Hi my name is Chris and I live in Mexico I am new to being diabetic i was diagnosed 06/21/2011 when to went to my doctor I had a fasting bg of 321. My doctor started me on glucovance then later added actos with met none of which worked for me I could not keep my bg below 230 for the past 2 months I have been taking levemir 23 units in the morning and 13 units at night before bed. I have much better control but still a little high after meals in the evening so my doctor added novorapid she says 1 unit if above 150 2 units if above 200 etc. I eat a low carb diet and try to eat as healthy as I can but I still think there is something I am missing I crated a spreadsheet of my numbers for the past month and was wondering if someone would look at my numbers and give some suggestions on better control.
Without looking at your numbers, I can suggest that for your meals your doctor has you on what is called a sliding scale. A sliding scale doesn't take into account the food you are eating. You need to bolus for every meal you eat, even if you are not high before you eat, because the food will make you high. If you eat low carb, that's great, and that's probably keeping you from going higher, but you still need to figure out how to match your insulin to what you eat. The way to do that is with an insulin to carb ratio. We all have different ratios and many of us have different ones for different meals. (Mine for example is 1:5 for breakfast, 1:10 for lunch and 1:19 for dinner. That means for example that for breakfast I take one unit for every 5 carbs I eat. I usually eat 20 carbs for breakfast, so I take 4 units.
The book Using Insulin by John Walsh is a good book to explain dosing in more detail. Your doctor might not know of the more modern way to dose insulin, many don't!
I just quickly glanced at your numbers. You say you don't have good control, but your numbers say you are doing pretty darn good. Your numbers are almost always below 140 mg/dl 2 hours after meals and your average is pretty good. You will get the best control by dosing your insulin as Zoe suggested, taking your insulin 15 minutes before eating and adjusting it based on the number of carbs in your meal.
But I have to ask you. Why is your A1c at 13% and you say out are out of control if your numbers are actually quite good? Perhaps you are not giving yourself enough credit? And remember, the A1c is the average over the last 3 months.
My A1C was 13 I only tested once back in march before I started insulin so maybe I will have a better A1C next time Thank you for your suggestions.
It looks like there aren't "Before" meal numbers? Those might help too? I agree with Zoe about getting a ratio or ratios figured out being perhaps the quickest way to make progress? With a ratio, there's also a "correction factor" (I'm not 100% sure of the term but, if you pick up "Using Insulin", it explains this to...) so that if your BG is higher before meals (or anytime really...) you take additional insulin to "fix" it.
When I'm yutzing around with numbers, if I'm running high and correcting at the same time every day, it suggests to me that "Well, maybe basal rate or ratio needs to be adjusted there..." so I can get things to respond precisely?
Thank you I will get the book using insulin and I will start to test before every meal do you have any idea what before meal numbers should be?
I like my before meal numbers to be 80. I don't beat myself up if they aren't but that's where I'd prefer them to be? One thing that seems to help a lot of people is that if BG is higher than say 80, or up in the low 100s, where a small part of the bolus would be for a "correction bolus", is to take that shot earlier, to give the insulin a "head start", maybe 15-20 minutes? This will put the insulin spike and food spike together and prevent the BG spike?
First of all, good for you for keeping a lot! It's really the only way to see patterns.
I also glanced at your numbers, and they don't look that bad, especially for using a sliding scale. I was also started on a sliding scale and oral meds (mis-diagnosed as a T2) and had horrible results (MUCH worse than yours!) and a lot of frustration, to the point that I was ready to give up.
Knowing your BG before the meal is only 1/2 the formula. As Zoe said, you need to figure out how much one gram of carbs will raise your BG. Easier said than done, but Using Insulin is a wonderful book and will help you figure it out in short order. Once you are using enough insulin to cover the carbs you are eating and adding insulin to correct if you're high to start with, you'll be amazed at what good results you can get! I also have different ratios for different times of day - 1:6 for breakfast, 1:10 for lunch and 1:7 for dinner.
There really is no 'should' for pre-meal numbers, though the 'party line' is below 140. My target is 90, but we are all different, and there are a lot of variables that will make you rise/fall.
Please keep us posted!
Those numbers look pretty good to me, but I am wondering- when you inject for numbers that are above 150, are you doing those injections before or after you eat? Do you ever have low blood sugars that you catch between meals?
Thank you I take 23 units of Levemir in the morning and novorapid before meals and another 13 units of Levemir before bed and yes my sugar has dropped a little low a few times around 40-45
Can you feel it when your blood sugar drops low? I would not call 40-45 a "little" low. That has the potential to cause big problems.
I can tell when it is low when it 55-60 range above that I don't seem to notice too much. at 40-45 it is very noticeable and a little scary. I seem to notice more when I am high.
Yep, 1 year is not that long. If you read around TuDiabetes, there are those struggling with it 5, or 10 or even more years after diagnosis. Unless we can find a cure, there will always be problems and complications.