Spoke to Diabetes nurse re: high BS's

[catsbd]

Well, for last few days I've been eating just 3 meals a day, avoiding **** and testing before and after meals. Mudt admit have not been very well ( luckily off work Sat Sun and today). Taking my steroid inhaler (asthma) more as coughing a lot. Look at my blood sugars this morning, they getting higher, mire so after meals. Are generally between 12 and 20. Don't know what to do really. Not doing correction doses as trying to see what my levels are doing without these. Rang DN this morning, who said do 3 am tests and do some carb free meals and testing (meal time only) to check background insulin.
Previously no pattern to my blood sugars as usually eat erratically. Aiming not to do this anymore.
Also hiw do people give half units of insulin?
Fed up but determined to get some balance!


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[catsbd]

PS - I've never been taught how to work out ratios or background insulin. Did DAFNE 5 yrs ago.


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[ciaramoh]

One thing you might want to look at is your steroid inhaler. I know that steroids can have huge effects on diabetes so might be worth having a look, but just a thought.
Why aren't you correcting? Assuming you're type 1?


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[catsbd]

Not correcting at moment was to get a feel for what my insulin was doing. Dunno if doing right thing. DN nurse didnt comment on it.


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[catsbd]

Ciaramob hi. Yep type 1 41 yrs! Must as you say check on steroid inhaler am on clenil.


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[ciaramoh]

Maybe best to have a fasting day and then you'll know for sure if that's how you want to see. If you're eating and not correcting you won't know.
It depends on area but you might be able to get a sensor and that can show patterns
Would definitely look at steroids though
Wow! I've had it 15 years this month, I'm 18


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[Lucie75]

Instead of having a fasting day, split the day into 3 separate chunks and fast for one of those chunks at a time. For example, if you are testing your background dose during the morning skip breakfast and have no carbs for a 4 or 5 hour period. When testing during the afternoon, have breakfast as normal but skip lunch and again have no carbs for 4 or 5 hours during the afternoon. For the evening, have lunch but skip dinner etc. You can still have a snack before bed if you need one. During each period of fasting test your blood every hour to see what's happening. If you go hypo during this time then you must treat it and abandon the test. Adjust your back ground with advice from your dsn and retest another day.

Only once you know your background is correct can you work out your bolus/short-acting doses.

Hope this helps.

 

[Daibell]

Hi. Yes, the inhaler may be adding to your sugars. My DN told me to set my Basal so that my morning fasting level is between 5 - 7 mmol. In practice I go for 4 - 5 mmol which I know is very low but I watch out for night-time hypos but haven't had any. My DN is happy for me to aim that low as she knows I understand the implications. So, go for 5 - 7 mmol? My DN started me on the standard starter ratio of 1unit to 10gm of carb. I have found that this works well for me. I'm nearer 09. to 10gm carbs but with the veg and protein adding a bit of carb I find for me 1:10 ratio works fine. You need to determine your ratio by checking before and after meals with different units and go for the units that keep your 2-3 hour post meal level generally in the region of 6 to 9 mmol. My latest Novopen Echo does half-units so you may want to consider this new pen as few others do 1/2 units.

 

[Garr]

Hi Catsbd, If you haven't been feeling well and your sugars are getting higher, have you been checking your ketone levels and following the sick day rules?

 

[Alanp35]

Hi Catsbd, If you haven't been feeling well and your sugars are getting higher, have you been checking your ketone levels and following the sick day rules?

Hi there
I'm fairly new on here. What are the sick day rules ? Thx


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[catsbd]

Yes I checked, no keytones. Thankfully. Have decided to do dose cortections and not try and 'sort' things out till I feel better. Have done sick day rules in the past that worked well. X


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[Garr]

Hi there
I'm fairly new on here. What are the sick day rules ? Thx


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http://www.mydiabetesmyway.scot.nhs.uk/resources/leaflets/SickDayRulesForType1Flow.asp
Click on here for the sick day rules Alan

 

[Alanp35]

Many thanks Garr. An eye-opener never having seen that information. I had a horrendous time over new year but at least I now know what to do.



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[SamJB]

Hi,
There are only two ways to do a basal test. Do an overnight test, or fast throughout the day.

A zero or low carb meal will NOT provide you with an accurate basal reading, despite what your DSN says. When you eat and food enters your large intestine, the walls of the large intestine stretch. This causes the cells in the large intestine wall to release glucagon so that you can immediately benefit from the meal that you have eaten. As a result, you will get a BG rise from any meal that you eat.

To do an overnight test, don't eat or inject fast acting insulin for around 4 hours before bed, if you do it will interfere with the reading. In Gary Scheiner's Think Like a Pancreas book, he suggests that for every 1.6 mmol/l change in BGs between your pre-bed and pre-breakfast readings should be compensated for with a 10% change in basal insulin. This method works perfectly for me.

I'd thoroughly recommend the Gary Scheiner book, I learned loads from it even though I'd been diabetic for a decade. It's got so much useful info on how to "think like a pancreas" and get your insulin dose correct.

As others have mentioned, steroids have been known to increase your BGs, so it might be a good idea to do a basal test for when you are taking steroids and a basal test when not.

 

[phoenix]

To add to Sam's post, here's a link to an article by Scheiner about basal insulin and how to test.
http://integrateddiabetes.com/Articles/insu/basal insulin for friends with diabetes.pdf

 

[Picci]

Hi,
There are only two ways to do a basal test. Do an overnight test, or fast throughout the day.

A zero or low carb meal will NOT provide you with an accurate basal reading, despite what your DSN says. When you eat and food enters your large intestine, the walls of the large intestine stretch. This causes the cells in the large intestine wall to release glucagon so that you can immediately benefit from the meal that you have eaten. As a result, you will get a BG rise from any meal that you eat.

To do an overnight test, don't eat or inject fast acting insulin for around 4 hours before bed, if you do it will interfere with the reading. In Gary Scheiner's Think Like a Pancreas book, he suggests that for every 1.6 mmol/l change in BGs between your pre-bed and pre-breakfast readings should be compensated for with a 10% change in basal insulin. This method works perfectly for me.

I'd thoroughly recommend the Gary Scheiner book, I learned loads from it even though I'd been diabetic for a decade. It's got so much useful info on how to "think like a pancreas" and get your insulin dose correct.

As others have mentioned, steroids have been known to increase your BGs, so it might be a good idea to do a basal test for when you are taking steroids and a basal test when not.

Well said Sam, keep spreading the word!!! I have read 'think like a pancreas'and Bernstein's book. I wish all diabetics would read these books, they are also written by type 1 diabetics!! However, hcp still claim we can eat a carb free meal to check background insulin.....I proved them wrong on the DAFNE course.


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[JustDomUK]

Don't know if this is making a difference but since you've been under the weather has your exercise and activity been reduced? I found that my bloods were greatly affected by whether or not I was sloth like or active. I subsequently found that my thyroid was on the blink so to speak. Have you had your thyroid level checked recently?


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