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Getting more and more confused....

linda321

linda321

Well-Known Member
Messages
118
Location
West Sussex, UK
Type of diabetes
Type 1
Treatment type
Insulin
I am so confused about basal testing. It sounds so straightforward, but everything I try just sends my sugars sky high!

I have fasted after 7pm, after eating a normal dinner (eg chicken plus loads of vegetables and 100g of potatoes). I have taken my blood sugar at bedtime, and then again in the night and in the morning. I have found that 17u of Lantus is about right to keep me within 2mmol overnight.

But, my blood sugars are still sky high! My libre is telling me that my average sugar level over the last 7 days is 11mmol/l!!! I am rarely in my range (5-9). The only good thing is that my levels are much more level and less spiky. I tried taking correction doses to get it in the right range, but it either stays high or drops so rapidly down to hypo! I can't seem to get it right. I am getting really worried about having high blood sugars for such a long time now.

I am seeing the nurse at my GP surgery tomorrow. She will tell me that I should be taking enough basal to get me in the correct range by morning. When I followed that advice I had much better pre meal blood sugars. That's different advice to 'proper basal testing'. I was also gven this advice at the course I went on last year (IMAGE).

Not really looking for any more advice, as I have read just about everything I can! Feeling depressed because I haven't found what works for me yet. It always seems to me that everyone else gets it right much more quickly than me:(.
 
@linda321 , I can't comment on your insulin regime or basal testing as I'm a T2 who has never faced those challenges, but just a comment on the numbers from your Libre. Have you "calibrated" each Libre sensor against your finger prick tests?

I usually do that for each sensor because some run higher than the finger pricks, some lower and some just go walkabout! Obviously, if you have calibrated (by finger prick testing, then scanning a few moments later) and those Libre and meter readings match, that's excellent, but not any good for your question!

I have found I have sometimes had to apply a correction factor, if say, the Libre/meter differential, on a given sensor, is usually 0.6, 1, or whatever.
 
Hi @linda321, I'm going to have a go at deconstructing your email, so please jump in if I'm misreading.

linda321 said:
I have fasted after 7pm, after eating a normal dinner (eg chicken plus loads of vegetables and 100g of potatoes). I have taken my blood sugar at bedtime, and then again in the night and in the morning. I have found that 17u of Lantus is about right to keep me within 2mmol overnight.
Click to expand...

What time did you eat your dinner and what were your blood levels before and after dinner? Let's say you ate at 6pm, your fasting basal test really starts at 11pm, when you can be sure that your food and bolus insulin are completely out of your system. From 11pm until you get up, you should see that <2mmol/l change as you described. You absolutely shouldn't be using your basal insulin to reduce your blood glucose level from high to normal overnight.

How about during the periods 7am-12noon, 12noon-5pm and 5pm-11pm? Have you undertaken fasted testing for these as well? Based on the next bit of your email, I suspect that you may see different results here.

linda321 said:
But, my blood sugars are still sky high! My libre is telling me that my average sugar level over the last 7 days is 11mmol/l!!! I am rarely in my range (5-9). The only good thing is that my levels are much more level and less spiky. I tried taking correction doses to get it in the right range, but it either stays high or drops so rapidly down to hypo! I can't seem to get it right. I am getting really worried about having high blood sugars for such a long time now.
Click to expand...
Going back to your meals, where are you before and after them? Assuming your basal is at the right level, this would indicate that your insulin to carb ratio is not at the correct level and will require a little testing to determine, The easiest way to do this is to look at starting with 1u:10g carbs and then adjusting up or down based on testing your blood before and two hours after eating the carbs.

Could you take a picture of your Libre display for the day you described in your post and post it in the topic? It might make it easier for people to understand.

Ultimately, if you are struggling, you should really get yourself referred to the Diabetes Clinic at your hospital. Typically the nurses at GP surgeries don't have much experience in dealing with this kind of thing, and as you have Continuous Glucose recording, one would hope that the Specialist DSNs at the hospital would be able to assist you better.
 
Hiya Linda,

Have you ruled out bad insulin cartridges, rotating injections sites as well as illness ?

For me when I run high it's like looking after a baby and crossing off the above before looking at my basal/bolus regime.

If it's none of the above then I call my DSN and arrange an appointment over the phone or in person to run through my daily doses - the sooner the better as it can really get me down too, but also please remember it is a temporary blip and will be fixed so try not to get too down about it ;)
 
the DAFNE course is very good and it will teach you how to determine which insulin is causing the problems. This is done having a carb free lunch time meal ( which then does not need any quick acting insulin) If sugar levels go up before your evening meal then it is likely an increase in your morning long acting insulin is needed. But the DAFNE course also teaches how to inject the correct amount of insulin for each meal. It does still go slightly adrift but I have found it much better.
 
