I was wanting to know it is normal to take a fixed rate of insulin or if its more common to be on a sliding scale. I have been seeing a PCP since November but should be going to see an endo some time this month. I am taking 10 units of Novolog with each meal and I still having highs. When I say highs I am talking about 230's-320's most days. I have been trying to stay under or around 45 grams of carbs for each meal but there are times I know that I have gone over but I know that I have not gone over 60 grams with is still in the range that they gave me. I believe that I am type 2 and over weight. I think that my PCP was going on family history and I know that they did not do a c-peptide test. Is this something that the endo will have done or that I should ask about?
Thanks for any information/help,
CJ

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Hi CJ D2 -

First off - I have NO medical credentials, just a finger sticker, a Type-2 guy, who HAS gotten my glucose level under control, so all I can do is tell you what I experienced. Like most diabetes related questions, the answer is "it depends". Remember, there is a genetic component and a life-style component to diabetes, and there are times when I truly believe the phase-of-the-moon is a factor as well :-)

I won't bore you with my whole song-and-dance, if you're interested it's at http://www.weloop.com/HATS.html . In a nut shell, I started with 15-units of Lantus at night, that progressed to 30-units with little or no impact. Then my doc started me on Humalog before every meal with the dosage based on the carb.content of the meal about to be eaten.
That is when things began to change - because I got actively involved.

I watched carb.content, and began to get about 30-minutes of exercise each day. I paid NO attention to calories.

In a year or so, about 18-months:
- I dropped 40-pounds.
- A1c was in the 5.5-5.6 area the last two tests. My glucose was averaging 104
- I have discontinued all insulin usage for the past 5-months now, my glucose averages 113. I've an appointment in April and am looking forward to the A1c results.

I believe the key is -- YOU must be ACTIVELY involved in the process. You will need the guidance of a good Diabetes Education and Support team and you will need to keep complete and detailed records for several months to get a good handle on what is going on with your body, and it won't be long until that chore becomes habit and a lot easier.
It sounds like a lot of work, and it is some work, but the stakes are high and it is will worth the time and effort.

I wish you the very best, because I also think luck may have a role to play as well. Do NOT get discouraged! Do NOT think you can not do it! You learned to walk, how to talk, how to roller-skate, how to drive, how to swim, how to use a computer, etc., etc., etc.
You CAN win this battle, it just means you must be "The Boss". In my case that merely required me to pay attention and get ACTIVELY involved.

IMHO the "sliding scale" is utter nonsense. Basing a bolus on your current reading alone is a logical absurdity. You have to consider both what your BG is, and what you are about to consume. To calculate a dosage strictly based on your present reading is to assume that it won't make any difference whether you eat a salad or a chocolate cake.

Cut the carbs! I was eating what a dietician told me and miserable, then I met a new dietician. You can help prevent or you can treat.
She recommends a carb neutral diet. It involves monitoring your meals and your reactions to them. The amount of carbs they tell us to eat are not necessary and can be gained in fruit and veggies. Make a lettuce wrap instead of a sandwich. I found Lavash bread which is very low carb and high fiber. I was hugely disappointed with the standard meal plan and I am now down to taking pills. It's worth a try.
Cut the rice, potatoes and bread. A sandwich sends me into the 200's.
We can't behave all the time but I think you will see a difference if you do.
I'm type 2 and have no tolerance to carbs.
I also had weight loss with Levemir and weight gain with Lantus...

If you can, try to find a good endo. They're hard to find. I think C-peptide is important. It's good to know where you are at. Then they should run the immune system tests to see if you are really a type 1/1.5.

Consider going low/lower carb. Many of us feel that the ADA guidelines are way too high. I'd say this is especially true with a type 2. By lowering your carb intake, your body is better able to control your diabetes on its own. Also, low carb helps you lose weight, and the extra weight does bad things to the blood glucose of type 2s. I'm not saying get rid of carbs, but eat lots of salads and greens and little sugar, bread, starch. Finally, a type 2 that not overweight needs to be checked out as being a type 1.5 (LADA).

I am completely insulin dependent, so I always base my fast acting insulin injections on both the number (g) of carbs eaten and my current BG level.

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