Not much better, starting to get frustrated again

[Jonathan_R]

I started a thread earlier this week about my blood sugars. Some advise was given, to mich I have applied that advise.

The good news: Sinse applying the advise of eating lower carbs, that has helped with my morning sugars. I have also split up the lantus a 2/3rd to 1/3rd ratio. So 30 units in the morning, and 15 units at night.

The problem: My standard deviation is still large. About all its done is shift closer to 0. I'm starting to have more hypos. The hypos could be cause my bolus ratio is off.

For breakfast I have 1 serving of cereal, which works out to about 25 carbs. I round that to 30. I also have a 2 egg omlet.

For lunch, I have 1 sandwich (double fiber whole wheat bread) of peanut butter and jelly. That's about 32 carbs. I round that down to 30.

My bolus for the morning is for every 10 I'm over, I take 1 unit. So if I'm 230, I subtract 230 from 105, which gives 125. 125 divided by 10 is 12.5, so I round up to 13. for the food, it's every 15 carbs I take 1 unit. So because I consume 30 carbs, I take 2 for a combined, a total of 15 units.

The rest of the day my bolus is every 15 I'm over, I take 1 unit. For every 15 carbs I eat, I take 1 unit.

I seem to have the most trouble after lunch. I am consistently crashing, having hypos after lunch. This would seem to indicate I am getting the peak of the lantus at around lunch time. I probably need yet another bolus ratio. Maybe 1:18 or something.

Anyway, I have included a link to my updated, published log. Complete with graph and corresponding to the correct measurements.

diabetes log (http://spreadsheets.google.com/pub?key=tQp5VrYrxH00p9ezK4jlc7A&single=true&gid=0&output=html)

[Tribbles]

I think your ratio is wrong and I'm not sure your carb counts are right either. Do you look up the count and weigh the food? My breakfast cereal is typically around 45g including milk and sugar which is why I am wondering.

Are you accounting for residual insulin? You have some shots less than four hours apart so some of the previous bolus will still be in your system.

You want to check your basal rate as well as I think that is low.

Bottom line I would see your diabetes team.

[Jonathan_R]

Not only do I look at the nutrition information, I also look up the glycemic index and glycemic load. I also do weigh, or measure the portions.

I don't do shots more frequently than 4 hours. I was advised not to. That it was called stacking.

When I was seeing my endo, dietician, and nurse, my figures were worse.

Golden Puffs, is 24g of total carbs per 3/4 cup. As to the milk, that is 12g of carbs per 1 cup of milk. Obviously, I have considerably less than 1 cup. So my calculations are spot on.

As to seeing my diabetes team, I am in the process of changing primary care doctors, due to the last incident they pulled on me. I need a referal to an endo, which that comes from the primary. So that will have to wait.

Golden Puffs® Nutritional Facts (http://www.malt-o-meal.com/products/nutritional-facts/malt-o-meal-golden-puffs.php?cereal=10)

Nutrition Facts and Analysis for Milk, reduced fat, fluid, 2% milkfat, with added nonfat milk solids and vitamin A (http://www.nutritiondata.com/facts/dairy-and-egg-products/72/2)

[Subby]

I don't do shots more frequently than 4 hours. I was advised not to. That it was called stacking.


Yes and no. If you shoot a correction, without taking into consideration previous boluses, that is stacking. If you eat in 4 hours, you need to bolus for it, and that is not stacking.

It can get more complicated than that but the upshot is: you eat food, you need correct bolus in your system, no matter when.


When I was seeing my endo, dietician, and nurse, my figures were worse.

I know that feeling. If you can't get basic help, change medical team. In the meantime have you ordered the book "Using Insulin" by John Walsh? If your medical team is not usefully educated about this stuff, you need to become more educated and knowledgeable yourself. That book is easy to read and will step you through adjusting your insulin doses to work better.


Golden Puffs, is 24g of total carbs per 3/4 cup. As to the milk, that is 12g of carbs per 1 cup of milk. Obviously, I have considerably less than 1 cup. So my calculations are spot on.


That's as may be, but the persistent question is "is your I:C ratio correct?" (and you ISF and your basal, these three things are the main points of tweaking). If you see a trend such as going low at some stage after a meal, the answer is your I:C is too agressive, it doesn't reflect on anything else. I said it you before, I can say it again: you may need to adjust your I:C ratio. In the aim of lowering dose, than means going from 1:15, to 1:16, or 1:17, for example, and seeing if that reduces the lows.

