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Help... The fasting test saga

bennyg70

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Wolverhampton
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CHEESE!!!
Hi All, New to this so please take it easy on me.

This could be a little long winded...

I have been a diabetic now since i was 8, I am now 28. I am a male, 172 pounds and 5 foot 7 (And a bit..)So for those that can do the maths - a smidgen over weight... which I am working on..

Throughout my teens I ignored my diabetes, and did the bare minimum to get by (Im pretty sure I rememebr HBA1Cs of 13 - 14%).. Just injected, didnt test, no matter how much my mom nagged. I went to university and lived a normal university life, drank like stupid ate like anything and slept all day.. again didnt test, just injected to get by.

When I got to 22 and got a job and realised how badly i was putting my health at risk and now I decided it was time to start going to diabetes check ups and get this under control. When I went in my HBA1C was around 8.5%. They switched me from the human mixtard (I think it was called, a 70 / 30 mix) to the lantus and novarapid regime. I learnt a little about carb counting and was given a dosage of lantus to start out on. Im pretty sure i was offered all the dafne courses, dieticen etc etc at the time, but i obviously hadnt become as commited now as I thoguht i was during this period and "didnt bother with it). My bloods did improve and the diabetic nurse put a tick in the box which was in poorly controlled now to adequatley controlled, and now apointments were every 6 months and not every 2!!

Ive muggled by like this for 4 or 5 years now A1cs of around 6.5 - 7.5 but im guessing that the amount of lows i have cancel out the highs i have giving a false a1c which looks, kind of OK? sometimes rigourously testing, and sometimes not for a few months at a time. I know now I need to get it sorted and under control and I just do not know where to start.

One of my main problems is I have moved so many times over the last 5 years, and during this had to change doctor 3 times. So I have never had that chance to gain a relaionship with a diabetes team. Im hoping to do this where I am now. I have just moved to the practise and they are signing me over to a diabetic nurse. But in the mean time (As these things seem to take a life time) I am testing all the time and trying to get to a point where i just need a few tweaks when i get to see the new nurse.

MY BLOODS ARE ALLL OVER THE PLACE!!!!

A day dosnt go by where I dont go hypo between meals, maybe 2 or 3 times on average a day, and for years Ive just treated this as normal and treated it with a snack to bounce it back up. Then it would usually go too high and then inject to bring it down then go low again etc etc etc etc... Grrrr!! I wake up to high blood sugars 50% of the time (10 - 13) when my bloods have been either OK, or a little low the ngiht before.

My understanding is I need to get this lantus dose right before I do anything else... Im on 17 units (When i first started out I was on 30, then down to 28, then 24 etc - suffered lows in the night all the time) Before I used to take this when ever sometime between 7 and 11 at nghit, but i now realise i should take this at the same time every day. I tried takeing it at 7 pm every night, but my bloods seemed consistently between 8.5 - 14 every morning (Yet im still going low between mealtimes)... I dont think im doing to much novarapid though... Ill test say at lunch it could be 5.1, test 2 hours after lunch and it will be 6-8 which i think is OK, then by the time i get home at 5 - 6pm im low! ARGH.

I inject at about 1 unit per 10/12 grams carbs. And I count all the carbs in the foods (and dont minus fibre).

I tried to do a basel test last night. which I had read about on the internet. Let me do the build up.

SUnday night I did my 17 units at 7pm, woke up to high blood sugars at aorund 15 (The bloods were OK ish the night before I was Low but corrected it before i went to bed) During that day I decided to do a basel test that night if i could but also switch my injection time to 10.30pm. So.... I ate and injected around 6Pm, I ate a chicken wrap, some snack a jacks and a little bag of apple and grapes from boots. Total 70g - Novarapid - 6 units. 2 hours after at 8pm - bloods were at 9. I thought this would be OK as I didnt want them low for the basel test. I didnt eat and at about 10.30pm I thoguht i felt low, so tested for my final basel test before bed (My plan was to test at 3am and 6.30am) the test was 2.1 so very low. I had to cancel the basel test. I did my lantus then at the 10.30 set time i had agreed with myself. I took the measures to raise my bloods and when I felt better, went to bed. Woke up this morning bloods were 13. What the hell.

