After being PU/PD for months (thirsty all the time and having to run to the restroom the rest of the time).. and losing 23 pounds over the course of 10 months without trying.. some of my friends were concerned about me, and I got concerned too. I kept blaming it on the fact that this is a stressful time in my life as I finish up with veterinary school. I went to student health and had bloodwork run. Lo and behold, a fasting BG of 293 prompted a call the next morning for me to come back in. Too numerous to count ketones in my urine along with glucose and protein prompted a visit to the ER because they thought I would go into DKA. They ran a couple liters of fluids in, set me up with insulin on what I realize now is a pathetic scale to use, and sent me home.
Since then, I've had 3 doctor's visits and am trying to get set up with an endo. On Friday, I received the call that I do have GAD antibodies and so I am type 1. My pancreas is still making a little insulin, but it's on it's way out the door. My A1C was 12.4, which means my average was running around 315. I feel really lucky that I had bloodwork run when I did, and that I didn't have to be hospitalized for DKA.
I'm currently on 8u Lantus at night, and 3 units of Humalog with every meal + 1 unit for every 50mg/dl over 150mg/dl. This is just until I meet with a diabetic educator a week from today. I've already got much better control, I'm waking up between 102 and 140. If I knew how to calculate my insulin to carb ratio, I'd go ahead and try it beforehand. Yesterday, I felt a little ill around 4pm in the afternoon; checked my sugar and it was 82. I realize my body's been running on high so I'm probably just not used to it- but I got scared and took a glucose tablet anyway since I don't know what my 'low' threshold is. Looking back I think I would have been fine. I wound up shooting my sugar up to 160- so I probably didn't handle it the best, but this is a learning experience.
I've been hanging around the diabetes.org forums and someone talked about this website and how much they liked it, so I decided to join too. It's really nice to have people to talk to who have been there before and can give little tips and suggestions that they don't tell you in the doctor's office.
That was a long ramble, and if you made it this far, thanks for reading.
My glucose seems to spike in the evening around 10pm. The last few nights it can be upwards of 212-250, even though during the day I've been around 120-140 most of the time. I don't know if it's because I take my Lantus at night, and it doesn't really have a full 24 hour effect, or what. I went ahead and took 1 extra unit of Humalog with dinner. Before dinner, it was 147. I took 5 units and two hours later it was 103, the lowest it's been all day. I'll see what it is at my bedtime dose; hopefully not 200 + again, like it always seems to be!
This is the problem I was having when on Lantus.
The problem is your body starts producing hormones at night that trigger the liver to send glucose into the blood. Everyone's body clock is a little different. For some this starts at 3am, for me , it seems to start earlier in the evening. Without diabetes, your pancreas will increase insulin production to compensate for the glucose being dumped into the bloodstream. With diabetes, it has to be compensated for by a change in basal rate. This is a case where the flat output of Lantus is not helpful.
THe problem I had is if I cranked up the Lantus high enough for the night time, then I went low around 5-7 PM. The solution for me was the programmable basal rates provided by a pump. Many people can find an acceptable compromise with Lantus or Levemir, sometimes by splitting the dose.
I didn't realize that it could vary that much from person to person. I still feel like the Lantus is petering out by the time 10pm rolls around and that is contributing.
I'm wondering now if I should give Levemir a try.
Or maybe I could give the Lantus earlier in the evening so that it has time to take more effect before my body spikes the glucose on its own.
Also... I have heard conflicting opinions on whether to give your long acting insulin at night or in the morning. Thoughts?
I tried both and it made no difference for me. It was flat all 24 hours and the problem was really my body needs a very varied basal rate : I'm at 1.75u/hr at night and 0.65 u / hour in the afternoon...with some intermediate steps at other times of the day...kind of extreme, but it keeps me relatively flat when not eating. Everyone is different and it changes from time to time.
As they say "Your Diabetes May Vary."
You are right, Lantus doesn't really last 24 hours. You could play with the time you take it to see if it reduces that high at 10PM. But many of us find we get better result with splitting it into two doses. Many also get a better result switching to Levemir. And, of course, the best result of all is using a pump because you can have varied hourly rates to better match your body's chemistry. I have 9 different rates and it works great.
Hi and welcome! Sounds like you are doing great, and what a relief to know what is going on and to catch it early. I also always recommend the two books that AcidRock suggests; I am glad you have them on order. And HPNpilot has given you some excellent "newbie" advice. As he says, there is SO much to learn at the beginning, but it does become second nature over time, and less overwhelming. Get the support you need here from your fellow D people.
Do you know of any books or a website I could use to help educate people who don't have the disease? My mother has been trying to help me and I very much appreciate her but sometimes I don't feel like she understands, and that I am perhaps not doing a good job at explaining.
Thanks for the welcome!
I'd refer her here too (Tu?)? I don't think that anyone who doesn't have it can get it. They figure that if you screw up and are a bit whacked out it means you are a loser who doesn't know what the hell they are doing, rather than a scientist trying to boldly go where no one has gone before?
Welcome to our exclusive T1 club where everybody is an involuntary member!
I agree your evening highs could be due to your Lantus conking out.
I was in mild shock for months after dx, so I guess I was kind of crazy and figured out my insulin to carb ratio on my own. My GP was not a good guide (he advised me to take 40u of Lantus when I only needed 14u), so...I just experimented by taking the carb count of something I eat all the time (pb sandwiches) and trying doses. I don't recall any disastrous results so it must have worked!
You've done well to have already discovered this site. I will always need a doc to provide my scrips but the online community is golden.
Wow. I got switched to student health insurance after turning 26 last fall (why couldn't all this have happened while I was on my parent's insurance?). I can't see the GP I used to see, so I'm seeing a group of family physicians at the university's hospital. They are nice and seem knowledgeable, but I really want to see an endo.
Even though after dinner my BG was about 103, it's already climbing- up to 126 now. I'm going to guess Lantus lasts about 22 hours with me. I think I can change this by backing up the time I take the Lantus so that my Humalog at dinner time covers for the time the Lantus is 'incapacitated'.
So many variables! I wish my books would show up soon. Even though the doctors I'm seeing are nice, they really don't give nearly enough guidance! I feel your pain with that. :(
I see from your profile that you've only been dealing with this a few days....if you keep a log of your blood glucose and food ,you can look for patterns to emerge. Before shifting things around , see if there is a consistent pattern emerging that repeats more or less, then use that as a guide for making changes. The books suggested will help with that.
Since you are studying vet. medicine, you'll find the same sort of analytical skills you use in school will serve you well with the diabetes management.
Since you are at a University, do they have a diabetes center ? The student health plan may give you access to that.
Yes.. All of the original visits occurred on February 10th; and they got the antibody results back on the 17th.
I'm using dbees.com to keep track of everything since it syncs with my phone. I perhaps too much, it drives my boyfriend crazy. I seem pretty even throughout the day and then 10pm comes around, time to take Lantus, and I've skyrocketed despite not eating any more for dinner than I did my other meals.
I can ask if they have a diabetes center, but I think most of the diabetics come in through their family physicians group and are type 2's.