As for post meal spikes, I've also suggested your insulin (no matter how much you take) may not keep up with fast carbs, highish GI or GL food, or anything you find spikes you too quickly. That may indeed still be an issue. You can't just take high GI and GL into account as far as shooting more insulin. There may be a range of these foods that simply have to be avoided. That's the limitation of not having "normal" insulin response in your body.

[Jonathan_R]

Subby, thank you.

I knew I could count on you. Yes, you did say in previous posts that my I:C needs tweaking. I did that for breakfast and just about nailed it.

It seems I need about three different boluses, at the moment.

Today I split my lantus from a straight 40 something units to 2/3rds in the morning and 1/3rd in the evening. I am still working on raising my basal 1 unit every 2 days.

I have also started to lower my carb intake, although not so agressivly yet.

I have also started doing different boluses as someone suggested in another thread. Currently I have 2 boluses. My morning bolus (for every 10 I am over I take 1 unit, every 15 carbs I consume I take 1 unit), and the rest of the day bolus (every 15 over take 1 unit, and every 15 carbs I consume take 1 unit).

The more agressive bolus is the morning dose, and for now is working fine. It's the lunch time bolus that is giving me hassle. 4 hours after I take my lantus, (I take my lantus when I eat breakfast), I have lunch. So I take lantus at about 8 am, then eat lunch at noon, and do my bolus for lunch.

Am I making sense?

[matingara]

these are very interesting numbers. to my way of thinking you eat way too many carbs. but that is your choice.

i am not an expert, but it seems to me your blood sugar is on a huge roller-coaster.

i get freaked out if my blood glucose is over 180 mg/dl. this only happens very rarely - once every two weeks or so.

i don't worry about lows until my bgl drops below 45 mg/dl or so.

but, we are all different.

:)

-- Joel.

[Jonathan_R]

I wont disagree that I might be eating to many carbs, but to change to many things...I'd never know what is really happening. So I'm working on the med side right now.

Yes, my blood sugar is on a roller coaster. This is what I'm trying to fix. So far, no one has ever been able to. Not my primary care doctor, not my endo. Flat out, no one.

I don't get freaked out by large numbers. I can deal with those. I can always take insulin. With low numbers, those bother me. I am already prone to seizures, throw some low numbers in and you exaserbate it. Wanna give glucose to one who is seizing? I do understand the complications that can, and will develop as a result of high numbers, but the low numbers can certainly kill me.

Indeed we are different. I wish I could be more like what you have. The tolerance of the lows. Blood sugar under control. That would be great. That is my goal. I just wonder if I'll ever reach it.

[matingara]

hi!

yeah - i tried to take that all into account when i read what you wrote. i do not understand seizures etc - so it is not my place to advise you on that - but i do understand why you would be wary of the lows.

however, with a really low carb diet you will need less insulin. small inputs=small numbers et al.

you seem to be a bit of a scientist - so i don't need to explain that any further. but that could be the next parameter that you vary in your testing!

:)

-- Joel.

[Jonathan_R]

Indeed, and it shall.

Right now I'm trying to read up on neuroendocronology. There is a lot I'm trying to make sense of.

I guess you could say I'm a scientist, although this is a bit out of my area of expertise. I'm more familiar with Physics, Quntum Physics, Particle Physics, and the like. Get me down to the particles and I can make sense of it. It's at molecules and so on that it becomes complex to me. You might think Particle Physics is complex, but really it's not. It's when you start combining other particles, and atoms to make a molecule and combining molecules, that's when it gets complicated cause then you need to take into account the relation, and the role of each particle to really understand the molecule.

My degree is in Electronics/Computer Engineering. I can remember when I was attending school, I'd ask questions. The professors would routinely tell me I should be in Physics. I had one of my former doctors offer to sponsor me for med school. I turned it down, explaining that I was terrible in Biology. Funny how that goes. Now I'm being forced to learn quite a lot about Biology and Micro-Biology.

[Lizzie G]

Subby, thank you.

I knew I could count on you. Yes, you did say in previous posts that my I:C needs tweaking. I did that for breakfast and just about nailed it.

