Replies to This Discussion

Permalink Reply by Jenny on April 27, 2008 at 5:48am

Here's a wild and wacky thought. You're diagnosed as a Type 1 but you are using a Type 2 carb/insulin ratio which may mean you are insulin resistant. This wouldn't be a surprise, lots of people are with and without diabetes, and autoimmune attack can hit anyone including people who are IR.

So my suggestion would be to ask your doctor if you could try using Metformin WITH your insulin.

When I take Met my carb insulin ratio is 1/15-20 without it it drops to about 1/10-12. That's 30% difference I'm not a type 2 and I am insulin sensitive, but still, what a difference that Met makes. It also improves the speed with which the insulin works.

But what really matters is this: when I'm taking Met I don't gain weight. When I stop it, I do.

So it would be worth a try. Docs have this idea that Type 1s don't need metformin, but if they are insulin resistant (as are a huge number of even normal people) they probably do.

Rejection site question: Tears as in "tearing paper" or as in "crying?" If the first, I wonder if you are having an allergy to the insulin which would also explain the apparent insulin resistance. If you are seeing little drops of insulin, try keeping the needle in longer. I get that sometimes.

Finally, how I adjust insulin (where the dose, for me, is always changing it seems) is testing every day, writing down my doses, writing what I ate (grams of carbs) and making very small, careful adjustments on my own based on the past couple days for the given time of day. Time of day makes a huge difference for me. In the morning I need more insulin than at lunch or dinner.

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Permalink Reply by Beth Ann Maldonado on April 27, 2008 at 8:10am

Hi my name is Beth and i have been diabetic for 5 1/2 years. well i can't give you the answers for everything, but my experience with symlin wasn't that great. It made me sick to my stomach. I didn't need as much insulin because the medicine made me lose my appetite. I stopped taking it about 6 months after my doctor put me on it and now that my husband and i are trying to get pregnant i can't take it anyways. If your doctor is not giving you enough information you should see if there is a nutritionist available to talk to. If not you may want to consult with another doctor. as a diabetic it has always been important to me to have a doctor that understood me and that i was comfortable with. I hope that helps. If you have anymore questions please let me know

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Permalink Reply by Meg on April 27, 2008 at 10:27am

Thanks for replying.
Me and my doctor talked about either possible allergy to the novalog (i thought I was allergic to the novalog because if it does leak out a little I get a red rashy spot) or insulin resistance, he wants and hopes it is just insulin resistance because my numbers and ac1 where so good he doesn't want to change anything.
I'm still taking metaformin and the glyburide (in the form of Fortamet, 1,0000mg daily, originally when I started I was taking 2000mg daily but it upset my stomach and we reduced it ). There is some definite wierd things going on in my immune system right now we're also doing tests for ms/lupus/fibro as I have a lot of other health issues) but that too is a long shaky process.
To clarify when I said tears I meant like paper tears they start in the injection site and in the process of a day turn into what looks like a little scratches.
I think I've actually been doing ok on the symlin. I haven't had any stomache upset or anything else, It does make me not hungry and I have a hard time even eating my 30 carbs to be able to take it. I just haven't seen the reduction in my meal time that I was hoping for and or even better numbers.

i've tried to set up the appointments with the diabetes group nutritionist but she was booked til the end of July! And I met once with a diabeties educator to see about an insulin pump (which I desperately want) obviously she didn't look at my chart because she tore into me telling me I eat too much and not doing a good enough job with my diabetes and should be trying to get off insulin and not use a pump (literally made me cry). .. I've been pretty traumatized since and she's the only one that does the pump/cbm training in that group I am no closer too pumping. It's ashame the endo himself is very very nice and knowledgeable, the rest of the team seams to be either just horrible or not available, but we're on an HMO and this is the only diabetes center in our area they cover.

