DIABETICS!!: whats your HBA1c???

The_Conductor · 17-12-2010 07:11AM

CathyMoran wrote: »

I can go down to 1.2 and be reasonably aware...is hard with the pregnancy.

Sometimes you're aware- other times you are totally non-responsive at this level, it varies (not sure why). Mental note to self, need to order more hypogel.....

robinph · 17-12-2010 09:47AM

Diabetic hypo alert dog:

http://news.bbc.co.uk/1/hi/england/8775849.stm

5live · 17-12-2010 11:37AM

Wow. Thanks for the link. My dog is untrained, a rescue purebred mongrel with no redeeming features other than being unbelieveably good natured. And blood sugar level detector! She sits under my chair whining until my bloods rise again which is handy when i am minding the kids. And the best news is chocolate is low GI. Merry christmas to me:D:D:D:D

CramCycle · 17-12-2010 12:48PM

smccarrick wrote: »

Sometimes you're aware- other times you are totally non-responsive at this level, it varies (not sure why). Mental note to self, need to order more hypogel.....

I remember a few times just getting the LO sign on my old glucometer and on my new one getting down to 0.8. At other times I would be totally gone mentally/physically at 3.2.

While there are AFAIK reasons for different responses at different levels, mainly your current energy expenditure and specific activity, it's also important to remember glucometers are often quite inaccurate (upto 1mmol in many cases) :eek:

Alanstrainor · 17-12-2010 12:51PM

The amount of hypos i've been having has increased a lot recently, have to sort out my pumps basal rates. As a result i've started to lose my sense of "low", at the minute i will feel them at around 3.0, which is a bit scary.

tbh · 17-12-2010 02:13PM

Al, have you increased your target bloods to try and regain hypo awareness?

Alanstrainor · 17-12-2010 05:46PM

tbh wrote: »

Al, have you increased your target bloods to try and regain hypo awareness?

I'm not too sure what you mean by this?

As of today, i've decreased the basal rates that i think are the cause of the lows. So i'm hoping that will cut out the excessive number of them. My blood sugars haven't risen about about 9.5 in weeks as far as my blood tester is concerned too, so i've been working on my control a good bit lately.

cynder · 17-12-2010 05:52PM

My lady has been having night time lows for the first time ever since we changed the lantus to pm but if we drop her lantus it doesn't last the 24 hours.

Wondering if we can split the lantus like we did with the levimir, Must phone crumlin on monday to find out.

tbh · 17-12-2010 06:17PM

Well maybe it's different on the pump but I have target bgs for each meal - say 5 - 7, and I would take corrections based on that. Say at lunch I'm 11, I'd take insulin for carbs plus two to get me back to 5 before the next meal. For people who have lost hypo awareness, they sometimes raise the targets say from six to nine. In the example above I'd only take one unit to correct, as five would be too low. Like I say, maybe it's different with the pump tho

5live · 17-12-2010 06:42PM

grindelwald wrote: »

My lady has been having night time lows for the first time ever since we changed the lantus to pm but if we drop her lantus it doesn't last the 24 hours.

Wondering if we can split the lantus like we did with the levimir, Must phone crumlin on monday to find out.

I am normally on split Lantus but dropped it when work rate dropped and hypos more often. It was just 2 units but helped bring down afternoon and evening highs. Oh and i dropped afternoon snack too so it seems to be ok for the next month until work gets busy again

Alanstrainor · 17-12-2010 07:15PM

tbh wrote: »

