# hello to all.



## stargatefan (Sep 20, 2011)

Hi,
i'm new to this forum but i am certainly no stranger to forums.

i was diagnosed Type 1 fourteen years ago and have battled highs and lows ever since. i am soon to be speaking with a diabetes nurse and showing my blood glucose levels over the last month. this is purely to try to figure out why i do not get low alarm signals!
so i signed up to see if there are others with the same problem and what solutions they found... plus any other information i can gain.


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## am64 (Sep 20, 2011)

hi and welcome to the forum have a good look around and remember no question is regarded silly here x


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## Northerner (Sep 20, 2011)

Hi, welcome to the forum  We do have some members who suffer from hypo unawareness, so I am sure you will be able to swap notes with them. Has your nurse suggested possibly using a CGMS (Continuous Glucose Monitoring System) to try and spot any patterns in your levels? What insulin regime are you on? I find that (like most people) if I have been on the low side for a while then my symptoms only appear at very low levels - I had a 2.4 the other day and was only just starting to experience symptoms and feeling a bit 'odd'. The general advice in such circumstances is to run your levels higher than normal for a while so you react more readily when you fall below what your body and brain are used to. Some people have found that a pump helps.

Have you investigated what might be causing your highs? Please ask any questions you may have, there is a wealth of experience here and often it is the most recently diagnosed who can help most as they are more up to date with current thinking, treatments and techniques


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## Steff (Sep 20, 2011)

Hi there stargate and a warm welcome to the forum


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## Robster65 (Sep 20, 2011)

Hi stargatefan. Welcome 

Hopefully, if you can get to grips with your BGs, with our help of course, then your hypo recognition will return. 

Rob


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## stargatefan (Sep 20, 2011)

thanks for the welcome.

yeah im currently investigating why i am unaware. (please no jokes here)
im generally unaware of most things let alone my glucose levels.

my lowest test yet was while i was cooking my dinner, i was a bit sweaty.
it was 0.7 i was fine, coherent and finished cooking my dinner then ate it.
i thought it best to jab after.

my nurse suggested that it could be that i am having hypos while asleep so this _could_ be a reason for the unawareness!

the highest i have tested myself was 28.0 but i don't get much of a hyper awareness apart from anywhere above 9.0 i get a metallic smell in my nose i believe that is from the sense of smell reacting to a slightly higher blood pressure.

prepare yourselves for silly questions.


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## Robster65 (Sep 20, 2011)

What regime are you on ? eg. MDI, pumping, etc 

And what sorts of doses/ratios work for you ?

Rob


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## stargatefan (Sep 20, 2011)

i am on Novorapid injections from a cartridge pen 3 a day before meals.
then Lantus at night.

breakfast i jab around 12-14 units depending on the glucose result.
Lunchtime i jab around 12-14 ------------ditto-----------
dinnertime i jab around 14-18 ------------ditto-----------

night jab is between 18-24 units depending on my night test.

i don't think i am very active during the day but i am in the process of decorating my bathroom. i am currently unemployed.


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## Northerner (Sep 20, 2011)

stargatefan said:


> i am on Novorapid injections from a cartridge pen 3 a day before meals.
> then Lantus at night.
> 
> breakfast i jab around 12-14 units depending on the glucose result.
> ...



What you say here suggests that you don't inject according to the carb content of your food but your levels before eating. Have you ever been on a 'carb-counting' course, such as DAFNE (Dose Adjustment For Normal Eating)? If not, then you should definitely raise this with your nurse. I'd also suggest starting a food diary, detailing everything you are eating and including the amount (in grams) of carbohydrate. Do you ever test after eating to see what effect the food has had on you?


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## teapot8910 (Sep 20, 2011)

Welcome to the forum stargatefan 

Further to Alan's post about Carb Counting, if you don't already have it the Visual Carbs & Cals book is a big help and they now do a pocket version too


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## stargatefan (Sep 20, 2011)

i try to inject units to encompass the glucose level just tested and the content of food. i will definitely mention carb counting to the nurse to see what she has to offer. im sure many diabetics can relate to me with this. when i go through these meetings its more they are reading from a script rather than actually looking at the person in the chair. so any words i can mention that breaks them out of the rigmarole and see that i could do with some help will be appreciated.

my levels seem to bounce from low to high like the blade of a saw rather than curve like a wave. that may be because i havent figured out how to draw graphs correctly in M$ excel...


