My insulin is not working.

Celsus said:

A drink with 20 grams of simple fast carbs. And you don't need to bolus for it?
As your basal insulin will cover for it (as your nurse told you when starting you on Lantus)?

I am not saying its impossible to realize a stable and predictable bg level when taking carbs like that and utilizing rather non-conventional way of countering fast acting carbs with a glargine long-acting insulin. But you are definitely not making it easy for yourself, as you set yourself up to be on a non-stable platform that will need non-stop corrections with bolus and carbs to bring you through the day without going hypo or hyper.

From your previous postings I can calculate that you typically (in best case scenario) would need to take:
- 1 unit of fast acting bolus to metabolize 7 grams of carb.
- 1 unit of fast acting to drive down your bg with approx. 1.4 mmol/L.
And yeah, you would actually normally need to bolus 3 units to counter that 20g carb rich coffee...

So without bolus for that heavily sugar loaded coffee, then your bg would spike up with approx. 4 mmol/L. (best case scenario)
Don't know the volume of your coffees, but with 20g of carbs in it, it might be more sugar rich than full fat Coca-Cola!

If you are challenged by going high all the time, then full fat Coca-Cola is normally not your best friend.
Just saying...

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It's the light version. It's 15g of carbs and isn't very fast acting for me because it has protein and fat in it. Its never done me any good for hypos. I have one every couple of weeks before work and i have never needed to bolus for it if I don't have time for food. When I got put on Lantus the nurse told me Lantus can sometimes cover up to 20g carbs snack or drink without going to high if your levels are OK before and/or activity afterwards. This has always reigned true for me up until a few weeks ago.

Either way I don't think that's the issue at hand here, it's not like I'm drinking one every single day when I wake up. Then I would understand. I literally have one every couple of weeks and not always in the morning. It barely raises my blood sugar in the past.

I've started taking Metformin again and sure enough, my reflux has come back mildly. I don't have much appetite at the moment at all.

I'm thinking the pump may be the answer for me. Because of my stomach i prefer to eat little and often rather than big meals. Which is resulting in a stupid amount of injections a day. I do have big meals of course but i get full very easily.

donnellysdogs said:

I think you need to log and record everything.. some of the food you described with having honey wiuld absolutely screw my levels up, if it was me.

Do you basal test? I hear what you say about small food n regularly. However that can lead to stacking of insulin and if food not passing well in stomach/colon-a fasting period with 10 hour of proper basal testing time can prove blooming good.

I have 3 or 4 injections before getting out of bed and starting at 3.30am.. and no food!! So I knowwhat a lot of injecting means, but I also aporeciate the value to my body and dosing and timing of eating to realise that basal testing and keeping food 5 hours apart to give ckear indications of food impact and insulins is best to get thenanswes that you are seeking... you may well like small regular meals for stomach.. But sometimes you need to basal test and start back at basics again...

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How exactly do I basal test? Check levels when fasting to see if they're rising or falling? I woke up today at 7.3 after no food for about 12 hours, I had some wholemeal toast when I got up 16.8g per slice but I didn't eat all of it, so probably about 28-30g carbs all in. Took 5 units and voila, 2 hours later I'm at 9.8! So hopefully I'm getting somewhere now. My ratio used to be 1:8-9 but I think it might be 1:6 now. I reduced my basal again today down to 32 as 36 units yesterday gave me a mild hypo after 4 hours.

I am wondering if my sleeping schedule has to do with it. It's so out of whack at the moment because I was so ill over the weekend I keep napping and now I'm completely nocturnal. So I am technically taking basal when I wake up - something that in the past DID NOT work well for me. A while ago I tried taking it at lunch time so I could go to work in the evenings without the hassle of having to take a break for basal at 6pm (which can really mess up my targets and stats on that job, and some stores this would mean going to find a member of staff with a key/card to where our stuff is... huge pain in the butt.) I remember my sugars being really high and when I changed it back to 6-7pm (when waking up at lunch time like an almost normal human) my sugars settled much better. I'm gonna try my hardest to stay up tomorrow and go to bed at a normal time. I'm terrible for having no pattern whatsoever with sleep. My sleeping pattern is like a broken clock, it will eventually be ''right/normal'' but it only takes one late work shift to mess it up again.

Just come back from a walk, was 11 when I left, up to 13 now... I haven't eaten since 5am.

I'm seeing my DSN again on Tuesday to possibly switch to a new basal insulin. I've had so many ups and downs the last few days it's unreal. Still can't figure out what the hell is going on. I want to mention my sleeping pattern is normal now. I'm waking up at 7-8am and going to bed at 10-12pm.

Blood sugar was slightly too low yesterday morning when I got up. Around 4. I drank a 10g carb protein shake for breakfast, no bolus for that, just to raise me a little. I had some pasta later on, bolused the right amount.. lunch time I'm sitting at 20.7. Took a correction of 9 units and I dropped down to 11 in 40 mins, then to 6 and I had to eat some jaffa cakes to prevent a hypo as I could feel it coming. Went up to 13, then 17 2 hours after that. Corrected again later with a few units and went for a walk, dropped to 7 before the correction peaked. I ate 2 digestives and 2 chicken nuggets at 8pm to prevent a hypo overnight, and some cheese because I was starving but my reflux has been too bad to eat a big meal. I had my Lantus normal time, about 6pm.

