Getting more and more confused....

Hi Linda - you know we are all different and respond differently to others, type 1 is unique to all of us, there are so many factors affecting our control, illness, hormones, heat, stress, exercise, weight, I really do feel your pain, as it's something that when you work as hard as you do it can be so self defeating when you can't get a grasp on it.

I agree with Azure - basal testing is a must as it's the foundation for good control, get this right and everything else falls into place.

I also eat low carb but bolus for protein, so if I eat nuts I take 0.5 unit for a small handful, same with salads and cheese and meat, I know that I convert all of these to glucose so they cause a spike, so depending on what I eat will take 0.5 to 2 units, it has been trial and error to get this right.

I also change my bolus ratio throughout the day as i'm more insulin resistant till lunchtime, then change till 4pm and change again in the evening (sorry I can't remember what they are off the top of my head!). Despite this there are lots of times I vary greatly so some days I can sit below 10 all day and others I hit high teens, I have learn't to accept this to some degree, mostly because I had to as it was driving me mad and I was becoming anxious about it, these days it rarely touches the sides as i've learnt to live with it, I cannot get perfection so have become less hard on myself (not sure if anyone with type 1 get's perfection, if they do please let me know..).

My best advice is to discuss this with your nurse/consultant, take in your libre results and a food diary and use them, they are there to support you as we all are too. It may mean they try you on a different background insulin as this could be causing you a problem, but they should be able to give you more guidance, good luck hun

Mrsass said:

What basal insulin are you on @linda321 is it just one dose you take? And at what time? X

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This might the key; could you let us know, also when and how much you take?

I personally don't believe that there is such a thing as 24 hour basal insulin. It's just sales guff to shift insulin.

It looks like your basal is running out around mid day.

linda321 said:

With regards to basal questions, I take Lantus, 17 units in the morning when I wake up, between 7 and 8 am. Gosh I wouldn't have thought it was running out by midday! Especially as my BS usually goes down over night. I'm going to do daytime basal testing to find out. I'll let you know.

I have been working on the assumption that I could have 20g of carb without injecting as per the info on the IMAGE course. Looks like that doesn't apply to me! I should have known that really, for example, I know that a latte spikes me loads, even though it may only be 8 or 9g carbs. I now drink Americano coffee and generally avoid snacks between meals.

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It might be me, but I've never heard that about being able to have 20g snack without a bolus injection. The only time I did that was when I was first diagnosed and on a two injection a day regime using mixed insulin. Once I swapped to MDI, I still ate snacks but bolused for them. Now I'm on a pump, I do the same unless there are special circumstances eg exercise, etc.

Edited to add that I often bolus for lattes and cappuccinos too, depending on my BS and what I'm about to do (if I'm shopping I find I can 'burn off' the coffee without a bolus)

linda321 said:

you can eat up to 20g of carbs without bolusing as your basal will deal with it!

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Holy ****! The people giving that course don't understand MDI if they are saying that and the course needs to be quickly stopped and retraining done.

Hi Linda, if you're taking lantus between 7 and 8 in the morning, and you still dropped by 4 mmol/l during the night then it can't be your lantus running out. The 20g of carbs as a snack theory might explain the rise from 7.3 -12.2 as 20g would make me rise by about 6. I never snack now as having to inject for them means you've always got insulin on board. I always leave at least 4 hrs between bolusing and leave at least 4 before bed. Your bolus for breakfast seemed pretty much spot on, 6.7 before, 7.3 after. I wonder if cutting out the snacks for a day and seeing how it goes on the Libre might confirm or rule out not bolusing for the snack as the problem. I use lantus and inject into my stomach and it seems to last the full 24hrs, when I injected into my thigh or buttocks as advised by the hospital it seemed to tail off after about 18 hrs.

Wow if ate 20g of carbs without bolusing my day would be over lol

Also, it looks as if you basal is too high as you noted so you can probably begin to scale that down a unit at a time every couple days until it levels off.

The nuts (depending on the type of nut) can raise your levels, and i find that coffee / caffeine also raise my levels. I have read that caffeine, in some, can make you more resistant to insulin and thus you can get an increase.

You should be bolusing for for everything you eat, not just when its over 20g - I found it really helped me to get a insulin pen that gave half units so that i didnt have to eat more or less match my injection (if you are 1:5 and eat 13g of carbs injecting for 10 is too low, and 15 is too much, so half units really help)

Also, it takes Lantus about 1-2 hours before it becomes stable and flat, so if it 'runs out' at 8 am, and you inject at 8 am then from around 8-10 you will likely be at a lowered basal rate from the rest of the day. Also, its not '24 hours' for everyone, for some its less, some its more.

I think you would have been fine if you hadn't gone to bed so high, had that first reading been ~7, you would have had a normal day.. or if you had injected to bring it down a bit before bed (obv now you need to reduce your basal) but your getting there.

linda321 said:

libre scan at 23.10 11.3, 00.35 9.8, 03.53 7.7, and 07.06 6.7.

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Just on a side note, you don't need to wake up to scam with the line. If you plug it into your PC and then go into the software. Cluck on file and you can export the results (about 90 days I think).

The sensor holds data for 8 hours so just scam the once if you happen to wake up (if you sleep for longer than 8 hours...)