Linda, can I ask if you exercise regularly during the average week? This has a big affect on my blood sugars, high-endurance exercise for 2-3 hours per week (running/swimming/playing sport) along with at least 30 mins walking per day could make a big difference to you. The other thing that works for me is dropping my daily carb intake down if I am not exercising as much as I'd like.
 
richyb said:
the DAFNE course is very good and it will teach you how to determine which insulin is causing the problems. This is done having a carb free lunch time meal ( which then does not need any quick acting insulin) If sugar levels go up before your evening meal then it is likely an increase in your morning long acting insulin is needed.
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Just a small correction @richyb, a basal check has to be a fasting one where no food is eaten, a carb-free lunch can interfere with the results as many type 1's have to bolus for such meals to avoid a postprandial bg rise.
 
I think perhaps the confusion lies within how basal insulin works.

Here is an example - If you eat at 6pm, then your test starts at 11pm as mentioned above so you should be testing at 11pm, then again at 1am, then again at around 3am, and by then you should see a trend of whether its moving up, down, or flat. If you test at 11pm and your sugars are, lets say 10mmol/L and then every test gives you 10, and 10 and 10 again then you can say that your basal rate is correct.

The reading is not what matters in a basal test but how much that reading changes over time, so taking a test at 11pm, and again at 7am doesn't yield the best results as you didn't get enough information between the two to know exactly what is happening - which is one thing that makes night testing so difficult.

So you may have a perfect basal rate and still have an average of 11, this just means that your Bolus at meals is incorrect. If you test 4 hours after eating a meal and your sugars are at 12mmol/L then with correct basal they will stay at 12 until you bolus to bring them back down to normal.

The basal insulins job is ONLY to keep you sugars flat, not to move them over time. So high average readings is because you now need to test and correct your bolus ratio, and ensure that you are weighing your food properly when counting carbs to ensure you are injecting for what you actually are eating, not what you 'think' you are eating.
 
linda321 said:
I am so confused about basal testing. It sounds so straightforward, but everything I try just sends my sugars sky high!

I have fasted after 7pm, after eating a normal dinner (eg chicken plus loads of vegetables and 100g of potatoes). I have taken my blood sugar at bedtime, and then again in the night and in the morning. I have found that 17u of Lantus is about right to keep me within 2mmol overnight.

But, my blood sugars are still sky high! My libre is telling me that my average sugar level over the last 7 days is 11mmol/l!!! I am rarely in my range (5-9). The only good thing is that my levels are much more level and less spiky. I tried taking correction doses to get it in the right range, but it either stays high or drops so rapidly down to hypo! I can't seem to get it right. I am getting really worried about having high blood sugars for such a long time now.

I am seeing the nurse at my GP surgery tomorrow. She will tell me that I should be taking enough basal to get me in the correct range by morning. When I followed that advice I had much better pre meal blood sugars. That's different advice to 'proper basal testing'. I was also gven this advice at the course I went on last year (IMAGE).

Not really looking for any more advice, as I have read just about everything I can! Feeling depressed because I haven't found what works for me yet. It always seems to me that everyone else gets it right much more quickly than me:(.
Click to expand...

Hi Linda!!

I had sooo much of a problem with my night time basal - I ALWAYS woke up with high readings, despite going to bed perfectly within range!

Are you injecting? I noticed that when I went from injecting, and on to my pump (where I can literally adjust how much basalo it gives me each half an hour if I want to), it totally changed :)
 
Thank you so much for all your replies! I am really grateful for your help and support, as I do feel as though I am floundering here! A little bit of background, I was diagnosed in June 2014, originally with type 2, but it soon transpired that medication alone was not going to bring my BS down, and in August 2014, I started on mixed insulin. After reading more on this forum I asked to go onto basal/bolus, which took ages, but I finally started on Lantus and Humalog last August. I started on such a low dose, my Hb1Ac was 9.5 last October. I did better on mixed insulin!

I saw the nurse at the Gps this morning, Hb1Ac not good at 9%! You can guess what she said, increase your basal, and have snack before bedtime if blood sugar is below 7mmol!!! I just smiled and said yes, (but with no intention of doing that!) Now is not the time to argue, I need to have better control myself first!

Sorry I don't know how to tag you all, but here's some answers.

AndBreathe, yes I have 'calibrated' my libre. I am on my 3rd sensor now, and they have all been within 1mmol, often exactly the same. Really pleased about that!

tim2000s, I statted on a 1:10 ratio, but have increased it over time to a 1:5 insulin to carb ratio. Surely it can't go any higher than this? In our area, we don't have the DAFNE course, we have IMAGE instead, and I went on this last October. I found it quite useful in learning how to carb count etc. The course was run by the specialist diabetic nurse plus the dietician, and here's what they said about adjusting basal, (quoting from the handouts)

'If your BGLs are persistently greater than 7mmols/l before breakfast then INCREASE your Basal insulin dose by 2units.
If your BGLs are persistently lower than 7mmols/l before breakfast, then REDUCE your basal insulin dose by 2 units.'

As I said above, now doesn't feel the right time to argue with this, but I feel I should do something to correct this wrong information, don't you?
I'll take a picture of my libre and upload later.

JuicyJ Yes I make sure I rotate injection sites and I have changed insulin phials if I think they might be bad.