Well maybe it's different on the pump but I have target bgs for each meal - say 5 - 7, and I would take corrections based on that. Say at lunch I'm 11, I'd take insulin for carbs plus two to get me back to 5 before the next meal. For people who have lost hypo awareness, they sometimes raise the targets say from six to nine. In the example above I'd only take one unit to correct, as five would be too low. Like I say, maybe it's different with the pump tho

ah yes, i understand perfectly. I just never knew the name for that technique although i've been doing that for years! At the moment mine is exactly the same as yours, between 5 and 7. I might raise that to 6/8.
The main problem is my base rates, i have about 8 different ones throughout the day, for example, from 12am to 3:30am my pump givdes me 0.8 units per hour. This varies throughout the day, with increasing/decreasing amounts of insulin per hour. I think some of these rates are set too high at the minute which slowly drops my blood sugars. It's just a matter of figuring out which ones. I've been keeping a diary for the last few days so I just have to go over them.

tbh · 17-12-2010 07:32PM

See this is where I think different practices are followed when the pump is involved. One of the things we were taught was that there's no point testing your blood sugars until three hours after your last insulin dose. the reason is that no action you can perform will be valid, because say you took 3 units an hour ago, and you're say 10 now, the 3 units haven't finished working, so don't do anything until they have.

I find it hard to follow that logic if you're using a pump - like you say, it's done on an hour by hour basis. For me, in a pen, 1 unit would do nothing at all. There may be some cumulative effect after time but it'd be impossible to know which one pushed me over the edge and into hypotown if I had units every hour. I can only assume that something in the pump delivery makes that insulin more efficient - I imagine it's a lack of preservative - there'd be none needed as the insulin is delivered just in time, and there is not expected to be a large gap between injections, so maybe it's shorter lasting.

The fact that so many people seem to achieve much better control on the pump suggests that the pen delivery isn't optimal.

Alanstrainor · 17-12-2010 07:44PM

tbh wrote: »

See this is where I think different practices are followed when the pump is involved. One of the things we were taught was that there's no point testing your blood sugars until three hours after your last insulin dose. the reason is that no action you can perform will be valid, because say you took 3 units an hour ago, and you're say 10 now, the 3 units haven't finished working, so don't do anything until they have.

Very interesting. Although it's something I know, it's all to easy to forget sometimes.

tbh wrote: »

I find it hard to follow that logic if you're using a pump - like you say, it's done on an hour by hour basis. For me, in a pen, 1 unit would do nothing at all. There may be some cumulative effect after time but it'd be impossible to know which one pushed me over the edge and into hypotown if I had units every hour. I can only assume that something in the pump delivery makes that insulin more efficient - I imagine it's a lack of preservative - there'd be none needed as the insulin is delivered just in time, and there is not expected to be a large gap between injections, so maybe it's shorter lasting.

The fact that so many people seem to achieve much better control on the pump suggests that the pen delivery isn't optimal.

I believe on day one of my pump, when they were setting everything up, they said that the pump is 20% more efficient than just injecting insulin using pens/syringes. As for the reason why, I have no idea, i'm pretty sure I asked that question, but the nurse didn't have an answer either.

The pump only uses a fast acting insulin, mine is novorapid. So rather than having a lantus shot, or a "slow" acting insulin, it just gives a constant stream of fast acting insulin. The pump allows you to control the times and levels of insulin, obviously this will vary greatly from person to person.

I know that if I take 1 unit of insulin now, in ~2/3 hours my bloods will drop about 2.5 units(This is taking insulin without eating at all). It's not an exact science by any means, but that's just a ball park figure.

Just discussing this on here with other boardsies makes this stuff a lot easier. I'm surprised the amount of stuff i've just forgotten over the years!

tbh · 17-12-2010 08:27PM

yeah - it's a fantastic resource, and it is nice to chat about it - hope you don't mind me asking all these questions, but like I said before, I was under the impression that you still had to take lantus and that it was really awkward - the fact that I was wrong about both really puts the pump in a new light for me.

to answer your other point - it makes total sense that you wouldn't take the lantus, of course. The lantus is basically the same as the novorapid, except it has an additive which makes it last longer in the body. I always though that the preservative was there to protect the insulin, but actually it's to control the takeup rate in the body. So, with the pump, the basal rate is replicating the action of the lantus and the bolus is the traditional novorapid jab.
In theory you could do the same by taking 1/24th of your lantus dose every hour one the hour, but it'd be a nightmare and anyway, the pump allows for units of less than one to be delivered.
I have to say, I'm actually quite positive towards a pump now. I saw one of the jonas brothers (on youtube, sorry!) had a pod thing strapped to the back of his arm - something like that I could definitely live with!