It seems I need about three different boluses, at the moment.

Today I split my lantus from a straight 40 something units to 2/3rds in the morning and 1/3rd in the evening. I am still working on raising my basal 1 unit every 2 days.

I have also started to lower my carb intake, although not so agressivly yet.

I have also started doing different boluses as someone suggested in another thread. Currently I have 2 boluses. My morning bolus (for every 10 I am over I take 1 unit, every 15 carbs I consume I take 1 unit), and the rest of the day bolus (every 15 over take 1 unit, and every 15 carbs I consume take 1 unit).

The more agressive bolus is the morning dose, and for now is working fine. It's the lunch time bolus that is giving me hassle. 4 hours after I take my lantus, (I take my lantus when I eat breakfast), I have lunch. So I take lantus at about 8 am, then eat lunch at noon, and do my bolus for lunch.

Am I making sense?

Hi Jonathan!

Sounds like you are having a lot of fun....stick with it and you will get there.

With a 24 hour (however you split it) insulin like lantus it makes it tough to determine the culprit when things go wrong and to an extent you end up compensating by adjusting your bolus upward or downward at certain times of day.

This aside, even on the pump, my carb ratios are different first thing in the morning to lunchtime/afternoon (I notice you change your correction factors which helps but the actual carb ratios need work sometimes too); for example until about 10 or 11am i bolus 1u for every 10g of carb, then lunchtime/afternoon that is about 1 to 15g, then later in the day/evening maybe around 1 to 12g (unless I have been exercising). As well as this my basal is a lot lower in the afternoon. These days Im pretty good at sensing what to take when depending on all the factors that impact on this rather complex equation!

Whilst you are on lantus it is fairly difficult to control the fact that you need different basals at different times of day, so knowing that you are going low in the afternoons, maybe you should try adjusting your carb ratio at lunchtime to compensate.

When I was on lantus I found that if I took a level that was adequate to cover me overnight I would always be hungry and have hypos during the day, so I reduced my lantus, then bolused agressively in the evening, and woke myself around 5am to take some extra novorapid to cover the insulin resistant dawn hours. this little routine, which sounds annoying, worked really well for me. not everybody's ideal but i much preferred it to the constant hunger of having too much circulating insulin in the afternoons and worry of hypos driving home from work!

Liz x

[Lizzie G]

Indeed, and it shall.

Right now I'm trying to read up on neuroendocronology. There is a lot I'm trying to make sense of.

I guess you could say I'm a scientist, although this is a bit out of my area of expertise. I'm more familiar with Physics, Quntum Physics, Particle Physics, and the like. Get me down to the particles and I can make sense of it. It's at molecules and so on that it becomes complex to me. You might think Particle Physics is complex, but really it's not. It's when you start combining other particles, and atoms to make a molecule and combining molecules, that's when it gets complicated cause then you need to take into account the relation, and the role of each particle to really understand the molecule.

My degree is in Electronics/Computer Engineering. I can remember when I was attending school, I'd ask questions. The professors would routinely tell me I should be in Physics. I had one of my former doctors offer to sponsor me for med school. I turned it down, explaining that I was terrible in Biology. Funny how that goes. Now I'm being forced to learn quite a lot about Biology and Micro-Biology.


I hear you! my degree is in chemistry. organic chemistry is one of the most painful and challenging things i have ever done, you are away from the logical mathematics of particle mechanics and into the realms of multiple factors affecting a macromolecule, polymer, whatever....a bit like diabetes you can change one really small factor and the rules go out the window!

[Jonathan_R]

Yes, working with lantus is annoying, to say the very least. When they had me on Metformin along with it, that was disastrous.

How can I do different basals at different times with lantus?

I don't mind coming up with different bolus ratios, even if it's for every dose I do. I just want this under control.

It also annoys me that I am the one doing the work and not my doctors.

I often take prednisone for my degenerative disk disease and carpal tunnel. I used to take morphine, vicodin and flexeril for my degenerative disk disease. You can imagine the fun that played with my blood sugars.

[Lizzie G]

Yes, working with lantus is annoying, to say the very least. When they had me on Metformin along with it, that was disastrous.

How can I do different basals at different times with lantus?

I don't mind coming up with different bolus ratios, even if it's for every dose I do. I just want this under control.