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Permalink Reply by saundra barragan on April 27, 2008 at 11:30am

Hi Meg,
I am sorry for the problems with the diabetes educator. Please do not take to heart the really mean things she said. And do not go back to her or anyone who can not be supportive. It sounds like you have a really good relationship with your endo and should keep seeing him. The rest of this can get worked out.
I think your liver is dumping glycogen on you in the mornings before you eat. Maybe you could try taking in something that is easy to drink or eat out of your hand while on your long commute to work. Work with your doctor to make small changes at a time to your insulin and make sure you log everything. Absolutely everything. I am old fashioned in that I use a pen and notebooks, but whatever works for you so that you can look back over every little change you make and see where you get with each one. This will all take time, but you can make it. The weight you can work on when you get your meds worked out. As far as injection sites are concerned, be sure to rotate each time and see if this helps. Also when you bathe or shower use some nice lotion or light oil to gently massage all of your injection sites (and all of your skin if there is time).... At the present time i am using some pure almond oil. but whatever is acceptable to you. The purpose is to treat your skin and to help circulatiuon at each of the sites. I really wouldn't worry about trying to get a pump right now. Especially if you have to deal with that horrible DE. What you need is what you are doing. You have asked for support. That was a great step and you will find it here. We will each have our own ideas what may help and that is fine. If one thing works for you, use it and it will make us all happy. Here you can do NO wrong. It is trial and error for us all and we all keep making small adjustments each day. Just don't get discouraged. Hang in there. Here is a great big hug from me. Good luck.

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Permalink Reply by Lauren on April 29, 2008 at 4:51pm

Wow...you're a type one and your pump educator actually told you that you should try to get off of insulin? Do they realize that as a type one diabetic, that isn't a possibility?

If you're really interested in getting a pump then I would suggest doing some research online about which pump you would be most interested in. I've been dealing with the pump sales people (who are extra interested in you getting a pump, since it benefits them! hee) directly lately and have had them act on my behalf for getting a pump and they have been actually been a big help! I feel like the pump processes has sped up since I've gotten in contact with them.

Try talking to your endo about your problems with the team. They're supposed to be there to help you with your diabetes, not prolong you getting onto treatments that would help you in the long run. *nod*

Good luck! :)

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Permalink Reply by Meg on April 30, 2008 at 7:17am

Thanks! Interestingly enough it was the endo who said I needed a pump (because of the ammount of injections I'm up to vs quality of life) and set up the appointment..I think she just didn't look at my chart just saw what my numbers had been before insulin and that I'm by no means a little woman (I'm 6' and not a waif but not grossly overweight either) and assumed I was type two. I talked to both my endo and the office manager about my incident with this DE and both agreed that I would never have to see her again and that they were sorry, also that since the practice had grown so much they were hireing another one that they thought I would like much better... alas she hasn't started yet.
About the pumps (really I think they'd just make my life so much more comforatble and my sugars easier to manage) I have been in contact with both Animas about the 2020 and the omnipod, I'm not sure which would be better for me I swim advidly and have 5 boys to run after so durability is a must.
This is such a great community and so active, I'm really happy I found it, it's made putting some of the pieces of treating my diabetes back together for me!

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Permalink Reply by Linda on April 30, 2008 at 10:23pm

Another suggestion about the blood sugars going up in the morning even though you haven't eaten yet - are you a caffeine achiever like me? Coffee stimulates the endocrine system, so will make your blood sugar go up, even though you haven't eaten anything. I work in a medical lab, and part of doing fasting labs is no caffeine, because of the effect on BG. Might not be the only reason, but could be part of it. It also sound like you might be a type 1.5 or LADA. Check the posts for that group, and do some searches on the internet for more info and see if it fits, it might explain some of the things that don't seem to be quite like type 2, but exactly type 1 either. (For example, some of the oral meds help type 1.5's, at least for a while, but don't help a classic type 1.) Good luck!

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Permalink Reply by Meg on May 1, 2008 at 7:30am

I have unfortuneatly witnessed the caffine phenomenon. I used to LOVE love love my coffee... I'd drink it several times a day until I really saw what it did to my blood sugars, they went thru the roof! I gave it up aside from an occasional cup of decaf (even though there's still some caffeine) seems to be ok as long as I use half and half or cream, not milk.
I've been waking myself up in the middle of the night to see what's going on with my sugars then because I wake up feeling like I've been run over by a frieght train (which is often how I feel after a low) and my sugar was 40! Had I not set the alarm I would have no idea. I think my high morning sugars are from that rebound thing (I can't spell the actuall term for it). Which I guess has to do with my Lantus rate, does it mean my dose need to be split or decreased? Which is even more confusing to me because on the Symlin my blood sugars after my meal are about the same as before but will start to go up 3-4 hours AFTER, which never used to happen before I started Symlin-- the doctor said that this means we would have to increase my Lantus. I'm confused.

