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karen8967
Master
hi jmk1954 only going by my own experience when i was first diagnosed just over 5 months ago i had terrible sensitivity to the insulin i was put on a metformin tablet which i take with my morning insulin and told to reduce my insulin at dinner and teatime seems to have settled a bit although of a morning now i dont take any insulin because i was having terrible hypos in work my job is quite physical and i only took 2 units but by the time i get home my bgs are very low and i do have breakfast while im at work (2 weetabix )although im told im still honeymooning .i dont know if this is any help to you but this is just my experience
Kristin251
Expert
I am very sensative to insulin. Eating a few small meals every few hours and taking smaller doses of insulin sorted that out. Well, as best it can.
Thanks for replying. I have always been more sensitive to insulin than average, but recently I have been having to eat extra and then have snacks and still need glucose to avoid being hypo before my next meal. I am gradually cutting my insulin which is the only way I can see out of this, but the doctor at the diabetes clinic is refusing any advice. She wants me on an insulin pump - which is NOT what I want. My DSN (the only one with a working brain !) is considerably more helpful, but I can see this is going to be a long, slow, slog to get things stable again. I was diagnosed in 1964 as a child and my dose of insulin has had to be cut repeatedly over the years. I just cannot understand what is the matter with cutting your insulin to avoid serious hypos and consequent spikes.
Kristin251
Expert
That's exactly what I did. I cut carbs as well and that allowed me lower doses of insulin. When I ate carbs I was constantly chasing insulin one way or another. I now eat 5 mini meals which are higher fat, protein and vlc every three hours and take 1/2 unit per meal. This way my errors can't take me too low. And I prefer eating more often and smaller meals than larger ones.
This is MY version of the pump which I do not want either. It's a few more jabs but worth it to me
I have a small bf, lunch is split into 2 meals, dinner and a cheese snack which I sometimes bolus for and sometimes not depending where I'm at.
Hope this helps. Chasing insulin is so frustrating.
Celsus
Well-Known Member
Hi @JMK1954, I am rather sensitive to insulin, so take e.g. max 3 units for a normal full carb dinner service! 1 unit drops my bg with around 3.5mmol/L. So I also use the Novo kid's pen for my insulin, so I can more easily dose half units of the fast acting.
Now everything is relative, so please lets hear how much your daily insulin intake is?
I can see you are an 'old timer' as me, so assume the honeymoon is long gone. ;o)
But like you, I had to cut back on my total dose several times since turning 35 or so to avoid constantly crashing into hypo. Absolute nothing wrong with that. And probably also as a result of with age we don't eat so much anymore these days, as we don't need it either as e.g. we don't go working cutting timber for a while day, or chasing the next adventure in the student club-out, or what have you, etc etc.
The days back where we as diabetics were told in no uncertain terms what we had to eat every single day, every single week, year in year out are luckily long gone. So the old trauma about we had to eat the carbs necessary (hungry or not) to meet the number of units of fixed set of insulin units are long gone! Fast acting insulin and the handy bg meters are exactly great to support that we can be totally independent and totally flexible. Just get your basals set right, so your bg stays totally stable for the whole day if not eating anything. And then just shoot up to match the carbs you do fancy eating whenever.
Sounds like you maybe still have the old nurse and Endo from the day you got first diagnosed and they have not been outside the hospital since then?
Now everything is relative, so please lets hear how much your daily insulin intake is?
I can see you are an 'old timer' as me, so assume the honeymoon is long gone. ;o)
But like you, I had to cut back on my total dose several times since turning 35 or so to avoid constantly crashing into hypo. Absolute nothing wrong with that. And probably also as a result of with age we don't eat so much anymore these days, as we don't need it either as e.g. we don't go working cutting timber for a while day, or chasing the next adventure in the student club-out, or what have you, etc etc.
The days back where we as diabetics were told in no uncertain terms what we had to eat every single day, every single week, year in year out are luckily long gone. So the old trauma about we had to eat the carbs necessary (hungry or not) to meet the number of units of fixed set of insulin units are long gone! Fast acting insulin and the handy bg meters are exactly great to support that we can be totally independent and totally flexible. Just get your basals set right, so your bg stays totally stable for the whole day if not eating anything. And then just shoot up to match the carbs you do fancy eating whenever.
Sounds like you maybe still have the old nurse and Endo from the day you got first diagnosed and they have not been outside the hospital since then?
No, It's a new consultant and I think she wants me on a pump because the hospital I attend specialises in pumps. She suggested I needed counselling when I refused a pump three times in one appointment, finally getting so stressed out by the pressure she was putting me under that my voice started to break. That was the last straw. I plan to refuse to see her sgain.
catapillar
Well-Known Member
Is the sensitivity to insulin just that it's causing hypos (I say that like pff just a few hypos, but I mean solely... No there's no way of phrasing this that doesn't diminish the hypos) because I'm not sure it's so much sensitivity to insulin that would be causing hypos, more plain and simple too much insulin.
What is your total daily dose of insulin? One way to work out whether you are unusually sensitive to insulin is to use a calculator that tells you the average TDD for people of your weight. If your miles under (& youre not low carbing) then you might just be sensitive to insulin. But we all have differnt insulin sensitivities and they do change. Is there anything that changed recently that might have caused an increased sensitivity? Things like more exercise, more sleep, less stress, the absence/presence of illness, menopause?
