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Hello!

RidingHigh

RidingHigh

Member
Messages
7
Type of diabetes
Type 1
Treatment type
Insulin
Hello. My name is Rachel and I am brand new to using this forum. I am 29 and from Portsmouth, Hampshire. I was diagnosed with type 1 diabetes in Nov 1995, aged 10. My diabetes management is currently unstable! I have never had a hba1c below 7.4 (old measurement). I have had some complications throughout my life, resulting from my diabetes, including carpal tunnel syndrome and corrective surgery in both wrists. I have had some horrendous hypos resulting in ambulance visits. But have never had DKA (which I am thankful for).

Over this past year I have been quite stressed from buying a house, with my then fiance, and then getting married (obviously to my fiance!). We are now starting to try for a baby! From the start of the year I have been looking more into my diabetes than ever before (previously I tumbled along just keeping myself above the parapet). But knowing that I wanted kids I became preemptive. However, this has forced me to seek what really is going on with my diabetes. And what I have found has upset (scared) me quite abit!

Note - sorry this is long. Please keep reading!

My main issue at the moment is my waking sugars...... there are stupidly high, sometimes in the 20s. This happens nearly everyday, just the high blood sugar bit, not the in the 20s bit! Over the past 3 weeks my d-nurse has been trying to help bring my overall levels down by decreasing my Lantus. My sugars are mostly fine before I go to bed (~7-8). My metadata is as follows;
Lantus = 11 units taken at 7pm (this used to be 20 units last December)
Humalog ratios are 1:7, 1:10 & 1:15 (breaky, lunch & dinner) (again this used to be (1:5, 1:7 & 1:7 worked out from a daphne course in 2006. Started changing them in June)
Usual eating times 7am, 12pm and anytime between 6-8pm (sometimes as late as 9pm)
Usual bedtime is between 9-10pm.
Usual getting up time 6am in week. Anywhen on weekends!

So over the past 3 weeks or so I have been doing the dreaded nighttime testing. I say dreaded because I love my sleep. As you can most probably see from the above info is that most times I go to bed with humalog still in my system. When I can I test 4hrs after my injection. Results are fine and in range for pre bed. However sometimes I have already nodded off and no alarm wakes me! For the past 4 days I have been eating my dinner at 7:30pm and checked my sugars before going to bed at ~9:30pm. Sugars have been above target (>10) but i still have humalog in my body working, so am happy with that. I have also set a alarm that goes off every 2hrs. On 1 occasion the first alarm at 11:30 has woken me and I have been in range (7-8) but have had 2 digestive biscuits, in case it dropped further. I have then gone back to sleep and tested again at 1:30am and have been sky high. On the other occassions I have slept throught he first alarm, but woken on the second at 1:30am and again been sky high.

I assume that I am going low. And not waking from them ( before I started to really manage my betes I would always wake up during nigttime hypos). So I need advice on what to do to try and resolve this! It confuses me because I am on the lowest amount of insulin I have ever been on and I always assumed that the more insulin you have the greater the chances of having hypos (clearly not!). But then am I even having hypos? Could it be something else?

Sorry for such a long opening/new member post but I my d-nurse doesnt seem to have all the answers!!

Even if you cannot help me solve my problems, it would be nice to hear from you.

Many thanks.

P.s. and yes I did post this at 3am!
 
It could well be the Somogyi Effect that is resulting in your high waking levels but without testing it's difficult to know.

When you woke at 11.30pm and had the 2 digestive biscuits this would explain why you woke later with sky-high bg levels, depending on the size 2 digestive biscuits can contain 30g of carbs, what you should have done was set your alarm for 1.00am and seen what your bg was like then.

Personally I suspect your basal dose is too low and this is why your waking levels are high and your struggling to control your bg levels throughout the day, as you know the first rule of DAFNE is to get the basal dose right or all else fails, it's a pain in the bum but you need to set your alarm 2 hourly throughout the night to determine how your bg is behaving, once you get a few nights readings show them to your DSN.

