Comment by Gerri on August 29, 2009 at 9:50pm

Sorry that your doctor hasn't taught you how to do this.

Are you counting carbs & matching insulin to what you're eating? Do you have a correction ratio to correct highs?

Don't know what you're doing now, so forgive me if this what you already know. Doctors usually start people off using 1 unit of rapid acting for each 15 carbs, injected 15 minutes before meals. Best to start off with lower carb meals to figure out your ratios to fine tune them. As a Type 2, you may need to start with a 1:10 ratio. Insulin doses are also based on your weight.

By recording your readings before & after meals, you'll see if you need to raise or lower your bolus doses. It's good to keep the same dose for three consecutive days to see a pattern. Raise or lower insulin by 1 unit when you change it. Many people have different carb ratios depending on the meal. Since you're Type 2, it may be different for you.

Keeping meals 4 hours apart helps by allowing one meal to completely digest before eating again & helps prevent stacking insulin that can cause lows.

As for Lantus, this is usually based (for starters) on weight, what your between meal numbers are & fasting BG. Hard to tell you this without more info.

For high fasting, it's helpful to take Lantus right before bed. It doesn't last 24 hours as claimed for many people. If your between meal BG is good, you may not need to take another Lantus dose in the morning.

When starting Lantus (if you take before bed), it's good to set the alarm for 2-3 AM to test to make sure you're not low.

Comment by Gerri on August 29, 2009 at 9:55pm

P.S.

Dawn phenomenon can effect Type 1s & 2s, though usually more a Type 1 thing. Not eating & seeing rising numbers in the morning is typical with dawn phenon because the liver is dumping more glucose. I inject & eat immediately upon waking to prevent higher BG.

Comment by Keith221 on August 29, 2009 at 10:49pm

Hi MeadowLark,
I have been type 1 for about a year. I am also a veteran( US Army 74-77). My numbers have been pretty good, A1c = 6.8. Here's what little I can help with.Basal here's how I found mine. I did a 12 hr fast using Lantus only, I do 30 units in the morning. During the fast your bs shouldn't go up or down more than 30, adjust as needed. Give yourself a day or 2 and fast again, Mine only varies about 10. It could take a while. Now bolus is trickier. I had to find my carb. ratio, which is 2 units Novalog for every 15 carbs. A good starting point is 1 - 15.
Using this method I test before every time I eat, if I am high( for me that's above 120) I add extra insulin to correct(2 units novalog brings me down about 50), I also tend to figure on the high side.
Here is an example, today I woke up checked my bs and it was 103 (KOOL). Did my morning wake up(30 units Lantus) Breakfast of Champions lol. Now mind you I was dx'ed at 52 so my eating is still not so good, a lot better but still. OK, my breakfast was 2 hot sausages in hot dog buns, the buns are 20 grams carbs(I don't adjust for fiber) 40 grams carbs. = round up to 45 = 6 units novalog, before eating. Lunch my bs was 88, tuna sandwich, some corn chips let's see 2 bread = 44 grams, small hand full corn chips = 30 grams, so 75 carbs. = 10 units novalog. Dinner bs was 108, same as breakfast, so 6 units bolus. Just checked my bs and 105.
Now mind you I am still new at this, so the other day my numbers have been so good it got me wondering. Humm? Just maybe I am getting better?? Well I did a little check.
I was with my daughter having just found out by ultrasound, that I am grandpa to a little girl (YEAH!!). We go to the mall because grandpa has to buy his grand daughter's first dress. We see a gelato shop, after checking the chart I get me one (small cup only 17 grams), but I didn't bolus(experiment). One hour later before dinner my bs was 188. Experiment results: I am still type 1 diabetic and there is no cheating!! Well I correct my experiment with 2 units novalog. For dinner I have grilled salmon, 2 servings mixed veg.( no rice for me) and some chips. I only do 4 more units novalog. 2 hrs. later I check my bs (always before driving) bs is 160 ok to drive. Later at home about 4-5 hours after eating I get that oh so special feeling LOL. Check my bs oops 55, well after my experiment don't want to over correct, so 1 little box of apple juice, wait for it, wait for it and check my bs is 85 Kool.
This is what works for me I hope it helps you!!

Comment by MeadowLark on August 30, 2009 at 3:58am

LOL! Keith! You sound like me!
ok going backwards:) Patricia, Nope I do not have a correction ratio to correct highs. I just know that when I'm high; I want to sleep. With 6 kids and no one around(since Stephen is deployed).. that does not happen. (LOL! never has. I didnt take any pain pills when I came home from having any of my kids:p I generally do not take meds for headaches either.) I need to be very alert with my bunch!

