Type 1: I can't get my levels down :(

[Lucielu]

Hi, hope someone can help. My levels are constantly double figures all the time, Im on Lantus at night 5 units and I tested my background insulin at 3am and I was 8.9 and then when I woke up I was 7.9 ( went to bed night before being 8.0) so that is working. Usually I'm always waking up double figs and going bed double figs. I'm on Novorapid for day time. Then that day I had bacon and eggs for breakfast then at 12pm I was 11.0 and then at 5pm I was back down to 7.4 so that is working too. Then yesterday I woke up being 10.7 for breakfast I had eggs and bacon so took 1 unit for that along with 1.5 for correction and by lunch time I was 10.7 , the correction didn't even touch me.
This is the case every day I wake up high then the corrections don't work then after lunch I'm high and before bed.

 

[noblehead]

@Lucielu, when you do a basal test it has to be a fasting one, meaning no food to be eaten (even if it's carb-free like bacon & eggs).

Try doing a basal test again when you wake on good bg levels and see how you get on, but some people do have to split-dose their lantus insulin to get a better 24 hour coverage.

 

[catapillar]

Have you chucked your insulin and started fresh pens/vials?

Have you done a proper basal test - https://mysugr.com/basal-rate-testing/

If you think basals working, do you need to look at changing bolus ratios? Do you need to check your correction factor? Do you actually give it time for corrections to work before eating?

Have you been eating anything different, doing less activity, put on weight, been under stress, or could you be coming down with something?

 

[Lucielu]

Yep I changed my pens thinking it could be them but it's still the same. For corrections I was doing 1 brings me down by 3 but then changed it to 1 brings me down by 2 and that hasn't even worked.
So with the Basal test I would wake up in the morning take my 9units of lantus and then not eat until when? Tea time isit?

 

[noblehead]

Yep I changed my pens thinking it could be them but it's still the same. For corrections I was doing 1 brings me down by 3 but then changed it to 1 brings me down by 2 and that hasn't even worked.
So with the Basal test I would wake up in the morning take my 9units of lantus and then not eat until when? Tea time isit?

Didn't you say you take your lantus on a evening?

You miss breakfast (and your usual bolus dose) and fast till lunch, during this time you would regularly check your bg, have a look at the following which explains how to do a basal test throughout a 24 hour period:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

Getting the basal right is the foundation to good bg control, once you get that right you can then look at things like your I:C ratio's.

 

[Lucielu]

Yeah I take 5 lantus at night then 9 in the morning. The nurses said when I need to check if I'm on the right amount of lantus they just said to do a no carb lunch, I didn't realise it was all day. They aren't the easiest to get hold of that's why I've come on here see.

 

[Lucielu]

So sorry just to understand say if I was to do it tomorrow ( hoping I'm not double figs in the morning) then would I still take my 9 lantus then not eat until lunch time then I can have lunch?

 

[noblehead]

Read the links @Lucielu , it isn't an all day fast but missing one meal at a time. You still take your lantus as normal and would eat lunch after skipping your breakfast (if doing a morning basal check).

If you get the book Think like a Pancreas it goes into great detail about basal testing and much more about type 1 diabetes management.

 

[Lucielu]

Ok thank you. I might just do a all day just to see. How do I know if my evening one is correct though, what am I looking for through the night and what I wake up with. Thanks I'll have a look at that book. Sorry for all the questions it's just getting really frustrating now

 

[catapillar]

Ok thank you. I might just do a all day just to see. How do I know if my evening one is correct though, what am I looking for through the night and what I wake up with. Thanks I'll have a look at that book. Sorry for all the questions it's just getting really frustrating now

Have you read the links on how to do basal testing @Lucielu thats probably a good place to start. They explain how to test chunks of the day in turn. You aren't really advised to do an "all day" basal test. The extended period of fasting might cause liver dumps which would skew the results of the test and mean it shouldn't be relied on.

 

[Lucielu]

Aw right I see. Ok I'll do it in chunks then. I don't really understand what I'm looking for each day to be honest. Just that I stay steady. Maybe I'll post the results up on here

 

[GrantGam]

Aw right I see. Ok I'll do it in chunks then. I don't really understand what I'm looking for each day to be honest. Just that I stay steady.

