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Offline Victoria

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is 6 mmols rise after meals ok
« on: 17 January 2018, 06:24:20 PM »
Hi everyone I have not been on for a while
Just got libre and so can see my mealtime rise is apx 6 although by next meal is okayish again
Asked dns if I needed a daytime basal dose as at the mo only night dose which is spot on but she says no just to raise bolus so as always had good advise here back for your view please
Am on Levemir so not longer lasting than apx 10-12 hours
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Offline Alan

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Re: is 6 mmols rise after meals ok
« Reply #1 on: 17 January 2018, 10:39:12 PM »
Hi everyone I have not been on for a while
Just got libre and so can see my mealtime rise is apx 6 although by next meal is okayish again
Asked dns if I needed a daytime basal dose as at the mo only night dose which is spot on but she says no just to raise bolus so as always had good advise here back for your view please
Am on Levemir so not longer lasting than apx 10-12 hours

Just wondering. What is usually on the menu in terms of carb portions? Forgive my ailing memory - are you T1 or T2?
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Slow Cooked Beef Brisket)
Born Under a Wandering Star (Surviving Long-haul Flights in Cattle Class)

Offline sedge

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Re: is 6 mmols rise after meals ok
« Reply #2 on: 17 January 2018, 10:41:13 PM »
What did she mean 'to raise bolus' Victoria?  Bolusing is what 'fast acting' insulin is used for before eating - Levemir etc are basal insulins and as far as I know - you should NOT use basal insulin to take care of meals.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: is 6 mmols rise after meals ok
« Reply #3 on: 17 January 2018, 11:17:45 PM »
Hiya Victoria and welcome back

(For Alan's info Victoria is T2 on insulin... we have our doubts from previous posts as to whether Victoria is producing any insulin at all or only a bit)

As I read it you are on one dose of Levemir in the evening and you are thinking it only lasts 10 to 12 hours.  So next day you bolus with Novorapid for your meals, you spike up to 6mmol after the meal and drop back down before the next meal (as witnessed on your Libre sensor).  Your nurse is suggesting more bolus per meal.  I would not do that as a first port of call because  if you are dropping back to normal before the next meal then increasing your bolus may make you hypo.  IMHO the very first thing I would do is a basal test, which means not eating for a period to see if your Levemir is indeed only lasting 10 - 12 hours.  With the Libre sensor that is a piece of cake to do.  See instructions about 2/3 of the way down this page where it says "how to discover or adjust your basal dose".

It may also not even be that.  For a lot of people Novorapid (or any bolus) doesn't kick in fast enough and simply adjusting the timing that you bolus may help.  Lots of people find bolussing in advance by anything from 15 minutes to 30 minutes will iron out that spike.

However, I reiterate, test your basal first.  If your basal isn't right no amount of fiddling with bolusses will work!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Victoria

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Re: is 6 mmols rise after meals ok
« Reply #4 on: 18 January 2018, 09:55:36 AM »
email re post not getting through so only just logged in and read replys
This morning I increased breakfast bolus and within the hour had risen from 6.2 to 13 .4 so had 20 min fast walk and am now down to 8.3
Will test daytime basal ,sorry to be thick but if no taking basal in the day at the mo what will that tell me ?
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Offline sedge

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Re: is 6 mmols rise after meals ok
« Reply #5 on: 18 January 2018, 10:38:23 AM »
I'm sorry - I was obviously too tired last night to make sense, so ignore my first post!

You don't eat anything for X number of hours at a time when you are basal testing, hence you don't have any Novorapid.

Ergo the only thing affecting your BG is the remaining Levemir.  Read the instructions!  Basal insulin is intended to keep your BG at an even keel all day and all night, in the absence of food and unusual, violent exercise or anything else different.  Levemir was never intended to actually last 24 hours in the first place so it would hardly be a surprise if you need two jabs a day!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Victoria

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Re: is 6 mmols rise after meals ok
« Reply #6 on: 18 January 2018, 10:50:22 AM »
That was the basis of question ,knowing basal taken at 9pm only lasts max prob 10 hours it made sense to me to take a daytime dose also but dns having said dont do that but raise breakfast ratio of bolus just made me doubt it.Extra info at each meal bgs okay for short while then rise rapidly hence me wondering about having daytime basal to keep things more even
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Offline sedge

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Re: is 6 mmols rise after meals ok
« Reply #7 on: 18 January 2018, 02:43:24 PM »
Absolutely Victoria - have you ever checked how long your Levemir could be expected to last given the dosage and your weight on the complicated-looking graph on the website?

http://www.diabetes-support.org.uk/info/?page_id=428

Your dose of Levemir divided by your weight in kgs = a rate per kg.  Follow your rate per kg up the upright axis, then follow the wavy line along the horizontal one.  It is true that when I was on it, my morning dose did not expire entirely until about 18-20 hours later - however, the amount left of it, still active, was not by then enough to do very much 'useful' so a top-up of a much smaller dose than the morning one, in the evening at about 14/15 hours later, saw me through the night pretty stable.  Hence I took 14u morning as soon as I got up, and 4u at approx. 9.00-10.00 at night.  Other people need more at night and less during the late afternoon evening and night.  It's very very rare to find anyone with a 12 hour, 50/50 split in total dosage.

