Hello. First post although I have watched this place for a while. I have been type 1 for about 34 years. The last 15-20 years have been on lantus and novorapid. For the last 10-12 years I have been under the supervision of the GP surgery and before that the diabetic clinic. During that time I have consistently been “told” that overall control was good. My target level was set at 58 and Hba1c levels have hovered at around this level or slightly above. Day to day blood sugar levels have been quite volatile and I have always done a lot of testing. I am relatively fit and up until the last 3 months did a lot of running. Shortly before Christmas I had quite a bad hypo and was taken to A&E but not admitted. Unfortunately the follow up meeting with the nurse at the GP surgery was extremely unhelpful. Everything was blamed on me, saying that I was not adjusting for exercise, despite having been doing this for years. Even more worryingly, she said that I was mismanaging the diabetes as the HBA1C shouldn’t be below 68 or 58. At this time HBA1C was 47. Since then I have been looking at things intensively to try and identify the cause of the blood sugar instability. Although there is a basic pattern, there is a lot of variability within that and this means there are unexplained highs and occasional lows. In terms of broad trends there is a fairly strong dawn phenomenon during the mid morning. Although there are occasional night lows (which wake me) from testing these are not consistent enough to explain the highs in the morning. I also find that blood sugars usually spike around 2 hours either side of the daily lantus injection (6pm). This is not always consistent however (tonight for example it went to 16 by 8pm, but equally on other nights it has gone low within the couple of hours following the lantus). Notably there does also seem to be a drop in blood sugars around 2am although this isn’t often severe enough to go hypo. Overall the trend is that if night time blood sugars are ok, it will run high during the day. The blood sugars seem to spike violently in the couple of hours after meals despite bolus dosing for carbohydrates. During the last 3 months I have eliminated exercise as a possible cause (wasn’t convinced this was the case anyway, that was just the nurse). Have also extensively rotated injection sites to try and eliminate absorption issues, and have changed to new cartridges of insulin. None of these have had any effect. Carbohydrate remains broadly the same (3 main meals plus a smaller supper). Having read around, there seem to be a number of possible theories for what is causing this instability. One thing I noted from testing was that during cold weather, if I went from a room environment to a cold outside environment, the blood sugar level would crash in the space of about an hour. Another theory was that the lantus does not absorb consistently. It doesn’t seem to last 24 hours and also seems to have a peak at around 6-8 hours after injection. Having tried splitting the dose a couple of years ago, this didn’t seem to solve the problem, but instead introduced instability else where during the day. Have also experienced what “may” be “lantus lows” where it drops extremely quickly after injection. Would be interested to hear from lantus to a different basal insulin and whether that has worked? Reports on others like Levemir seem to be a bit inconsistent. Another question was whether it might be undiagnosed Addison’s disease. Would be interested to hear from anyone who has this. Have read that it can cause unexpected lows, but was wondering if it can cause unexplained high blood sugars also? There is also the possibility of stress, although stressful events don’t seem to correlate to changes in blood sugar. Have wondered if reactive hypoglycaemia could be an issue, but can’t find terribly much on this. Was just wondering if anyone had any information about the above or indeed anything else that might be relevant? I have another follow up with the GP surgery in a couple of weeks and think it may be necessary to demand referral to the specialist diabetic clinic as I don’t think they really have a good knowledge of diabetes/ endocrine issues. Thank you.