Hello everyone, I hope you have all had a wonderful summer : )
So here I am wondering??? Did I make the right choice or not starting insulin.
I started levemir 3 months ago, bedtime only shot as per Dr. ( but did mess around with a split dose but could never figure it out so went back to 1 dose a day.) BTW the Dr thinks Im getting about 19hrs of coverage which he says is rare. But I've struggled the last 3 months , A1C was up to 6.7 ( it was 6.2)
Anyhow I saw Dr this past week, told him PM post dinners are difficult for me, excercise helps, but my BG # go down right after a run. But with in 1 hr or so they start to climb again. So that by the time for bed Im usually at 8.5 to 9.8 range. He is a really nice guy, and really wants me to continue with the excersise, all well intended and I agree. But not always possible with kids, work ect. He gave me Apidra and said to use it before dinner on the nights I don't jog. and also to stop taking the Onglyza.
Well the numbers are going crazy IMO, not what I want to see. Okay so perhaps being new to this all I consider my carb counting less than perfect, I've had to do a few correction bolus, and perhaps Im a little gun shy about getting too much and going low.
But now my AM numbers are climbing, and after dinner is not so happy either.
Seriously did the onglyza help that much?
So the question is really a bunch of them because we all know this isn't just a one answer issue when controlling diabetes.

But 2 hrs PP should I be less than 6.0?
Do I correction bolus at 2 hrs if still higher than 8.0?
He has set my ratio 1:10- I think this needs to be tweeked.
I'm now taking 10 U levemir at bedtime.
And bolusing before breakfast ( with a correction )
And bolusing before dinner ( with correction)
As I write this all down I keep telling myself to not be so hard on myself and expect perfection and control so quickly. It's only been 4 days on some fast insulin.
I really don't want to jump back on the onglyza to quickly I know I should give it sometime to sort out.
But any advice would be helpful.

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Four days on insulin isn't long enough to get a handle on it. Yes, please don't be so hard on yourself, but I understand your frustration. It's helpful to keep doses the same for 3-4 days to get a better picture.

6.0 at two hours is great!
Correcting when higher than 8.0 at 2 hours pp is a bit risky since you've just started on rapid acting insulin & you don't yet know how long Apidra stays in your body. You need to be careful about stacking insulin to prevent a crashing low, especially if it's close to bedtime. Apridra tends to last 4-5 hours, with a peak around 2 hours. If you do correct, do it conservatively. Since you mentioned corrections, I'm assuming your doctor gave you an ISF.

Agree that if you need constant corrections after meals your ratio isn't right, or your carb counting is off. Most people have different ratios for different meals. Breakfast is usually when people are most insulin resistant/carb sensitive, so the ratio is typically smaller.

Correcting before meals points to your Levemir dose not being adequate. Levemir is best taken in two doses. If your fasting is high requiring a correction before breakfast, than 10 units isn't enough for you overnight & it's not lasting to help your pre-dinner reading. Other things can contribute to high fasting--eating too close to bed & eating a protein/fat heavy dinner that takes long to digest.
Thanks Gerri for you imput, But 6.0 after 2 hrs is what I thought might be reasonable. I'm actually double that : ( 12.0
The only thing the Dr said was do 1 unit for every 10 carbs.
I'm guessing most of it is up to me to figure out.
I know this is bad bad bad, but tonight after the kids swimming , we went to ackkk Mc D's ! I thought ok not a great choice but at least I could have a decent carb count. The coke zero, small fries and mini chicken tai sandwich came to 64g of carbs.
I took a guess in the car and did a dose of 6units. Well the results so far are at 1 hr 10.7 and at 2 hrs 12.8-
Ok so bad experiment. But hey all you out there reading this ... should my dose have been bigger? I am 5.7 in height and 140lbs, Far as I can tell that was a correct dose.... So maybe my basal dose is still off, ... or gasp some IR
Yet to be figured out.... so I will just keep counting, testing, testing, did I mention testing : )
Sorry for the bad experiment. I question the accuracy of fast food carb counts. Potatoes & bread are rarely a good choice:) Being 12.8 at 2 hours, depending on where you were before eating, means too low a dose. This isn't related to your basal. Basal keeps BG level between meals & overnight.

A correct dose is the dose that's right for you & what you're eating. According to what your doctor told you, your dose was correct. What was BG before you ate?

What ratio are you using to correct?

If you'd like advice, here goes. Get Dr. Richard Bernstein's book Diabetes Solution & Using Insulin by John Walsh.

The best way to figure out what your I:C ratio is by eating food with a known carb count. Much better to start with a meal with fewer carbs. Though it seems that if something has 40 carbs taking 4 units should work, it doesn't always. So, eat something with a known 10 carbs, take one unit & see what happens. If one unit keeps you pretty much at the same BG as before you ate, it's correct. Keep in mind that protein & fat slow digestion & you may see a rise past two hours. Recording everything (such a pain) helps.
Im just heading to bed......zzzzzz Im a tired gal.
Anyhow I was 5.8 before dinner. 10.7 1 hr pp- then 12.8- 2 hr pp and 7.7 at 3hrs 15min. So numbers are coming down. I didn't do a correction tonight. It's all so new, but if I remember the Dr said 1 unit should bring me down 2 points..... But your suggestion by eating a known food carb count of 10 is good info. How long after eating / giving 1 unit should I test? I just did my levemir thought I'd try 12u for the next 3-4 days and see. This is the part where I try not to really get upset at my stupid pancreas that decided to divorce me ! Gosh it's not like I was cheating on it. LOL !
I think it might actually deserve a name, I will ponder that for awhile.
Ok off to bed I go, maybe tomorrow is the day I figure just one more piece of the puzzle. : )
Test after 1 hour & 2 hours. Timing is as important as dose & the goal is to head off the high, of course.

Have you found the correction factor to be true? I weigh 103 lbs. & 1 unit lowers me 3.3 points. Yours sounds accurate. It's loosely based on weight.

I didn't cheat on mine either, but I did take it totally for granted. Maybe that's why:) Let me know what name you come up with.

Sweet dreams!




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