Weird Readings

[skilz123]

Ok maybe you guys can help me with this one. I finally figured out my readings somewhat, in the AM I have about 10-12 carbs per 1 unit and lunch and Evening I have 15 carbs per 1 unit ratio. Just so you know I am on 8 lantus bedtime 8 lantus AM, and Novolog. So I take my lantus in my leg and my Novolog in my leg and stomach. Thing is in the AM or lunchtime if I take Novolog in the stomach it fully works in 2 1/2 hours and if I take in the leg it take 3 1/2 hours. In the evening i must take it in my leg or else for some reason I am fine after 2 hours and then I magically shoot up 50-100 points in the third hour for no reason whatsoever. (If anyone can shed light on that reasoning I would love to know) As for the main problem I am posting for is this: In the evenings after dinner some times I have a 15-30 gram carb snack if my sugar is good 3 hours after dinner. 2-3 hours after my snack my sugar is right back where it started, and I take my Lantus have 30 grams, go to bed and wake up great. Other times I will mess up dinner and be say 160-200 3 hours after, and instead of bolusing to come down, my sugar will just go to 90-120 2 hours later, then I take my Lantus, 30 grams sleep and good in the am again. The weird part is this, sometimes for no reason, I will be good 3 hours after dinner (same time in the evening and all), I will have my 15-30 grams and boom 2-3 hours later I'm up 50-100 when I should be back to normal again. I have analzed everything, exercise, times of shots etc... and it doesn't appear to be anything as far as I can see. Did anyone ever have this problem? Or can you shed light on this. Tonight I went out to eat, was 209 about 2 hours after (had a little desert, stupid, didn't bolus enough), I was thinking about bolusing but I guarantee I will be perfect by 12:30 AM, was 209 at 10:30 PM. Why is this? What is bringing me down, and how come sometimes when I am fine at 10:30 and have the snack my sugar goes up pretty high? Please help I am desperate here.

[mariwood]

Well, you need a CDE to go over your diabetes journal with you and try to work this out. Now, obviously you are carb counting, so you have knowledge in that but are you paying attention to glycemic index of diet? What about stress? Have you some other physical problem? Exercise and work load can effect blood sugars too. I suppose you already know this, but I was concerned since some of the members of this website are far more analytical than I am, but you have no replies yet from the "experts." There are people on this website that would make my doctor look dumb. And my doctor tries to keep up with all the latest facts. Good luck to you.

[skilz123]

Yeah it's not stress or exercise, been looking for that, I guess it could be glycemic index and such, would be best if I went to my CDE and went over everything with her to try and figure it out. I think I will make an apt with her tomorrow. Hopefully the experts will give some advice in the meantime.

[HeatherP]

You're CDE is your best bet. They know every little wrinkle in the maze of insulin dosing, so work with her and be patient. I'm sure she'll have you back in shape very quickly!

HeatherP

[skilz123]

Ugh, no one else? Left a message with my CDE hopefully she wll get back to me and we can figure this out. In the meantime do any of you think my Lantus dose may need changing. Here is a perfect example of what happened today: I woke up sugar was 153, so I took my 8 Lantus and 2 N and had about 20-23 grams of carbs (1 and a 1/2 Waffles) 2.5 hours later my sugar is 193, not that bad considering I was 153 before I ate, so I expect it will come down a bit more as the Novolog finishes working. So 1.5 hours later my sugar is 130 ok good, but, why did it take 4.5 hours to come down? Then I took 3 N for lunch and had 45 grams carbs, Pastrami on Rye and 15 grams Popcorn, 2.5 hours later I'm 54, no warnings, didn't even feel it, why did I go so low, is it too much Lantus? Same reason why these things happen at night? How much would you suggest I lower, 7 and 7, or 6 and 6 or even lower. All I want is for my Boluses to work and then my sugars to be stable until my next meal and bolus. I can handle counting carbs, not overeating injecting and everything. Any advice? It seems Lantus should be easier if I had it right, but Lente and Regular just worked so much better.

[HeatherP]

Well, you might want to work at adjusting your lunchtime ins:carb ratio. I think the short-acting stuff can stay in the system for up to about 4 hrs.

It would also be good (and extremely boring) to eat the same things for bkfst, lunch & dinner for about 5-7 days in a row. That may make it easier for your to spot trouble spots.

I also split my Lantus dose. I find if I split evenly I start having hypos after lunch and before dinner, so I take 11 u @ night and 9 u in the a.m. You may need to divvy up your dose a little differently.

I assume you're taking into account any extra or unusually strenuous physical activity?

I am very sensitive to insulin so I only go 1 to 1/2 unit at a time when making changes.

I find that from time to time my needs change, for no apparent reason and so I adjust until I'm back where I need to be. It happens out of the blue sometimes to all of us.

