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| | From:  Matty-Lad (Original Message) | Sent: 2/6/2005 3:23 PM |
Hello all,
I wonder if someone could offer me some advice.
As I work shifts, I use two different types of insulin. Novorapid (short term) and also Lantus (long term).
The trouble I seem to have is that- whilst I can keep fairly good control during the day time- when I sleep is proving to be a real problem.
Each morning I wake up and it's usually about 9 (I had a scary moment during the first day of a cold reaching 14.5). For the rest of the day, I keep myself to around 5 or 6.
I'm obviously having hypo's when I'm sleeping (and I'm a very heavy sleeper so it won't wake me). Therefore, when I wake up it feels like I have a hangover without the fun of beer the night before.
The same has happened this morning. Throughout my night shift, the reading was between 4.5 and 5.2. Quite healthy, I thought. I come home, have three hours sleep and it's 8.9 again.
Thankfully, I've got a medical check up due in the next few weeks, but I'd be most grateful for any advice.
Incidentally, I think it should be noted that the treatment I have with the NHS in the UK has been nothing but outstanding.
Thanks mucho,
Matthew |
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I think perhaps it may be a consideration for the future. However, needless to say they want to try this treatment for a while to see if it works.
Because of restrictions, I believe the neighbouring borough- Dudley- it shortly going to start trialling it. However, when you think there's only about a dozen trials in a population of 200,000 people, I'm sure you can appreciate that those who are going to get it are quite likely. I understand that it will be limited to people who are type 1 and multi-injections has failed them.
That does make me a good candidate for it, but we'll just have to see.
I've decided to double my does of Levermir up to 40. This may sound a bi harsh but any blood sugar above 6 and I do feel quite woozy. I'd prefer to keep it low down.
I could accept the whole hypo issue when I wake up as long as it's not causing any long term health problem. My guess is, however, that it would. |
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| | | From: sarahQ | Sent: 12/5/2005 5:42 PM |
Matt if you are going hypo in the night and then having a rebound high in the morning doubling your long acting will prob kill you in the night you need to cut the long acting if you are using it twice a day cut the evening dose by say 4 units to start with set your alarm and get up and test in the night to see what is happening if still low cut it again untill you are comfy with it. Make sure you test test test as you adjust your insulin. I also find having a wholemeal scone about 10pm stops me going hypo in the night. The more insulin you take the more you will eat and the more your weight will go up then u have a vicious circle. Lots of lows/hypos will also cause brain damge in the long run. |
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Hello Sarah,
Certainly some very useful advice. Thanks very much. I've honestly found that any long-term working insulin has little or no affect on me. My body seems somewhat unresponsive to how much I use.
Once I get over the intial problem of waking up and feeling groggy, my day control is ok. Still, this is not the answer.
You're quite right about the food as well. I find it very frustrating how much weight I put on- the whole eating food when I don't want to does pee me off.
Even though I'm 6ft 2 tall, I'm still about 17 1/2 stone which is far too much.
The problem occurs also with shift work. It doesn't matter what levels I have before I go to bed and whether I eat or not it still returns to about 9 or so when I get up.
Still, your wise thoughts has spurred my mind in the right direction. I will start again from scratch with my Levermir and see if I can resolve this frustration once and for all.
Cheers,
Matthew |
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It's been a while since I've put anything to this and- with my other posting- now's a good time as any.
There was talk about going on the pump treatment but- as yet the consulant I saw- does not feel that the time is right. I was a tad aggrieved by his approach to me as I felt I wasn't being listened to and the appointment was rushed (even though it was held 30 minutes later that it should have been).
The hypo's have been getting worse. This morning I woke up and it was about 14.5. The other day I had a 21 which is the highest I've seen it since I was diagnosed.
One such thing they may wish to progress me on does sound useful- the DAFNE course. This is Dosage Adjustment For Normal Eating. It's a week long course with the NHS (paid for by the Government).
With the course you can balance your insulin adjust to carbs in food, exercise, etc.
This will be a very useful course, but I still maintain that my body does odd things as soon as I sleep. Just a few hours kip- regardless of blood sugars beforehand- and it's all goes tits up again.
Oh, and Turtle, sorry for the delay. I have varying shift patterns. Currently it's 2 earlies, 2 lates, 2 overnights, 4 rest days.
Ta. |
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| | | From: sarahQ | Sent: 8/5/2006 8:54 AM |
Matt I hate to sound dumb but I have just reread your post. In it you state you are waking up at 14.5 and 21! now that is not low that is way over the top and reading your comments about you have perfect numbers when on shift I have to wonder when you change your shift pattern do you increase your insulin to make up for the lack of exercise? Going that high after an untreated low is a bit over the top I suspect you need to sit down and think it out a bit more or change jobs doing shift work is very difficult to control diabetes. Do you split your Lantus? If not this might help ask your GP/endo. Oh and the DAFNE is only carb counting some prat in the NHS is after a medal for inventing soming new!!! carb counting has been going on for many yrs I learnt the value of carbs back in the 60's. If you are using MDI now you should be carb counting. |
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Yes, I agree. Carb counting is a huge help when used with Humolog, Novolog, Aprida, or other rapid insulin. You would have to know how many carbs you are eating in a meal to wear a pump also. Having an insulin to carb ratio is key to keeping conrol of your sugars when you're insulin dependant. In the US, a reading of 14.5 is 261 and 21 is 378, which are hyper instead of hypo. Good luck with the carb counting!! You'll get the hang of it quickly. You can always go to the book store to get a book that lists the number of carbs in foods also. |
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They've suggested that I need to increase my Levermir dosage because they feel I rely too much on Novorapid to deal with my control.