It also annoys me that I am the one doing the work and not my doctors.

I often take prednisone for my degenerative disk disease and carpal tunnel. I used to take morphine, vicodin and flexeril for my degenerative disk disease. You can imagine the fun that played with my blood sugars.

ouch it sounds like you have quite the array of painful conditions. i feel 'lucky' to have only the diabetes!

you cant really do much about lantus itself as its profile is flat, but tweaking the boluses can go a long way to helping.

where are you based? in the uk doctors tell you the basics then if you want to have decent control you pretty much work it out yourself. i know in the beginning that seems wrong but over time you will realise that is is far better than you are in the driving seat from the word go, as things change so much and for so many different reasons that you need to be able to work out quickly what you need to do; it would be crippling if you needed medical advice all the time.

why did they put you on metformin by the way? that seems odd.

[Tribbles]

I don't do shots more frequently than 4 hours. I was advised not to. That it was called stacking.

...

Golden Puffs, is 24g of total carbs per 3/4 cup. As to the milk, that is 12g of carbs per 1 cup of milk. Obviously, I have considerably less than 1 cup. So my calculations are spot on.
I was going by your spreadsheet. There are definitely times when you are taking shots less than 4 hours apart hence my comment. As Subby said you can take shots closer provided you allow for the insulin already in your system.

Likewise for cereals you have 60g in your spreadsheet but ir sounds like you are only eating 30g (I have 1/2 cup of milk with my cereals). I'm not sure how you arrive at 60g unless there is something you are not noting in the food section.

I agree with Subby about Using Insulin - definitely get that book.

[Subby]

There is one thing that tends to strike me here Jonathan, as something that might be contributing to instability.

First, let me say I agree with reducing carbs if needs be to find some more predictable and reasonable results. The actual amount you go can be up to you. Some go "extreme" and have maybe 40g of carbs. I find I can get pretty good results in a number of ways, with what around 100 - 120g daily at the moment. I find it easier to dose for and get good results with, than eating higher carbs or anything near the mainstream recommendation for my body (about 300g I think?)

Just as important is picking the right carbs, I avoid foods that spike (may well be high GI, high GL, but the tester is the ultimate authority) I concentrate on good natural foods.

Now, lets talk about something completely different. Your basal situation. I wanted to bring up what some people like me find.

If you take insulins like Lantus or Levemir and think about how they work, what is occuring is that they are "metering out" insulin at a steady rate over the time of action (usually 20 - 24 hours). So, you can translate that into a relatively steady stream of x units per hour, for example.

This, in a perfect world (well, in a perfect world we wouldn't have D... but I digress) will match your body's internal releases and usage of glucagon, or - sugar. This process is occuring all the time, it's the basic body fuel being released by the liver (and other sources), both as a kind of maintenance feed and in response to further stimulus such as waking up, stress, activity.

The majority of the population appears to have a relatively flat basal needs from hour to hour. So a person might only have the need for let's say, 1 unit an hour all day. So a dose of 24 units of Lantus might do quite nicely. And blood sugar is kept relatively steady (and a kind of table upon whith food and boluses work on top of).

For these people, providing basal converage is pretty much a case of finding a good Lantus dose and sticking to it.

BUT. There are some lucky people who seem to work differently. They have a real graduation of "basal" needs through the day, as a mysterious part of their 24 hour biological body clock. So they might need 1 unit per hour for 8 hours of the day. But then they only need .5 units per hour for another 8 hours, so the Lantus dose is far too much for that time period. And they might need 2.5 units per hour for another 8 hours of the day, and the Lantus dose is woefully inadequate for that time period.

I'm one of those people, and was very unstable on MDI largely for that reason. I was kind of aware of it, but it's easy to see trends around food and boluses (and especially LARGE amounts of food and bolus) and get stuck on thinking they are the cause of the trouble. Think of it this way, the lake has already got ripples and waves on it, but if you keep throwing stones and boulders in creating waves, as far as you know it's your actions that cause the entire problem, and in your imagination if you did stop throwing rocks it would become still. But without doing it, you really don't know.

So that leads on to what I suggest you might do to work out if, for you, your basal situation is stable or not. Basal testing. I don't know if it's mentioned in Using Insulin, I have the companion book Pumping Insulin. In that book basal testing is described thoroughly. It's seen as a "pump" tool, but there is no reason you can't use some version of it to at least gain insight into whether you have problems with your basal coverage, even before you pile food and boluses on top.

