Report from my visit

[Pitzi]

Ok, today was finally D-day to see the specialist regarding my change in medications and to get my blood test results.

A1c was alarmingly low, 4.7. This went to show that my control is certainly off target and that I am a time bomb as is.

He changed me to Lantus and something that sounds like Apidra (some rapid acting insulin). Biggest benefit is that I am on the pen for both, so no more syringes for me.

I think it's gonna be a bumpy ride for the next few weeks until the right dosage is found. I'm also new to the whole carb counting thing :dontknow: :banghead: .

Most worrying of all, he thinks there must be some kind of autoimmune disease underlying both my diabetes, and all the other complications that I have encountered in the last few years, like the digestive enzyme deficency, and various intolerances. Any ideas on that? I remember having done quite a few complete blood tests in the past, but nothing ever came back positive. Funny thing is, whatever autoimmune disease that I might have, it's only been attacking the pancreas. I'm more confused and depressed than ever :(

[Pitzi]

Ok people, got another question. Sorry if it might be very stupid, but I am new to this treatment regime of 1 x long acting insulin injection and 3 x fast acting insulin injections with meals.

The doc said to test 2 hours after meals/injections. what do I do if it's high? give another shot of fast acting?

[JediSkipdogg]

The doc said to test 2 hours after meals/injections. what do I do if it's high? give another shot of fast acting?

Depends on how high. If your goal is to aim for 100, and you are running 130, you can let it slide till your next long acting shot. However, if you are running 200, you need another shot most likely. And FYI...personally, I consider 2 hours pointless and like to do a 3 hour test since at 3 hours 90% of the insulin is out of the body, 2 hours still has a good amount to go.

[DeusXM]

Depends how high you mean by high. Apidra works for around 3-4 hours or so, although its peak action is in the first two. However, if you're running high, then you can take a few extra units of Apidra as a compensation bolus. However, to do this successfully you will need to find out exactly how much your BG is lowered per unit of insulin.

The only way to do this really is through trial and error. If you are concerned with a high reading after two hours, I'd suggest making a note of that reading, taking a very small amount of Apidra as a comp. bolus, and then test every half-hour to see how your BG is doing.

[corwin]

I agree with Jedi about the numbers. As far as the 2 hours go, if you had a high fat meal and you test over 200 in the 2 hours mark it's pretty safe to say the remaining insulin in your system won't cover the high and you can take a correction shot already instead of waiting to be even higher at the 3 hours mark. Same thing if you are 70 in the 2 hours mark and you ate a low fat and protein meal, it's better to fix asap before going seriously low. It's something you need to figure out for yourself how the new insulin and the meals effect your bg, but the 2 hours mark can give a good indication of what's going on. 3 hours would be good for a complete effect of a meal for figuring ratios.

[Pitzi]

Thanks people

[jen_slc]

The doc said to test 2 hours after meals/injections. what do I do if it's high? give another shot of fast acting?Like it's been said, you will have to go through trial and error and although most people might be likely to say do another bolus, I wait it out. My rapid insulin is Novolog so I don't know how it compares to Apidra, but I tend to spike post-prandial (even 2-3 hours out) and return to normal later than other people, so if I do a correction at 2 hours I will undoubtedly bottom out. Example: last night post-dinner I was 221. Not a good reading but my carb count was spot on, my ratio works and for whatever reason I went high. I was itching to give a correction bolus but knew I would hypo in 2-3 hours in the middle of the night. I woke up this morning at 99. Perfect. I have been trigger/correction-bolus-happy in the past and it's always made me hypo. I get the feeling that maybe this isn't the norm with most diabetics (insulin appears to last longer or whatever) but it's another perspective that you'd want to be aware of. Trial and error, who knows how your body will work with this new regime! Good luck!

[poodlebone]

Ok people, got another question. Sorry if it might be very stupid, but I am new to this treatment regime of 1 x long acting insulin injection and 3 x fast acting insulin injections with meals.

The doc said to test 2 hours after meals/injections. what do I do if it's high? give another shot of fast acting?

I usually test at 2 and 3 hours after a meal. Be careful about giving yourself an additional correction shot at 2 hours, since some of your previous insulin will still be working. Your doctor should have gone over a correction factor with you - telling you how many points you might drop for 1 unit of insulin. As someone else pointed out, if your goal is 100 (5.6) and at 2 hours you test at 140/7.8 you shouldn't need a correction because 1/2 to 1/3 or so of the injection you took for your meal is still working. If you test and you're 300/16.7 then I'd say it's safe to take additional insulin to bring it down, but the amount of insulin you'd need is most likely different than what I'd need, or the next person would need. On the other hand, if at 2 hours you test and you're at 80/4.4 then you might want to consider having a snack, because you will most likely drop some more. That's why I usually test at 2 hours, just to see where I'm heading, and then again sometime between 3-4 hours.

