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Need help. BG are ruining my life.

Discussion in 'Type 1 Diabetes' started by paulpapa, Apr 6, 2016.

  1. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Hi all

    I try to stay positive with my diabetes but lately it's been really getting to me. I'm training to be a teacher and this is easily the most stressful year of my life with work and my health.

    I went and saw my DSN on Tuesday and I was there for three hours - not in the waiting room - with her talking.

    I've been having troubles with my blood sugars - hypos and hypers.

    I think that my basal rate was fixed as it was flat in the morning when I skipped breakfast. So that's one bonus.
    She suggested that I might be insulin resistant as previously I had high morning readings, but when I go to sleep in a good place the readings are pretty much in the same place when I wake up. That's made me think that the pre-bed Levermir at 10:30p.m. is doing its job properly. She suggested I adjust the morning Levermir to be taken at 8a.m. rather than 10:40a.m. when I usually took it (when I wasn't teaching) so it could start kicking in before the other one runs out. Her thinking was I'd need the help keeping the sugars lower in the a.m. It seems to be working.

    My issue is that as soon as I eat carbs my BG shoots up. The DSN advised me to play around with my bolus ratios. I tried doing correction doses today nothing big just 3 units and it made me hypo. I did one uni correction tonight and it's done nothing. I can't find any rhyme or reason to it.

    I've included a link to my Libre readouts from the last 90 days and one for a week (might be easier to see patterns). Proof of how tough things have been. Maybe someone will be able to understand them - I can't bring myself to look at them again.

    https://www.dropbox.com/s/grfqf85pbicrbhi/90 days.pdf?dl=0 (90 days)
    https://www.dropbox.com/s/kwunv7en4jmw774/1 week.pdf?dl=0 (1 week)

    Also, I was wondering if anyone can explain the traffic lights on the Libre graph to me.

    Thank you in advance.

    P
     
  2. Mrs Vimes

    Mrs Vimes Type 1 · Well-Known Member

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    Do you bolus as you eat? I will bolus about 20 minutes to 30 minutes before I eat to give it a chance. Also try Doctor Bernsteins diabetes solutions is a good one to read. He recommends 6,12,12 g of carbs for breakfast, dinner and tea.
    I use low carb high fat to control that roller coaster effect.
    PS I'm a teacher - good luck. It is doable but I had to stress bolus 3 units for a mental yr 9 class a few years ago because they made my sugars go up.
     
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  3. paulpapa

    paulpapa Type 1 · Well-Known Member

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    I try to bolus 30 minutes before I eat, too.

    I have his book and his diet one too. I might try the 6, 12, 12 way and see if it works. I'll try to stick with LCHF as it's the only way I've ever seen good results.

    Thanks, I hope I pass this year!
     
  4. Mrs Vimes

    Mrs Vimes Type 1 · Well-Known Member

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    Lots of good advice on this forum too for lchf. Also there is a Facebook page called typeonegrit that I like. They are mostly parents of T1s but a couple of us adults too. They follow Bernstein and share information.
     
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  5. Juicyj

    Juicyj Type 1 · Expert
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    Hi @paulpapa sorry to hear it's a nightmare for you at the moment, I call it work in progress as it will always change, please don't get down, it's experience and a learning curve, thank goodness for the Libre, what an amazing tool. I've had a scan on your readings can see a pattern to your readings.

    Can you start with doing some basal testing - please see this link: http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

    Please remember running high and low will get you down, it will affect your moods so this is normal, but once you've checked your basal then you can start to tweak your quick acting ratios, at various times of the day too, however getting basal ratios right are key to control ;)
     
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  6. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Thanks @Juicyj. Yes, I'm doing it from tomorrow while I'm off work. I'll skip breakfast and see what happens.

    What pattern can you see to my readings?
     
