Levels still high after starting insulin

Glargine is a long acting (background) insulin. Are you on a fast acting insulin (NovoRapid?) as well? Your Dr will not want your levels coming down/leveling out too quick as it could cause damage to your eyes etc....

Medina27 said:

Took my 2nd shot 9am morning 8 units of insulin glargine. As well as metformin

2 hours after breakfast my levels are at 15.1

I am still in the investigative/trial error stage and my doctor said he'll get in touch to see how I am getting on

Do I need to take action? The levels were 7 before breakfast

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Hi there, I would say yes you do but as a new diabetic you must phone your diabetes team and tell them what is going on. When I was first let out on insulin I was given a telephone number and told to phone them whenever I needed to (independent of the Dr), I did this most days and they helped me to safely adjust my insulin doses whilst they were monitoring. YOU have to be proactive I'm afraid, if you sit back waiting for them to contact you then days or weeks could go past with you on high numbers. x

Divide mmol by 18

Angiegood69 said:

Divide mmol by 18

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@Medina27

Please do not do anything of the sort.

HbA1c of 48 mmol/mol translates to an average blood sugar level of about 7.8 mmol/l which is what you'll see on your meter.

Angiegood69 said:

Divide mmol by 18

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That's what you need to convert mg/dl to mmol/l I'm afraid so not quite the right conversion for this case.

Medina27 said:

Nope. It says my treatment target is HbA1c 48 mmol/mol but I don't even know what that means with all these different unit measurements

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The HbA1c is an average of 3 months and so will not like the finger prick readings at all, if you use the convertor on this page: https://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html you can see what the average result would be for a particular HbA1c level, or enter your average finger prick test to get the HbA1c - the HbA1c figure you've quoted of 48 is the 'IFCC – mmol/mol' value

HBA1C is an average of 3 months bloods. And is a different reading to your daily BG levels

Please do NOT divide your HBA1C by 18....to get where your average levels should be. As @bulkbiker has already said that A1C would be around 7.5mmol/l on average

Angiegood69 said:

Divide mmol by 18

Click to expand...

That is to convert mg/dl to mmol/l

Medina27 said:

Took my 2nd shot 9am morning 8 units of insulin glargine. As well as metformin

2 hours after breakfast my levels are at 15.1

I am still in the investigative/trial error stage and my doctor said he'll get in touch to see how I am getting on

Do I need to take action? The levels were 7 before breakfast

Click to expand...

I'm assuming you're on a fast acting as well as long acting glargine?

The glargine will take a while to settle in your system before you see results, it might be a bumpy transition!

@Medina27

Obviously I cannot speak for your healthcare team, but I would encourage you to give them a call (especially since it is a Friday, and you don't know if there will be anyone answering the phone over the weekend).

How about getting together a list of questions to ask, such as:
- I understand that Glargine is a slow acting insulin, can you please explain to me in detail how it works, when I can expect to see my blood glucose lowering, and what this should look like.
- will I be put on fast acting insulin? When?
- what do I do about the high readings I am currently getting?
- when should I be calling you? Is it for any little query, or just in emergencies?
- what are the opening hours on this phoneline?

I am sure you can think of a few more questions too!

Please do not hesitate to make the call.

Frankly, all these things should have been clearly explained to you before you were sent off to flounder about without enough info, and with instructions to inject insulin.

Please let us know how you get on?

Hello I would get on the phone to your team to get some more help. Your insulin Lantus is a background insulin which is not used to cover food or carbs in your food. You’ll need another insulin to do it which is what fast/rapid acting insulin is for. But your team might be taking precautions to slowly bring your levels down. At the same time it doesn’t make any sense without rapid acting insulin to help you with food.

I totally agree that you need to get some further advice and help urgently. You seem to have been given no real information and need to report your test results to someone who can advise you on what to do about them.

Medina27 said:

No I'm not on fast acting

Just the glargine and metformin

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If you're going onto insulin injections as a Type 1 you need to use fast acting insulin too, such as Novorapid, to be taken with meals and as a correction for any high sugars. Are you on reduced Metformin due to using glargene? That would explain the increase in readings.

Don't make any changes without talking to a proper diabetes consultant i'd recommend calling 111 and explaining that you're in this transition and you've been given next to no information about what you need to take. They've given me some solid advice in the past!

A type 1 normally uses 2 different kinds of insulin, one is a basal (like Glargene) which you take once or twice daily. The other is bolus (like Novorapid) which is taken at meals and high readings, which only lasts for a few hours in the system. Once you have both working together your readings should be pretty smooth, but until then you need to figure out your ratios (how much to take at meals) and what background to do.

Hope you get in sorted soon

Medina27 said:

Thanks guys

I've just called them and they advised that I up the dose by one unit and see how that goes. They don't wanna push me because I'm new to insulin

But looks like I'll be on meal time injections eventually, which sucks ass

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Believe me they're miles better than the alternative of high sugars. And depending how you eat and what you like, you may not need to inject for some meals Might be worth getting a head start with carb counting, it will really help you figure out your insulin needs once you start on mealtime injections the Carbs and Cals app on your phone is great for diabetics. You will be fine

Medina27 said:

Took my 2nd shot 9am morning 8 units of insulin glargine. As well as metformin

2 hours after breakfast my levels are at 15.1

I am still in the investigative/trial error stage and my doctor said he'll get in touch to see how I am getting on

Do I need to take action? The levels were 7 before breakfast

Click to expand...

From your previous thread, I understand that you are probably T1 but that you haven't yet had a test to confirm your level of insulin production (c-peptide) or been tested for antibodies to finally confirm that you are T1.

So there is a possibility that you are T2 or T1 in the honeymoon period with high insulin resistance but still producing insulin. In this case taking extra insulin will only have a small impact at first.

As I understand it they sometimes just start you out on a basal insulin until they have fully diagnosed you, and also to see you settle down on basal before offering any fast acting insulin. This may, of course, be out of date with modern regimes.

Do you have some further tests scheduled?

If it's any help I was (mis) diagnosed as a type2 for 3 1/2 years , constantly screaming at the the doctor with abdominal pain, weight loss, bad moods etc, took myself to hospital where I was immediatley placed on Abasaglar (background) and Novarapid (fast acting) after two weeks . I asked for a copy of my medical notes which states in writing after an initial 6 month period (LADA case ?).
I do feel cheated by the negligence of my GP in not carrying out this simple blood test.....when it was carried out it confirmed type 1 with a reading of 224.
For just over a year I see my consultant every 3 months, I have a libre sensor fitted again for over a year, been on as many courses as possible including (which i feel honoured) DAFNE, a must for any type 1. This course has given so much knowledge and now allows me to control the diabetes instead of the diabetes controlling me.
Agree for anyone new (i'm in my late 50's) it is an absolute minefield, you need to chase your diabetic team and really listen to what they say.
Until you know what doses your background insulin settle on it's hard to control the quick acting insulin plus you need to find out your ratio, please talk to your team , probably going to take you six months to find the happy medium. Good luck