• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Type 1: Need a new start...

linda321

Well-Known Member
Messages
118
Location
West Sussex, UK
Type of diabetes
Type 1
Treatment type
Insulin
I am a 50 something year old woman diagnosed with type 1 diabetes 2.5 years ago. I have had a libre for just over 1 year. I eat a reasonably low carb diet, generally about 100g - 150g per day. But I still can't get my Hb1ac down to a reasonable figure! Last year it was in the high 7's but has gone up to 8 recently. I am beginning to despair!

My libre regularly shows a mountain range! It shows that my average BS is over 10, and I am lucky if I am in range (4-9) 1/3rd of the time. Anything that passes my mouth seems to take me up high. I exercise a lot, and walking makes me drop like a stone. I walk my dog twice a day so that helps. But going to the gym doesn't affect my BS at all.

I know that I should do some proper basal testing, but have been tinkering with it lately, down from 17 units (Lantus) to `15 units. This was because I was going low quite a lot during the day, but when I lower my Lantus, I find I spike much higher! I have lots of questions and instances when I would like some help, so I am hoping you won't mind me posting quite a bit!

My first problem is that even though I eat a fairly low carb diet, and inject my rapid acting (Humalog) at least 30 minutes before eating, I still spike to at least 13 or 14mmol/l. I try to use a ratio of 2units to 10g carbs.

For example, I ate a salad for lunch with some cheese, and had blueberries and full fat creme fraiche afterwards.
12.33 BS before insulin 11.2
1 pm ate a salad plus fruit and creme fraiche
1.47pm BS 9.8
2.47 (approx 2 hours after eating) BS 13.6

Is it just that I need to inject more rapid acting insulin? Or should I do another injection, say 2 units after eating? If so how long after eating? Is it because of the high fat creme fraiche? It is a meal I eat quite regularly for lunch, and I always spike, but it's different every day.
 
If I was 11.2 an injection of insulin probably wouldn't have any impact on blood sugar after 30 minutes. Did you do a correction dose along with your lunch bolus? Did you see from your libre that you had come into range (so under 7) and curving down before you started eating?

A rise from 11.2 to 13.6 is only a rise of 2.4. That's a pretty acceptable spike. If you were going from 4.2 to 6.6 you'd be pleased with that, it's just you're starting off from a higher point so it seems bad.

Maybe you need to look at doing separate correction doses, and the bolus doses. Or looking at you correction factor and pre bolus timings.
 
As you yourself pointed out you need to look at your basal. 11.2 before a meal is way to high the rise of 2.6 is very good though.

I was always taught not to eat if bloods were over 8 so in my eyes it's your basal that is out. If you are struggling with Lantus perhaps talk to your team or GP and ask to try Levemir as that can be split into two doses where as Lantus as I understand it is not a good option for doing so. Being able to split the basal would mean being able to change the dosage a lot easier. Other option is a pump.
 
Linda - would be great if you could post 'a day in the life of Linda', showing timings and results of blood tests, injections, carbs and what the food was, exercise and any notes you may wish to add - in the example you gave, you never mentioned how much insulin you gave at lunch time and what carbs or correction it was for - the more info we have the more likely we'd understand what's going on.

If you really are low carbing you may find you have to inject for protein and fats as well as carbs, but lets see whats what first.

The good thing is the Libre will help a lot and is a god send when basal testing.
 
Hi @linda321 After 30 years of terrible control, for me, once I got CGM, buying and reading Sugar Surfing and Think Like a Pancreas made all the difference. Both (in their own ways) put all the things I think you know you need to do, like basal testing, correction doses, timings and insulin sensitivity, into context. You'll get all the same answers and guidance, here, but it is a great bible to give you a quick, simple, yet comprehensive overview.
 
Hi @linda321

I agree with what others have said, you need to start with basal testing, getting a pattern over a 24 hour period of what your background is doing is key to getting everything else right.

I find that my insulin needs change every few months so being aware of what and why helps me to understand and adjust. I never accept that a set pattern of insulin will work constantly, so i've just had 2 weeks of waking high above 10, so have been adjusting overnight background, also my morning carb ratio has changed too, so have had to increase my morning dose, I have a different carb ratio for lunch and for dinner.

If you can start with doing a morning fast to check your background, then another day try afternoon and another try evening, if you're still using your libre then download your results and see if you can email them to your DSN, mine is quite active on email and it's the best way to contact her.

You mentioned that you have reduced your background because you were going low in the daytime, however you are still going high which is contradictory - hence the advice about basal testing which will pinpoint what's going on, it may be your background is not working so contacting your DSN will highlight this to them and so if necessary to change they can ensure this will happen quickly for you, I found success with Tresiba as lasted longer and more stable, however it may also be a discussion to prompt into looking at getting a pump as you have greater control with making changes to your insulin requirements in using a pump - whatever course of action is required keep your DSN informed and on board as they will help you
 
I've learned to my cost that trying to eat carb on a high bg level even with a correction, doesn't produce normality
within 4 hrs. It takes ages and usually means using a bit more correction.
I now wait for a good hour to allow bg to lower with the correction and then bolus for food.
Basal bolus is all about getting the harmony between the two insulins all ok so try lower carb, and watch the Libre.
 
It is worth noting that for me, the higher my BG, the lower my insulin sensitivity, and so this needs to be factored into correction and carb bolus doses. As @iHs says, it is all about finding the harmony.
 
Last edited:

Thanks @catapillar - That's comforting that you think it is an acceptable spike. That means my ratio is about right, but of course I needed to take more to correct my already high reading. I am not at all sure when I should do the correction dose.
 

