So I atend two hospitals in ireland and at my last appointment my hbA1c was 9.2 which for my was really good as I have naturally bad control evernce I was a baby but I haveanother appointment in a feww weeks but my bloods have been really high for the last few weeks because I have been sick between kidney infections chest infections and flu's I'm afraid the hbA1c will be up high again is there anyway I can get it to come and stay down rapidly??

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Comment by Brian (bsc) on September 27, 2012 at 10:10am

Most typically, we take "corrections" to help bring our blood sugars down from highs (as opposed to a meal bolus which is used to offset the blood sugar rise from meals). You can talk to your doctor about these.

But first, let me ask you. Did you and your parents attend a DAFNE course? Do you use a long acting insulin and then take rapid injections at meals? Or are you on a fixed dose with 2-3 injections a day?

It will make a difference in how and when you can safely do these corrections. I do think you are right that you need to bring your blood sugars down, but you need to work closely with your doctor and parents to do it safely.

Comment by Sara_Louise on September 27, 2012 at 1:06pm

i take a 24hr insulin in the morning a quick acting in the evening and a 12hr one at night. im unaware of what this DAFNE course is. im from ireland so maybe we dont do it here im not sure if we have that here. im on 3 injections a day but the dose varies.

Comment by Holger Schmeken on September 27, 2012 at 1:58pm

Could you tell us the names of the insulins you are using (24h, 12h, quick)?

Comment by Sara_Louise on September 28, 2012 at 5:34am
24hr-humilian m3
12hr-humilian I
Quick acting- humalog :)
Comment by Jacob's mom on September 28, 2012 at 5:43am

Hi sarah, I have a 14 year old son with diabetes. Are your parents still highly involved with caring for your D? I really hope so, because at this age, even though you have been a diabetic all your remembered life it is still a challenge with as you suggested sickness, growth and hormones to name only a few. this should be a transition age where you are doing alot but still have the support and higher knowledge of your parents. as far as trying to quickly get your A1c down for a good "report" card. i would just take it day by day, making the best decisions you can and learning as much about yourself and your D while still enjoying these "carefree" years! sounds like a lot ha! one thing when you are sick do you drink a ton of water and up your insulin? you cannot expect bs's during a time on illness to reflect your healthy baseline. i hope you feel better and are getting the support you need! amy

Comment by Holger Schmeken on September 28, 2012 at 4:25pm

Morning: "Humulin M3" is a mix of 30% quick acting and 70% long acting (12-18)
Night: "Humulin I" is 100% long acting (12-18h)
Carbs: "Humalog" is quick acting

The problem I see here is that the mix insulin "Humulin M3" is always giving you quick acting insulin that last for up to 4 hours. How to know which effect is coming from the humalog and which is coming from the 30% quick acting in the mix?

It would be better to just inject the basal insulin "Humulin I" every 12 hours and to use humalog to cover the carbs you eat and for corrections. This way you can better identify how one unit of humalog is working for you. This would look like this:

Morning: Humulin I 100% long acting (12-18h)
Night: Humulin I 100% long acting (12-18h)
Carbs: Humalog quick acting

Furthermore I would question the "Humulin I" itself. I have used this type of insulin for years. The problem is that it does not act evenly as a basal insulin is supposed to do. Instead it has a peak with higher insulin activity around 4 hours after the injection. For me this made me prone to lows around noon and at night around 2 am.

Today we have two better working basal insulins: Levemir and Lantus. Both are designed to work more evenly. You are used to inject the basal insulin in the morning and at night. Thus the Levemir would more fit for your current injection pattern.

Important reminder: this is food for thought. I have read that you are 13 and I recommend to talk with your parents and doctor about these points. Maybe there are reasons why you are using the mix-insulin I am not aware off. Please do not make any changes on your own.

Comment by Sara_Louise on September 30, 2012 at 3:51am
Thanks but the insulins worked brilliant for me for the laast 6 months so I'm not looking to change them. I was on the novorapid and levemir and lantus and insulatard and all of those ones for 11 years and they never worked for me. I was always in hospital at least once every two weeks and even the doctors in the leading hospital here in ireland couldn't figure it out. I suppose you could say I was a medical mystery at the time. But before all the sickness over the last few weeks my bloods were brilliant xompared to recent years. Although my hbA1c is 9.2% now that's the best its been for 9 and a half years because I've always had bad control no matter what I or the doctors done. So I really an not going to change insulins now when I'm finally in 12 years having a strike of success! I was really just wondering is there a way I could get my hbAa1c down quickly!!
Comment by Holger Schmeken on September 30, 2012 at 7:48am

You know what is best for you I have no doubt about that. Still I would recommend to lower the A1c slowly. Just try to achieve good control and it will show later in the A1c. You can not compensate for some periods of elevated BG due to infections.

On the topic of basal insulins: to me there is more to it than just the insulins because the pattern of application has equal importance. With Levemir at least two shots per day and even Lantus might be more efficient if splitted in two equal shots every 12 hours. Different patterns of application should always be tried first before the basal insulin is given up for another one. The same can be said about rapid acting insulins. Different waiting times might show a completely different reaction to digested carbs.

Imagine you would skip all of your meals on one day and would just inject your basal (morning, night). Do you think your basal insulin will keep you in the healthy BG range? I do not recommend to do that. I am just interested in what you think might happen.

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