Help with sugar roller coaster

Has anyone ever spoken to you about carb counting? Sounds like you need to be adjusting your insulin based on what you're eating, so if you have a really carby meal you can prevent the high with insulin and visa versa for a low carb meal.

Hi. Yes, it' essential to adjust your Bolus insulin for the carbs in each meal if you want to avoid hypos. Your doctors should have told you this. If you can't get any advice from your health team come back and perhaps we can guide you on areas to look at. Do change GPs if you can. Do ensure that your Basal insulin balanced. It may well be but aim for a fasting blood sugar of 5-7 mmol testing over several days and only making very small changes if needed and use the meter to avoid hypos.

@ryan1990, if your levels are all over the place in the absence of food then its likely that your basal insulin needs adjusting, given your hypo unawareness problem and other issues you would fit the criteria for a insulin pump.

@ryan1990, it's probably best to go back to first principles and see if your basal levels are correct by doing some basal testing.

If this looks like it is okay, then many of us have found that reducing the amount of carbs we eat dramatically reduces the blood glucose swings we get. Given your experiences this may be something that you could look at.

It's easy to become resigned to the fact that your BS control will always be a veritable roller coaster. However, there are a number of measures you could adopt to mitigate, and 'normalise' erratic BS levels.

I've been type 1 for 20 years, during which time control has varied, a lot. I attribute this to POOR advice from medical professionals and a lack of 'education' as to best practices/strategy to achieve optimal BS.

I've always been a 'concientous' Diabetic (I.e. testing regular, avoiding sweets etc), but only over the last couple of years have I manged to achieve a real degree of 'control', and therfore approach some level of normality, and 'freedom'.

It can initially be difficult to change habits and have a more disciplined, pragmatic approach. But very doable with a little effort/persistence.

A few suggestions (in addition to the advice by other posters:

• Really plan your food intake; stick to regular types of foods that you know won't spike your BS. Can be a bit 'boring', but worth the sacrifice.
• Lower your carb intake; Lower carb > Less Insulin > Less room for error in dose (hypo/hyper) = Better control
• Start doing resistance training: Weight training has such an incredible effect on insulin sensitivity; therefore as per above, less insulin (increased sensitivity) = Less room for error in dose = better control.
• You also appear to be a 'good' candidate for either a continuos glucose monitor, or Insulin Pump - speak to your GP/Consultant about refferal.

First test your basal rate like this:
http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
That will get rid of most of your hypos, and leave you feeling more in control and hopeful.

Then test your bolus ratios like this:
http://www.salforddiabetescare.co.uk/index2.php?nav_id=2006
And life will be great! You can do it, and you will feel better. Sometimes we T1s try, and try, and try, but without the right info we keep failing. I spent years out of control and never got any detailed advice until I found this site.

The third factor is activity levels. That can really destabilize things, but you have to get basal and bolus right first, then you can start altering doses for activity.

ryan1990 said:

So if I take 16 units of levimir at night I am proberly doing the wrong thing ? Should I split the doses ?

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If you do the basal testing, this will tell you whether this is the correct approach or whether you need to consider splitting it.

There are a number of reasons for the roller coaster. It could be one of them or all of them together. The trick is to find the reason/s by elimination. If it's your basal rate that's wrong it has the worst effect (in my experience) and once you get it right, you start in the right place to sort out any other reasons quite quickly.
Your basal rate doesn't look like it's very high compared with your boluses, which are pretty large (but we don't know what you are eating yet). It may be, for example, that your basal is too low, and you overcompensate with boluses, and that causes the hypos. But really, only you can find out, by checking as in the Salford advice, step by step. Also, it is useful to learn these techniques because our insulin requirements can change over time. For example, I have increased my exercise lately, and my blood sugar is regularly dropping a bit too far overnight, so I am planning to retest my overnight blood sugars and adjust my basal rate if necessary. Last time I did that was about June.

ryan1990 said:

is 7 , 10 , 12 large doses of humolog insulin ? compared to 16 of levimir i hate the fact i dont understand my levimir im not entirly sure what a basal insulin does really its a nightmare this morning i woke up with a blood sugar of 4.3 then took 7 units of humlog ate about 40g of carbs and then a hour later my blood was 1.2 i didnt feel this i might add until i started getting a slight headache then my blood sugar now after correcting the hypo is 12.5 see how my days are playing out regularly this has been going on for a year and a half now so its a nightmare

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Okay, here is the 101 of how these work.

Your liver constantly produces a background level of glucose. This needs something to counter it otherwise as a Type 1 your blood glucose level would just rise. Basal insulins do this. They are slow release and are intended to keep your background, fasted blood glucose as flat as possible.

