? Question ?

[am1977]

Lately I have been having some problems with my control :rolleyes:. Needless to say, I'm frustrated :argh:. I've been a lot higher than I would like and it's pretty much driving me crazy. Instead of going low directly after exercise and then spiking after dinner, I now end up high after my workout and spike even higher later on. I think I going to go mad with all this **** :banghead:.

Today, I repeated another basal test (think I lost track of what number test this is :hmpf: )... and it basically showed the same trend my last couple have shown. I spike 2 hours post breakfast and then I start falling... I was 87 fasting, 2 hours after breakfast I was 232 :eek:, 2 hrs later: 143, 2hrs later: 74, 2hrs later :63.... I then had to stop the test.

Anyway, I've noticed that this basal test seemed to follow my typical pattern, that is spike immediately after breakfast and then start dropping from there. I know if I tell my Endo, he will just reduce my basal rates a bit more, but I really feel like that isn't the answer :thumpdown.

I think that when I go back to eating like usual, my numbers seem much higher than they should be and I have a hard time controlling them. If I mention that to my Endo, I know he'll suggest that I change my carb to insulin ratio. And, yes, that may be what I need to do, but I think there is more involved than that. :frown:.

I know that food causes really dramatic spikes in some people, me being one of them :rolleyes:, but I somehow feel that there's other issues involved here. I guess my question is, how do I know there isn't another health issue going on that's contributing to me having a hard time with my numbers. What if there's some unresolved health problem lurking that I'm not aware of? How would I find that out?

My instincts tell me that this might be the case, but I don't know how I would know that for sure... I'm hoping someone here might have some advice or suggestions.

Thanks so much in advance :)

[koblenz]

Hey Am. Sorry you are having such troubles.

I can't comment on the possibility of the "hidden" factors that may be causing it, I'm no doc.

On the morning spike issue, I have that, to a T. My endo said it is related to a morning release of hormones. I tried lots of different strategies to solve the problem including different foods, insulin timing, different basal rates, etc. What works for me is Symlin; it has been a miracle cure for my morning spike. Now a days, I rarely go above 130 post breakfast and in the 90 to 110 range just before lunch. Might be something to discuss with your doc.

There is a big honking Symlin thread with lots of discussion on this topic at: http://www.diabetesforums.com/other-medications/9447-symlin.html

Anyway, hope it helps. Keep at it and I am sure you will figure it out. :thumbsup:

[camjen1]

Let's say it all together now, THIS DISEASE SUCKS!!

Am how has your progress been with the Symlin?

I can't really comment because I need a little tuning myself but I hope me and you both can get this all figured out soon. :)

[Tim_Roy]

About you spiking two hours after the meal, perhaps you want to start using the combo or square bolus function of your pump.

Talk about that with your doctor. It can spread the dose out over time. It basically turns your bolus into a "super basal."

I've been diabetic for 29 years, my digestion has slowed. Add to that I tend to eat fatty foods (bachelor diet). Every bolus I do is a combo, and with my Animas I can extend it as long as I want or even put more of the dose on the end of the bolus (like I do when I'm low and expecting a rebound).

Note: One potential issue this can cause is that you'll have to keep the pump connected during the entire bolus. Luckily mine is waterproof so I can wear it in the shower. Don't ask what I clip it to. :-p

Just kidding, I hang it on my medic alert necklace. Dog tag chains are very strong.

[Shotokan]

Today, I repeated another basal test (think I lost track of what number test this is :hmpf: )... and it basically showed the same trend my last couple have shown. I spike 2 hours post breakfast and then I start falling... I was 87 fasting, 2 hours after breakfast I was 232 :eek:, 2 hrs later: 143, 2hrs later: 74, 2hrs later :63.... I then had to stop the test.


I'm confused. You're not really testing your basal rate if you're eating and bolusing are you? Typically, basal testing is done by skipping a meal. For example, you would skip breakfast and test your BG every hour or two to determine whether your basal insulin is keeping your BG level in the absence of food.

Once you establish your proper basal rate, then you can eat and bolus to test your I:C ratio.

Basal testing is explained in John Walsh's book Pumping Insulin and also explained at this web site:
http://www.insulin-pumpers.org/howto/ratio.cgi

[am1977]

I'm confused. You're not really testing your basal rate if you're eating and bolusing are you? Typically, basal testing is done by skipping a meal. For example, you would skip breakfast and test your BG every hour or two to determine whether your basal insulin is keeping your BG level in the absence of food.

Once you establish your proper basal rate, then you can eat and bolus to test your I:C ratio.

Basal testing is explained in John Walsh's book Pumping Insulin and also explained at this web site:
http://www.insulin-pumpers.org/howto/ratio.cgi


According to the testing guidelines for daytime rates I have, you would eat breakfast and then test every two hours afterwards, skipping lunch, until dinner time or until you have to stop the test (like I did). I guess there are other ways to test this too... but this is the way I have been told. :dontknow:.

[Shotokan]

Yep. Sorry, I assumed that you were testing your morning basals. My bad.

[Lilly164]

This creaping higher sugar through the day sounds familar. I suspect it is related to getting older and a slowing of my digestion. Two things that have maybe helped are: change Lantus to 12 noon, and increase Novolog in AM before breakfast. That is, extra Novolog on arising, then at breakfast time, (1-2hours later) divide that extra dose by three to get the amount left. Count the amount left as part of breakfast dose.

does this make sense?

