Would appreciate your thoughts

[Senga]

Sorry if this is more like a book than a question. Don't really know where to start so will explain as best I can about myself. I am on Levemir 13 on rising and 6 before bed. Also Novarapid taken with meals. I have been a db over 13 years. For over a year now the db nurses have been trying to get my levels under control without much success.
I used to love thoroughly cleaning my house but my levels could drop by about 7 if for instance I did a thorough clean of bathroom. So to try to gain control I have let my standards drop. I felt it was used to explain highs and lows by the db nurses and I wasn't getting anywhere. I recently attended a db course on carbohydrates and counting. I was doing this previously but had never been shown properly how to do it.
They changed my ratios from 1:10 to 1:8 this worked a bit better but still meant I could not be as active as I would like. So I went back to my cleaning and did a lot of minus corrections. was going pretty good until couple of nights ago when the clock changed.
Due to the large drops I have when busy I like to keep my levels around 9 or 10 whilst I build up my confidence.

Today and yesterday me levels have gone crazy left message for db nurse today but she has still not got back to me. Have checked for ketones but none. I feel ok just anxious at why this is happening.

Monday 1157 pm level 16.7 half correction taken an 7 levemir bed

Tuesday 7.40am level 18.2 13 levemir 4nr for food 30carbs and 2 to correct went shopping
1.40pm level 17.1 8 1/2 nr 69.6 carbs no correction as determing which ratio works here
5.15pm level 20.3 3 nr taken to reduce. carb free meal cheese/streaky bacon omelette
7.23pm 12.1
10.30pm 13.7 7 levemir bed
3.25 in morning 15.2


Wed 7.10 level 18.4 13 levemir 4nr for food 30 carbs 2 to correct back to sleep till 9
11.30 level 21.3 3 nr to reduce
2.50 level 12.8 salad no carbs
6.15 15.4 8 nr 51.8carbs 1 and 1/2 to correct
9.27 21.2 2nr to reduce
11.15 15.8 7 levemir bed

I inject stomach with nr and bottom with levemir and keep an eye on the sites.

I hope some of this makes sense I will let you know what nurse says hopefully she will phone tomorrow.

 

[Senga]

Sorry if this is more like a book than a question. Don't really know where to start so will explain as best I can about myself. I am on Levemir 13 on rising and 6 before bed. Also Novarapid taken with meals. I have been a db over 13 years. For over a year now the db nurses have been trying to get my levels under control without much success.
I used to love thoroughly cleaning my house but my levels could drop by about 7 if for instance I did a thorough clean of bathroom. So to try to gain control I have let my standards drop. I felt it was used to explain highs and lows by the db nurses and I wasn't getting anywhere. I recently attended a db course on carbohydrates and counting. I was doing this previously but had never been shown properly how to do it.
They changed my ratios from 1:10 to 1:8 this worked a bit better but still meant I could not be as active as I would like. So I went back to my cleaning and did a lot of minus corrections. was going pretty good until couple of nights ago when the clock changed.
Due to the large drops I have when busy I like to keep my levels around 9 or 10 whilst I build up my confidence.

Today and yesterday me levels have gone crazy left message for db nurse today but she has still not got back to me. Have checked for ketones but none. I feel ok just anxious at why this is happening.

Monday 1157 pm level 16.7 half correction taken an 7 levemir bed

Tuesday 7.40am level 18.2 13 levemir 4nr for food 30carbs and 2 to correct went shopping
1.40pm level 17.1 8 1/2 nr 69.6 carbs no correction as determing which ratio works here
5.15pm level 20.3 3 nr taken to reduce. carb free meal cheese/streaky bacon omelette
7.23pm 12.1
10.30pm 13.7 7 levemir bed
3.25 in morning 15.2


Wed 7.10 level 18.4 13 levemir 4nr for food 30 carbs 2 to correct back to sleep till 9
11.30 level 21.3 3 nr to reduce
2.50 level 12.8 salad no carbs
6.15 15.4 8 nr 51.8carbs 1 and 1/2 to correct
9.27 21.2 2nr to reduce
11.15 15.8 7 levemir bed

I inject stomach with nr and bottom with levemir and keep an eye on the sites.

I hope some of this makes sense I will let you know what nurse says hopefully she will phone tomorrow.