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Permalink Reply by Jenny on May 4, 2008 at 2:11pm

Meg,

I had a problem with Lantus causing rebounds in the morning even with split doses. I'm much more sensitive to basal insulin than post-meal insulin (some weirdness of my particular kind of diabetes)

But I'm doing MUCH better with Levemir instead of Lantus, I do two shots with a slightly lower dose at night than in the morning, and for the very first time in my life when I cut way back on carbs, too, I am seeing fasting blood sugars in the mid 80s both waking and before meals. (before if I cut carbs, I would eliminate spikes but I would still have a fasting bg 110-120.)

I have been using insulin for a couple years now, and this is a first, as I get a very strong rebound if I go over the right dose.

I did NOT gain weight at all during the two years when I only used Regular Human Insulin. Then, very fast, I gained a bunch of weight when I switched to Lantus with Novolog.

I think it is because the swift drop in blood sugars caused by the faster insulin makes me hungry so I was eating more without really realizing it. Plus with the R, I had to plan what I ate, because I had to inject an hour before eating. With the Novolog, if I wanted to eat something I injected there and then, so I ate a lot more.

I developed an allergy to the R, thanks to being stupid and adding NPH to my regimen (the protamine in it causes antibodies!) So now the only way i can lose weight is to cut way down on the carbs and on the fast acting insulin.

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Permalink Reply by Meg on May 4, 2008 at 6:45pm

I think in the end maybe my endo has been a little over zealous and changed to many things too fast at the same time, that it's been hard to sort out what helps and what doesn't. Like I was put on my 30carb meal (3 meals a day---the nutritionist at the hosipital seminar said I shouldn't go much lower than that or I'll start harming my lean muscle mass) 45g of fat per day the same time they switched my insulins and added glyburide (which I don't even know why I'm on a drug to stimulate my pancreas when I have no function at all) and decreased my metaformin. My blood sugars have gotten so much better (when I was diagnosed my ac1 was 12.4 down to 6 this last month) but its hard to tell what's really doing it and I take a lot of shots and a lot of insulin to get there, but in the mean time I have so may scary lows and swings (like the mornings) it makes life difficult, I would just like to get on an even keel even if it meant my ac1 go up a little bit... once again tomorrow calling the endo... see if we can't simplify this any. You guys have been so helpful I have so many new questions for him now.

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Permalink Reply by Suzanne~ on April 30, 2008 at 12:37pm

Hi there!!

Insulin can (does??) cause weight gain, and also, when your diabetes is undiagnosed, you may lose weight. So when your blood sugars level out and become more normal, you regain that weight. So that may be what is happening there...

To stop the little tear drops from forming, I just leave my needle in for a little while longer so that it can get absorbed before taking it out.

I definitely feel your pain with the CDE!!!! For my own issues you can read my blog at thisismysos.blogspot.com. I completely do not understand how some people can be so harsh when all you are trying to do is get on track. Isn't it scary enough???

Good luck with everything! You CAN do this! =:~)

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Permalink Reply by Kimberly on May 1, 2008 at 7:42am

Hi Meg - sorry to hear about the crap CDE. Hopefully you can find a good one that supports pumping. I love my pump so much that it will only be pried off of my cold, dead body.

Some suggestions for now -
1) you should talk to your doctor about splitting your Lantus, or more to the point, going back to Levemir and splitting that into 2 doses. I found that Levemir worked for about 12-13 hours for me, but I had almost no peak so it wasn't too bad. Supposedly Lantus has a definite peak, but it still doesn't seem to last 24 hours for most people. The lows in the middle of the night are probably because you don't need as much basal at that time. This is one of the places where a pump is fantastic - you set lower basals for when you need them.
2) Your morning rise is most likely dawn phenomenon. Mine starts about 6am, for others it starts earlier or later. But once it starts, my basal needs go from 0.4 units/hr to 1.5 units/hr (that's almost a 400% increase!). It stops either around 9am or when I eat. Again, you either need to take rapid-acting to cover it or eat as soon as you wake up.

Good luck with everything. Hope you get your pump soon. I was diagnosed in June last year and was pumping in September, so don't let anyone tell you that it's too early to pump.

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