Help

Hi

I am a 46 yr old male, diabetic for approx 17 years.
Been on Humalog and Humilin Isophgane for around 15 of those years.
My blood sugars were always high before breakfast and was told to just up my Isophane
which I was taking at dinnertime
They tried me Lantus about 4 months ago to0 see if it would make any difference but I just didn't feel right on it and asked to try animal insulin. Have now been on Hypurin Porcine Neutral and Isophane for 3 weeks. The Isophane twice a day.
I graduated from Dafne 2 weeks ago where I was on a 3:1 ratio. BS was runninjg high so they put me on a 4:1 last week and they are still running high, as you can see from my diary.
I decided this morning I would try a 5:1 as the 4:1 wasn't doing anything considewring the amountn of correction dosages.
No surprise to me this lunchtime I am higher despite taking a lot of insulin. I onjly had 1.5 cps for breakfast, 1 slice of wholemeal bread b(15g), boiled egg and tablspoon of mayonnaise.

I need some help and hopefully somneone here can advise me.
I am overweight and I hate it, hate being unfit, tired, depressed etc. My BMI is 43 (tested at hospital) and my waist size is 46",but I'm a nice guy lol. I use 5mm needles to inject into my stomach, should I maybe inject somewher else or use longer needles? Used to use 12mm ones and changed onto the 5mm 6 months ago.

Appreciate any help you kind folk can give me.

Best regards

Derek

I'm not sure what to say about the doses at the moment considering you've admitted to being overly dependant on your stomach area and being on animal insulin... but I will try.

Firstly, you should be circulating your injection sites for your own good - because you're so reliant on your stomach, this may be why you're not seeing any effects of the new doses you're taking. Lumps can develop that are not always easy to spot and once you have them, they can hinder your insulin release. This can result in unexpected hypos or highs.

It's almost always buttocks for my BI jabs but if I cannot, I do the sides of my thighs because this is where the fat is on the legs. I used to inject in the top/front of my thighs, but considering that's straight into muscle, this isn't a good practice which I soon got corrected when I did my DAFNE course.

For most meals I try to use my thighs or my stomach. If I have to inject in the same spot more than once during a day, I try to keep the injection sites away from each other. If I get desperate, I'll inject my arms, but I don't have much fat to inject there.

Try not to feel depressed, you can do this. The fact you're trying to work this all out is great progress! Don't be afraid to ask loved ones for help as well because sometimes they can help bring things into perspective as well.

I find it very interesting that most times you're around the 11-12 BG range. This does suggest to me that you need more BI assistance (to stop all that correcting) rather than ratio adjustment, but I am speaking as a human insulin user. I have never used animal insulin through my 21 odd years of being a type 1.

Considering you have also admitted to trying humalog for a day when you're on a different insulin - this will not help you because you should be leaving it at least two days of similar patterns to establish if it has worked for you. I'm not sure about animal insulin, but you must also realise that quite a few QA insulins can work up to 5 hours after you took the dose, so some of your blood tests are not giving you the clear picture you seek.

If you plan to adjust your BI, my nurse recommended that I leave it longer than 2 days to see any changes because, well, your body needs time to process it. She recommended a week to me, but others may disagree with this.

Also - avoid correcting after a hypo. When you hypo, your body's sensitivity to insulin increases and if you correct, can lead to another hypo (also known as the boomerang effect). I know you've not hypo'd again on these results you've posted, but you need to be aware of this.

I think that if you stop and give your body a chance to use the insulin you're giving it, and circulate those injection sites, things will become much clearer.
On that, trust me, you're not the first to have this trouble. I have been just as bad myself but luckily have managed to break some of the bad habit! ;)

Keep your chin up, you'll get there!
If it helps, look at getting hold of your DAFNE centre number so you can confirm yourself as a DAFNE graduate and get access to the DAFNE guidebook here on the DAFNE Online website if you don't have your own book. If you have any trouble with this (like, for example, you centre has shut down now), use the contact link at the bottom of this site page to contact the DAFNE Online team directly for assistance.

