Testing all the time - Can't get the hang of insulin

[Clarky]

I've been type 1 for five months now. I was started on 14 Levimir and 4 Nova rapid with my evening meal.

Gradually I've been reducing my Levimir since I'm very active and suffer hypos. During work I don't need any Nova Rapid (I'm a bricklayer) and 2 to 3 hours after eating my blood is where it should be. But I have to snack to keep it from going too low, so I'm continually reducing my Levimir. I had a fasting blood test the other day, so I was told to take a much lower dose of Levimir the night before. I only took 4 units, but all day my BG stayed around 5. I didn't eat very much that day at all and still it stayed around 5. Usually I would need to eat at regular intervals to avoid going low. I explained this to my doctor and he agreed that I need to reduce my Levimir to around 4. Should my BG stay reasonably level even while I'm at work and exerting myself?

I've now been on a dose of 4 Levimir before bed for a few days, but I'm still experiencing hypos at work and I'm finding that in the morning my BG doesn't reduce overnight like it used to. If I went to bed at around 5-6, I used to wake up at around 4. But now it just stays the same. So If I eat late and go to bed slightly high, it stays high.

Here's an example of my work day:

6:30am - BG 7.8 Breakfast, 2 slices of whole grain bread. Approx 40g in total

8:33am - BG 9.8

9:28am - BG 3.4 One and a half cereal bars to correct. Approx 15g

11:02am - BG 4.4 First break - Cheese, Ham, Salad sandwich, small bag of crisps and an apple. Approx 60g

12:31pm - BG 8.8

1:00pm Cereal bar. Approx 10g

I sometimes suffer a hypo around this sort of time as well.

2:00pm BG 5.9 Second break - Cheese, Ham, Salad sandwich, small bag of crisps. Approx 50g

3:25pm BG 7.4

4:04pm BG 4.7 Half a Cereal bar before driving home.

5:05pm BG 5.8

I then went to the gym for and hour. This included some weight training and a run of two miles. I top up with lucozade whilst running since it rapidly drops my BG.

7:16pm BG 5.3

7:30pm Evening meal - Egg, Chips, Fish. Approx 120g Carbs. 4 Nova Rapid

8:34pm BG 7.3

8:57pm BG 8.2 1 Nova Rapid to correct

9:43pm BG 9.4 1 Nova Rapid to correct

10:27pm BG 9.6 1 Nova Rapid to correct

11:01pm BG 10.2 2 Nova Rapid to correct

11:48pm BG 8.5

4 Levimir before bed.

As you can see I'm also struggling to adjust my Nova rapid in the evening with the new lower Levimir dose.

Should I lower my levimir even more? What would happen if I didn't use levimir at all??

Here's an example of my day when I'm off work:

6:00am BG 6.9

6:30am 2 Slices of toast Approx 40g - 2 Nova rapid

8:04am BG 8.3

8:40am BG 7.5

9:40am BG 4.6 One Cereal bar. Approx 10g

10:20am BG 6.7

10:41am BG 6.0

11:35am BG 3.7 Tuna Sandwich, Crisps and an apple Approx 60g - 2 Nova Rapid

12:03pm BG 4.0 - 2 wine gums to boost a little

1:01pm BG 6.8

1:58pm BG 6.3

3:05pm BG 4.0 Tuna Sandwich, Crisps and an apple Approx 60g - 1 Nova Rapid

3:46pm BG 7.2

4:45pm BG 10.1 - 1 Nova rapid to correct

5:44pm BG 12.7 - 3 Nova Rapid to correct

6:47pm BG 9.9

7:00pm BG 6.9

7.25pm BG 5.6

7:36pm Evening meal - 110g Pasta Approx 79g of Carbs 4 Nova Rapid

8:44pm BG 4.1 - 4 Wine Gums to raise a little

8:54pm BG 3.3 - 2 more wine gums

9:00pm BG 3.6

9:07pm BG 3.8

9:51pm BG 8.3

4 Levimir before bed.

As you can see I'm testing like mad and I'm seeing no rhyme nor reason to my BG levels or insulin results.

Any advice would be most helpful.

Thanks

 

[fergus]

Hi Clarky,

Well, you're a honeymooner and no mistake!
Given the amount of carbohydrate you ate on the work day, and the relatively very small dose of insulin, your pancreas is still producing significant amounts of insulin I'd say.
300g of carbs is an enormous amount of, essentially, sugar to consume in only one day. Without some panceatic function, your blood glucose would be well into double figures on that sort of diet.
I think you're very smart to reduce your Levemir, and your Novorapid too if necessary, to ensure your bg remains stable and at a good level. Around 5 would be absolutely ideal in my view.
I'd also have to say your honeymoon probably won't last too long on such a high carb diet though. Your body will need a lot of insulin from somewhere, and your pancreas won't be up to the job for long if you overwork it.
It would be fascinating to see what your bg levels did if you ate a meal much lower in carbohydrate. Based on what you've told us so far, a breakfast of eggs, bacon, mushrooms etc. may need no injected insulin at all, and probably a further reduction in Levemir. Believe me, if you can keep your bg in control by prolonging your honeymoon period as long as possible I think that would make a lot of sense.