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## Northerner (Sep 20, 2011)

stargatefan said:


> i try to inject units to encompass the glucose level just tested and the content of food. i will definitely mention carb counting to the nurse to see what she has to offer. im sure many diabetics can relate to me with this. when i go through these meetings its more they are reading from a script rather than actually looking at the person in the chair. so any words i can mention that breaks them out of the rigmarole and see that i could do with some help will be appreciated.
> 
> my levels seem to bounce from low to high like the blade of a saw rather than curve like a wave. that may be because i havent figured out how to draw graphs correctly in M$ excel...



There are a lot of refinements you can make to improve your post-meal glucose levels. Courses like DAFNE teach you about ratios i.e. the amount of insulin you inject according to the carb content of food, and also that these ratios can change throughout the day - for example, I need four times as much insulin per 10g carbs for breakfast than I do for my evening meal, so it is far from constant through the day. I also inject 15-30 minutes prior to eating to give my insulin a chance to get working as the food starts to digest and this has improved my post meal levels a great deal. 

You might also want to consider your lantus doses and perhaps doing some 'basal testing', which determines if the amount of lantus you are talking is set correctly - another good question to test the knowledge of your nurse! If he/she hasn't heard of it then you might question the level of knowledge...

Do you have software for your meter that can do the graphs and statistics for you? What meter do you usually use, and how many times a day do you test?


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## stargatefan (Sep 20, 2011)

just about to sit down and eat my dinner now... just pasta and a sauce.
pre meal test is 2.1 so i tend to jab after eating as im afraid to fit and jab the fork in my head. 

i really should fill in some history about myself further. let me eat first and swear at the news for a bit and then i'll post a little more.

bon appetit.


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## Northerner (Sep 20, 2011)

stargatefan said:


> just about to sit down and eat my dinner now... just pasta and a sauce.
> pre meal test is 2.1 so i tend to jab after eating as im afraid to fit and jab the fork in my head.
> 
> i really should fill in some history about myself further. let me eat first and swear at the news for a bit and then i'll post a little more.
> ...



If I was 2.1 before eating I would have some fast sugar like jelly babies or full-sugar coke first and wait until levels started to rise. There's a danger that your meal will be too slow at bringing you levels up and they may fall further first. From what you have said, I'm guessing a 2.1 has little in the way of symptoms? How long since your previous meal? If over 4 hours, this would suggest your lantus dose might be too high.


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## stargatefan (Sep 20, 2011)

Thanks for your time on this by the way. (humbled)

yeah 2.1 has no signs with me what so ever. it could continue to fall and i would be none the wiser.
i think you are right about lantus. i know very little of how it works apart from in 2007 a nurse gave me the new pen and said "this is your new night jab".

so in 2007 i was diagnosed with mouth cancer and spent 2 years in and out of hospital having operations and radiotherapy.
im fine now, i think, let me look up 'fine' in the dictionary... 
so having mouth cancer makes it difficult to eat. when in hospital they put you straight on a sliding scale for insulin then right after that they hook up a liquid feed tube for nasogastric intubation. sounds great until you have a look at the liquid food, being pumped into you, which is basically sugar. so my levels went to hell in hospital. since i have been 'better' i still use a liquid supplement food as i only have 1 parotid(saliva) gland and i cant open my mouth very far.
So want to know what is in the liquid food supplement? its lactose based right?
so when i eat lunch it is supplemented with an high fiber liquid feed. that is why my lunch jab unit is quite big.



> How long since your previous meal?


it was about 4 hours. so if you say that is possibly something to do with the lantus jab i shall take that information to the appointment with me too.
i prefer to go with questions.

the other problem i have is with fast sugars. perhaps it is something to with my metabolism but fast sugars can take me from low to double figures in minutes.

so personal info :
Sex = male
Age = 40
Height = 5'7" / 172cm
Weight = 11 stone / 70kg

can you give me any more information on this carb counting diet?



