Very concerned after doctor visit...

[artyfarty30]

Hi,

A quick question. I went to see the diabetic centres GP today for a check up. He said I was doing really well as I have lowered my bg levels from 25+ to 4.0 -10.00 within 10 days, using Novorapid as my only insulin. However, my concern is that he didn't suggest anything else and told me to carry on! :shock:
He didn't suggest bolus/basal insulin like my DN suggested last week or mention how I can improve my diet or what I should do when I start going to the gym. His reply was very vague, I'll know how much insulin/food to take when I'm exercising.
Does this sound right? Should I be getting a second opinion?
I've asked to see my DN when she returns from her annual leave next week. I'm very concerned

 

[Sanober]

Your profile says you're a T1 - I doubt very much you'll be kept just on Bolus.

The DN's can be far more experienced than GPs regarding Diabetes as they get specialised training on it. So the DN will guide you on changes/adjustments and the Basal (I actually don't know why she didn't add that in too, sorry, I'm new myself).

Basal is for background insulin, it basically trickles throughout the day and night as does the insulin our Pancreas make in non Diabetics. Obviously in T1 (and in some cases T2) the insulin production becomes deficient (T1) or defective (T2) so the Basal or background insulin basically is there as a safety net because during the day and night if you don't eat the body will dump glucose held in reserve in the liver so the basal keeps that steady.

As an example. I had a morning reading of 9.7 - I only took my Basal and had no breakfast and 2 hours later I was at 9.3.

Are you on small dosages of the Novo? You say your range is 4 -10 are you getting any hypo feelings when your glucose level comes down? Are you dropping quickly and have a large reduction in glucose after a meal? If not, don't be too worried for now and keep testing your sugar and especially if you feel weird or ill and as soon as anything happens that does cause you worry or you feel ill just call NHS24.

You will have many questions as I do! I'm also unsure about adjustments for the gym etc but I'm not going to be working out for a week yet as I've got a chest cold anyway and it's the time of year to forget about the gym :lol:

I'm sure a more experienced T1 will be along to elaborate much better than me.

 

[artyfarty30]

Hi,

Thank you for replying to my post.

My current insulin dosage is 8 units before breakfast and 4 units before my evening meal and 500mg metformin after both meals. However, I have had few rough nights where my bg levels have dropped around 3.2. I woke up not feeling right, heart racing,trembling and disorientated, treated them like a hypo and went back to bed. This has left me extremely tired as I'm having broken sleep and nervous of going to bed with bg levels under 10 in fear of going low overnight. I've spoken with another DN who told me to drop my insulin level to what I've mentioned above as I was getting low after my midday and evening meals. Today, my bg level dropped to 3.9 before midday meal and I over treated it which spiked my bg levels big time! I'm still learning

I've been told to reduce my insulin dosage further if I get anymore hypos.
I've got appointment with DN and the Dietician next week, can't wait to show her my food diary which I made myself!

 

[Tracey69]

Welcome artyfarty30,
I am a type1 and have been for 36yrs and i am now 42yrs old. I am on novararip 3 times a day and Lantus solar star ( which is Bolus) i take this as i go to bed, this also helps tthrough the next day as it is a slow release insulin. I am surprised they didn't start you on both insulins in the beginning.
Are you doing your own blood testing as it sounds as though your doing well.
Talk to your DNS on tuesday or even leave them a message and they can call you when they are in.
If you find your sugars dropping below 4 then obviously you need glucose and some carbs, if this keeps happening lower the Novararip by a unit at a time, but others seek medical help as we can only go by our own experience.
If you need help please contact on this sight as one of us moderators will be looking around.
Take care
Tracey

 

[artyfarty30]

Hi Tracey69,

I agree with you, something isn't right!
I tested an hour ago and I'm 4.3, far too low for me to go bed on. According to the DN, I should lower my insulin again tomorrow, which I'm reluctant to do as I need my body to get used to this amount of dosage first, or is this wrong? If I carry on at this rate I'll be on bare minimum insulin. Can anyone explain to me whats happening (a guestimate will do)?!

Ive seen my DN twice, both in first week of being diagnosed (last week) all she was concerned with was getting my BG levels down. She's on annual leave this week and therefore Ive been unable to speak to her and the visit to the doctors confirmed he knew bare minimum about type 1 diabetes

 

[Sanober]

You're going into Hypo territory under 4. Frequent testing will help you catch and correct. However the symptoms are there too in your case to help you realise that you need to do something. I assume you know how to correct a Hypo?

You must follow you DN's advice regarding reduction of dosage (or increase) I've been reduced down a bit as I was getting hypos a few hours later and felt I had to constantly eat.

Sugars quickly dropping down (or going up) isn't good in any case. The aim is for gradual improvements and to keep things stable. You're going to be Diabetic forever why are you desperate to get to an excellent level in a couple of weeks? Also you may very well be producing some of your own insulin so you will get odd readings here and there too. Did your DN explain the Honeymoon period (search here for info).

Everyone's different and I too am realising a newbie there's no one fix to suit all.

We're not qualified to give medical advice so please do use NHS24 or your local hospital out of hours GP service to guide you in the absence of your DN.

Good luck