So about 4 weeks ago, I posted here how my nightly BGs kept running up in to the 250s by 5am (for like 3-4 months). I could not figure it out. One of the members suggested upping my basal at night, and lowering it in the morning to a 33/66 split, vs 50/50. This worked great for about 4 weeks. I would go to bed and wake at 7am, almost totally flat.
Well here I am 4 weeks later and I'm totally out of control again. Literally over the course of the last 6 days, I went from flat to 220, 220, 220, 260, 265, 220, mid-nightly numbers. Monday I went to bed at 118, 4 hours later I was 265
I'm so mad, because I justed upped the nightly, now what? Even adding two extra units at night, has done nothing. I suppose, I'll just keep adding, until its gets level again. I guess what I don't understand is for 4 years, I was relatively flat on 24 units per day, now I'm at 35, and now, again, I need to add more. No slight rise, just straight back in to the mid 200s.
Thanks for listeneing.
Welcome to basal insulin variability...many of us had a love/hate relationship with it for years our body's stopped absorbing it the same way each day, one day utilizing 90% and the next day 60%. The main reason for using a pump is to correct the absorption problem and supply the correct amount of basal insulin throughout the day and night.
I always use more insulin during the winter, and my requirements have doubled in the last 20+ years, I'm not fat but I do weigh 40 more pounds than I did 20 years ago and my activity level is probably 75% less...I'm confident that this adds up to needing more insulin. I also use 50% of my basal insulin between 3am and 11am.
If the Bete's was predictable we would not have a need for a DOC....how boring is that..;-)
From the scenario you're describing last night, reasonable food but a post meal spike that kept pounding, I'd speculate that at the 210, you may still have had "protein on board" (baked chicken, my favorite but I've burnt the family out on it a bit!) that had yet to deploy so the 210 + CB didn't cover both the high and the subsequent proteinapalooza. It may have been more of a bolus issue than basal as a lot of times there's overlap? I've tried to get better about including big hunks of protein as 5-10(+)G of carbs in my bolus estimation and it seems to help.
Interesting idea, I have never thought about the protein continuing to cause a sugar spike. My basal bolus does have a little overlap, I usually do my dinner bolus at 8pm, then my second basal shot at 11. Last night was a little better where I moved my second basal shot to 9:30. At 11pm, I was 110, at 3am, 150. Took a unit at 3am, but was still 210 at 7am this morning.
I can't claim credit for this but learned here that 53% of protein converts to carbs. There's a group, TAGers or something like that (total available glucose) here and I'd seen people talking about it and have used it. If a burger bun is 12 G (the "light" ones, I think they are airier...) and the meat is 25G of protein, bolus for like 23G of carbs and it should work fairly accurately. You have to have your meter handy to check and all that, particularly the first few times, but the food will be working and maybe hard to get rid of if it's not covered.
Here's an idea that I've been aware of for 10 years. The body does notice foreign invaders and slaps cholesterol over them. That is evident from the fact that in the USA they designed a stent with medication over it to help dissolve the cholesterol the body immediately tries to throw over it. That's why so many people become all blocked up again within 6 months to a year after an angioplasty.
Dr Bernstein suggested never injecting more than 7u if insulin in any one place (chap7 of 3rd edition). That makes a lot of sense, but he didn't give a reason. He just said there is such variability of effectiveness for large injections. So, I propose that the body is more or less wakeful in sending out the defence mechanisms. After all it expects insulin in the blood stream and not as pockets in fat and the analogue long term insulins are not truly human insulin. So the smaller the pocket in one place the better. It is easy to draw up the full amount you intend to take, but inject 1/3 in one spot, pull out and inject in another spot, and then a third time. BUT notice that as less is going to be destroyed, it behoves you to take less or else you will get a low blood sugar reaction.
