[DanG]

Originally Posted by Stuboy

It's weird how we all react differently to basal's, too much too little, they all have tell tail signs i guess!

I am going to need to do the duck basal testing real soon. My experiment with split does basal is over for now.

I did not make it thru 2am last night.
The problem is, when low, I am violent - even my adult son didn't want to try to hold me down. I was thrashing and gone... gone. Finally I came to after an hour and emt visit. Is anyone else violent at night time basal low?

This is the second awful low from lantus I have had in 4 days. I am going back to full dose at night - which didn't leave me with any problems. Until after I do the basal test thing I am done with the split dose experiment I have been doing for the past week. Plus I'm gonna drop the lantus to 16 or so.

Question: Has anyone else noticed that a lantus low is really awful to recover? I mean, it takes maybe 10 minutes with humalog low, but the lantus low takes almost 30 minutes to get sane again. Stumbling, operating at 15 minutes, but back to sense takes 30 minutes. I do not like lantus low at all.

I let Stuboy say it all again: "It's weird how we all react differently to basal's, too much too little, they all have tell tail signs i guess!"

[duck]

I went from NPH to Humalog (later Novolog) on a pump, so I never used Lantus. But in theory, since it is a basal insulin that provides about 1/24 of your shot amount every hour (for example, you take 24 units at 8AM, then for the next 24 hours you get 24/24=1 unit Lantus and hour), a low from Lantus should be easy enough to recover from since there shouldn't be *that* much Lantus working...

But that theory is fraught with issues. If you need as much as 1.5 units an hour at some points in a day and less than 1 unit at others, then you will either go high or low depending on how you took your Lantus. My suspicion for you Dan G is that your overnight needs are lower than your waking needs, and at that point your Lantus is working "harder" than you need...

You could try Peanut Butter at bedtime for a slow-release/slow breakdown food that should "prop up" your sugars. Or we can take a look at your shot times/amounts and see if further tweaking can be had.

When I was on NPH, I noticed that if I went low very, very slow, I was **** for a long time afterward. I was "stupid", couldn't reason to save my life. I was weird, I would throw things and act out. Drink a little coke and I was almost instantaneously better.

I have a story for Dan G too: My freshman year in college, some of the football players lived in my dorm. One of the upper-classmen football players was over visiting, and someone said I had diabetes. He asked me if I got violent when low, and I said no, just weird sometimes. He said his freshman year, the starting Senior Tight End was diabetic, and became violent AND paranoid when low. His girlfriend was constantly calling on the offensive and defensive linemen to come over and hold him down to get him to eat/drink something, and dude said it was ALWAYS a mammoth battle. Part of me wishes I could have witnessed that, 300-pound boys trying to forcefeed a 260-pound paranoid diabetic.

[belyro]

Originally Posted by BlueSky

Bethany,

Have you actually done this test yet? I was very resistant to the idea before I first did it, mainly because my BG was unstable at the time. And I couldn't see how this would help. But there could be any number of confounding factors here. And speculating on what might happen only messes with your mind. Doing the basal test exercise will enable you to separately focus on basal and bolus insulin action. You could be surprised at what you find. And the exercise will definitely help you use the most approrpriate tactics.

Oh, I'm not questioning the value of basal testing. I do intend to do that. I just mean I don't see how I could be bolusing too much. I very often get the balance wrong and bolus too little, and then I'm too high within 2 hours of eating. If I bolus such that I can be closer to 10 2 hours after a meal, I WILL come down before the next meal.

I just want to wait until the Christmas season is over and my life's on a more even keel before I try the basal testing, though. But I will.

[belyro]

Originally Posted by grace girl

I think you need to do some basal tests to really know what you need to do. Doing the tests sucks, really, but what you learn from it is great. I would also add, though, that I'm not convinced that the tests are always 100% accurate when you're on mdi, as opposed to the pump. According to the guidelines the results of my tests say I'm taking too much basal, but I've found a system that's working for me and giving me the results I want.

I don't know what you're carb ratio's are, but what you're saying makes me think that perhaps you need to increase you're basal and decrease your carb ratios.
A few months ago they had me on a small amount of basal and a larger amount of bolus and I found it to be a major roller coaster....way too easy to go low after meals.