Good Morning Everyone
I am feeling a lot better today woke up at last in single figures 7.3 was so worrying was afraid in case the insulin was building up in a pocket and not getting through. I have a blood pressure check and blood test tomorrow and will ask nurse to check my sites. I did ask when I was on the course where I should inject my thighs but do not have enough fat there.
I feel this site is the only place I can get good advise that will help me. I have followed everything the db nurses have asked me to the letter. I write down medication activity etc so I am able to give them a good picture, but felt my last appointment was like a cattle market 5 times someone came into the room to speak to the nurse that was going over my paperwork with me.

Enough moaning. The sun is shining and it is pay day so going to enjoy. Hope you all have a good day to

Regards Senga

 

[Senga]

Good Morning Everyone
I am feeling a lot better today woke up at last in single figures 7.3 was so worrying was afraid in case the insulin was building up in a pocket and not getting through. I have a blood pressure check and blood test tomorrow and will ask nurse to check my sites. I did ask when I was on the course where I should inject my thighs but do not have enough fat there.
I feel this site is the only place I can get good advise that will help me. I have followed everything the db nurses have asked me to the letter. I write down medication activity etc so I am able to give them a good picture, but felt my last appointment was like a cattle market 5 times someone came into the room to speak to the nurse that was going over my paperwork with me.

Enough moaning. The sun is shining and it is pay day so going to enjoy. Hope you all have a good day to

Regards Senga

Good Morning Everyone
I am feeling a lot better today woke up at last in single figures 7.3 was so worrying was afraid i

Good Morning Everyone
I am feeling a lot better today woke up at last in single figures 7.3 was so worrying was afraid in case the insulin was building up in a pocket and not getting through. I have a blood pressure check and blood test tomorrow and will ask nurse to check my sites. I did ask when I was on the course where I should inject my thighs but do not have enough fat there.
I feel this site is the only place I can get good advise that will help me. I have followed everything the db nurses have asked me to the letter. I write down medication activity etc so I am able to give them a good picture, but felt my last appointment was like a cattle market 5 times someone came into the room to speak to the nurse that was going over my paperwork with me.

Enough moaning. The sun is shining and it is pay day so going to enjoy. Hope you all have a good day to

Regards Senga

Hi All,
Not another story lol just an update. I am just off phone to db nurse she is not sure what happened last couple of days but gave me an idea what to watch out for. Going by my readings she thinks I was no getting my basal into my bottom. I was running low on needles so for couple of days using the same one on basal. This is now sorted as she has sorted my prescription that I get what I need. I will also ensure I wash my face when I wake up before taking the basal to ensure it is going in properly. I am still doing good so hopefully problem resolved.
Another step forward in gaining control x

 

[AndyS]

Glad you are back into single ranges.

Do you know what your BG drop is per 1U of NovoRapid? If this were me then a 2U from 18mmol/l wouldn't have much effect for a couple of reasons:
1) I have found that once I get above 13 I seem to need an extra unit to unit and half of insulin just to kick things into motion.
2) To drop me from 18 to 6 (without the kick) would tack me at least 6U of NovoRapid (Please do NOT use my correction example as it may be WAY too much for you)

The key there is that I know that 1U = -2mmol/l for me so that is how I work the corrections.

With regards to your activity etc the other bit of information you need to work out is how much a set amount of activity will drop you down. Given that you seem to be logging everything quite meticulously I think you really just need to do a little bit of analysis to work out what you subtraction needs to be.

For example, let's take you full house clean example of a drop of 7mmol, and let's say that takes you 4 hours.

So (using my insulin to BG ratio from above, you will need to work out your own) I would need to back off by 3.5 units. So let's say I had a couple bits of toast for breakfast, I personally would need 8u, so I would dose 4.5u.

No to add a little twist to all of this. If I knew I was going to be busy pretty much all day I may actually reduce my morning levemir dose by a few units, this will also help to stop my sugars dropping so fast but I would likely need to correct with the NR.

In terms of what you have seen the last few days some things that could be a factor are:
- Could you have been a little ill and not realised?
- Did you switch insulin pens, you may have had a bad one.
- Are you doing test shots in the air and making sure they are good before you inject.

Unfortunately there are a ton of things that could cause that sort of thing to happen.

With regards to other injection sites have you tried the back of your upper arms? It's a spot I tend to use fairly often and I don't see bruising or bleeding like I did when I tried my thighs.

All the best.

A

 

[novorapidboi26]

If it was me, I would want to ensure the Levemir doses were correct before making changes to the Novorapid.......

did your nurses rule those doses out first.....?

