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Novorapid and Lantus - Perfect morning sugar level rising

Discussion in 'Type 1 Diabetes' started by Wizadora87, Oct 4, 2012.

  1. Wizadora87

    Wizadora87 · Active Member

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    Hi, I was diagnosed with Diabetes Type 1 when I was 7 years old. I am now 25 and 6 months ago I was diagnosed with Premature Ovarian Failure.

    My Diabetes has always been under fairly good control, but my last few HBa1c results have been around 7-8. I am currently seeing a lot of specialists due to the recent diagnosis, and they are trying to get my HBa1c perfect so that I can attempt pregnancy.

    I have a few questions about how people are managing their insulin and blood test results.

    Personally, I have NEVER been good at eating breakfast. A year ago I was eating nothing until my evening meal. Now I am managing a "brunch" and evening meal too.

    I am usually around 4.0 when I test in the morning when I wake up, which to me is perfect!! However, if I eat nothing, I rise as high as 17.0 + by 10am. It stays high and I will eat around lunch time and take my insulin which then makes my sugar levels low before my evening meal.

    I was taking 12 units of NOVORAPID and 14 units of LANTUS prior to seeing my specialist. He has now suggested I take 14 units with my meals, and 12 of the lantus at night.

    Sure, my morning blood test is still perfect, but the reason for the swap was because I was going low before meals. Which I still am, and I am still high in the mornings. I don't know the best thing to do. I spoke with a dietician today who suggested I could consider taking 2 doses of the Lantus, or give myself a dose of NOVORAPID anyway even if I eat nothing in the morning.

    I am just curious if anyone else has the same results or had them and fixed them. I also heard that the average is to take 1unit of NOVORAPID per 10 grams (Carbohydrate Portion) - I take 14 units with 3 Carb portions.

    I don't eat a lot in the evening either, still taking 14.

    Doctor didn't want me to change doses yet, (I've usually switched them about on my own until now) But it would seem I'm taking far too much insulin for the food I actually eat, but I don't want to be running high because I NEED the HBa1c to come down before they will let me take other pills other than birth control for Estrogen (I don't produce any) :(

    Any advice would be GREATLY appreciated!!!!

    Many thanks :)

    And sorry if you managed to read all the way through this wall of text!!
     
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  2. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    By the way - I am VERY good with not eating naughty things - Never was into sweet things as I was diagnosed from a young age. I'm more into savoury. I eat a sandwich for brunch and a well-balanced evening meal.
     
  3. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Obviously if you are not eating and your blood sugar is rising like it is in the morning you do not have enough basal (lantus) for you at that time of the day.
    Most find that Levemir is better as it can be split a lot easier than Lantus.
    Yes novorapid can be used for correction doses.
    Have you not done any basal testing to see exactly what is happening?
    Your team needs to get into this centuary as well regarding dose adjustment of insulin for food consummed :roll:
    google bdec and sign yourself up to teach yourself to carb count this will help you no end :)

    Basal testing link http://diatribe.us/issues/13/learning-curve even though it's aimed at pumpers it applies just the same for people using MDI
     
  4. robert72

    robert72 Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Hi Wizadora87 and welcome to the forum.

    I get this too. BG is flat all night long, but as soon as I wake up it's starts to rise - whether I've had 5 hours sleep or 10 - and even though I've eaten nothing. (The horror of having to get out of bed :lol: )

    It's caused by the liver dumping glucose. I generally take 3-4 units to cover it. If I took more Lantus at bedtime I would hypo during the night, so it seems the best way to deal with it.

    It would be worth finding out what your insulin:carb ratio is. 14 seems a lot for 30g carbs.

    Robert
     
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  5. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Yes I'm sometimes less than 4.0 in the morning too (3.3 is lowest), so I don't need more Lantus I believe. Perhaps a correction dose since I'm rubbish at eating early would work for me. But I don't want to tamper with it too much myself right now as they've asked me to continue with what I'm doing before they look at my results again.

    I mentioned I was going quite low before my evening meal, and that's when the doc suggested reducing the Lantus from 14 to 12. Still low though. Eventhough I'm around 12 2 hours after lunch. Dropped down to 2.1 today :D

    High in the mornings, low in the evening. Sighh. It's never ending!

    Hopefully they will sort me out, I'm seeing the dietician in 2 weeks, then my consultant in 5.

    Spoke about carb counting today, and have been doing so lately, it's weird that eventhough I take 14 units with 30carb portions I drop from 17 units to 12 only. and I don't go low until 4-5 hours later (doc said that novorapid wouldn't last this long and it's the Lantus dropping me down). Don't know what to think.
     
