General Advice

[Munchers]

Any advice is welcome.

I'm type 1 using insulin circa 4 times a day (injection). Use Novorapid and Levemir.

Over the last couple of weeks my blood sugar levels have increased significantly. Normal control was between 4 to 8 on blood tester and easy to achieve based on circa 8-10mls of Novorapid and 10-20mls overnight of Levemir.

However I can't reasonably get below 10-15 on blood count tester now and am taking circa three/four times amount of insulin. There is no significant change in my diet, if anything I am eating less. I am now experiencing similar symptoms as to when diagnosed three years ago, i.e. overuse of toilet, excessive thirst, headaches, tiredness etc. I have also replaced insulin pens including new batch from chemist but still coming out high.

I have seen my GP but this useless, didn't take blood pressure, advised me to use just Levemir and reduce dosage and couldn't even take blood tester as couldn't work machine. I was safer out of there! I'm due to see Diabetic nurse of Friday.

 

[jopar]

Hi Munchers

Firstly welcome to the forum

A couple of questions here..

Do you carb count so that you know how much novorapid to inject to what you eat?

Have you considered other factors than can change how you BG’s might react?

Factors such as

Have you or are you, coming down with a illness or infection
Changes in routine
Changes in exercise
Are you under an increase of stress
Changes in the whether, is been warmer lately and this can effect your control

Another thought is injections sites… Sometimes you can find the insulin reacts differently in different areas that you inject, as it adsorbs at a different rate…

As to the symptoms that you are suffering, increased thrist etc, being similar to when you were first dignoised are related to your blood glucose, and if at any point blood glucose becomes high, you get identical symptoms…

I would ask your GP/Diabetic nurse, to prescribe you some Ketur-test strips so that you can check for ketones in your urine, as there is a danger that once your BG’s are above 14mmol/l that the body could go into DKA, which isn’t good and needs immediate medical assistance...

If you feel ill, start feeling sick or stomach pains and your BG;s are above the 14mmo/l I would suggest that you get medical advice straight away… As if you haven’t got any ketone test strips to test for the presence of ketones in the urine don’t know if symptoms are because you are just unwell, or whether your are starting to suffer DKA…

 

[hanadr]

ketostix are available at the pharmacy without prescription. Atkins dieters use them.

 

[Munchers]

Jopar

Thanks for your comments.

I don't carb count but I have a good idea about the level of insulin to take - control has been very good for circa three years and I monitor my blood glucose levels regularly so adjust if need to. This is different though, it seems to me that insulin is suddenly having about 25%-30% impact. There are no obvious reasons for this however the only change in my routine was an increase in physical activity (42 year old and needed to lose a stone or two and sharpen up). But I would have expected this to benefit the metabolism and if anything reduce my blood gluose levels? Even so, when I increase my injections (my Novorapid total on Sat was 60mls with 40mls Levemir, and similar yesterday - this is nearly treble my normal level and I ate much less than normal).

As for other points - not really stressed, no illness to note (GP suggested I had a virus and things would settle down, but no evidence of that to me!) I inject in stomach area and move around this area - no obvious problems. The GP checked for ketones - none present however I have little confidence in their ability based on their advice.

My BG is has been between 10-23mmo/l this last week with average of circa 13 to 15mmo/l. This didn't overly concern GP and they suggested reducing insulin and waiting two weeks to see diabetic nurse! Last week, in fustration, I forced my BG down to 4.6mmo/l but this took Novorapid totalling 26ml - what I would normally take during a whole day. This just isn't right.

In response to sickness, I have felt sick a couple times but this hasn't felt significant yet.

 

[jopar]

I agree that normally one would expect exercise to lower the blood glucose and in most it does… But for some diabetics they find that there insulin needs increase with certain types of exercise.. As the body builds a resistance to insulin and can’t use it properly hence the need for more to overcome…

You seemed to have ruled out illness and stress as a factor…

Have they ruled out, thyroids (mainly under active) as this can effect BG levels as well..

