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Permalink Reply by Zoe on October 14, 2010 at 6:42pm

I understand your frustration, Marty. Especially when you are used to having good numbers. But I don't quite understand your insulin regimen. You don't routinely bolus for food? This is a definite setup for highs. I would suggest figuring out your I:C ratios which might be different for each meal and then getting into the habit of bolusing routinely before each meal. If you are crashing sometimes perhaps you need to first establish your correct basal numbers before you go on to figure your bolus. Trying to eat as little as possible is not a useful option imho.

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Permalink Reply by Stuart on October 15, 2010 at 8:25am

Hello Marty:

Look up the term "honeymoon period" re diabetes. That may provide some answers

An A1C of 5.1 is dangerously low. I would wager you have a bunch of tiny factors adding up making life difficult.

Example depending on the short acting insulin you use, shooting AFTER eating would typically be a problem. Its too late to prevent the food spike. The new apidra can be shot during or close after because it works within 15 minutes (ie before food gets broken down into sugar, nutrients, etc.)

The trick is always finding the patterns. In a three day period how many numbers can you account for. If your numbers are consistantly higher than desired, more long acting insulin is likely necessary. If you have weird numbers only once a day, with no pattern you can find to it, then you'll have to dig deeper. Diabetes loves to mock our vigilence.... 18 months, 18 years its the same problems.

But i would guess that though it is counter intuitive, I would wager if you let your numbers be 25 or 50 points higher across the board, I would wager you get far fewer wacko numbers. My gut suggests you are likely going low just enough to trigger a body response... fairly regularly (ie too low a threshold).

Pssst, starvation is NOT the answer. You'll really get slammed then. The body thinking its starvng will turn on your liver, and other systems to privide you energy to stay alive. Not a good approach. And you don't need three different meters. One, any one will work just fine. If you think the readings are off use the control solution to make sure the meter is callibrated.

But dispassionately, objectively, start with any issue you want. Food, insulin, numbers. Figure out what you are able, what you CAN account for and then work backwards carefully. Do all of them simultainously and we all get overwhelmed.

Stuart

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Permalink Reply by SF Pete on October 15, 2010 at 10:02am

You should probably check your glucose at 2 hours after the meal rather than an hour. Two will give you a better idea of what you are doing. It does sound like you are still in the honeymoon period. That can make things a little less predictable. Fast acting insulin is best taken before you eat. If you are nervous about giving the whole dose, cut it down. When you check at the 2 hour mark, if you are elevated, you can give a bit more as a correction. Levemir is a background basal insulin. If you are producing insulin, you probably have a bit too much in your system. Your A1C of 5.1 in within non-diabetic levels, but it may also indicate that you're too low with the insulin combination. The body will shoot out some glucose if you go low and don't treat. It's a shotgun blast so you tend to go up. I used to wake up in the 300s because I'd drop between 3 and 4 and not realize it.

If you can get one, a continuous glucose monitoring system is a great idea. With one of the CGMs you can see what's going on in real time. Most insurance companies are covering them without too much trouble. It's a very powerful tool and I've found it to be the most helpful in maintaining good numbers. I don't make any insulin and it makes things a bit easier to manage. :)

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Permalink Reply by carb101 on October 15, 2010 at 10:40am

Wow, what a confusion! I can't give any advice about the insulin useage, but I would reduce carbs, at least until you have your sugars more under control. Have a lettuce wrap instead of bread with your lunch, for example.

It just occurred to me that if you're eating out, the makings of the sandwhich could be very inconsistent from day to day. If you've got anything on that sandwhich that has carbs, it could be having a large effect.

Also, not everyone agrees that an A1c of 5.1 is dangerous, unless you're getting there by going low a whole bunch. According to Dr. Bernstein's book, non-diabetic BG ranges from 80-95 with A1c of 4.2 to 4.6, and he preaches that diabetics can achieve that same BG levels as nonD folk, stating that his own is consistently at 4.5.

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