Hope that helps a bit, but I'd still recommend you visit w/ your CDE,
HeatherP

[skilz123]

Thanks for all your time, I will definitly still see my CDE. Your advice makes sense, maybe I took to much N this afternoon. I think I need to for now take into account the Lantus lowering mysugars throughout the day until we find a better solution. If Short Acting stays in for 4 hours how do most of you handle having your sugars below 140 2 hours after meals?

[HeatherP]

It should be under 140 2 hours after meals, and there's some here who expect it to be even lower. For me I shoot for under 150 at all times.

The trick is in the timing. The onset is about 10-15 min, peak is about 2 hrs and then it drops off and fades out by about 4 hours. Generally your digestion time is about 2 hours at it's peak.

HeatherP

[sparkle9]

If it makes you feel any better, I think we are all "works in progress"! Seriously, I have been Type I for 34 years and I've been on lantus and humalog for about 9 months. Generally things are a lot better, including my A1C, but sometimes I still get whacky readings for several days for what appears to be no reason at all!

I think what affects me most is varying amounts of physical activity. And not nescessarily planned exercise, such as jogging, but just "running around" more than usual. Sometimes I don't think we realize how much our physical activity varies from day to day.

Sometimes it's so frustrating. especially when the doctors say, "You're doing fine. A few occasional lows and highs won't hurt." I'd really like to find an endocrinologist who's diabetic, but so far, no luck!

[skilz123]

Totally, for now I think I will shoot for under 160-170 after 2 hours and hope to fade off to 90-110 by 4 hours, if I can get there then I'll work on doing better after 2 hours. So do you guys see that even after the 4 hours you drop lower, for example say I eat dinner at 7:30 and at 9:30 my sugar is 150 and then at 11:30 my sugar is 100, since I am not taking Lantus till about 1:30 AM and having my snack then, I usually try to have a 15-30 gram carb snack at 11:30 and then most of the time my sugar is back at 100 at 1:30 AM (sometimes it messes up, point of my original post) Do you guys need that snack? Or does your sugar stay stable 4 hours after meals? That is why sometimes I think my Lantus is to much. Any thoughts on that? Should I just be eating every 4 hours?

[HeatherP]

Dropping lower at 4+ hours would indicate too much Lantus. Theoretically, you shouldn't have to eat anything if all you've taken is Lantus. You'd only eat when injecting your short-acting.

I find that my b/s does better if I take Lantus on a 12-hr cycle: 7-8 a.m. and 7-8 p.m. My problem is dawn phenomenon because I tend to wake up in the 200's even when I haven't eaten anything and my bedtime b/s was in target.

[MarkMunday]

Readings that go all over the place can be really confusing. Normally there is combination of factors involved - Lantus, Novolog, carbs, exercise etc. And the challenge is to minimise the impact of these variables.

The top priority should be to establish the right Lantus dose. Because of it's almost flat action profile, Lantus shouldn't make your BS vary much as long as the dose is right. So if you don't eat and you don't inject Novolog, your BS should stay fairly constant.

You can test to see if you are on the right amount of Lantus by not eating/injecting Novoplog. This would be a worthwhile test. Because if you are not using the right amount of Novolog, your blood sugars will be unstable, no matter how much you play around with carb ratios, correction boluses etc.

Bear in mind that the phisiological requirement for insulin increases in the morning (Dawn Syndrome). Test your BS when you get up and, if it is in the target range, skip breakfast and your Novolog shot. Test every half hour for as long as the blood sugar level is in an acceptable range. If it rises too much in the late morning, you probably need more Lantus. It falls during this period, you are using too much.

Before making dosage changes, repeat the test. You may get different results. According to a recent study, the coefficient of variability for Lantus action is 29%. Variability of Novolog is also 20-30%. So, at best, it is a game of hit or miss. You just have to use the best approximate amount.


Mark

[eevee]

That is good advice from Mark, but as a T1, don't carry that 'not eating' bit on for too long..!! (like all day...) Going without food for too long tends to make our livers spring into action with glycogenesis.

........Eve

[skilz123]

Well I saw the dietician, she thinks I should split my Lantus does up more on a 12 hour cycle, since I'm not really. Also that I should be seperating times between meals more. One thing we decided was that one of 2 things is going on. A) I am not shaking up my Novolog, never heard of this but apparantly it may not work as well if you don't and may be one of my major problems, does everyone know about this and has this affected you? and B) That I may be on too much Lantus and because of this and the combination of the N sometimes not working on account of not shaking the bottle, this may be why sometimes I dip lower in the evening and sometimes break even. What do you guys think?

[HeatherP]

I think those are some good ideas. You'll know for sure when you put them to the test.

