TYPE 2 AND TREATMENT
Hi All, I am wondering if any of you are on so much medication. i'm on 2500 metformin per day, 28 units novolog, and 72 units of Lantus. I am still unconrolled with A1C of 8.9.
Replies to This Discussion
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Permalink Reply by Zoe on -
Do you use an insulin:carb ratio for your dosing of the novolog before your meals? How many carbs do you eat? If you don't use a ratio and know your correction factor to correct after meals if you are too high, you might want to get the book Using Insulin by John Walsh.
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Permalink Reply by Pauly on -
Hi carolyn,
Sounds like pretty high insulin resistance. Are you on a very low carb diet? Also are you seeing a endo for your treatment?
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Permalink Reply by carolyn mcquis on -
yes i am seeing endo, since 2004 and this is as good as it's gotten. i am so disgusted i could scream.she raised me yesterday to 28 novolog and 70 lantus. i was 254 at bedtime and this morning 198.
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Permalink Reply by bsc on -
I think you are right to not be pleased with that level of control. How is your primary treatment going, diet and exercise?
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Permalink Reply by Leo2 on -
Carolyn,
I'm really feeling for you. Is this 5 years?
Is your basal set to return you to 80-120 all night and between meals? Have you fasted one meal per day to learn just what the Lantus is doing round the clock? Have you tested around the clock?
I would be ready to throw these insulins back to the company saying they're not working!!!
I can't help but wonder if you don't need an alternative to Lantus. What has your prescriber said about something else? (I won't even grace the prescriber with being an endo!) People with weight gains with insulin are seldom well understood by prescribers.
I have all sorts of questions. I would hie me to Dr. Bernstein, settle at a hostel and live there til managed fully.
And if that's not an option, I would insist on a second opinion, a CGM, an option to use a different long term insulin til level around the clock, an option to go VERY low carb (not above 6 grams per meal for one week), and get that much covered by boluses. Then, I would start eating gingerly a bit more for lunch. I hope you're both laughing and taking me seriously to some extent. I fire doctors. I do not willingly do what they say without second opinions. If I were you, I would go for a second opinion. Somethin' ain't rite. There can be other things going on, too!
And I suppose you have to understand that I'm just a very in-your-face, person who won't take one endo's idea of diagnosis.
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Permalink Reply by carolyn mcquis on
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i've been in this damned mess since 2004. my levels have not improved at all. all they do is keep adding more insulin.
as of this past week im on 70 units of lantus at night plus 1500 metformin. during the day id 30 units of novolog befre each meal and 1000 metformin. I am sick, sick of this. for example yesterday my readings were 243 upon rising, 262 before lunch, 188 before supper and at 12 midnight before bed 360 and this morning 243. this is about the average every day. there is only one game in town as for endo's. 5 of them all in the same practice. HELP
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Permalink Reply by Teena on -
Carolyn...how are your daily meals like? Are you on low carb diet? Do you have routine exercise activities?
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Permalink Reply by carolyn mcquis on
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honestly, i have no idea about some of the things you all speak of likke bolus and basal what is it? ratio??
can you give some idea for breakfast meals? I need all the help I can get. thank you for responding
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Permalink Reply by bsc on
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I hear the dispair in your voice about your condition. I know you have struggled with the for a while. I am going to speak bluntly to you, please don't take my comments as a criticism. Some of us have a harder time getting our blood sugar under control and it really sounds like you are on the difficult end of the scale. I am on three medications and I'll use whatever level of medication is needed.
1. Your doctors have been cr*p. They should never have let you go this long with this level of control. You should have had an escalation of your medication and insulin treatment.
2. You need to take charge. Not just fixing the doctor thing, but become a smart and aggressive patient when it comes to your care.
3. Diet - Get your diet in order. You say you are doing low carb, I would suggest you really tighten things up. Consider the Bernstein diet. Keep a tight control on your carbs, limit your calories to keep your weight controlled and do not binge.
4. Exercise - Be dilligent, if you can only walk, then just walk, but do it regularly. If you can't walk, do upper body aerobics.
5. Education - You need to become really smart about insulin and take the lead. Get "Using Insulin" by Walsh and "Think like a Pancreas" and read them and become very familiar with them.