As a refresher you might want to have a look at the following course which is an on-line version of DAFNE:

http://www.bdec-e-learning.com/
 
Thank you very much @noblehead. Your response makes a lot of sense. I am booked on a JIGSAW course this September. I have always struggled with swinging sugars. I think I am going to try raise my basal by a unit and see how it goes! I also hope to try out a CGM in september as well but I hope my sugars are more stable by then! Thank you so much for responding. Sometimes I just get blindsided and dont see the bigger picture and therefore smaller details are missed! Thank you.
 
No problem. I would test for a few nights before increasing your basal just to rule out the Samogyi Effect, if you do increase it only do so after speaking with your DSN and discussing your results. Once you get your night/waking levels sorted you can concentrate on your day time levels, to do this I would do some fasting basal tests just to make sure your Lantus is doing the job its supposed to do , sometimes people on lantus have to spit-dose due to it not lasting 24 hours or switch to an alternative basal insulin.

Do keep in touch with your diabetes team as this is important if you plan on trying for a baby, good luck and I wish you both all the success and happiness in the world.
 
Hi. Did you really mean that the DN is REDUCING your Lantus when you awake with high blood sugar? Surely it should be the opposite? When you have high blood sugar that signals the need for one or both of the insulins to be increased. As has been discussed you need to start with the Basal. Try to avoid having the Bolus too late when trying to set the Basal correctly. My DN, sensibly, told me to get my fasting blood sugar between 5 - 7 mmol. Now it's not for me to say the DN is wrong, but you really must discuss this seriously with the DN i.e. high blood sugar needs more insulin. Any changes should be made gradually checking frequently with the meter. Once the Basal is right then you can check that the Bolus ratios are right. I'm interested in what DAPHNE said to get the three Bolus ratios right? You are obviously carb-counting and I'm a little surprised at how much your ratios change during the day. I use the same ratio all day; probably not quite correct, but yours do seem to vary a lot? I'm guessing but I suspect that what you think are hypos during the night aren't hypos? With high morning sugars a night-time hypo seems unlikely? Good luck in trying to sort things out.
 
Hi @Daibell. Thanks for responding. My dn put the lantus down first because I was swinging all over the place and its easier to get higher stable levels and bring them down (by increasing basal) then the other way round. I was having lots of night time hypos which I was waking to, again another reason why the basal come down. I think that I am at the stage where I am no longer going hypo so can slowly bring my basal up. I do carb count..... as I put on first post my levels were quite similar (1:5, 1:7 & 1:7) this was when I was eating a load of carbs for every meal. Now I have changed my diet and lifestyle where I have more carbs at breakfast then at lunch and dinner and do more activity. The new ratios work as I am in targrt after meals. What screws everything up however is the high morning sugars and this results from the low basal dose. I went straight down from about 18 units to 11 so that the hypos at night would stop. Does this make sense! I am going on another course soon, so will have the chance to review and correct them if necessary. I think my dn does as well as she does. I would prefer it though if there were more nurses in the section so that everyone had more attention from their nurse! But that will never happen!
 
Hello - nice to have you here . I spent a lot of years in Portsmouth so knew it well and worked at St Marys Hospital. Probably too many changes now for you to identify with - but thought I'd share the connection. I'm not able to be of much help as am a borderline type 2. Have found this site brilliant and because I need to lose weight I am learning a new way of eating with the extremely valid advice I have been given. Weight loss it seems will bring me back from the brink - so I'm perhaps one of the lucky ones.
You will find also there are some very supportive folk who have doubtless been thru your experiences and it helps enormously to even just know that - . In fact it has already started for you I think.
Anyway hope u didn't mind me attaching a post - but it's more real when u find someone who can identify with you - not just through illness so to speak.
Good luck - especially with your plans for a little family - I think you will be pleased u found this site x
 
Thank you very much @Countrykins. I have put off joining a group or club for nearly 18 years now so it was about time. No more living with my head buried in the sand! And i think this forum will help, i never thought anyone would comment to this post, let alone help! I did testing throughout the night last night and didnt go low so i have that to take to my DN. As for your situation, all I can say to you is continue with your hard work so that you do not become a type 1. Because once that line has been crossed, or the diagnosis made, there is no option to not have it. I wish you all the best with having a healthy, needle free life! Take care xx
 
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