Because there is something else I wanted to mention too. Like the lake with waves crashing and rebounding, once a certain amount of instability occurs things get very confusing and chaotic. There may be no real pattern to be seen because you might be in a state of "general flux" from such issues as basal problems. So what I am saying is it's worth using the tools to look into this, even if you feel intuitively that the problems lie elsewhere.

Anyway, basal testing is just short term fasting (like, 8 hours at a time, or skipping a meal) and regular tests through that period to observe what BGs your basal insulin is generating. The idea is to do it in segments (at your leisure) over the whole 24 hours. There are rules and regulations to make sure the waves are not going to interfere: you can see a good list of those rules here. Basal Testing Rules (http://www.integrateddiabetes.com/pump_bt.shtml) There is a good link to basal testing for injections here, well worth a read. Basal Testing for MDI - Diabetes Daily (http://www.diabetesdaily.com/forum/articles/16675-basal-testing-multiple-daily-injections)

I realise that is a lot to take in, but have a read and let it sit with you. It's not a hard thing to do, just takes some patience really. It would be undertaken in your case to see if there are definite stability problems you might be able to improve, either by changing dose or dose time, or other things like strategically eating snacks.

The answer for me to fix my basal instability, was to go on a pump, which allows you to program that units per hour (or, 30 minutes). I dread the idea of trying to deal with rigid long acting again if I have to. Not only do I get inevitable periods of horrible highs or crashing lows even with the "best fit" injection, I find basal problems can significantly affect how well a bolus works.

But I do seem to be the exception, not the rule. Maybe you have some simple basal problems you can really improve with your long acting regimen, if you basal test and adjust accordingly.

[dbaratta]

You don't take much of the rapid insulin. Have you considered cutting back even more on your carbs and maybe going on metforum instead? Long acting insulin and met. 1 unit of insulin per 15g of carbs is very low, not even worth it. Or did I read that wrong? I am trying the Adkins diet. I lost 3 pounds in less than 48 hours. Maybe try Adkins and cut out the rapid insulin? Just a few thoughts.

[dbaratta]

I started a thread earlier this week about my blood sugars. Some advise was given, to mich I have applied that advise.

The good news: Sinse applying the advise of eating lower carbs, that has helped with my morning sugars. I have also split up the lantus a 2/3rd to 1/3rd ratio. So 30 units in the morning, and 15 units at night.

The problem: My standard deviation is still large. About all its done is shift closer to 0. I'm starting to have more hypos. The hypos could be cause my bolus ratio is off.

For breakfast I have 1 serving of cereal, which works out to about 25 carbs. I round that to 30. I also have a 2 egg omlet.

For lunch, I have 1 sandwich (double fiber whole wheat bread) of peanut butter and jelly. That's about 32 carbs. I round that down to 30.

My bolus for the morning is for every 10 I'm over, I take 1 unit. So if I'm 230, I subtract 230 from 105, which gives 125. 125 divided by 10 is 12.5, so I round up to 13. for the food, it's every 15 carbs I take 1 unit. So because I consume 30 carbs, I take 2 for a combined, a total of 15 units.

The rest of the day my bolus is every 15 I'm over, I take 1 unit. For every 15 carbs I eat, I take 1 unit.

I seem to have the most trouble after lunch. I am consistently crashing, having hypos after lunch. This would seem to indicate I am getting the peak of the lantus at around lunch time. I probably need yet another bolus ratio. Maybe 1:18 or something.

Anyway, I have included a link to my updated, published log. Complete with graph and corresponding to the correct measurements.

diabetes log (http://spreadsheets.google.com/pub?key=tQp5VrYrxH00p9ezK4jlc7A&single=true&gid=0&output=html)
I looked at your spread sheet. I think you have too much refined, or simple carbs in there. Trade your cereal for protein, get rid of the candy bar and cinnamon roll, trade that snack for a healthy carb, some veggie or fruit. Be careful with fruit though cause that can cause spikes like the candy bar. If you really have to have creal try Bran Buds, it is good and has a ton of fiber, the fiber helps. ( I am sure you know that). Eat salad, drink lots of water. Water flushes glucose from your system, but be careful cause when you are on insulin too much water can make you crash, at least it does for me.