If you're working on reducing your insulin what is causing a long slow slog with the DSN to do this?
Have you done any analysis of when the hypos are hapening to see if they are related to basal or bolus insulin? If they are happening within 5 hours of a bolus then it's more likely that your insulin to carb ratio might need adjusting. It they are happening at night or a good distance away from any meal it might be the basal dose than needs adjusting. Have you done any basal testing too see if your basal dose needs reducing?
Here's a link on how to basal test - https://mysugr.com/basal-rate-testing/
@Books1 and @Celsus mention a half unit pen, if you haven't got one do ask your DSN for one.
The smallest dose you cand achieve on mdi is half a unit, 0.5 units. The smallest dose you cand do on a pump is 10 times smaller at 0.05. I didn't want a pump when it was first mentioned to me, and had I been forced into it it would not have gone well for me, or the pump. But I do genuinely love my pump now. I just mention the smaller increments thing as something to bear in mind, not to try and sell you!
Yes, I have finally got half unit syringes. (I abandoned insulin pens after three failed to inject any insulin in six months. That was about 25 years ago, so I decided that at least with a disposable syringe you could see what was going in and see if it didn't.) The same consultant told me repeatedly that it wasn't possible to get syringes marked in half units, so I mercilessly interrogated a pharmacist. Actually, I was very nice to him as I was grateful for the info, just very insistent. I am totally exasperated with this stupid woman. I have already asked my GP about being referred elsewhere, but he says I will have to get the current hospital to discharge me first.
catapillar
Well-Known Member
I'm not entirely convinced your GP is correct - https://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/gp-referrals.aspx - it might be worth pushing the point if you aren't getting on with the consultant, of ask to see a different consultant at the same hospital?
I have already said a pump is not my choice. I am aware that it makes it easy to use very small amounts of insulin but it's not for me. The hypos are really down to the fact that I know I'm eating less because I have a permanent stomach ulcer caused by ramipiril. I am permanenly bloated by gas caused by a succession of drugs to reduce the acid in my stomach. My consultant just tells me to est more when I can't. So I'm cutting my insulin gradually to match what I can eat.
TheBigNewt
Well-Known Member
You never did elaborate on how much insulins you take.
Kristin251
Expert
I couldn't live without my half unit pen. I'm sure they've changed considerably in that amount of time. And I do joke sometimes if I have a hypo that I got that one extra drop of insulin or if I rise that I didn't get that drop. I found syringes to be very hard to take small units and get the right amounts of literal drops.
I agree with @catapillar that you could just be taking too much insulin. Better to error on the side of caution and reduce it until you don't hypo. It's better to ride a little higher than too low.
In my opinion of course
I agree with @catapillar that you could just be taking too much insulin. Better to error on the side of caution and reduce it until you don't hypo. It's better to ride a little higher than too low.
In my opinion of course
catapillar
Well-Known Member
Um, well, I'm, obviously, not a doctor. And I think the OP found the link on how referrals from your GP work useful. So was there something wrong with posting it? Cos normally someone saying "thank you doctor" would be saying it pretty sarcastically/mockingly, I don't really know if that's how your saying it so I thought I'd just ask to check to see if I'd done anything to cause mocking?
catapillar
Well-Known Member
Aren't you carb counting? The whole point of carb counting is to match your insulin to what you are eating. There's a free NHS course on it, just in case you aren't - https://www.bertieonline.org.uk
It could be, and I'm just guessing because you haven't said when the hypos are happening, that if you've got gastro issues going on that means the carbs that you are eating aren't getting digested in time to match when the insulin starts working (something with issues a bit similar to gastroparesis?). That sounds like a real drain to deal with, without lots of hypos on top and a not terribly helpful relationship with the consultant.
Kristin251
Expert
I read that too and not sure where it came from. Interpreted like you but why??
Sorry. Router problems last night so couldn't answer at all. I didn't understand the 'Thank you, doctor' response either. Think strange people are best ignored.
I have always counted carbohydrates, but when you feel you are going to explode if you eat anything more at all, but need to, in the end your judgement becomes skewed. You still think you are eating enough carb but it's fractionally less from day to day as time goes on. You guesstimate rather than weigh, because you are in pain unless sitting down and can't be bothered. Then you realise how fast you get through the tub of glucotabs and it begins to dawn on you........ That's how I arrived in this position. Thank you for what you've said. I had already decided that I needed to let things run high for a bit while I got on top of the situation.
Can we call the discussion closed, please ? I'll post again if I need to. Wish me luck with getting referred elsewhere.
Thank you.
I have always counted carbohydrates, but when you feel you are going to explode if you eat anything more at all, but need to, in the end your judgement becomes skewed. You still think you are eating enough carb but it's fractionally less from day to day as time goes on. You guesstimate rather than weigh, because you are in pain unless sitting down and can't be bothered. Then you realise how fast you get through the tub of glucotabs and it begins to dawn on you........ That's how I arrived in this position. Thank you for what you've said. I had already decided that I needed to let things run high for a bit while I got on top of the situation.
Can we call the discussion closed, please ? I'll post again if I need to. Wish me luck with getting referred elsewhere.
Thank you.
@JMK1954 - I have to agree with @catapillar - if you are using both long acting and fast acting insulin, the most important aspect of use is to adjust insulin to match what you are eating, and not to eat to the insulin you are using.