Alanstrainor · 17-12-2010 08:39PM

tbh wrote: »

yeah - it's a fantastic resource, and it is nice to chat about it - hope you don't mind me asking all these questions, but like I said before, I was under the impression that you still had to take lantus and that it was really awkward - the fact that I was wrong about both really puts the pump in a new light for me.

to answer your other point - it makes total sense that you wouldn't take the lantus, of course. The lantus is basically the same as the novorapid, except it has an additive which makes it last longer in the body. I always though that the preservative was there to protect the insulin, but actually it's to control the takeup rate in the body. So, with the pump, the basal rate is replicating the action of the lantus and the bolus is the traditional novorapid jab.
In theory you could do the same by taking 1/24th of your lantus dose every hour one the hour, but it'd be a nightmare and anyway, the pump allows for units of less than one to be delivered.

Tbh, I never understood how lantus worked! That's very interesting indeed. I was one of the only people on the old type of regime, using mixtures of slow/fast insulin to control everything before moving to the pump.

I suppose the pump gives you that bit more control as I can vary the effectiveness of the base rate for different parts of the day. I never understood how this works for lantus users.

tbh wrote: »

I have to say, I'm actually quite positive towards a pump now. I saw one of the jonas brothers (on youtube, sorry!) had a pod thing strapped to the back of his arm - something like that I could definitely live with!

I saw them before, it's like it's a wireless system, where the insulin is all contained in the one unit. I thought they looked bulky, would love to try one though.

tbh · 17-12-2010 08:45PM

It must have been fantastic going from the mixed to the pump. For me, the worst thing about the mixed was having to eat whether you were hungry or not - the freedom around the basal/bolus system is a huge advance, and I think the pump advances it further.

CathyMoran · 17-12-2010 08:50PM

CramCycle wrote: »

I remember a few times just getting the LO sign on my old glucometer and on my new one getting down to 0.8. At other times I would be totally gone mentally/physically at 3.2.

While there are AFAIK reasons for different responses at different levels, mainly your current energy expenditure and specific activity, it's also important to remember glucometers are often quite inaccurate (upto 1mmol in many cases) :eek:

Mine is pretty good - had a bad low today, could not even speak. Long day. I find that as I am keeping a HbA1c of less than 5 (will find out soon but last one was 5.1) that I am totally hypo unaware - I also had surgery for something unrelated that makes things a lot more complex, also being pregnant makes things interesting.

CramCycle · 18-12-2010 06:43AM

tbh wrote: »

to answer your other point - it makes total sense that you wouldn't take the lantus, of course. The lantus is basically the same as the novorapid, except it has an additive which makes it last longer in the body. I always though that the preservative was there to protect the insulin, but actually it's to control the takeup rate in the body.

Just to clarify for those who have an interest in such things like myself, AFAIK, its not an additive that gives the Lantus its rate of action. it's actual amino acid structure is similar to human insulin with a few changes. It forms a hexamer structure when it is injected due to these structural changes and the change of pH from acidic to neutral with the subcutaneous injection. This increases its time of action.

On the other hand, novorapid, has one minor change in its structure which actually causes repulsion so that it acts alot quicker as it does not form hexamers.

I could be wrong as in my research I have only used novorapid but this is my understanding.

Also on other interesting facts, Glargine is produced by genetically modified Escherichi Coli and Novorapid is produced through modified Saccharomyces cerevisiae.

eilo1 · 18-12-2010 07:00AM

oh I like the sciencie bit!!

tbh · 18-12-2010 10:57AM

Yeah me too, thanks cramcycle!

