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lantus w/sliding scale for humalog

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#1
mj&litlev

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HELP!!!! My fiance is a type 1 diabetic and has been since age 3 (he is now almost 32). He is classified as a "brittle" diabetic and has NEVER had his sugars under enough control to be put on a pump (which he really wants). In the almost year we have been dating I have seen his bg over 400 and as low as 28 (recent trip to the ER). We have managed to get his levels below 200 for the most part by using a lantus dosage at bedtime and I:C ratio before meals BUT then he gets massive lows and there is no rhyme or reason to when or why these lows hit him. Yesterday the doctor he has been seeing for about 6 months now told him he either follows her regimen or he goes elsewhere and since we have no insurance it's hard for him to find a diabetic doctor. SO with all that said here is what she wants and where my fiance is fighting hard to NOT do.............
she wants him to take 23 units of lantus at bedtime (his dosage he has taken for couple years now) BUT instead of doing an I:C ratio (because as she put it he is chasing his tail by doing this) she wants him to using a "sliding scale" meaning if his sugars are within in a 50 point range he takes X amount of humalog and that he should have four readings per day (fasting & 1 for before each meal). THAT'S IT. NO COUNTING CARBS. NO CORRECTION FACTOR PLUS AN I:C FOR WHAT HE EATS! Do this for one week then go back to her and she will adjust his lantus up or down depending on what his fasting bg level has been for the past week.

At this point of having him go SO low SO many times I am willing to try anything BUT he is reluctant. Anyone ever heard of this way of lantus/humalog regiment for a type 1 diabetic or is the doctor out in left field?

#2
poodlebone

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The problem with a sliding scale is that it doesn't take food into account. Did she also tell him what he should eat at each meal? If one day he has bacon, eggs and one slice of toast for breakfast and the next he has pancakes & syrup those meals will require vastly different amounts of insulin. I believe carb counting makes the most sense. The thing you have to watch for is stacking insulin. Humalog lasts around 4+ hours in most people so if he does a lot of snacking or smaller meals he could be stacking insulin. I would also make sure that he doesn't do any corrections before 4 hours unless his BG is really high.
--
Liz
Type 1 dx 4/1987
Minimed Paradigm 723 Revel + CGMS
13mm Silhouettes + Sure-T infusion sets
Lifescan Ultra meters
Last A1c: 7/10: 5.4

#3
networkguy

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The problem with a sliding scale is that it doesn't take food into account. Did she also tell him what he should eat at each meal? If one day he has bacon, eggs and one slice of toast for breakfast and the next he has pancakes & syrup those meals will require vastly different amounts of insulin. I believe carb counting makes the most sense. The thing you have to watch for is stacking insulin. Humalog lasts around 4+ hours in most people so if he does a lot of snacking or smaller meals he could be stacking insulin. I would also make sure that he doesn't do any corrections before 4 hours unless his BG is really high.


I second this. But no consideration for carbs or corrections is TERRIBLE. He really should be on a pump. IMHO, almost every type 1 should be. I was on Lantus/humalog for many years, and was able to keep A1C's 6.5-7.5. But I also counted carbs and corrected when necessary. My average, I think, was 5-8 shots/day.

#4
alcatar1

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Hi, I've been using Lantus and Novolog(meal time insulin just like humalog) with a sliding scale since i found out i have type 1 diabetes and it work well for me.
I think u should do what the doctor say if u need to get better instead of questioning his methodes.
remember that DOCTORS only want to help provided u listen and do what they say.
As for me i take 26 units of lantus b4 bed and novolog with my scale to ajust after each meal.work fine for me but it took time to get it to work.
Just do what the doc say and allow him to ajust u'r doses .. u should be fine.:)

#5
networkguy

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Hi, I've been using Lantus and Novolog(meal time insulin just like humalog) with a sliding scale since i found out i have type 1 diabetes and it work well for me.
I think u should do what the doctor say if u need to get better instead of questioning his methodes.
remember that DOCTORS only want to help provided u listen and do what they say.
As for me i take 26 units of lantus b4 bed and novolog with my scale to ajust after each meal.work fine for me but it took time to get it to work.
Just do what the doc say and allow him to ajust u'r doses .. u should be fine.:)


IMHO its up to us to adjust our doses...but thats just me :) I disagree with the follow whatever the doc says thing. I guess Im more of a hands-on-its-MY-disease type of guy. Docs spend so little time with us I think alot of times its too hit and miss.