> Do you have software for your meter that can do the graphs and statistics for you? What meter do you usually use, and how many times a day do you test?


i use an Ascensia Contour glucose tester its awesome, 5 seconds, tiny amount of blood required etc etc.
i test about 4 times a day varying before and after meals.
it didnt come with any software or any cables to attach it to a pc to download it.
i am quite proficient with spreadsheets and have a template to generate a decent graph to show me where the problems are (n't).
just doing a test now for the after dinner result = 6.8 (and climbing fast)

thanks for any info or loaded questions you can give me to take to my appointment.


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## Northerner (Sep 20, 2011)

Very sorry to hear about the mouth cancer, I can see that that can present extra problems for you. My Dad had mouth cancer too, but has been thankfully 'clear' now for over 20 years. It would certainly be worth finding out what the carb/sugar content of the liquid supplement food is. It may be possible to reduce any post-meal spikes by changing the timing of your insulin - this can take a lot of trial and error, but is worth it in the long run. I usually inject 15-30 minutes prior to eating, but obviously wouldn't do this if I was low like you were.

We sound very similar in a lot of ways! I am a little older than you (52) but it sounds like we are a similar build/height/weight. This is interesting because the doses you give are very similar to what I started on when first diagnosed 3+ years ago. I found that the lantus had been set way too high for me (20 units originally, causing me to wake with night hypos or very low in the morning). Eventually, I reduced it to around 8 units, although it has been as low as 3! My novorapid has also reduced, although not as significantly as the lantus.

Carb counting isn't a diet, just a way of calculating insulin doses according to what you want to eat. There is an online version of the course here if you want to learn more about it: http://www.bdec-e-learning.com/ and you should definitely ask your nurse about what might be available in your area.

Regarding your meter - most companies allow you to register the meter which then gives you access to free batteries, logbooks and control solution, and usually free software and cables, although some companies may charge around ?20 for this.


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## trophywench (Sep 20, 2011)

Hiya

Couple more questions !  Are you under stress?  Are you now or have you been, taking steroids for anything? - both of those are a pig.  

When my BG was doing the Hi/LO shuffle (caused by stress, over-correcting hypos, the ups and downs causing recative ups and downs (where a hypo is followed by reactive hyper-glycaemima and a high is followed by reactive hypoglycaemia) we worked out a strategy which involved the number 7.0 LOL

Never correct more than to bring my BG back down to 7.0.
Never correct unless my BG was over 7.0.  As 1 unit of Novorapid brings me down by 3.0, that meant I had to be - well at least - 9.5 before I corrected.

I only learned the last bit, by actually participating on a Carb Counting course.  Essential piece of info, together with '10g of Carb increases my BG by 3.0'  for anyone on insulin, IMHO

Yes it's counter to everything we are told, must keep your BG under this that or the other, must have an A1c under this blah blah - but it worked actually - and worked pretty quick.  I stabilised at a much higher level than I was currently striving to achieve.  My hypo symptoms returned.  Then we started gradually knocking mumbers off the levels to correct down to, etc.  All in all took 6 months.  That's nothing out of your whole life!

And since then I have never had AWOL hypo symptoms.

There could be other things at work -  eg Thyroid?  Addisons? ........


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## stargatefan (Sep 21, 2011)

trophywench said:


> Couple more questions !  Are you under stress?  Are you now or have you been, taking steroids for anything?



i dont really suffer from stress. thankfully, i can shrug off anything and deal with it.
i am treating a skin condition on my hand and the cream says (steroid potency: mild) so that may be something.
its strange with diabetes how something slight for one person can affect another considerably. it's a case of finding what triggers ones hi/lo Pogo.



trophywench said:


> When my BG was doing the Hi/LO shuffle (caused by stress, over-correcting hypos, the ups and downs causing recative ups and downs (where a hypo is followed by reactive hyper-glycaemima and a high is followed by reactive hypoglycaemia) we worked out a strategy which involved the number 7.0 LOL



sounds like great advice as if i start getting high or low readings i react by changing my dose or eating fast sugars which is, in fact, counter productive.
7 seems a decent number, a nice safe zone above and below it.