Did your doctor give you an insulin:carb ratio - for example take 1 unit of Apidra for every 10 (or 12 or 15 or whatever) grams of carb that you eat? I assume he did since you mentioned carb counting.

A lot of Type 1 diabetics have other autoimmune issues. A common one is being hypothyroid, which I am. I think rheumatoid arthritis is another autoimmune disease that many Type 1's also get. A lot also have Celiac Disease but I'm not sure if that's actually autoimmune or not. I thought it was genetic but I could be wrong.

[Pitzi]

I usually test at 2 and 3 hours after a meal. Be careful about giving yourself an additional correction shot at 2 hours, since some of your previous insulin will still be working. Your doctor should have gone over a correction factor with you - telling you how many points you might drop for 1 unit of insulin. As someone else pointed out, if your goal is 100 (5.6) and at 2 hours you test at 140/7.8 you shouldn't need a correction because 1/2 to 1/3 or so of the injection you took for your meal is still working. If you test and you're 300/16.7 then I'd say it's safe to take additional insulin to bring it down, but the amount of insulin you'd need is most likely different than what I'd need, or the next person would need. On the other hand, if at 2 hours you test and you're at 80/4.4 then you might want to consider having a snack, because you will most likely drop some more. That's why I usually test at 2 hours, just to see where I'm heading, and then again sometime between 3-4 hours.

Did your doctor give you an insulin:carb ratio - for example take 1 unit of Apidra for every 10 (or 12 or 15 or whatever) grams of carb that you eat? I assume he did since you mentioned carb counting.

A lot of Type 1 diabetics have other autoimmune issues. A common one is being hypothyroid, which I am. I think rheumatoid arthritis is another autoimmune disease that many Type 1's also get. A lot also have Celiac Disease but I'm not sure if that's actually autoimmune or not. I thought it was genetic but I could be wrong.Thanks for the input. Yes he gave me ratios and stuff, but he also gave me a basis bolus dose for every meal (10 units) and he said to see what happens and adjust accordingly, because being quite frail he is not sure that the formula will work well.

[DeusXM]

I'd be surprised if 10u for each meal will give you the right coverage. Your ratios will be different throughout the day and somehow I doubt that you eat exactly the same amount for each meal.

A good rule of thumb is to work out what your total basal dose is - it should probably be about the same as your total bolus dose. Then divide that amount down by the relative size of each meal in relation to your total food intake.

For instance, my evening meal makes up about 2/3 of my food intake, so 2/3 of my bolus goes on that. Lunch is a little more than third, and breakfast is a little under a third. Obviously this is specific to me and doesn't take into account pretty much everything relevent. But it might help make some sense.

If I were you I'd test every half-hour to see what's going on. I don't mean to be rude or dishearten you but frankly your doctor appears to be clueless to the point of almost being dangerous. Is there another doctor you could see?

[Pitzi]

I'd be surprised if 10u for each meal will give you the right coverage. Your ratios will be different throughout the day and somehow I doubt that you eat exactly the same amount for each meal.

A good rule of thumb is to work out what your total basal dose is - it should probably be about the same as your total bolus dose. Then divide that amount down by the relative size of each meal in relation to your total food intake.

For instance, my evening meal makes up about 2/3 of my food intake, so 2/3 of my bolus goes on that. Lunch is a little more than third, and breakfast is a little under a third. Obviously this is specific to me and doesn't take into account pretty much everything relevent. But it might help make some sense.

If I were you I'd test every half-hour to see what's going on. I don't mean to be rude or dishearten you but frankly your doctor appears to be clueless to the point of almost being dangerous. Is there another doctor you could see?see what I mean about SA specialists? this is a doctor from the best Diabetes clinic in this country...

Let me give you a bit more details thouigh. i havent started the new treatment yet. the treatment I am still on is Humulin I approximately (+ -) 50 units x day

he broke it down to the new medication as 20units at bedtime of lantus, and 10 units with each meal of Apidra. i gave him the exact size and quality of my 3 daily meals. Smallest is breakfast and lunch/dinner is almost identical, with the only difference being that lunch is when I have my protein too