So why am i getting low bloods through out the day, High bloods in the morning, Ok bloods usually 2 hours after meals, but low 3 or 4 hours after.

I did do a few mid night tests (2.30ams) when i started playing with my lantus dose at that time i was trying splitting my dose in various ways, say 11 night and 11 morning. These mid night result trends were good before bed - 4.1, 6.5 & 5 then mid night , 6.1, 12.8 & 10.2 then morning 9.6, 9.8, and 8.5. My bloods were OK throughout these days with a couple of hypos thrown in for good measure.

All in all i think i need to start again. From the begining and Im ashamed that its taken me this Long

I eat well and try and do some exercise, a little tennis, a fair bit of walking too.

My breakfasts consist of all brans or multi seeded breads and fruit, my lunches of multiseeded brown sandwhichs, wholewheat wraps with salad and fruit, and dinners usually consist of either brown rice or new pots, some meat and lots of veg.

I drink every so often now, maybe a little too much once a month, and the odd drink here and there.

Im an ex smoker.

And I have lost 3 stone nearly since last september.

Im getting there in many aspects of my health I just need some direction as I think im becoming obcessed with it!!!

My doctors recently told me I had protein in my urine and possible kidney complications, this is being investigated at the moment, I just hope its early stages.. Nothing had been picked up 5 - 6 months previous so there is hope.

As you can see I have to get this right, and soon. I hope there are people out there who could help.

And for any new diabetics out there thinking to ignore your diabeties and treat it as something ignorable, Please dont

Thankyou.

ben
 
Re: Help...

Can't really answer your questions as I'm a type 2 and not using insulin. Just wanted to say welcome, and I'm sure some type 1's who will be able to help will be along soon. Having said that, wether type 1 or 2, it is easy to kind of ignore things and hope they'll go away. I continually remind myself of the penalties of getting wrong to keep me on the right track. You now seem to have accepted that, so with help, I'm sure you'll soon be back in charge of your diabetes.
 
Re: Help...

Ben.. I have just seen this but am now on my way out.. hopefully one of the experienced type 1's will respond before I am back if not I promise a response this evening! In the meantime take it easy and don't stress out!
 
Re: Help...

Ben.. reading your post my first thought it that your background insulin is incorrect.. you display all the 'classic' symptoms..

First off I would split your background insulin.. if you are overweight then this will help keep the profile of the insulin more 'flat' and avoid swinging blood glucose at certain points of the day.. I would to start do a 50/50 split morning and night.

Next you need to check that the amount of background insulin you are injecting is correct..

So the best way I have found to do this is fasting tests... split the day into four parts morning/afternoon/evening/night... then over consecutive days we are going to look at each of those parts..

The idea on any fasting test is as follows:
1. You fast!
2. You have no active rapid insulin
3. You do not exercise!
4. You test once / hour..

So for instance on a morning fast I would... wake up and test blood glucose make sure it is between 4 and 7mmol/l before you start.. if it isn't then correct and treat as a normal day.. if you constantly have high or low readings in the morning then start with the afternoon part of the day.. i.e. correct in the morning and eat as usual and fast from lunch. I would test every hour from when I woke until say 1pm.. if your background is correct your blood glucose should not vary by more than 1 mmol/l... i.e. if my first test was 6.5 mmol/l then I would expect all readings in the morning to be between 6 mmol/l and 7 mmol/l.. that would indicate stable blood glucose..

You repeat this test for each part of the day until you have a profile.. then you can correct the background insulin to match this.. so if you are dropping during the day but going up at night then change your ratio's.. if you are stable during the day but go up at night then increase the corresponding background injection..

Once you have a stable platform you can then begin to work out your rapid ratios.. but we can deal with that once you get there!
 
Re: Help...

Thankyou : )

Right Ill give this a try - Looking back at my diary although it wasnt great, my ebst readings of late were when my dose was split.

