How long to get stable?

markpj31

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I was put on insulin in December 2021.

Up until now, following advice from the nurses, I am still not stable.

How long does this usually take?
 

Antje77

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There's no way to answer this.
Some are more or less stable very quick, some never get stable, no-one is stable all the time.

What helps a lot is using a CGM or test a LOT, and keep a food diary, counting the carbs and finding patterns.

Is it still correct you use Lantus only?
 
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In Response

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What do you mean by stable?
How are you using insulin?
Just stabbing yourself a few times a day and assuming a fixed dose of insulin with no other lifestyle change will make you “stable” will not work.
 

markpj31

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Hey @markpj31, I started insulin in September last year, and following the doctors advice I really battled to find stability. I recently tried the libre and made some adjustments - doing much better, but also looking for a new doc.

Does your team work with what you tell them, or do they advise by the book? I think getting stable depends on finding what works best for you,

It seems they advise by the book. Telling me to do a set number of units per meal makes no sense to me seeing as each meal is different (carbs etc). I seem to be going backwards, not forwards. What is also surprising to me is that they don't ask me what I'm eating which you would think would be massive factor(?) seeing as that accounts for about 50% of the "treatment".
 

markpj31

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177
Type of diabetes
Type 2
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Insulin
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Diabetes.
There's no way to answer this.
Some are more or less stable very quick, some never get stable, no-one is stable all the time.

What helps a lot is using a CGM or test a LOT, and keep a food diary, counting the carbs and finding patterns.

Is it still correct you use Lantus only?

Using Novarapid now too for meals (x3) on a set amount of units per meal (as instructed to do so).
 

markpj31

Well-Known Member
Messages
177
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Diabetes.
What do you mean by stable?
How are you using insulin?
Just stabbing yourself a few times a day and assuming a fixed dose of insulin with no other lifestyle change will make you “stable” will not work.

Stable with numbers between 6-8 which I have achieved before on oral meds.

I have been set a fixed amount of units to inject per meal by by nursing team.
 

In Response

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Type 1
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Stable with numbers between 6-8 which I have achieved before on oral meds.

I have been set a fixed amount of units to inject per meal by by nursing team.
No one (not even someone without diabetes) has stable levels between 6 and 8. My partner has measured numbers below 4 and Libre graphs from people without diabetes rise as high as 9.

Fixed dose insulin does not work with meals unless you always eat the same amount of carbs which is why those of us with Type 1 carb count and dose accordingly.
 

Antje77

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Using Novarapid now too for meals (x3) on a set amount of units per meal (as instructed to do so).
Worth updating your profile information, or adding this information to your question to prevent confusion.

I agree with @In Response , fixed doses don't make sense when not eating fixed amounts of carbs for each meal.

What you can do on fixed doses though, is count your carbs and make note of them, along with your before and after BG.
This may show you how many carbs you need for the dose you take, and you can adjust the carbs to your doses.
Or you can insist you need to adjust your doses and get the green light for that.
Still, this means the same kind of record keeping to work out how much insulin you need for how many carbs for different times of the day.
 

markpj31

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Type of diabetes
Type 2
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Insulin
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Diabetes.
Worth updating your profile information, or adding this information to your question to prevent confusion.

I agree with @In Response , fixed doses don't make sense when not eating fixed amounts of carbs for each meal.

What you can do on fixed doses though, is count your carbs and make note of them, along with your before and after BG.
This may show you how many carbs you need for the dose you take, and you can adjust the carbs to your doses.
Or you can insist you need to adjust your doses and get the green light for that.
Still, this means the same kind of record keeping to work out how much insulin you need for how many carbs for different times of the day.

Yep. No mention of carb counting though by the nursing team, seems to be a case of just throw a number at me, as if it was pulled out of thin air.
 

markpj31

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177
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Diabetes.
No one (not even someone without diabetes) has stable levels between 6 and 8. My partner has measured numbers below 4 and Libre graphs from people without diabetes rise as high as 9.

At one point I was a pretty steady 5-8 when measuring 4 times a day over a period of 2 weeks. Now its all over the place. I have extreme highs and lows. For example, the other day I had a low of 1.9mmol/L to a high of 16mmol/L before bed.
 