The request to lower your insulin isn’t as daft as it sounds, as sometimes too much insulin can cause the body to become resistance to it strange but true…

As to the carb counting side of it, the more accurate you can be, with learning carb-insulin ratios, and what different types of carbs effect your BG, you can really fine tune and it is easier to have a look at where any problems may lay..

In theory when you inject background insulin, this should just tackle the glucose that is coming from your liver, and should if the background dose is correct, enable you to fast without your bg raising or dropping by 2mmol/l, and leave the quick acting to sort out the carbs that you have eaten…

But if you haven’t enough background insulin to deal with the liver, then when eating you would have to give quicker acting to meet the needs that the background isn’t meeting… If you have too much background swimming around, then when you eat you would need to reduce the quick to compensate for the background…

If you need to correct your BG too often in the day, then this is a sign that one of your insulins isn’t doing what it should be doing…

A afterthought

Do you inject your background insulin at the same time of the day? (as it’s been known for diabetics to be told to inject at bedtime, but well bedtime can be anytime for most)

And what are your BG like before bed, and upon waking up?

 

[Munchers]

Jopar

Thanks again.

I will follow up illness / stress with nurse and mention thyroid although again think this is ok as tiredness is not excessive. But worth following up.

Interesting point re fitness - I have stopped at moment as wasn't sure what was happening but I certainly feel my body is not using / resisting insulin, again I will discuss with nurse.

I tend to take background at bedtime (yes this varies). I have tended to manage well on quicker acting with food and background over night or if I doing something different ie if travelling I will only have extra large background until arrived.

Everything I am seeing is saying quick acting insulin isn't working effectively or certainly no where near as effective as before. I will continue to monitor and will review with nurse on Friday.

Thanks for your comments, if you think of anything else I'd appreciate any further advice / information.

 

[jopar]

Concerning your backgroun injection, this does really need to be a timed injections, same time every day as near as possible...

The problem with background it last for around 24 hours, sometimes though to get best effect of coverage, either due to it not lasting long enough in an indiviudal, or one part of the day needs a higher requirement of background, so this leaves you facing at one point not enough, and the too much, it can be split into two timed injection, so you can adjust as needed...

But to injected the background evring times on a daily bases, means that you are unlikely to maitain good control as it will alter how it's dealing with what it's doing and not matching the needs to create a decent basal line to work from, when considering carb -insulin ratios for covering food..

And sometimes, changing the timimg of the background jab can help control, matching the needs required to deal with how the liver is tickling glucose into your system...

I use a insulin pump now, but when I was on injections, I found that I had to split my Levimer into 2, as my morning needs were a lot higher than evening/nite time, this helped to reduce night time hypos, and also morning high to some extent... I found for me, that injecting at 11pm and 11.30am, gave me the best effect... where as my husband (also T1) finds that 1 injection of levimer at 10pm suits him down to the ground..

 

[lilibet]

Hi
Jopar has summed it all up admirably. I would suggest

-blood tests in general -thyroid, and other hormones. Not sure if you are female, but menopausal changes? Some hormones make you insulin resistant , or imbalances cause problems

-change needle sizes - maybe cutaneous level is clogge. so if at 6mm change to 8mm.Also injection site idea is sound

-insulin resistance? Double diabetes is not unheard of, and to be taking 3x amount of usual insulin is not normal if you cant find any obv reasons

-How long have you been diagnosed? Some people do have brittle diabetes. Unlikely to be extended period of honeymoon but?

- change of insulin. For some reason it all just goes pear shaped and some people find changing insulin helps. So if basal is ineffective then bolus needs to work harder too.

Good luck

 

[Munchers]

Thanks all for advice.

I will discuss issues you have raised with diabetic nurse - may need follow up at clinic but at least I am getting a picture of what key issues to look into.

ps I'm male.