Okay, a little back ground here. I am 27 y/o and when I was 23 I was diagnosed by my PCP as a type 2 diabetic, simply because I was over the age of 18 and had an A1c of 8.0. I was put on all sorts of different oral meds then Byetta, then Victoza, then back to Byetta. I began working out feverishly and eating a very low carb diet... I lost 60lbs! But all these things did not keep my b/g from steady rising more and more. So, after 3.5 years my PCP finally agreed to let me see an Endo. After reviewing my chart and talking with me she said I am DEFINITELY type 1, not type 2. She said if I hadn't gone low carb and started exercising like I did they would have figured it out much sooner. She immediately adjusted all my insulin (which I began taking in Nov. with my PCP cause everything else had failed). And she wants me on a pump which I am all for an incidentally have am just waiting on the paperwork to go through.
Okay, so last night I was very very upset because they keep decreasing my insulin doses to increase my blood sugars because they are too low, I am frustrated because my sugars are all over the place and I hate that! My CDE says its because I work out so much that I am very sensitive to insulin and require extremely small doses. Some days I just feel like maybe I shouldn't be taking any insulin but with none it shoot right up into the 300s within 24hrs. I'm frustrated and confused at the moment.
I suppose what I really want to know is, I am taking only 16u of insulin total 6u Lantus, 10u Novolog that just seems like an outrageously small amount considering how the "standard" is 0.5-1u/kg/day. Thoughts? I mean is it possible that I can honeymoon 4 years after because I just started on insulin. Incidentally when I first started I was on 18u Lantus and 7u Novolog.
And finally, all these fluctuations are making me nervous about getting my pump. Is having a pump going to help with all these lows?
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
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.
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!
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".
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?
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!
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.
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!