To disagree with the way they are treating my diabetes - insulin user

[SaIIycinnamon]

My post meal spikes are high. They have me on the lowest 2 units of novid rapid. My post meals range anywhere from 9 -11.
All they keep doing is upping and upping my background insulin ( twice daily) to treat my post meal spikes and its making me feel insafe. Background insulin works slowly over 12 -24 hours whereas its the rapid insulin i need to bring down those post meal spikes.i feel like they are just putting me at risk of having a hypo and ive actually read you can cause over basilizsation .
Am I wrong in thinking they are dealing with this incorrectly? Everything im reading on Google suggests this is not the correct way to treat post meal spikes. Wondering how others are treating their spikes. The increasing my background always comes from the diabetes nurse.
I dont understand why they wont increase my novorapid especially to deal with my dinner spikes.

Why can’t you increase it yourself? Are you type 1 or 2? Do you bolus your insulin 20 mins before a meal? Do you have an insulin to carb ratio?

What are our sugars like before meals? Have you had any hypos?

Are you only taking 2 units of Novorapid? My starting dose was 8 which was increased up to 20 and has decreased to 16 recently.

I know Novorapid is the insulin which is bad for causing weight gain, which may be why they are reluctant to increase it.

My friend is a long term diabetic, she’s also a nurse. She frequently has disagreements over her care. She maintains that she knows far more about diabetes and her own body, than anyone else. She challenges the decisions made on her behalf.

I have an app called carbs and cals. It gives you the carbs in different foods and you then adjust your insulin accordingly. For example if a food had 47g of carbs you would inject 5 units of insulin if your ratio is 1 to 10. You round up. I have found it very useful in keeping my diabetes on an even keel. I’m a type 1.

@Gingerkittykat fasting and pre sugars are fine now which indicates the background insulin is doing its job , its the post meal spikes im having difficulty with.
Everytime I phone them they just keep telling me to more lantus which isnt dealing with the spikes post meal. That should be requiring rapid insulin

@penguinchocbar type 2

From the sounds of it, yes they are giving you incorrect advice (I have no experience of T2 though)
I’m T1 and carb count so I have a different amount of insulin depending on what I’m eating. Pie n mash is gonna need a whole lot more than a chicken salad! It’s the timing of the fast acting that can help with post meal spikes as novo rapid is known as ‘novo sluggish’ in the T1D community. Takes a good 30min to start working and by that time you’ve finished eating.
who are you getting advice from?
all T1’s are managed by the hospital here and T2 tend to be managed via GP/nurse.
having said all that a post meal spike is a normal occurrence for T1 as long as it comes down to back in range. Unless you eat low carb all the time which is an wffective way of managing spikes.

Sounds like your approach to diabetes is all off if you’re relying on someone else to tell you how much insulin to take. It’s your diabetes, you choose how much insulin to take. Try the Bertie course online to learn how to count carbs and adjust insulin doses. Spikes are dealt with by the timing of the rapid dose, if your pre meal readings are back down by the next meal then the dose is correct, and it’s the timing to fix. If you’re only spiking to 9-11 though then that’s normal

I’ve had type 1 diabetes for over 20 years. I remember discussing what to do when readings are high - should I give myself more insulin? The answer was no. Which I didn’t understand. Now I adjust my insulin as I see fit. It seems clear as day that you are not giving yourself enough novorapid before you eat.

What actually are your fasting and pre meal levels? When after meals are you testing (as in how many hours post meals)? Are you on any other medications for your diabetes?

Does it help if you eat lower carb meals? I tend to agree with you about increasing your short acting to match your carbohydrate intake, but if there is a reason your team don’t want do that, an alternative could be looking at your food intake.

Your comment is not helpful.

Of course, a diabetic should listen to the advice of a medical professional, especially if newly diagnosed or new to insulin.

I would also say a spike of 9-11 is too high; sugar levels should be 6-8 after a meal.

On insulin levels should not be 6-8 at 2hrs post meal. Your insulin is going to work for another 2-3 hours yet so if you’re 6 at 2hrs likelihood is you’re going to be hypo by the time it’s finished. I’ve been T1 for a very long time, I know what I’m talking about.

That’s exactly what I was wondering! I thought most type one was carb counting these days.