I tried suggesting this to a woman taking 30u before bed and she found 3x7u=21u worked just as well. Given that people who change to using a pump end up using 75% of the level of total insulin they used before, it seems to show how much used to be destroyed by the body. Large sized injections also contributes to lumps forming under the skin. So the smaller injections are getting it "in under the radar" as I call it. It would explain why I have not had to increase insulin in so many years as I have always taken very small but frequent injections. Please don't think the body is unable to notice. It does. It's trained to use cholesterol to patch damage. Too bad we can't just tell the body that this is injected for a good reason. When people talk about absorption problems this could factor in. It's only slightly more complicated, but it does reduce lumps forming, so it is well worth it. I use a syringe up to 60 times, so each injection does not require a fresh syringe. So pulling out and reinserting in another place can easily and quickly be done.
I think you can't ask a person to split one injection into 3, that's not living well.
As for the explanation it doesn't match: as you say insulin pumps inject all the insulin into one place for 3 days, nevertheless the total amount of insulin is lower than when in MDI.
You have to consider that the needle itself "hits" the skin and causes inflamation, so 3 times the injections are not good for lipodystrophy.
I have friends using pumps which found helpful to ease the "infusion" of insulin through the skin by doing a small bolus followed by a very short square wave. Sometimes, for big boluses, they felt pain. Doing so seemed effective too about kicking in sooner, as if insulin flowed easier toward the capillary blood.
I don't have a direct experience myself about that.
With a pump, the amount going in is a much smaller volume at one time and the short acting insulins are closer to human insulin. What is your explanation of the smaller amounts needed once on the pump? What's your explanation for why the medical industry felt it was useful to dissolve cholesterol that is immediately "plaqued" over a stent? Your consideration of piercing the skin as cause for lipodystrophy does not impress me as much as just having too large injections of a foreign substance into one place over time as being the cause. That is why rotation of sites is also recommended. Are you going to insist that all acupuncture be done away with? My GP informs me that a pin prick does draw the attention of the body to a location for healing and whatever it feels it needs to do. Small 7u injections of insulin is Dr Bernstein's idea and he suggests the balance go in another location at the same time. Are you going to write him and tell him he is wrong? I don't have any sign of lipodystrophy even after 31 years because of needing so little insulin. This would happen from re using the same site over and over. I still have had no problem even though I have used just around 240 syringes since 1986 and I use separate ones also for B vitamin injections and still no sign of lipodystrophy. So reuse of syringes that are kept clean has not caused me a problem in all these years.
I'm not going to discuss the details of being on a pump as I have no experience.
I thought you might make a comment, just as you shot down supplements with an example of someone overdoing synthetic vitamin E which I would not recommend anyway.
You've been studying diabetes since 2009 and I have been doing the same since 1981. I stand by what I said. Syringe pricks are not as damaging as large injections of analogue insulin into a single location repeatedly. I did not say inject three times into the same location. The best idea is to always rotate.
Short acting insulins of a pump are the same as analogue insulins in MDI.
Usually under a pump you need less insulin because you get better absorption, and because on MDI usually you keep an overdosed basal insulin in some periods of the day.
I don't question Dr Bernstein but I cannot stop using my judgement only because "he said" something: he's not the only one knowing about diabetes, and on this point I don't know what exactly he states anyway.
Better absorption on a pump usually is explained by the site being "primed" by previous insulin, local tissues don't keep there any more insulin and every unit goes to capillary blood, as it finds a "river" already set up.
That makes sense, as makes sense that insulin as an hormone grows cells in fat were it flows, causing occlusions over time.
Always rotate sites, yes.
As for the poster, his problem is not an injection problem, probably he has to increase his evening basal dose.
During the period when I said "I want a pump" and when I got it, I reread Bernstein (to learn it didn't say much about pumps, and then discovered the DOC through the ADA message board...) and saw the multishot suggestion and tried it and it works very well, at least in the short term. At that point, I'd been shooting for 24 years and the shots didn't phase me at all, although it was for very short-term so the lipodystrophy didn't really come up.
Poking myself 3 times for one shot was never an option! Hard enough to do the one shot in the first place. So not interested in more pin-cushion action ;) So the pump is fine!!