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Novorapid and Lantus - Perfect morning sugar level rising

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

  1. etmsreec

    etmsreec Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Re-reading the original post Wizadora87, I'm wondering whether the 14u for 30g carbs includes a correction for your blood glucose going high?
    Novorapid has a short onset - about 15 minutes with a peak at about 45 minutes - and a duration of 3 to 5 hours. If you're dipping after the 3 or 4 hours, I'd think that it was the Novorapid causing the hypo.
    I think there needs to be several tasks here:
    - start eating breakfast and at regular intervals through the day;
    - get advice from a diabetes team that has experience with diabetics in pregnancy. This isn't a thing that all diabetologists seem to be able to do, if the pattern in my diabetes clinic is anything to go by;
    - try and get onto a DAFNE course (or whatever it's called in your area). this will explain the correction doses, dose versus carbs and such like.

    Just as a thought (I'm a sufferer of diabetes, not a consultant) - Could it be that you're about right at breakfast time (maybe a little on the low side), going high because of dawn phenomenon (as cortisol, glucagon and epinephrine are released to wake you up), taking enough insulin to deal with carbs and correction at lunch time, going hypo before evening meal from too much Novorapid?

    Remember also that the motto is, "less than 5, don't drive".
     
  2. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    So, I have an annoying update. My regular "diabetic nurse" who I really do not get along with (we totally clash!) called me and wanted me to see her this morning. So I did. I brought up the 0-carb to test Basal insulin theory and she said "We don't recommend this, don't do it". Great, thanks. She also told me that I'm not going high in the morning due to kidneys releasing Glucose "No way this is not what happens". Great, thanks. She ALSO said that Lantus works for 24 hours, and I DO NOT NEED ANOTHER DOSE. That's for sure! Oh really?

    I told her I'd found this forum and brought up some things people are doing (who live with the condition, unlike her), and that they are getting along fine. She told me "forums are just a bunch of random people - Don't do anything they tell you. They're not professionals." I said, I know they're not docs, but they do live with it and they are advising on alternatives that work for them. I brought up the other Basal insulin (totally forgot the name during this rant) and she said we'll look into it. She said SHE WILL CHANGE MY INSULIN if she thinks it needs changing. Yeah, cause I'm going to see her again.....

    <-- A little bit mad at this useless woman who doesn't specialize in Type 1 Diabetes and assumes she knows better than people who DO live with it.

    Seeing Dietician at hosp on Thurs, who seems to know a lot more what she's talking about. Hopefully this IS the case. Evil woman today also gave me a flu injection, ouchie. :(
     
  3. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Oh by the way, I got a DAFNE book telling me all about carb portions in food which is rather useful.
     
  4. iHs

    iHs · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    I dont like to say it, but I think you are going to have to do your own thing with adjusting your insulin. We've given you different ways for. you to think about.... you've got the Lantus and you've got the Novorapid. It's up to you to do whatever you need to do to get your bg levels better balanced without too many highs and also without too many lows.. Insulin to carb ratios do work for people and if DUK and BDEC recommend using them with bolus insulin, then this nurse that you have seen needs to be questioned as to how she expects you to achieve good bg levels by keeping bolus dose the same and eat whatever carb you want.????? :crazy: Good job you haven't got an insulin pump :lol:

    All I can say is test your bg levels every 2-3hrs and adjust the amount of carb that you eat so that your bg levels are ok. You may be able to eat more carb at lunchtime than you do at breakfast.. It's up to you with the testing to find out how Lantus and the bolus affect you.
     
  5. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    She's rubbish. I suspect she doesn't specialize in Type 1 Diabetes, so I have no idea why I need to see her since she is not exactly helpful. I know I shouldn't be taking the same insulin regardless of what I eat, they just wanted me to do it for now to look at my BG patterns I suppose. I did take more insulin last night though as I made a yummy risotto again :D Seemed to do the trick, and woke up at 4.3mmol :thumbup:

    Now they decided to give me the flu, I guess BG will fly :)
     
  6. iHs

    iHs · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Hi

    Having the flu jab done won't necessarily make your bg levels go up so have the jab done as real flu which is 100 times worse than a heavy cold can really knock you off your feet big time and make you so weak that it will take effort to get out of bed, go to the loo and get back into bed again.........

