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Help with raised blood sugars at my wits end

No not any more, I do a bit more exercise and avoid the traditional forms of carbs such as bread, pasta, rice etc.

I've gone through many many changes of insulin/carb ratios, injection times and exercise/insulin sensitivity. Very difficult to explain why sometimes, but being adaptable is key, even if you dont know why.
 
Twinkle1710 said:
Well today my level was 4.9 when I got up I took my insulin 30 mins before breakfast and 2 hours later it was 7.2. It was 7.9 before lunch did the same again and it was 7.4 two hours later and 7.1 before tea have taken my insulin 30 mins before Again so see what tonight brings. I'm just a bit uncomfy with this as what if I get way laid and forget I have taken my insulin or something happens and I forget to eat how does everyone else feel about this
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Yes you do have to be very careful Twinkle, 30 mins would be far too long of a gap for myself to wait before eating food and the longest I leave it is 20 mins, usually its between 10-15 mins but there are some meals where I'll inject immediately before and sometimes after.

One word of advice I would give is to look at the food you are eating for that particular meal when injecting ahead, if say you were eating a meal with a high fat content then it's highly likely your insulin will peak before your food is digested (fat slows down absorption) and you could end up hypo, likewise if the carbs in a meal were low-gi.

I always suggest that members speak with their diabetes care team before contemplating injecting ahead of their food, although I do know it works and I do it myself for most of my meals it can be a tricky one to get right and you need to be prepared, if you do speak with your care team you could ask to speak with the dietitian who will explain the role of fat in the diet and the difference between low and high gi carbs, if your lucky you may get a dietitian who is DAFNE trained and will also advise on dose adjustments.

Good luck!
 
Excellent readings twinkle, well done snack before bed good idea :)

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I had a snack before bed of 2 ryvita and my level was 4.9 this morning so a drop of around 2 overnight. Wondering if I should drop my lantus down one unit to see if that helps but I did it a week or so ago and my morning level was 7+ so not sure if I should just stay with what I have now as it does seem to be working any ideas
 
The more I think about it, the more I think Donnelly is right. Perhaps you need to drop your Lantus and increase your Novorapid. To figure out how much to change your Lantus by is that for each change of 1.6 in overnight levels, change your Lantus by 10%. Make sure you don't eat or have Novorapid within about 4-5 hours of bedtime as it will distort the results.

Keep reporting your numbers back and I'd follow nobleheads suggestion of speaking to your DSN.
 
Ok I will drop my lantus to 23 tonight which is only 1 unit or would you sugest 2 units I am carb counting around 60 - 90 carbs a day now and low gi foods. I take novo rapid 1.5 to every 10 carbs so do you think I should increase this to 2 per 10 carbs. I have spoke to my dsn on a number of occasions and she keeps telling me it's trial and error and nothing is set in stone it's just a case of changing to get the right level for me. I am pretty confident with the whole diabetes concept and my consultant and nurse agree I am a registered nurse for 17 years now so knew about diabetes but I must say there was a hell of a lot I didn't know and have learnt over the last few months. I know I am pretty stable with my levels and it may seem a bit obsessive to want to get them perfect but I just need to find the right level so I can not let diabetes take over my life and just have good control
 
Hello Twinkle

I have been type 1 for nearly 50 years and nearly all of my hba1c levels have been around 6.4 - 7.4%.

Whenever I have got my a1c to be below 6.8%, it has cost me some mild hypos and as a result, my awareness of going low only came when my bg levels were below 3.5mmol.

By all means look after your bg levels but dont do it to such a degree that you are constantly trying to walk across a tightrope as there will be times when you will fall off.

Not everyone will develop complications. I am probably one of thousands of diabetics who have been able to get away with only developing a touch of background retinopathy in 1 eye, frozen shoulders which cleared up and carpal tunnel syndrome which also cleared up with a small op. The background retinopathy also cleared too (but that was when my a1c was at 7.4%). Once I got my bg levels slightly lower so that the a1c dropped back to 7% again, I was fine....................
 
