I need a quick bit of advice please.

[Deleted member 504664]

Hi there,

About 4 years ago, I changed my insulin regime from mixtard 30/70 twice a day too one long-acting insulin (Lantus) in the morning and 6 to 8 quick acting (Apidra) insulin, ranging from 1 to 8 units each time.

Since then I also use an app called Hedia that helps me calculate my quick acting insulin dosage.

I have a problem though.

For argument’s sake let’s say that my insulin sensitivity ratio is 1 Unit of quick acting to 10 Carbs and a cup of tea say has 10 carbs, (I do Like my milk and it is actually 7 carbs per mug) so each time I drink one cup of tea I should inject one unit of quick acting. But I drink more tea than it takes for the insulin to work and wear off and I am finding now that I am at the end of the day, I am having hypos as I have 5 units of active insulin in my body still working, but not having anymore tea, then if I eat on top I am told to inject even more.

My question is, how do I prevent the hypos at the end of the day, but still enjoy my regular cups of tea, is that possible even?

My Insulin Sensitivity Ratio is, 1 Unit to 13.5 Carbs currently, and has worked fine.

I self-treat my diabetes and have not seen a doctor or nurse about my it for over 14 years. This is probably why I do not know the answer to this question, and I cannot find the answer online.

This has only just become more of an issue for me as I recently invested in a Libre Lifestyle Monitor and Sensors, so I can now see things much more clearly, though there is a 10 minute time lag from what my sugar actually is and what the reader tells me, I take that in to consideration when calculating my insulin. It it a great investment so far, though it is bringing up more questions.

I have already started taking a smaller dose (5 Units) of Lantus in the evening to stop my blood spiking during the night, and it works great and all stable through the night now.

Thank you for your time in this matter and any advice would be appreciated, so that I can start to level my sugars off in the day.

Matt.

 

[Fenn]

Hi, I’m not smart enough to advise on the insulin stuff but that’s a lot of milk in a cup of tea to get to 7g, have you tried almond milk or soy? You can train yourself to still like the tea with less milk, maybe try a distracting your taste buds with different tea that tastes different while you trick your brain with less milk, just an idea, I would sooner give up tea than have hypos.

I hope you find a path… I’m going to put the kettle on.

 

[Jaylee]

Hi @NRG ,

might be worth basal testing & finding out how your Lantus is performing?
I inject mine in the evening. But can sometimes be sensitive to it the following day as its meant to be tailing off? Causing hypos. (That's with no novorapid on board.)

 

[Deleted member 504664]

Hi Fenn and Jaylee,

Thank you for your replies.

Fenn, I love my tea unfotunately, and my mug is 500ML, but I do use 160ML of Low Fat Milk, not ideal and yes I should cut back on it.

Jaylee I might try that Basal test tomorrow. But I know my Lantus is working as on the odd times I have forgotten to take it, my blood goes through the roof, even if I inject fast acting. Can you tell me what I can deduce from the results, or what am I looking for to, to make sure my blood sugars are still dropping and at what rate?

Thank you both for your time,

Matt.

 

[EllieM]

Hi @NRG, I'm not sure I quite understand your question, but it sounds to me that if you are getting hypos as soon as you stop drinking your tea, you have too much insulin on board for your carbs. Are you injecting a separate dose of insulin every time you have a cup of tea? (I guess you need .5 unit per cup) Or are you injecting a larger lunch dose to compensate for the tea in the afternoon?

So, some possibilities that I can see

1) Your lantus dose may be wrong, so you are going hypo because of the basal in your system.
2) Your insulin ratio is wrong, so you are injecting too much insulin for your tea.
3) Your Hedia app isn't working properly and isn't accounting for your insulin on board when it calculates a new dose.

Are you attempting to avoid all spikes? My understanding is that you will spike after carb intake because you can't exactly mimic a working pancreas with injections.

 

[Deleted member 504664]

Hi Ellie,

Yes you are right, I have built up so much insulin during the day as I am injecting one unit per two cups of tea, and I drink about 6 cups a day so 3 units in total for tea, plus then what I ate for breakfast and lunch, roughly a combined total of 120 carbs so another 10 units. I inject each time my app is telling me too at a ratio of 13.5 Carbs per 1 Unit of Quick Acting Insulin.

Is there a way to be able to drink my tea without spiking too much (I am not trying to avoid all spikes) and not building up so much quick acting insulin that I am having hypos if i do not continually to eat at the end of the day, I am not a big eater, so eat enough carbs just to cover the current hypo.

I have cut down on my quick acting, but then I really spike 13 + mmol/L or 250+ mg/dl and above per cup of tea, or is it simply that I need to cut down on my milk, even though it is low fat milk.

Thank you for your time in answering earlier

Matt,

 

[zand]

As a T2, not on insulin, I am merely asking a question, not advising.
Would switching from low fat milk to whole milk help to level out/ spread/slow down the spike? I think that whole milk has marginally less carbs? And would there be a mini 'pizza effect' due to the extra fat?

Edit I prefer tea but do sometimes have coffee with cream when I am trying to reduce carbs. Also for tea, I sometimes make 'milk' by adding water to 30 mls cream to use throughout the day. Not suggesting this for you though as it's an acquired taste and you do have insulin to reduce spikes, which I don't.

 

[EllieM]

I inject each time my app is telling me too at a ratio of 13.5 Carbs per 1 Unit of Quick Acting Insulin.

Have you considered that your ratio might vary throughout the day?

 

[Deleted member 504664]

Hi Zand and Ellie,

Thank you for your replies.

Zand, I will look in to that suggestion and see if it would have any effect. I also drink coffee too, but with the same amount of milk in.