[Subby]

You don't take much of the rapid insulin. Have you considered cutting back even more on your carbs and maybe going on metforum instead? Long acting insulin and met. 1 unit of insulin per 15g of carbs is very low, not even worth it. Or did I read that wrong? I am trying the Adkins diet. I lost 3 pounds in less than 48 hours. Maybe try Adkins and cut out the rapid insulin? Just a few thoughts.

dbaratta, this person has type 1 diabetes... these comments don't apply or are actually dangerous for a type 1. For example, failing to bolus for carbs no matter what the ratio they use, may well land a type 1 in hospital within a few hours. A ratio of 1:15 is pretty typical for a type 1, nothing like "not even worth it". Type 1s don't have insulin resistance like a type 2 (usually) and metformin may well do no good at all in that context. I don't think Jonathan is dieting at all or that there is a particular weight problem. Could be wrong there, but even if there is weight it's not central to insulin dependency at all.

Not trying to jump on you at all, but there are genuine differences with insulin use between type 1s and most type 2s - and just leaving rapid acting out altogether is potentially very dangerous advice to give in a type 1 context.

[e||ement]

You don't take much of the rapid insulin. Have you considered cutting back even more on your carbs and maybe going on metforum instead? Long acting insulin and met. 1 unit of insulin per 15g of carbs is very low, not even worth it. Or did I read that wrong? I am trying the Adkins diet. I lost 3 pounds in less than 48 hours. Maybe try Adkins and cut out the rapid insulin? Just a few thoughts.

dbraratta...this is dangerous advice. i am a type 1 with an I:C ratio of 1:30. i was initially misdiagnosed as type 2 and was on the maximum dose of metformin for 6 weeks and eating extremely low carb and i still had very erratic blood sugars. the first day of my proper diagnoses, and after my first shot of insulin, i could not believe the difference in my readings...and in how i felt.

no matter how big or small a type 1's insulin:carb ratio is, the insulin is the key to maintaining healthy blood sugars, as we do not produce our own insulin to cover eating carbs. not taking the insulin, no matter how small the amount, could lead to dangerous outcomes.

[e||ement]

johnathan...maybe you need to approach this like a "newbie". sometimes the more research, or trial and error we do, the more clouded are results are.

i think you need to be doing basal testing, and ISF testing...

[Jonathan_R]

I was going by your spreadsheet. There are definitely times when you are taking shots less than 4 hours apart hence my comment. As Subby said you can take shots closer provided you allow for the insulin already in your system.

Likewise for cereals you have 60g in your spreadsheet but ir sounds like you are only eating 30g (I have 1/2 cup of milk with my cereals). I'm not sure how you arrive at 60g unless there is something you are not noting in the food section.

I agree with Subby about Using Insulin - definitely get that book.

No. I test more frequently, but don't give shots more frequently. I do not administer meds every time I test. Gotta look at more than the top 3 rows.

Your looking at the beginning of the month as apposed to where I am now. At the beginning of the month I would have at least 2 servings, hence the 60 carbs. Now, I only have the 1 serving. It is all documented.

[Jonathan_R]

I have also cut out the snacks. So no candy bars, ice creams or what not. The only time I snack now is when I'm hypo. When I'm hypo I'll have trail mix or something.

I noticed something bizzare this moring. At 51 minutes after midnight, my blood sugar level was 115, so I took no action. No snack, no meds. I had taken my meds at 10 PM. Which is why I was down to 115. Then this morning after waking up, testing at 8:04 AM my sugar was 339. That's a jump of 224 for doing nothing.

[dbaratta]

dbaratta, this person has type 1 diabetes... these comments don't apply or are actually dangerous for a type 1. For example, failing to bolus for carbs no matter what the ratio they use, may well land a type 1 in hospital within a few hours. A ratio of 1:15 is pretty typical for a type 1, nothing like "not even worth it". Type 1s don't have insulin resistance like a type 2 (usually) and metformin may well do no good at all in that context. I don't think Jonathan is dieting at all or that there is a particular weight problem. Could be wrong there, but even if there is weight it's not central to insulin dependency at all.

