Insulatard and Gliclazide

What is your level pre bed time ? What is your fasting level in the morning ?

According to the PIL :

1.What Insulatard® is and
what it is used for
Insulatard® is human insulin to treat
diabetes. Insulatard is a long-acting insulin. This
means that it will start to lower your blood sugar
about 1½ hours after you take it, and the effect
will last for approximately 24 hours. Insulatard is
often given in combination with fast-acting
insulin products.

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If you are low at bed time then go lower with the Insulin maybe you are liver dumping during the night and raising your morning level. May be worth waking up around 2 or 3 am and testing to see what your levels are then.

Patch,

I take it you mean your levels upon waking or is it mid-morning after food? If it's waking levels then you do really need to test during the early hours to establish your bg readings as Sue suggests, providing your bg is within range before bed your Insulatard insulin (provided you find the right dose) should keep your bg levels stable till the following morning. However if you are referring to mid-morning it may well be that you are eating more carbs than you realise, so perhaps look at your breakfast and make some changes accordingly.

I was on Insulatard some time ago and found it didn't last for more than 16-18 hours, I tried splitting but my bg became erratic and I finally give-up and changed to Levemir insulin. So it may well be the case that Insulatard insulin may not be for you Patch, there are other basal insulins so I suggest you speak with your dsn who should advise you further.

Nigel

Patch said:

Thanks for the responses - I really appreciate it.

My DN told me that the "tard" in Insulatard means "tardy" - ie, late/delayed.

My night time readings are ALWAYS lower than my early morning (fasting). Usually around the 8-10 mark at about 11pm, then 12+ at aound 7am and have been for over a year, well before starting Insulatard.
That's a lot higher than my bedtime readings......usually about 6 - 7. Then about the same at 8 am. Just before a breakfast, even if only a slice of toast. What's the latest that you eat and what sort of food would it be ?
I'm sure I'm not taking too much carbohydrate - although the DN did "advise" that I start to eat some. I'm still quite reluctant to do this, although I have eaten some basmati rice on a couple of ocassions since starting Insulatard. Can't say that it made much difference to my fasting, or night time readings.
Do you actually know what amount of carbs you are eating per day/meal ? There is nothing wrong with a few carbs, portion size is what matters really. I'm low carbs at the minute and can still eat most things if they are restricted. As regards Rice of any kind I find the peak is between 3 and 4 hrs later........not 2 hrs.
I don't eat breakfast.
Not a good idea really, the body needs something to keep the Bg levels in balance and fuel you for the day ahead.

Looks like I'll be setting the alarm for 4am to test my BG...

(I'm not too keen on taking insulin, and wonder if I might have a kind of reverse placebo effect going on?)

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Stress can raise Bg levels.........worrying about something, such as taking Insulin and why things don't seem to be going right despite all your best efforts. Sue asked what are your Bg levels throughout the day........pre meals, 2 hrs post meal. Might help us to help you if we knew what they were ?

Hi Patch,

Sorry, I don't know if the gliclazide effect the insulatard at all.

Have you noticed your BG dip at all, at any time of day? I would expect that it may cause your BG to lower at soem point...although maybe not when you hope for, as that is sods low, that your profile and teh insulins profile do not match...but for it not to have any effect is unusal.

It is years since I was on insulatard....which is completely irrelevant to you, EXCEPT...if the majority of T1s are not using it anymore, it does make me wonder if the supply you have might have been in the back of the pharamcists fridge for rather too long? Just a thought.

Sugar2
Gliclazide is a class of drugs called Sulphonylureas. They work by stimulating the pancreas to produce more insulin, which should then lower your BG levels. They are normally used in combination with Metformin or other tablets to control BG levels. Not very often with Insulin though ?

When used with Insulin frequent monitoring of Bg levels is advised as the combination could lead to hypoglycaemia if not balanced.

Thanks..I was wondering if there was a rug interaction between these particular medications? It just seems unusual for then to have no effect...some effect, but not at teh right time, or the right amount etc...I understand (a bit!) but Patch said no effect....I hope t o learn more.

Patch said:

I know this is going to sound controvercial - but I'd love to have a hypo. At least then I'd know the drugs DO work.

The lowest readings I've had recently have been in the 5's and 6's, and are usually at around 5-7pm (before I eat my evening meal). My food intake on a normal day is:

Wake at 7am - BG 10 - 12 mmol/l
No breakfast

Not a good idea to have no breakfast as Ken said. If your job is energetic then that would tend to make you liver dump so you have the energy etc. If it is sedentary then it will stay high as you don't burn it off.

Lunch at midday - BG 10-12 mmol/l
Lunch is usually home made soup

It all depends on what is in the soup ?

2hrs after meal - BG 12 - 14mmol/l
Dinner at around 7pm - BG 6 - 10mmol/l

Dinner will always be a lo-carb meal - chilli, curry, lots of veg, chicken, steak, omellette...

Chilli and Curry can be high in carbs depending on what you put in it. Do you eat rice/ chappatis/naans etc. Some of the spice mixes can also contain hidden carbs. Red kidney beans are 16.7carbs per 100 gm. A 400gm can of beans would therefore be 66.8gm carbs in the chilli. What do you use in chillies and curries ?

2hrs after diner - BG 8 - 10mmol/l
Bed time 11pm'ish - BG - 8 - 10mmol/l

It's really my fasting BG that I'm worried about. Through out the day my BG behaves as I would exoect it to based on the food I've eaten - but my fasting readings are really worrying. What the hell is causing "the Dawn Phenomenon" (if that;'s what this is) and how do I stop it?