  7. Juicyj

    Juicyj Type 1 · Expert
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    The general pattern I can see if that you are rising from about 4am which is the dawn phenomenon, so assuming you are taking a correction for this upon waking along with breakfast, then dropping before lunch, rising again with your lunch, before dropping in the afternoon from 2pm onwards, to me it suggests testing your basal rates though as no assumptions can be made before working out if this is covering your needs over a 24 hour period. I would also question the role of Levemir as your background, I have used Levemir and Tresiba and found Tresiba a much easier background to work with due to the fact it is a flatter profile and lasts longer.

    Test the basal and let us know how you get on ;)
     
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  8. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Ah okay, I thought that was the case with dawn phenomenon. I sometimes have a correction dose when I wake up but I rarely eat breakfast in the week. Only at the weekends - even then it's occasionally.

    I'll do a basal test tomorrow providing I wake up with okay blood sugars and see what happens. I do two doses of the Levermir. I'll ask my specialist about the Tresiba when I see her in a fortnight. Just Googled it: it works for 42 hours, right? Sounds impressive.
     
  9. Juicyj

    Juicyj Type 1 · Expert
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    I also know you mentioned about eating low carb - however are you taking any insulin to cover protein ? I find by eating low carb that I have to keep a close eye on what protein I consume, I will generally need to bolus for anything that passes my lips as my body is clever at converting protein to sugar, it will find any way to get the sugar it needs.

    Tresiba lasts around 36 hours, however no one can say for sure, it's still only one jab a day and no hardship if you forget to inject as you simply inject when you remember to, some trusts are ok with prescribing it, some aren't keen, it's a cost issue with the NHS.
     
  10. paulpapa

    paulpapa Type 1 · Well-Known Member

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    I'm not sure how to work out how to count for the protein, as it were. I'm having enough trouble working out actual carbs least of all a pack of ham. Ha.

    I'll ask and see what they say. Worth a shot. Pun intended.
     
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  11. steve_p6

    steve_p6 Type 1 · Well-Known Member

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    Hi @paulpapa there seems to be lots going on. @Juicyj is right about your basals at lower doses (.2u/kg) levemir starts to drop off after 8-10 hours this could be causing your bolus to not appear to work in the evenings.

    Couple of the nighttime rises look similar to my experience. Eg Fri night fish and chips gives a strong rise and stays high unless I really bolus hard (eg 20u just for the fish) kfc does the same to me too! The rise you got on occassion at 3 am is similar to delayed rise I get if I eat a steak in an evening.

    You mention low carb, its certainly a good idea to try as it will get you off of the carb/insulin roller coaster and simplify working out what is going on. Just remember to count the protein as it will act like a delayed carb.
     
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  12. steve_p6

    steve_p6 Type 1 · Well-Known Member

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    Try the carbs and cals app it helps for estimating both carbs and protein. Take 50% of protein as carb equivalent.
     
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  13. Kristin251

    Kristin251 LADA · Expert

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    Bernstein Solution is a great book. A tad high on protein for me but as others have said blousing for it helps a great deal. All macros make a difference in balancing bs. Some, fat and protein slow the rise but you still get one. Carbs straight up peak fast put them all together in the same basket and it's a guessing game. LC and moderate protein with normal amounts of healthy fats generally work well.

    I really don't understand how people can eat random meals and keep steady. As Bernstein suggests I eat the same macros at the same meals at the same time of day and I know exactly what my bolus is for each one. I mix up my proteins and fats as well as veg but always the same size and macros. I am never far off and take much less insulin low carb so little fear of hypos or hypers.

    Diabetes is a beast but if you play the game right you can get very good at it
     
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  14. Bluemarine Josephine

    Bluemarine Josephine Type 1 · Well-Known Member

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    Hello everyone, I hope that you are having a great day!
    May I ask, how many units or Levemir do you take and how do you split the dosages?

    Regards
    Josephine
     
  15. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Hi Josephine

    I inject 33 units at 10:30am and 31 units at 8am. Started injecting earlier as DNS said it'll need time to kick in with all my high sugars in the morning.