 

[TorqPenderloin]

You asked for thoughts so I’ll share mine and try to be as objective as possible:

-I can’t really understand why your cleanliness has anything to do with your diabetes.
-Based on the numbers you’ve shared, I can’t really understand why a 7 mmol/l would be the worst thing in the world. The lowest number I saw you mention was 12.1 and 5.1 is certainly not a hypo.
-I can’t really understand how increasing your insulin ratio from 1:10g to 1:8g made things better. In theory that would make you more likely to hypo.

It doesn’t sound like you have a solid grasp of carb counting (by your own admission). What are you struggling to understand about it?

Are you actually having hypoglycemia (less than 4mmol/l) or are you just worried about it? If you are having actual lows, can you share how frequently they occur and when?

This seems like a lack of knowledge and confidence issue rather than a physiological issue. That’s actually a good thing because it’s much easier to spend a little time learning and reading about this stuff than it is to fight things like insulin resistance, absorption issues, and random liver releases of glycogen.

 

[Robinredbreast]

Sorry if this is more like a book than a question. Don't really know where to start so will explain as best I can about myself. I am on Levemir 13 on rising and 6 before bed. Also Novarapid taken with meals. I have been a db over 13 years. For over a year now the db nurses have been trying to get my levels under control without much success.
I used to love thoroughly cleaning my house but my levels could drop by about 7 if for instance I did a thorough clean of bathroom. So to try to gain control I have let my standards drop. I felt it was used to explain highs and lows by the db nurses and I wasn't getting anywhere. I recently attended a db course on carbohydrates and counting. I was doing this previously but had never been shown properly how to do it.
They changed my ratios from 1:10 to 1:8 this worked a bit better but still meant I could not be as active as I would like. So I went back to my cleaning and did a lot of minus corrections. was going pretty good until couple of nights ago when the clock changed.
Due to the large drops I have when busy I like to keep my levels around 9 or 10 whilst I build up my confidence.

Today and yesterday me levels have gone crazy left message for db nurse today but she has still not got back to me. Have checked for ketones but none. I feel ok just anxious at why this is happening.

Monday 1157 pm level 16.7 half correction taken an 7 levemir bed

Tuesday 7.40am level 18.2 13 levemir 4nr for food 30carbs and 2 to correct went shopping
1.40pm level 17.1 8 1/2 nr 69.6 carbs no correction as determing which ratio works here
5.15pm level 20.3 3 nr taken to reduce. carb free meal cheese/streaky bacon omelette
7.23pm 12.1
10.30pm 13.7 7 levemir bed
3.25 in morning 15.2


Wed 7.10 level 18.4 13 levemir 4nr for food 30 carbs 2 to correct back to sleep till 9
11.30 level 21.3 3 nr to reduce
2.50 level 12.8 salad no carbs
6.15 15.4 8 nr 51.8carbs 1 and 1/2 to correct
9.27 21.2 2nr to reduce
11.15 15.8 7 levemir bed

I inject stomach with nr and bottom with levemir and keep an eye on the sites.

I hope some of this makes sense I will let you know what nurse says hopefully she will phone tomorrow.

Hi Senga, If I am active, like this afternoon, 2 hours of gardening, I took less Insulin. If I am just plodding about, more inactive I have to increase my Insulin. So instead of going from 1 unit to 8 carbs, maybe 1 unit to 12 carbs to start with and see how you go. It can take some tweaking, but as a lot of type 1's know, it doesn't always work out the way it is supposed to do.
Just step back a little, deep breaths , take your time and look at it ( on the whole) as a possible marathon, rather than a 100 meter sprint.
Take care RRB

 

[Senga]

Glad you are back into single ranges.

Do you know what your BG drop is per 1U of NovoRapid? If this were me then a 2U from 18mmol/l wouldn't have much effect for a couple of reasons:
1) I have found that once I get above 13 I seem to need an extra unit to unit and half of insulin just to kick things into motion.
2) To drop me from 18 to 6 (without the kick) would tack me at least 6U of NovoRapid (Please do NOT use my correction example as it may be WAY too much for you)

The key there is that I know that 1U = -2mmol/l for me so that is how I work the corrections.

With regards to your activity etc the other bit of information you need to work out is how much a set amount of activity will drop you down. Given that you seem to be logging everything quite meticulously I think you really just need to do a little bit of analysis to work out what you subtraction needs to be.

For example, let's take you full house clean example of a drop of 7mmol, and let's say that takes you 4 hours.

