Trouble with mid-morning blood sugars

[squishee]

Hi all,
I posted this yesterday with no response, so I'm re-posting in this section in the hope someone can help!!

I recently (about3 or 4 months ago) switched to Lantus as my background insulin. Things seemed to be going fine at first, the early morning high blood sugars I was experiencing on Humulin I have stopped sompletely, and apart from a fiddle with the doses everything seemed to be going really well.
In the last few weeks however, I've been having a real struggle
Following advice from my diabetic nurse I have split my Lantus into 2 doses, 12hrs apart. It wasn't really lasting the full 24hrs for me (I was peaking at lunchtime), so she recommended doing this. I now take half at 9am, and half at 9pm. But now my blood sugars are getting ridiculously high around the time of my mid-morning dose.
Today, for example, I was 17! I was 7 before going to bed, and 8 when I woke up which is fine, breakfast was a small bowl of bran flakes, ss milk and a small banana, and I gave myself 8u of Humalog.

I'm continually playing with my breakfast Humalog, but if I had the same amount of carbs for lunch, for example, I'd only give myself around 3 units of Humalog which would be more than adequate. For some reason at breakfast no matter how much I give myself I always seem to be high at midmorning.

It's starting to really get me down now, any advice gratefully recieved

Edit: 12:35 - Have just done another blood test (it's still an hour until I normally have lunch) and I'm now at 7! How is this possible? I didn't inject any extra Humalog mid-morning, only my normal 12u of Lantus. So, if I'd given myself a larger dose at breakfast I'd probably be hypo now.

 

[noblehead]

It could be that your breakfast food is acting faster than your insulin, hence the post-meal high reading, but never used Humalog insulin myself, but when do you inject your insulin, before food or after? Don't also forget that it is not unusual for type 1's to have a different insulin ratio throughout the day, therefore you may need more insulin per 10g of carbs in a morning than you do later in the day.

You could try also to increase your bedtime lantus by 2 units to see if this helps resolve the problem.

Nigel

 

[Lucie75]

I don't use either of those insulins so I'm afraid I can't really help, other than saying that some food groups make your blood sugars peak sometimes 1 hour, sometimes 2 hours after consumption.

I know that weetabix makes many people run higher than normal, and then it drops back off again around 3 hours after consumption. I am one of those people.

Can't be of much help, but felt I ought to respond. Have you tried posting in 'Ask a Question'?

 

[squishee]

Hi Lucie, thanks for replying

some food groups make your blood sugars peak sometimes 1 hour, sometimes 2 hours after consumption.

This is true, but to be honest it doesn't seem to make any difference what I have for breakfast!
In the last couple of weeks my breakfasts have been:
Toast
Branflakes & milk
Branflakes, milk & banana
Banana, 3 ryvita & tablespoon peanut butter
Scrambled egg
Porridge

Sometimes it doesn't happen, even if I've eaten the same breakfast as when it has happened before! :?
Porridge is the worst for me, I really badly peak 2 hours later.

 

[squishee]

Hi Nigel,

Sorry, I completely missed your reply!

I've used Humalog for a long time. It's always worked very well for me, and seems to act very quickly (eg if I'm running high and inject a bit extra I can start to feel/see effects around 20 minutes later). I take it before I eat.

This is a fairly recent problem though, which is what's confusing me.

 

[iHs]

Hi Lucie, thanks for replying

some food groups make your blood sugars peak sometimes 1 hour, sometimes 2 hours after consumption.

This is true, but to be honest it doesn't seem to make any difference what I have for breakfast!
In the last couple of weeks my breakfasts have been:
Toast
Branflakes & milk
Branflakes, milk & banana
Banana, 3 ryvita & tablespoon peanut butter
Scrambled egg
Porridge

Sometimes it doesn't happen, even if I've eaten the same breakfast as when it has happened before! :?
Porridge is the worst for me, I really badly peak 2 hours later.

Hello squishee

I have a feeling from reading yr messages that you are not counting the exact carb content of the food that you are eating?? If I am wrong on this, then pse accept my apologies.