Woke up this morning at 7:30am, sitting at 10.4. I took 3 units of Lantus (my nurse told me to if I am waking up high), I corrected with 3 units of Novorapid and ate an avocado and some mackerel. 2 hours later I'm at 11.3. I've just tested again, and I'm at 12.4 now. Reaaaaally don't get this. Lantus is either working too well or not at all. I am so miserable right now. I think it might be to do with my stomach problems? My reflux has been so horrible the last few days. I don't have it in the morning, I swear it comes on about an hour after I take my anti-acid medication...

I've tried going off the Omeprazole and for a few days it helps, then my reflux comes back, then I go back on the meds and it goes away, then after a couple weeks it stops working. I honestly can't wait for my gastroscopy at this point.

At this current moment, my bolus is absorbing at all different rates so I'm not eating as many carbs as I usually do. That pasta was probably the first carb meal I've eaten in days. Few months ago we were eating pasta quite a lot, and I need about 8 units for a plate. It's surprisingly low GI and I was happy to discover my sugars were tolerating it beautifully, because I've always avoided it in the past as I thought it was really high GI.

I've just got back from a 2 hour walk after taking 1 more unit of Novorapid and my sugars are the same as when I left. In the last 5 years of diabetes, walking was always a reliable way to get my sugars down. The only thing I've changed recently is I've stopped Metformin and I'm exercising more but nothing extreme. My DSN said I may have to increase my insulin to make up for the Metformin, but when I increased my basal the other day it sent me hypo. If I'm completely honest, I was supposed to take 2 Metformin a day but I was only taking one because I would always forget my morning dose.. I can't see how Metformin would make a huge difference. There were times where I would come home from work and fall asleep and miss my doses for days at a time and nothing changed...

I can't seem to find out why. I'm still sitting at 12. I'm starving and weak and don't even know what to eat right now as everything is sending me high and my stomach feels rubbish when I do eat. It burns and I get reflux. My day got ruined today, my friend gave me a ticket to a comic con and I walked in, started feeling really ill and just came home. I keep getting dizzy and nauseous, and just this pit in my stomach like I'm very poorly and then panic sets in and I need air or to go home.

Digestives don't usually send me high, which is why I ate them an hour before bed. They're only 7g per biscuit and in the past my Lantus has always been able to cope with a bedtime snack like that, especially 10 hours later it should be dropping the sugars, not raising them. I'm completely baffled here as I'm not seeing any patterns or anything, and this is completely out of nowhere after having pretty well controlled type 1 for 6 years now. Something is causing my sugars to slowly rise, and the only thing I can think of is the stomach issues and/or my liver. Maybe my food is digesting really slowly at different rates.. but then that would more likely send me hypo right after bolusing which isn't happening.

I should probably go for a full MOT at the doctors soon just to rule out anything else, but blood tests give me panic attacks. I'm such a handful recently. I feel like if none of these problems were happening, I would feel FANTASTIC, because I can feel my body getting fitter and stronger from exercising and eating better. It just feels like the stomach/blood sugar problems are blocking me from feeling the most energetic I have in years.

Trust me, I am eating plenty of vegetables. I snack on carrots, I made kimchi cauliflower rice for dinner last night with spinach, and mushrooms, and our fridge is full of vegetables, I also make kale smoothies but haven't the last few days. I always include veg in my meals.

The thing is about this whole thing is that it's not usual for me and yet I'm not doing anything that I haven't done in the past. I've just woken up at 10 at 3 in the morning. My dinner was under 10g carbs and my blood sugar didn't go below 10 all day despite multiple small correction doses, lots of exercise and a borderline keto diet yesterday.

8AM - BG 10.7, 5 units of bolus, ate an avocado and mackerel slice.

12PM - BG 11, bolused one unit and left house for walk

2PM - BG 12, bolused 6 units and ate some carrots with peanut butter and seafood sticks, left house again to go shopping

5 PM - BG 13, bolused 4 units for Kimchi cauliflower rice

6PM - 33 units of Lantus

8PM, BG up to 15.7, bolused a few more units before bed

8:30PM, BG 14.8

3:30AM - BG 10.4

I almost collapsed in the kitchen last night and went to bed at 8pm, I felt like every ounce of strength was drained from me, I think I overdid it on the walking yesterday, I didn't stop all day. The ''dawn phenomenon'' has never been a thing for me, my Lantus has always kept my sugars under control upon wakings.

There were times yesterday that I felt so weak and light headed I thought I was hypo, yet I test and my levels were between 10 and 16 all day. I lost count of how many times I bolused but I've tried to list them here. In the past, if I ate what I ate yesterday, I probably wouldn't need ANY Novorapid. I've done low carb diets and generally speaking if I eat eggs and cauliflower rice I've never had to bolus for them, and if I did, very little.