    Regarding your present problem with basal and bolus dose being correct. Test your bg levels frequently and from the results you get you will be able to see if your insulin dose is keeping you within a healthy target. This is where insulin to carb ratios start to shine... as people either adjust the insulin in the ratio or adjust the carb so that bg levels are ok. My advice to you is to maybe start with using a ratio of 1u for every 7g carb and then test, test, every 2hrs to see how the bolus affects your bg. If the insulin is not enough you can adjust the ratio to 1u for 6g etc. If insulin is too much...... causing you to go a bit low 2-3hrs after eating you can adjust the ratio to 1u to 8g carb and then keep testing and keep adjusting until you've found the correct ratio for YOU....

    What helped me with adjusting ratios was to eat the same amount of carb for all of my 3 main meals per day as I felt that would enable me to get a better idea... so I just kept to eating 30g carb at each meal time and adjusted my ratios for that.... and that was how I got my 1u for 6g carb ratio worked out for breakfast, then 1u for 8g carb lunchtime and then 1u for 7g carb evening meal. By using these ratios, I then started to eat different amounts of carb at the mealtimes and by using a 0.5u pen was able to deliver a better bolus dose than using 1u pen... The carb value of most food is clearly listed on most packaged goods. It's usually listed per 100g weight so you can work out the carb value from looking at that.

    Look at the NICE bg targets for insulin dependant people and then use your ratios to achieve those targets.
    Carb counting made easier to understand ........... http://www.diabetes.org.uk/carb-counter

    In an ideal world.... everyone could use the 1u to 10g carb ratio and have their background insulin set dead correct by fasting so that without eating their bg level would always be at the same target level.... but guess what.... this is a bit wishfull thinking though as loads of people have found that they need to use different ratios at different times of the day in order to be well. Many have gone on to use insulin pumps because of the way bolus/basal MDI style has failed them....

    Once you've found your ideal ratios your bg levels will start to be ok and you can then TELL your consultant and this so called DSN how youve gone about it and then they can think whatever...... who cares.. they can put it in their pipe and smoke it :lol:
     
  7. sanchia07

    sanchia07 Type 1 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    I have had the same problem ny morning reading was anything up to 17. I have a split dose of lantus 14 at 8 pm and 14 at 8 am then average novorapid at 24 at meals. I also work shifts which is hard when dealing with diabetes!
     
  8. bethan90

    bethan90 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    My blood sugars often rise if I wake up late and have a late breakfast. If I wake up at 11, have breakfast, by 12.30, 1 o clock my BS will rocket. I have learnt that I can't sleep in late and maybe that's what you will have to learn too. Wake up early and have a bit of breakfast, it will do you good!
     
  9. etmsreec

    etmsreec Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Hi Wizadora87,

    I've obviously no idea who your nurse is and whether she is attached to a doctor's surgery or to a consultant at a hospital with a dedicated diabetes team. If she's attached to the doctor's surgery, I'd ask your GP to refer you to the local hospital and get the attention of a diabetologist and his/her team.

    Interesting re: 0-carb Basal check. The DSN at my diabetes clinic recommended it to me for the specific reason of checking whether my Basal insulin was right.
    Ten years ago, I would have agreed that there isn't a release of glycogen in the morning and that there's no such thing as the Dawn Phenomenon. If you do a web search on it now, you'll see that it's real, it exists, and if your nurse doesn't know about it then she needs to be brushing up on her diabetes care and reading.

    As for Lantus, it's supposed to be a 24-hour insulin and there aren't meant to be any peaks in its profile. It gets a bit fussy about being mixed or the same injection site used for it and for other insulins though. A switch to Levemir may be an option, but I'm pretty certain that it isn't a 24-hour insulin so you would probably need two jabs.

    It seems pretty clear to me that you're not getting the care and help that you need Wizadora, and that's not acceptable. If your care is handled by your GP surgery, ask to be referred to the local hospital and their diabetes team. If you're already seeing someone at the local hospital, maybe a word with the dietician will help to find someone else in the hospital that you can deal with more easily? It's rubbish when you have someone that you can't deal with and can't discuss your problems with - I used to have a dermatologist like that...
     
