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Just can't control my sugars!

julian27ish

julian27ish

Member
Messages
23
Type of diabetes
Type 1
Treatment type
Insulin
I've been trying so hard to control my sugars recently. I log every carb, every injection, I measure around 6 times a day and log all that too.

Tonight my sugars were 9 before my dinner. I did my usual insulin:carb ratio injection. I ate fish and veg, nothing too fatty. After 4 hours my sugars were 4.7 so I had a snack before I went to bed (20g of carbs). I have an exam in the morning and desperately wanted a decent night's sleep.

I couldn't sleep at all so measured an hour later (now 5 hours after my dinner injection) and they were down to 4.1, despite the snack. So I had another 20g. Still can't sleep. An hour later still and they're now creeping over 5.

Why are my sugars plummeting so long after my injection? Why don't my sugars respond to carbs and insulin predictably? I use lantus and suspect it doesn't work for me but I haven't seen a diabetic nurse specialist or consultant for almost 8 years so have no one to ask. I have asked twice for my drs to refer me but still have heard nothing. Beginning to absolutely despair!
 
Theres a lot to answer here..

You seem to relate going low at 4 hours to be your bolus. It won't be.

As a general rule of thumb if you go low within 2-3 of a bolus.. Then your bolus is incorrect. At all other times it would indicate your basal being incorrect.

So with the details you have listed tonight it would indicate that your basal is too much.

However, this then leads to a question of why your levels are 9.0 pre food... Have you any idea or reason why this would occur? Ie had you had a snack without bolusing, had you over treated a hypo or are you high at this time every day?

Are you getting your eyes screened and your hba1cs done and your feet checked annually or has this also been stopped?

If you can, please write a letter to the Practice Manager and ask him/her to find out why you have not been referred to a hospital despite asking twice and waiting xx weeks/months.
Ask for a full letter of explanation and an urgent referral to be made. If you have not had your annual retinopathy screenings etc either you should mention this as well. You will not be treated differently and it will be dealt with as a priority. Your GPs are not allowed to treat you differently for making an enquiry or complaint.
 
You should be getting an appointment at a diabetic clinic at least once a year, and much more often until you get things sorted. There are government targets for diabetes care and your GP is not meeting them. I don't know where you live but my GP could just go online and make an appointment for me there and then. Go and insist. It's your absolute right.
 
Please don't despair, once you get onto your local practice and insist on getting a referral to your team this situation will change, they really deserve a good telling off (to put it politely) that you haven't been getting the support you need and to of asked twice with no response is very poor.

As Donnellys has said your basal sounds too high here but also worth noting that if you can pin point why you were running at 9 beforehand ? It's not massively high so try not to worry too much.

Good luck with your exam too, what's the subject ? ;)
 
Thanks all. You're right that I definitely need to persevere with getting a referral. I've been banging on one door but just because that hasn't led me anywhere doesn't mean I don't have other doors to try. I'm going to write a formal letter and also contact my local hospital to ask for advice.

I've previously tested how long my bolus lasts and it seems to still have an effect until about 4 hours after injection. I read that it is not uncommon for novorapid to still be 'on board' until this time. Is this not correct? I'm quite skinny and don't have many injection site options so think it might not be absorbing properly all the time.

I'm going to test my basal again tonight. I think you're probably right that it is too high. I base it on my morning sugar levels but suspect dawn phenomenon is affecting those results.

Thanks for taking the time to help though. It really does make me feel better! I am feeling drowsy today but exam didn't go too badly. It was my last one my masters in law so not a stimulating subject at the best of times!

Thanks again.
 
Glad to hear that exam went ok...law is a very stimulating sunject indeed!!

Yes bolus does last for 4-5 hours but its peak is 2-3hrs and my consultant told me the general rule and it has always worked for me...

I am lean and muscly. Do you inject in your bum cheeks?

Now your last exam is over before celebrating go bang on doors and get your hospital referral sorted out...
 
DP might be misleading you re basal level. Quite a few old hands on here take a correction QA dose on waking to deal with DP, and don't use overnight basal for that.
 
I do sometimes inject in my bum but I find it difficult to reach round and pinch some fat. (Sorry for the strange image that may have left you with)

I forgot to say that my slightly high reading of 9 is very common for me. My sugars are often spot on a few hours after my lunch, at around say 3pm. Between 3 and 7pm they always creep up. Again I thought this was an issue with my basal and that's why I started injecting a bit more.

Is there an easy way to test appropriate basal injections if you experience DP? Most of tests I read about involve doing a 3am measure and then testing in the morning. But mine are always higher in the morning and I'm not sure if it's because my basal is too low, or I'm having a night time hypo, or DP. Not really sure what do about it...
 
My bolus also finally tails off at about four hours usually. I'm using Novorapid. And the image? Part of our daily routine on these boards
 
julian27ish said:
Is there an easy way to test appropriate basal injections if you experience DP? Most of tests I read about involve doing a 3am measure and then testing in the morning. But mine are always higher in the morning and I'm not sure if it's because my basal is too low, or I'm having a night time hypo, or DP. Not really sure what do about it...
Click to expand...

you basically answered it, a 3 am test will allow you to adjust your overnight basal [or just basal if a single dose] up until that time before the liver contributes......

the best you can do about the DP is get up as early as you can, fill your belly with something, anything really, and correct if required.....

a pump can obviously help a lot, but doesn't always work, speaking from experience........;)
 
@julian27ish, what time do you take your lantus dose, the 3 - 7pm rise in bg levels could be down to the basal insulin tailing off or could be a results of your lunch if you've included a lot of protein or fat in your meal.

Generally its said that the action time for Novorapid is 4 - 5 hours from injecting, however some people don't find this to be the case and feel that its all but exhausted between the 3 - 4 hour mark, but it depends on the individual really.

If you do find your basal is tailing off in the afternoon but your experiencing night-time lows then maybe split-dosing would work best, alternatively switching to another basal insulin might be a better option, either way have a word with your DSN when you eventually get referred.
 
Hi all, just wanted to say thanks again for all your help. I've been referred now and even managed to switch from lantus to levemir, which apparently may help with the basal issues I've been experiencing.
Thanks for taking the time to respond to my little meltdown and making me feel better!
 
Hi Julian, when injecting in your bum you don't necessarily have to pinch skin, just inject, doesn't matter where which makes it an easy place to inject.

Just remember when your levels are performing the way they should be it just requires a little detective work, it's always temporary and it just helps you gain more knowledge so in future you can react with more confidence the next time knowing more about how to put it right. The forum is a great help as it's a problem shared here ;)
 
Hi Julian, this is very off topic but you mentioned you study law. How are you coping with that? I am in my 2nd year and haven't met another type 1 diabetic who studies law too
 
Hi Grace, I really enjoy it. I sat my last exam a few days ago and am due to start work soon.
I found that my diabetes really affected my studying. In particular, if my sugars aren't at a good level my concentration fails very quickly. Personally I noticed parts of the day when my sugars were most stable and made sure I always studied at those times (7am to midday and then 9pm until about 11). It was an unusual work routine but trying to force myself to work in the afternoons when my sugars were often unstable (as alluded to above) just left me feeling frustrated.
The thing that worries me the most is the advocacy in courts. I've taken part in several 'mooting' competitions and been fearful of a hypo whilst speaking, but running my sugars high significantly affects my performance. It's also a very stressful situation, which has all kinds of unpredictable effects. I'll make sure I let you know how I find it once I start if you like?

How about you?
 
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