There was a time when I was on steroids that for a week or so I ate a very low carb diet because my sugars were in the high 20s and insulin didn't work well at the time, and even THEN my sugars slowly dropped between meals because of Lantus. Nurse is thinking of swapping me to a super long acting insulin but I can't remember the name, it starts with D and she said people have been very successful on it. I wanted to try splitting my Lantus but I'm not sure it's going to make a difference if my highs don't have a pattern.

donnellysdogs said:

If going to bed 7-8 and waking 10-12 that is still not normal..its an increase by a minimum of 3 and a maximum of 5 mml. Yes, its out of hypo land but not within the standard deviation fluctuations that we should try to achieve..to reducepossible complications

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7-8 and 10-12 are my bedtime, not my blood sugar levels lol.

donnellysdogs said:

Lol, sorry!!

If you are constantly feeling light headed etc.. I would be asking for a full run down of blood.. whole blood counts, ferritin, b12, d3 as you coukd be blaming diabetes when something else is the cause.. low iron can cause problems with T1 and T2 people.


With 33 units of background it doesnt look like the ratios of your bolus's are matching the 50/50 ratio... and it may just be that the bolus ratio for meals could be upped to give a little more.. so if on a 1 unit to 10g (only an example) then a small adjustment to 1 to 9g may be better and it doesnt have to be the same for each meal..
Same with corrections if at the moment its 1 unit beings you down by 3mml then perhaps at the moment you are needing more and it should be 1 unit only brings you down by 2.9 to give you more correction.. only made up details...

Dont forget our hormones kick in / out and insulin is after all a hormone.. so it can kick in same ways!

Incidentally are your pens in cool places, out of sunshine? Is your fride definitely the right temperature and changing needles every time? Perhaps ask for new pens as well. Cover every angle...

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I'm definitely going to go for a full MOT at the docs. I've not had blood tests in years because I have panic attacks. I bolused 4 units last night and woke up at 6.1.

So far I've had 3 small meals of porridge, rye bread and a naughty cake because my bloods were OK so far today. I bolused 5 units each time I ate, as all 3 were roughly 22g carbs. Bloods have been around 11 which, considering I've eaten more carbs today, I'll take that as an improvement. Seems like I might need 6 units rather than 5 for 20-22g. Going to trial and error.

I will say, I feel much better today now I'm eating properly again. I felt very drained this morning and felt better after some oats.

Right, I saw my DSN again yesterday. Didn't really tell me anything useful other than looking at my graphs she thinks it's the bolus not the basal. Got given slow release Metformin which after 2 hours made my reflux come back and I was up most the night sweating and feeling really ill so I won't be taking that again.

I woke up this morning at 9mmol which is weird because I had a dinner with under 10g carbs and was only at 12 2 hours after eating. I WEIGHED bran flakes this morning on a flipping scale, something I've NEVER had to do. 19g of carbs per 30g. I had about 20-25g.. 6 units. 2 hours later I'm sitting at 17mmol. I'm getting REALLY frustrated at this. I've lost about 7kg with no effort in the last few months, why am I resistant to my meal time insulin? Small doses don't seem to shift my blood sugar in the slightest, and if I take too much it drops too quickly and makes me feel sick. I'm really at a loss here as to why I suddenly need so much bolus. 1 unit per 3g is ridiculous. I can't even low carb because it makes me feel really unwell. I feel so weak and faint all the time where I'm afraid to eat because of my blood sugar being so unpredictable...

Sorry to keep posting here, but my insulin has weirdly started working again which is making me a bit worried about hypos now.

The only thing that changed in the last 24 hours was, splitting Lantus dose but not on purpose lol. I was working about an hour away, and in the stress of packing a bag I forgot to change my Lantus cartridge so I only had 16 units/half a dose at 5:30pm-6pm normal time. I took the other 19 units when I got home from work, about 1am. Maybe this was the solution all along!? My nurse told me NOT to split my dose before trying other things first, because too many changes ''can't pinpoint the problem''.

I haven't been eating much the last few days as I've been travelling and working, so yesterday was avocado on toasted rye bread for breakfast, 11mmol after that, then 9mmols before break at 6pm. literally barely anything on my break (I had carrot sticks and a boiled egg and spinach thing at dinnertime, I injected 3 units as I had half a flapjack), and when I got home I was at 5.2, I had a cheese toasted sandwich with kimchi, I only injected 4 units because 5.2 was a little low and I was worried. I woke up at noon, 8.6mmol, injected 4 units for a chocolate rice cake (10g carb), and a Graze snack box, so probably another 10g in that. 4 hours later I'm at 7.6! I'm really pleased with that! Just had some char siu buns and took 6 units, I'll see how it goes later.

This is what I mean about ratios drastically changing and causing me unsuspecting hypos, it's so scary. I want to split my Lantus dose again but I doubt I'll be up at 1am, so I might try taking it at bedtime instead like a lot of people do. Thoughts?