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Missed insulin dose.

S

SamCNatty

Active Member
Messages
25
Type of diabetes
Type 2
I was diagnosed with a HbA1c of 75 in July, I'd had a random test in a shopping mall and it was 17 so I followed up with Doctor.
I had gestational diabetes with my third child, 9 years ago. I was getting a yearly blood test and in Feb HbA1c was 35.
Two weeks after the 75 I was at 86.
My doctor started me on insulin right away. He also ordered a lot more tests as there is indications it could be LADA rather than T2 but nothing confirmed.
I started on 10 units of Lantis and I'm now up to 40, my fasting glucose has come down from 27 at highest to 11. Im to keep increasing insulin until it's below 9.
I'm also taking metformin at the insistence of Diabetes Nurse. 500mg 4x daily.
I was given the standard low fat diet of 1/4 plate carbs, 1/4 plate protein and half a plate of low carb veges.
Yesterday I woke up with a dry mouth, sore throat and phlegmy cough. I just went back to sleep and woke 4 hours after I should have had my insulin.
I was expecting to be really high but was 11, this is lower than usual for me (usually 14) and as I'd not eaten and didn't feel like eating I decided not to catch up the insulin as advice on packet said take catch up within two hours. Of course it's the weekend so nobody available to call.
I monitored carefully all day and later ate some small meals - low carb. I got almost normal readings all day, actually getting into the 7's and this morning (I'm in NZ) fasting was 8.8 the lowest since diagnosis and 48 hours since my last insulin injection.
I'm thinking ***! My sore throat isn't so bad that I'd class myself as ill but I'm now reluctant to take insulin again as I've had the best readings in nearly two months without it.
Any ideas what is going on with me?
I'm wondering if I'm so insulin resistant I'm nowhere near a dose that will help. Less food low carb, two chicken drums and an omelette, has done more for me than the recommended diet and medications.
I did 4 days of low carb back in July between the two HbA1c tests and had no reduction in BSLs and my fasting is often the highest of the day.
Thanks in advance
 
I'm a Type 1 and I have an insulin pump so don't use Lantus. I'm going to tag some people who may know more - @noblehead @tim2000s @urbanracer

Illness usually makes blood sugar higher, but occasionally it can make it lower. I've experiencd this myself.

8.8 is still higher than desired. It may also be the case that you have a small amount of Lantus still working. It would be unwise to stop your Lantus without speaking to someone, I feel. Perhaps continue as prescribed, testing rgularly, and speak to your team as soon as they're available?
 
I guess my main concern is I'm usually much higher so if I'm putting in the usual dose of insulin will it make me too low?

I just find it unbelievable that the first time I've had a fasting below 9 ( what I'm increasing to achieve ) was after forgetting to take it.
This disease has come on me suddenly, the only symptom I had at diagnosis was unexplained weight loss. I'd lost 8kg without trying between Feb and July.
 
SamCNatty said:
I guess my main concern is I'm usually much higher so if I'm putting in the usual dose of insulin will it make me too low?

I just find it unbelievable that the first time I've had a fasting below 9 ( what I'm increasing to achieve ) was after forgetting to take it.
This disease has come on me suddenly, the only symptom I had at diagnosis was unexplained weight loss. I'd lost 8kg without trying between Feb and July.
Click to expand...

I can understand your fear. The usual advice for someone on insulin is to keep taking it. I can't give you specific advice as I don't know your situation. It's a difficult one. If you don't want to take your insulin then you should test your blood sugar frequently to make sure all's ok. I really do think you need some guidance from your team as soon as you can get it.

Your weight loss does make LADA a possibility. If it is LADA, you may be going through what's called the honeymoon period. Basically, the insulin you're injecting gives your failing pancreas cells a rest and they can make a little more insulin of their own for a while. That might explain your lower results. If that was the case, a reduction in insulin would be sensible but should be discussed with your team.

The bottom line is that you need to keep your blood sugar ok. Not too high and not too low. You'll have to monitor your blood sugar carefully to see what you need to do. If you decide not to take the Lantus, then I'd eat lower carb meals like it seems youve been doing.

You might also want to,talk to your team to see if a GAD test would be appropriate. That looks for antibodies that are involved in Type 1 (LADA is sometimes known as Late Onset Type 1).

