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No insulin or brekkie

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victry77

Well-Known Member
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Hi! I have to go for a synacthen test in a couple of weeks & didn't realise until I phoned up today to confirm the time I had to be at the clinic that I can't take my insulin beforehand.

They told me I could have my breakfast but to not take any insulin with it, I have to bring it with me & take it when the test is over. However, as I take the pre-mixed Novomix 30, I can't take it (approx 2hrs) after breakfast. I explained this and was told that I couldn't have either breakfast or insulin then & that they will make me some toast when the test is done & I can take it then.

I'm just really anxious now. I've never not take my insulin or not had brekkie. I'm going to be going just over 3hrs without either and when I get worried or anxious my BG goes really high. Does anyone have any tips or advice?

Thanks
 
I would give your diabetes nurse or the diabetes nurse at the hospital a call and just check that one out, and also get some advice on testing your blood glucose during the morning and what to domif it is low/high.
 
what are you waking/fasting BG numbers usually like? It's ok to go without breakfast but your BG will start to creep up without any insulin at all at that time. Could you ask for the appt to be earlier? When do you take your background insulin? Perhaps you could split your dose and that would help?
 
Hi Victry

Try not to worry about having the test. You'll be able to inject yr usual amount of Novomix after the test and even though yr bg level will be higher, you can sort it out by probably eating a smaller carb breakfast (1 slice of toast instead of 2) and that will help lower the rise up in bg. As long as you are able to test frequently, you'll be able to eat to the action of Novomix on yr bg levels.

I have had a few minor ops done in the past using twice daily insulin and I was ok by feeding carb to my insulin instead of insulin to my carb. :mrgreen:

Dont worry and good luck with the test :)
 
Forgive my ignorance, please could you tell me why they don't want you to take any insulin? What's the test about? (and if a 'normal' person had to take it, wouldn't they have insulin in their blood anyway, so why would it matter if you did?) :?
 
Snodger said:
Forgive my ignorance, please could you tell me why they don't want you to take any insulin? What's the test about? (and if a 'normal' person had to take it, wouldn't they have insulin in their blood anyway, so why would it matter if you did?) :?
Click to expand...


A Synacthen test is to measure the amount of Cortisol your body is producing and to check how well your body can produce cortisol. therefore the instructions about fasting and no Insulin prior to the test are very important. Intake of either will render the test invalid according to some links......therefore you should clarify it with the relevant HCP.

This NHS Tayside doesn't mention fasting etc......... http://www.dundee.ac.uk/medther/tayendo ... n_test.htm

However if your HCP wants a fasting and no Insulin, maybe they have another reason and it is for other purposes as well ? Check with them rather than take the advice from here, however well intentioned.

An initial blood sample will be taken to check the baseline level of cortisol. Then you will be given an injection to stimulate your own body's production of cortisol. A blood sample will be taken at 30 minutes and 60 minutes after the stimulation to measure the cortisol level. That's it basically.

Then you can inject and eat if that is what they want you to do.

Ken
 
If you check this link
http://www.endobible.com/investigation/synacthen-test/

that discribed the procedure for both the medic's and the patients.. Giving information concerning medications etc it doesn't say not to take insulin?

I've doubled checked with my friend who has both T1 and Addisons, and they said that they took there insulin and ate before their test!

I would take a read of the link, then phone and discuss this with the doctor who's carrying out the test to clarify what you should be doing or not be doing..
 
Thanks for the replies, everyone.

I guess I'm just going to have to get on with it. They have booked me the earliest appt. at 8.15am, so I'm likely to be without insulin & food for about 3hrs.

Jopar - when I enquired about this at the clinic were I'm having it done, the guy who deals with the appointments (who was very nice & helpful) said I definitely couldn't take insulin & he also went & double-checked with a medical member of staff. However, as I was still worried & unsure of what to do, he went & got the ward manager to come & have a word with me (who wasn't quite as nice & helpful). She came on the line & very curtly told me, "If you take insulin the test can't be done as simple as that. OK?"

Guess I'll just have to do as I'm told.
 
Sadly it does seem as they got there own procedure, and you'll have to go by there procedure..

But out of interest, take a copy of the link and ask them to explaine why the difference as the link is standard procedure that addison's suffers all know about.. Could be interesting what they say about it...

Addisons is reasonable rare condition for anybody, and rarer to find somebody with both, addisons+ diabetes, in a lot of cases it's over looked by the medical profession due to it's rareity, until it reaches a real crisis point for the individual..

