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Permalink Reply by jdridge on September 16, 2011 at 10:49pm

Super sally I would LOVE to have a reading of 5.1 (A1c). Have you had higher A1c's and what tips can you give that have worked for you?

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Permalink Reply by Super_sally on September 23, 2011 at 4:18am

I tried to answer this already a few times and it got lost. Anyway, in summary:-

1. I am lucky enough to still have a little of my own insulin production (I suspect, but not tested as I get high from eating carbs without bolusing (with basal on board), but not soaring (close to 200). I haven't tried eating a carby meal in such a circumstance of not bolusing, so maybe if I ate a carby meal it would go far higher.
2. Low carb, following Bernstein approach (but not always so low as some of his patients) - but probably 60 - 80 g on most days. I dose humalog based on how many grams of carbs I eat. For me; 20 g of carbs to 1 unit of humalog.
3. I now aim to try to keep my bs between 70 and 90. I adjust 2 hours after eating if I am 110 or above, as I know from experience that whereever I am 2 hours after eating, I will still be in the same place (give or take 10 points) in another 2 or 3 hours.

I should exercise more than I'm doing (which is currently NOT), and that would probably help even more.

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Permalink Reply by jdridge on September 24, 2011 at 6:47pm

Super Sally thanks for the response. I have had some problems with "lost" data as well.
Anyways, I will take a look at the Bernstein approach. I find that for 30 minutes on the treadmill I can reduce my BS by 5 points, so far that is the only thing that I have been able to count on because my insulin has no pattern..

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Permalink Reply by Super_sally on November 11, 2011 at 8:19pm

Just got my latest A1C of 4.6, which I'm thrilled about. This has been with a combination of agressive use of insulin (and immediate correction of highs), and the Bernstein low carb diet approach.

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Permalink Reply by Bob on November 11, 2011 at 8:33pm

Great news on the A1c! I have just ordered the Berstein books, should arrive in a week or so but what are your carb daily intakes like based on his recommendations?

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Permalink Reply by jdridge on September 16, 2011 at 10:42pm

Crashette, I am on lantus at bedtime too, plus metformin. I have not been on insulin that long either but it is not working for me that well. Now the doctor is talking adding insulin (fast acting) for meals. Quite frankly my blood sugar reads were better before I started taking insulin. Are you finding the levemir works well? Did your doctor do the testing to determine that you are a 1.5? Has your doctor give you any advice about your carb's to insulin ratio?

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Permalink Reply by Crashette on September 16, 2011 at 11:32pm

The dr call's me a type 1- but he said I had very low insulin production. I know I'm a 1.5 or a 1 what ever. The biggest part is still having some output from my pancreas... we are going through a divorce right now and it occasionally gives me a little support once and a while. lol Others like to call it the honeymoon phase... that is just a little so happy sounding for me.
Anyhow enough of my sillyness.
Dr started me at 1;10 carb ratio. It's been 5 days since I started the fast acting. But I also dropped onglyza which the Dr said that my insulin needs would climb up... but he didn't know how much.
I feel the levemir is working, I am close to having the basal rate figured out.... I hope. I've had a few great suggestions from other members on testing the carb ratio, so I will work on that this weekend and hopefully get a few answers. I will let you know how it goes.
Oh and yes for sure my BG numbers are up this week aftermeals for sure. I keep thinking I should try some metformin in addition, but I hate the GI issues. So I will continue along with my experiment on myself to see if Im SMRT enough to get some answers.

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Permalink Reply by jdridge on September 24, 2011 at 6:40pm

Crashette - Well we seem to be approaching this challenge on a similar basis. I will be taking the meal time insulin as of the 26th the insulin is called Apidra and I was told to take 4 units per meal. My doctor says that until they get me stablized that they would have difficulty determining a ratio.
I don't know if it is possible, but would you like to exchange emails?

I have to admit I'm not all that up on some of the terms used, " you stated you talked about metformin and GI issues, what is that?

So how do you know that your pancreas is still functioning, did you have tests or because your BG numbers are reasonable?
Talk to you soon.

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Permalink Reply by Trudy on September 25, 2011 at 5:51am

Hi jdridge. There is talk in this discussion about low carb and exercising to keep your insulin needs low. I'm not a medical person, but I'd suggest not taking 4 units of Apidra with a low carb meal or after exercise on the first day or two. Experiment with just a small amount of Apidra at first, find out if a low carb meal really does need 4 units. When/if you eat something higher in carbs (potatoes, rice, cereal,etc.) note what they require. Keep a log about exactly what you're eating and when you've exercised. Test your blood sugar before a meal, then 2 hours after,and record it. You'll soon work into an understanding of how the Apidra is working for you. I'm not saying a long, drawn-out period of experimenting, just start carefully and be aware of what's going on. (I've had LADA/Type 1 for 18 years.) Best wishes.

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Permalink Reply by Zoe on September 25, 2011 at 9:36am

I absolutely agree with Trudy, jdridge. Taking a set dose per meal is bound to get you into a cycle of eating to match your insulin dose, when it should be the reverse - dosing insulin to match your food. If you eat low(er) carb and still produce some of your own insulin, you may find 4 units excessive.Your doctors can't determine a ratio, but you can. Start with say 1:15 which is a good middle point, then if you are high two hours after your meal, lower it to 1:14, if you are low raise it to 1:16, etc. You may also find you have ratios that are different for different meals. It does take some time, but trial and error is a large part of diabetes and will help you get things in range.

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Permalink Reply by jdridge on October 2, 2011 at 8:16pm

Trudy thanks for the advice, it certainly pointed me in the right direction. I have to admit that it seems my doctor seems to give me the perscription and lets me go to it. Your help is really appreciated.

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Permalink Reply by Crashette on September 25, 2011 at 10:41pm

Hey, I agree with Trudy, 4 units can be alot with every meal. You need to carb count and document everything.
If you have an Itouch or iphone there are some apps that help with the math.
I take Apidra and Levemir- Currently I'm at about a TDD ( total daily dose) of 24-26 units - 13 units of Levemir at bedtime then the rest through out the day. Since starting 2 weeks ago on the Apridra my BG numbers are really coming down ! Which leads me to believe I've got little insulin production.
The Metformin caused GI issues ( Gastro Intestinal ) means lots of loose #2's : 0
with me so Im glad to be back to normal. But that said the metformin did work on me for the first few years, but now that Im only on insulin I can say that I feel way better because I now have energy. I was so tired before, makes clear sense to me now as with out insulin my blood cells were not getting to use the glucose.
So Im glad to hear you are starting on insulin soon. But do take it slowly... test test test.
My first week on Apridra was a roller coaster but now I'm carb counting better.... but not tonight I totally blew it !
It's easy at times to fall off the proper diet and cheat.
The other thing that helps to figure out insulin doses although a bit boring is eating the same thing for breakfast 3- 4 days in a row and see if you get the carb count correct with the correct dose.
Apparently you should be about 1.66 mmol ( 29 ) with in range from your premeal reading 2 hours later if you got your dose correct and carb counted correctly. Try and keep your activity level the same daily as well so there are less variables to figure out in the beginning.
Hope this helps, you have some great advice happening, and you will figure out the lingo, but ask if you don't know : )

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