I was taught from the beginning to roll my Humalog, so that's something I've always done.

When do you start putting her theories to the test?

Keep us posted on how you're doing! I hope it works better for you!
HeatherP

[skilz123]

I start right now with the Novolog rolling, and will be taking my Lantus earlier starting tonight.

[HeatherP]

:thumbsup:

[skilz123]

Hoooray! I was 109 before dinner, took 3N (shook and shook that bottle) ate 50 grams of carbs and 2 hours later 130 :) Yes!!!!!! Who would've knew this could have solved things. I had almost the same type meal last night but 30 grams carbs took 2N and was 192 2 hours after, so this is actually working. Thanks for everyone's support and I had me a nice 20 gram carb snack just to celebrate!

[Shalyndria]

Agitating a clear insulin?! :confused: Now that's a new one! I'd be interested to see what Lilly/Novo would advise concerning that. Haven't ever had any problems with my NovoRapid personally, and I've never agitated it in the years I've been on it.

In any case, I'm glad to hear that it's working successfully for you, skilz :thumbsup: ! Keep us posted on your progress!

A quick note of caution (in case your CDE missed it) is that you should never shake your insulin. Any excessive or overly forceful agitation can actually damage the molecules. Like Heather said, it's best to roll the vial gently.

Shy

[eevee]

Roll/shake Humalog..?? The only reason for rolling/shaking I should think would be to mix the insulin with the inhibitor---doubt that Humalog has much of that...it is rapid onset..!!
Carbohydrates could be your problem--lower them, lower your shots. You will really be surprised. Try shooting for pp of 150....
Cheers, Eve

[skilz123]

I'm not really shaking just rolling. My CDE seemed to think that rolling the Novolog was extremely important in getting it to work properly, and that if not it could be altering the actual amount I am taking and the amount of time it takes to react on my system. I really hope you guys are wrong and that rolling is what truly worked in last nights case, but I guess we will see. Maybe someone who takes Novolog can comment on this? Maybe it is just with Novolog? As for carbohydrates, I'm supposed to be eating like 60 grams at dinner so I'm not gonna lower those, I barely eat much carbs as is, maybe 90-120 a day.

[HeatherP]

I'm glad you're feeling and doing so much better Skilz!!!:D

I've always been told to roll all my insulin clear or not: Regular, NPH, Humalog and Lantus.

[Shalyndria]

Originally posted by skilz123
I'm not really shaking just rolling. My CDE seemed to think that rolling the Novolog was extremely important in getting it to work properly, and that if not it could be altering the actual amount I am taking and the amount of time it takes to react on my system. I really hope you guys are wrong and that rolling is what truly worked in last nights case, but I guess we will see. Maybe someone who takes Novolog can comment on this? Maybe it is just with Novolog? As for carbohydrates, I'm supposed to be eating like 60 grams at dinner so I'm not gonna lower those, I barely eat much carbs as is, maybe 90-120 a day.
skilz, maybe next time you see your CDE you could ask what the premis is behind rolling your Novolog? I'm really curious about this...

As I said, I use NovoRapid, which is the same thing as your Novolog. Outside of America Novolog is called NovoRapid.
Isn't this strange; I've only ever been told to roll my long-acting insulins such as NPH when I was on MDI's. I've never rolled my NovoRapid (Novolog) and before the advent of analogue insulins I was on Toronto (Novo's regular) and never agitated that either. And I've never had problems with fluctuations as a result of unevenly concentrated clear insulins, either. I do remember being told as a child that to minimize the pain of injections I could roll a vial of clear insulin to warm the contents slightly.

No matter how it turns out though, skilz, I hope that your current success continues!
Shy

[skilz123]

Well this mornings dose seemed to work the same, maybe I'm eating better, plus I did go for a 20 min walk which could be the reason why things worked better this morning, but for now I'll still believe it to be the rolling until I see otherwise. What my CDE told me was that if I am not rolling it the substance is not evenly mixed and therefore I could be only getting 1/3 or 2/3 what I am actually taking, or it could possibly slow down the onset. Logically I'm not sure why? But again she seemed pretty sure, and the way my numbers have been going so high and then dropping much later it makes sense about the slow onset. I will keep trying and we shall see.

