type 1 severe insulin resistence

Megan.. You have taken 9 units of correction today and seen no movement in your BG's... if you are happy that your ratio's are correct for breakfast / lunch then I think you can probably afford to increase your Lantus by a further 10 units... how you split this you will have to work out what's best.

If you have been running consistently high blood glucose then you can 'feel' weak even if you blood glucose is still high this is normal and will fade with time.. I would suggest that you need to be more aggressive with your corrections.. if after 2 hours you see no change inject more rapid until they come down.. just be-careful when you have multiple or 'staked' rapid injections going.. you will need to monitor your blood glucose carefully test at-least once / hour whilst you get them under control. Also remember as you increase your Lantus over the next few days you will probably need to correct less..

I'd be inclined to add that if Megan's waking BG level is the same as or lower than her before bed reading, then it'll be a case of upping the bolus insulin rather than the basal -which will save Megan from being exposed to nocturnal hypos once her through the day blood glucose stabilises.

Sorry to refer to you in the third person Megan

Ed

Megan

You are only slightly making a dent in your bg levels at the moment using the same carb ratio. Up the morning Lantus a bit more so that it has more of a lowering effect at lunchtime and beyond. I would be inclined myself to go upto 17 or 18u and use a carb ratio of 1u to 3g carb just to get my bg levels going a bit lower.

Although you are not eating any carb at lunchtime etc, you are eating minute carb from the salad plus protein from the cheese, meat or eggs etc so you will need some bolus insulin to cover that. Do you drink milk in your tea and coffee, if so that has got to be accounted for either in the basal or in your carb ratios.


hmmm just realised that Ive made a mistake over the above paragraph as you had 3 ryvita (21g carb) and you used the same carb ratio of 1:5. The way bolus/basal works for many is that they usually need more bolus insulin in the morning than they do at lunch because of DP, so use 1:3 to cover breakfast and then hopefully by increasing the morning basal, you will be able to use a 1:4 or 1:5 ratio for lunchtime. The more basal that is used, the less bolus will be needed. Its just a matter of getting the balance right so that bg levels even out better.......

Novorapid's action varies according to how many units are used against the amount of carb eaten. Its action varies from 4hrs to about 6hrs for some people especially if they are using loads of it to lower very high bg levels and hardly eating any carb.

Still increase the evening dose of Lantus to deal with the rise up in your bg levels before you get up in the morning but also eat some carb before you go to bed to deal with the effect that Lantus with the remants of the Novorapid has on your bg causing you to go low. Sounds strange I know but this will probably work for you (It did for me when I used Lantus - always prone to hypos around the 2am mark).

I would agree with iHs...

You are going to see some rise towards the end of the night 4 - 6am in your blood glucose this is normal (DP)... however if you are hypo at midnight - 2am then I would suggest this is too much Novorapid with your evening meal.. this can be corrected two ways:

1. Inject Less Novo or Eat more Carbs with your evening meal... i.e. increase your ratio (I seem to remember you saying 1:5 somewhere perhaps try 1:7).

if this causes unacceptable +2 hour readings.. then

2. Then stay with the current ratio but eat a small amount of uncovered carbs at around 10 - 11pm maybe 20g's or so

Hi. Your post really concerns me. I have been on insulin for going on for 45 years and have frequently been ahead of the medical team and to be honest do not take too much notice of the 'teams' only the specialists!! Many diabetic teams seem to go on training courses and come out with the latest fad - the worst for me was statins but won't go there now...

There are a few things that ave happened to me that you might benefit from
Firstly Re your hands have you had your Vitamin D levels checked? I thought I was getting Diabetic neuropathy but my fab GP told me you can get different types of neuropathy the simplist to get sorted out is low Vit D. I also found that once this started to normalise (from 3 monthly high dose injections p,us daily high dose pill) not only did hands and feet improve but so did insulin requirements.

Lantus did not work for me but now I use Levemir and things have sorted themselves out lasts 24hours now

The last thing is perhaps you are trying too hard with percentages etc? I have found that if I consistently add a few units here or there outside the usual injection times my body doesn't like it ! I have taken around 36 units a day in total but getting the units at the right time has not always been easy. It can take ages to get the balance right but that is what it is all about

One last word stress has been my biggest problem as I then suffer from fight or flight syndrome with body releasing sugar and adrenaline how to solve it has been the challenge but never take pills always talk to someone or remove the stress

Don't know if any of this helps but hope it might?

Di

megan said:

sorry to sound dim but what does the 1:5 and 1:7 mean?

thanks

Click to expand...

The 1:5 stands for 1u for 5g carb and 1:7 stands for 1u for 7g carb.

Some find it easier to adjust the carb in their ratio while others just adjust the insulin in the ratio. Whichever way round you feel is easier, then just use that. Everyone has to round out their insulin to the nearest 0.5u anyway or trim off some of the carb that they are going to eat.

How are things going now?

Hi

For many diabetics exercise has mixed effects on bg levels............ some types of exercise may make bg levels increase whereas other forms may lower bg.

Weight loss will come eventually as once your bg levels lower, you will also need to use less basal or less bolus. Its all about getting the balance between basal and bolus correct for you and that can only be achieved by doing bg tests, taking notice of the results, looking at the amount of carb or protein that you are eating and making the necessary adjustments so that your bg levels start to even out throughout the day and stay within some sort of healthy target range. At the moment though, you need to lower your bg levels slowly rather than quickly especially if your bg levels have been on the high side for a long time. A D consultant should be able to advise you on this though......

I fairly good way of achieving weight loss is to go for a slow jog with a dustbin bag cut up and wearing it underneath a t-shirt. Yes, you will sweat buckets but that's the idea........ Not sure how much it would lower your bg levels so be on the watch and have some glucose or sugary sweets on you........

50 units -if that's your daily intake (basal + bolus) doesn't sound like (to me) an excessive amount of insulin to be on.

I'm currently on about 44 units each day -give or take a few units depending on the day and that's for about the same amount of carbs (60 to 80g) each day.

My split is 22 Levemir and 22 Humalog (split between meals through the day).

Ed