At the moment, I do not have an endocrinologist or a diabetes educator or, indeed, anyone helping me. I believe passionately in the necessity -- FOR ME (I make no prescriptions for anyone else) -- of eating quite a low-carb diet, in order to try to manage my diabetes, but all the endo's I have seen (and I've seen four, all highly regarded and expensive, since April) buy into the American Diabetic Association guidelines, and want me to eat at least 180 grams of carbs per day. I think this would be disastrous.
I'm currently eating fewer than 40 grams of carbs/day, often fewer than 30, and I'm following the insulin guidelines I was given in April: check my blood sugars before meals, and take 3 units of Novolog if my BS is 100-150, 7 units if it's 150-200, etc.
This ain't working. I am struggling to get my blood sugar levels below 200, and in the morning (I take 28 units of Lantus at night), they are typically over 250. I know I need to increase my insulin, but I don't know how to do this safely. Can anyone advise?
Also, I am pretty desperate, at this point, to find an endocrinologist I can work with. I'm in NYC, but am willing to go just about anywhere to find the right doc. All suggestions WARMLY appreciated.
That sounds pretty tasty and pretty low carb. If nothing else, maybe a whiff more insulin from your bolus ratio to cover it and you'd be great. 179 and low 200s aren't that far off from where you'd want to be.
Since you said you take your Lantus at night (and it still isn't enough for your needs) it may not be lasting 24 hours (it rarely does, that's why many people take it in two doses). So that rise at the 3 hour mark may be due to running out of basal. Since your meal was both low carb and low fat it isn't likely to have caused a spike that far out.
I really want to thank you all for both recommending the Walsh and Scheiner books and for making it clear that this is something I can adjust on my own, as my own guinea pig. In retrospect, I am so jaw-droppingly angry at the first endo I saw, in particular. His instructions, it's now clear, were entirely out of date, the dose of Lantus he prescribed was too low by about 50%, he didn't tell me that I needed to check my BS levels after meals...nothing. So to get good information and the book recommendations has been a godsend, has left me feeling more capable of managing this than I have since it first hit. I have taken the Lantus up by 10 points, and so far it seems to have been absolutely the right move: My morning BS is much lower, and I stabilize during the day. AND it's comfortably below 200. Much more to do, certainly, but....anyway, thank you.
That's a great start and its true that to control this disease we must turn ourselves in to our own personal science project. Experimentation is what it takes to get the numbers right but you must keep a close watch on bg to avoid bad lows when you add too much insulin into the brew.
There's good advise for to be found here on ways to determine the different aspects of insulin use. There is a method for figuring out basal rates, insulin to carb ratios and insulin sensitivity. Look around and do some searches it will be a great help working these thing out.
May I ask another question? Well, I hope I may, because I'm sure I will have a ton. At any rate, Gary Scheiner talks about the need to eat a "moderate fat" meal before testing basal dosages. I get it; he wants me to avoid having to deal with a spike in my BS that might be three or four hours out. But I honestly don't know what a "moderate fat" meal is. He says to avoid restaurant and take-out food, ok, but in a low-carb context, I just don't have any sense of what a moderate-fat meal is. I mean, are we talking steamed chicken breast and a salad with no dressing here? Or do I get some poached salmon and asparagus with some butter?
Well, I can't be sure why Scheiner says this, I think we would have to ask him. But I will tell you that both Scheiner and Walsh submit to the ADA dietary recommendations, which are to get 45-65% of calories from carbs and 25-35% of calories from fat. So if you want to follow the directions to the letter, then go for a meal like that.
Personally, I think the best way to do a basal test is to eat the way that you expect to eat all the time. If I ate an ADA style meal and took large bolus insulin doses, it wouldn't make for a good start for fasting basal test.
I'll have to admit that I haven't read Scheiners book. I learned most of what I know from the good folks here. I will suspect that the reason he doesn't spell out what is moderately fat is because what is moderate for some is not moderate for others. Moderate fat is different for a vegeterian than for a burger and fry person. I would guess moderate fat should be judged by whats normal for you. After all it's your basal rate you are testing.
I can't really offer much help - especially since your pancreas maybe still squirting out juice (I'm a T1D - my pancreas ran away on me when it was 6 ) - so not sure how to offer you any advise that may screw you up even more. If you are having difficulty finding a endo - one person I can recommend is to contact Gary Scheiner (he is a T1D) and his team - http://www.integrateddiabetes.com/about.shtml (if you haven't read Think Like A Pancreas - it is a bible for diabetics).
Also, John Walsh's book like Zoe has recommended is another great place to look at (your local library "may" have the book - I know mine does here in Montreal).