[mariwood]

Here are my suggestions. First, follow the medical staff suggestions. Second, when you are trying to figure out a problem, draw a diet plan up for three days where all your meals are virtually the same in those three days. Keep the portions regulation size, space four hours apart, exercise the same amount the same time every one of those three days. This takes the wobble out of experimenting with your insulin. The results you get during three days of regulation diet will give a better overview of how the insulin is working without all the confusion of a varied diet. This has worked for me.
Third, I find that following the ADA diet and tweaking the carb counting to a lower level, I get better results with my insulin regimen than if I strictly follow a low carb diet. I don't know why this is, my insulin just works better when I balance my diet.
Fourth, try to learn the glycemic index principles. White flour, white rice, white pasta, no no. Waffles for example, would be challenging to test your insulin regimen. Try a breakfast of an egg, whole wheat toast with margarine or butter, orange juice, one or two breakfast sausages or a strip of bacon. This balances protein, carb, and fat. My mother-in-law ate the same breakfast for almost 84 years before she died. She was diabetic and she ate this breakfast every morning of her life. So she always had the same set point at the beginning of day with exception for sick days. She had the same insulin regimen too. However, she passed away years ago before Humulog or Novolog were available. So now we are lucky to have the ability to vary our diet and meal times and all that, but when you need to test your insulin regime, keep everything simple and conformed. The less variation in the diet, the clearer the picture of how your insulin works on you. I hope this helps.

[skilz123]

That is some amazing advice, thanks so much, I will definitly "try" to test some things that way. As for the rolling, unfortunatly that didn't last as last night I had the same meal as the night before and the rolling didn't work, but I think I figured out the real culprit and that was that I took my morning Lantus 2 hours later the morning it didn't work. So today I woke up at 9 AM to take my Lantus and just went back to sleep for a few hours. Hopefully this wil work and I am now taking my nighttime Lantus at 10 PM, I think this schedule will work, so please everyone keep your fingers crossed for me, and thank you all so much for your help.

[skilz123]

Well, the scheduling didn't seem to work either, obviously I may need some more results before I can be certain, but from the initial results even the timing of the Lantus is not helping dinner. What could this possible be, if I take the shot in my leg it sometimes works and other times it takes like4 hours to come down, (my legs have hardly any fat on them) and if I do the stomach sometimes it works but most of the time it comes down after 2 hours then shoots back up. Maye now that the Lantus timing is beeter I will go back to trying my stomach. Any ideas on this guys?

[Shalyndria]

You may just need to give it some time. I know that it's hard to be patient, but maybe that's all this needs to work out?

After re-reading your posts I have a few questions for you:
- do you have a correction factor, and if so do you do the math and bolus for hypo's and hyper's accordingly?
- how's your carb counting? Are you guessing CHO content when you eat or do you know for sure (based on say the nutritional content guide)?
- Do you keep a detailed log of what you've been eating and then look for trends based on what you eat in correlation to your ensuing BG's?
- Do you schedule your shots in specific sites; that meaning, is your morning Novolog always in your leg or stomach while your evening shot is always in the same spot?
- do you factor in the GI and/or fat content of what you're eating and how this is going to affect your post-prandial BG's?

Sorry for the 20 questions lol!
Shy

[skilz123]

No these questions are great but unfortunatly the answer to all of those are yes, I wish I didn't know what I was ding but unfortunatly being diabetic for 9 years I know way too much. Correction Factor Yes, Nutritional Guide sure do. Detailed Log you betcha, Morning always in stomach and evening was always in leg because stomach wasn't working (like I said I kept shooting up 3 hours after dinner if in the stomach) Lantus always in leg. Maybe I'm not 100% with GI and fat content, but seriously, when the same exact meal has different outcomes something is weird. I'm gonna try shooting dinner in my stomach a few minutes after completing my meal and see how that goes. For some reason I think that may help cause I take all my other shots pre meal there, not sure why it used to raise my later, but maybe that was a Lantus timing thing and since now my Lantus timing is better :) Just hoping, well, I'll let ya'll know later, off to dinner.

[eevee]

I'm supposed to be eating like 60 grams at dinner so I'm not gonna lower those, I barely eat much carbs as is, maybe 90-120 a day.
Wonder who says you have to eat that many carbs..?? The more carbs one eats, the more unpredictable one's bGs will be, and the harder to guesstimate the amount of rapid acting insulin required. Another little advertised fact about carbs is that they are what fuels 'cravings'. How often do we 'crave' a piece of steak compared with how often we 'crave' something sweet..??
I am not saying "go no-carb"..just that you shouldn't feel compelled to eat that many. Our brain reportedly needs only about 12g carb per day to function well--our heart prefers 'fat' as a fuel..!!
Personally I have about 60g carbs per day, having most at
breakfast and lunch, and try to have very few at evening meal. My bGs aren't wonderful (these days mostly in 80-150(4.4-8.3) range...heaps better than when I was 'told to eat' twice the amount.

..........Eve

[skilz123]

No worries, I do keep my carb count low, and the stomach shot seemed to work pretty decently, so let's hope this is the trick. Usually do 90-120 carbs per day, but I also work out 5 days a week and am pretty muscular so I do feel my body needs some decent carbs.