Matt

Ah, ok so your basal isn't running out; it's just getting going!

Every single carb needs to be bolused for; a 'free' 20 gram snack is nonsense. This is not your fault, of course, but that advice is completely pants.

This is hard enough as it is without that sort of rubbish!

Try and get your GP to prescribe you Levemir and then split it; so half when you get up and half when you go to bed. A lot of people (including me) have had problems with Lantus.

Best

Dillinger

I have mixed views about snacks and doing a bolus. For a long time on MDI, I used the regime much like twice daily and still carried on with the little and often way of eating but I never knew about using a ratio or correction factor to use the MDI regime more safely. I eat a snack of about 10g carb to prevent going hypo so definately didn't do a bolus.

Levermir and dose splitting will make a big difference. Appallingly I was on 44u of Levermir before bed and it wasn't working effectively for about 14 years and no one told me why or how to fix it. I'm still playing with my before bed Levermir dose, as it used to crash me, and now my readings are a touch higher on wake up than I'd have hoped. Having to do a 1 or 2u Novorapid injection if I don't eat until lunch. But I think that's normal?

@paulpapa, I notice dawn phenomenon much more with Levemir than I ever did with Lantus, but when I look back at the Lantus years, there was precious little pattern to overnight bloods at all. That only became obvious when I got continuous recording!

@linda321, before asking to go on levemir ask if Tresiba is available, it's a basal insulin that you only have to inject once a day and is said to last up to 42 hours.

tim2000s said:

@paulpapa, I notice dawn phenomenon much more with Levemir than I ever did with Lantus, but when I look back at the Lantus years, there was precious little pattern to overnight bloods at all. That only became obvious when I got continuous recording!

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That's interesting; I've got very marked dawn phenomenon which I didn't really have before (or wasn't paying attention to) and am on Levemir.

To be honest it doesn't bother me as I just don't eat breakfast and bolus anyway to deal with it as it matches my waking up time pretty accurately (as shown by the Freestyle Libre).

I wonder if anyone else has this?

Dillinger said:

That's interesting; I've got very marked dawn phenomenon which I didn't really have before (or wasn't paying attention to) and am on Levemir.

To be honest it doesn't bother me as I just don't eat breakfast and bolus anyway to deal with it as it matches my waking up time pretty accurately (as shown by the Freestyle Libre).

I wonder if anyone else has this?

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That's interesting to hear, @Dillinger.

I'm finding that it's been higher recently on waking up. I think because I had a scary-while-asleep hypo I've been having a bedtime snack and not doing a bolus or it. I'm going to change my ratio tonight to 1:6 from 1:5, so I'm a little higher after dinner/before bed, thereby not needing a snack and hopefully waking up in a more reasonable place - if it is indeed the snack that's making me rise and not Dawn Phenomenon which I don't think it is as yet.

I don't have breakfast either during the week. today, for example I did a 2u correction dose at 7:33am when I was a Libre 11.7 (BG told me 13.7!) and it didn't do anything - I was 15.8 three hours later...

Does your correction dose change in the morning? I've read that people tend to be more insulin resistant in the morning and also because my sugar is higher it might need a bigger dose to bring it down. More trial and error I guess.

@linda321 I know that having to inject sometime before you eat is a pain, but it really does help you normalise the spike you get after eating. I had sushi last night - all white carbs - and the reading was nowhere near as bad because I had waited 25-30 minutes after injecting before eating . It's not always possible to do (at work for instance) but I find at dinner, when I'm at home, I can inject when I put the oven on and by the time dinner's ready I get to eat. Also, I get to have a hot meal because I'm not fiddling around testing my blood sugar and injecting for five minutes. Winning!

As usual I find there is more than one thing going on. DP i understood starts before you actually awaken, extent to which it occurs for me depends if I was eating carbs into the evening. The other effect is actually waking and getting into work, depending on stress levels that can cause similar rises in BG. Third (if you are on Levemir) I find it peaks about 9 hrs in (6am) which suits me for DP but also means the basal is dropping off during most of morning until the 9am basal starts to kick in.

steve_p6 said:

As usual I find there is more than one thing going on. DP i understood starts before you actually awaken, extent to which it occurs for me depends if I was eating carbs into the evening. The other effect is actually waking and getting into work, depending on stress levels that can cause similar rises in BG. Third (if you are on Levemir) I find it peaks about 9 hrs in (6am) which suits me for DP but also means the basal is dropping off during most of morning until the 9am basal starts to kick in.

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On Levemir, I found that an asymmetric dose and timing model worked best for me. I agree on the DP and carbs effect. It definitely increases dp related glucose level increases.On a pump, my peak hourly dosage is between five and six am as my biggest spike seems to come between seven and eight.

tim2000s said:

On Levemir, I found that an asymmetric dose and timing model worked best for me. I agree on the DP and carbs effect. It definitely increases dp related glucose level increases.On a pump, my peak hourly dosage is between five and six am as my biggest spike seems to come between seven and eight.

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@tim2000s when you say asymmetric are you suggesting taking the morning levemir earlier or do you mean different doses morning/evening?

steve_p6 said:

@tim2000s when you say asymmetric are you suggesting taking the morning levemir earlier or do you mean different doses morning/evening?

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Both.