As you ate before bed last night, I wouldn't change anything tonight. Just make sure you don't eat or have Novorapid within 4-5 hours of bedtime tonight. Have you got any recent (past few nights) overnight readings that match this criteria? We could work from those.

You'll end up chasing your tail trying to change Lantus and Novorapid at the same time, so just concentrate on the basal first as that if that is wrong then your Novorapid will be too.
 
I would if me drop by 1 unit only.

We got to accept some rises of bgs with food when on mdi.. Pumps you can fine tune more, but unecessarily so. As all 'norms' will have some level of rises too.

For an mdi user you afe doing **** good..
 
I also agree with DD. Try dropping your lantus down by 1u at a time and then get up 4hrs later to see what your bg level is (about 2am) and then again at 4am, 6am. You may find that lantus has too much of a lowering effect and will need to eat a snack before going to bed. If I didnt eat a snack at bedtime, I definately found myself in hypo land around the 2-3am mark.

It wasnt until I went on a pump and did some basal testing that everything came to light.... I found out that my bg levels naturally dropped from midnight to 4am and then started to rise up from then on. So, that was the reason why I needed to eat something at bedtime without doing a bolus when I was using MDI.
 
Ok so last night I ate tea at 5. I dropped my lantus by one and took 23 units by bm was 7.2 before bed and I didn't eat anything since 5. My bm was 4.2 this morning and I am going to continue taking my insulin 30 mins before meals today. Do u think I should drop my lantus again tonight or give it a couple of days Also do u think it is my lantus that is to high
 
Using the formula I gave above you need to drop your Lantus by about 20%, which is just over 4 units. I'd try dropping it to 19.

I change my Lantus nearly every day based on when I last did exercise. Dropping it by a single unit would only produce a subtle change when my total dose is in the 20s as dont forget, that single unit is spread over 24 hours. When my total dose is in single figures a change of a single unit would produce a more pronounced effect as its a higher percentage of the total dose. Everyone is different though and I expect others have contrary experiences.
 
Wow I have been a bit high with it haven't I. I will drop it to 19 tonight. Will this make my day time levels go up ? I am taking 1.5 units per 10grams already and don't really want to have to increase that
 
It looks like you've had a change in insulin sensitivity/requirement. Happens to me all the time. So you may need to tweak your Novorapid, which is difficult to get right unless your Lantus is correct. Keep reporting your numbers back, we'll get there soon!
 
Thanks very much for ur help and experience it means a lot. I took my bm 2 hours after breakfast and it was 6.5 so the delay in giving my insulin and eating seems to be working for now. I will reduce my lantus to 19 tonight but will this make me have to increase my novorapid ratio I'm a bit confused about that bit but I agree with u I need to get my basal sorted first
 
I'm not sure Twinkle whether Sams advice is going to be ok for you. Lantus isnt one of those insulins that consultants would want diabetics to constantly adjust all the time. They would rather diabetics adjusted the bolus so that bg levels were higher before they went to bed and keep the background dose the same each night.

All I can say is try the 19u and see what happens during the night and what your bg level is tomorrow morning when you wake up.
 
Sorry, maybe I've not been clear. I'm not suggesting twinkle changes her Lantus dose every day. That certainly isn't for the faint hearted. I do it because my insulin sensitivity changes dramatically because of exercise. I understand very well how my sugar levels change according to when I last did exercise. Works well for me, I've not had a high reading for over 3 weeks. Can't remember last time I went hypo either. I agree though, its not for everyone.

Ultimately twinkle its up to you, if things are going ok with what you're currently doing then you may want to carry on with it. On the other hand, you may want to reduce your Lantus to keep overnight levels consistent. Doing this might mean you need to make small adjustments to your Novorapid though, but at the same time you might not.
 
It's ok Sam I agree totally with your calculation and will adjust it to 19. I increased it myself thinking the highs 2 hours after a meal was my lantus not being enough. So I now know its not. Just need some help on what to adjust my novorapid to if I need to now and I should be sorted
 
Ok no worries, post your numbers up tomorrow and I'm sure we'll be able to figure it out.

And don't worry, I used to get anxious about increasing my Novorapid. Used to really panic about hypos especially when I lived by myself.
 
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