All the best,

fergus

 

[sophsmam]

2 things ive noticed when you've had a your hypo before lunch and you take novorapid.Do you take Glucotabs to get your b/s back above 4.We were told by the nurse if sophie was ever in a hypo before a meal to treat the hypo get her above 4 then to eat and to take her novorapid.And also pasta is a slow releasing carb and sophie would also hypo after having pasta then rise well over ten.the best way to have pasta is split the dose and have the next dose say 2 hours later.
Good luck its all trial and error and a lot of hard work but worth it in the end.

 

[Clarky]

The trouble with reducing my carbs during my work day is I'd suffer even more hypos. I'm already snacking between meals to stop from going too low as it is. Admittedly my evening meal could and probably should contain less carbs. The problem I have with that though is that I'm already losing too much weight. I've always been a keen body builder and before diagnosis I was nearing 15 stone with very little fat. I'm now down to 13 stone and struggling to maintain that. I think I can correct this by adding more fat to my diet, but would that not be unhealthy? I'm also still trying to get a grasp of understand food, having not had to worry about it up till now.

2 things ive noticed when you've had a your hypo before lunch and you take novorapid.Do you take Glucotabs to get your b/s back above 4.......... etc

I don't generally use glucose tabs to correct. I use lucozade for the bigger hypos and either cereal bars for minor hypos, or just eat as I would normally if it's meal time. I wont take the Nova rapid straight away if I'm low before eating, I'll wait a while to make sure I don't go lower.

I did wonder if I was indeed honeymooning. Should I lower my Levimir even more do we think? Should I be able to get through work without snacking, or is this always going to be an issue because of how physically demanding my job is? Also on my days off when I'm pretty much inactive should my BG fall so rapidly through the day? For example if I don't eat after breakfast for say 6-7 hours should my BG stay reasonably stable? It seems to me that mine just continually falls and falls until I hypo.

Many thanks for your replies so far.

 

[lilibet]

Couple of things I thought when reading this.

Firstly - agree with Fergus. You are most def in honeymoon. For example, eating the same as i always did, in the earlier days of T1 i was on a total daily dose of 9u mixed insulin for ages, then was eventually on 20 total before moving to same regime as you two months ago. I think if I was to eat a 110g carb dinner I would need to be put on an rapid acting IV drip! :lol:

Technically speaking you should be able to take Levemir and not snack if you dont want to but if
you are dropping too much outwith meal times it does suggest Levemir dose needs adusted. The thinking is also that if your levemir is within 1mmol to 1.5mmol difference across the day then its set right but of course 1.5mmol is a margin for error between being at 5mmol or being hypo for talking sake. On the day you fasted it didnt move all day, and that suggests therefore its right

You say it would drop to 4 from 5ish and I would say thats ok too though it does mean that you have little margin for error with those numbers (and as you become more experienced and confident you will likely be happy with a fasting bg of that too). If it stays the same or thereabouts it is fine

It is strange mind you that you are finding correction doses hard to tackle your bg given you appear so insulin sensitive. I believe that if your basal is set wrong then correction doses do very little, or appear to, but I dont see that being an issue for you according to numbers

What I would say though its that Levemir (esp) on low doses can run out more quickly and maybe rises at night you cant correct are due to having no basal

Best way to test basal is to skip meals, or take very low carb meals to see, though I find non carb meals do still raise my bg though I do believe my pancreas has prob now given up the ghost!

Also, Novo is not usually taken in fixed doses so maybe you need to look at working out ratios over time. Most people start with 1u novo to ten grams carbs eaten, but you maybe want to be more conservative given honeymoon and hypos etc

 

[fergus]

Hi Clarky,

If you are continually having to eat carby snacks in order to avoid hypos then you are definitely taking too much insulin. If the body is in hormonal balance, or homeostasis, it will use glucose for energy immediately after a meal, then begin to use fatty acids for fuel thereafter, until the next meal. It will find the transition from glucose to fatty acid metabolism impossible if insulin levels are raised and your bg will fall as a result instead. Then you will need to correct that fall with carbs, causing another rise in insulin, and the cycle begins again.
Contrary to popular opinion, there's nothing to fear from increasing the fats (other than hydrogenated trans-fats) in your diet to up your calories and stabilise your weight loss. With available calories from fats, stored or in the diet, your insulin levels can remain low and you'll find the hypos and the need for carby snacks will begin to disappear.

All the best,

fergus