  10. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Thanks for the replies folks, haven't seen them until now!

    I saw my Dietician earlier today and she was VERY helpful! She told me that the nurse I was seeing at my GP practice does not specialize in type 1, and is giving me advice you would give a type 2 patient. Nurse told me I have to eat 4 meals a day etc etc, and I said but I'm on bolus/basal BECAUSE of my lifestyle?! My dietician said to still see her for annual reviews, but not to discuss adjustments/important stuff! :D

    She gave me a Carbs and Cals book to borrow which looks great, and a 3 day fasting sheet I can do if I wish where I cut out carbs for certain periods of the day and test every 2 hours at different times of day to check my Lantus dose is correct.

    Overall she was really helpful, she said it seems I need to take less Lantus as I am around 4mmol when I wake up which means it's highly likely my liver is releasing the glucose sending me high in the morning as I'm running a bit low overnight/morning, as I have a similar pattern in the evening (always hypo pre-dinner). So reducing the Lantus and she gave me predicted units-to-carbs now to try too for both of my meals (only 2 per day)! So a bit more testing, but seem to be making progress. Seeing her again in 2 weeks to check how things are going :thumbup: Basically seems I've been taking too much bolus and basal for many years - Causing me to hypo then go high, resulting in higher hBa1c results - doh!

    She also said eventhough the manufacturer doesn't recommend it - Lots of people have high success with 2 doses of Lantus, which I may have to do if this doesn't work out for me. :D
     
  11. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Barrie,

    I take my insulin WHEN I eat as I am on Novorapid and Lantus (Bolus/Basal). I do not eat breakfast and someone mentioned something about waking early and eating breakfast - I do wake early every day, but I do not eat until lunchtime regardless! I am 4mmol when I wake (around 8am).

    The Diab nurse I was seeing is a nurse at my family GP who apparently does not specialize in Type 1, as most people have Type 2 diabetes. So I am now (since diagnosis of POF) seeing a team who specialize in Type 1 along with her. Though it would seem I should have been seeing them for the last few years instead of her so it would have been sorted even sooner. Oh well, live and learn. I assumed she knew what she was talking about. :lol:
     
  12. etmsreec

    etmsreec Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    A dangerous thing that, assuming that the GP's nurse knows what she's talking about! :shifty: I'm really glad that you're now being seen by someone who should understand type 1 and be able to give you better guidance. [My practice nurse told me once that I should reduce the number of bananas I eat as my potassium level was too high. The DSN and dietician told me that she was talking rubbish! I know who I believe!]

    Sorry to ask again, but have you tried eating something at breakfast time and taking some insulin with it? Does that avoid the rise in blood glucose? I know it's not what you want to do, but if it levels off that morning high then it might be worth it in the long run...?
     
  13. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Will definately try eating something really small at breakfast if the new regime doesn't work out :)
     
  14. Beanpole

    Beanpole · Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Hi I used to wake with high BM and was told I was going hypo during my sleep. I had poor control for years and was also on novo rapid and lantus. I took lantus spilt morning and evening.
    However I moved area a year ago and was immediately given a pump and had constant BM monitoring which proved I wasn't going hypo but instead at 2.30am my liver kicked out heaps of glucose causing high BM on waking. The pump has enabled me to adjust my insulin at this time to counteract this.
    Prior to the pump I did DAFNE etc but the pump has been the only thing to sort me out. My sensitivity is 1unit of insulin lowers my BM by 5 mmol and 1 unit of insulin per 18g carbohydrate. It is all a bit of a mind field hope they sort things out for you soon x
     
  15. etmsreec

    etmsreec Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    That's not unusual. The "dawn phenomenon" kicks out glycogen and other hormones into the blood to give you the kick to wake up. I guess it's just a little early when it was doing it at 2.30am. With once daily Lantus, it would (I guess?) be sending you hypo at other times to try and bring down that fasting sugar?
     
  16. etmsreec

    etmsreec Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    How're things going with you now Wizadora87? Have you tried the snack in the morning?
     
  17. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Sorry I haven't been on here in a while :oops:

    Thought about updating though! Saw the dietician a month back and she adjusted my insulin/gave me a carbs and cals book for carb portions, and I've been running high generally.