5live · 18-12-2010 02:24PM

CramCycle wrote: »

Also on other interesting facts, Glargine is produced by genetically modified Escherichi Coli and Novorapid is produced through modified Saccharomyces cerevisiae.

Sssshhhhh. The greens still in power so they can make GM insulin illegal to protect the rainforests:D. I wonder if they would inject if diagnosed though

Urbanrose · 22-12-2010 04:21AM

i'm taking Levemir at night around 10pm, but only 16 units of it! this seems a much lower dose than most people taking levemir/lantus. my overall general control is running high and has been for about two years. any one think this could be part of a reason why?

CathyMoran · 22-12-2010 08:46AM

I am taking 8 units of Lantus a night - but I think that I do not take a lot of carbs (30 at breakfast - 30ish at lunch and 30ish at dinner though it does vary!). Should get my latest HbA1c today.

tbh · 22-12-2010 09:13AM

Urbanrose wrote: »

i'm taking Levemir at night around 10pm, but only 16 units of it! this seems a much lower dose than most people taking levemir/lantus. my overall general control is running high and has been for about two years. any one think this could be part of a reason why?

What's your last reading before bed and your first On waking?

Urbanrose · 23-12-2010 04:42AM

tbh wrote: »

What's your last reading before bed and your first On waking?

on waking usually fine, in the region of 5 to 9.9, but would be running higher from late evening and before bed

MUSEIST · 23-12-2010 05:32AM

CathyMoran wrote: »

I am taking 8 units of Lantus a night - but I think that I do not take a lot of carbs (30 at breakfast - 30ish at lunch and 30ish at dinner though it does vary!). Should get my latest HbA1c today.

You take 8 units of lantus at night, wow. I take 29 (so high because I am inactive at this time of year) and down to 24ish during the summer.
It works well for me.
Does anyone know if there is a limit to the amount you can use because I normally adjust the dosage myself.

tinkerbell20 · 23-12-2010 08:41AM

CathyMoran wrote: »

Should get my latest HbA1c today.

Good luck with the A1c Cathy!

Im new here on boards and so so happy I found this thread. My latest A1c is 9.2 (Nov), which Im not happy about. I am working at getting it down but being a good diabetic 24/7 is hard work! :pac:

tinkerbell20 · 23-12-2010 08:48AM

MUSEIST wrote: »

Does anyone know if there is a limit to the amount you can use because I normally adjust the dosage myself.

Hi Museist,

I dont know of a limit. I was on 28 units when I was on Lantus. I moved to a pump a few years ago.

I knew of a T1 girl who was on 96 units of Lantus. :eek: Compared to that, 29 units seems tiny!

CathyMoran · 23-12-2010 09:06AM

tinkerbell20 wrote: »

Good luck with the A1c Cathy!

Im new here on boards and so so happy I found this thread. My latest A1c is 9.2 (Nov), which Im not happy about. I am working at getting it down but being a good diabetic 24/7 is hard work! :pac:

They were delayed, I found out that I had slightly too much protein in my blood so they are keeping an eye on it. Am a pregnant type 1 who also has other health issues that could explain the results - I know that my HbA1c will be low but I have to test so often, were I not pregnant I would keep it higher - was about 2.6 all night last night. I agree that it takes a lot of work - would be lost without my husband keeping an eye on me - I tend to have a lot of low blood sugars

robinph · 23-12-2010 09:29AM

Pretty sure there is no limit to the amount of insulin that you can take, there would of course be issues once you got to a certain level of individual dose just down to how much the pens can comfortably deliver. And would you really want a pen full of insulin delivered at once. :eek:

I'm taking 24 units of lantus a day at the moment, and am very far from being inactive, so 29 units is not that huge a number. Just different people need different amounts due to food intake and activity levels, and have different levels of sensitivity to the insulin as well I believe.

DIABETICS!!: whats your HBA1c???

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