Edited to,add that there are a number of ladies here who were told they had gestational diabetes but later turned out to have Type 1/LADA. It's more common than you'd imagine. Do let us know if you get an answer, and do update us as to how you go over the next couple of days.
 
I was typing a reply but with respect to weight loss and LADA it pretty much echoed what @azure has written above.

What other tests did your doctor order?
 
Last lot of blood tests my Dr printed out the form then wrote a few extra tests like GAD antibodies and C Peptide on it but when discussing the results there was none for those and Dr wasn't sure if they were still to be received or hadn't been done due to being hand written not printed.
Blood tests again next week. They have been included.
 
Lipids and blood counts, c reactive protein, kidney function and albumin in urine as well as thyroid functions as antibodies.
5 years ago I was given a diagnosis of Graves' disease - an autoimmune disorder which causes high thyroid and awesome symptoms like unexplained weight loss and light menstrual periods, loads of energy and getting everything done. On the bad side my heart rate was too fast, hands shaking, hair falling out. The Graves' disease has pretty much vanished and thyroid levels are normal and antibody levels dropped quickly and now are trace only.
All were within normal range.

I had one grandmother who had T2 in her 70's but no other family history.
 
SamCNatty said:
Last lot of blood tests my Dr printed out the form then wrote a few extra tests like GAD antibodies and C Peptide on it but when discussing the results there was none for those and Dr wasn't sure if they were still to be received or hadn't been done due to being hand written not printed.
Blood tests again next week. They have been included.
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Good stuff. Between GAD and C Pep, something ought to stand out if you're actually a T1.
 
I took my 40 units of insulin two hours after eating a two egg omelette with mushrooms and tomato. I went up to 12.8mmol as it seems I can't eat anything with carbs and stay low.
I'm taking readings hourly - have gone down to 12.3
 
It just reinforces to me whenever I eat and go high just how sick I really am. That a tomato, small and expensive, raises my BSL so dramatically.
 
SamCNatty said:
It just reinforces to me whenever I eat and go high just how sick I really am. That a tomato, small and expensive, raises my BSL so dramatically.
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From What level was it raised ? Remember if you are type 1 diabetic you only have you intake of insulins to lower your blood glycose . Protein can cause raise in blood glucose as well , but NOT in the scale like glucose starck and sugar But if your blood glucose was High even before your meal Then you dont need much food to raise it even more . The most important is to get your basic blood glucose down to under 6mmol an easier way is eating a little less than usual and of cause lower carb though NOT to the extreme
 
From 8.8 before eating to 12.8 two hours after.
I'm still classed as T2 but am being tested for LADA
 
Latent Autoimmune Diabetes in Adults. Type 1 but it has a much slower onset in adults. It is more common to get type 1 in childhood to teen years.
 
SamCNatty said:
Last lot of blood tests my Dr printed out the form then wrote a few extra tests like GAD antibodies and C Peptide on it but when discussing the results there was none for those and Dr wasn't sure if they were still to be received or hadn't been done due to being hand written not printed.
Blood tests again next week. They have been included.
Click to expand...

That's good news that the tests are being done. I believe some people do have to wait longer for the results of the GAD test but do make sure you chase it up if you hear nothing.

Obviously no one here can diagnose you, but you'd be surprised at how many people develop Type 1/LADA and who are initially assumed to be Type 2.

As you probably know, Type 1 is an auto immune disease like Graves' disease.
 
Yeah and having one auto immune makes you more susceptible to others... Now I'm wondering what next. It's a lovely feeling that your body is self destructing.
 
SamCNatty said:
I took my 40 units of insulin two hours after eating a two egg omelette with mushrooms and tomato. I went up to 12.8mmol as it seems I can't eat anything with carbs and stay low.
I'm taking readings hourly - have gone down to 12.3
Click to expand...

Have you tried taking your insulin BEFORE eating, I take mine at least 1 hour before eating in the morning and 1 1/2 hours before in the evening as its my main meal of the day, to allow the insulin to get to work,
 
@satindoll The OP is currently only taking a basal insulin. It may be she might need a bolus insulin too, which would help much better with dealing with meals.
 
Lantis is long acting for basal function and should be taken at the same time each day. Once my fasting level is below 9 on a daily basis I will start on bolus insulin, before meals, but the basal needs to be right first.
 
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