Ellie, I have considered it, but for me to try and work that out, I will need more data, too see if there is a constant pattern happening throughout the day, like what was happening in the night and spiking at around 2 to 3 AM.

Thank you

 

[EllieM]

Ellie, I have considered it, but for me to try and work that out, I will need more data, too see if there is a constant pattern happening throughout the day, like what was happening in the night and spiking at around 2 to 3 AM.

I may be missing the obvious, but if you are hypoing there has to be too much insulin at some point in the process. And yes, I see no reason why you can't adjust your insulin to allow for your tea.

 

[Deleted member 504664]

Hi Ellie,

I was actually having a hypo when I wrote the previous message to you a few hours ago now, so the same thing happened again, and this is another thing that confuses me a little,

Libre Sensor told me that I was down to 2.72 mmol/L or 49 mg/dl but that did not feel right so did a finger test and I was actually lower and down to 2.3 mmol/L or 42 mg/dl. I ate my usual super low hypo food, corn flakes, milk and two tablespoons of sugar, all in all about 80 carbs, so I finally start to feel better and of course I need to slow my sugars going up so fast by injecting more insulin, but really do I need to be injecting 7 units again staright away when I have just come out of a hypo. I did not give myself that amount, but I gave myself 4 units, then followed by another 3 units after I ate another 30 carbs. How can I work out how much insulin I should be taking straight after a hypo, or it is quite common to spike after a hypo.

As to your latest post, then tomorrow I will adjust my insulin sensitivity to 17 carbs to 1 unit of quick acting and see how I get on with it there, if running too high all day, then I need to decrease it back down to 15 carbs.

OK, thank you all for your time, I have an idea on what to do now,

 

[philly1991]

What happens if you don't inject for your tea out of curiosity? I only ask because when I did the DAFNE course I had a similar experience to yourself and they advised not to inject for tea and if needed correct at the next meal which I found I didn't need to do anyway.

 

[Lobsang Tsultim]

It sounds like you're drinking more tea than my Grandad did, and they always had a pot on the go. Almost 6 pints a day! That's a lot of tea.

 

[Zhnyaka]

why don't you eat something with tea to prevent hypos? eat so many carbohydrates that a unit of insulin is just enough?

 

[Deleted member 504664]

Hi Philly, When I do not inject any insulin my sugars spike to about 12 to 13 mmol/L once I drank a cup of tea and stays there.

Hi Lobsang Tsultim, I do drink a lot of tea, that I can confirm. And of course a lot of milk too.

Hi Zhnyaya, it is not so much that I am having a hypo at the time of the tea drinking, it is more of the case that each time I drink a cup of tea or two, I inject one unit to for the carbs, during the course of the day and by the end of it I still have about 5 units active working in my body. I dont always want to eat and eat, I am not a big eater and never have enjoyed it.

Thank you everyone for your contributions.

 

[Outlier]

You could try drinking tea without milk - I've done this most of my life, but had to work towards it by gradually adding less and less milk until I reached the stage where I preferred the taste without it.

 

[TriciaWs]

I slowly moved from milk in tea to none but weakened the tea at the same time many years ago. On becoming a T2 I was still having lots of milk in coffees - but switching from low fat to full fat meant I could happily use less milk.

 

[Daibell]

Hi. It's unusual to inject for something like a cup of tea. I only inject Bolus for, say, 30gm of carbs or more. It sounds like your Lantus needs some tweaking. The Libre should be showing an excessive up or down trend during the night when you are sort-of fasting and the Basal balance is wrong. Be aware that swapping to Levemir Basal and splitting it twice day with different amounts can give better control than once-a-day Lantus

 

[EllieM]

I self-treat my diabetes and have not seen a doctor or nurse about my it for over 14 years. This is probably why I do not know the answer to this question, and I cannot find the answer online.

It might be worth seeing a clinic for some advice, but am guessing you are not in the UK because I don't think you'd get away without any interactions from a medical professional there. I'd also strongly suggest you see someone for eye checks at the very least, because untreated retinopathy used to cause blindness in a lot of diabetics, and modern treatments save eyesight. (Not saying you have any eye issues, but without a check up you won't know). And modern diabetes technology (such as pumps and cgms, might be worth your consideration).

Also, can you confirm that you are T1? Advice for insulin dependent T2s who may still be producing some of their own insulin might be slightly different.

 

[Deleted member 504664]

Sorry for the delay in reply,

Outlier: I have tried to drink tea without milk and I just find it too bitter. But thanks for the suggestion.

TriciaWs: I believe I need to stick with the low fat for cholesterol reasons. Goes hand in hand with Diabetes I find. But thank you for your reply, appreciated.

Daibell: I am following the advice of an app called Hedia on my phone, and I put my blood sugars and what carbs I am going to consume and it is telling me to take one unit every two cups of tea or coffee. You are right since using the Libre sensor I see a consistent trend of my blood going up during the night and peaking between 2 and 4AM so I started also injecting 4 units of Basal (Lantus) which helps, but last night it did not help at all. I really appreciate your input and know I have more work to go.

EllieM: You are right, I do need to seek a diabetic professional to go through all my data from the sensor, and find my insulin sensitivity throughout the day/night and my carb to insulin ratio. Since having this sensor it has been an eye opener and now want to get even better control, hence why I have finally started to ask you good folk some questions on this forum. And yes I am T1. I am from the UK and spent a good part of my life there, but the past 14 years I have been out of the country and my local healthcare is not what it is in the UK. Thank you also for your contribution.


Thank you everyone who has taken to the time to comment, very appreciative,


Matt.