Your bolus insulin is used to counter the amount carbs from the food you eat at meals. Under the DAFNE and other carb counting courses you learn to adjust the amount of insulin you give at meals based on what you eat. This online course is really helpful in learning more about this: http://www.bdec-e-learning.com/

If your basal is not quite right, or you are taking too much insulin with a meal (and it sounds as though you are taking set amounts of insulin per meal, which means that you will need to eat a specific amount of carbs with each meal), then it can cause swings like those you are experiencing. The example you have given of 7u of Humalog for 40g of carbs is quite a high insulin:carb ratio. That's essentially 1u:6g carbs and appears to be way too much insulin. The normal point that people start at is 1u:10g carbs.

It's worth you having a read of both the basal testing site: http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007 and the earlier linked BDEC course as I hope it will help you understand what the insulins are used for and how to use them more effectively.

I can't comment on the foot drop, but certainly some people managed to regain some degree of hypo awareness once they have their levels better controlled. Apparently if you reduce the number of hypos you have, the more you should eventually be able to notice them. Just be aware that carb ratios can be hard work, you may find at different times of the day you need different ratios I.e. you could eat 50g for breakfast and dinner but need more insulin for one than the other. A good book to look up would be "think like a pancreas"

Most type 1s do need to split their levemir basil as its action on controlling bg levels tends to be about 12hrs so by injecting an amount in the morning as well as the evening, that then alters the amount of bolus that is needed for a meal.

6u for a 40g carb meal works out at a carb ratio of 1u for 7g carb (6x7=42). 1u to 7g is not that high but looking at your bolus doses at lunchtime (10u) this does more or less look as though your evening basal is starting to run out of steam and its definately run out of puff by the time you do your eve meal bolus of 12u.

Have a talk with your DSN about splitting your Levemir as I think you will find yourself a bit better controlled.if you do.

The way to find your ideal carb ratio is to test bg levels before a main meal and 2.5hrs later and alter the bolus to be a good bg level of about 5-6mmol before a main meal and allow for a rise in bg to be no higher than 3mmol above the before meal bg level mid way and then by the time the bolus has finished its action (4.5hrs), the bg should have fallen back to about 5-6mmol again

Can you bg test frequently (6 times during the day) and write the amounts of carb down with the bolus and basal doses? Things always become clearer when you write stuff down and look at the results to make adjustments.
The BDEC website is good to explain insulin to carb ratios and for correction dose adjustment the 100 rule saves guessing and making mistakes.

ryan1990 said:

is 7 , 10 , 12 large doses of humolog insulin ? compared to 16 of levimir i hate the fact i dont understand my levimir im not entirly sure what a basal insulin does really its a nightmare this morning i woke up with a blood sugar of 4.3 then took 7 units of humlog ate about 40g of carbs and then a hour later my blood was 1.2 i didnt feel this i might add until i started getting a slight headache then my blood sugar now after correcting the hypo is 12.5 see how my days are playing out regularly this has been going on for a year and a half now so its a nightmare

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Your waking blood sugar is good. Perfect even. But wow! 7 units for 40g carb is a BIG dose of insulin. No wonder you hypo. Most young men have more muscle mass and better insulin sensitivity so they tend to need lower boluses, unless they are eating great quantities of carbs, or they are very insulin resistant for some reason (usually overweight or inactivity/sedentary lifestyle.

Most people start on 1:10, that is one unit of insulin per 10g of carb. Then you take your bolus fifteen minutes before eating and then test again between one and half and two hours after the bolus. By that point, your blood sugar should, ideally be back in "normal" range (under 7.8), but if it is a lot below that, you may very well hypo again - though not as fast or as badly as you are now.

You might find that even 1:10 is too much. But if I were you I would try it for three or four days, and see how it goes.

The other question, if you are reluctant to go full on and test your basal rate by fasting etc, is what was your blood sugar reading BEFORE bed last night. dId your blood sugar fall much overnight? What you want is for it to stay at roughly the same level.

You don't have to increase your carbs to "feed the insulin". You can cut the insulin to match the carbs. The ideal is to be eating enough to maintain your weight, while taking as little insulin as possible and keeping your bloods in the normal range. If you eat 100g or so at every meal with 10 units of insulin you will pack on the weight ( and possibly STILL hypo).

[So, for example, I am 53 year-old female T1 and my insulin to carb ratio is 1:11 or 1:12. So for 45g of carbs I take only 4 units. It's is extremely unlikely that you need 10 for the same amount of food.]

You can really discount the highs after over-correcting the hypos. What you should focus on is getting rid of the hypos, then you will automatically cause the over-correction highs to disappear. Those hyper corrections may be making your hba1c test high, so your consultant will be telling you to increase your insulin, when by all accounts you may need to decrease it, particularly your boluses.