In Response

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Type of diabetes
Type 1
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At one point I was a pretty steady 5-8 when measuring 4 times a day over a period of 2 weeks. Now its all over the place. I have extreme highs and lows. For example, the other day I had a low of 1.9mmol/L to a high of 16mmol/L before bed.
That is most likely due to not matching your insulin to your carbs.
You many benefit from the Bertie online course (you can find it with Google) This is aimed at Type 1 but the theory of carb counting is the same.
 

Antje77

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the other day I had a low of 1.9mmol/L to a high of 16mmol/L before bed.
How long after eating did you have the low, how many carbs did you eat and how many insulin did you take for it?
Same questions for the high.

Without this kind of information over multiple days, no-one, not even the most learned endocrinologist will be able to start working on finding the right doses for you.

There's a lot of information to gain, even on your fixed doses. But you need to do some bookkeeping to get this information.
 

Antje77

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What about taking it one meal at the time, say lunch.
Count the carbs, note the time, keep track of your numbers before eating and 2 and 4 hours after eating.

Post meal numbers high? More carbs than your mealtime dose could handle.
Post meal numbers low? Not enough carbs for your mealtime dose.

It does take a while of experimenting, but you should be able to get close to the amount of carbs you need for that meal and dose that way.
 

markpj31

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177
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Diabetes.
How long after eating did you have the low, how many carbs did you eat and how many insulin did you take for it?
Same questions for the high.

Without this kind of information over multiple days, no-one, not even the most learned endocrinologist will be able to start working on finding the right doses for you.

There's a lot of information to gain, even on your fixed doses. But you need to do some bookkeeping to get this information.


Low came around half hour after eating. I ate around 30g of carbs.
High I think came when I over-done eating Jelly beans to get back up from the Hypo. But I am generally high when I wake.
 

markpj31

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177
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Diabetes.
@markpj31 That is frustrating! My doctor was also giving me advice on insulin without really considering any other factors, unfortunately I was in a tis and followed it too long and now I feel like it made me quite sick.

Are you able to see a different team/doctor/nurse? Monitoring your numbers, diet and doses would be a good starting point either way, and if you are able to do a course they sound quite helpful!

If you do have to stick to the set doses, the monitoring should help you figure out how many carbs you should have for that dose, and you could try at least match your food to your dose to avoid the extreme highs and lows - at least until you find a team who supports you adjusting your doses according to what you are eating!

I am writing down my figures 4x a day. I have now been given some flexibility to increase my doses if need be (or lower it I suppose). There is only one nursing team where I live, as far as I know.

I think at the end of the day, it is your body and you do what works for you even if it means taken action into your own hands, because you are the one that has to do deal with potential complications that may arise.

My Doctor said to me once when my sugars were high (8.6mmol/l Hba1c) that I would get organ damage, so he said I need to get it down asap. I got it down to 6.0 mmol/L in 3 months, to then find, because it had dropped so suddenly, that it had caused issues in both eyes - I wish I was told of the dangers of dropping blood glucose levels down so rapidly and the damage it can cause.
 

Antje77

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Low came around half hour after eating. I ate around 30g of carbs.
So now try to find out if that's a one off or a pattern.
Does it happen again with the same amount of carbs at the same time? How long after your last dose did it happen? Those are the questions you need to ask yourself and keep track of.
High I think came when I over-done eating Jelly beans to get back up from the Hypo.
Do you remember how many jelly beans you had? If it was too much, you might want to have less to treat your next hypo and see how that works.
 

markpj31

Well-Known Member
Messages
177
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Diabetes.
So now try to find out if that's a one off or a pattern.
Does it happen again with the same amount of carbs at the same time? How long after your last dose did it happen? Those are the questions you need to ask yourself and keep track of.

Do you remember how many jelly beans you had? If it was too much, you might want to have less to treat your next hypo and see how that works.

Oh. yep. It is a pattern and I managed to counteract it yesterday.

I eat the same thing daily at the moment.

Today, I woke with 7.5, did 8 units of NovaRapid and BSG 2 hours after breakfast (2 slices of cheese on toast) dropped to 3.3. I walk a lot so that may well be taking a chunk out of the BSG levels.

NHS guidance in the UK says to eat 5 or so jelly beans and then follow up with a glass of milk or slower release carbs, and to test 10-15mins. Problem is with that, is that I find it takes much longer than 10-15mins for my BSG to rise, even after something sweet, so sometimes I over compensate.
 
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