Hi JWo

Thanks for replying.
As I said I have been on Humalog for around 15 yrs and have always injected into the middle section of my body, I do rotae the injections always
I injected into the buttocks for lunchtime and will try other sites from now on as you coulkd be right about the lumps, although threre are none I can seen or feel.
I don't know if there is a long transition time from Humalog to anilmal insulin because I seem to need a lot more animal insulin.

Went to see the dsn who done the dafne course last Thursday and she reckoned I needed a 4:1 ratio and was very resistant to insulin. She said the BI was fine because the
BS's were consistent during the day, IOW lunch 12 and dinner still 12. Though it looks like she didn't take the corrections into consideration she did say I should go upto a max 0f 8 correcdtion and a 1:1. Looking at this mornings BG and amount of insulin and then higher at lunchtime is why I am so frustrated.
For lunchtime I had 3 cps and should have taken 15+7 correction/22 units total, I only took the 15 as I have never taken as much insulin as that and my BS's are never as high as this so was a bit para about hypoing.

I will phone the DSN tomorrow as they are on holiday and see what she said.
On another note I mentioned I was trying low carbto try and lose weigt, both her and the dietitian didn't like that one bit. I read the Atkins diet and was getting carbs from vegetables but shake their head, no, no, no carbs in vegetables yet i still needed insulin. Their reason for this was because my body was crying out for glucose so was sending a signal to my liver to produce glucose. Your thoughtrs on this would be much appreciated.


Best regards and have a nice day every day


Derek

it looks like you use similar correction rules for higher blood sugars, like me, the aim should be to get your morning as close to good as possible, with dawn phenomenon, this might not be possible/easy, you should try upping your evening dose until you go hypo during the night or in the morning...then you know your have passed the correct amount.

Another option I have tried and has given good results, is to move the evening BI dose forward a few hours, thus leaving more insulin in the system at the time of liver action....

just an idea, whatsd the action time of animal background.....

Okay, I've just done a bit of research on the Hypurin Porcine Neutral insulin... the DAFNE guidebook (pages 12 - 13) says it starts working within 30 minutes after the injection, peaks around 2-4 hours after and can affect you BGs up to 8 hours after. This does make things a bit awkward considering it doesn't work as efficiently as the QA Analogue Insulins (like I use.. I'm currently on Levemir, a split dose BI, and Humalog, a 5 hour working QA).

It's because you're correcting so much that I really don't think your BIs are fine personally. I don't understand why you've been advised to have a cap on how much correction you should do on that note - you should be looking at how much 1 QA unit takes you up or down by, not restricting you to some set guideline. Considering you're on HPN though, it might be better to speak to a specifically to a DAFNE nurse (not just a DSN team member) about this.

DAFNE is all about working out what your body specifically needs. DAFNE gives you so much power over your own condition and it can take some time to work out! There is some trial and error involved unfortunately.

Your BI is supposed to do most of the work so you're not having to correct so much.... unless you've taken the wrong insulin for your food, or have exercised, or are having a naturally produced high after a hypo because your liver released glucose to assist you. There can be other factors to consider like these.

Try not to be afraid of hypos while you're working out your requirements. Hypos are a good sign that you've hit the top limit of what insulin your body wants and this should prove very helpful to you (I'm not sure now because of the animal insulin QA). ...and I've just noticed that novorapidboi26 has also said this! Kudos! ^_^
When you do hypo due to a change, you're allowed to apply the one day rule which states for you to reverse the change you made, eg, if you put your ratio up for lunch but found you hypo'd within the insulin working time, it's safe to assume that it was probably caused by the ratio put up so put it back down so you don't hypo again the next day.

8 hours is such a long time to have to wait... so much over lap...

I understand about being uncomfortable with taking on so much insulin or being too afraid to let an old fear or habit go... It took me a year or two to stop myself from correcting after hypos because I was worried about going high. I was extremely worried about going high.

Oh dear. Um, I personally would never do the Atkins diet because it encourages ketone production. It works like when you leave your sugar levels high.
If you don't eat for long periods/do exercise, your body naturally produces a small (harmless) amount of ketones as a result of your body burning body fat. Ketones can be a harmful waste product of this particular process if in your system large quantities (it's why DAFNE gives us the sickday rules that are dependant on ketone amount) and diets like the Atkins encourages this larger production. It is a route I would avoid because it's harmful and not worth it IMO.

