Having trouble

[Stuboy]

Lately, the past two or three weeks, i've been having trouble keeping my levels down.

I've recently upped my lantus dose to 10u in the evening, from 7u, and still find that im waking at high numbers. I used to wake up in the 5's, but now i rarely see a number below 8. This morning and yesterday, i woke up to find myself at 12!! I also increased my morning dose from 5u to 7u. So in all, im taking an extra 5units than before!

Pre meal numbers are up too, again, rarely below 8. All day today i dont think i've been below 7 or 8.

I can't work out if my lantus needs adjusting first or my bolus? Perhaps my insulin:carb ratio has changed recently, i was about 0.5u : 10g CHO.

I might sound weird, but it feels like im taking TOO much insulin if I inject more at a meal than i have been. Perhaps because im used to seeing a meal wit such a small dose.

Do you think my honeymoon period could be at an end? The number changes have been fairly dramatic compared to what im used to seeing, and I haven't really changed anything, not food, not diet, not been ill.

Where do I start?? Basal or Bolus... or BOTH??

I really want to sort it out, I hate seeing numbers in the teens on my meter everytime i test :(

[BlueSky]

... I can't work out if my lantus needs adjusting first or my bolus? Perhaps my insulin:carb ratio has changed recently, i was about 0.5u : 10g CHO .... Do you think my honeymoon period could be at an end? The number changes have been fairly dramatic compared to what im used to seeing, and I haven't really changed anything, not food, not diet, not been ill....(
Inconsistent insulin requirements are not unusual during the honeymoon. Very frustrating ... You could also have an infection you are not aware of. Apparently it happens quite often with tooth/gum infections. I would suggest increasing the Lantus and the boluses insmall terative increments. But do it cautiously and and test diligently.

[type1tenorlady]

I would say start with the bolus. Outside of any other mitigating factors (illness, stress, etc), you might be correct in thinking that the honeymoon is over. If your body needs more insulin, it needs more. How much you take doesn't matter, as long as it works for you.

Lantus can also go bad after about a month if you don't keep it refrigerated all the time, and even then it might still expire (there's actually another thread on that topic, but I don't know how to link you). Maybe try a new vial and see if that works.

[tanyatype1]

Hi Stuboy! I agree with BlueSky - it just sounds like your Honeymoon stage is fading! :) I went through this too and for some strange reason, I really didn't want to increase my insulin, but I did so (slowly) and my numbers are really good again.(IMO) Someone once posted, not to worry about how much insulin your using, as long as you're getting the numbers you want. It's true and it helped me get over that little bump in the road! Good luck Stu!

That's funny! TenorLady and I must have been writing back at the same time! I agree with you too!

[Stuboy]

im glad you know what i mean about feeling weird about taking more insulin, I dunno... it's not fear but something else...

my lantus is near the end of it's caartridge, but to be honest, it's never older than the usuall 28 days given out of the fridge... I just feel like my control has slipped so much, but i haven't done anything different, i dont like it!

If it is the honeymoon period coming to an end... im sorta glad in a way because it means i can get on with working out my real ratios. But it's having to test so much again, my fingers were just starting to feel better too!

diabetes is certainly nothing short of a bumpy road...

[Cyborg]

If you notice this is not just a temporary increase in bg, you'll want to set your basal correctly before adjusting your I:C ratios for your boluses. Good luck...

[grace girl]

I totally understand how you feel about taking more insulin...I tend to eat the same amounts so my insulin amounts stay about the same, and on those occasions that I eat more the amount of insulin I need to take usually freaks me out. It's all mental!
I totally believe in going basal first....having that set right is so important. Before you change it too much I'd do some basal testing to see just how far off the mark you are. Once you have the basal set you'll know if you need to adjust the bolus.
I would imagine getting beyond the honeymoon will be a blessing, really. I never seemed to have one myself, but I would think that it's sort of frustrating. Hang in there....

[Scarlett]

5"5"
155lbs. 4/2004
started out on Lantus 25U am/25 pm
LBS GALORE and cut back immediately
3/9/2007 @ 17U am/15U pm and still having LBS' in the am and some highs in the pm after eating too many carbs and not enough Novolog to counteract.
water, water, water-DRINK water to dilute the sugar and help the blood carry the bad sugar out of the body-no less than 64 oz. daily-spread it out too!-
maybe you're insulin is too low-your Dr. should be regulating how much you take

[xMenace]

maybe you're insulin is too low-your Dr. should be regulating how much you take

If this were true, we'd all be dead by now. No, Drs and DEs give us general guidelines, but it's our job to make it work right.

It could be an unidentified source of stress, a change in lifestyle, a development of insulin resistence, or simply hitting bad absorption sites. One important thing to do is basal test so you can adjust the correct injection types the correct amouns. Another necessity is increased testing to validate whether this is apermanent change and to catch any reversals.

[HollyB]

Hi there,

We've been in this situation oh, at least a half-dozen times since my son was diagnosed -- his honeymoon seemed to lurch to an end in stages. We've learned that for Aaron at least, the most effective/quickest way to get back good control is to ease up basal and bolus both together a little bit at a time -- ie keep the proportion similar. Obviously you then need to test your basals but it's easier to do that when you're also taking boluses closer to what you need (so you can actually start your test with a normal reading). That strategy may or may not work for you, but thought I'd throw it out there.

PS If it makes you feel any better about increasing your insulin, he's gone from under 20 units total a day to over 60 in 18 months.... but the doc told us yesterday he consistently has the best A1c of any kid in their clinic.

