Help please!

[Positive-ish]

Hi,

I've been on insulin for 3 weeks now after the tablets stopped working for me. Over the last 2 nights I've woken up drenched in sweat and feeling very weird. I've looked it up and understand that I'm having hypos but don't know how to stop them.

Currently on 12 units levemir on waking
Then 14 nova rapid at breakfast, 16 at lunch and 18-20 for dinner.

Levels going to bed range from 9-13 and they are dropping fast during the night, I've still got good hypo awareness as my levels have been high for a while and currently get hypo symptoms at 7 and below.

I've not seen the dietician for carb counting yet, I am booked in for mid January. Just worried going to bed, my daytime levels are getting better, as in mostly below 10 so it's heading in the right direction...

All advice greatly appreciated! Thank you

Jenny

 

[Daibell]

Hi. Yes, you need to get onto carb-counting as soon as you can; I'm surprised your DN or GP didn't give the advice when you started the insulin as mine did. Those NovoRapid shot sizes look a little high compared with the Levemir shots. This will sort itself when you start carb-counting but to avoid night-time hypos before you see the DN you might want to tweak the dinner time rapid down a bit?

 

[noblehead]

Going low during the night may mean that your basal insulin (levemir) needs adjusting, basal insulin is a background insulin that meant to keep your bg steady between meals and when fasting, when the dose is too high you experience hypo's, when the dose is too low you go hyper, so if your having a early tea and can rule out it being your bolus insulin (Novorapid) then it's almost certain to be your basal dose,

If your not confident with adjusting your own insulin then do contact your HCP's, but I do think you need to test your bg levels when wake up sweaty just to see if your actually having a hypo. Good luck.

 

[Positive-ish]

Thank you both for your replies, they are very helpful.
I'm going to have a look and see if I can start counting carbs and will try tonight with a reduced rapid dose.

With the levemir, I inject first thing in the morning. Will it have run out by the middle of the night?

 

[noblehead]

Thank you both for your replies, they are very helpful.
I'm going to have a look and see if I can start counting carbs and will try tonight with a reduced rapid dose.

With the levemir, I inject first thing in the morning. Will it have run out by the middle of the night?

Not sure about type 2's, but most type 1's on levemir have to split-dose to give them a full 24 hour coverage as the profile for this insulin is around 16 hours I believe, so if they were to take it first thing in the morning it's likely that they would go high during the night rather than low.

I'm afraid no one on the forum can give advice on insulin doses @Positive-ish, you need to speak with your diabetes team with regards to your insulin doses and bg levels, but do brush up on your carb counting skills.

 

[azure]

If you're prone to nighttime hypos, then you may want to set an alarm to get up and test your blood sugar during the night. Then you can eat if necessary and hopefully reduce the risk of a hypo.

Obvious, but always make sure you have hypo treatments by your bed. Glucose tablets or Lucozade work quickly.

I hope you get it sorted

 

[Positive-ish]

Thanks, I've had less insulin tonight with tea. But also having a sneaky glass of wine, I'm going to set my alarm for sometime horrid in the night and test again, fingers crossed I can work this out soon. I really don't like hypos. Carb counting book has been ordered on good old Amazon and I will speak to my diabetes nurse about the best way for me.

I think the reason I'm only on one dose of levemir is that I still have some beta cells but they are packing up quickly.

Thank you and have a fab Christmas & New Year!

 

[Mep]

My endo tells me to drop my basal by 2 units if I'm having hypos at night. But being honest I can hypo on any level on basal. My endo knows this and just said it is hard to prevent hypos. He had me waking up at 3 am to check my sugar level. What I tend to do these days is if I'm up for anything else, I will also check my sugar level. If I'm under 5 I will go and get some juice and milk and then head back to bed (I don't like eating early hours of the morning unless I absolutely have to). What I do usually works for me to stop my sugar dropping too low. But as mentioned I still can get hypos and I know I've had one in the morning usually as I have that awful hypo hangover.