From looking at the menu of stuff you eat, toast is about 17gms carb per slice, branflakes with milk is about 30-35gms, banana is about 20gms, ryvita is about 7gms carb per slice, tbspn of peanut butter is about 3.5gms, scrambled egg is nil in carbs but the protein content in it will elevate your bg levels a fair bit just on its own, porridge but tends to also raise bg levels fairly high but unlike normal carb food; porridge will keep you up for longer due to it being low GI.


Can I suggest that you try and keep the type of breakfast you eat, the same every morning and don't vary it. It will be easier that way for you to work out the exact amount of Humalog you need to use so that you will be a bit lower mid morning. I have found myself over the years that I used bolus/basal, that breakfast meals were best kept lowish carb to allow the basal insulin more time to become fully active. So I always kept to eating about 15gms carb at breakfast, then did a bg test mid morning to see what level I was and then ate a small snack (usually 10gm carb biccie)if I had a bg level of 7-9. This might be what you need to start doing until you can figure out your exact insulin to carb ratio. Many people usually use a ratio of about 1u to 5gms carb at breakfast, then 1:10 lunch, 1:5 eve meal but everyone is different so its only by logging down the amount of carb you eat, the amount of insulin you inject, looking at what yr bg levels are, can anyone then start to accurately calculate the amount of bolus insulin they need to use so that they can then get their bg levels to be at healthy targets.

There is an awful lot to be said for using ratios instead of guesswork as you can then more or less govern how high or how low you want your bg levels to be.

 

[squishee]

Hi iHs, thanks for replying!

I actually had my carb:insulin ratio worked out by my dietician about a year ago, but found that I was getting a lot of hypos so kind of ditched it...
I didn't realise (no one ever told me!) that the ratio can differ at different times of the day.
How would I work that out?
I'm loathe to reduce the carbohydrate amounts I eat at breakfast as I find that leaves me very hungry about 2 hours before lunch, but if I snack at any point after breakfast I find then I don't want lunch at all

What's concerning me more is the fact that a) this is a recent development for me since splitting my Lantus, and b) it doesn't follow any discernable pattern. I tend to go in cycles with my breakfast - the same thing all week, then something different at weekends as I have more time on a morning - and sometimes I have perfect days, when I haven't done/eaten anything different! :roll:

 

[copepod]

Had you been taking 1 or 2 shots per day of Humalin I before changing to Lantus? I ask because, I was getting early morning lows with 1 shot per day of Humalin I around 2200 - 2300, but problem was solved when DSN suggetsed splitting doses I changed to 2 equal doses, one around 2200 - 2300, other around 0600 - 0730. Humalin I is so much cheaper than Lantus (or Levemir), so I prefer the lower costs to the NHS, and refuse to use pre-filled pens due to waste of resources and bulk when travelling for long periods.

 

[noblehead]

Hi iHs, thanks for replying!

I actually had my carb:insulin ratio worked out by my dietician about a year ago, but found that I was getting a lot of hypos so kind of ditched it...
I didn't realise (no one ever told me!) that the ratio can differ at different times of the day.
How would I work that out?
I'm loathe to reduce the carbohydrate amounts I eat at breakfast as I find that leaves me very hungry about 2 hours before lunch, but if I snack at any point after breakfast I find then I don't want lunch at all

What's concerning me more is the fact that a) this is a recent development for me since splitting my Lantus, and b) it doesn't follow any discernable pattern. I tend to go in cycles with my breakfast - the same thing all week, then something different at weekends as I have more time on a morning - and sometimes I have perfect days, when I haven't done/eaten anything different! :roll:

A year ago is a long time and insulin ratio's can change in this time, my own have changed quite considerably in the last 6 months but have thankfully settled for the time being, but I do keep a eye on them by regularly testing blood glucose. You already know that you have a different insulin ratio, as you said in your original post that you only inject 3 units of humalog at lunch compared to 8 units at breakfast for the same amount of carbs, so take ihs advice and monitor and record your carb intake and bg before and after eating. As I said earlier, try increasing your bed time dose by 2 units, but as always remember to test and do allow at least 2-3 days for the changes to take effect before changing again.