Does the advice given to women who get gestational diabetes to go for a ten minute walk after a meal to prevent spikes also work for people like you? Just wondering as I know it works in gestational diabetes.
Would be better than more insulin I would think

Walking post insulin and food does very much help! Or a hot bath 🥳

@PotatoFan im type 2 on insulin and metformin medication.
Im not type 1 so insulin is not instructed to be adjusted according to carbs consumed.

Fast acting should be adjusted according to carbohydrates though, that’s how it works in t2 as well as t1. I was misdiagnosed as t2 for 16 years before being correctly diagnosed as t1 and all that time I adjusted my fast acting to carbs. Do the free online Bertie course and it will teach you. Or ask for a referral to the Victor course which teaches it to t2 too.

Think of it simply, if you go out for dinner and have a pizza, that’s 100g carb or more. If you have a steak with salad that’s under 10g carb. The purpose of fast acting insulin is primarily to deal with the carbohydrates in your food, but those two meals have vastly different carb contents so they’ll need different doses. You also adjust the fast acting dose based on your blood sugar at the time and what insulin on board you have, but keeping it simple here.

My diabetes is mainly caused by a endocrine and metabolic disorder.
Adjusting my carb intake hasn't made a difference,
I would spike even with minimal carbs.
Ive always had a insulin resistance .
My doses are set by the diabetic team and ive never been instructed to adjust insulin according to carb ratio , so i dont really know how to do that safely.
All my fasting and pre meals are perfectly in range but post meals continue to spike
I told the diabetic team i wasnt happy but as usual, they advised me to take ANOTHER 2 units of lantus and refuse to increase rapid to deal with my post meal spikes. Im still on same 2 units that I started with weeks ago.
I should mention, i was diagnosed with diabetes type 2 but now Im newly pregnant so im managed by diabetes team in hospital for the duration or pregnancy then itll just be managed at GP practice.
Completely cutting carbs in not an option as I need adequate carbs but ive tried limiting / cutting carbs in the past and it didnt help my spikes. Id been on metformin to try and manage my diabetes , was pre diabetic for years before diagnosed with diabetes but it doesnt manage it and I was taking maximum dose.
Im feeling very confused how to deal with the post meal spikespikes and diabetes team aren't listening to my concerns so im unsure how to manage my blood sugars safely. Increasing my background insulin further yet again when my readings are perfect jusy makes no sense. I cant understand the logic in it and have not taken the doses they are suggesting because I believe its putting my at risk as those numbers dont need to come down any more if perfectly in range

Would that be helpful for all people, not just diabetics?

I'm type 2 and I am on slow release insulin only (plus metformin and diamicron), so no opportunity for short term adjustment. I get quite spiky after lunch (not so much after dinner for some reason) and I can usually drop it by about 3 points by doing 1km on my rowing machine or a 40 minute walk. Flights of stairs work really well too, when I'm in a building that's reasonably high I will go down and back up 5 flights, then 3 flights, then 1 flight. If there's no other opportunity for exercise then little jumps work quite well too, three sets of 50 little jumps with a short rest in-between, repeat 15 minutes later if needed.

Do you know whether you are particularly sensitive to stress? Just worrying about your glucose levels might be pushing them up. I wear a glucose monitor so I can see stress in the graph, for example a nightmare can push me from below 6 to over 11 temporarily, a phone conversation with my mother can sometimes send me up two points depending on the subject.

@SaIIycinnamon I would personally try to raise the NovoRapid by yourself; try just one extra unit at a time so that you can see how your body reacts to it.

I was started on insulin in December. I started on 8 units of NovoRapid and increased it by 4 units every 3 days till I was in a normal range. I was on 20 units till I started on Ozempic and reduced down to 16 but I give myself an extra couple of units if I think I need it.

Do you wear a CGM?

Different injection sites react differently. How far in advance are you bolusing? If I’m injecting into my tummy I aim for 5 mins before eating but if I need to use my thigh I have to inject around 15 mins before food to prevent a spike. The important number is where you’re at around 2 hours after eating, if you’re still around 9-11 then I would probably agree that you need a higher dose of rapid acting. To increase you’ll need to titrate up by 10% every 3 days until you hit the right level