Help with diabetes control please!

[ConantheLibrarian]

Hi everyone,

I'm 23, type one diabetic for 15 years now, when i was on 2 injections of premixed daily, my control was pretty good, but since i switched to multiple injections, my diabetes seems to be out of control. I'm on 2 insulins (insulatard for morning and night, and humalog for each meal), and also 2x 500mg metformin in a morning, though i've been advised i can take 2 in the evening also. Also suffer from underactive thyroid (take levothyroxine) and photosensitive epilepsy (take epilim)

My diet isn't perfect, i eat a lot of ready prepared foods, rather than cook from scratch, and i know that is a factor.

The big thing for me, is i find if i decide to eat fruit as a morning snack, instead of nothing at all, then even if i do no insulin for the orange, my blood glucose drops drastically within an hour, which means i have to fix with something sweet, which then causes the blood glucose to go too high, meaning i do insulin to correct, and then the cycle begins...

I'm looking for people to chat with, as its kinda depressing, trying but not getting anywhere, hoping to find people who can either help, or are going through similar things.

Thanks

 

[KimSuzanne]

Don't get down we all go through these problems I'm 25 and have had type 1 for 18 years now, sounds like strange questions but what happens if you don't take insulin for the orange? Also how much insulin do you take to account for a piece of fruit? It may be that the insulin you have with your breakfast is enough to cope with your snack.
Trust me its trial and error sometimes to get the control back - how long ago did you change regime? It could be that your body hasn't quite made the adjustment yet!

 

[ConantheLibrarian]

Hi Kim,

If i eat an orange at say, 10am (2 1/2 hours after breakfast) and do no insulin, by around 11:30, my blood sugar drops to around 3.2mmol. If i don't eat anything mid morning, it either stays ok, or goes too high :S

Normally take 2u humalog for an orange. My daily doses are roughly 44U Insulatard morning/night, and 6-10U humalog per meal, my HB1AC was 13% last time

Been on the regime for about 6 years now probably, so quite a while

 

[jopar]

You say that you take insultard morning and night 44 u, is this a striaght split or even?

Do you inject the insultard at the same time every day?

It could be that you need to take a slightly different spilt or adjust the time that you inject...

I had trouble when I started the basal/bolus regime as I was instructed to take at bedtime which I did, what wasn't said that it was a timed injection and needed to be taken at a set time! which would have been helpfull as for me bedtime could be anywhere from 10.30pm to 1.30pm depending what shift I was on doh...

Have they ever suggested that you go onto either lantus (which many don't like) and Levimer that both have flater profiles than the insultard does.

 

[ConantheLibrarian]

Yeah, it a straight split 44U morning, 44U night time, always before i go to bed, no set time :|

I tried Levimir when it first came out, didn't seem to work too well for me, and the doctors took me off it again after 3 months, saying the trial tests were 'misleading' and it might not work as well as it was promised...

 

[jopar]

Hi conanthelibrarian

That could be some of your problem, the insultard being a long acting insulin really needs to be taken a set time, in my case I ended up as taking 8 units at 1pm and 10 units at 11.30am in the morning but it is a bit of trial and error to find a good time...

I would start with choosen a almost convienant time (as there never really seems to a consistant time) then see how this effects the underlaying control... You will be able to see better if you might need to to do a uneven split to get good coverage over the day...

 

[sofaraway]

So you are taking 88 units of basal insulin and 30 units max of bolus. thats quite a big difference and wonder if thats contributing to your problems. most people do better on a more even split.

are you carbohydrate counting at the moment?

 

[ConantheLibrarian]

Hi sofaraway,

Kind of carb counting at the moment, but then get fed up part way through and give up

 

[hanadr]

All I can add to this is: try lower carbs for a week or so and see how you do. you will have to reduce both basal and bolus insulin a bit

 

[lionrampant]

Hi sofaraway,

Kind of carb counting at the moment, but then get fed up part way through and give up

How exactly have you survived this far in life without carb counting? I say this since you're only two years younger than me (or will be come next week) - which means you must have learned the old-school method of type 1 control, which is almost fascist in it's discrimination against inexact carb intake.

Seriously man, you need to do it. It's not hard, and it makes life a whole lot better.

 

[KimSuzanne]

Others have said it too but you really need to get the insulatard done at set times getting the base insulin right and balanced is a major part of the control - just a suggestion but try taking it 12 hours apart thats how I do mine 20 units at 9pm and then 20 units at 9am then I have novorapid when I eat. Give it a couple of weeks and see how things go, it might just settle things! Let us know how things go and there plenty of us to give some advice if needed.
Don't get disheartened though I'm 18 years in and sometimes my control gets unsettled and needs a good kick so it knows whose the boss