Insulin not working...??

[Squish]

Hi Folks,
Newbie here... Apologies if this is on another thread but I couldn't find what I was looking for!

I am a carer for a man with Type 2, as well as numerous other health issues including non-alcoholic liver disease, heart issues and mental health problems.

Having been on Metformin for over a year, he had to stop taking it as it was just making him ill to the point he had no life. Gliclazide and Sitagliptin did nothing to bring his bg below 15mmol so the decision was taken in December to start insulin injections twice a day. All other tablets stopped. He started off taking 8 units twice daily, increasing by 2 every other day.... His bg in the morning could get down to 11 (only if he slept for 10 hours, which is exceptionally rare), normally it is 14-16, but through the day it increases up to 24mmol. We have found that the only way to keep his bg down is to literally not eat! Whatever he has, be it a bacon buttie, Sunday dinner, mackerel on toast, salad... his bg is always high. Only yesterday it shot up to almost 29 . He doesn't have sugary drinks, has practically cut out nearly all of the little sweet treats he would normally have (biscuit with tea etc) and doesn't eat a huge amount of carbs - one potato or 2 slices of bread in a day.

He is currently taking 42 units of NovoMix 30 twice daily, but his levels are still way too high, usually 14-16 in the morning, increasing to 23-29 by tea time.

The other problem he is having is since starting with insulin, he cannot stay awake... Is this a common? He gets up in the morning feeling ok, an hour after insulin & breakfast he has to go back to bed and can sleep for another 3 hours. This is highly unusual for a man who has spent his whole life working 2-3 jobs and going to the gym most days. Because he is so tired and has no energy at all, he has been unable to do his normal exercising , which I do understand will impact his bg levels.

Talking to Diabetic Nurse, she is concerned, but just keeps telling him to increase the dose every other day! It almost seems like the more he takes, the worse his bg is.

If anyone has had similar problems, please can you advise??

Many thanks for your time reading this... all help will be gratefully received

 

[Chook]

Hello and welcome to the forum.

It could be the carbs that are making him sleepy - they do that to me.

I am going to tag @daisy1 who has a great introduction email which explains things better than I can.

 

[azure]

Hi @Squish His high sugars will be making him lethargic.

Can I ask if you count the carbs in his meals? As he's on set doses of Novomix, he should be having a set amount of carbs per meal to keep his blood sugar controlled.

 

[daisy1]

@Squish

To help you to help him, here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you like and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 147,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.

Take part in Diabetes.co.uk digital education programs and improve your understanding. They're all free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.

 

[Scott-C]

If his blood glucose levels are that high it means that the glucose is not getting into the cells to be burned as energy and that's probably what's making him tired. Think of a car with a full tank of petrol but a blocked supply line - lots of energy but it can't get to the engine to be burned. I'm type 1 and know practically nothing about type 2, but with type 1s it's the absence of insulin which causes this. Insulin is like a chemical gate which lets glucose into cells to be burned. Absent insulin, or enough insulin, the glucose just stacks up. Don't know whether this applies to type2s but it does kind of sound as if there's not enough insulin.

 

[Squish]

Thank you for your replies, we will spend this week testing before & after meals etc to see what has the worst effects... bread & potatoeshave been reduced but he is partial to a pie or pasty...!
Will definitely have a closer look at diet.
As for the tiredness, it only happens after taking insulin, he didn't have this problem before insulin...

 

[Kristin251]

Thank you for your replies, we will spend this week testing before & after meals etc to see what has the worst effects... bread & potatoeshave been reduced but he is partial to a pie or pasty...!
Will definitely have a closer look at diet.
As for the tiredness, it only happens after taking insulin, he didn't have this problem before insulin...

For me insulin took awhile to adjust to once i started. But carbs made it worse. With bs levels like that either his carbs are still too high or his insulin too low. Talk to his team about adjustments.

I us,in does take awhile to get used to but so does fluctuating bs.

I don't mean to sound harsh but who isn't partial to pie and pastry??

Maybe you could ask about the basal bolus regimen rather than the mixed insulin??? Then meals could be better calculated. I've never been on mixed but it's my understanding you need to eat at the same times and the same amount. Basal bolus gives more flexibility for meals and timing.