I am going to up the dose back to 20 and do a ten / ten split.

My thoughts are to inject between 7.30 and 8 on an evening, and 7.30 and 8 in the morning - Do you think the 12 hour gap is sensible?

Also before starting the fasting testing regime do you think I should give it 3 days to settle in the new system? Maybe start doing fasting testing next monday?

Many thanks again
 
Re: Help...

Hi Ben

All I can say is well done.

You are not a vintage model. Your a Classic that needs a little self restoring.( You can guess what my hobby is ).

Was there any reason why you did not mention meat on your diet.

Oddly enough your new methods will become very interesting and helpful for many on this Forum.

Good luck and good work.

Roy.
 
Re: Help...

It would be nice for everyone to see my progress over the coming months as I try and suss this with everyones help...

I am a meat eater, usually chicken with most meals, but i do like the odd treat now and again of a bit of sausage and bacon, or beef, pork and lamb... I probably need to kick the fatty bits habit thoguh... :cry:

Ive bought myslef a little notebook to record the next months worth of results, eating habits and insulin habits to help myself, and maybe I could unload this information here every few day so people can see how im getting on and whether things do start to improve... (And let people rip my diet to shreds if need be!!)

As for the "You are not a vintage model. Your a Classic that needs a little self restoring" - I love this. Will be my new motto until I am fully restored.

Cheers all
 
Re: Help...

Just an update...

I think things have been going quite well really. I have as previously stated split my lantus 10 / 10 7 am and 7 pm.

I havn't had any high blood sugars and have been making it through the night usually going to bed with a 4 - 6 and waking up in the same range.

However I am experiencing some lows , usually between meals. however there are definate patterns to these.

Today is my first fasting day, I plan on (As per Pneu's guidence) waking up, testing, not eating until 1, and testing on the hour every hour.

I went to bed with a 4.9, woke up at 4.7 (7am) its just gone 8am - 4.9...
Ill give a full update later.... P.s - Im starving..!!
 
Re: Help...

Further update...

As i expected the fasting morning test showed a decrease in BG.

Results - Last night - 11.30pm - 4.9 (Lantus was taken at 7pm, full dinner with nova taken - Apple eaten at around 9pm)
Lantus - 10 units @ 7am
7am - 4.7
8am - 4.9
9am - 4.4
10am - 3.1

Fasting test cancelled at his point...

So do i try reducing morning dose or evening dose? by how much? , might try evening fast tommorrow.

Advice appreciated..

Thankyou
 
Re: Help...

Hi bennyg70!

Looks like you're doing pretty well. Personally I'd reduce the morning Lantus as you held really steady overnight. I'm not an expert and I'm sure Pneu will be back later to advise. I'm doing the same tests at the mo to sort out my Levemir dose having just switched to it. Lantus is really long acting and at the point you take your morning dose, you have effectively got a double dose going on for a while as your llast night's Lantus is probably still active.

Just a little warning - I think maybe you should be going to bed with your BGs a little higher, at least until you are confident with exactly how the Lantus affects you. I aim for high 5s at bed time. Some forum members will laugh at me giving you that advice, because I am quite bullish about low numbers, but even I wouldn't go to bed in the 4s in case the levels drop overnight. Nighttime hypos are no fun!

Incidentally, if you're going to adjust the Lantus dose, you really need to wait 3 days before your next fasting test to make sure the new dose has taken effect.

Smidge
 
Thanks Smidge, How are your tests going?

Yep experienced so many night time hypos that its become just part of everyday life for years and years and years , but im fed up of them now!.. thats why i want to get this thing beat!

Its so confusing with the double dose and when they overlap but my intial thoughts also are to reduce the morning insulin, do you think by 2 units at a time is sensible, or should i maybe cut it by 4? Its just that drop between 9 and 10 seems quite dramatic?

Really appreciate all of your input!
 