6. Testing - You need to start testing 10-12 times a day until you get this under control. Get your doctor to prescribe it, bite the bullet and do it. Test to see if your basal is right, before a meal for insulin dosing and after to see if you need correction. Testing has a purpose, be purposeful in your testing and make your testing purposeful (see I said it three times, all different).
7. Insulin - You need to accept that your insulin requirements are your requirements. Work with your doctor to get an insulin regime that meets your needs. Set your basal rate properly, you need to do basal tests to establish your levels. Determine a proper insulin:carb ratio and use it for "every" meal or snack. You need to correct after your meal if you are still too high. Finally, accept that you may be severely insulin resistant and require large insulin doses.
8. Do not accept high blood sugars because you don't want to use higher insulin doses or fear weight gain. Use the required insulin and treat your weight with your diet, exercise and medication.
9. And if your doctor won't get on board, fire his *ss. And if the next doctor won't get on board, fire his *ss as well.
I understand you have struggled with this for a long time, and my heart goes out to you. I know you may look at this list and feel that it is just impossible. But that is not true. You can do this. You can turn this around and get control of this. You need to believe in yourself and it will happen.
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Permalink Reply by The Diabetic Welfare Queen on -
Carolyn, I feel your frustration. It's hard when you've had a condition for a while, and you expect to have control, and don't have it, or your medical team is not exactly meeting your needs. I think you've gotten a lot of good advice, and I caution you to try to take things one step at a time as you learn new things within our community... These are things, in fact, that should have been taught to you years ago when you were diagnosed. I would consider perhaps looking for a certified diabetes educator and a new endocrinologist. For now, here are some definitions:
Basal: Long acting insulin that is typically dosed in the mornings, upon rising. (This would be your Lantus)
Bolus: Fast acting insulin that we typically dose to deal with meals or snacks.(This would be your Novolog)
Insulin to carb ratio is simply... how many units of insulin would take for you to cover 1 gram of carbohydrate. Usually, people measure this with something that is really easy to use as a standard measurement, like say, 1/2 cup of orange juice which equals 15 grams of carbohydrate. You drink it, you measure how much your blood sugar rose, you see how many units of insulin you would need to bring your blood glucose down. This sort of helps people know how to dose for carbs, approximately (accounting for protein and fat, sometimes), when at meal times or snack times.
Insulin Sensitivity Factor: This is how many units of insulin will lower you a certain number of points in your blood glucose. This is also important to note if you have a really high blood sugar, and you need to correct, so that you don't overdose, and go too low...
Many folks in our community will tell you that they "restrict carbs" which means that they are very watchful of how many grams of carbohydrates they consume (by measuring, or weighing), so that they do not exceed a certain amount that might spike their blood sugars a certain amount. Some people eat 36 grams or less, daily, some people eat 80 or less daily, some people 160 or less, daily, etc... They divide them up accordingly during their day.
Many folks will not even eat very many carbohydrates (you know, all those starches, fruit, cereals, grains, pastas, bread, starchy veggies like potatoes, etc.) for breakfast, because that is when they are the most insulin resistant, or glucose sensitive, and they will spike really bad. People have different tricks of the trade that they practice here.
The best advice that I can give... is to take it one day at a time, read discussions here, get ideas on people's diets and exercise regimes, get a different doctor... And buy some books, and do some reading. You can also look up a site called "Blood Sugar 101", which I am sure someone already has suggested. For now, you probably should stick to lean meats, omega 3 fats, non-starchy veggies, berries, and nuts... until you can become more stabilized with your numbers. You can later adjust, and add more carbohydrate servings, if you want, and test with your glucose meter to see how you react, and what adjustments you may need to make.
I know it can all seem overwhelming, but ... Slow down, and take heart. :) We've many of us been where you are.
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Permalink Reply by carolyn mcquis on
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Lizmari thank you so much for your wonderful advice. I know it took some time and thought to respond so throughly, thank you. Would you please give me some meal ideas, especially breakfast. I'm lost on what to eat and have never heard of bolus, ratio, basal. there's only one endo grp in this area. it's a smaller town and far behind in alot of areas.
Any help you can offer will be appreciated.
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