I am curious, do most of you on the DR.Bernstein diet use R insulin for meal coverage? If so, at about what time of the meal do you inject? Before, during, after? And approximately what are the doses?

I will be starting R for meal coverage this weekend, and I am a little bit scared. I am currently using Humalog for coverage but end up either to high or low after about 2-3 hours after eating. I was on Bernstein forum and many followers suggest I swith to R for meals. I really hope to see an imporvement in my BG readings by doing this.

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Hi

If you mean Regular insulin (which is what it sounds like), NO. You should use the fast acting analogs like Novolog or Humalog (I have tried Apedra...not that much different for me over Novolog). You want an insulin that will peak in < 1 hour so that in 2 -3 hours the insulin will begin to drop your blood sugar when your food is digested and the carbs are converted into glucose in your blood. Regular insulin takes way too long.

How long after you eat does your blood sugar peak?

Ken

I use R for some meals because I have gastroparesis. I need insulin that doesn't work quickly & stays around longer than rapid acting. I don't see how R will help with postprandial highs. Have you tried different timing with Humalog?

R is typically injected about 45 minutes before meals since it takes that long to start working. Ratios are different with R & one of those things that will be trial & error. I need more R (smaller ratio) than Apidra for the same amount of carbs. For me, R sticks around for 5-6 hours.

Keep your Humalog to correct highs.

Hi Yolanda. Regular works well for Gastroparesis, or slow digestion. I have slow digestion and I use Apidra, Regular and Levemir. I would not be able to get proper digestion or reasonable blood sugar using the Regular without also using some fast acting insulin such as Apidra, Humalog or Novolog.

You said that you are either high or low after eating, which sounds to me as if there might be some other problem that changing to Regular would not address. I can't really give advice, but I would have to ask whether or not your insuln to carb ratio is correct, whether your counting of carbs is correct, or something like that. Eating to your meter while eating low carb might be a good way to start addressing the problem without changing insulins. It would be a good idea to speak to your doctor or CDE before changing insulins -- that's a big step.

(I just saw Gerri's comment, so we covered some of the same stuff.)

Thank you all for the replies. I guess I am confused. In the book DR. B says to use R insulin before meals. Some say to use R some say to stick with Fast acting.

Gerri, how do you know if you have Gastroparesis? If I eat protein anything over 3 ounces it seems like my BG gets pretty high into the 200's 3 hours after eating. If I eat only a little protein and still feel hungry I don't get up that high. Not sure if this is something I should look into or not.

Maybe now I won't switch to R for meals after all.

Yep, I mentioned R is usually taken 45 minutes before meals.

Did the members on the other site mention why they suggested R for you?

I had consistent serious lows after eating. Insulin was working faster than my digestion. Then, highs 4-5 hours later (sometimes longer) when insulin was gone. Classic gastroparesis symptoms. Dinner is typically the most problematic meal. I also had high fasting, which is usually attributed to dawn phenomenon. In my case, it was food still digesting overnight. I'm careful not to eat a lot of fat at dinner because that slows digestion even further. You may want to look at if you're eating fat heavy meals when you see highs 3 hours later.

Not to add to your confusion, but you could try splitting your Humalog dose. Take some before meals to hit the carbs & then another dose 2 hours or so after eating to head off 3 hour the protein spike. Three ounces of protein isn't much & you shouldn't be hungry. Hope this helps.

Thanks Gerri. On DR.Bernstein's forum, they recomended R because DR.B recomends it in his book. And they all seem to sware by it. Sometimes I can cover what I eat with Humalog splitting the dose a little before and a little after and sometimes I am right on. Most of the time I'm not. I guess maybe I am eating 3-5 ounces of protein and that's too much. I don't eat a lot of fat. 1 pat of butter with two eggs in the morning, and if I do make a stir fry at dinner it is 1 tsp of coconut oil. For lunch many times I will only eat some peanut butter 2-3 tablespoons. This does make me feel full but sometimes I am high 3 hours after eating it. High like a BG of 185 high. Sometimes its only a BG of 120.
I have only been on the diet a little over a year. So I am still trying to figure out all my insulins and there dosages. 4 years ago my A1c was 13 today it is down to 6.6 My goal is to be in the 5.5 range. I really hope I can get there.

So frustrating. Sorry, Yolanda. I can relate because gastroparesis is unpredictable. I never know when to bolus, or how much. Seems that every meal is a new adventure. Know how hair pulling it is to get widely varying results eating the same thing.

Incredible A1c improvement! Kudos on your success.

Adequate protein is critical, so please don't eat too little. Likewise with healthy fats.

Hi Gerri!
Did u have other symptoms of gastroparesis also? Things u are describing sound like me now. I can't figure out if it is change of my diet -low carbing or gastroparesis ... Thanks!

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