Need advice on controlling blood sugars

[tintin99]

My partner Tricia has been diabetic for about 17 years and has never managed to get her sugar levels under control. We'd really love to hear from others to help us work out if there's anything we can do to improve the situation.

She has 2 jabs of Insulatard a day - one before lunch and one at bedtime - and 3 of Humalog - one before each meal.

Although her routine is pretty consistent from day to day her readings can vary enormously, and the spread over a few days can be from about 3mmol/l up to 16-17mmol/l and sometimes even higher. She also goes through phases of having Dawn Phenomenon's with very high waking levels.

From her meter her 7 and 14-day averages are around 9 or 10mmol/l and her last HbA1c was 7.1.

Her Insulatard doses are always 15 at lunchtime and generally 15 before bed although if her reading is lowish at bedtime she reduces the Insulatard to avoid the risk of a hypo while she's asleep.

As for the Humalog, she decides how much to have by taking into account what she's about to eat and also what her reading is at the time. She keeps a record every day and looks at previous days' reading to help her decide.

Because of the unpredictability it's a constant battle to try and keep the levels down without risking hypos. I know that's probably stating the obvious!...but I worry about the long term damage of so many highs and I also believe that she'll feel a lot better in herself if she can improve her control.

We'd really like to understand better what's happening so all advice and help would be greatly appreciated.

Many thanks,

Bob and Tricia.

[sparkle9]

I'm not sure what insulatard is, but I think it's similar to NPH. I was on NPH for years and constantly struggled with very variable blood sugar levels. About a year ago I switched to lantus and I don't have all the ups and downs anymore. Perhaps your partner could ask her doctor about switching to lantus?

Sparkle

[rzrbks]

sparkle9

I'm not sure what insulatard is, but I think it's similar to NPH. I was on NPH for years and constantly struggled with very variable blood sugar levels. About a year ago I switched to lantus and I don't have all the ups and downs anymore. Perhaps your partner could ask her doctor about switching to lantus?


I'm assuming you are from UK?

Took time to read up on insulatard, and I too wonder if it isn't close to NPH.

NPH, according to my Certified Diabetes Educator(the main dibetes health care professional you work with in the U.S.) is very unstable and not as long acting as Lantus.

On the other hand, there have been a few people, not many, who have had reactions to Lantus.

So, like sparkle, I'd advise y'all to talk to your Dr./Health Care Professional because most who have switched to Lantus find they have much better control.

[MarkMunday]

I also recently switched from NPH to Lantus. And my control has improved enormously. It sounds like a review of your partner's insulin regemin is long overdue. I would suggest getting her to an edocrinologist and exploring other options.

Because of the flatter action profile, using Lantus causes blood sugar levels to be more easily predictable and provides more flexible control options. So you should be able to reduce that variability.

Mark

[tintin99]

Thanks to all of you for replying so quickly. I believe you're right about Insulatard being the same as NPH. We'd been wondering whether Lantus might help so it's great to hear such a positive recommendation.

Do you find Lantus helps with the Dawn Phenomenon too?

Bob.

[rzrbks]

Do you find Lantus helps with the Dawn Phenomenon too?

Bob,

According to the CDEs and the Drs. I recently cornered at a live diabetes forum/fair, long acting insulins, NPH, Lantus, etc. can't be adjusted for DP. All of them agreed that Pump was the only way to deal with that--three of them were pumpers.

Other sources I have read suggest finding the right combination of carbs, protein and fat to have with a bed-time snack can help somewhat if you really want to stay with basal injection and Multiple Daily Injections.

Which is what I do since I Do Not want to go onto a pump, but that's my Personal Hang-up. Many here swear by Pumps and they have had great results with dealing with DP and bringing their A1c down.

It's a personal thing.

[sparkle9]

When I was on NPH, I frequently woke up with high blood sugars. When I tested in the middle of the night, sometimes I was low and sometimes I was high. I was never sure if those morning highs were due to dawn phenomenon or going low in the middle of the night and having rebound highs in the morning. I just never got consistent results with NPH.