Thanks @CarbsRok That sounds like a good idea not to eat if my BS is over 8. I am thinking of asking about changing to Levemir, as I could do a split dose then. I take my Lantus all in 1 go in the morning, and I have read that it can act like rapid acting insulin in some people. As I do a lot of exercise I think levemir might be better.
 

Thanks @slip , yes I will try to post 'a day in the life'. In actual fact, I have had a much better day today! Yes I do try to take into account protein when working out my dose. I am working on the assumption that I need 2units for 10g of carb, but not really sure whether this is correct.
 

Thanks @paulliljeros. Yes I have read both Think Like a Pancreas and Sugar Surfing. I use sugar surfing technique of eating a jelly baby or 2 when going low (in the 4's with a straight down arrow on the libre). I think I will re read Think Like A Pancreas. It is nice to come on here and get support from you all as well as reading the books!
 

Thanks @Juicyj Yes I know I should do proper basal testing. But when I try to do an overnight test, I have always eaten too late or my BS is too high and I need a correction dose! I am just making excuses aren't I? Generally I do go down overnight, which is why I think I might still be taking too much basal. Definitely I must do the basal testing throughout the day too.

Re DSN, and my team. I don't really know how to contact them. I have 1 consultant appointment per year, which is coming up in April. I was given a phone number for the DSNs at the hospital, but I once left a message and they didn't get back to me! I had my annual check at the GP surgery last week but the nurse I saw hadn't even seen a libre before! She found it difficult to analyse the graphs I had printed out for her, so wasn't a great deal of help.
 

Thanks @iHs. Interesting to hear that you find eating carb on a high bg level doesn't produce normality within 4 hours. It sounds like I really need to do proper correction doses before I think about doing a pre-meal bolus..
 
Hi! I used Lantus for ten years, and now I have used Levermir for some years.What I found was challenging with Lantus, is that it felt like it is in the system so long, that any changes like lots of activity or being sick, hormonal stuff, anything that ment my basal could benefit from small adjustments, were not possible to do as the Lantus taken one day seemed to work too late to fit with what I had done or was doing.I insisted also on taking my Levemir only at night, because I wanted less risk of overlapping wrong if I forgot to take one dose, and I wanted to not have as many injections (just tired of them and had been using a pump that ment no injections) however, it did not work and my bs was high the last few hours before it was due. So...now I have just bitten the bullet and take two doses.It is fine as it means less fixing after and keeps it more steady.The morning dose is very low (3units) but still very essential.So short, I recommend two doses of Levemir instead of Lantus.Especially if you have days you go to the gym etc.Those days you might need less.
 
Totally agree with not
eating if levels over 8.

In these scenarios its a good way to test your correction doses you are giving (I assume).
On a day like you had with level at 11 I would have done a correction, tested hourly and see if it came down to normal target levels 5 hours later.

Also if you had scanned every 15 mins in that 1st hour or you checked your graphs it would tell you what your off set time for bolus's to start working.

This would them help you to know how far ahead before food that you need to bolus for a normal meal.

Also have you got 1/2
Unit pens to enable you to tweak your insulin better or have you been given 1 unit dosage pens?
 
With all other basal insulin I have had problems but now finally with tresiba and stupid as it sounds-having a bit of slcinammon added to my chai teas throughout the day my insulin needs have jyst dropped and the last two days have been totally fantastic with basal testing.
I have also come off a tablet on 5th Jan which gave bad side effects but the most recent change was having the equivalent of a teaspoon of cinammon as well spread throughout the day in my teas...

I think tresiba degludec insulin is also better to be honest. It is suiting me more now than when I was physically so active all day, everyday.

To be honest if your levels are not good your Consultant and hospital staff should be seeing you more.

Persevere with messages on the answerphones (why does every hospital department do this now?) and say you need an urgent appointment to review dire levels... they should respond. (Not saying they are dire, just not great!!)

Also your target range is set quite high? Is there a reason for this? Ie hypos previously??

Are you using libre to calculate food doses of insulin or are you doing it from a meter? Or calculating in your head?
 

Thanks @donnellysdogs. You say you would have corrected for a level of 11 and tested hourly. Would you have eaten anything in that time? I think my correction doses get all muddled up with my next meal and bolus.
 
Ok here is my day yesterday:
All was going fine until I ate dinner!
7.40am woke with BS 7.5 15 units Lantus, 3 units Humallog
8.10 am eat breakfast i slice toast (Burgen bread, 11g carb) boiled egg, fried mushrooms
8.30 to 9.30 dog walk - not all walking, met some friends in the park!
10 coffee with milk
11 coffee with milk
12.20 4 u Humalog
1.00 eat large bowl of salad, lettuce, tomatoes, cucumber, olives, 40g brie, olive oil adn vinegar dressing
handful of blueberries plus full fat creme fraiche (3 tablespoons - a bit too much really!)
2pm out with Mum, driving, walking round garden centre
3pm coffee at garden centre
5.50pm 8 u Humalog
6.30 pm eat dinner, salmon, few oven chips (20g carbs) carrots, brocolli, sprouts, peas
lno sugar jelly plus half fat creme fraiche
1 square 80% chocolate
7.15pm approx 40 minute walk with dog
8.30pm 2 units Humalog (as blood sugar at 15+ with straight up arrow 2 hours after starting to eat dinner)
10pm herbal tea
3am woke with hypo BS 2.9 ate 4 jelly babies and half digestive biscuit
7.15am woke with BS 5.3
 

Attachments

So I was going to do my basal testing last night, but couldn't do it because of high BS after dinner and needing a correction. But as I went low over night (2.9 on the libre) maybe the correction dose wasn't necessary?
 
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn More.…