humalog or "R"???

[1type2go]

Hey

I've only been on Humalog and Lantus for about five months now and I'm finding the peak time a little lagging then lasting to long ,I go low about 2.5 to 3 hours later ( taking 5 units per meal and 16 at bed time of the Lantus) as I'm typing this I'm realizing I've got ta start counting carbs !!! some larger meals I'd take 8 units and then BG of 13, 2.5 hrs later

Oh boy*sigh* Any help?

I'm considering going back to "R" & "N" (Humalin)

Is there anybody taking "R" and lantus???????

Confused:confused:

[BlueSky]

As you have just changed both basal and bolus insulins, it is hard to tell which one is causing blood glucose levels to move out of the target rang. Are you satisfied that the Lantus you are taking is satsifying your basal insulin requirements? The only way you will know this is to skip meals and test your BG levels. My advice would be to do this and get your Lantus dose/timing sorted before changing anything else. It could be that Humalog actually works fine for you. ;)

[xMenace]

R & N are not the way to go. Lantus gives you more complete and stable coverage while Humalog is much much faster than Regular.

Humalog only peaks at around 2 and is far from done. When I see lows shortly after eating I attribute it to your basals. Basal testing is something you and all basal insulin users should do. It's not just for pumping. You really should know what your basal insulin makes you do (high, low, or level) during each part of the day. Very often it creates hills or valleys that you need to compensate with insulin or food.

Here's some info.
Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals)

http://www.diabetesnet.com/images/graphs/novolog-dynamics350.jpg

[1type2go]

Bluesky

pls explain (layman terms) how to figure out if I need to adjust my basal dose.......skip meals ,no rapid shots,and test at certain intervals???

I've heard of a friend on 19 Lantus and per meal( with sliding scale which I've never had proper explanation of )a dose of 2 to 4 units of rapid ???

Thnk you for the link (going to chk it out)

Donovan

[BlueSky]

Donovan,

The link John provided explains it all. It is a long read, but it is all good information. He starts off on page 3 by saying :

It is a good idea to fine-tune your basal insulin before settling on specific bolus doses to use at mealtimes. When high or low blood glucose appears, it is difficult to know what to adjust unless the proper basal insulin levels have already been established.
Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals/3)


And he goes on to explain how to do this.

How are your waking blood sugars? If they are in the target range, that is a good start. Skip breakfast and the Humalog, and test every hour until lunch time. If your blood sugar goes very high or very low, you may have to abort the test. But you will have learned that your evening Lantus is providing too much or too little basal action in the morning. On another day, try doing the same thing after skipping lunch, and then supper. It will show where the gaps are and you will be able to experiment with different dosages at different times of the day.

[TenderVittleS]

I would not go back to R and NPH. I would go low unexpectedly and I would have to drink a few cokes to bring me back up, its just too unpredictable. The solution to spiking after meals for me is to increase your fast acting, it also depends on what you eat as well. Good luck!!

[1type2go]

OK I'm back on the path

I'm starting tonight .........I've had a great day of BGs 4.5, 5.6, 5.6, 6.5, skipping tomorrows breakfast (go for blood work while I'm at it )and test at 7:am 10:am and then at 11:30am
Sound good ??
Then eat right ?? with insulin
Thanx again Donovan

[xMenace]

OK I'm back on the path

I'm starting tonight .........I've had a great day of BGs 4.5, 5.6, 5.6, 6.5, skipping tomorrows breakfast (go for blood work while I'm at it )and test at 7:am 10:am and then at 11:30am
Sound good ??
Then eat right ?? with insulin
Thanx again Donovan


I'd rather you tested hourly. Don't take any unnecessary risks. Have food with ya.

SOme of us will get a liver dump the following meal if we skip one. I do at lunch and have to double my bolus. Test 2hrs after lunch to see if you are ok.

[1type2go]

liver dump ??
going to boost glucose ? for higher BG Oh I don't know what I'm saying !!what will I be looking for ??