With lantus, I don't wake up with high sugars unless I've had a really late dinner or a high fat dinner like pizza (both of which I try to avoid) the night before. But even with lantus, my bsl will rise significantly about 30-60 minutes after I wake up. During the week I usually take my humalog and eat breakfast within 60 minutes, so it's not a problem. But on weekends I like to eat breakfast later or not at all. I find that if I take 1 unit of humalog shortly after I wake up, it prevents the bs rise. Of course, this may not work for everyone and the amount of humalog you would need might be different.

[eevee]

Hi......
Pizza..is really a very high carb food (the base) as well..!! The combination of fat + carbs pretty much guarantees high bGs. I believe that the topping on it's own wouldn't bring on the same high. 'Fat' in the absence of carbs doesn't really make much, if any, glucose.
Carbs at bedtime....leave them out and have a slice of cheese or a piece of meat instead...protein/fat is slower to digest, so it covers the period better......
Also...
.....by adjusting my protphane(similar to NPH,Lente etc) dose and timing, I seem to have put DP to sleep.
When following standard advice of around 7am, 7pm it was never any good. I progressively reduced times to where I'm at now
...11am & 11pm

Cheers..........Eve

[sparkle9]

I just know that on the rare occasions when I eat a high carb/high fat meal, my bsl can be normal at bedtime but will rise during the night. I have been told that it's the fat which delays the absorption of the carbs. Does anyone know if this is correct?

[LauRa Lu]

Originally posted by tintin99



Her Insulatard doses are always 15 at lunchtime and generally 15 before bed although if her reading is lowish at bedtime she reduces the Insulatard to avoid the risk of a hypo while she's asleep.

As for the Humalog, she decides how much to have by taking into account what she's about to eat and also what her reading is at the time. She keeps a record every day and looks at previous days' reading to help her decide.


Because of the unpredictability it's a constant battle to try and keep the levels down without risking hypos. I know that's probably stating the obvious!...but I worry about the long term damage of so many highs and I also believe that she'll feel a lot better in herself if she can improve her control.



I'm similar to this. I'm on levemir which is basically the same as lantus only a diferent make and diferent pen.

I too judge how much insulin I need by what I eat. I dont adjust the levimir...just my fast acting insulin. I also tend to avoid having too much in the evenings because i worry about lows in the night.

I dont really know what to say to help because apart from using a different insulin, i'm basically in the same boat :( at the moment my levels are mainly between 7 and 10 mmol/m constantly. and night time is hard... i usually wake up a little high.

The trouble is any adjustments i make just seems to make it all even worse!

I wish I could help... but I think I need some advice too. When ever my b.g is about 5mmol/l it will NEVER stay that way and will ALWAYS drop low... but less insulin and im too high :( i really need to sort my self out.

[archimeech]

I used to have the same problems that you are all facing. It's the problem with absorption of the long acting insulins. They all are essentially insulin with traces minerals attached to them to force the body to metabolize them slowly. The problem is that your body won't do that right or at the same exact rate every time. Right before I got the pump, I was bottoming out at 30-US# each night around 2:30-3:00 and then my sugar would be 300-400 in the morning. When I got off the long acting and got a beter grasp of my basal rate on the pump, my sugars have been much more steady.

Sorry I can't be any more help than that.

[tintin99]

Thanks to everyone who responded to my post! All your replies were very helpful if only by confirming that it can be a tricky problem to solve in some cases. I had thought maybe we were doing something wrong or misunderstanding something...at least I know that's not the case now.

Tricia is going to ask her doc to let her try Lantus so we'll let you know how it goes.

Best wishes to all,

Bob.

[buzzborne]

Both my dad and myself where on Insulatard (its a long acting insulin which ((i think)) peaks at 12 hours...) I found that my control wasn't good at all using this and sugars were all over the place, even after many adjustments, and found with lantus that the sugars were under more control.
My dad who has always had gd control also switched to lantus and he prefers it as well!

Let us know how you get on :)

Sarah

[lgvincent]

Do you think it might be helpful to consider taking a fast-acting insulin injection at each meal? I used to take one injection of NPH each day, then went to 2, then 2 of short-acting and long-acting, then I went to taking short-acting at each meal and an injection of long-acting at lunch and bed-time. I still have trouble, perhaps because of the NPH, but it's a lot better taking an injection at each meal than it used to be without doing it.