I've raised my basal to as high as I can stand it and lowered my carb ratio's as I've gone along. Over the last few weeks I'm at about 65% basal and 35%bolus....I've found that with the basal being the major player I've got more steady b/s....it's not as unpredictable as it was before. I've got one time a day when I'm prone to lows, as opposed to three or four, and I'm now beginning to figure out what's really causing these lows (it's all activity level for me. If I get really busy after lunch I have to watch out) so I have a better idea at least of when it will happen.

The thing is, I just decreased my basal not long ago, and I have had SO MUCH better control since then. I was really taking too much. I'm confident of that. I was coming down WAY too much between meals before. I used to come down from 15 to a low between meals while sitting on my butt. Now I can go from 10 to 4 comfortably, so I'm SURE my current basal amount is better, and if anything, it would seem to me that I should decrease it even more and it would give me MORE stability.....but I just don't know. I just don't see how raising my basal would do anything OTHER than bring me right back to where I started, and that's not a place I want to be anymore.

[belyro]

Originally Posted by duck

Let me make sure I understand what your query is:

You take 6 U of Levemir at night...You eat breakfast, you bolus. But it's not your AM sugars you are worried about.

You eat Lunch, bolus. And even though you are 7 two hours later, without eating anything you continue to drop the rest of the afternoon, right?

What I am saying is, skip LUNCH--don't EAT. I know, it sucks. But you are meal bolusing for lunch, right? In theory, if you are not going to eat lunch, you don't need to bolus for it. If you skip lunch, you can get a better idea of whether your basal insulin is indeed too much in the late afternoon, or if maybe your bolus insulin lingers longer for you than the "typical" four hours. As it is, we have no idea which of the two are affecting your sugars to knock them down later in the afternoon...

Bingo, Duck. (Sorry Mods, feel free to combine my posts.)

Yeah, it's definitely lunch I need to try skipping. I'm going to do that when my schedule's back to normal. I assume I can still eat non-carb foods? Chicken or something? Otherwise I'm afraid I'll pass right out in the afternoon.

[BlueSky]

Originally Posted by belyro

...... If I bolus such that I can be closer to 10 2 hours after a meal, I WILL come down before the next meal.....

That used to happen to me all the time, until I reduced the amount of carbohydrate in my meals. It cuts the peaks and valleys off the BG cycle.

[grace girl]

Originally Posted by ****

Question: Has anyone else noticed that a lantus low is really awful to recover? I mean, it takes maybe 10 minutes with humalog low, but the lantus low takes almost 30 minutes to get sane again.

Well, this is just my opinion, as one who is on Lantus, but I find that the lows are VERY different with Lantus vs. Humalog. And, yes, the humalog lows are easier to recover from. For me, most Lantus lows happen either overnight or upon waking in the am, and I think that because it's such a slow acting insulin that by the time you become aware that you are low, you've been there for a while. It's just my own personal theory, I could be wrong.
All I know is that a low from humalog is easy to recover and I bounce back pretty well. With lantus it takes me longer to recover, and I generally feel terrible all day long, like I'm hungover, and there's nothing I've found to fix it.

You said you've stopped your split dose experiment, but I'm curious, were you splitting it 50/50? That doesn't work for everyone. My total dose is 24 units. I take 16 in the am and 8 at night...I had to do it this way to avoid night-time hypos. Just something for you to consider if you decide to try it again.

[belyro]

Originally Posted by BlueSky

That used to happen to me all the time, until I reduced the amount of carbohydrate in my meals. It cuts the peaks and valleys off the BG cycle.

I was wondering how long it would take for someone to suggest lowering my carbs. I think you're probably right.

[duck]

Originally Posted by belyro

Bingo, Duck. (Sorry Mods, feel free to combine my posts.)

Yeah, it's definitely lunch I need to try skipping. I'm going to do that when my schedule's back to normal. I assume I can still eat non-carb foods? Chicken or something? Otherwise I'm afraid I'll pass right out in the afternoon.

I'd go cold-turkey (the technique, not the meat), but that's just me. If you know for a fact that there is a food/foods that don't affect your blood sugars, sure. But use sparingly.

