Replies to This Discussion

Permalink Reply by Zoe on March 10, 2012 at 1:08pm

If you are regularly getting two hour post prandials such as 178 and 218, then you need to adjust your I:C ratios as you are not getting enough insulin. Keep in mind that many of us have different ratios for different meals, so you just have to play with it making small changes and watching it for a couple days until you are in target more of the time than not.

As for the lows in between meals: Unfortunately, Lantus is not an exact science because it doesn't really last 24 hours. And since you are so insulin sensitive, you are right, that 5 units may be too little. I would suggest you split your Lantus into two doses or switch to Levemir which has a bit smoother action. Then you can figure out how much to take at night and how much in the morning

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Permalink Reply by juliannaergrl on March 10, 2012 at 2:07pm

I would agree with you about not getting enough insulin for the 2 hour mark, but then t seems like I have too much at the 4 hour mark. My CDE says its better to be high then low especially since I have hypoglycemia unawareness. But decreasing these dosages doesn't seem to have help much with that. 
And I thought about splitting the dose of Lantus but I clearly don't need to take any in the am cause then it'll be working at noon and 4 web I'm tryig to avoid lows. Maybe I'll try taking it at like 6p every night. Then it'll peak about 4 hours earlier? 
And until I get it fixed I suppose I'm gonna have to add snacks into my diet again. 

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Permalink Reply by timmy on March 10, 2012 at 2:40pm

theres your culprit- your not snacking hence 4 hour lows. Technically, you should try and get 5-6 smaller meals in a day. EG, have an apple midmorning, some low sugar/fat free yoghurt etc. Im honeymooning like you and dont need to bolus for such items, you may not have to either. Andi agree, your two hour readings are too high. Up the insulin and snack on healthy (even low carb if you wanted to) foods. Your waiting too long if your not eating in 4 hour windows imo.

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Permalink Reply by Zoe on March 10, 2012 at 3:08pm

You have Lantus active all the time, although many of us don't think it lasts 24 hours. So it's more likely to reduce lows if you have less of it at any given time.

Some people eat small meals, but that is an older concept of diabetes management. If your basals are set right, then there is no reason you should have to snack. If you are going low and then eating snacks you're "feeding the insulin" instead of the other way around. Unfortunately with such a low dose, it's hard to set it right. One option is also to get syringes with 1/2 unit markings, that way you can try to decrease it by 1/2 unit rather than a whole one. Or you can just get a pump...lol. With a pump you can input multiple different hourly rates to accommodate different basal needs.To answer your original question, yes, a pump would help you, because you can have different basal rates and you can make changes as little as .025!

I also disagree with your endo. Doctors tend to overemphasize preventing lows. Moderate lows (I don't even treat unless it's under 60!) come with the territory and if you avoid having them too frequently you can restore your hypo unawareness. Purposely staying high to avoid going low to me is indicative of somebody that doesn't have any useful ideas on how to fine tune doses!

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Permalink Reply by juliannaergrl on March 10, 2012 at 3:29pm

I have had a lot of low blood sugars this past year, many below 50. It has to be below 50 before I even notice now. They are very concerned about this

As for my endo no having ideas, they do have them. My pump was ordered on Wednesday. I am waiting to hear from someone to see about the insurance and if they will approve it etc. Hopefully I'll be able to get one within the next month and that should help with a lot of things. 

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Permalink Reply by Zoe on March 10, 2012 at 4:05pm

Oh, I didn't know you were that close to getting a pump. There is definitely a learning curve with the pump, but you will find it much easier to manage your blood sugars with one. Yes, it will help with a lot of what you are struggling with!

Sorry,I might have come on a bit strong about your endo, but I just wince everytime I hear "it's better to run a bit high".

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Permalink Reply by juliannaergrl on March 10, 2012 at 3:33pm

Yea I'm gonna keep eating snacks until I get my pump at the very least. Then maybe I can get some of this worked out

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Permalink Reply by Super_sally on March 11, 2012 at 7:15am

How much carbs are you eating at each meal? Seems you are spiking too high and then dropping too low.

Some carbs do seem to spike us worse than others. And seems that the profile of the insulin is not matching your blood sugar rise and fall.

Do you bolus just before you eat, or in advance of eating?

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Permalink Reply by juliannaergrl on March 11, 2012 at 8:06am

I eat 40 carbs at breakfast, 60 at lunch and less than 100 at dinner, I bolus 15 minutes prior to eating.

I agree that the insulin is not matching my rise and fall, I just don't know how to fix it. If I wait too long after I bolus to eat, then I go low before I eat... it's like no matter what I do I go low!

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Permalink Reply by Zoe on March 11, 2012 at 10:20am

You might want to try cutting the carbs a bit. I personally find that when I go over 50 carbs at a sitting my usual I:C ratio doesn't work well. At breakfast that threshold is lower. Also certain types of carbs will always spike me and I've found them impossible to accurately bolus for so I just don't eat them. Everyone has their own list of these, but for me it is cereal, rice and to a bit less extent, pasta. I used to love granola, yogurt and fruit for breakfast. I tried every kind of healthy, hi fiber, sugar free flax added, etc etc cereal and none of them worked, so now I just eat some kind of egg dish with a small amount of carbs.

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Permalink Reply by Terry on March 11, 2012 at 12:14pm

I have a couple of thoughts that may help you. Since you've read Gary Scheiner's book you probably understand the importance of getting the basal rate (in your case the Lantus) set right. Have you done any of Gary's basal testing? It involves missing one meal at a time and closely monitoring the changes in your blood glucose. The goal is to set the dose and timing of your Lantus regimen so that it metabolizes the sugar released by the liver only.

Once you are satisfied with your Lantus dosing and schedule then you can experiment with your bolus (Humalog) insulin. Have you experimented with giving your Humalog 15 to 30 minutes before you eat?

As you can well appreciate, we can quantify and calculate all we want, sometimes the variability of our own personal insulin sensitivity can throw our BGs wildly out of control, even with all our efforts.

You are doing the right thing by seeking more information. Attempting to gain normal blood sugars is very important. Frustration is normal, giving up is not an option. Good luck to you.

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Permalink Reply by Zoe on March 11, 2012 at 12:34pm

I agree, Terry, that the basal seems off and needs to be set first. Unfortunately this is hard to do when you're very insulin sensitive. I so think julianne is going to thrive on a pump!

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