Discussion
Struggling with sugar control right now, and I think my diabetic nurses are a bit scared of what to do with me due to being on chemo, so think I'm going to ask for referral to specialist, but curious in the meantime as to what are 'usual' does.
I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
Forgive my reply, it is animal based I am sure there will be more appropriate help along soon!!
Do they test fructosamine levels in people? It is really useful to assess insulin/glucose control over the previous 2-3 weeks.
If an animal were still showing signs of excessive thirst/urination we would be increasing the insulin. The dose usually varies between 0.5iu-1iu/kg bid I think.
There are exceptions where control isn't gained such as pancreatic tumours, insulinomas and hepatomegaly but they're not common.
Do people get somogyi overswings? This can cause glucose readings to continue to read high even though insulin is being increased. If control isn't being gained we do hourly blood glucose readings. Sometimes half an her post injection if an overswing is suspected.
Carbs can cause an increase in insulin amounts in animals. Some specialist diets for animals work on being very very low carb content. This is more detrimental to cats than dogs so I have no idea how vital this is to people. Though I think insoluble fibre in the diet is meant to be good to slow down glucose release.
Apologies again for the animal connection I hope something in there helps a bit. I have no idea if you should change protocols/ treatments for diabetes due to chemo treatment though.
ETA just seen you had the hba test which is just starting to be used in animals, I think this is the more up to date test compared to fructosamine. I don't know if your reading was a good one or not sorry.
Do they test fructosamine levels in people? It is really useful to assess insulin/glucose control over the previous 2-3 weeks.
If an animal were still showing signs of excessive thirst/urination we would be increasing the insulin. The dose usually varies between 0.5iu-1iu/kg bid I think.
There are exceptions where control isn't gained such as pancreatic tumours, insulinomas and hepatomegaly but they're not common.
Do people get somogyi overswings? This can cause glucose readings to continue to read high even though insulin is being increased. If control isn't being gained we do hourly blood glucose readings. Sometimes half an her post injection if an overswing is suspected.
Carbs can cause an increase in insulin amounts in animals. Some specialist diets for animals work on being very very low carb content. This is more detrimental to cats than dogs so I have no idea how vital this is to people. Though I think insoluble fibre in the diet is meant to be good to slow down glucose release.
Apologies again for the animal connection I hope something in there helps a bit. I have no idea if you should change protocols/ treatments for diabetes due to chemo treatment though.
ETA just seen you had the hba test which is just starting to be used in animals, I think this is the more up to date test compared to fructosamine. I don't know if your reading was a good one or not sorry.
Edited by bexVN on Friday 15th March 22:37
Broomsticklady said:
Struggling with sugar control right now, and I think my diabetic nurses are a bit scared of what to do with me due to being on chemo, so think I'm going to ask for referral to specialist, but curious in the meantime as to what are 'usual' does.
I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
Sorry to hear of your dual problem and of course you should see a specialist. No usual doses for everyone is different. But the results i.e.sugar levels of 15 to 25 are very high, & HbA1C of 10 is well into diabetic territory and explains the thirst and suggest you need a higher level of the basal insulin (lantus) - perhaps.I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
What other diabetic medication are you on?
It may also help to change to an alternative to Insulin. I am not medically qualified and no doubt some medical professionals will be along shortly.
Broomsticklady said:
Struggling with sugar control right now, and I think my diabetic nurses are a bit scared of what to do with me due to being on chemo, so think I'm going to ask for referral to specialist, but curious in the meantime as to what are 'usual' does.
I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
I've got an employee with very very brittle, hard-to-control diabetes... definitely get the referral, the diabetes nurses are amazing for providing good care to relatively stable and straightforward patients, which you - well - ain't. I would guess that a bit of feedback from an endocrinologist who's familiar with chemo stuff in particular might be really very useful as it might change how well it works or is absorbed in all sorts of ways. I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
Have the nurses increased your dose in the meantime? If your sugar is always highish, really consistently, then that would normally lead to bumping up the doses a bit.