Because none of the so called fast acting insulins (Novorapid, Humalog, Apidra) are that fast AND they also remain active quite strongly for MUCH longer than 2 hours - if you try to correct what is really the basal insulin's job with bolus insulin as the nurse suggests - the potential for hypos during the remaining 'life' of that increased bolus, will increase A Lot until another at least 2 if not 3 hours have passed - ie 4-5 hours after that meal.

Far far more gentle on the body to 'drip' small releases of insulin in gradually, which is in fact how a normal pancreas works in the first place!

(I think someone has told Nursie that Levemir lasts all day OR that all T2s have enough insulin production of their own to cover any gaps.  Or both.  Unfortunately as WE all know all diabetics what ever Type, race, creed or colour they happen to be, don't do anything 'the same' !  LOL)
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Victoria

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Re: is 6 mmols rise after meals ok
« Reply #8 on: 18 January 2018, 03:02:06 PM »
Thanks Jenny my brain got a workout but graph won LOL
Going to start with Patti,s suggestion ie take insulin a bit beforehand and if that fails going to add a bit of basal to see how that works  ???
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Dec hba1c 63 April 53

Offline Pattidevans

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Re: is 6 mmols rise after meals ok
« Reply #9 on: 18 January 2018, 05:25:38 PM »
Victoria

What it seems like you are doing at the moment is using your bolus to prop up your basal.

So, going back to testing your basal.  If you get up and have nothing to eat, nor a drink with milk in it, it should show you on your Libre when exactly your Levemir is running out  because the line will start to rise.  If you then want to have another dose of Levemir you will need to administer it approx 1.5 to 2 hours before that line starts to rise.  Start with a small dose and build up slowly.  That will give you important information that you can base every other tweak and change on.  Once your Levemir is holding you steady you can see then how your bolusses of Novorapid are affecting you.

However, Novorapid is not instant, it takes up to 45 minutes to kick in for some people.  Now you have the Libre you can see that too.  For example take your breakfast dose and eat nothing, watch your Libre line, scanning frequently until you see the line start to go down at which point that's when the Novorapid has started working and that will tell you when the optimum time to bolus ahead will be.  It's all so much easier with a Libre sensor!  It takes all the guesswork out of things.

Quote
Extra info at each meal bgs okay for short while then rise rapidly

That's the amount of time the food takes to be digested and start entering your blood stream.

Hope this helps.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Victoria

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Re: is 6 mmols rise after meals ok
« Reply #10 on: 18 January 2018, 05:29:30 PM »
Patti
If I get up at 7am bgs 6.3 ish but if I get up at 8am its 7.8 -8.4 ish so basal has already run out im thinking
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Dec hba1c 63 April 53

Offline sedge

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Re: is 6 mmols rise after meals ok
« Reply #11 on: 18 January 2018, 08:08:02 PM »
Ah - perfect example of Dawn Phenomenon.

If you have basal at bedtime - yep you'll get that.  If you increase basal dose at bedtime, it could quite possibly send you hypo in the early hours - BUT!! firstly, roughly what's your BG when you actually go to bed, and how many hours later is your lowest BG during the night and how low is it?  presumably you know this from your recent Libre graphs?
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Alan

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Re: is 6 mmols rise after meals ok
« Reply #12 on: 18 January 2018, 09:54:28 PM »
Hiya Victoria and welcome back

(For Alan's info Victoria is T2 on insulin... we have our doubts from previous posts as to whether Victoria is producing any insulin at all or only a bit)

Thanks Patti. I won't comment on insulin regimens but I am still wondering about the menu. Bernstein's sage advice comes to mind: The Laws of Small Numbers
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Slow Cooked Beef Brisket)
Born Under a Wandering Star (Surviving Long-haul Flights in Cattle Class)

Offline Pattidevans

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Re: is 6 mmols rise after meals ok
« Reply #13 on: 18 January 2018, 11:53:26 PM »
Ahhh  OK Alan quite right.  Victoria what is breakfast?  How many carbs and what kind of carbs?
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Victoria

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Re: is 6 mmols rise after meals ok
« Reply #14 on: 19 January 2018, 10:15:28 AM »
Jenny bedtime 6.6
3am 6.3
6.45 am 7.
Patti
always oats 27gm carb 3.5 units insulin (morning always lower ratio)
Gave insulin 30 mins early today but rose from bg 7 to bg 13.5 in an hour
Now its 3 hours later and am back to 7.3 so maybe this rise is just par for the course for me
novorapid
indapamide
Levemir

Dec hba1c 63 April 53