Hi ya, so much to write, so little time! Top tip - when fasting, you don't actually have to not eat, just don't eat carbs! I have this as (sound!) advice from my pump rep when I first got my pump. She suggested steak and a small green salad or a x1 egg/cheese omelete (without milk). When I fast I snack on cheese and little bites of 'meat' (chicken, beef, whatever is left over from the weekend!). I can usually totally fast in the morning but it's the afternoon stints where I struggle ;-)

Keep at it!

Deb

PS - I too used to suffer from lows between meals, not hard to fix, often looking at your carb ratio is a good place to start - give it a go!
 
Thanks Deb! Makes sence to me.. Ill be off midnight snacking on chicken legs and Steaks during my nightime one then!

Ive put my carb ratio to one side for the moment.. I base it around 1/10, but seems to be around 1/8 morning and 1/12 night... However.. I dont want to get fixed on that until my lantus seems to be holding me steady... When trying to move both around it gets so confusing on which one is causing problems or working well! And then changes altogether when I change my lantus dose..

So plan of action, Lantus - sort,

Rapid ratios, sort!

 
agreed, stick with one and then it will become apparent which one is causing the problem! I messed around with my basal for ages until I had a total lighbulb moment and realised it was, in fact, my ratio that was the issue,. Another top tip (courtesy of my DSN!) is to resist the need to test and correct before your 'time is up' or rather your bolus time is up ie: I tend to test after 1hr 30 mins and then get all strssy if my BG isn't perfecct then I over correct which then causes a low. Easily done but not to easy to spot when you've got all the other factors going on
 
Hi

If you can...try and get yourself an insulin pen that delivers in 0.5u increments. Lilly do one that accepts Lantus and Apidra cartridges so get one of those. If you can't get one, then ask your doctor to switch to Levemir and use a 0.5u pen. Levemir has a more even and gentle effect on bg control and I found a good difference with it and had far less low bg levels than I did using Lantus and adjusting insulin in 0.5u increment can make a lot of difference....

Also dont worry too much if you cant get your background insulin to give you even control all day long.... I just adjusted my carb ratios to suit, so controlled my bg levels that way. It doesn't matter that much how you control your bg... what does matter is its effect on your bg levels and also your well being etc...
 
Hey Ben sorry for the delay been in meetings all day so no chance to check the forums..

Reference the fasting tests... first good job.. although whilst testing I would run those numbers a little higher it does initially look like splitting the background has sorted your night time readings.. make sure you do a couple of checks in the night say at 0:00, 02:00 and 04:00 just to make sure that you aren't doping below 4 mmol/l..

Now this one is going to confuse you a little... Lantus takes around 6 hours before it begins its job and although its profile is mostly flat it has peak activity is typically between 10 and 16 hours post injection.. so your injection at 7pm in the evening is most active between 5am and 11am the following day.. I would reduce your evening dose by 2 units and re-run the fasting tests.. if the change looks good leave it a couple of days and do a couple more morning fasts just to make sure..

Reference the fasting... now I am old school and fasting wise is water and nothing else in my book... now some people say it is ok to eat as long as its no carbs.. now for the occasional fast if you don't regularly low carb then this won't give you problems.. however if you eat a reduced carb diet then you may find that your body is geared up to convert protein to glucose (this is called Gluconeogenesis).. thus you can find that this natural method of your body getting glucose from non-carbohydrate based foods can effect your fasting blood glucose.
 
Hi Pneu

Hope your well - and thanks for your reply again.

I think thats what confused me with lantus being supposedly a 24 hour lasting dose, the morning , the evening or both could effect the lows im having, and the good steady blood sugar through the night.

I have decided to try dropping both down 2 units. This gives me a total of 16 units per day. Which out of interest better matches my average daily amoun of nova.

Last night I went to bed @ 5.6 - but this time i hadnt had an apple to keep me going between dinner and bed. I woke up to low blood sugars at 6.30am so i assume they had steadily fallen through the night. Hence the reson for dropping the evening one too.

Im going to let this settle in and commence with some fasting tests later in the week!

Hope everyones good and i really do appreciate the useful input from everyone, I really feel like im on a track to beating this and really getting under control.
 
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