Next time you speak with your dsn, ask about the DAFNE courses in your area, this is a carb counting course for type 1's and teaches the principles of insulin/carb ratio's.

Nigel

 

[iHs]

Hi again

Nigel is right. If you can get your bg level to be a bit lower first thing in the morning (8 is a bit high) and be on 6-7, then that should make it easier to get all your other bg levels to be ok. You will though have to get your insulin to carb levels sorted otherwise you'll always be struggling. Although Nigel has said for you to increase yr Lantus a tiny bit, another way is as Nigel has said on another thread; to get your insulin to carb ratio sorted for yr eve meal so that when you do yr bedtime bg level; you will be lower. Its all about increasing or decreasing yr ratios so that you start to get good bg levels. If you can get yr bedtime bg to be more or less the same; you'll then be able to use the same amount of Lantus and hopefully wake up every morning with more or less the same bg level. On saying all this, most basal and bolus insulins do need to be adjusted now and again. The only way to find out unfortunately is in testing and knowing what your hypo awareness is like.

Regarding Lantus or Levemir, get yourself an insulin pen that delivers in half unit increments. Believe it or not, that can make a huge difference control wise and is the nearest to using an insulin pump. Lantus and Apidra cartridges will fit inside a Lilly HD pen. The only thing is that the pens will be the same colour as Humalog is also Lilly, but one of them you could use a bit of wet and dry paper on the body of the pen and get a felt tip pen and re colour it something else.

Thinking about carb counting and using ratios, get yourself a bg monitoring diary from DAFNE website. They have column or row for entering carbohydrate value of food so will make yr calculations a bit easier.

 

[squishee]

Hi all, and thanks for some really helpful replies!

Had you been taking 1 or 2 shots per day of Humalin I before changing to Lantus?

I had been on 2 a day of the Humalin I, but had continually raised morning bg. The point of switching to Lantus was that my specialist reckoned I'd be able to just take 1 shot a day, but that didn't work. Now my early morning bg is better, but I'm getting these mid-morning peaks!

ask about the DAFNE courses in your area

I'd like to do one of these. Could you recommend anything similar that is as good, as we don't seem to have this in Bristol so I can't get referred.

get yourself an insulin pen that delivers in half unit increments

I was given one of these at my last clinic as my lunchtime doses are getting so low. It's great!
Does putting a Lantus cartridge in a Lilly pen not affect the accuracy of the dose? Only I have a spare Lilly pen (in a different colour to my usual Humalog pen!) and I HATE the Lantus pen, so would love to use it!!

get yourself a bg monitoring diary from DAFNE website. They have column or row for entering carbohydrate value of food so will make yr calculations a bit easier

I've got one of those funky Lifescan meters that records all that stuff, it's not always easy to know how many carbs you're eating though This is, in fact, the bit that I'm finding the hardest over all, I'm just guessing most of the time.

Thanks again for all the help. If anyone could recommend a course similar to DAFNE that I would be able to get onto round here, that would be great!

 

[Lucie75]

I'm from Bristol too and no, they don't do DAFNE courses - I've already asked my clinic about them. Which hospital/consultant do you see?

 

[iHs]

get yourself an insulin pen that delivers in half unit increments

I was given one of these at my last clinic as my lunchtime doses are getting so low. It's great!
Does putting a Lantus cartridge in a Lilly pen not affect the accuracy of the dose? Only I have a spare Lilly pen (in a different colour to my usual Humalog pen!) and I HATE the Lantus pen, so would love to use it!!

No not at all. My consultant in Essex told me about doing it; that's how I know :mrgreen: If you read all my messages (click on my user id and then read my profile and click on my messages), in the search box enter Lilly Humapen Luxura HD and then you'll be able to read how to use the Lilly pens with Aventis cartridges. Workhardt cartridges will also work. The Owen Mumford Autopen will also work but unfortunately the Autopen is not in half unit increments.

By the way, you can do a do-it-yourself DAFNE by looking at the BDEC website or do a google search for carb counting and using ratios. Get a good bg diary like I said and then you'll be able to see in black and white from one week to another where you are going right and also going wrong.

All the best