Northerner said:


> I usually inject 15-30 minutes prior to eating, but obviously wouldn't do this if I was low like you were.



This '15-30 minute' window is that roughly how long Novorapid takes to kick in to gear?
or is insulin reaction times subject to each individual too?
i use an 8mm needle on my pen and my nurse asked if i wanted 4mm needles. i declined as 8mm is fine for me, i think she saw that i dont have a lot 'spare' for injections.
i use injection sites in my belly (for all 3 day/meal jabs) and at night i inject into the gluteus maximus  i dislike using arms and legs as it smarts there. 

another diabetic told me, the other day, that your day jabs should be done in the gluteus maximus. im just guessing that we all have our own injection areas.
unsure exactly why but im trying to find more and more diplomatic ways of saying 'bum'. 
perhaps after the diabetes nurse i can visit a psychologist.

im still reading through posts and picking up loads of information which is great news for me.


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## Robster65 (Sep 21, 2011)

Soemthing to watch for, when resitricting injection sites, is fatty lumps or areas which are slightly more padded. If you inject in the same sort of area too often, over time you will develop fatty lumps under the skin, which feels comfortable to inject into, so you keep doing it there, ad infinitum. Trouble is, the insulin then comes in fits and starts instead of a nice, steady trickle.

If you could introduce your arms or legs, it would possibly help with absorption. 

I was told at a recent visit to the DSN (which tallies with advice I had years ago) that the major muscles in the thighs and buttocks can also delay absorption. I now do bolus (humalog) in abdomen and arms and basal (lantus) in thighs and buttocks.

And just to get you on road to recovery. BUM. 

Rob


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## stargatefan (Sep 22, 2011)

ok,

back from seeing the diabetic goddess. 
i never asked her if she was married... 
she has booked me on a carb counting course but they are really busy and full.
there must be loads of diabetics given this course. so i am guessing it is really beneficial.
i think she wanted to keep my graph of blood test results so she can make a poster like "this is how NOT to handle your glucose levels".
i need to be more strict on my diet and have been told to bring my lantus injection to a much earlier time. just after dinner! so about 6-7pm.
this is because it sits in the background giving a slow release of insulin over 20-22 hours. so when my lantus starts dropping off it will be in the afternoon rather than the evening after my evening meal (which is the largest meal of my day).
she dropped a little warning that if i turn up to my next meeting showing low blood sugars that she will have to phone the DVLA and get my drivers license taken away. that would be ... Catastrophic for me. its possible that she said that to scare me into a much tighter controlling regime.

all i can say is bring on this carbohydrate counting course. as looking at my food it is fairly heavy in carbs. pasta, potatoes and bread as well as these lactose based food supplements.

still... all scary stuff for me personally so i thought it might be best to get some telephone numbers in the waiting room for any of these volunteer type support people. now all i have to do is pluck up the courage and call them.

she did give me a new glucose meter to try out called "Freestyle Insulinx" and has a nice usb cable to download the results. there are 2 modes to the device "simple" and "advanced" or "Geek!" as i like to call it.  
freestyle-insulinx
it helps to calculate insulin doses depending on the test result and the meal you are about to eat.
the jury is out on this device.
ill let you know how i get on with it. i'll probably be using my old Bayer Contour at the same time to settle my nerves... lol.

last of all... my HbA1c was 7.5% so it has risen by 0.2 in a month.

Goodbye favourite foods and alcohol. sniff.

(hello diabetes support---Recipes )


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## Andy HB (Sep 22, 2011)

stargatefan said:


> back from seeing the diabetic goddess.
> i never asked her if she was married...



Give her a call on the pretext that you need to check how to use the new meter?

Andy (Agony Uncle ... but for other reasons .... just ask my nephews and nieces) HB

p.s. A very, very late welcome to the forum by the way!


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## stargatefan (Sep 22, 2011)

Andy HB said:


> Give her a call on the pretext that you need to check how to use the new meter?



and show off my injection sites too, yeah?! 


thanks for the welcome.

already been made to feel at home buy the gang!


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## trophywench (Sep 22, 2011)

A bum is a bum.  We all have one (as opposed to bellies where some of us have at least 2 if not more) and the word is much quicker to both type and say than the other eg Does my gluteus maximus look big in this?