    I fasted for 2 days with an obvious pattern both days, and similar even whilst on bolus.
    I wake up around 6.5, rise to 24mmol by 12pm, and start dropping again around 8pm (whilst fasting).

    Saw a crew of 4 today (I'm interesting apparently!) Dietician, Doctor, Random guy, and Midwife/Nurse. Doctor has said today that I should try a second dose of lantus in the morning, and if things don't improve I may have to go onto a pump. So starting my second dose (6 units at 10am) tomorrow. Will see what happens (with fasting and normal eating!) - Poor me, I hate bacon and eggs, makes me feel horribly unhealthy! Hopefully I wont go low in the night with the additional Lantus (and dropping naturally around 8pm) :)
     
  18. etmsreec

    etmsreec Type 1 · Well-Known Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Well, as if by perfect timing to illustrate...

    The last few days I've been getting up at about 7.30am and blood glucose at about 5.7. This morning, I woke with the alarm but decided to snooze in as I was quite tired. By 8.45, my blood glucose was up to about 17.
    For anyone who says the dawn phenomenon doesn't exist, I've got news for them...!
     
  19. Wizadora87

    Wizadora87 · Active Member

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    After testing yesterday and thus far today, I went up, but only to 18mmol at 2pm yesterday (same pattern) and went hypo again before dinner, whoopee!!!

    Today I woke at 9.3, up to 20mmol at 12.

    I just spoke to my dietician on the phone and she suggested dropping my lunchtime bolus to a ratio of 1 carb portion to 2.5 units (down from 3) and she FINALLY agreed with me that maybe it lasts way longer in me than average, since I ALWAYS drop 6 hours after I take it at lunch. So did less today to see if I don't hypo before dinner (If not, maybe I can increase the Lantus and drop the Novorapid even more and have no high readings, would be lovely!) Just lots and lots of trial and error it would seem.

    I was browsing on another thread yesteday regarding what times people take their basal insulin, and from what people said, it changes things a LOT. So I wonder if my crazy highs could be... changed lol.

    I'm not sure about my view on having a pump, it seems like a great idea, and if it controls things better, fantastic. However, I'm not sure how I'd feel about being strung up to a tube 24 hours a day. Make me feel as if I'm connected to a drip in hospital, which technically you are I suppose. But I have no experience, or even discussed them much. Just seen some pictures and videos on youtube since they mentioned it.
     
  20. sooty26

    sooty26 Type 1 · Newbie

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    Re: Novorapid and Lantus - Perfect morning sugar level risin

    Hi i was diagnosed at 13 and am now 27. Up until 4 years ago(when i got married) i never had a problem with my sugars,hba1c always below 6.5. But then it was like something triggered it off.i had really bad hypos where it took up to an hour&a half for glucose levels to rise. Such a worrying time&the amount of glucogel,lucozade&food i had to eat to raise it was colossal.and so scary.my diabetes team did some bloods inc cortisol test but reaction was normal&bloods clear.eventually they changed me from lantus to levemir.i also take novorapid.they cut my levemir by 2 units initially i took 16 lantus eventually ending up on 9.5 levemir now.my novorapid was also reduced quite significantly so i am now on 6,6,5. I eat 2weetabix 40g banana&200g milk in morning 2ham rolls small packet of crisps 25g&pear at lunch&chicken peas and 200g boiled potatoes for dinner.my last hba1c was 7.8 so still not great but better than had been.at night i need to eat 2slices of white toast to stop hypo in morn.sugars usually about 9-12 before i have toast before bed.if i test at 6am usually about 8-9 but this drops to 3.5-4 by 8.30!was diagnosed with ovarian cysts a year&half ago but just last month said its endometriosis.my sugars always rise the week before period is due. Goin to see An endocrinologist after christmas to try to get to bottom of it all.frustrating time as i have low bp, v high pulse, nausea dizziness & possible chronic fatigue. Lost a stone last dec as i got a really bad bug so now just over 7stone. My dsn said weight is a big factor in adjusting insulin as less fat reserves mean absorption is quicker.i am using 0.5 unit pens as easier to correct a dose later and 5mm needles.Would love a baby but just dont know if it will ever happen as i need to get myself sorted first.
    I would def change to levemir though if i was you.
    I wish u all the best in getting sorted!!
     
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