INSULIN AMOUNTS

[caitycakes]

Hi all,

Hoping someone can give me some advice on insulin amounts. Have been low carbing and am able to adjust my insulin lower in the evening (pre-mix injecting twice daily) to account for less carbs, but I only take 1unit am. I was at 4.1 before brekkie today and 4.2 2 hrs after but that means I am going to keep going down and I doubt the usual apple mid morning is going to keep me level until lunch! I don't want to eat more than I am so any ideas would be appreciated.

p.s. I have a 1/2 measure pen I could use, but do you think taking 1/2 unit instead of 1 unit would make that much of a difference?

Thanks caitycakes x

 

[fergus]

Hi Caity,

Those numbers look really stable to me. You've risen only .1mmol/l in 2 hours, which is a real achievement! Are you finding your numbers begin to fall away after that, because I'd expect them to remain pretty stable if the basal part of your dose is at the right sort of level? The mixed insulins are a bit harder to work with though if you're looking for really tight control.
I use half unit pens too and find them really helpful. If your doses are as low as yours and mine, that half a unit becomes a big percentage in the grand scheme.
Going to a half unit at breakfast would be a 50% cut, so you might find your bs rising a bit if you didn't eat a bit less. Mind you, at those sizes of dose, the mistakes you make will have a pretty small impact.

All the best,

fergus

 

[caitycakes]

Thanks fergus,

Yes I will still be falling away. Last night, got home from work and before cooking evening meal I was 4.2. I took my usual 5 units and had dinner, but 1 hr later I was 3.1 (don't know why I tested at 1 hr - must have been instinct because I seem to be losing my hypo awareness). It took 4 glucose tabs, 4 choc brownies (yum) and 1 oatcake to get it up. It still only went to 6.2 at it's highest. BG was good this morning. I will def drop my evening dose. The mix I am on is 75/25. Are there mixes with a lower base insulin and would that mean that there would have to be more fast acting insulin because of that? Even on my tiny morning amount since low carbing I am more likely now to get really low even at about 7.15 pm whilst on the way home from work!

I must admit I am loving the low BG readings but am a bit nervy about sailing so close to the edge BG wise being that I seem to have lost my hypo awareness. Last night's 3.1 only kicked in when I saw the result on my meter (even then it was just the shock!!!).

Thanks caitycakes x

 

[fergus]

Hi Caity,

Sorry, I'm not up to date on the different mixes of insulin on the market these days. Some of the others might know more? I've been basal / bolus for about 10 years (I think?) Your diabetologist would be better placed to advise you.
You could also talk to him/her about basal/bolus because it sounds as if you might get better control with that. Ideally, once your basal dose is properly set your bs should be pretty stable and you'd be able to fine tune your mealtime doses to suit what and when you eat.
As I remember, eating to the insulin was always a bind on the mixed insulin regime.

All the best,

fergus

 

[caitycakes]

Hi fergus

Spoke to my DSN on monday about basal /bolus. Told her I was def going on it at some point. She suggested staying as is for the moment as it might be tricky making the transition given that my amounts are so small and still honeymooning. Will try the half unit in the am and if I'm still not happy, I will go back to DSN and discuss again.

Thanks for your help Fergus.

regards caitycakes x

 

[lilibet]

Hi caitycakes

How you doing (well thats just etiquette, cause your post tells me how you are doing? ).

Am having similar probs to you (not as good readings) but always low before lunch no matter what I eat for breakfast, mid morning or how many carbs I eat. Also find the drop is quite quick, went from 5.5 to 4 in 20 minutes - yuk yuk yuk. Had a warning at 5.5 (or was that espresso :wink: ) so didnt expect to be at 4 when I retested and knew I would keep dropping (just caught a 3.7 the other day). Was going to eat a bit of Cadburys Twirl to prevent a further drop but just had my lunch in stead and a bit of pineapple.
My worry is a further cut cause then pre dinner bs readings will be highter though of course the less insulin the better. I tend to snack on nuts/cheese mid afternoon to prevent this though I tend to eat a lot earlier than you seem to.
This pre mix lark is a holy pain in the ****. Mines is 70/30 split (Mixtard) but if you are going to change then you might as well wait for basal bolus I suppose? I dont want to inject more but the thought of being housebound in the mornings (virtually) cause things start to drop from 11am onwards and is so rapid at times that I am freaked. I've brought my lunch forward to prevent it but no luck so far. Im sure If i get stopped by police for anything they will think I have stolen from a supermarket such is the load in the car/bag etc. You seem to eat quite late so maybe you could try a (slightly) more tiny tiny bit more carb on route home to help?