Re DVLA - you've had the gypsies warning mate and you need to take heed.  If you don't have hypo warnings, then you ARE unsafe to drive whatever you might think and if a medic who knows this about you doesn't tell the DVLA then they are risking knowing that and your having an accident where you maim or kill somebody else.  Frankly I think she's bent the rules by not telling them anyway and I have no sympathy for people who know this and still drive.  I know there are others on this board who feel the same as I do.  May seem harsh, am not trying to fall out, but that's the facts.

So like it or lump it and I'll certainly still try and help where I think I can, and I'm sure evrone else will too - as long as you take it on board and treat this as seriously as you ought.

Don't drive under 5, wait for 45 mins after you get up to 5 before you get in the car.  If you are in the car, then take the keys out and sit in the passenger seat if you can't get out and go sit somewhere else for 45 mins.  Test at least 2 hourly, pref more frequently in your case at the moment and be prepared to have your meter taken off you to provide evidence of testing, should you be involved in an accident.

If you lose your licence, it's 12 months until you can re-apply by which time there better be irrefutable medical evidence that this little glitch is cured, otherwise you are wasting your time.  And it could take months and months and months before the DVLA let you know one way ot the other.

Right then, now read this  http://www.diabetes-support.org.uk/info/?page_id=120  and then having done the basal testing and got that right, move on to carb counting training and the BDEC website you've already had a link to http://213.106.147.101/bdec2/index.shtml  click on e-Learning on the RHS.

By the time you get on that carb counting course - you should be an expert !

Good luck.


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## trophywench (Sep 22, 2011)

PS  Two things - I'd like to know how well the Insulinx works in practice, I haven't seen a review of it yet on here or my other forum.  However in theory it's similar to the Accu-Chek Expert which I and other Roche pumpers get anyway as part of the package, and also various other forum members use the Expert with MDI.  And it has it's little idiosyncracies and it ain't a mind-reader, but it's great all in all.

Like it didn't guess this morning I was having a reactive hyper when I got up (11.7)  and neither did I at the time! - so it told me correct as well as cover my breakfast.  I did that and subsequently went hypo.  Breakfast had gone straight to Mr Liver to replace it's stores.  Never touched the sides of my overall BG.  

Be aware that if you have iffy sites - and I can promise you you will have some! and the insulin you put in em from time to time which didn't appear to have worked very well at the time, hasn't already decided to come out and work already, it can hang round there for up to 12 years.  And then suddenly hit you ......

If anyone ever told you diabetes wasn't complicated, then they were lying .......


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## Andy HB (Sep 22, 2011)

trophywench said:


> Be aware that if you have iffy sites - and I can promise you you will have some! and the insulin you put in em from time to time which didn't appear to have worked very well at the time, hasn't already decided to come out and work already, it can hang round there for up to 12 years.  And then suddenly hit you ......



Sorry for hijacking the thread, but can insulin really last 12 years in an injection site?!

Andy


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## stargatefan (Sep 22, 2011)

trophywench said:


> So like it or lump it and I'll certainly still try and help where I think I can, and I'm sure evrone else will too - as long as you take it on board and treat this as seriously as you ought.



trust me, no one is taking this more seriously than me.
i always test before getting in a car i have a bag of jelly babes in the car all the time (they go out of date before i need them but they are always there).

i dont drive much at all maybe once or twice a week (im redundant at the moment).

so as im out of work with time on my hands i can for the first time in 14 years sort out my diabetes.

i had surgery a couple of years ago and they needed skin grafts which they took from my stomach so i do my jabs above and below the scars from belly button to love handle. this is because a friend of mine, who has been type1 since age 6, said that he has build ups of tougher skin where he injected regularly as a child because it was less painful.
i dont want that. and so manage to keep the injection zones well apart.

your warning concerning the DVLA is well heeded.
but seriously, nobody is more concerned about this as i am. i am not your run-of-the-mill cowboy diabetic. its just my dry sense of humour gives the impression that i dont take things seriously....

Yeeeeeeeeee Haaaawwwwww.


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