ok so maybe im posting in the wrong forum but I am lil frustrated and thought maybe yalls could provide a lil perspective on things.
I have been dealing with diabeties for over 2 years now (i dont claim to be a vet on this subject). I have been thru multiple insulin medication changes (started at 500mg 2x day of metformin moved up to 1000 a day then put on novolog and lantus). My a1c was a 9.1 last time it was done. My sugar is uncontrolled (my last fbs was 437 and normally ranges from 200-300 believe it or not.)
Recently my PCP referred me to the endo and they knocked my insulin to lantus in the morning and evening and a set number of units for novolog. My PCP had me on a sliding scale. Is there a reason for this. I just dont see the point in a set dosage with novolog without a sliding scale.
Also my PCP believes i should be a canidate for an insulin pump. but here are my fears about that. I live on a limited income (i have medicare and medicade) and I allready have issues getting my insulin with prior authorizations. I do worry about supply cost.
anyway i should stop this post before it turns into a rant. Feedback welcomed
You're getting good advice, but I have to ask: What are you eating?.....Judith in Portland
It pretty much depends on the day of the week. 4 Days out of the week it is normally subway. I am a student and I am on the go so I normally dont have time to get something. when i am home i tend to go for something white meat or hot dogs sometimes chicken. I tend to stay away from pork products. Breakfast is normally eggs of some sort (i use egg beaters). I do tend to hit up the sour patch kids every once in awhile but I do not do that 2 often (gotta cheat sometimes).
let me know if there is anything else you want to know
Does Subway list the carb counts on their sandwiches? I can't even imagine how much insulin I would need for all that bread!
I don't eat much fast food but when I do Subway is often the choice. However I don't touch the bread at all, it would turn the meal into a blood sugar disaster for me.
Good to know :) thanks :)
Also, are you sure that you are not LADA?
here is the quick run down
12-26-08--First incidient with low blood sugar
1/09--diagnosed with type 2 by Resident (started metformin)
1/09-9/11 switched between januvia, glipizide, and upped metformin
9/11-present Started lantus
12/11-started novolog (sliding scale) started by resident
3/12-seen endo for the first time who adjusted insulin to a set dose
so far everything on my records says type 2. Also if you look at my profile there is a picture of my glucose trends since 2010. Still wouldnt rule it out (my dr still considers me young at 26)
Your insulin doses are pretty typical of Type 2. But I would focus on figuring out your I:C and ISF and basal and getting things into range.
You should definately learn to count carbs, and start dosing for what you eat. Sliding scales and set doses are outdated. Set doses can work if you eat exactly the same thing for every meal, and the dose is the right dose for that meal, but that gets pretty inconvenient, not to mention unbalanced from a nutritional standpoint.
You should also consider cutting your carbs back, fast food is notoriously highi in carbs, salt, and grease, all bad things for diabetics.
If you want a plan you can follow, try the South Beach Diet, maintenance level. Start making your own lunches and brown bag it. Its your health, its up to you to make this work. Take the time to make lunch the night before. Eating out is destroying your health, and hurting your wallet too. If you're on a limited income, I don't know how you can afford to eat out anyway.
Also, if you make changes in your insulin, make only one change at a time, and make it a small one. Wait at least 4 or 5 days before making any other changes, because it can take a few days for those changes to have their full effect on your body.
And last, but certainly not least, test more often. Try testing before each meal, and at 1 and 2 hours post meal (start timing from the beginning of your meal). Keep a log of what you eat and how much, and these numbers, then you can start to figure out which foods trigger high numbers and which ones help keep your numbers in line.
Check with your endo before making changes in your insulin regime, and talk to him about carb counting. Obviously what you're doing now isn't working for you and the doctor should be able to help you make these changes safely. If he's not willing to help, try to find a better doctor, who is more uptodate on treatment.
Good luck, and don't give up!
You've gotten great advice. In addition to appropriate insulin doses based on what you're eating, timing is also very important. The usual guideline of 15 minutes before meals isn't always helpful for everyone. Some meals digest more quickly or slowly than others. Those high in carbs digest fast. Those high in protein & fat digest slowly & you may not see rise for 3-4 hours. Though medical people rarely, if ever, tell us, protein does effect BG. The only way to head off the spike is testing for a while using both one & two hour readings.
The best way to learn your I:C ratio is by keeping meals consistent to learn how food effects you & when. Lowering carbs will result in lower insulin doses. Lower insulin doses result in better control. Pass on the starchy foods. Eat protein, eggs, cheese, nuts, & non-starchy vegetables. Portion control is important. Just because something is lower carb doesn't mean you can eat it in large quantity. The good thing about avoiding carby foods is that soon you stop craving them. I'm a former carb junkie & promise they hold no appeal any more. The other positive thing about forgoing high carb items is that you won't be hungry. Protein & fat stay with us a lot longer. It's carbs that make us hungry & craving more because they digest quickly.
Second Gerri's advice. Timing was a very big problem for me when eating a lot of carbs. I found that none of the insulin I tried peaked as quickly or consistently as expected. Also, couldn't predict quite when the food would hit me. Got the best results bolusing about an hour before eating, but rarely pulled this off. Protein didn't seem to affect my BG much.
On the LC diet, I bolus Apidra right before eating. Food and insulin both peak about 1 - 2 hours, and not as hard, so cover eachother pretty well. Protein does affect me a lot more, now. I bolus for it 50%/g vs carb. If I eat a lot of it (eg. 1/2 roast chicken), it hits me fairly hard, about 3-4 hours and later. Also, if you choose to go this route, you will be very hungry the first few days, while your body is adjusting.
Personally, I don't think the insulin pump is the way to go for you. I think your doctor is just trying to prescribe the latest "big thing", hoping it will help. But if you're not achieving even moderate control on injections, the pump will only let you achieve the same, but for $6000 or so more.
Another commenter asked if you're sure you aren't LADA. That's a very good question, and misdiagnosing LADA as T2 is unfortunately very common. I would ask your PCP or Endo for a C-Peptide test to see if your body's making any insulin at all. If he says no, find another doctor.
You say your PCP thinks you should be a candidate for a pump, but what about the endo? Once you see an endo, every other doctor that tries to care for diabetes becomes irrelevent. Listen to the specialized expert.