  6. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Your Dr needs to get up to speed on the durration of insulin is all I can say on that matter.

    As to the rest ,the simple thing to do is make yourself a good supply of sugar free jelly and basal test.
    I did put a link in my previous post for you.
    Unless your basal is right then nothing else is right. So start from the begining and carry on from there. Once basal OK then move on to meal carb ratios.
    As to not needing more basal, no one said you did, all that was said was you might be better splitting your dosage into 2 injections thus giving you the option to change either dosage to suit your needs.
    To help you invest in the books think like a pancreas and using insulin. Both can be found on amazon.
     
  7. iHs

    iHs · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Hi

    The reason why you are needing to use 14u of Novo to cover 30g carb meal in the evening is because the Lantus has virtually run out of steam and you are needing to relie on the effects of the Novo to control your bg at that time of the day. If it makes you feel any better, I used to inject 12u of Humalog to cover a 30g carb meal in the eve when I was using Lantus once a day ( I injected it about 1hr before going to bed) and also had a snack before going to bed because if I didn't, I would be in hypo land at about 2am.

    When Lantus first became available in the UK back in 2002 it was thought that it would transform many diabetics lives and yes that was true.... it caused many to have loads of hypos every day. That was then when DAFNE type courses started to spring up but although many people have now got the hang of adjusting their bolus insulin using a carb ratio, many find it too difficult and dont want to do bg tests all that often so for them... they just inject the same amount of bolus for every meal and inject the same amount of basal which just results in a 'hit and miss' attempt to get bg levels ok.

    Ideally it does pay for people to find out about how to adjust insulin by using a ratio its not as hard as people might think. You just start at using 1u for 10g carb and then increase it in 0.5u increments so that your before you eat bg level is about 6mmol and then 2.5hrs later if the ratio is correct, your bg level should be about 8-9mmol. If its lower than 8mmol then you need to wait a bit and test again about 30mins after the 2.5hr mark to see if the bg has dropped too low which will mean that need to eat a small snack and if the 2.5hr mark is below 6mmol then that does mean that if you dont eat a snack you will go hypo. Testing bg levels every 2-3hrs work wonders when trying to find out what your insulin to carb ratio needs to be. You can't find it out by any other way really so even though bg teststrips are costing the NHS an absolute fortune in money... the basal/bolus regime is just going to end up being dangerous to use unless frequent bg testing (at least 6 times) is done every day.

    If you do as CarbRok has suggested and test your basal out by not eating any carb... you will find out when Lantus starts to lose its effect on how it controls your bg and then you will start to understand why you are needing more bolus insulin to take over the control. It's all about getting the balance correct between the basal and the bolus.

    If you dont want to adjust your insulin because you dont feel comfortable in doing so... then just test yr bg levels like I said above but alter the amount of carbohydrate that you eat and then your bg levels will start to drop into line. If you write everything down on paper like carb eaten... you'll then be able to look at what amount of bolus youve injected with the carb eaten and then you'll be able to work out your insulin to carb ratio that way..........like you inject 14u for 25g carb if your bg levels are above 8mmol 2.5hrs after you eat.

    If you haven't got a 0.5u insulin pen then ask your DSN or GP to prescribe you one as that will help you get better bg levels.......

    All the best
     
  8. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Thanks very much for all your input. I have a lot of questions now to bring up when I see the dietician/consultant.

    I've just registered to bdec so hopefully it will give me a bit of help too.

    I'm already checking all the packaging when I eat things for the carb amounts so I'm writing down how many portions I'm having in a food diary, also testing pre-meals as they've asked (and after because I want to). My poor poor fingers!!!!!

    Woke up today rather late :oops: at 12:00pm and was 5.6 (Normally 17+) but perhaps this is because I was sleeping and my hormones hadn't kicked into action yet. Anyhow, I ate a sandwich at 12, took my 14 units of novorapid and tested 2 hours later and was 7.5 (seems good to me) tested again at 5:30 as I felt the hypo and was 3.3. Ate a shortbread finger as have no juice in house at the moment and I will gradually come up a couple of mmol before I eat dinner to have a reading of around 4-5.

    By the way, the doctor thought it was odd I was having so much novorapid as I am not overweight. I'm perfectly average weight. Been reading a bit on it and says it can last 3-5 hours? So surely that covers my hypo. However, it seems odd that I go from 5.6 up to 7.5 after having the novorapid then dropping back down to a hypo. Seems like it could be the Lantus that is the culprit? Should I perhaps drop the Lantus down to 10 and see what happens, and do a correction dose of Novorapid in the mornings I don't eat breakfast?

