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Type 1 in need of advice!

lcarter

Well-Known Member
Messages
513
Location
Nottingham
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
My pancreas
Hi. I have recently posted elsewhere in here re hypos following sertraline medication for anxiety/ depression. I will try to be as detailed as I can.

I am now off sertraline and only took it for 2 days. I have been prescribed an alternative but not taking that yet.

My sugar levels are erratic. I can drop anything from 5-10mmls in the night, so having to go to bed high to wake up normal. I wake up anything between 9-17 mmls. During the day I have the most random readings as I am not taking any nova rapid due to side effects of medicine AND what I suspect my lantus overworking. Now for example. Today I had 50g of porridge. I would normally take 5 units for this, using the ratio 1:10g carbs. I didnt take any today and my levels were waking: 17mml. Then an hour later they were: 13mml. Then I had the porridge. Two hours after this and no insulin they were: 14mml. Lunch time. Levels were 11mml. Had 88g of carbs in pasta. No insulin taken. Two hours later my levels are 15mml. This was at 245pm. I just did a random check and they are 14mml. Yesterday my levels were 27mml following a late lunch- so I took 7 units of fast acting at 620pm which would normally bring me down to around 19mml, so i could correct further if needed. My levels went to 12mml in one hour. They dropped to 9mml at 10pm..so seeing as my levels have been dropping over night I had a slice of toast and a digestive biscuit and went to bed. Levels were 11mml before bed. Woke to levels of 17mml this morning.

Now I have been to see my dn, and spoke to her today. She thinks I am anxious and need to take fast acting insulin as normal as she does not think my lantus is over working. She is happy for me to average about 14mml as a target for a few weeks due to high stress levels. The thing is as much as I am anxious and stressed, this is definately my lantus not being right as far as I can see. If I wouldve took my fast acting as normal today, I would've taken 4 units using the lunch ratio of 0.5:10g and surely would have had low levels if they are 15 two hours after. I need them around 14mml bear in mind for short term. Now we have spoke today about reducing my lantus from 24 units at 9pm to 22 units at 9pm. This time last week they were 30 units at 9pm. So we have been reducing them this past week. Im utterly terrified of a hypo and just feel like my lantus needs to be much lower so it can run nicely in the back ground keeping me stable and I have fast acting for any carbs. Im really lost. Please help, again. @Spiker @noblehead I know you guys help me out so much but I would appreciate any advice.
 
Ps meant to add. My dn suggested the basal test where I eat carb free meal for tea and test and same for breakfast but I can only do this when im sure levels arent going to drop through the night..
 
I would agree that your basal is too high. You ratios and correction doses won't work until you get the basal right. I would keep adjusting the Lantus until you are at least stable through the night, then work on your daytime levels.
 
Would you just reduce it by 2 units at a time? I can't take novarapid until I see consistency, totally sure of that. Thanks.
 
Ps.. am I right in thinking I can't really do that basal test whilst my levels are so unpredictable? @robert72 meant to tag your earlier just wasnt certain of your name!
 
Also..how come is it that this has even occurred? Suddenly im really sensitive to insulin. Is this still a side effect five days later? Sorry for the million questions.
 
Concur with what Rob has said, you need to address your basal insulin dose as your bg levels (despite eating carby meals) are hardly moving despite not taking any QA insulin, do some fasting checks as described in the following, once that's sorted you can look at your I:C ratio's:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
 
lcarter said:
Would you just reduce it by 2 units at a time? I can't take novarapid until I see consistency, totally sure of that. Thanks.
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The priority would be to avoid night time hypos. Personally, I would be inclined to reduce Lantus more and work back up.

Obviously you'll need to discuss this with your nurse.
 
lcarter said:
Also..how come is it that this has even occurred? Suddenly im really sensitive to insulin. Is this still a side effect five days later? Sorry for the million questions.
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Have you been more active than usual or changed anything in your diet?
 
Not a thing. Its so very very strange.
 
Also apologies if you see this post twice. I posted in two groups incase.
 
So Rob, would you drop it to 20 or lower? Im in total agreement more and work back up.
 
lcarter said:
So Rob, would you drop it to 20 or lower? Im in total agreement more and work back up.
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It depends how bad your night hypos are. Did you take any bolus or correction doses in the 4-5 hours before bed that might have contributed to a hypo?

Also, don't forget that it can take 3 days for Lantus changes to fully take effect.
 
No I didnt take any fast acting then.
 
OK, well if you feel confident. We are not doctors and can't give specific dosage advice here on the forum.
 
I know.. I just want to know what you would do if it was you. My medical advice is to take QA insulin alongside my current lantus and that I just dont feel comfortable doing. I think I may reduce it by 2 units down to 22. I just wamt to be able to take QA but at the minute my carby meals aren't having much of an effect on my bgs.
 
Unfortunately, basal bolus MDI style is not the same as using an insulin pump. Its hard to adjust a basal like Lantus or Levemir to give the same bg level every 2hrs as there will always be a difference. What a lot of people did in the past is adjust the bolus to suit the sction of the basal with the carb that is going to be eaten and test bg levels to monitor the effects.

As the others have said, it sounds as though yr basal dose is a bit high and as such you are needing to either eat some carb before going to bed or eat more carb at eve meal and go to bed a bit too high.

What time are you giving yrself the Lantus? I tended to inject Lantus before bed and adjusted it downwards so that I didnt go in hypo land and used the bolus to deal with my Breakfast, Lunch and Eve meal. I did have to adjust the bolus to suit the basal and needed a large bolus dose for small evening meal but that was because the basal was running out but could use a smaller bolus to deal with breakfast and lunch.

Do you know anything about calculating the bolus using a ratio for the carb to be eaten
 
@iHs That's the approach that I've always used. It is why I split my Lantus dose to a morning and evening dose (which incidentally, is often recommended for people that are suffering night time hypos).

I think that maybe splitting the lantus dose might help you.
 
If anyone finds fault with these readings I would tell them to put it where the sun don't shine!
I've been type1 for 66 years and on a pump for 6. Needless to say I have a few problems.
I just wanted to say that I gave up on this site a few years back but was tempted back today to find that diabetes problems are just the same . So, what's the point of these blogs I ask?
The people who control and monitor us are never satisfied.

I've been banging on for several years that what we diabetics need is a test that differentiates between carbohydrate highs and glucagon/glycogen highs. With all the help and advice (?) we get we know how to control carb intake and insulin but what we don't know and can't control is highs caused by hormones.

Thanks for this opportunity to rant, I wish you every success in controlling your diabetes but listen to your body and watch out for the nasty hormones. They produce highs which insulin cannot treat but no-one can tell what sort of high you have yet!
 
If they can put a man on the moon, why cant they have the tech products to help diabetics, and be more made available. Every time i ask for a special meter, or pump its cost or you need to be in poor control of your diabetes.
 
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