I have noticed that Lantus held my sugars steady in the late afternoon/early evining so long as I didn't eat anything. Maybe it holds my sugars more steady in the early morning hours too.

Beth

[am1977]

Thanks everybody for your advice and support... again, tonight, I had another problem :bawling:. I spiked again at 300 after dinner. Aarrgh! I'm so frustrated :argh:. Seems like no matter what i eat at that time of night, I will pretty much always end up high :frown:.

I'm not on Symlin yet, but now I'm getting really anxious to start. I think it could only help me with these horrid post-prandial readings :mad:. But, my endo wants me to continue to do further basal testing. Honestly, I'm beginning to wonder if these tests are ever going to end... :rolleyes:.

Beth, thanks for your response. I am actually a pumper, so I don't use Lantus at all. I only use Novolog in my pump and carb count to decide how much to take to cover my meals.

I am glad that your system is working so well for you- take care :)

[Tony]

Hi Am,

Did you start your basal testing off with the overnight test first? Then your morning and now your working on your afternoon test?

[am1977]

Hey Tony...

Hmmm, I'm trying to remember :hmmmm:.... I've done SO many basal tests by now, that I've kind of lost track with which ones I've done :rolleyes:.

Ok, yes, I did start with the overnight test. That's the one where you eat dinner and keep testing every two hours, skipping breakfast, until lunchtime the next day, right? Yeah, I've done that, and suprisingly, my rates seem ok...which kind of shocks me since that time period give me the most problems.

I've also done the daytime test... which is what I described before in this thread. Basically, eating breakfast and then testing every two hours after, skipping lunch, until dinnertime (or you need to stop the test b/c of highs or lows).

But, now, my Endo wants me to do a lunchtime test. I don't know if this one even actually exists. Well, I guess it's possible to do. This one he wants me to eat lunch and then test every two hours after, skipping dinner, until around midnite, he said.

I'm getting really impatient with all these tests, b/c I don't see an end to them. I just want to be over with them ALL, but I guess I don't see that happening anytime soon.

I am planning on talking to him about it, b/c I am starting to doubt that I am ever going to see improvement. He's a really nice person, but as a doctor, I don't know if he's right for me. But then sometimes, I think I am being too harsh.

Thanks for your response :)

[Tony]

Yes pretty much, you tested the over night and morning in one test. You never moved more then 30 points right? If that is the case then you need to look into your morning bolus.


That's the one where you eat dinner and keep testing every two hours, skipping breakfast, until lunchtime the next day, right? Yeah, I've done that, and suprisingly, my rates seem ok...which kind of shocks me since that time period give me the most problems.

[jenet]

I'm getting really impatient with all these tests, b/c I don't see an end to them. I just want to be over with them ALL, but I guess I don't see that happening anytime soon. ... I am starting to doubt that I am ever going to see improvement.
I soooo understand this. :stupido: I know it's got to be possible to figure out good pump settings. I'm going back to square one this weekend, and starting over with all the different tests for pump settings. I am determined to get to the bottom of this. Hang in there, and good luck with your testing. :)

cheers,
j

[am1977]

Yes pretty much, you tested the over night and morning in one test. You never moved more then 30 points right? If that is the case then you need to look into your morning bolus.


Well, it's been a while since I've done that test... so I'm not sure if I actually rose over 30 points or not :dontknow:. All I know is that we somehow determined that my nighttime and morning basals were ok, b/c we stopped testing them and moved on to the next basal test. I'd venture doing them again, but then I don't want to open a whole other can of worms again... with testing and retesting and testing the basal rate some more! My God, my Endo is a little bit obsessive with these tests! :albertein

I am going to discuss my last results with him and then I am going to be quite blunt and ask him if there's ever going to be end to these tests. I can see if it was helping me somehow, but I don't think it is.

I'm at my wits end with this **** :mad:...

Sorry for being so b*tchy, but I guess after a while it wears on you. Thanks for letting me vent! ;)

I soooo understand this. I know it's got to be possible to figure out good pump settings. I'm going back to square one this weekend, and starting over with all the different tests for pump settings. I am determined to get to the bottom of this. Hang in there, and good luck with your testing.

Jenet, I'm sorry that you can relate to this... but it does make me feel better that I'm not the only frustrated with all this ****! Hey, misery does love company, lol :laugh:. Anyway, I'm trying to hang in there, but I think I'm going to lose it soon :argh:, if I dont' start seeing improvement. Like I mentioned above, it's different if you are doing these tests and feel like you are getting somewhere then it is when you are doing these tests and are still having problems.

Logically, yeah, it makes sense to test these rates. I know it helps to determine whether things need to change or not, but it also can be SOOOO aggravating.

I wish the best of luck with your own testing and please keep us posted! :)

[Shotokan]

It might help if you do your own analysis. If necessary, review basal and bolus testing in Pumping Insulin or go to one of the web resources like this one if you don't have the book:
http://www.insulin-pumpers.org/howto/
Then analyze your results and make recommendations to your endo. That's what I did. We often compromised because I wanted to make bigger changes than she did, and that worked our well in my case.

For me, it was much less frustrating when I felt I had some control. It was also a great learning experience for me. I ended up understanding the theory and application of basal and bolus testing to the point that my endo was convinced I could do it on my own after a few weeks.

Good luck!