If you look at your DAFNE guidebook, it is recommended that you use exercise to your advantage to get your insulin intake down and as a result, lose weight (see page 47 particularly). When you exercise, your body uses insulin a lot more effectively so you need less insulin than usual. It may not give quick fire results, but it will be a much healthier option in the long run.. your insulin demand will also change as you exercise, often resulting in your body being a lot better user of insulin as a whole.

I can understand that with some carb free meals you still need insulin - you're not alone because I know there are others on this forum that also have to even count sausages (though I don't have that problem myself to be honest). As long as you don't go nuts with eating veg, the carbs are so slow releasing so you can usually get away with no insulin... but I know some people are different (such as the sausages situation) and find they do need the insulin with veg (though not much!).

You do clearly have quite a puzzle on your hands, I hope the DSN call tomorrow gives you some better answers. Best of luck!

...and to also add, as novorapidboi26 has hinted, you may need to consider the dawn phenomenon issue that some diabetics have, but considering your BGs are consistant from evening to morning, I'm not convinced that you need to look too much into the dawn phenomenon issue (but that's me).

In all seriousness, I do hope you can get some answers from your DAFNE team.

Hio

Thanks for your replies JWo and novorapidboi26.
I was taking 18 ||BI at 22.30 and thought i would try taking it esarlie, becauses when I was on Humilin Isophane I took that at dinnertime and it has the same properties as the
Porcine |Isophane. I reduced the amount to try and coincide with the totals I was recommended to take, 32 units.
As for low carbing there are a few succesful type 1 low carbers on the Diabetes UK forum, will have to ask them what they do.
I can't help associating carbs with weight gain because that is when all my weight has gone on, following the governments recommended diet. Despite always eating very low fat foods
the doctoirs woukd always think I was eating too high a fat diet.
As for exercise I did join a gym last year and was starting to enjoy it, but whether it was a coincidence or not, after they put me on Lantus I became really tired, no energy or motivation. This is only my 3rd week using aniimalo insulin and I am hoping I will have more energy soon, aklthough I probably need to sort out my dosages first.

Once again thank you so much for your inputs I really appreciate them.

Best regards

Derek

The high BGs, or unstable BG times you are working though right now, are probably encouraging your tiredness. Perhaps a friend will go with you to keep your spirits up?

Talking about food, it is also worth keeping in mind about portion sizes for your food because it is easy to over eat! People today dont take their time. Its all rush, rush and this means their bodies dont get a chance to make you feel full!

Can also consider eating more complex carbs in your diet because they help you feel full for longer.

At the end of the day, the only reason carbs stay on as fat is because not enough exercise is being done for the carbs eaten. Its your body's natural response to the amount eaten.

Crash dieting can make your body respond in negative ways, such as boomeranging weight because of sudden big change in diet. A lifestyle choice change works a lot better in the long run because they tend to be gradual changes, which in turn, stresses your body out a lot less.

Either way, its your body, your choice - no one elses. Take care, okay?

Hi JWo

thanks for your reply.
I know all about how to eat and what not to eat, always take my time eating etc. However it si different puting into practice all the time when you just seem to put weight on.
The last time I can remember being fit was about 5 years ago and the way I feel now I can't believe how really unfit I am. Your right I should take a mate to the gym with me but noone is interested, all got their own lives etc.
regarding my BSs, their better today, I took 20 units BI this morning and 14 units at 10 tonight. Never took any corrections today, other than 4 at dinnertine and my BS was 7.5 at bedtiime.
So I shall see how good it is tomorrow at breakfrast.

Best regards

Derek

Okay, I understand.
I'm glad to hear your sugar levels are hinting at starting to behave a bit more now - so have mine the past few days which is a relief! My body's regular hormonal changes really do mess my levels around - it's been hard working it all out! X(
Either way, we'll keep working at it and we'll get there. ;)
Best wishes!

Spoke too soon, 14.9 at breakfast!! Had 2 CPs and 4 units for bedtime snack, know it's the worst time to snack at bedtime but it';s a very hard habit to break, been doing it since childhood. Maybe shouldn't have taken insulin with the snack or taken more. If I was still on Humalog I would have taken none but don't know with this Porcine Neutral, seem to need a lot more than with Humalog.,