I've made the point that I think I'm on a fairly acceptable dosage because I've tested my blood two hours after eating, checked it again after several hours of no additional food and it's 'round about the same.
Oh well.
Had my first consultation for the DAFNE course today. I see Sarah's not too keen on the idea of it, but I'm prepared to give anything a go to resolve this issue. The course starts proper in a few weeks. |
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| | | From: sarahQ | Sent: 9/7/2006 6:09 PM |
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| | They've suggested that I need to increase my Levermir dosage because they feel I rely too much on Novorapid to deal with my control.
I've made the point that I think I'm on a fairly acceptable dosage because I've tested my blood two hours after eating, checked it again after several hours of no additional food and it's 'round about the same.
Oh well.
Had my first consultation for the DAFNE course today. I see Sarah's not too keen on the idea of it, but I'm prepared to give anything a go to resolve this issue. The course starts proper in a few weeks. | |
Matt,
I did not say I wasn't keen on DAFNE I was saying it is one and the same as carb counting. Which is what you should be doing if you are are on MDI (multi dose injections). I also stated you were not on enough Levemir and it looks as if the consultant or whoever saw you has agreed with me. Novorapid only lasts for a few hrs IE it covers your food(thats what it's for) the rest of the time you need Levemir to keep your blood sugar in an acceptable range which it obviously can't do if you are not taking enough. Try doing as has been suggested by the hospital. You will prob find your weight problem will improve as well. |
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Oh right- I'm sorry for misunderstanding your point.
Yes, carb counting will certainly be very useful in getting an idea of how much insulin I need for food.
I have one question still though- if I can manage to keep the same bloody sugar over several hours when I'm awake (ie a period- as an example 2 hours after eating and several hours until I next eat) then why would I need to increase my Levermir dosage?
The Levemir is taken at 8pm. Most likely a time a few hours before I go to sleep (although as a shift worker, not always).
I would have thought by increasing the dosage, I'm more suspectable to my blood sugar decreasing after several hours of not eating. |
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| | | From: sarahQ | Sent: 9/8/2006 6:49 PM |
Hi Matt, The reason you need more insulin(background) when you sleep is because your pancreas does not work so needs a slow steady release of insulin i.e. levemir this mimics the pancreas ours are on strike  . When you sleep your body slows down , no exercise etc, so your blood sugars rise. A lot of diabetics have what is know as the dawn phenominon sp! is cr*p tonight sorry. thus blood sugars rises when the liver dumps glucose ready for waking up in the morning. Hence your very high numbers in the morning. You are then having to take a lot of quick acting to bring those numbers down to normal levels and are at a very great risk of having a massive hypo doing that and needing medical assistance to right it. If that happens in the UK and you drive a car you can kiss goodbye to your driving licence for a whole yr or untill your endo or swansea say you can drive again. Sorry my explanation not that fantastic but if it's not clear please say so and I will have another go.  |
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| | | From: sarahQ | Sent: 9/8/2006 6:56 PM |
Sorry just an add on for you. Levemir or Lantus is a background insulin nothing else, all it does is keep your blood sugars in a normal range when you do not eat. So in theory if you starved yourself for 24 hrs and were on the correct dose of levemir your numbers would stay in the normal range for that 24 hrs. Your quick acting is for when you eat. It covers the carb content of your meals or snacks hence it's called MDI so if you snack you inject or have a meal you inject. |
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That was my reason for the confusion. On my current dosage of Levemir, I can go without eating for several hours without my blood sugars either increasing or decreasing, which is why I was suprised about the suggestion of increasing the dosage to hold off the hypos when I sleep.
I don't know what it is with my body, but every time I have a kip 4, 8 hours, etc the blood sugar crashes and then I get the hypo.
With the increase of Levermir, I find that I have more low blood sugars during the day when I have eaten for a while. I'm almost been sent home from work on a number of occasions. |
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| | | From: sarahQ | Sent: 9/13/2006 5:28 PM |
Your short acting insulin does not stay in your body for 6-8 hrs. it peeks at the most 2 hrs after you have eaten. It lasts in body for about 5 hrs gradually fading as it goes. You are not going hypo if you are waking up with blood sugars in the 20's. It just means you have not got enough Levemir to tide you over when sleeping. If you have increased your levemir then you need to reduce your novolog at meal times. Are you carb counting and adjusting your insulin for what you eat? Have you a carb ratio? Or do you just have a set amount for each meal time? Your other option is to split the levemir dose in 2 many people have found that levemir does not last 24 hrs. |
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