That's exactly what you're looking for, your levels staying steady

You should be most concerned with whether the numbers are trending upwards or trending downwards during your little fasting periods. Basically, you want all the numbers to be very similar. For example, if I was testing each hour over a four hour fasting period and I got readings like the following - I'd be very pleased:

5, 6, 5.8, 6.2

If they were like this, then I'd be needing more basal insulin:

5, 8.3, 9.2, 9.9

Likewise, if the numbers looked like this - I'd need less basal:

7.3, 4.3, 3.6, 3.1

The numbers aren't important, but you can see which way they're going (up, down or staying steady). You may find you're numbers are a lot higher, but the key is to focus not on the numbers, but the trends. You can worry about the numbers later.

I've not read the links which have been provided but I'm sure they'll detail everything very thoroughly. I just added my bit to make things slightly easier to digest, hopefully

 

[Lucielu]

Thank you, that is helpful
Am I ok to do the test even if my morning readings are like 10 or so? Or only do it when they are at a normalish level?

 

[GrantGam]

Thank you, that is helpful
Am I ok to do the test even if my morning readings are like 10 or so? Or only do it when they are at a normalish level?

You're unlikely to get "normalish levels" without having completed some form of basal rate testing and making the relevant adjustments to your dosage.

It doesn't "really" matter how high the number is, if your not taking enough basal insulin - your BG will climb regardless. Tbh, I never bothered with basal testing until I had fairly good control. HbA1c around 45 at the time. Until that point I just added a unit of basal insulin to my dose at a time, if I noticed that my levels were running high consistently. That dumb approach worked for me to start, and the basal rate test helped me get my HbA1c down even further and my control even tighter.

As @noblehead has said, read through the link that was provided and make sure you understand what is being asked. By all means, if there is anything there which you do not understand then please don't hesitate to ask

 

[Lucielu]

Fab thanks. I'm going to start tonight and do the night time testing through the night. I think once I I completed all this I'll upload the results incase I'm confused. I just can't believe the when I went on the DAFNE course they didn't teach it like this, they just told us to do a no carb lunch and that's it.

 

[GrantGam]

Fab thanks. I'm going to start tonight and do the night time testing through the night. I think once I I completed all this I'll upload the results incase I'm confused. I just can't believe the when I went on the DAFNE course they didn't teach it like this, they just told us to do a no carb lunch and that's it.

You should really be seeking advice and guidance from your diabetes team, and not solely from the members of this forum. As much great advice that you'll find on here, your medical team are the only people qualified to tell you what to do with your doses and insulin. We can advise on the best course of action for improvement, but cannot tell you to take more or less insulin

Post your results here for sure if you can't make head nor tails of them, but your DSN is a wealth of help and advice in situations like this one so use them to your advantage

 

[Lucielu]

Ok thanks. They are so hard to get hold of and never get back to me so that's why I've come on here

 

[azure]

Fab thanks. I'm going to start tonight and do the night time testing through the night. I think once I I completed all this I'll upload the results incase I'm confused. I just can't believe the when I went on the DAFNE course they didn't teach it like this, they just told us to do a no carb lunch and that's it.

Have a good read of the links @Lucielu Basically, you're looking for the basal to keep your blood sugar steady throughout the day and night, and basal testing allows you to check the day and night in segments - ie not all at one time.

It'll take you a while so don't worry, and do keep detailed records.

You're welcome to post your results here Just bear in mind we can't advise on dosages.

 

[Kristin251]

Are you only having problems in the mornings? I need to take my normal basal dose, then an hour later another small dose to counteract the cortisol rise. Sometimes I even need another small dose around noon. Taking correction with my bf does nothing. Or it will lower me for about an hour and then I pop back up. However splitting doses keeps me very steady. It kind of mimics a pump I would imagine. Mornings are a bummer. I can't eat nay carbs and I even need to keep protein low so I usually have a thin slice of turkey and some avocado.

I also find if my fasting is high it sets the trend for the day. I can bring it down with corrections but it likes to pop back up.

Just sharing MY experience.

Also to add, for me and I believe @azure as well, find it's worse to not eat bf. Then we still keep rising

 

[azure]

Yes, @Kristin251 makes a good point about the 'waking rise'. I have that and I find if I delay breakfast, my BS will go up. Mornings are my most insulin resistant time.

Once you get your basal testing done, you can then look at your mealtime ratios, if necessary.

Mine vary depending on the meal (ie Brek, lunch, etc) and that's very common.