Hope you get this sussed, I know it can make you feel pretty pants if control really goes south, and the avoidance of feeling pants is kinda the whole point really isn't it?
Thanks guys - appreciate your input - particularly Bex - don't worry about animal comparison - some think I'm a cat in human form anyway due to my close familiars and my yearning for kittens not babies!! Interesting to her BVD that bad control is not uncommon. Taking no other diabetic drugs - been thru several including metformin and byetta before going onto insulin in hospital in 2009 when sugar levels got screwed by septicaemia, and had it since. Never been great sugar levels but asymptomatic before - now it's bothering me physically I need to do something I think.
Lousy day today - dry mouth doing my head and my knee ligament on what was my good leg is giving me a lot of pain and my former bad leg is fed up behaving as a good leg so they're both bad now - so rushing to the loo to pee due to the extra fluid is no fun - woe is me! But at least neither are cancer related ...
Lousy day today - dry mouth doing my head and my knee ligament on what was my good leg is giving me a lot of pain and my former bad leg is fed up behaving as a good leg so they're both bad now - so rushing to the loo to pee due to the extra fluid is no fun - woe is me! But at least neither are cancer related ...
That sounds high insulin doses.
I'm type 2 and active no other problems 18 units of ultratard over night and 18 of novarapid per day with meals (4 breakfast 4 lunch 10 dinner)
If I'm not well (cold, virus, stressed) my BS goes right up and I take whatever novarapid to bring it down, but monitering in small amounts. I will increase the ultratard slightly but just a couple of units.
I'm type 2 and active no other problems 18 units of ultratard over night and 18 of novarapid per day with meals (4 breakfast 4 lunch 10 dinner)
If I'm not well (cold, virus, stressed) my BS goes right up and I take whatever novarapid to bring it down, but monitering in small amounts. I will increase the ultratard slightly but just a couple of units.
I did the DAFNE course ( http://www.dafne.uk.com ) last year and the main thing it taught me is you need to get your background insulin level right before you can work on your Novorapid doses (edit: in case you're wondering, your liver is constantly releasing sugar and the background insulin is there to compensate for that. Then your novorapid is to cover what you actually eat)
Do you take the Lantus directly before bed? If so you may find its affect is wearing off by your evening meal the following day - the literature says it works for 24 hours, but insulin is never black and white (I'm on Lantus and very sensitive to it - if I take more than 6 units before bed on a normal sugar level I wake up with a hypo before 4am. Others are more resistant and need a hell of a lot more). The amount you're taking is probably not enough, but it might also be worth looking into taking it twice a day (I take 2x 4 units doses per day) - or switching to Levemir and doing the same, as it has a slightly shorter action time. By taking the long-acting insulin twice a day, 12 hours apart, you're ensuring a consistent level of background insulin is working at all times.
To test if you have the right level of background insulin, you should do a blood test before a carbohydrate-free meal, then test again a few hours later. If your background insulin is correct, your blood sugars won't have changed.
After you have the background sorted, then you can begin to work out what Novorapid doses work for you - you'll need to find how many units you need per unit of carbohydrate and how many m/mols one unit of insulin reduces over a four hour period. Sounds really nerdy and boring, but once it's sorted, you can begin to think about other things and eat anything you want. If you don't, you'll keep feeling as you are.
But what I've just said is a week-long course for Type 1 diabetics condensed into a couple of paragraphs. You definitely need a long chat with a specialist and regular checkups for a few months to get yourself on track. After that you should be able to self-manage.
Do you take the Lantus directly before bed? If so you may find its affect is wearing off by your evening meal the following day - the literature says it works for 24 hours, but insulin is never black and white (I'm on Lantus and very sensitive to it - if I take more than 6 units before bed on a normal sugar level I wake up with a hypo before 4am. Others are more resistant and need a hell of a lot more). The amount you're taking is probably not enough, but it might also be worth looking into taking it twice a day (I take 2x 4 units doses per day) - or switching to Levemir and doing the same, as it has a slightly shorter action time. By taking the long-acting insulin twice a day, 12 hours apart, you're ensuring a consistent level of background insulin is working at all times.
