Low readings and insulin

[vespa]

Hi all,

I am quite new to this since I was diagnosed type 1 about 6 weeks ago, so I am still learning and I do have a question if anyone with experience can advise me in.

The first week I was high averaging 15.0 peaked at 20.0 once, since then I have come down a great deal and is levelling off 90 % of the time, now I am occasionally dipping to 3.8 one or twice a week, I don't feel any hypo and do eat brown bread to carb up to compensate, I was wondering if I should tweak back on insulin to increase sugar level so that it doesn't go too low ? or other ways of ensuring an even sugar level preferably at 5.0.

One other question if I tweak back, will the sugar will still be utilised or will it will build up or just gets washed away in urine ?

I need to stabilise it if I want to be able to get my C and D driving entitlement back, I think they need to be around 5.0 mmol/l

I am on Novomix 30 using 18 morning usually around 8am-9am and 12 units 5pm-6pm, injecting twice daily.

Any suggestions please, Thanks.

 

[AMBrennan]

Depends - when do you get low BG? After certain meals? If so then you should eat a bit more at those times. Otherwise, you will have to reduce the insulin doses - on mixed insulins you will have to adjust your meals based on your basal requirements.

One other question if I tweak back, will the sugar will still be utilised or will it will build up or just gets washed away in urine ?

Glucose starts spilling into urine when BG is greater than 10ish mmol/l. And if you take less insulin you are, basically, leaving a bit more glucose in the blood stream where it can be used by your brain (else neurological impairment) rather than moving it into fat/muscle cells - like keeping an extra £10 in your wallet maybe?

 

[smidge]

Hey Vespa!

I have never used mixed insulin, so cannot give you any advice about adjusting it. However, my understanding is that you need to eat enough carb at the right times for the insulin dose you are on. With a mixed insulin, your basal and bolus dose is mixed to a set percentage, so you cannot change one without the other, so it is far less flexible than a seperate basal/bolus regime.

As you are so new to it, it would really be worth contacting your diabetes team about adjusting it rather than jumping in and making adjustments yourself - they should be closely monitoring you at this stage and should be able to help you if you ring them. With many Type 1s/1.5s, the first few weeks/months after diagnosis and insulin treatment starts can be a bit unpreditable as you can go through a 'honeymoon phase' where your pancreas starts to kick out random amounts of insulin again thanks to the rest it has received by having the injected insulin helping out. Mine certainly did this, and I had to keep reducing my insulin dose, and some days I didn't need any basal at all. I should say, though, that it was a bit different for me as I am LADA rather than full Type 1, so my pancreas does still produce some insulin and I am on a seperate basal/bolus rather than mixed insulin, so it was easier to adjust the different insulins.

Smidge

 

[angieG]

Hi Vespa,

Totally agree with Smidge there.
When I was put onto insulin my DSN said that I would be best on the Basal / Bolus regime as opposed to the mixed due to my job. On the mixed she said your meals have to be regular and at set times, something which is pretty impossible as a coach driver (yesterday had my evening meal just after 7pm, if not working it's just after 5pm) so a mixed regime would see me going low or snacking all the time.
She said if I go on the basal / bolus I can fit my meals and insulin around my work easier and I have to say now I am back on the road some days it is certainly the way to go. If I'm having one of my better days and I've got things right I can go for 7 hours easily without eating.
If you have to keep eating to stop going low you may end up putting on weight too I would think.

Good luck in getting it sorted.
Angie

 

[Pilgrim22]

Novo mix 30 is at it's strongest around 5 hours after injection. I inject at 8am with my breakfast, if I do not have lunch, I go low around noon/1pm. I then inject at 6pm with evening meal, if I do not have supper, I go low around 11/12.

 

[noblehead]

As your 3.8 readings are just once or twice a week you need to look for a possible explanation why you reached this level, were you more active than usual after your previous meal, perhaps you over-calculated the carb content of your food, forgot to snack, might just be you need to tweak your insulin doses, as a rule and without stating the obvious postprandial lows are a result of too much insulin or not enough carbs.

The basal/bolus regime that Angie mentions above is a far better option and gives you the flexibility to eat what you want and when you want, in other words you can decrease or increase your insulin to suit the carbs in your meal.

 

[vespa]

Cheers hadn't thought about keeping glucose in blood for the brain, I thought all glucose had to be bonded with equivalent glucose to be used, so if it was free floating in the blood stream, the brain can still utilise it without insulin ?

I am also slightly confused about carbs, I thought if you eat more carbs you can keep your blood sugar up on slow release, however in one comment if you over carb you reduce Blood Glucose, how is that ?