[grace girl]

Originally Posted by belyro

The thing is, I just decreased my basal not long ago, and I have had SO MUCH better control since then. I was really taking too much. I'm confident of that. I was coming down WAY too much between meals before. I used to come down from 15 to a low between meals while sitting on my butt. Now I can go from 10 to 4 comfortably, so I'm SURE my current basal amount is better, and if anything, it would seem to me that I should decrease it even more and it would give me MORE stability.....but I just don't know. I just don't see how raising my basal would do anything OTHER than bring me right back to where I started, and that's not a place I want to be anymore.

You know, the whole thing is so individual it amazes me that doctors actually try to lay all that blanket treatment stuff on us at all! I don't know what the answer is for you, but I do know that if you keep at it you will find it! The last two weeks is the first time I've been able to take the same dosages of both insulins for more than 7 days in 6 months! It takes some time sometimes!

[carolyn]

Thanx For Your Help Of Converting Carbs/insulin Scheme. It Seems To Be Working. Many Many Thanx. Carolyn.

[BlueSky]

Originally Posted by belyro

.... Yeah, it's definitely lunch I need to try skipping. I'm going to do that when my schedule's back to normal. I assume I can still eat non-carb foods? Chicken or something? Otherwise I'm afraid I'll pass right out in the afternoon.

Well, no, if you want to get a true result, you can't eat anything. Protein and fat, when they are metabolised, also use insulin. So they indirectly increase blood glucose.

[DanG]

Originally Posted by grace girl

You said you've stopped your split dose experiment, but I'm curious, were you splitting it 50/50? That doesn't work for everyone. My total dose is 24 units. I take 16 in the am and 8 at night...I had to do it this way to avoid night-time hypos. Just something for you to consider if you decide to try it again.

Yeah, I stopped. I am at total 18/20 for 24 hours and was doing 12/8 for breakfast/bedtime. But it was there that I had the awful low in the am that took forever to defeat, and then the incident at 2AM which was scary. Without the split, I have had zero problems for a couple years - lows when I wake as you say. My usual waking is at 60 - which really is low, but I have no problems functioning there, then I eat and things go up. Oatmeal with a dab of molasses and 4 units for bkfst, pbj for lunch+kefer and 10 units which gets me to 350 or so. Dinner is complex carbs and little protein and 8 units, but the lantus kinda brings that all down to 50 by morning.

Perhaps I will do the split again soon, but I'm freaked for now. I know what has worked, and will calm down for the time being. Perhaps I had some residuals that hung around and blossomed under the split. Does that ever happen with insulin? I mean, there are times when I take gobs of units, and eat very little, and nuthin' happens - where does the stuff go? It must go someplace. Does it hibernate for future blossom?

Duck - thanks for the story on holding the lightweight guy down. Interesting. Perhaps each of us is strong when low and paranoid. How do I defeat the paranoid? Just too weird. And the basal baseline testing will happen soon for me. I wanna know what lunch is doing to get me so high. I'm not like Bethany and dive low, I just don't have any effectiveness at my lunch experience and get to 350 for dinner. Then I gotta defeat that with something, plus eat dinner. Oh, well, I play with this/that and figure things out eventually.

The give/take and experience exposed here should be recommended reading as part of any doctor treating diabetes worth his MD. Books mean squat in the applied world of anything.

[duck]

Originally Posted by ****

The give/take and experience exposed here should be recommended reading as part of any doctor treating diabetes worth his MD. Books mean squat in the applied world of anything.

Dan, JediSkipDogg (a member here) says this isn't a science, it's an art, when dealing with this disease. I tend to agree.

I also see it as a war, since I think there is no denying this disease would like to ultimately kill us, but in the meantime break us, beat us down, etc. When we figure things out, its tactics can change. But what it does not know is that our intelligence operations are better than its, and we can get to a point where we can counter-act and intervene before it can make its move.

Let us know how the basal testing goes...

[belyro]

Originally Posted by duck

I'd go cold-turkey (the technique, not the meat), but that's just me. If you know for a fact that there is a food/foods that don't affect your blood sugars, sure. But use sparingly.

Even salad is a no-no for this?

No chicken breast? Oh man.....I'm going to be starving.....