To test if you have the right level of background insulin, you should do a blood test before a carbohydrate-free meal, then test again a few hours later. If your background insulin is correct, your blood sugars won't have changed.
After you have the background sorted, then you can begin to work out what Novorapid doses work for you - you'll need to find how many units you need per unit of carbohydrate and how many m/mols one unit of insulin reduces over a four hour period. Sounds really nerdy and boring, but once it's sorted, you can begin to think about other things and eat anything you want. If you don't, you'll keep feeling as you are.
But what I've just said is a week-long course for Type 1 diabetics condensed into a couple of paragraphs. You definitely need a long chat with a specialist and regular checkups for a few months to get yourself on track. After that you should be able to self-manage.
Edited by zeduffman on Saturday 16th March 21:49
Mermaid said:
Broomsticklady said:
Struggling with sugar control right now, and I think my diabetic nurses are a bit scared of what to do with me due to being on chemo, so think I'm going to ask for referral to specialist, but curious in the meantime as to what are 'usual' does.
I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
Sorry to hear of your dual problem and of course you should see a specialist. No usual doses for everyone is different. But the results i.e.sugar levels of 15 to 25 are very high, & HbA1C of 10 is well into diabetic territory and explains the thirst and suggest you need a higher level of the basal insulin (lantus) - perhaps.I take 48 of lantus every night time, and 30 of novorapid with meals - I'm type 2 so have never been asked to assess carb levels or such like. Is this high? Sugar at moment between 15 and 25 whenever I test it - last HB1AL or whatever its called was about 10, 3 weeks ago. Probably wouldn't be worried too much - other greater things are likely to top me before the diabetes gets a look in - but it's making me drink water like a fish which means I'm running to the loo every 2 seconds and my mouth is so dry!!
What other diabetic medication are you on?
It may also help to change to an alternative to Insulin. I am not medically qualified and no doubt some medical professionals will be along shortly.
I would certainly agree you need to see a consultant. ASAP! Given your serious condition I would think that effective control will be difficult to sustain but certainly the levels you describe explain the thirst and other symptoms. I do wish you well and I do suggest immediate medical attention.
Those readings are extremely high and need bringing down, I would suggest speaking to a doctor ASAP, could you contact the out of hours GP tonight for advice?
Are you taking steroids at the moment? These will increase your blood glucose recordings.
I hope you get this under control soon
Are you taking steroids at the moment? These will increase your blood glucose recordings.
I hope you get this under control soon
Hi BSL
I've been diabetic for about 35 years now and am also currently on Lantus and Novorapid.
Firslty - lots of good people saying get a referral and see a consultant - please do this
A couple of things are staring out at me that doesn't seem right:
A) Lantus and Novorapid doses throughout a day a normally within a margin equal, your values seem to be out of kilter quite a bit
B) Yes the results are very high but also the variation in the testing results is quite a large swing
So a couple of questions would be:
1) are you varying injection sites?
When lumps start to appear under the skin, which they do with repeated injections, and they do go away, the impact of the lumps is that it delays, blocks or stalls the insulin getting in. When this happens it is either having no affect at all or its stacking up with the following injection
2) When are you testing? Is it pre or post meals? if post meals, how long afterwards?
The general rule of thumb is if your blood glucose levels are high before a meal then the Lantus dose is too low, if the level is too high 2 hours after a meal the Novorapid levels are too low
However given the volumes of insulin you are using without knowing how much you weigh, lifestyle, diet etc it's hard to judge. However I've always been told its about 1 unit of Novorapid per 10g of carbohydrate as stated on the nutritional information section on the food you are eating.
Bascially 1 slice of standard white bread = 1 unit
Please note these details are all relevant to me, given my size, weight, activity schedule etc However they have been borne out of the info from the consultants.
I've been diabetic for about 35 years now and am also currently on Lantus and Novorapid.
