Overwhelmed

[jmilliman]

I'm feeling overwhelmed or disappointed, not sure which. Since deciding to take charge of my sugar I haven't seen much good, granted its been a few days, but today had a rough start.

When I went to bed last night my sugars were up. I got them down to a okay level at lunch time, but they jumped right back up.

http://i26.photobucket.com/albums/c106/jmilliman/Untitled-1-1.jpg

Am I expecting too much too fast?

[duck]

Whoa.

Okie dokie, this can be fixed. How much insulin are you taking, when are you taking it, and what types are you taking? What did you eat for dinner last night?

[jmilliman]

Whoa.

Okie dokie, this can be fixed. How much insulin are you taking, when are you taking it, and what types are you taking? What did you eat for dinner last night?

Well for starters I'm taking Lantus at night, usually around 1030, 45u. Then with meals I am take 1 unit of Novolog per 15g of carbs. Also to cover highs I take my sugar subtract my target (120) and divide by 25 (supposed amount it should drop per unit.

Last night for dinner I had a whole Roast beef sub and some chips, and to be honest I don't know what my sugar was before hand nor to I remember how much insulin I took.

Today I had a McDonald's breakfast, their website said that there was 151 carbs. so given my sugar I took a total of 20u of novolog.

Lunch was some frozen chinese dish, 141 carbs, 21u of novolog.

And for Dinner we had Fish, Fries and Coleslaw which I wasn't sure how name carbs was in it so I guess about 80 (might have been wrong :confused: ). and took 8u of Novolog.

*note at lunch time 11:30 my sugar was 140. @ 2:15 it was 92

[viranth]

remember the glycemic index! Something may say it has x amount of carbs, but it depends on how fast they are. People with diabetes are generally adviced to eat good with low GI.

McDonald's and such is processed food, so it has quite an impact on your BG levels for sure.

I would eat low GI food for a couple of days to get back in control of your BG levels, then slowly add the foods you want.

Since I'm recently dx'ed, I don't have a whole lot of experience, but when my BG levels go up it feels like I've let myself down. But there's only one thing you can do, that's get better =)

[ant hill]

Hello Jake :), If you're anything like me then you have to look at your Basel and that's the long acting insulin. And the BG difference is alarming.
I should talk!!!!, My BG's aren't that good ether and I whey a ton!!
I see that you take 45U of Lantus as I too Take 44U so I figure that you are around 100Kg at least. Basel's are usually taken 12 hours apart and try to stick to those times that's set buy you. I should look at carb counting too :) and do something about shifting the weight so I am about to do a D.A.F.N.E. course and learn to eat a safely low GI and knock off some insulin as well losing the weight too. :D

[WAMB00]

I use to get the evening highs when I was on single shots of Lantus (at bedtime). It helped when I switched to Lantus 2x a day (bedtime and late afternoon).

[xMenace]

Read this for starters. Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals)

You need a plan. It takes some dedicated work and time, but you'll be much better in one to four weeks.

The basic process: 1. get basals as matched as possible. Your goal is to wake up on target. 2. adjust your I:C for each meal. Start eating the same, modest meals. Stick with known, low GI, measureable foods like whole wheat bread. Keep it uber simple. Adjust your insulin up or down until you are close to normal for each meal. 3. learn how to get those 2hr post-prandials down. You may need more insulin, lower gi foods, early boluses, etc. 4. Try these ratios on different meal sizes of the same food. If they work, you got it. If not, there's a basal gap you need to cover with a fixed bolus, + or -.

That's my quick & dirty. I prolly forgot something important. It's always important to validate all our advice anyway ;)

[CaptainMike]

I think you will have an easier time getting into range and managing things if you cut out the huge carb meals, at least initially till you are in the ballpark. I really only eat around 150 grams of carbs per week! Which is certainly not something you need to do as a T1 on insulin, but 400+ grams per day is going to be extremely hard to match your insulin to.
Best of Luck!

[jimhodges]

It sounds as though you are mostly eating out at fast food places. I would suggest that you get online and research the calorie,carb and fat content of those foods and I think it will blow you away.
I know what my bg does when I eat at those places and it isn't pretty. Pretty much I don't/can't do that. It is kind of like quitting somking after I quit the fast food places I find thinking about all the fatty foods replusive. Was it hard? Yeah it was it was harder than quitting cigarettes but the stakes are pretty high.
I could be a poster boy for all that comes with not keeping bg under control. Numbness in the extremities, vision problems.
I thought for years I could ignore it. I cleaned up my act a couple of years ago but I will deal with the complications the rest of my life. Don't do that.
Good luck.
Jim

[Jan B]

Hi Jake,

Please don't be discouraged. This may take a while, but it will be worth it, really!! You have the basics down in counting carbs and taking insulin to match, but it sounds like you are overwhelming your system.

You are eating a huge amount of food/carbs. It would be easier to get your bgs level if you cut back to no more than 60 carbs per meal or less -- even half that. Ideally, you need to know exactly how many carbs in each meal. To make it really easy, eat Lean Cuisine type meals with the exact amount of carbs printed on the box.

