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Please help! Type-1 on Apidra-Toujeo.

S

sannie230

Newbie
Messages
3
Type of diabetes
Type 1
Hello everyone!

I want say sorry for my English in advance but I'll try my best. I am a 24 years old girl from Hungary. I have type-1 diabetes from the age of 5 years old. I got a new basal 2 months ago. This is Toujeo. I used Lantus before but I had stable high blood sugar levels with it. With Toujeo I get very good morning level. I give 27 units. But in the daytime even if I have good after meal levels, my blood sugar starts to go up. And for the next meal it will be high. This is my main problem. For example the other day I woke up with 4,0 mmol/l. After breakfast I got 5,9 mmol/l. But then (no unnoticed hypo) before lunch I had 9,3. But usually I get higher results too. I didn't eat anything between. Sometimes this happens even if I do exercises between meals. It's going up and up. I know that as a result of hypo you can get higher levels the next day. But this is happening always. If I had hypos or not. I tried to give more Toujeo in the evening but I have hypo at night with more. The 27 unit is the perfect for me cause I have stable low blood sugar all night and also in the morning. But the daytime is horrible! Could anyone please give me advice what I am doing wrong? Thank you so much! Have a nice weekend!
 
You could try to switch to Levemir and inject twice a day, once in the morning and once in the evening and adjust based on your needs.
 
sannie230 said:
Hello everyone!

I want say sorry for my English in advance but I'll try my best. I am a 24 years old girl from Hungary. I have type-1 diabetes from the age of 5 years old. I got a new basal 2 months ago. This is Toujeo. I used Lantus before but I had stable high blood sugar levels with it. With Toujeo I get very good morning level. I give 27 units. But in the daytime even if I have good after meal levels, my blood sugar starts to go up. And for the next meal it will be high. This is my main problem. For example the other day I woke up with 4,0 mmol/l. After breakfast I got 5,9 mmol/l. But then (no unnoticed hypo) before lunch I had 9,3. But usually I get higher results too. I didn't eat anything between. Sometimes this happens even if I do exercises between meals. It's going up and up. I know that as a result of hypo you can get higher levels the next day. But this is happening always. If I had hypos or not. I tried to give more Toujeo in the evening but I have hypo at night with more. The 27 unit is the perfect for me cause I have stable low blood sugar all night and also in the morning. But the daytime is horrible! Could anyone please give me advice what I am doing wrong? Thank you so much! Have a nice weekend!
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There could be many causes for this, but here's the two ones that I think are likely to be contributing to your problem:

-Basal insulin not working the full 24 hours. This is possible as you take your injection in the morning, when the basal insulin may already have run out, and it takes a further 5 hours or so (certainly with Levemir anyway) to kick in. That could explain partly why your morning sugars creep up and up.

I'd personally opt for an evening basal injection, as to avoid the high morning BG issues. When you tried an evening injection, did you still take your basal in the morning too? If you did, you will have taken a double dose and that could be why you had the evening hypos.

-You experience a "waking rise". Many of us find our BG rises as soon as we get out of bed. Personally, I need to take 2u of bolus insulin as soon as I get up to counter my BG rise which is usually around 4-5mmol/l.

FYI, you may find that exercise increases your BG too. So although we often think that exercise typically drops our BG, you'll probably find that it actually spikes it initially - and only drops if you have prolonged, sustained periods of exercise.
 
I would think you are getting a rise due to getting out of bed (symogyi effect)..
Try getting up, testing hourly but not having anything to eat (unless hypo) until 5 hours after you get up.
If levels just go up then its symogyi effect... and it would be an idea to give a bolys injection before getting up.

You would need to test over a few days, dont go on just one days of readings.

I have tresiba and its perfect till 4am. I have to now have a 1.5 unit injection at 4am to stop the rise starting at 6am. I then have to inject another 4.5 units at the moment an hour before I get up. If Ibdont do this routine my blood levels can go from 5 to 18 in 5 hours.
 
sannie230 said:
Sorry I forgot to convert my blood sugars. Before breakfast 72 mg/dL, after 106 mg/dL. Before lunch 168.
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This is a UK forum so the units you gave in your first post were fine :) That is, in mmols :)

I don't think you're nevessarily doing anything wrong. Different basal insulins suit different people. You could try moving the time of your basal injection (with the help of your DSN) and if that doesn't work, then a basal insulin that can be injected twice a day would give you more flexibility as you'd have two separate doses to adjust.
 
Thanks, everyone! I started to use Toujeo 2 months ago so I have to wait with the change. I think I need to give it a little more time. I use Toujeo once at 9 pm and it should last for 36 hours (but of course it doesn't, that's fine). Sorry, somehow I thought you use mg/dL in the UK. Unfortunately in Hungary we don't have a nurse or a diabetes team who help us only the doctor. Last week I went for the control and I had 10 minutes to talk with her as there were lots of patients. She said I have to ask very quickly cause she's busy. I live in the countryside, so I go to the nearest town to see the doctor but here the opportunities are limited. That's why I am trying to solve my problem alone. I asked for help in Hungarian groups and forums but wasn't successful. I just need to find a little system in this, why is this happening cause I start working next week and it's impossible to eat at the same time everyday and check every two hours. Sorry for the complaining and thanks again! I appreciate! Have a lovely day!
 
GrantGam said:
Not being picky @donnellysdogs, but the Symogyi effect is basically rebound hyperglycaemia, not a "waking rise" as we call it.
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Agree but a waking level of 4.0 could be indicating lower at some point during the night..

It is important to check night time levels... make sure no lows are causing rebounds (symogyi effects)....

After establishing night levels are ok and even then yes, look at dawn and waking phenomenon...

I had symogyi effect.. and I also have DP and WP. My levels will be worse though for rises if my levels were lower post 4am... ie sometimes I can be 4.0 at 4am, sometimes 5 or 6 or rarely 8.0. My levels rise less if they are 6 or 8.0 than they would at 4-6.0...

I would definitely if it was me basal trst over night. Establish that day levels are not due to rebounds.. then basal test mornings...
 
donnellysdogs said:
Agree but a waking level of 4.0 could be indicating lower at some point during the night..

It is important to check night time levels... make sure no lows are causing rebounds (symogyi effects)....

After establishing night levels are ok and even then yes, look at dawn and waking phenomenon...

I had symogyi effect.. and I also have DP and WP. My levels will be worse though for rises if my levels were lower post 4am... ie sometimes I can be 4.0 at 4am, sometimes 5 or 6 or rarely 8.0. My levels rise less if they are 6 or 8.0 than they would at 4-6.0...

I would definitely if it was me basal trst over night. Establish that day levels are not due to rebounds.. then basal test mornings...
Click to expand...
Good point.

I had a similar issue with Symogyi effect (it's actually why I joined the forum). Thought I was having issues with my insulin storage temperature, but I was taking too much basal.

Good post @donnellysdogs:)
 
Team work to get me to explain myself properly..
 
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