[am1977]

It'squite possible that your honeymoon is over :bawling:... I've read that for most people it ends somewhere abouts 1 year post diagnosis. How are you doing with testing? I would try to test a little more freqently, keep good logs, and be in touch with your docs. That way, it will help your doctors and yourself know how to adjust your insulin.

Good luck

[ant hill]

Lately, the past two or three weeks, i've been having trouble keeping my levels down.:(

i'd look at the lantus and increase the dose in 1U dialy and use the bolus as a reqirement to what you eat and try and calculate the avarges and aim at 100 md/dl or 6 mmol/l and that's the fasting tests before you eat. 2 hours after you have eaten don't be too alrmed to see10 or 11 mmol/l or 180 mg/dl i concider that as normal. Not all control is perfect, We can all can do some inprovement.;)

[blue_eyed_devil]

i just posted on the same topic... sorry about that.

it is really frustrating though... i'm not sure where to start either.

i'm on a pump, and to be honest can't really remember that much about mdi (and to be honest i was usless at it!!!), so sorry i can't give advise like these guys can. i'm thinking upping your doses slowly and steadly would be the way to go and keep monitering...

hope you reach you target!!!

[Stuboy]

i tend to change my adjust my basal every three days if it needs adjustment, not each day.

Ill be honest... im not really sure how to basal test really... im still pretty new to this!! Only been diabetic for around 9 months now.

So, the burning questions for me now are...

How to basal test?
and
How to accurately test bolus I:C ratios?

[Cyborg]

Here's (http://www.insulin-pumpers.org/howto.shtml) a good link to help with your questions. Most of the information can be applied to non-pumpers also.

[ant hill]

i tend to change my adjust my basal every three days if it needs adjustment, not each day.
Yeah that's the go. :) go easy :D

Ill be honest... im not really sure how to basal test really... im still pretty new to this!! Only been diabetic for around 9 months now.
That's ok, The baseal is calulated on the average blood glucose like add all your tests then divide that total over how many test that you have done. Do you have softwhare for BG's? If not then get one. They are a great tool for control!!

So, the burning questions for me now are...

How to basal test?
and
How to accurately test bolus I:C ratios?

Ok let say you have these tests 4.4 6.7 11.8 4.6 and add these up and you will have 27.5 then divide buy 4 tests and you will have an answer of 6.875and that is how it's done :)

[Stuboy]

... i dont get it.

[type1tenorlady]

I'm not sure what ant hill meant but here's what I've been told:

Basically what you need to do is skip a meal during the time of day when you are having the most trouble and test your BG every hour or 2 (starting from at least 2 hrs after your last meal) to see what your body is doing in the absence of any food or other short-acting insulin. If it stays in a good range then your basal (in your case, your dose of lantus that covers that time of day) is fine, if not then you need to adjust it up or down accordingly. Obviously if you go hypo, stop the test and eat something to bring it back up.

Since I think you are having trouble in the morning, what you need to do is start testing at least 2 hrs after dinner and keep testing every two hours overnight to see what your body is doing while you're sleeping. Or, if you have trouble waking up that many times, you could try spreading it out over 2 or three days and wake up at 2 and 6 one night, 1 and 5 the next, etc. The other thing I should mention is that when you are doing basal testing you should try to keep your meals as regular and as similar as possible, preferably eating foods whose exact carb content you know and that you already know won't have a crazy affect on you (eg, no pizza).

Hope this helps.

[dbc]

I can't work out if my lantus needs adjusting first or my bolus? Perhaps my insulin:carb ratio has changed recently, i was about 0.5u : 10g CHO.

Where do I start?? Basal or Bolus... or BOTH??

(

From everything I've read, first get the basal right, then worry about the bolus. Again from what I've read, the best way to check basal is do a 12-18 hour fast & check the numbers regularly. There should be very little variation. But, hey, I'm new to this, so take it from whence it comes.

But I am going to try this method later this week - once I have got my fbg numbers in range. Hopefully I'll last a day without eating......

[pinkytricia]

aawwww......Stu
Sorry, to hear of your troubles... little buddy....
Hang in there !!!....
No advice ....Just well wishes Hun....

(((( hugs )))) and (((( sunkisses ))))

Trish
:T

[LancetChick]

Yes, you must be fasting when you test, because carbs and insulin bolusing mask the action of your basal. If you go hypo, by all means eat something, and know that it means you are overdosing your basal insulin. If you run high, it may or may not mean you are underdosing, since you could be rebounding from an overnight low. In that case, you just let it run, and if it tops out and starts going down, assume that you are rebounding from an overdose. If you run high into the afternoon without topping out, assume that you are underdosing your basal, and adjust accordingly.

In other words, if you wake up in the morning and decide not to eat or bolus, every blood sugar reading you get tells you how your basal dose alone is affecting your blood sugar, and common sense will tell you how to adjust.

[DeusXM]

My gut instinct would be to increase both and see what happens. If your honeymoon period is ending then you're going to need more insulin for both anyway. The other side of it is Deus' Seasonal Insulin Variation - this is a phenomenon that I've decided to rather arrogantly patent. Basically your insulin requirements will change depending on whether summer or winter is coming along, and these always seem to happen in a flurry around March and October.

You're something like the 5th or 6th person in the last two weeks to post on here that their insulin requirements have suddenly changes, so you're not alone. Rather oddly, mine have actually dropped in the last two weeks.