Firslty - lots of good people saying get a referral and see a consultant - please do this
A couple of things are staring out at me that doesn't seem right:
A) Lantus and Novorapid doses throughout a day a normally within a margin equal, your values seem to be out of kilter quite a bit
B) Yes the results are very high but also the variation in the testing results is quite a large swing
So a couple of questions would be:
1) are you varying injection sites?
When lumps start to appear under the skin, which they do with repeated injections, and they do go away, the impact of the lumps is that it delays, blocks or stalls the insulin getting in. When this happens it is either having no affect at all or its stacking up with the following injection
2) When are you testing? Is it pre or post meals? if post meals, how long afterwards?
The general rule of thumb is if your blood glucose levels are high before a meal then the Lantus dose is too low, if the level is too high 2 hours after a meal the Novorapid levels are too low
However given the volumes of insulin you are using without knowing how much you weigh, lifestyle, diet etc it's hard to judge. However I've always been told its about 1 unit of Novorapid per 10g of carbohydrate as stated on the nutritional information section on the food you are eating.
Bascially 1 slice of standard white bread = 1 unit
Please note these details are all relevant to me, given my size, weight, activity schedule etc However they have been borne out of the info from the consultants.
Justr feeling so fed up. It seems the iller you are the stronger you have to be to get anywhere. Had a call in for a diabetic nurse to ring me - there's 3 of them so one ought to be able to. Got call from another nurse whom I don't know and who doesn't know me. Explained situation and some of history. Will get diabetic specialist doctor to ring you. She rings back 3 hours later - he's busy, has no appointments til next week but as a special favour will ring you tomorrow. Be aware referrals take weeks if not months to be seen. Thanks!!
Rang local private BMI hospital - they don't have a diabetic specialist - nearest is Scumdee - sorry Dundee - 90 minutes away. In despair rang chemo nurse, cos it will be blamed on chemo - they're already saying that. This chemo which is used long term while it works for secondary breast and bowel cancer doesn't have a problem with diabetes - a few do but not this one. He however has at least arranged me a call with a specialist diabetic nurse tomorrow am who will have a diabetic doctor on hand. Alleluia!! But I don't really have the strength to go thru this - I'm in tears right now at all the fighting and pushing I've had to do and the attitudes I've had (except Danny my chemo nurse).
To answer some questions, avoiding steroids so far. Injection sites are very varied - there's lots of me to chose from and I never get 'lumps'. I inject lantus with evening meal novorapid before food and test blood before food too. And first and last thing.
Back to bed now to rest knee again - it doesn't like sitting normally. Morphine lyrica 1800mg nurofen and 4000mg paracetamol not holding the b
d! See what another GP can suggest tomorrow - at least this one won't fob me off.
Rang local private BMI hospital - they don't have a diabetic specialist - nearest is Scumdee - sorry Dundee - 90 minutes away. In despair rang chemo nurse, cos it will be blamed on chemo - they're already saying that. This chemo which is used long term while it works for secondary breast and bowel cancer doesn't have a problem with diabetes - a few do but not this one. He however has at least arranged me a call with a specialist diabetic nurse tomorrow am who will have a diabetic doctor on hand. Alleluia!! But I don't really have the strength to go thru this - I'm in tears right now at all the fighting and pushing I've had to do and the attitudes I've had (except Danny my chemo nurse).
To answer some questions, avoiding steroids so far. Injection sites are very varied - there's lots of me to chose from and I never get 'lumps'. I inject lantus with evening meal novorapid before food and test blood before food too. And first and last thing.
Back to bed now to rest knee again - it doesn't like sitting normally. Morphine lyrica 1800mg nurofen and 4000mg paracetamol not holding the b
d! See what another GP can suggest tomorrow - at least this one won't fob me off. Mermaid said:
Broomsticklady said:
... See what another GP can suggest tomorrow - at least this one won't fob me off.
Sorry you have been messed around. A good GP can make all the difference, and hope it does for you.Gassing Station | Health Matters | Top of Page | What's New | My Stuff