Yo-yo problems

• I walk between 4 to 5 miles every morning, and during that time my bs very often drop to around 3, and I have to have something to boost sugar. Before lunch, I’m usually stable at between 5 and 7.
• However, when I eat lunch - usually crisp breads and cheese - and then have a cup of coffee in the afternoon, my readings are up to 14 or higher by evening meal time.
• I then have Humulin injection and have evening meal, after which my readings can be as high as 18 by bedtime.
• My HBA1c is 7.4 which I think is due to the fact that my lows in a morning, balance out the constant highs.
• I also have an autoimmune liver disease PBC, which does affect my liver function.
• I have recently seen my Consultant, who didn’t really offer any ideas re my concerns. Her only comment regarding reducing readings after lunch, was to walk again. Bearing in mind my age - 70 - and the fact that I walk daily, I found myself leaving the appointment totally disillusioned.

Antje77 said:

So it looks like your insulin (an intermediate acting one) is keeping you relatively stable, except when you eat. You can't up your insulin or you'd get hypos when not eating.

Most T1's are using a basal/bolus system, the basal a long acting one to keep steady in the absence of food, like your Humulin, the bolus a quicker acting one to cover their meals.
I'd have a talk about adding a bolus insulin with your consultant.
It's more work, having to work out doses before every meal, but seeing as you already self fund the Libre, it sounds like you have lots of motivation.

Another thing worth looking into is finding out if you actually are a T2. You've progressed to insulin quickly and you mention weight loss. Was the weight loss intentional? You also already have an autoimmune disease, increasing the chances of developing other autoimmune diseases.
You might want to see if you can get a referral to an endocrinologist (assuming your current doctor is a GP), they have much more experience with adjusting insulin types and doses. And they can order a test for C-peptide to see how much insulin you're producing yourself.

In the mean time, from your rises after food it's clear you're having more carbs than you can handle with your current insulin regime. You could do some experimenting with eating fewer carbs and see if this results in lower numbers after eating.
However, being on insulin, be very mindful of hypo's if you do!

I'd try to have something before you drop below 4. You already know you'll likely drop, so keeping a close eye on your Libre can alert you to a starting drop, and you can have a little something to munch on while walking without needing to treat a hypo.

Click to expand...

Antje77 said:

So it looks like your insulin (an intermediate acting one) is keeping you relatively stable, except when you eat. You can't up your insulin or you'd get hypos when not eating.

Most T1's are using a basal/bolus system, the basal a long acting one to keep steady in the absence of food, like your Humulin, the bolus a quicker acting one to cover their meals.
I'd have a talk about adding a bolus insulin with your consultant.
It's more work, having to work out doses before every meal, but seeing as you already self fund the Libre, it sounds like you have lots of motivation.

Another thing worth looking into is finding out if you actually are a T2. You've progressed to insulin quickly and you mention weight loss. Was the weight loss intentional? You also already have an autoimmune disease, increasing the chances of developing other autoimmune diseases.
You might want to see if you can get a referral to an endocrinologist (assuming your current doctor is a GP), they have much more experience with adjusting insulin types and doses. And they can order a test for C-peptide to see how much insulin you're producing yourself.

In the mean time, from your rises after food it's clear you're having more carbs than you can handle with your current insulin regime. You could do some experimenting with eating fewer carbs and see if this results in lower numbers after eating.
However, being on insulin, be very mindful of hypo's if you do!

I'd try to have something before you drop below 4. You already know you'll likely drop, so keeping a close eye on your Libre can alert you to a starting drop, and you can have a little something to munch on while walking without needing to treat a hypo.

Click to expand...

Antje77 said:

So it looks like your insulin (an intermediate acting one) is keeping you relatively stable, except when you eat. You can't up your insulin or you'd get hypos when not eating.

Most T1's are using a basal/bolus system, the basal a long acting one to keep steady in the absence of food, like your Humulin, the bolus a quicker acting one to cover their meals.
I'd have a talk about adding a bolus insulin with your consultant.
It's more work, having to work out doses before every meal, but seeing as you already self fund the Libre, it sounds like you have lots of motivation.

Another thing worth looking into is finding out if you actually are a T2. You've progressed to insulin quickly and you mention weight loss. Was the weight loss intentional? You also already have an autoimmune disease, increasing the chances of developing other autoimmune diseases.
You might want to see if you can get a referral to an endocrinologist (assuming your current doctor is a GP), they have much more experience with adjusting insulin types and doses. And they can order a test for C-peptide to see how much insulin you're producing yourself.

In the mean time, from your rises after food it's clear you're having more carbs than you can handle with your current insulin regime. You could do some experimenting with eating fewer carbs and see if this results in lower numbers after eating.
However, being on insulin, be very mindful of hypo's if you do!

I'd try to have something before you drop below 4. You already know you'll likely drop, so keeping a close eye on your Libre can alert you to a starting drop, and you can have a little something to munch on while walking without needing to treat a hypo.

Click to expand...

Antje77 said:

Which means you have 3 different markers to have your doctor look further into your type of diabetes: unintended weight loss, quick progression to insulin and a pre-existing autoimmune condition.
Which can be purely coincidental, all those things can happen in T2 as well, but I'd do some pushing for more testing.
And if you are a T2, there's still action to be taken to get your postprandial levels lower, and your doctor seems out of his depth there, a basal/bolus regime is prescribed to T2's as well at times.

I'm afraid your age is not helping you. Apart from many doctors forgetting you can develop T1 at any age, and it should be looked into if someone's T2 doesn't behave as expected, there's also the assumption by many people that being old equals not being able to adapt to modern technology and more complex treatment types.

Do you see a specialist for your PBC? While they have the wrong specialism for diabetes, they might be more interested than your GP.

Click to expand...