Thankfully, there has been an awareness campaign so when control issues arise that may indicate addisons may lay behind it, the medics are checking a lot quicker and eariler...

Good luck with your tests, don't forget to take your insulin + food etc with you
 
I suppose we could speculate all we want about the reasons for the instructions about Insulin and Food intake given by the Hospital. It does seem that many hospital's have their own set procedures as in this case. I found some that say eat and drink normally, but they do also say medication has to be discussed prior to the visit ? Then again maybe they are testing more things as well. Any or all of these for instance. As for asking them to explain themselves.......I don't think I would bother personally.

Other investigations:
* Insulin tolerance test 1 - hypoglycaemia is induced by an insulin infusion and the cortisol response is monitored; this is not regularly performed due to safety issues
* Adrenal autoantibodies - if negative, consider investigating for other causes, e.g. tuberculosis
* ECG - PR and QT interval prolongation
* CXR - lung neoplasm
* Abdominal X-ray - any adrenal calcification which may indicate previous TB infection
* Specific investigations, e.g. CT scan of adrenals
* It may be appropriate to test other hormones of the hypothalamic-pituitary axis, e.g. TSH, prolactin, FSH/LH
 
Jopar - I saw a new endo at my annual review who, while exceptionally thorough, I do wonder if she was being somewhat over-zealous in sending me for this test. The reason she is getting me tested is due to hypos but I feel it's the the 2xday shots that is causing my somewhat topsy-turvy control. I had a brilliant 2yr honeymoon phase but the past 6 months have been a bit over the show. Obviously, I need to go on MDI, but all she kept banging on about was Addison's (I mean really going on about it - worried the heck of me, tbh) & that my honeymmon has been too long & that I may need a pump (!)

I mean, who knows, maybe I do have Addison's as she is really on the ball, but I do remember the professor that I normally see at the clinic said that due to my weight & overall physique (very slim, not a weight gainer) that I would likely be quite sensitive to insulin & would need to be careful re hypos.

Personally, I'd have rather been given an appt. with the nurse to go on MDI as opposed to the synacthen test, but there ya go :roll:

Anyway, just hoping I don't have it, so fingers crossed.
 
Hi Victry

Twice a day jabs work fine for most people as long as they remember to eat regularly at set times of the day and eat a snack (usually about 10g carb) mid morning and mid afternoon. Doing this usually prevents hypos but testing frequently will also tell you a lot. Eating just 3 meals per day usually results in poorish control. With twice daily you have to eat to the action of how the insulin affects your bg levels. Testing 6 times a day will give you a better idea of how yr control is and you'll be able to balance out your carb intake so that you start to see better bg levels.

Don't go down the bolus/basal road unless you want to, as you will end up going from 4 jabs per day to 5 or 6 AND your hypos might still be a big problem unless you find out more info about using an insulin to carb ratio.

I'm fairly happy now that I've got a pump but never have I suffered so many hypos while using lantus/humalog then Apidra and finally switching to levemir/novorapid than I did using twice a day. The DAFNE principal helped no end but it took me a while to realise how to use it to my best advantage.

Hope your test goes ok.
 
If your bg's are rising with stress this indicates not Addisons, as with Addisons stress lowers the blood glucose and your blood presure (drops when standing from sitting) and alot of Addisons suffers crave salt nearing a crisis point, for the diabetic showing signs of addisons, the hypo is very hard to treat, requiring an very hefty amount of carbs, as it's the lack of cortisol that causes the hypo and not lack of carbs...

As iHrs says, the pre-mixed regime is fine for certain people, who are happy to continue to supply carbs at regular interviews during the day, and lead a lifestyle that changes very little from day to day.. But for most people this isn't flexible enough to cope with most people who lead a very changeable active lifestyle...

Have you spoken to your diabetic team about this test and what they are asking of you, as no insulin puts you in danger of DKA, as I wondering if the hospital sort of things that you are already on MDI, so in theory you only missing the quick with breakfast insulin, and you will have background insulin in the body, to safe guard against DKA..

Edit additional info

I've asked my friend Paul to check my reply, (speaking to him on MSN) to ensure I've got it correct, he's has asked me to say, Speak to your diabetic consultant directly concerning this test.. To sort and resolve everything as he will have the knowledge, and can if necessary contact the doctor who's going to carry out the test etc..
 
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