Dan87, yes I do a lot of exercise. I walk my dog twice a day for up to an hour each time, which does often bring my BS down. I also exercise at the gym (Boot Camp) 3 times per week. I used to find that my BS would go up by about 3mmol after 1 hour at the gym, but now it seems to be fairly level.

Diamaticc, thanks for the explanation. I think I do carb count correctly, and I usually weigh out any carbs, eg potatoes. In fact, I don't eat a lot of carbs, maybe 50 to 100g per day. I understand that basal insulin is to cover the underlying glucose made by the liver, and bolus insulin to cover carbs you eat at mealtimes.
 
Here's yesterday and today on my libre. I conducted a better basal test last night, libre scan at 23.10 11.3, 00.35 9.8, 03.53 7.7, and 07.06 6.7. (Libre is reading about the same as meter). So from this I am still too high on the basal, as it has fallen by over 4mmol!

Have a look at today 28 Jan.
7am BS 6.7
I injected 2units for breakfast about 20 mins before eating. 1 egg and 1 piece of Burgen toast (11g carb)
7.57 BS 7.2
10.44 BS 7.3
11am, I had a very weak coffee with milk, a small handful of nuts and 1 cocktail sausage
11.58 BS 12.2

What made that spike up to 12.2?
It has stayed up at 12 all day until I did a correction dose at 4.30pm (I had been out all afternoon) and exercise at 6pmDSC_8065 (2) (800x532).jpg DSC_8066 (800x532).jpg DSC_8065 (2) (800x532).jpg DSC_8066 (800x532).jpg !
 
I find nuts can put my blood sugar up even if I have a small amount sometimes. Could,it be that? Is that something you've noticed before? I find peanuts particularly bad. Sausages have small amounts of carbs in so maybe the combination didn't help?
 
@linda321 Your diet is quite low in carbs. Do you bolus for protein at all? If not that might be the reason for your high readings.
 
linda321 said:
Here's yesterday and today on my libre. I conducted a better basal test last night, libre scan at 23.10 11.3, 00.35 9.8, 03.53 7.7, and 07.06 6.7. (Libre is reading about the same as meter). So from this I am still too high on the basal, as it has fallen by over 4mmol!

Have a look at today 28 Jan.
7am BS 6.7
I injected 2units for breakfast about 20 mins before eating. 1 egg and 1 piece of Burgen toast (11g carb)
7.57 BS 7.2
10.44 BS 7.3
11am, I had a very weak coffee with milk, a small handful of nuts and 1 cocktail sausage
11.58 BS 12.2

What made that spike up to 12.2?
It has stayed up at 12 all day until I did a correction dose at 4.30pm (I had been out all afternoon) and exercise at 6pmView attachment 17439 View attachment 17440 View attachment 17441 View attachment 17442 !
Click to expand...
@Mrsass is probably right you seem to have a drift upwards from the morning afterwards. My levemir tends to peak after 9 hours and then drop off, not so bad as I take twice daily but maybe if you are on single shot? The spike at 12.00 is only a jump of 4 mmol, easily triggered by only 10 g carbs (or effects from nuts as @azure suggests). Wrt your insulin/carb ratios I had the same when I reduced carbs, however in actual fact it was the effect of the protein/fat in meals causing me to appear to need more insulin for the same carbs! Its been an interesting learning experience the last 6 months!
 
Thank you so much! Yes I have been thinking about bolusing for protein and fat, after reading another thread on here. It's 50% of protein and 10% fat isn't it?

Just thinking about the nuts and sausage. No peanuts or cashews as I know they are higher in carb. Here's another wrong piece of advice I was given at the IMAGE course: you can eat up to 20g of carbs without bolusing as your basal will deal with it!

Re my basal, I take it all in 1 go as soon as I wake up, between 7 and 8am. I guess I'll find out more how it is working when I do more basal testing during the day.

I'll do more basal testing through the night and the day, and try bolusing for protein and fat. I didn't anticipate that basal testing would take so long! One of these days I'll get it right, haven't really got a choice, just got to keep on going!
 
Basal testing is a pain, but it's the best starting place. Once you get your basal right, then that provides a solid foundation to build on :)

If you're still having trouble and think it could be due to your basal, it may be worth discussing other basal insulins with your DSN.
 
Following @azure's nut intolerance question, I will follow it with a 'could you be intolerant to dairy?'

I am, and silly-small amounts of milk will send my bg much higher than you would expect from the carb content.

I'll shut up now, because I can't contribute anything about insulin use...
 
I know i go high if I get up later than I normally do. Levemir does not last 24 hrs,probably nearer to 20hrs with me. I take 2 doses of levemir one in morning and a small one in evening. But before morning at about 3am I start to go up. I counteract some of this by have my morning Humalog about 17mins before I have my breakfast ( this seems to help a lot it gives insulin a chance to catch up) so I agree with the comments above. I find once you go up/ or sometimes down it takes some grtting back. Its a bit like trying to walk a tightrope i always think . ( type 1 for 51 years )
 
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