[Metermaid]

Hi,
Is it possible for you to get some 'Diabetic' teaching? It would help you tremendously....get your doctor to order it? Most insurances cover it. And then after you get the basics, most of this 'mumbo gumbo' will make a little more sense. It is all so overwhelming. I am thinking on going back to get some 'review courses' myself, even after 10 yrs, I am so lost!!
Good luck!

[lilituc]

I would recommend the books "Using Insulin" by John Walsh or "Think Like a Pancreas" by Gary Scheiner.

[1type2go]

Had to post great info found here

Thanx to xMenace http://www.diabetesforums.com/forum/type-1-diabetes/26016-liver-dumps.html

[1type2go]

K.
I'm lookin for the book and ........
a table conversion for mmol/L and mg/dL

I think it may be easier to change my meter:T

Getting Down to Basals :: Diabetes Self-Management
To determine whether your overnight basal insulin dose is set correctly, try the following:

1. Have a fairly healthy dinner that does not contain a great deal of fat. Avoid restaurant or take-out food before this test. High-fat food will cause a prolonged blood glucose rise and will contaminate the test results. Take your usual doses of dinnertime and nighttime insulin.

2. If you normally exercise in the evening, go ahead and do so, but keep the intensity and duration modest. Very heavy exercise may cause blood glucose to drop several hours later, which would also contaminate the test.

3. At least three hours after dinner, perform a bedtime blood glucose check. As long as your blood glucose level is above 80 mg/dl and below 250 mg/dl, do not eat any food or take any rapid-acting insulin. If your blood glucose level is below 80 mg/dl, have a snack and try the test another night. If it’s above 250 mg/dl, give a correction dose of insulin and try again another night.

4. If your blood glucose level was above 80 mg/dl and below 250 mg/dl and you have decided to go ahead with the basal insulin test, check your blood glucose again in the middle of the night (or the middle of your sleep time) and again when you first wake up the next day. The middle-of-the-night reading is needed to rule out the Somogyi phenomenon, in which low blood glucose causes “rebound” high blood glucose.

If your blood glucose remains within 30 mg/dl from bedtime to wake-up time, your basal dose is probably OK. If it rises more than 30 mg/dl, increase your basal insulin dose by 10% and repeat the test. If it drops by more than 30 mg/dl, decrease your basal insulin by 10% and repeat the test. Continue adjusting and repeating the test until your blood glucose holds reasonably steady through the night.

For example, if your bedtime reading was 185 mg/dl and your wake-up reading was 122 mg/dl, your basal insulin dose is too high, because your blood glucose dropped by 63 mg/dl while you slept. Had your bedtime blood glucose level been closer to normal, you would have experienced hypoglycemia during the night. Reduce your basal insulin dose by 10%, and run the test again the following night. Had your blood glucose risen from 87 mg/dl to 160 mg/dl—a rise of 73 mg/dl—an increase in your basal insulin dose would be in order. If your bedtime reading was 95 mg/dl and you woke up at 87 mg/dl, your basal insulin dose would not need to be adjusted because your blood glucose level changed by only 8 mg/dl.

Fine-tuning pump basal rates
Appropriate basal rates must be established to obtain quality blood glucose control and enjoy the flexible lifestyle afforded by an insulin pump. Remember: The right basal rate is one that keeps your blood glucose at a fairly constant level when you have not eaten or taken a bolus dose for several hours and are not exercising.

To test your basal insulin settings, you will need to wait approximately four hours after your last bolus and meal or snack. This will give the carbohydrates in your food time to finish digesting and the bolus dose time to finish working. The meal (or snack) eaten before the test should be fairly low in fat (no restaurant or take-out food) so that you don’t have a delayed blood glucose rise. You must stay connected to the pump continuously during the test and go about your normal, daily activities. However, heavy exercise should be avoided during the fasting phase of the test. Testing should not be performed during an illness or onset of menses, following hypoglycemia, or if your blood glucose level is greater than 250 mg/dl at the beginning of the test. (See "Insulin Pump Basal Rate Testing Schedule.")