Need advice re blood sugars.

[kikarne]

10.4 First thing this morning

Diagnosed September 2007

Was put on insulin (Lantus now 22 units am ..and Novo Rapid now 34 units before lunch... 32 units before evening meal) some weeks back, still on 2 metormin 500mg a day also, but my levels, although dropping, are still high ??

Diabetic team call once a week for readings (taken twice a day) and have,til now, increased my units of Novo each time...

I am disabled, with chronic back pain and hart problems (still ongoing after triple by-pass in 2010) so not too active. but try.......and I eat sensibly...

My daily readings, first thing and either before mid-day meal or evening meal, have been running around 10 - 16+ (was at 28 + prior to insulin )

Anyone have any ideas how long it might take to get my levels down and if these doses are high.. low or average ?? I was hoping to get rid of the metormin now I have insulin but looks like that is a way off as yet...

 

[novorapidboi26]

everyone is different of course but it is usually normal and more common to have your basal, in this case Lantus, roughly half or more of your total daily dose......

from the way you have described it also, the meal time doses are a complete stab in the dark.....

novorapid needs to follow a insulin/carb ratio for meaningful dose adjustment......the normal place to start with adults at least is a ratio of 1 unit to every 10g........

with doses of 32 and 34 this would equate to about 320g - 340g, of course you seem to be insulin resistant, however, even with that, those doses seem very high for meal time doses.........unless you really are consuming that amount...

if not then its likely yout mealtime insulin is compensating for a lack of basal, Lantus......

the logical steps to take, which your healthcare pros should know is;

Basal Test, test the lantus overnight at first and then carry out similar test during the day, a split might be needed

Once basal is correct, you can tackle the meal time doses......

 

[Daibell]

HI. Those levels are quite high and I wonder what your weight is like? What sort of diet do you have? Are you trying to control the carbs? I'm surprised that you haven't been shown how to carb-count the NovoRapid. This means adjusting the number of units to inject to match the carbs in your meal. If you feel confident in knowing roughly the carbs in each meal then do discuss moving to carb-counting with your team. To reduce your blood sugar, I suspect you might need to increase the insulin but if you are insulin resistant due to excess weight you can get into a vicious circle. The highest priority for you currently may be to adjust your diet to reduce your weight and blood sugar. Do let us know some typical meals and we can comment on those. Don't worry about staying on Metformin. It does help a bit even when on insulin and it has other protective properties.

 

[kikarne]

Many thanks guys..

As I said it has been some weeks now since I was placed on insulin and the team sent a nurse to my home for the 1st 2 weeks, to talk things through and check my food intake, weight and general state of health.

I was indeed started on the Lantus only, at 8 units, to start with novorapidboi26 and then the Novo was introduced little by little. Some of my problems in getting the numbers down seem to be because it had been out of control for so long. my GP at the time was not very supportive. Once the local diabetic team got asked to visit, which was when I started getting leg infections and had ulcers start on my foot, and community nurses were called in to dress my legs etc., they got to work on helping me also... they checked my blood, both via main testing and via my home kit, and, given I was already on 1500mg of metformin and 100mg of Gliclazide they felt insulin was the best way forward. They contact me once every week and I have an open line to them if I feel unwell or worried, However, as this is till relatively new to me I had/have no idea what to ask or what is normal or not... but they are really kind and never rush any conversation.

Maybe their plan is to start on a food based dose system but so far it seems to have been about getting the level down...

My food intake is small, lunch would consist of a small portion of baked beans, maybe a couple of mini frankfurters and some potato... I dont eat breakfast and my evening meal is maybe a pasta based dish.. Of course every day varies and I will start to look the levels of food, and definitely my weight because that is much too high. (mainly due to my lack of mobility but also yars of eating what I wanted, when I wanted )

 

[TorqPenderloin]

Many people find that a low-carbohydrate diet has a significant impact on their blood sugar regulation. There is a wealth of information about it on this forum.

Your food intake may be small, but it sounds like it is very rich in carbohydrates which probably isn't necessary as you live a sedentary lifestyle (for legitimate reasons).

I would be cautious comparing yourself and your insulin needs to other people. There are some of us (with type 1) who may need less than 5 units in a day while there are other people with extreme insulin resistance who may need several hundred units per day (I know of one member who needed as much as 450 units/day.

The reality is that you need to find a way to address your body's inability to regulate your blood sugar. That can be achieved through several basic ways:

More insulin- pretty simple...increase your dose
Less Insulin resistance- it could be more metformin, losing any excess body fat you may have, avoiding oral steroids, or a number of possible approaches that may work, but certainly aren't guaranteed to work.
Less glucose- Again, it's not guaranteed to work, but if you avoid the main source of glucose (carbohydrates) it can have a strong positive impact on your blood sugar levels.