Type 1.5 Rollercoaster Levels Post Prandial and Fatigue

[simonmanchester]

Hi Everyone,

Long time reader of the forums, but first time poster. I'm having a problem with my levels, mainly that whenever I eat I seem to have huge prolonged glucose spikes that last nearly 4-5hrs post prandial. I'm constantly fatigued, but also experiencing possible night time hypos and rebound high morning levels.

A little history and my current situation:

I'm a 32yr old Male and have always had an issue with weight (currently around 130kg). My diet isn't great, as I physically cannot eat most vegetables (as I feel physically sick at the taste), same with salads. I therefor eat mostly dairy and meat (so high fat), and a medium-high amount of carbs in the form of wholemeal bread (for sandwiches) and potatoes/pasta etc.

Originally (possibly incorrectly) diagnosed Type 2 in 2009. Was placed on Metformin and gradually increased to 2000mg daily. Was also place on Pioglitazone which brought down my HbA1c down to 6. Maintained a good HbA1c for years.

December 2012 I was in a near fatal car accident, spent 6 weeks in intensive care, and lost a lot of body mass. Levels were good during my recovery and was dropped to just 1000mg of metformin. Felt the best I had in years despite the trauma/recovery period.

It wasn't until mid 2014 when I started to experience the same symptoms I had at diagnosis in 2009 (frequent urination at night, fatigue, thirst, slight weight loss without trying, constant hunger). My Levels were in the low to mid 20mmol's so I knew I needed to see the doctors.

November 2014 I tested positive for GAD antibodies and told I was Type 1 LADA. Started a mixed twice daily insulin (Humalog Mix 25) and found that I needed to keep increasing my doses to cover my meals to get my levels right, taking an average of 110u daily.

Switched to MDI mid 2014, and been ok level wise preprandial since then. I did the DAFNE course in May this year and have played with my levels as recommended by the DSN at DAFNE as she believed I was taking way to much insulin. Before DAFNE, I was taking Levemir for my basel, 30u in the morning and 30u at night, with a 2u:10g Carbs Novarapid for my bolus. After DAFNE, I dropped this slowly to 15u twice daily Levemir and a 1.5u:10g Novarapid bolus.

Present situation:

Being on the lower levels I eventually found I was constantly fatigued and levels had started to rise pre prandial so decided to re-up my basel to 25u morning, 20u evening. I'm now at this level, feeling better but still fatigued. My sleep is currently disturbed in that I get around 5hrs sleep and then seem to be woken in the night, seemingly for no apparent reason.

I have since my DAFNE course been using the Freestyle Libre sensors, and when I am woken in the night I can usually see that I have kept at steady 'in target' levels, followed by a sudden rise prior to waking. I'm not going anywhere near Hypo levels, so seemingly its a dawn phenomena type thing.

So my main questions and need advice for are...

1. Am I taking too many units or not enough?
2. How do I combat the 5hr elevated levels after eating? I'm usually back to target before the next meal, but this results in me being over target for most of the day (which leaves me fatigued)
3. could I have "double diabetes?"
4. what adjustments would you all recommend?

Sorry for the lengthy post, but I thought it would be best to give you all the background since its my first post on here. I will try and get some of the graphs from my libre posted up when I'm next on my home PC (currently at work).

Regards,
Simon

 

[novorapidboi26]

Welcome,

From the Libre readings, it suggest your basal, overnight at least, is doing its job, and that your experience some dawn phenomenon, which is common, in fact, happens to us all, just some more extremely than others.

Preventing spikes after eating is usually combated by delivering your meal time insulin in plenty of time, before you actually eat. These times can be increased and decreased to suit different foods. A five hour increase sound extreme though. Initially I would say that the daytime basal is out, but if not, I would then assume you have some kind of delayed digestion., so gastroparesis maybe. But further to that, being LADA, the destruction of you beta cells are happening much slower and could peak and through I suppose, which would make your insulin responses quite unpredictable...

As far as double diabetes is concerned, this simply means you are type 1 [1.5] and have insulin resistance....I would argue we all have some degree of it, being more resistant in the morning etc....of course weight is an issue for resistance too, so if your overweight significantly you would naturally be more resistant....as weight come off and your muscles become more active, that resistance should decrease...

If it was me in this situation, I would be looking to test for any digestion issues......in the hope that they may be causing any fatigue issues....

Looking for ways to increase your activity and get your muscles moving no matter how small those movements are would be a good idea....

Limiting your carbs to what I would consider 'silly' amounts should be considered and of course you did mention feeling sick at the though of vegetables etc....Its hard to advise about that as thats obviously something you need to deal with mentally....you should look around and try different things, prepare them in different ways.You say you eat meat and that its high fat.....there are leaner choices of meat out there....what meat do you eat...?

What is a typical evening meal and what would your blood sugar levels be an hour/2 hour after it......?

You say your back on target for next meal....how long do you leave between main meals...?

What have day time basal test revealed, if you have done any? [Libre]