Be sure to test upon awakening, before eating, 2 hours after eating and before bedtime.

I love your charts . . . keep asking questions and posting -- you can do it!

[jmilliman]

Thanks Again for everyone's input, today so far has a little better. I'll post again about it later, hopefully it will be a lot better :cool:

[Stuboy]

Do you know what your numbers are doin in the night?

Looking at your graphs, my initial thoughts are that your lantus is running out towards the evening... and that you may be taking too much insulin because you are waking up high in the morning... you could be going hypo in the morning and bouncing causing you to wake up high.

I would try splitting the lantus dose. you say you have 42u a day... try 21 in the evening and 21 in the morning (i take mine at 10am and 10pm). I had the same symptoms as you when i first started on MDI and splitting the basal dose worked for me.

Also try working out your carb:insulin ratio. As sue mentioned in my other post, try the 500/TDD formula to work it out if you're not sure.

Ps; i have lots of carbs too, i love carby foods, if you have your ratio right and keep an eye on it and keep adjusting you'll be fine, eventually you'll learn what foods even need a split rapid dose.

Keep your chin up an dont let it get you down, it's a good feeling when you get it right. I find that logging my numbers, food and insulin help keep track of things!

[Alice]

I'm not a low carber like some on this forum...but...

You are really eating extreme high carb meals. Yes, these are meals that are typical in the U.S. and most people don't blink twice at them. But you are in a "different" and much smarter class of people as a diabetic. (grins!)

Try for an experiement to maybe stay under 60-75 for starters. Just to get you out of the 100's on carb grams. Later, you might find about 45 (3 carb servings) a very livable amount.

You also need to measure your food. I'm sure when you are figuring restaurant foods, some counts are pre-measured and fixed (macD's) and some such as chinese would involve actual measuring...which really surprises people.

So glad you are taking a look at this. You'll work it out and be able to eat all your favorites...maybe just a little less of them. Never feel like you need to be a member of the "clean plate" club as a Type 1. (0pposite of what was pushed at us back in the dark ages)...it's all about quantity. You, in theory, should be able to eat almost any carb, as long as you monitor the quantity and insulin bolus. Good luck!

[TenderVittleS]

It looks like your morning numbers are consistently high. I would increase your nightime Lantus dose at least 5 units, maybe more, you can adjust it when necessary. Also you need to take more insulin before you eat. I would allow at least 15 minutes before you start eating. Don't be afraid to go low. With Lantus lows are easy to correct. When I wake up with high numbers, like 200 or so. I find it hard the whole day to keep control. But definetely start taking more insulin before you eat. Your numbers look scary!:eek:

[Stuboy]

It looks like your morning numbers are consistently high. I would increase your nightime Lantus dose at least 5 units, maybe more, you can adjust it when necessary. Also you need to take more insulin before you eat. I would allow at least 15 minutes before you start eating. Don't be afraid to go low. With Lantus lows are easy to correct. When I wake up with high numbers, like 200 or so. I find it hard the whole day to keep control. But definetely start taking more insulin before you eat. Your numbers look scary!:eek:

dont be afraid to go low??? :confused:
i wouldn't follow that advise personally, lows are dangerous and pose an immediate danger.

Yes highs are bad for the long run but as you're new you have plenty of time to get it right without causing complications, if you go low more often you will become hypo-unaware which could result in collapse or a car crash if you drive.

Increasing a lantus dose by 5 units is craziness if you ask me, insulin should be increased gradually if needed, 1 unit at a time 3 days apart.

Sorry, but i had to voice my opinion on that last comment because i think it's NUTS!

[TenderVittleS]

He woke up at 600 and the other day he woke up at near 300. You really think 1 unit more of Lantus will do much? I don't think so. He needs to take control and not be scared, its the only way as I see it. Also Stuboy your A1c is almost 8! I think you need to do something as well instead of 1 unit here and there.

[Stuboy]

yeh i am doing something about it thanks, but you know what? i've had to LOWER my lantus dose to fix it. So had i followed advise like yours i'd end up worse off wouldn't i!

You have no idea how sensitive to insulin change someone might be, 5 units is a massive change. an extra 5 units could probably kill me over night if i did that.

This post isn't about me anyway.

[2high]

Boys, no arguing!! :T

I think most endos suggest (and someone correct me if I'm wrong) no more than a 10% increase every couple of days, as the lantus takes a few days to settle. Also, everybody has different insulin needs, we all know that, so I don't really see that we should be suggesting dosages. 1 unit may be a lot for some people, whereas 5 units may be nothing for others.

Basal testing may be a good thing to do about now too... which reminds me not to be a hypocrite!!

[shiftzor]

Endos tend to play it safe though ;) I wouldnt personally be afraid of taking control, going low is just a part of the learning process, even at night your body is very capable of recovering from most lows. No one is perfect first time. That dosnt mean go mental and change everything all at once. Work with what you have now and change 1 thing at a time 1unit/2unit etc (depends how sensative you are).

Put some time aside for you and just you alone, i know its hard. I am bad at it, i really need to sit down and check my I:C.