 

[Positive-ish]

Thanks @Mep I've started having a banana before bed if my BS is close to 8 and that seems to be working and stopping the hypos.

I'm also learning how to carb count and after seeing the dietician in Jan who will hopefully tell me my insulin / carb ratio. Does it normally start at 1/10 and then adjust or is it different for different people? My BS shoot up after eating..

 

[Mep]

Thanks @Mep I've started having a banana before bed if my BS is close to 8 and that seems to be working and stopping the hypos.

I'm also learning how to carb count and after seeing the dietician in Jan who will hopefully tell me my insulin / carb ratio. Does it normally start at 1/10 and then adjust or is it different for different people? My BS shoot up after eating..

My endo has me on a sliding scale. He basically tells me what units to have. I haven't been taught insulin to carb ratio... although from what I've read it can alter for everyone. I notice myself sometimes I need to increase my bolus and other times reduce.

 

[Daibell]

Thanks @Mep I've started having a banana before bed if my BS is close to 8 and that seems to be working and stopping the hypos.

I'm also learning how to carb count and after seeing the dietician in Jan who will hopefully tell me my insulin / carb ratio. Does it normally start at 1/10 and then adjust or is it different for different people? My BS shoot up after eating..

Yes, many are started at the 10gm to I unit of Bolus as I was. It does vary from person to person and for some quite a bit during the day, so the 10gm to1 unit is a fairly safe start point but obviously you should see seek guidance from the DN so that you have their buy-in and you may be an exception. BTW my reason for suggesting a small tweak downwards for the Bolus is the Levemir doesn't last 24 hours, in practice 12 to 18 hours, so will have run out during the night. If you Google the web you can find a 3D graph of decay time versus dose.

 

[ickihun]

How are you getting on @Positive-ish ?
I have the opposite to you. I wake on a hyper if I don't leave my dinner inject til supper.
I'm carb counting but I take a mixed insulin. My daytime control is good but through the night I go higher. (Unless I inject with nuts or something small.)
Because i'm showing good control and hba1c is 48 nurse isn't concerned.
I've managed to reduce my insulin to just 44 with food (15 mins before). When I was at one stage 30 breakfast, 30 lunch and 60 for dinner.
If I have bread or breadcrumbs I have to inject 10 units before them. Mixed insulin is strange to me. I have previously been on on levermir and novarapid but only when I was pregnant for tighter control.
Do you suffer with diabetic complications?
I hope you were ok over Christmas and your banana before bed was still working for you.

 

[philchap1]

Hi, without carb counting and knowing your insulin to carb ratio it's a guessing game, cut down the evening insulin by a unit or 2 and keep some glucose tablets lucozade or jelly baby's handy

 

[Positive-ish]

Hi ickihun, thanks for your reply. Im getting there thank you. Its gone the other way now. Nice tight control during the day but going to about 10 and waking about 10. The basal is now taken at night in an attempt to bring down my night Bs but increasing that slowly.
Daytime now between 6-8 yay and I:C is 1:5

Saw the dietician at local hospital and she was very helpful, I feel much better and now even losing weight! And once the night time is sussed all will be well!

Jenny

 

[Positive-ish]

Hi, without carb counting and knowing your insulin to carb ratio it's a guessing game, cut down the evening insulin by a unit or 2 and keep some glucose tablets lucozade or jelly baby's handy

Hi philchap,
I think my I:C is about right but the dietician I saw recently has recommended a carb counting course. Booked it for Feb so we will see, daytime going well now. Just need to sort evenings!

Ive been keeping lucozade by my bed, good suggestion thank you.

Jenny

 

[philchap1]

I use a phone app called carbs and cals , it costs around £3.99 it's easy to use.

 

[Positive-ish]

I use a phone app called carbs and cals , it costs around £3.99 it's easy to use.

That sounds good, I will have a look.
Thanks Phil