    This is totally what I would do at least. Opinions welcome and appreciated! :)
     
  9. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    As already stated and you are ignoring it............ test your basal (lantus) you will then know what is going on. There is no point in guessing.
    Once you know what is going on then you can work on it. Sort one thing first and not 2 or 3 things in one go.
    Hypos should be treated with quick acting carbs and not fat laden biscuits or chocolate as this slows down the absoption and could cause you to go lower still. :(
     
  10. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    I know, just didn't have anything to hand today! Usually drinking some high-sugar fruit juice and a cereal bar to keep them up after a hypo.

    Would rather speak to the Dietician before starting this as I don't really know the best way to go about doing it - and haven't had it suggested before.

    Good point, just desperate to have things as perfect as possible before Christmas ideally :thumbup:
     
  11. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    The link to basal testing was given in an above for you it's the gold standard test.

    If you are using more than 15 carbs to sort a hypo then your levels are way out.

    You really need to start taking action yourself and not relying on a 2nd rate team who so far have done B all for you.
    The only way you will get there is your own research and listening to the people that have and do live with the condition.

    I'm not having a go at you, but you really need to wake up and help yourself. If you want a baby as stated then you need to understand how carbs and insulin work for you as you will need to do one heck of a lot of adjustments throughout your pregnancy. Your team! wont be there 24/7 to help you out.
    Buy the books I suggested in a previous post and sort your basal as a starter. Full instructions for basal testing are in the link and it was written by someone with far more qualifications than your dietiction.
     
  12. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    The only concerns I have with this right now is the high results I am getting in the morning. If I do not eat anything (and take the novorapid) my levels constantly rise until I do. The dietician is the one who said I may have to consider 2 doses of Lantus, or the correction dose of novorapid. (My consultant just told me to reduce Lantus, increase Novorapid)

    Surely it's better to take her my food diary/results as I am before we try anything? Or should I really skip food/insulin and let my BG rocket?

    I was told as standard when I was a kid to drink a carton of sweet juice and then eat a cereal bar to keep my sugar levels from rising then dipping back down again - So stuck to that as a standard hypo-fix and works without problem for me.

    That's why I'm here :) It's just difficult to get answers set in stone as everyone is different, and I've often thought that my doctors' don't have to live with it, I do. I've always fixed my insulin doses myself before now because I'm used to it, but I am letting them deal with it since I figured they'd be able to get it more "perfect".

    It also fluctuated a lot due to the new diagnosis, since I don't produce any estrogen, it made me hypo daily (unconscious in the mornings) and they had no answers why at the time as I wasn't diagnosed. Up until I was diagnosed with the Premature Ovarian Failure, I was seeing a non-specialist Diab nurse once a year. Now I'm seeing a nurse, dietician, and specialist in endocrinology for both the Diabetes and POF.

    My last hba1c was 7.8 (If I remember right) which isn't that bad, it has been higher, but also been better. :mrgreen:
     
  13. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    You do not skip your basal insulin when you test. Just food and bolus insulin.
    Read the link.
     
  14. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Yes I've read the link; but if I don't take my novorapid in the morning before 12:00, my sugar levels just keep rising, so I need to eat and take the novorapid to keep them from rocketing. My thoughts are that if I am not eating carbs, thus not needing to take the novorapid, I will still go very high and the sugar level will continue to rise without the novorapid.
     
  15. CarbsRok

    CarbsRok Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    If that's the case it proves what we have said all along. Your basal is wrong.
    You need to split it.
     
  16. iHs

    iHs · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin


    Hi

    The point of monitoring your bg levels throughout the night is to determine exactly what times during the early hours that they start to change. You do not need to eat carb in order to give yourself a correction bolus. Bolus insulin can also be used on its own to deliver 'a correction'. If you look at the BDEC website you will see the mention of TDD - total daily dose. This means the total basal insulin per day plus the total bolus insulin. My TDD is 24u at the moment so if I divide that into 100, it will give me a rought idea of how much insulin I need to use as a correction. What I did when using MDI in determining my correction dose was aim to a sensible target. I used the target of 8mmol so if my bg reading was on 12mmol:- 12 - 8 = 4. My correction factor using the 100 rule is 100 divided by 24 = 4, so this means that 1u of bolus will drop my bg level by 4mmol. So that would mean that as a correction dose I would need to inject just 1u of bolus to get me back to the target of 8mmol. Your TDD is a lot more than mine (I've just used mine as an example). Because you dont really know at the moment what your 'true' TDD really is you can have a go at using 1u to make your bg levels drop by 3mmol. So if your bg is on 16mmol when you test during the night you can use th 100 rule to give yourself a correction with your bolus. If you write all your bg levels down with the times you test during the night and what insulin youve used as a correction if your bg is really high (above 12mmol), then the DSN and your consultant will see that all is not ok and as CarbRok has said.... you will probably need to use a basal x 2 per day instead of just once.