Not trying to jump on you at all, but there are genuine differences with insulin use between type 1s and most type 2s - and just leaving rapid acting out altogether is potentially very dangerous advice to give in a type 1 context.
No problem. Those were just my thoughts. Type 2 isn't always insulin resistant and over weight. I am a type 2 and am not resistant though I could lose a few (which I am working on). He seems to be crashing a lot? My suggestions are only what I think and not what I know. I would hope that no one would change anything they do without asking their doctor first.

[dbaratta]

I have also cut out the snacks. So no candy bars, ice creams or what not. The only time I snack now is when I'm hypo. When I'm hypo I'll have trail mix or something.

I noticed something bizzare this moring. At 51 minutes after midnight, my blood sugar level was 115, so I took no action. No snack, no meds. I had taken my meds at 10 PM. Which is why I was down to 115. Then this morning after waking up, testing at 8:04 AM my sugar was 339. That's a jump of 224 for doing nothing.
That happens to me to, it is very frustrating.

[dbaratta]

Subby, thank you.

I knew I could count on you. Yes, you did say in previous posts that my I:C needs tweaking. I did that for breakfast and just about nailed it.

It seems I need about three different boluses, at the moment.

Today I split my lantus from a straight 40 something units to 2/3rds in the morning and 1/3rd in the evening. I am still working on raising my basal 1 unit every 2 days.

I have also started to lower my carb intake, although not so agressivly yet.

I have also started doing different boluses as someone suggested in another thread. Currently I have 2 boluses. My morning bolus (for every 10 I am over I take 1 unit, every 15 carbs I consume I take 1 unit), and the rest of the day bolus (every 15 over take 1 unit, and every 15 carbs I consume take 1 unit).

The more agressive bolus is the morning dose, and for now is working fine. It's the lunch time bolus that is giving me hassle. 4 hours after I take my lantus, (I take my lantus when I eat breakfast), I have lunch. So I take lantus at about 8 am, then eat lunch at noon, and do my bolus for lunch.

Am I making sense?
Please ask your doctor before you change anything? Just my suggestion but every "body" is different. One size does not fit all so you should keep in close contact with your Doc. Just my suggesstion.

[dbaratta]

Hey isn't Lantus a 24-hour drug? Not sure but I don't think you are supposed to take that more than once a day, it is a slow release. I did that in the beginning too and my doc told me I could have caused myself serious injury. You should ask the doc.........

[Jonathan_R]

Hey isn't Lantus a 24-hour drug? Not sure but I don't think you are supposed to take that more than once a day, it is a slow release. I did that in the beginning too and my doc told me I could have caused myself serious injury. You should ask the doc.........

Yes, it is a slow release 24 hour med. I have been on it before as once a day. And I have been on it before, by the doc, to split up the lantus. This is nothing new.

[Jonathan_R]

johnathan...maybe you need to approach this like a "newbie". sometimes the more research, or trial and error we do, the more clouded are results are.

i think you need to be doing basal testing, and ISF testing...

That was the primary thing I was working on. I have been, all month long, brining my basal dose up. It's all in my log. It is only as of yesterday I started splitting it again. So I am taking 30 units of Lantus in the AM, and 15 units of Lantus in the PM.

[e||ement]

well i mean basal testing like this:
Basal Testing for MDI - Diabetes Daily (http://www.diabetesdaily.com/forum/articles/16675-basal-testing-multiple-daily-injections)

what you are doing is more like basal experimenting ;)

[jenb]

I'm with e||ement. You need to do some organized basal testing.

Most (but not all) people need more basal insulin starting in the early morning hours, so taking 30 units in the morning and 15 in the evening is probably not working to your advantage. What time do you take your split Lantus doses? Using myself as an example, I take 8.5 units of Levemir at 10:15 p.m., 6.5 units at 6:15 a.m. and 3 units at 2:15 p.m.. As you can see, my highest dose is in the evening - this covers me for about 9 hours. 8 hours after the evening injection I do another 6.5 units. Again, this lasts about 9 hours. In the afternoon and early evening my basal need drops precipitously - 3 units carries me through until I start the routine again.

Only by doing carefully organized basal testing was I able to find the schedule and amounts that work well for me. I hope that when you do it too you'll find a good regimen for yourself.

Jen

[Jonathan_R]

I will find something that works.