Just my opinion :D

#6
alcatar1

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For someone who has diabetes for 29yrs and still can't get it under some type of control.... i think u should realy listen to your doctor.
but then again that's my opinoin:)

#7
Lizzie G

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i agree in principle with network guy and that is how i treat my own diabetes; my doctor understands this and we dont even discuss how much insulin i take, im in control of my diabetes and theres an unspoken knowledge that i make the necessary changes to respond to changes in my body and my environment - he knows it would be insulting my intelligence to even bother asking and that me living inside my body with my condition i know best.

HOWEVER, if i was struggling with my diabetes i think things would be different and i would accept that i needed someone else's help and advice. but the advice of using a sliding scale probably isnt very helpful, the kind of advice your boyfriend needs is not someone telling him what doseage of insulin to take, but to work with a sensible starting point and tailor things to his own life, the activities he likes to do and the foods he like to eat; the book 'think like a pancreas' by gary scheiner available from amazon might make a really nice gift for your boyfriend; its a fantastic book that really really helps to separate out all the different things that might be causing problems, and allow the person with diabetes to really take control, understand their body and to live a really unrestricted life. the book is written by a medical professional with type 1 diabetes, and changed my life to be honest!

[SIGPIC][/SIGPIC]

Lizzie
Type 1
Mum to Samuel, born 09 Sept 2011 and James, born 10 Feb 2014
Latest HbA1C: 5.8%


#8
networkguy

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i agree in principle with network guy and that is how i treat my own diabetes; my doctor understands this and we dont even discuss how much insulin i take, im in control of my diabetes and theres an unspoken knowledge that i make the necessary changes to respond to changes in my body and my environment - he knows it would be insulting my intelligence to even bother asking and that me living inside my body with my condition i know best.

HOWEVER, if i was struggling with my diabetes i think things would be different and i would accept that i needed someone else's help and advice. but the advice of using a sliding scale probably isnt very helpful, the kind of advice your boyfriend needs is not someone telling him what doseage of insulin to take, but to work with a sensible starting point and tailor things to his own life, the activities he likes to do and the foods he like to eat; the book 'think like a pancreas' by gary scheiner available from amazon might make a really nice gift for your boyfriend; its a fantastic book that really really helps to separate out all the different things that might be causing problems, and allow the person with diabetes to really take control, understand their body and to live a really unrestricted life. the book is written by a medical professional with type 1 diabetes, and changed my life to be honest!


Your second paragraph makes sense to me. I think to add to that thought about starting from a base...even though he's had diabetes for his entire life doesnt mean he understands it. Perhaps "starting over" might be in line? Start with a nutritionist, and maybe take a few diabetes education classes. Most insurances cover those.

And then there are those who, no matter what steps they take, cant control things. Ive seen cases where people will literally weigh every morsel of food, eat at the same times, etc, and have A1C's in the 12-14's. Its unfortunate. But I would start with the "starting over" thought and go from there.

#9
Lizzie G

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Your second paragraph makes sense to me. I think to add to that thought about starting from a base...even though he's had diabetes for his entire life doesnt mean he understands it. Perhaps "starting over" might be in line? Start with a nutritionist, and maybe take a few diabetes education classes. Most insurances cover those.

And then there are those who, no matter what steps they take, cant control things. Ive seen cases where people will literally weigh every morsel of food, eat at the same times, etc, and have A1C's in the 12-14's. Its unfortunate. But I would start with the "starting over" thought and go from there.


yup i agree on the starting over thing too, if things arent working its worth taking radical action.

re the taking lots of different steps and not controlling things still i know people like that too. i do think though, that a lot of the time it is because they are missing certain vital factors, stress, exercise, temperature, menstrual cycle, hayfever, seriously, the amount of insulin i need to deal with 10g can vary between 0.5 and 1.5 units depending on these things; carb counting is just the starting point. and as far as eating normally is concerned, as i said to someone recently 'sensibly guestimating is the sophisticated older sister of weighing one's food'.

[SIGPIC][/SIGPIC]

Lizzie
Type 1
Mum to Samuel, born 09 Sept 2011 and James, born 10 Feb 2014
Latest HbA1C: 5.8%





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