Help with fluctuating Bgs!

Sutrer · #1 (**permalink**) 02-01-2006, 08:27 AM

Hi there, was just wondering if any one can give me some help with my diabetes control. I was diagnosed in feb 03 with type 1 and started off on the novomix regime which at the time suited me fine but then in Oct 03 I was put onto the basal bolus regime as I was told this was more flexible which I had to agree.
My first HBA1c was 6.3 and then the next one in dec 04 had risen to 7 and then my most recent was in nov 05 which was 7.5! think you'll agree there is a pattern emerging.
I'm just finding that the moment im struggling with my bgs particularly during the day. Most of the time they start off around 8mmols in morning but when i have my lunch and take my insulin(round of sandwiches, apple, occasional packet of crisps) it can sometimes go as high as 15mmols thru the afternoon and I end up having to take extra insulin to cover it way more than I would for a meal in the evening.
I am on novorapid for bolus and lantus for basal.
wondering what should the ratio be for number of units for lantus to amount of bolus I take?
Currently I take 22u on lantus at 5pm each day with about 10u on novorapid for evening meal but for some reason I have to take upto 12-14u for lunch?
Thought by now after3 years i should have my bgs even better than when I first started but it seems to have got gradually worse! Im finding this depressing to say the least and hope some one can offer some advice??
I've just turned 30 and dont want to feel im running myself into an early grave.
Sorry for sounding so depressing many thanks

Simon · #2 (**permalink**) 02-01-2006, 08:45 AM

Hi Sutrer,

Well for starters 8 mmol/l is very high for fasting bg. You need to get it down to more like 5.5. Secondly the reason you need more Novorapid for lunch is probably that your Lantus is running out before the 24 hour claim the manufacture makes. Splitting the Lantus into twice a day and increasing the total dose should help lots.

Most people find the total Lantus and total bolus doses are about the same but you need to experiment to get a grams of carb/unit ratio and use that.

Sutrer · #3 (**permalink**) 02-01-2006, 08:53 AM

thanks for the advice. If i split the dosage of Lantus what would be your suggestion for the 2 times of day to take it?
thanks again

duck · #4 (**permalink**) 02-01-2006, 08:57 AM

Quote:

Originally Posted by Sutrer

thanks for the advice. If i split the dosage of Lantus what would be your suggestion for the 2 times of day to take it?
thanks again

That depends on many things, not the least of which is convenience to the user. Also, consider that at some point in the day, you'll have some overlap of Lantus, so you need to factor that into your timing(s).

What if you moved your Lantus shot time? Late evening or early AM? You'd still peter out toward the end, but maybe the end time would be a time you could 'cover' better with novorapid? Just a thought...

Sutrer · #5 (**permalink**) 02-01-2006, 09:10 AM

thanks there Duck, think I might try moving the timing of it first and then maybe go to split dose if that doesnt work!
Does anyone ever feel as though the insulin just isn't working sometimes? I dont know if its to do with injection sites or faulty pens?! Its like I can go thru really good periods of good control and then without warning I'll take my insulin for something as simple as sandwiches on brown bread and its like my insulin just hasn't worked properley or maybe its me not working properly!! ha ha! Its so much fun being diabetic I say sarcastically! BTW thanks everyone so far for your kind welcomes

Simon · #6 (**permalink**) 02-01-2006, 09:17 AM

Yep, same for all of us I think. I think I've tracked it down to a variability in the uptake rate from each injection. Spreading doses over more injections should help to average out the variability but the best way to minimise it ultimately would probably be to use a pump.
Injecting Lantus into the leg rather than the abdomen is a good move too.

Sutrer · #7 (**permalink**) 02-01-2006, 09:24 AM

thanks Simon, its so good to know im not the only one! think I've made one of the best moves ever joining this forum knowing I can have a chat with people in a similar position. Dont get me wrong my gf is a fantastic support but its nice to talk to people who really really know how it feels to be in this position.

duck · #8 (**permalink**) 02-01-2006, 09:25 AM

Yeah, I have days where I have been high all **** day, have literally eaten nothing and yet have pumped voluminous amounts of insulin into myself. Very frustrating, the only "consolation" is knowing it happens to us all.

jen_slc · #9 (**permalink**) 02-01-2006, 12:08 PM

Hi Sutrer, welcome to the forum. I'm also on Lantus/Novolog and I find that my Lantus runs out at about the 20 hour mark, so your bg rise in the afternoon could be due to that. Like the others suggested, try moving the timing of your one shot to see if makes a difference. If you still go high towards the end of the 24-hr period, then you could try splitting it. That's what I do now, 50/50, 12 hours apart and I get much more even basal coverage. But if after those changes, you still find that your afternoon readings are high, it could be that you require more insulin at lunchtime. Everybody's insulin needs vary throughout the day. My carb ratios are different for just about every meal and snack, so I'd keep that in mind.

In theory, your total daily insulin intake should be 50:50 basal:bolus, but that will change depending on several factors. I remember an old thread about ratio of basal/bolus insulin and a total daily dose (TDD) calculator, I think you'll find it here in a post from Mick:

http://www.diabetesforums.com/type-o...tus-users.html

Cinnabon · #10 (**permalink**) 02-01-2006, 12:26 PM

MDIs, Pumpers, non-pumpers... It happens to us all. As much as you try, there is always work there to be done to achieve good control. I think taking this step to get good control is taking you very far from your grave. It takes work but you CAN do it!

Aftiel · #11 (**permalink**) 02-02-2006, 07:15 AM

Absolutely there are days where BG has a mind of it's own.

All week has been great for me - then yesterday my BG decided 200 was a great number to hang around all-day-long.

Today things are back to normal.

As for Lantus, I take mine in the morning (6 am,) and it lasts roughly 20-22 hours in my case.

Let me also throw in that some things can cause BG to rise/fluctuate - like caffeine - so watch the caffeine intake.

- Aftiel

duck · #12 (**permalink**) 02-02-2006, 07:23 AM

Quote:

Originally Posted by Aftiel

Absolutely there are days where BG has a mind of it's own.

All week has been great for me - then yesterday my BG decided 200 was a great number to hang around all-day-long.

Today things are back to normal.

As for Lantus, I take mine in the morning (6 am,) and it lasts roughly 20-22 hours in my case.

Let me also throw in that some things can cause BG to rise/fluctuate - like caffeine - so watch the caffeine intake.

- Aftiel

I can't decide if caffeine has that effect on me...the problem is, I can't seem to get a "controlled" test arranged. It seems to me I have had days where coffee consumption has left me high (with no carbs in the coffee, how can it raise sugar?) and days when it did nothing at all (as expected, with no carbs). I need to sort this one out, actually, or give up caffeine for good...