Hello! I have some basal questions as well. I started DR.B in December of 2011 so it's been a little over 1 year for me. I love it!! I had no problem adjusting to the 30 carbs per day, and basically eating protein, veggies, some seeds all in fairly smaller portions than I used to eat. I have been using Levemir and have been taking after breakfast about 8units and 7units after dinner. I then seem to wake up every 2-4 hours at night and check my blood sugar and sometimes end up taking 1-5 units Humalog, depending what the meter says. I usually can keep my sugar in the 100-120 range till I eat breakfast. Usually two eggs with one pat of butter and a couple cups of coffee with cream. Two hours after breakfast my blood sugar is anywhere between 160-200 so I take some more Humalog. When I eat lunch, I take my Humalog about 1 unit and two hours later will take anywhere from 0-4 units depending on what my meter says. And the cycle continuous throught the day/night. I test like crazy! 12-17 times in 24 hours. I did take my insulin before meals like DR.B says early on this diet, but had a super terrible low that scared the hell out of me. Now, I take my insulin both fast and slow after I eat. Not sure how to bring my insulin usage down, and not sure how to correct properly. Does any body else take their insulin after meals with success?
Thanks for any and all help!
Sorry no one has commented so far, but I think most here would agree that a 2 hour post-meal BG between 160-200 is too high. Most shoot for a two-hour postmeal below 140, while some would say shooting for a BG below 100, putting you in a "normal" range is ideal.
Since you are eating low-carb, and check often, take a look at your 30 minute and 1 hour post-meal numbers. You might be seeing a rise from protein conversion to glucose. On a pump, I'd program in a dual wave, or extended bolus, to take care of something like that. On MDI, splitting your meal bolus to take the late rise into account would be fine.
Whether or not a pre-meal bolus is necessary depends on what your numbers look like. If you are seeing good numbers up to 2 hours postmeal when you find yourself up into the 160-200 range, then I don't see an issue.
Difficult to say what is happening - I am not sure why your blood sugar goes so high after breakfast of just 2 eggs butter and coffee. First thought is whether it is the cream?? (usually not but just check the pack to see how much carb per 100 ml it contains then measure out how much you add to a cup (pour it into a millilitre measure first) so you know exactly how millilitres and hence how many carbs you are taking in 2 cups - it may be more than you think(???). If this check only shows a very small number of carbs, then you are as you say eating a very low carb breakfast (as 2 egggs and butter should only have 1-2g carb and this is too small volume for Chinese restaurant effect to be affecting you) so next thought is this rise you mention could be "Dawn phenomenon" (which is in the morning the liver dumps out a load of glycogen to get you going and at the same time mops up insulin as per Dr B's book; so after getting up, many people have a rise in blood sugar). To address this you may need to take a small amount of insulin immediately on waking (Dr B takes 1.5U I think he said (could be wrong but anyway I take 2U apidra immediately on waking for this reason). To find out what to take to address dawn phenomenon, one morning when you get up, test your blood sugar every 30 mins for 3-4 hours (don't eat, just have water) and see if you go shooting up and if so to what level. If you do go up, you can work out what dose (by knowing how much 1 unit of insulin lowers your blood sugar as per Dr B's book) is needed each morning to correct this dawn phenomenon. A final thought is perhaps it is the coffee causing your morning rise - I have heard some people say that coffee raises their blood sugar. I think this less likely but test by having the same breakfast but with a different hot drink (green or fruit tea (hence no cream needed either) or sparkling water etc etc just to see if this addresses it.
In terms of sorting out your basal dose, again follow Dr B (or as described in thread above). Basically when stable and not having eaten for a few hours (usually therefore in the morning), take basal dose insulin as usual and miss breakfast (eat nothing just drink water if needed) for a few hours testing every hour. If you stay stable you have the right basal dose. if your blood sugar falls over the hours, your dose is too high, if you slowly rise in blood sugar over the day, then your dose is too low. etc.
It is hard to address all this at once and there are lots of ways to do it! I suggest first assess how much 1 unit of insulin drops your blood sugar and how much 1 gram of glucose raises your blood sugar / how many carbs 1 unit of insulin covers for you (to do this, read Dr B's book - not the whole thing! just check the pages that tell you how to do this which is quite short). Once you have an idea of how much carb you can cover with insulin, sort out why your sugar goes so high after a low carb breakfast - have the usual breakfast but omiting coffee and cream. If your sugar still goes up despite having only 2 eggs, butter and clear fluid then likely cause for rise is the dawn phenomenon - if so, one morning, miss breakfast and test to see how high it goes / how much you have to take to correct it. Once you have dawn phenomenon sorted (by taking for example 1-2 units immediately on waking (or whatever you testing tells you is the right dose for you)) you can then test your basal dose as above. Once basal sorted you can test 1 and 2 hours after each meal as suggested above and take insulin to control these figures again as per Dr B / your dose schedule. If you have the right doses you should be able to take insulin when you start eating. I am sorry to hear you had a hypo which sounds very scarey but it should not be becasue you took insulin before meals. (It may be that you took it too early before a meal or it may be your dose was too big that gave you a hypo but if you take (a correct) dose when you actually start eating, you shoudl be fine (and this is much safer than letting you sigar go high then taking insulin a few hours later to chase it back down).
Sorry for such a long answer but a lot to describe! Summarising the above: having 2 eggs, butter and clear fluid breakfast one day and testing afterwards for 2-4 hours will sort out whether your high sugars are from coffee / cream or dawn phenomenon. Knowing your insuin to carb ratio as per Dr B's book (only need to read a couple of pages that describe how to do that) will help you find dose of insulin to correct dawn phenomenon (if you have one) each morning. once that sorted, you can check basal dose, then check 1 and 2 hours after meals to work out dose of humalog you should take when you start eating (you may do this bit before checking basals?). Good luck with it!! regards, Ralph
I have been eating low-car Dr. Bernstein's way for about 8 years. I have loosened up my eating a few times and found that my control just got worse. Now I am convinced that going very strict is the best approach. I think Ralph is right on everything he has mentioned. I have read and re-read Dr. Bernstein's book, and I have also availed myself of many of the great resources found in the Paleo/Primal world.
On basal insulin... it does depend on the person, but, if we are all ideally healthy we will use an approximate amount of insulin for our body weight. As Ralph mentioned, lack of sleep can cause insulin resistance, and so can many other lifestyle factors. Even in non-diabetics, people who live a less healthy lifestyle are producing more insulin to meet higher demands. Reducing insulin resistance is always a good thing. Whenever I make positive changes in my health regimen I get confirmation by seeing lower insulin numbers and lower glucose numbers. They travel together, and when they both go down together,it's good change.
I use a pump and my current basal dose is 17 units of Novolog. I have seen it come down from up to 35 units a day down to my current level. My ratio of basal to bolus is still not what has been described by Dr. Bernstein and others on this thread. I am seeing my basal:bolus ratio at about 7:3. I will be looking at seeing if a reduction is needed, but it has been working well for me. I have found that eating a ketogenic diet has created a need for more basal and less bolus overall.