It's no good concentrating on one level, the fasting Bg in the morning. What is happening is that, throughout the day your levels are all high, therefore it has a knock on effect. Your bed time level is high and remains that way throughout the night giving you the high level in the morning because you are sleeping. If you concentrate on reducing your day time levels by whatever means you can, carefully monitoring the carbs you eat at each meal and any snacks /drinks etc then you should be able to reduce the day time levels so you bed time level will be lower having a knock on effect to the next morning.

Will Insultard stop high fasting BG's???

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When was the last time you went back to basics, Patch ?

It's good practice in low carbing to occasionally go back and weigh out and calculate all your meals to see if you are still eating the same amount of carbs you think you are. I do this every now and again as the portion sizes can creep up as we get more complacent about things.

Patch said:

I know this is going to sound controvercial - but I'd love to have a hypo. At least then I'd know the drugs DO work.

The lowest readings I've had recently have been in the 5's and 6's, and are usually at around 5-7pm (before I eat my evening meal). My food intake on a normal day is:

Will Insultard stop high fasting BG's???

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Sue has answered you with some detail about your day......I will deal with these other points you made.

A Hypo........
It isn't controversial....I too think everybody should experience what a hypo feels like, then maybe some wouldn't be so 'blase' about the effects. A hypo is not at all a nice place to be, the symptoms, even the warning signs before the hypo can be quite bad......I have had a few and trust me they are not pleasant at times !

A Hypo for a Type 1 can be life threatening. Anybody can hypo, low blood sugar levels and some probably won't even notice, put it down to something else.

Your lowest readings are all because you have used up your energy stores, your glucose after a hard day at work. Hence the lower pre meal levels. That would seem to indicate that there is nothing drastically wrong metabolism wise.......just something you are doing needs correcting. Not a criticism, just a plain fact. I presume you have been tested for things that could be causing wayward BG levels ? There are no additional drugs you are taking which have an effect of raising Bg levels either.

As for the Insultard......it might and it might not, depends on what is the cause.......

Patch said:

Will Insultard stop high fasting BG's???

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The Insulatard (basal insulin) is there to deal with the slow trickle of glucose that is naturally released by the liver Patch, so it doesn't on it's own reduce bg unless it is taken in larger doses than is required to deal with the above.

So say you are going to bed on 10mmol, really your fasting morning reading should be in-and-around this figure give or take 1-1.5mmol. What you need to do is look at why you are going to bed with higher bg readings and make adjustments/reduction to the carbs in your previous meal to lower your bg.

Not sure when you take your Insulatard, but say you take it 10-11pm, try changing this to 6-7pm and see if this makes a difference to your morning readings, but do keep in mind that you may need to increase your dose by 2 units should you find your bg still elevated in the morning. Good luck!

Nigel

As I said earlier Patch there are alternative insulin's which may be more suitable for your needs, so do have a chat with your dsn should things not improve.

Nigel

Will Insultard stop high fasting BG's???

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Patch It's meant to . As far as I can see (through reading not experience) the Gliclazide is aimed at stimulating your pancreas to produce insulin after eating. The main aim of the insulin is to 'mop' up the excess glucose produced by your liver during the rest of the day and from when you are taking it particularly the night.
Insulatard is an insulin with a peak .
Unfortunately, that peak and how long it lasts varies considerably between people. Many people find that with the sort of levels you are going to bed with , and the right dose,they do indeed end up with a good fasting level as the morning coincides with the peak. As the insulin continues working during the day it should also help levels a bit lower for the rest of the time. That's probably what your nurse is aiming for. It maybe that your insulatard will still need to be tirated upwards a bit.
Nevertheless it does seem that you are getting high levels throughout the day, in spite of your low carb diet . I'd give it a while, as these things take time to settle down, obviously taking advice from your nurse about adjusting upwards . If after a while , the high daytime levels continue, I think you should discuss with your nurse whether the Gliclazade is really being effective at doing it's job

The reason that Gliclazide on it's own is possibly not doing much for you is because you are only on half the maximum dosage.

It's documented as usually being very effective in lowering Bg levels throughout 24 hrs, just has the unfortunate side effect of possible weight gain. Maybe you should ask for it to be increased so your levels will drop, this may then 'cure' the late night and morning highs.

I used to take the max dose of Glic until all my levels had dropped, then was able to come off it totally once things had settled down. I also was using a low carb diet at the time. Less than 40g per day. I think that the combo of the two was beneficial in helping me gain better control. I lost weight while doing this, not put it on.

A 'liver dump' is caused by levels which are too low, thereby increasing your levels as the body goes into a 'what the hell is happening mode'. Is the Insultard dropping your night time levels while you sleep........you need to test during the night as stated previously. We could surmise as much as we like, testing and experimenting till you find out what is happening is your way forward.

It's all a balancing act really.......

This is from the BNF60 Patch:

Dose
•Initially, 40–80 mg daily, adjusted according to response; up to 160 mg as a single dose, with breakfast; higher doses divided; max. 320 mg daily

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For a diabetic not to eat breakfast , is just absolutely crazy. No wonder this guy has poor BG control.
Carb intake should be little and often . Any fitness fanatic or body builder will tell you that.
That's all you have to remember . It's not rocket science.
Moderation and Balance, Balance , Balance.