    With time your TDD will get to be more accurate as you wont need to do too many corrections. Your bg levels will be more controlled with your insulin to carb ratios.
     
  17. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Thanks for the reply, briefly skimmed it as I'm busy working right now,

    I found the bit about correction doses on Bdec site. Seems crazy that everyone is injecting SO much less than I am, and I have ALWAYS injected this much, or more. Never been at 1u per 1carb portion. Never been overweight either.

    I always wake up with around 4mmol which is a "bit" low, but generally good, tests within 1-2 hours = 17+ mmol. So I guess as soon as I wake up, I need more Lantus?

    I guess I need more Lantus in the morning then, and a bit less at night, and less novorapid generally with my meals.

    Would it not be easier to go back to Humalog(sp?) (The insulin I was on as a child for a few years) and force myself to eat breakfast?

    I'm already having issues with injecting this many times per day and seems I'll be doing even more.

    Thanks for the input.
     
  18. iHs

    iHs · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Everyone is different..... my carb ratio is 1u for 8g carb and 1u for 7g carb and I'm still fairly slim (size 10/12) and I eat carb but not too much and that keeps my weight ok for my height.

    If you are waking up with a bg level of 4mmol and then 2hrs later you've gone high.... that means that your carb ratio is not correct and that you need more bolus at breakfast time so that by mid morning your bg levels are a bit lower. You need to adjust your bolus insulin so that you stay within the bg targets recommended by your HCP. If you inject Lantus in the morning... it's effect wont really show until lunchtime and you would then start to see lower bg levels then (so would mean that you need to use less bolus in your carb ratio at lunchtime). Everything is learn as you go along though through testing your bg levels frequently. It sort of takes 2 days for adjustments to basal to even out their control so you need to do the adjustment and then wait.........Bolus insulin is different.. the action of bolus is more or less immediate so what the basal doesn't control.... the bolus will.

    You will probably be better off using either Humalog or Apidra as both insulins will work a bit faster than Novorapid and if you can get off of Lantus and use Levemir twice per day as it's a bit gentler and wont cause you to have sudden drops in your bg.....
     
  19. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    It rises up without me eating anything! I have never been a breakfast eater (which is why they put me onto the Novorapid/Lantus in the first place. I usually eat between 11-1:30 - But by the time I eat, I'm already at around 17mmol, then I take 14 units with 30grams of carb (3 carb portions) and am low around 5 hours later.

    I'll have a chat about different insulins when I go to the hospital next week anyway. If they think it's required. If I can get away with a correction dose in the AM of Novorapid, great. Right now I don't know when I should take it. Right away? As eventhough I'm lowish when I wake, I go up straight away to reach 17 within an hour or two (without doing ANYTHING) - Not even a drink other than water.

    And it doesn't matter if I wake up later - I woke up quite a bit later than usual the other day and was still fairly low (5.0) when I woke. Makes me think my kidneys are sleeping when I do, and start to release lots of glucose when I'm up and about.

    At least I have a pattern daily which can easily be fixed presumably, just need to work out the best regime for me. A correction dose some time in the morning, and less with my lunch would hopefully fix the high and the low before dinner. Then see what happens from there. This is what I would do, but docs insist I test and write everything for THEM to see too, before I change anything. Guess it's better to trust someone who doesn't live with it than someone who does :D
     
  20. iHs

    iHs · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    I think you probably have a good possibility of getting yourself onto an insulin pump as you would be able to increase the hourly basal rates up to cover the DP that you are experiencing in the morning. The only other way would be to wait an hour after getting up and then giving yourself a small bolus to cover the hike up in bg levels......... and then do bg tests to make sure that you've not used too much bolus

    ].[/quote]
    At least I have a pattern daily which can easily be fixed presumably, just need to work out the best regime for me. A correction dose some time in the morning, and less with my lunch would hopefully fix the high and the low before dinner. Then see what happens from there. This is what I would do, but docs insist I test and write everything for THEM to see too, before I change anything. Guess it's better to trust someone who doesn't live with it than someone who does :D[/quote]

    If you haven't got a bg meter that also works as a bolus wizard then ask for one at your clinic or get the freebie one that is advertised on the forum. As long as you enter the correct settings in the bolus wizard.... the meter will do all the maths for you
     
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