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Please, where am I going wrong?

R

rubecula

Member
Messages
23
Location
Newent on the Gloucestershire/Herefordshire border
Type of diabetes
Type 1
Treatment type
Insulin
Hi,
I've been lurking on here for a while looking for an answer to my problem, without success, so I thought it was time to ask.
I'm on a basal/bolus regime using Levemir and NovoRapid. Based on a misunderstanding with a diabetes nurse I've been taking enough insulin to ensure that my blood glucose is between 4 and 8 before the next meal and ignoring what happens in between. I've found out from reading here that's completely wrong. So when I check my BG 2 hours after a meal it's too high. Typically 10 - 14. I've increased my insulin to keep the 2 hour reading within bounds but now am having hypos (2.5 - 3) before the next meal. This seems worse between breakfast and lunch.
What am I doing wrong?
A few facts:
68 yrs old
LADA (I think - slim build, low levels of insulin).
Quintuple heart bypass 12 months ago
Thanks,
Robin
 
Hi Robin and welcome,

I am still learning on this as I have only been on insulin since August but I would be looking to reduce my basal a bit and try that as I was having a similar problem initially. I knocked one unit off my basal (lantus) and this seems to have made things a bit easier.
When do you take your levemir?
To do a basal test don't eat anything after 7pm in the evening and then check your level before bed and once during the night (to make sure it isn't going too low and then rising again) and then first thing in the morning before breakfast. If it drops more than about 1.3 or so your basal is too high. This can done during the day too if you go about 7 or so hours without eating carbs.

HTH
Angie
 
Hello

Well I was on Levimir and Actrapid and I found that hypos were mainly due to the amount of Levimir and when you injected. I was on 2 injections per day and my hypos were mainly mid afternoon, but through sheer grit and determination I reduced my lunchtime actrapid and this seemed to sort out the hypos. I think I was pannicking as had highs 2 hours after my lunchtime meal and so put up the amount of insulin (not strict carb counting), so more or less ignored the numbers lunchtime and it all sorted itself out.

However, I am now on a pump and oh how things have changed for the better. Never been so well controlled.
 
You are not doing anything too wrong really.... Some consultants and DSNs will tell diabetics to only worry about achieving the OK target every 4hrs but according to the NICE guidelines for healthy bg targets it states that bg levels should ideally not be over 8.5mmol 2hrs after eating food. However, in reality this is not always easy to achieve without the risk of going hypo which is what you are experiencing by increasing the bolus insulin. What you can do to stop the hypo feeling before lunchtime, is eat a small carb snack mid morning. Years ago when people used twice daily insulins, it was fairly common for diabetics to eat a small snack mid morning and mid afternoon as failure to do so, would result in hypos.

Have you attempted carb counting yet and working out an insulin to carb ratio? Carb ratios once worked out can help avoid some of seriousness of hypos.
 
Hi,
Firstly, thanks to all who have replied to my post, I really appreciate your help.

I've been on insulin since Feb 2008 and thought I was doing OK HbA1c down from 9.9 to 7.3. I mistakenly thought that the 7 compared to a BG reading of 7. :oops: Having surgery got me really thinking about whether I could do better and trawling the internet I came across this site. As I said I have been lurking here for a while trying to decide what to do. Given the perilous state of my arteries and now knowing that high BG contributes to hardening of the arteries I want to do as much as I can to keep it within bounds.
After reading a lot here I'm really confused. Do I stay on a high carb/low fat diet (which I assumed would be better for my heart) or do I move to low carb/high fat or something else?
I bought Patrick Holford's and Dr Bernstein's books and also went to see my DSN recently (hadn't seen her since 2008). She gave me an Insulinx meter so I'm just about to start carb counting. Unfortunately she's just moved to another area so I have to contact someone at another hospital.
I now go to the gym twice a week, at first my bg was ok as the level of exercise was quite low. Now I'm fitter and doing much more I have a whole set of different problems re BG levels.
I thought this diabetes lark was easy to manage but the more I read the more it's seeming like a black art!!
Thanks again,
Robin
 
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