I am doing a ration of basically 1 to 15. ( I have noticed that if I "choose" to eat something sugar free and go wild with it... I need to do 2 to 15.) that does usually happens around "that" time of the month. ugh.
I'm 5..... decades that is.. and still not menopausal! Though age wise I am. ugh!

My meals have always been "odd" time wise. Just depending on what is going on in the family. Bascially,
4 to 6 hours apart. This meaning, I get up between 7 and 9am.( breakfast usually an hour after I get up as I just cannot eat as soon as I wake. yuck!) Lunch is usually between 1 and 3. Dinner is anytime between
5 and 9 pm. We're really scattered on our timing:) We homeschool so I fix meals or the kids fix meals just depending on when the kids want to eat. I generally don't eat what they eat anyway.:)
My breakfast is normally an english muffin with peanutbutter and two cups of coffee using splenda.
Lunch varies A sandwich with 4 slices of turkey or ham and one slice of 2% PepperJack cheese with romaine lettuce and mayo. or hummus with veggies. Winter time can see me with a bowl (2 cups) of chili and maybe a salad.
Dinner is two veggie burgers(by Morning Star) topped with barbque sauce ( 1 teaspoon each) and a slice of PepperJack Cheese. With one of those frozen boxes of veggies from Walmart.
Or if I get really rebellious.... I eat whatever the kids are having and pay for it or basically double whatever shot I would give myself on a "being good" meal. :p

ok I've got one more mess to throw into the bag.
I've noticed that when my blood pressure goes up with fusses with my kids ( special problems of verbal abuse etc...) My bloodsugar races up with it and can throw a great bloodsugar day into a nasty mess.
Does anyone else have this problem too?

When you are talking about fasting. Does that mean upon waking drink only water and take a shot to try to get numbers at least rolling in the right direction?
I'll need to go get an alarm clock to do that night time checking:) Mine walked off somewhere.....
Huggles
MeadowLark

Comment by MeadowLark on August 30, 2009 at 4:06am

oh ugh.. forgot to add... one Dr suggested that I "might" have PCOS.. wonder how much that really affects things? He did do that cpep test on me and told me that I was not type1. Kinda blew me away because everyone in my family history is type 1.

Comment by MeadowLark on August 30, 2009 at 5:15am

I was 132 at 7:12 am and this is what happened.

ugh one hour later... I'm 167! :( I didnt do anything...well... I changed a diaper, woke a few kids up, did not have anything to eat or drink! well, that answers when my numbers go haywire. I'm no where near ready to put food in my mouth!ugh.

(Just for everyone's info a "mommy all nighter was pulled from 4 am this morning. so this is all a little peek into my daily life:)
Huggles
MeadowLark

Comment by MeadowLark on August 30, 2009 at 5:19am

ok 167 means 4 units of humalog...It's Sunday. Normal habit is to double and not eat so that at lunch I will be around 110 or so, sigh,
What better thing could I do?
huggles
MeadowLark

Comment by Gerri on August 30, 2009 at 8:37pm

Highs make me want to sleep also. With kids you sure don't have this option! Better to keep moving anyway & bet you never stop for a moment.

Ok, for starters you need to find out your correction ratio--how many units of Humalog lowers BG how many points. This way when you have high BG you'll know how to lower it to your target BG. Since you know your insulin:carb ratio, you'll take that to cover the meal in addition to a correction dose. Like everything else, this is an individualized thing. I use Apidra. One unit of Apidra lowers me 60 pts. I'm a small person. There was a discussion you can look at to see other people's correction ratios for different rapid acting insulin. It's going to be trial & error. Next time you're high & take Humalog & record your dose & before & after readings. Test at 1 hour, 1.5 hours & 2 hours to learn how much Humalog lowers you & in what length of time. Start slowly so you don't go low.

Fasting:what your BG is when you wake up & before you eat.

With dawn phenonmenon your BG will continue to rise if you don't eat. Test, inject & eat as soon as you can after waking. Not easy with little ones, but you have to take care of yourself to take care of them. Don't skip meals:) Eat a high protein breakfast that's very low carb. This helps the dawn phenomenon spikes & you won't be starving by lunch. Caffeine in coffee causes BG to rise for many.

Don't just double your dose for the "bad" meals. Count the carbs & use your same 1:15 ratio (or hormonal ratio). Keep logs of doses & readings. You may need to raise or lower your ratios, esp for different meals.

Stress, whatever the cause, causes BP & BG to rise.

If the sugar free food contains sorbitol, manitol, etc (any sugar substitue ending in "tol"), these are sugar alcohols. Some people experience BG spikes from sugar alcohols & you may be one. Of course, there are carbs in these foods also, so if you over-do it they will effect you.

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