Let me know how you get on. I am down to 6 and 4 now, likely to be cut to 4 and 4. I wish someone would harvest the good pancreatic cells before it goes completely to pot.

L x

 

[caitycakes]

Lo lilibet,

Yep looks like I'm going to have to have a digestive biccie before I drive home from work at night (omg what a hardship!!! lol).

If you are having problems with hypos a.m. then just cut your insulin. Try doing it just one unit at a time and see how you get on. I had to do that as I don't like to eat a lot during the day. You won't get high BG levels pre dinner if you go really low carb for lunch and have a lo carb snack in between. I seem to have lost my hypo awareness. Down to 3.1 and nothing, until I read the result!!! Thought it was never coming back up again!

The thing that annoys me the most is that this blasted disease changes the goalposts all the time. Wouldn't it be marvelous if you got everything set and your insulin requirements stayed the same for ever? Get sick of constantly adjusting all the time.

Going for flu and pneumovac jabs on wed. Aaaargh! still hate needles. Wish I could just do the jabs myself!

caitycakes x

 

[jopar]

For once I agree with furgus, bolus/basal is a lot easier.... One of the reason you seem to be losing your hypo awareness is because of the nearer to norm levels... It gets scary when you test and find your self 1.7mmol/l and still functioning didn't for long when I realised how low I was....

I was surprised by what you used to treat your hypo, as it's better to have 15g of quick acting sugar such as your jelly babies, test after 15mins then if still low another 15g and test in 15mins... once your level have returned to normal a form of slow acting carb... Oatmeal cake, banana ect. The only problem using oatcakes, chocolate ect to treat a hypo, is that either it's a slow carb or the fat content such as in chocolate will slow the asorbtion down a lot.. so it will take longer to bring levels up and there is a high possiblity that the levels will drop slightly before the cabs kick in... And then it's too easy to over-treat the hypo...

As for the honeymoon period, well this can last for a while, and many diabetics will go through a period that they don't require that much insulin and as they come out of the honey moon period there requirements tend to get more, I am surprised that your DSN said that you should stay on mix until after your honeymoon period as in one way no-one really can tell how long it will last and really if your are having one! I should imagine that it would be a lot easier to adjust as the honeymoon period ends with a basal/bolous regime that a mixed regime? Prehaps this could be your argument to change regimes?

I might be that you are very senitive to insulin, as for me even 1/2 unit of insulin can have a very high impact.... We worked it out that 1 unit of insulin would bring me down by 7mmo/l or more scary stuff and made control very difficult so I'm usr the insulin pump now, and this has made control so much easier for me with it's very fund tuning fo delivery...

 

[caitycakes]

Hi Jopar,

Thanks for the hypo treatment tips. When I am hypo I usually have dextrose tabs and then a couple of oatcakes but I was told by DSN to have something nice e.g bar of chocolate. Now you mention it, it makes sense that the fat in the chocolate would slow the absorption of the sugar needed. I don't usually overcorrect but panicked slightly! Couldn't believe with all that correction I never even got to 7. 3.1 one hour after main evening meal is definitely not usual for me but when I thought about it I was even lower carb for that meal than I usually would be.

I am wondering now just how low I would go before noticing (not going to test it though!). I am definitely going basal/bolus at some point, but really scared of having two lots of insulin to get right! Still finding my feet, but feeling much more confident and I feel that my life is now officially back on track.

Regards caitycakes x

 

[fergus]

For once I agree with furgus

Dangerous precedent there jopar. Any more of that and the dieticians will be after you.

fergus