So (using my insulin to BG ratio from above, you will need to work out your own) I would need to back off by 3.5 units. So let's say I had a couple bits of toast for breakfast, I personally would need 8u, so I would dose 4.5u.

No to add a little twist to all of this. If I knew I was going to be busy pretty much all day I may actually reduce my morning levemir dose by a few units, this will also help to stop my sugars dropping so fast but I would likely need to correct with the NR.

In terms of what you have seen the last few days some things that could be a factor are:
- Could you have been a little 8 rand not realised?
- Did you switch insulin pens, you may have had a bad one.
- Are you doing test shots in the air and making sure they are good before you inject.

Unfortunately there are a ton of things that could cause that sort of thing to happen.

With regards to other injection sites have you tried the back of your upper arms? It's a spot I tend to use fairly often and I don't see bruising or bleeding like I did when I tried my thighs.

All the best.

A

Thank you so much for all your information will take me a wee while to digest it but will help a great deal. To answer one of your questions 1 unit drops me by 3 and yes I have fond if it is high the one unit will not drop me as much. One example was on Thursday 7.40 levels were 13.4 on rising I took 1:8 ratio (only been put on this new ratio couple of weeks by the db nurses) still experimenting. I had same breakfast I have been having for past year 1 Weetabix and 1 digestive biscuit and coffee which is 30g carbs I took 4nr and 13 levemir. I took down 3 sets of vertical blinds washed them. Cleaned window frames then windows and put blinds back up in kitchen and living room would say this took about 2 hours by lunch time I had dropped to 5.7.
I was recently told at the db course that they now do not advise you to inject arms.

Thanks again your advise is much appreciated and I will take my time and absorb it x

 

[Senga]

If it was me, I would want to ensure the Levemir doses were correct before making changes to the Novorapid.......

did your nurses rule those doses out first.....?

Hi,
Thanks for replying I spoke to my db nurse today and she also thinks it is something to do with the levemir. Could be several things like I was using same needle. The pen could have been faulty or I might not have got the full amount into my backside ( this might be the case as I have to take on rising and I am not a morning person lol). From now on I am going to wash my face to waken myself up before taking

Regards Senga

 

[Senga]

You asked for thoughts so I’ll share mine and try to be as objective as possible:

-I can’t really understand why your cleanliness has anything to do with your diabetes.
-Based on the numbers you’ve shared, I can’t really understand why a 7 mmol/l would be the worst thing in the world. The lowest number I saw you mention was 12.1 and 5.1 is certainly not a hypo.
-I can’t really understand how increasing your insulin ratio from 1:10g to 1:8g made things better. In theory that would make you more likely to hypo.

It doesn’t sound like you have a solid grasp of carb counting (by your own admission). What are you struggling to understand about it?

Are you actually having hypoglycemia (less than 4mmol/l) or are you just worried about it? If you are having actual lows, can you share how frequently they occur and when?

This seems like a lack of knowledge and confidence issue rather than a physiological issue. That’s actually a good thing because it’s much easier to spend a little time learning and reading about this stuff than it is to fight things like insulin resistance, absorption issues, and random liver releases of glycogen.

Hi,
Thank you for your input it is much appreciated. Sorry I didn't manage to explain myself very well, I wrote it when my levels were high as a last resort. I will try to answer some of your questions but would take too long to go through my history,
1. cleanliness and diabetes. Thorough housework can lower levels to the same as extent as a workout in the gym.
2. The numbers I shared were only based on the last 2 days when the problem arose days prior to that I was working at getting myself back to single figures and doing ok.
3. Yes I have had several hypos in the past one not too long ago where I required assistance from a family member.
4. I know 7 is a good number to be at but would need to keep an eye on my activity as even shopping for provisions has dropped me about 4.
5. You have hit the nail on the head with the confidence issue. 2 years of mainly eating the same foods and cutting back on activity ( I found activity was always used as an excuse why I was having hypos instead of looking at my insulin intake) so the db nurses could get a better picture of my daily routine, has knocked my confidence.
6. I have had enough so taking matters into my own hands and tying to gain as much knowledge as possible to allow me to feel comfortable about questioning the db team.
7. I have just been on the adapt course for carb counting so still learning. Prior to this I had basic knowledge which I was putting in place with the help of the dietician. My main concern at the moment is noting down the effects the different foods have on my levels to avoid spikes drops etc.

Hope this is a clearer picture of my situation. I appreciate you taking the time to reply to my help request.

All the best
Senga