    Thanks.

    P
     
  16. paulpapa

    paulpapa Type 1 · Well-Known Member

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    I just tried having a low carb meal, a pack of fried cherry tomatoes and two eggs cooked into a kind of eggy scramble and it still spiked me up from 9.9 to 12.9. I worked out that the carbs are only about 10g of carbs but didn't inject to cover it as today I had a bad hypo from injecting to cover some veggie sausages and eggs I had. Injected 1 unit an hour ago hoping it would lower me down by 2mmols and now I'm 13.5mmols.

    I feel really lost with it all. I'm starting to think that maybe I need to inject another unit to cope with where the BG will be by the time the Novorapid has kicked in. I'm just a bit cautious of doing so as I'm scared of dropping too low - especially as it's nearing bedtime.
     
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  17. steve_p6

    steve_p6 Type 1 · Well-Known Member

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    @paulpapa have you setup the activeinsulin calculator on the libre, I find that very handy for working out whats left and then any add-on needed as a correction. If you only injected the Novo an hour ago it will only just be showing any efect on the Libre, as a rough rule of thumb i expect most of Novo action in hours 2 & 3. For me 1u drops me 1.5 mmol so would roughly expect the BGs to drop 0.75mmol per hour in those 2 hours.
     
  18. paulpapa

    paulpapa Type 1 · Well-Known Member

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    I have indeed. The little yellow man mocks me daily.

    It certainly seems to kick in and start working within the 2nd and 3rd hour. I feel that it might bring my down different amounts at different times of day but I've never been able to work out the amounts it lowers me by per unit.
     
  19. steve_p6

    steve_p6 Type 1 · Well-Known Member

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    Use the 100 rule for a rough measure. ie 100/(total daily insulin) gives you no of mmol drop per unit, as your rough correction ratio. People do find the ratio changes during the day but equally I find it is also affected by the levemir losing effect as it goes past 8 hours (depending on your dosage levels)
     
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  20. Bluemarine Josephine

    Bluemarine Josephine Type 1 · Well-Known Member

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    Here are my thoughts:
    Firstly, the average diabetic needs somewhere between 22-24 and 28 units of background insulin during the day.

    You are taking 64 units overall which is a rather generous amount. Therefore, I would be surprised if, with such a dosage, you are running out of background insulin at some point during these 24 hours. I am not suggesting that it cannot happen…

    Secondly, although background insulins are flat, they do have a peak after certain hours and the peak depends on the dosage that you are getting. The graph which I attach herewith was kindly sent to me by "Tim2000s" and I find it very useful when you wish to understand how your background insulin works.

    The bigger the dosage, the bigger the peak. Divide your overall Levemir units (64) with your weight. You will be able to see during which hours your Levemir peaks. For example, my dose units per kilo is 0.2. Therefore my Levemir’s peak is in between 4-8 hour after injection. So, if I inject my morning Levemir at 07:00 am, I am prepared that I will start seeing a peak around 11:00 am to 13:00 pm. (possibly up until 15:00 pm).

    There are doctors, including mine, who are treating type 2 diabetics who are using background insulin (but are not using Novorapid) on the basis of Levemir's peak. They place the injection times in such a way so as to use the peak in order to match mealtimes. In this way they can have a meal without spikes.

    I suspect that you can use your Levemir peaks in a similar pattern to avoid spikes. For example, transferring your morning Levemir 2 hours earlier (to 8 am) will not do anything for your dawn phenomenon as your morning Levemir will kick in at 10:00-11:00 am.

    It is, in fact, your evening Levemir (and matching its peak to your fasting/breakfast hours) that will help you minimize your dawn phenomenon.

    Accordingly, with your morning Levemir, use this graph to check what time you can expect your Levemir to peak.
    You are more sensitive to insulin during these hours and have greater possibility to hypo.

    I hope this helps.
    Regards
    Josephine.
     

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