haven't seen any replies on this thread recently and am wondering if you got things sorted , or if the course helped ??

all the best !!