Numbers gone out of the window

[Angelc]

Hi

recently diagnosed Type 1. Started on Lantus a couple of weeks ago then Apidra. Managed to get some control of the numbers, although not nice and low, at least getting some consistency with waking BG's around 8 and between 6.5 - 14 during the day (I know that's not low, but they were around 20-28 before Christmas)

It was felt I was ready to get my teatime units down a bit so Apridra was increased. Control has gone straight out of the window! Waking BG is now betweeen 8 - 10mmol and the rest of the day mostly between 14 and 23 mmol!

I don't know what went wrong, I only increased tea time Apidra by 2 units and decreased Lantus by 2 units, so now on 16 units Lantus, 4, 4, 6 units Apidra.

There hasn't been any changes in what I am eating, so where has the little bit of control that I had gone? I was looking forward to a gradual reduction, but it seems I can't control things

Feeling rather fed up, I'm off work at the moment and really want to get better and get back to some normality!

 

[Jen&Khaleb]

Did you get some advice from your Diabetic team before changing the doses of insulin? Having the correct basal dose makes it much easier to manage the meals. I can't work out why you took 2 units away from the Lantus and added 2 units of Aprida. I hope I read your post correctly.

Diabetes can be very frustrating and there is no 'quick fix'. Try to keep some perspective and just take things slowly. Being only newly diagnosed you can't expect to have fantastic control all the time. Your still adjusting to a different routine and learning how foods and environmental factors change your bsl's.

I'm sure someone will be along who's on the same insulin who might be able to help you out a bit with their experiences.

 

[kay957]

I think you need to go see your Diabetic nurse asap, maybe the drugs don't suit you. I am type 2 but have had so many changes, now I am on the right meds. I hope all gets better for you.

 

[Angelc]

Thank you for your replies. It is the Diabetes Nurse at the hospital who is changing my dose at the moment. It was on her advice that I reduced the Lantus (I had a hypo the night before this) and increased the Apidra (to get better control in the evening).

Sorry I don't think I am writing it very clearly.

 

[janabelle]

Hi Angelc,
as you said, you are only recently diagnosed and it does take time to adjust as it's not only what you eat, but your daily activities that will affect control. It's important you are aware of carbohydrate:insulin ratios. However further to what Kay said about the possibility of the drugs you're taking not suiting you; I've been type-1 for 21 years, and the most important factor in control for me is being on the correct insulin. I'd been on synthetic human insulin for 15 years and never had really manageable BG control. I was then put on Lantus in '04, and what a nightmare that was. I have posted a lot on this forum about my experience, and erratic, inconsistent BG numbers was one of the probs I experienced. I was constantly told by my DSN and consultant that Lantus did not cause these probs, and remained on it for 4 years. :cry:
Since changing to animal insulin since May '08, I have stable daily BG control for the first time with no nasty surprises. Wish I'd been offered it at diagnosis, but at that time the fashion was for all newly diagnosed patients to be offered only "human" synthetic insulin, these days it's "analogue" synthetic insulin.
Please remember it's very early days. However if you feel you are doing everything correctly, and following advice from your team, and BG numbers aren't stable, don't waste time blaming yourself, consider you could be on the wrong insulin or regime for you.
We are all diffent, and as one regime or treatment will suit one person, it may not suit the next.
Best of luck.
Jus

 

[jopar]

It is probably to early to tell if the insulin itself is a factor...

I am surprised that your DN suggested 2 changes at one go, as the normal rule of thumb is change one thing at a time, then wait a couple days to see it's true effects, as you can see as you changed both insulins at the same time that you dont which one might be causing the underlying problem..

If your bg pattern had been pretty stable with a constant raise before and after meals, then it's likely that an increase on basal rate is needed to lower this.. So would be looking at increaseing the lantus first...

But as janabelle said, you do need to work out carb;insulin ratios, and monitor what sort of activity/exercise you are doing as well as this can effect insulin that you might take when you eat..

 

[kegstore]

Don't forget also that if you're recently diagnosed, you could well be in honeymoon period still. This means you may still be producing some insulin yourself, but only erratically. This makes it even more difficult to work out your correct doses, but only temporarily.

As jopar says, your DN shouldn't be changing more than one thing at a time. How on earth are you supposed to determine which change is having the required effect? Sounds like this person is meddling and fiddling unnecessarily to me!

 

[LittleSue]

Getting the basal dose right doesn't just reduce your numbers, it also keeps things more stable and less affected by small variations in food and activity levels. It may be that you need to adjust by 1 unit each time. On top of everything else, your menstrual cycle can also change your insulin needs. Nurses often seem to think this only has an effect for a few days when you're premenstrual, but some of us need to adjust for this reason a lot more than that.

 

[Angelc]

Ah, the two changes at once! Yes can see that.

I am improving a little on 18 units Lantus 4, 4 and 8 or 10 Apridra, depending on before evening meal results. 7's and 9's are better to see than 17's and 23's!

Had a long chat with Diabetes nurse yesterday, and she is telling me that it's going to take a long time to get me anything like where I need to be permanently and isn't planning on me getting down to 4-7 between now and the next 2 months or so!

Hope it doesn't take forever, can't begin to say how much this is all getting me down.... or perhaps this is EXACTLY the place to say it

Angela

 

[ajsmum]

AJ's Lantus was reduced a week ago by his diabetic dietician. Her reasons for doing this was because he was going to sleep at 9, and then having 2 or 3 hypos in the night. She said that the key to knowing if your basal insulin is right is to look at the before bed reading and the waking reading - if these arent very different (more than 2) its a good indication its correct. Since reducing,his night hypos have stopped, but his waking readings are still under 4, so she reduced his lantus again today by another 2 units - we shall see!
Everyone else is right in what they say - so many other things can have an effect. And unless you are eating exactly the same foods, cooked in the same way, same portion sizes, doing the same amount of activity and being in the same state of health (oh and the weather is the same temperature) then you will find that you can not inject the same number of units of fast acting insulin at each meal- you will learn to count the carbs and adjust. But being so newly diagnosed there are loads of other things to take into account at the minute - and this will be introduced further along your journey.
Good luck! Its a massive learning curve :wink:

 

[lilibet]

Glad you have got support from DNS.
Mines didnt want my bg dropping too quickly either but to be perfectly honest, I had no intention of running bg in the double figures for three months

Two things to reiterate as noted
Apidra should be taken on what you eat. If DNS has given you fixed doses then this will only work if you eat the EXACT same thing at each meal in terms of carbohydrates. If you eat more, your bg will be higher, if you eat less it might go lower

Lantus takes 3 or so days to show any change so monitor patterns for a few days before making changes. If you had good control and it goes to pot, I ALWAYS look to my basal first (eg when it was wrong I was taking correction doses of 4u of insulin and seeing little change in bg with NO food )

Over time you will get more confident and manage to do all this yourself. If you feel better then stick with DNS for now, but its your diabetes so feel free to insist on tighter control , sooner, if this is what you wish

 

[Angelc]

Seems to be something seriously up the spout with my fasting numbers/Lantus reading the above!

I go to bed with readings of between 12 and 15 mmol and on waking they are 7.5 to 9.5 mmol!!! so that isn't right at all if they are not supposed to change during the night! eeeek!


I have fiddled a little with my Apidra, taking a higher dose if I know a meal has lots of carbohydrate in it, and still my numbers are on the high side.

Thank you for the replies, it's really helping me to hear about others experiences, as I know NO other Type1 diabetics at all