When I was diagnosed, and saw my endo, they never told me about basal testing. Only a couple months ago did I learn that if I was on the correct dose, I could fast. Other than that, all i knew was increase by 1 unit every couple days.

I am hitting the internet, and the public library hard. Reading everything I can find. Currently, I have 67 tabs open in Firefox.

In a way, I feel like I'm in med school. Even when I was in school, I didn't study this hard. I feel like I'm cramming for finals.

[Jonathan_R]

well i mean basal testing like this:
Basal Testing for MDI - Diabetes Daily (http://www.diabetesdaily.com/forum/articles/16675-basal-testing-multiple-daily-injections)

what you are doing is more like basal experimenting ;)

It says that I need to be in target range to start the test. You have seen my logs. I am almost never in a target range. I'm not experimenting, I am doing what my doctors advised me to do. Unfortunately, they did not educate me very well. Like I said, I have learned more in the last 2 weeks, than in the past 3 years. I'm trying to get into target range.

Let me try and explain a few things. I don't sleep much. As you can see, I live in Arizona. I often stay up till 3 or 4 AM reading and researching and posting. Why, mostly cause I'm ADHD, and just cant sleep. I then get up somewhere around 8 AM, test, take lantus and humalog, and eat. Then begin again, reading, researching and posting. When I am up, I test regularly. Sometimes quite often. So I am testing out of 20 hours. So I have a lot of test results going all the way around the clock. That, right now, is about as good as I can do. Unless you have another suggestion.

[Subby]

No problem. Those were just my thoughts. Type 2 isn't always insulin resistant and over weight. I am a type 2 and am not resistant though I could lose a few (which I am working on). He seems to be crashing a lot? My suggestions are only what I think and not what I know. I would hope that no one would change anything they do without asking their doctor first.

I'm sorry, but type 2 is synonymous with insulin resistant. That is the basic biological mechanic of type 2. It is not the basic mechanic of type 1.

As for your continuous suggestion that Jonathan only go through a doctor, the message is sound but the suggestion is that you think there has been inappropriate advice. how about you point out precisely where there has been inappropriate advice given here, please. I take great pains to try and educate and suggest potential courses of understanding, in the aim of understanding more about the perplexing nature of trying to get progress with insulin dependent insulin therapy. I try to be CAREFUL at all times, and NOT do things like prescribe different doses or concrete changes - both because I have no right, and because it's not likely to help someone anyway. I would like to know specifically where you see this as an issue here, and why.

I try to make it clear that I am not an expert, and these are my thoughts - exactly as you posted your thoughts. Because I have more to share and a different style to you, does not invalidate my opinion, either.

[Subby]

Let me try and explain a few things. I don't sleep much. As you can see, I live in Arizona. I often stay up till 3 or 4 AM reading and researching and posting. Why, mostly cause I'm ADHD, and just cant sleep. I then get up somewhere around 8 AM, test, take lantus and humalog, and eat. Then begin again, reading, researching and posting. When I am up, I test regularly. Sometimes quite often. So I am testing out of 20 hours. So I have a lot of test results going all the way around the clock. That, right now, is about as good as I can do. Unless you have another suggestion.

Another factor for your consideration, your basal profile which I talked about in that long post a page or so back, may well be impacted badly by bad sleeping habits. Here is what I find: the more I can get decent sleep at regular hours, the less volatile and problematic my basal becomes. If I'm up to 3 or 4am one night, 5am the next, 12am the next, it seems to exacerbate problems with basal control. It can basically be playing with your biological rhythms.

So something else to consider in the mix as you observe if your basal profile is a problem. It really sucks. I'm a real night owl, but I've learn't that if I want a big step or two up in stability, I need to curb my night activities. The more regular, the better. :(

[Jonathan_R]

Subby, I so appreciate your posts, along with everyone else. As I have said time and again, I have learned more here in the short time that I have been here, than in the almost 3 years since I was diagnosed.

The sleep factor could end up being a really big problem. Let me put it this way. It's a bad idea for me to take narcotic pain killers at night. They keep me up. Caffeine has no effect on me. When I was a kid I used to take theopholin, which is concentrated caffeine. The theopholin was a prescription for my asthma at the time. Now I take inhalers, or nebulizer treatments. I do that very rarely.

The point is, in general, stimulants work as downers for me, and depressants work as uppers. But even that is no guarantee.