[silverfrost]

Hmm, I know that some people are extremely sensitive to insulin, but if I woke up at 600, I would probably increase my lantus at least 5 units. :P

You know, I didn't really get good enough results until I decided to be a bit more aggressive about how much insulin I take. I had so much trouble with breakfast for months, probably because I was scared of dropping low. As soon as I increased my dosage for that meal, however, I did a lot better. I'm still doing well with that. It really is different for everyone, though...

Don't be discouraged yet! Your numbers will come down as you learn more and more. I know mine did. :)

[2high]

Hmm, I know that some people are extremely sensitive to insulin, but if I woke up at 600, I would probably increase my lantus at least 5 units. :P



See the issue is, I've btdt, and increasing my lantus did nothing... hmm, lets do a basal test, see what happens... lo and behold, early am lows. My liver was kicking in in a BIG way for huge nypos, and I was bouncing back way high.

Just because you are high in the AM doesn't mean you are short on insulin...

[ant hill]

Hmm, I know that some people are extremely sensitive to insulin, but if I woke up at 600, I would probably increase my lantus at least 5 units. :P
And that will probobly last the first 24 hours. Basel insulin (the long ating stuff) is for your liver and it don't make any difference what your BG's are now except your fasting BG's

You know, I didn't really get good enough results until I decided to be a bit more aggressive about how much insulin I take.
Here I would be cautious as it can lower your BG faster and test more often.
I had so much trouble with breakfast for months, probably because I was scared of dropping low. As soon as I increased my dosage for that meal, however, I did a lot better. I'm still doing well with that. It really is different for everyone, though...
Hey good!! :)

Don't be discouraged yet! Your numbers will come down as you learn more and more. I know mine did. :)
Yeah, One step at a time and while you're are doing this have the tools with you like your meter and jelly beans or similar. ;)

[jmilliman]

Thank you everyone for your input, I am going to be heading to my doctor new doctor in two weeks so hopefully we'll be able to get this all straightened out :D

BTW, I have still been running in the lower to mid 200s

[silverfrost]

Just because you are high in the AM doesn't mean you are short on insulin...

Well, I was kidding about taking tons and tons more insulin, hence the smiley, but... Yeah, that's happened to me too, as far as dropping low and having my liver compensate. It is not fun. :/



Here I would be cautious as it can lower your BG faster and test more often.

True, but I mean, I was scared to even raise it gradually. When increasing my ratios finally, I did do it carefully. You're right, though- it could be very dangerous if you start going too fast with it.

[Eddy]

Disclaimer: I'm no doctor.

Yes, that's quite a range.

My first thought: Cut back on carbohydrates until you sort out your basal. (I cut back at first, and now eat between 225g and 350g on a typical day.) Be certain that you get enough calories, though: You don't want to try sorting out your insulin while "dieting". I hope you like olive oil and fish...

As others have suggested, consider splitting your Lantus in two. DO NOT do it in such a manner that you'd have excess Lantus in your system! I'd suggest 40u at night, then the remaining 5u the next morning. The next evening, 35u; the balance (10u) the next morning. Keep shifting -- by delay -- a few units at a time until you have a 50/50 split.

Next figure out how you react to your fast/rapid insulin. I find that Humalog acts much more slowly when my sugar is high. (What a pain!)

Check more frequently when figuring out foods. I found that pineapple, rice milk, and Gorton's fried fish spike my BG _very_ quickly -- faster than Humalog can handle. Conversely, whole-grain rice spaghetti converts to glucose so slowly that I must use 60% Humulin-N + 20% Humulin R + 20% Humalog to avoid nasty hypos. (I could also split my bolus into one pre-prandial and two or three post-prandial shots... but that still would be less smooth than the mix.)

Vegetables and protein seem to help control my swings.

Beware of allergies (including possible unknown food sensitivites) and stress.

[TenderVittleS]

I would also suggest waking up in the middle of the night to test and see if you are going low and your liver is kicking in the glucose. I doubt that is the problem but you never know.

[Eddy]

dont be afraid to go low??? :confused:
i wouldn't follow that advise personally, lows are dangerous and pose an immediate danger.

[...]

Sorry, but i had to voice my opinion on that last comment because i think it's NUTS!

I'm going to agree with you. As much as I _hate_ highs, and would be angry if I even hit 300, jmilliman is seeing some huge swings... lowering would be dangerous. Yet such highs are also dangerous.

Debug first. Optimize second.

[Eddy]

BTW, I have still been running in the lower to mid 200s


Consistently? If so, congratulations!!! Much better than having peaks that are pushing hyperosmolarity!

Yes, you'll want to bring those numbers down more. However, stabilizing is the more difficult task... once you're getting consistent numbers, you're just about there. :)

Keep us posted, please.

[artlizard]

I am not taking insulin right now, so I can't offer any advice about doses, etc.

All I can say is watch what and how much you eat and try to avoid processed foods.

It can be frustrating but don't get discouraged. The fact that you now know what your levels are means you are trying and one step closer to getting it under control. Be informed with how much calories/carbs you are taking in so you can dose properly and as your body gets adjusted the numbers will come down.