[DCaplinger]

Um, I don't think I've discussed that before, but according to my doc, if I am still producing any insulin at all, it's very very minimal.

They are still adjusting my basal. I was just upped two more units per day. My biggest problem right now, is that I'm spiking too high after a meal (two hours after, I'm ranging from 250 - 300 or more). That's why he's got me taking so much to cover my meals. And I am very careful with what I eat. For instance, at lunch yesterday, I ate a bowl of soup, total carbs was 40 grams, with 17 grams of fat... and I spiked out at 273 two hours post prandial. We are trying to get my 2 hour mark nearer to 150.

This is all a learning experience for me. Most of what I know about diabetes, is about type 2, since that's what I thought I was for the first month. There just aren't many books that I've found about type 1, so you guys are my resource. Please, keep throwing stuff at me, because I need to know this stuff.

Thanks for everyone that has replied so far.

Regards,

[Lizzie G]

Originally Posted by Eddy

Aiyee. My condolences; it would seem that U-100 made even 0.5U corrections a dicey affair for you.

thats funny I was just reading Jan's stats and i thought 'yup, sounds just like me'...my carb ratios vary from 1:12 to about 1:25, mostly sitting somewhere in the middle, and as for correction...well, in the US scale, a unit will bring me down by about 60 or 70 points (sometimes more)...so this past week i have been on a total high (pun intended!!!!) since i got a half unit pen...i can actually correct now, its amazing...i really dont mind extra shots as it makes control easy peasey once i know how much is floating around, what im adding to the mix and so on....practice makes perfect (or better at least!)

[BlueSky]

Originally Posted by DCaplinger

... according to my doc, if I am still producing any insulin at all, it's very very minimal. ....

Darian,

The logic behind my suggestion that you are producing some insulin is simple but very compelling. You were mis-diagnosed T2 over a year ago, and that autoimmune attack has no doubt being going on for a number of years. But you only started injecting insulin 3 months ago. If you weren't producing a substantial amount of your own insulin before you started injecting it, your blood glucose would have gone much higher and you would have quickly gone into ketoacidosis. Your blood glucose was not dangerously high 3 months ago so you must have been producing a fair amount of insulin then. And it is unlikely that the supply would have suddenly dried up. Usually the opposite happens. Injecting insulin relieves pressure on the beta cells and they seem to regain some of their lost function.

In saying that your residual beta cell function is minimal, your doctor is no doubt trying to make sense of your substantial bolusing requirements. But lack of endogenous insulin production is not the only possible explanation for needing to inject so much to cover meals. In addition to the autoimmune attack, you could also be insulin resistant. Or you could be having absorption problems. You could also be one of the few people who simply don't respond well to the modern fast acting insulins. And then, of course, your problem could at lest partially be explained by inadequate basal insulin coverage. Any of these things would increase the apparent bolusing requirement.

For what it is worth, I also have great difficulty covering carbs, especially with the modern fast acting insulins. I find that Actrapid (Regular insulin) works much better for me, especially in the mornings. We are all a bit different in how we respond to insulin treatment, and figuring out what works best is an ongoing learning process. But until such time as you have got your basal requirements reasonably well covered, bolusing correctly is very difficult.

[DCaplinger]

BlueSky:

Okay, most of that made sense to me. Let's keep this in close perspective, because it's easier for me to follow that way. I was only diagnosed 5 months ago, even as a Type 2. Since I know very little about Type 1, other than what is required to control the after effect, I don't have the slightest clue how quickly, or slowly, the auto-immune damage takes. Also, when I asked him about running a C-Peptide, my Endo said he could do one, but he had a feeling he already knew what the results would be. I didn't feel like arguing then.

Now, I can say, that I am now up to 38 units of Lantus each evening. I have a strong feeling that will be going up to 40 come next week. I'm slowly starting to understand the curve, and how long the Novolog is supposed to take to start working, and to reach max effectiveness. I know I still have so much to learn, and some times, it seems like a bit much to digest, but alas, I am quite fond of my feet, and would prefer to keep 'em around in good working order for a while. LOL.

As far as the breakfast coverage goes, I don't eat a very big breakfast. The dietician told me she wanted me to eat 3 carb choices for breakfast. I generaly get about 42 grams at breakfast, which would put me right on her target. I end up spiking about 2 hours later, however, it's usually about 6 hours after I have had breakfast, before I can really eat again, because of my job. Unfortunately, that usually leads to me going near hypo stage by 11:00 am, fully one hour before I can eat again.

My education nurse has been trying to think of snacks that I can buy, that HAVE to meet the following for me to be able to eat them while on the job:

1) Has to be absolutely quiet. Chips and nuts make noise when being eaten, so those are out. Soft foods would work fine, however, then there is:

2) Has to have no smell. The judge won't let me have foods that have odors in the courtroom, for obvious reasons. So, peanut butter on it's own is out. Now, some kind of snack with PB in it, I could probably get by with, but again, it has to be quiet.

3) Has to be okay without refrigeration. I have no refrigerator in the courtroom. I have plenty of space to keep snacks, but no way to keep 'em cold if needed.

As far as my judge goes, he has no problems with the beeps from my meter, so I can check my BG's all day with no worries. I just need something that isn't really high in carbs, but will carry me for the last 2 hours before I can eat lunch.

Right now, I'm taking glucose tabs when needed to prevent the hypo, but I can't follow the rule, because I can't follow that up in 30 minutes with some type of solid food. That's another reason why I worry so much about going hypo.

Overall, my dietician wants me to consume roughly 210 grams of carbs per day. At one point I felt that seemed like a tremendously high amount, but frankly, I am finding that I am in a foreign country right now... as I haven't the slightest where to go from here. I only know that I want to keep it under control.

The problem is, I've gained 40 pounds since this all started. Some of that is due to my smoking cessation, however, I know some is because the insulin is doing it's job at the cellular level (at least somewhat).

I do understand what you mean about the possible resistance. What would be a good way to approach that? I've seen a few T1's here that also take metformin. Should I talk to my Endo about that? I'm wide open to ideas, and I'm listening.

Thanks for being patient with me. I have a lot of questions, and some of what I'm learning doesn't sit with what I know as an EMT... so I'm having to throw what I already know out the window, and replace it with the new material.

Regards,

[BlueSky]

Darian,

I am going to respond to to your comments separatelyas there are important insights involved. Having said that, these are just my opinions, which have evolved over many years. By way of background, as a T1, I was well controlled for the first 15 years. My HBA1c, after they started measuring it, was typically about 6%. But my control started to deteriorate, and the HBA1c edged upwards. It peaked at 8.6% 6 years ago, and my daily insulin requirement peaked at 60 units at the same time. I realised that I was becoming increasingly insulin resistant, and that I had to start doing things differently. The main tactics I used was to build muscle through resistance exercise, and to eat low carb. I have built a fair amount of muscle and lost a similar amount of fat. I weigh much the same, but my insulin sensitivity has improved enormously. Eating low-carb has also a helped a lot, and my HBA1c is back in the 6.0-6.5% range. My total daily dose is down to about 35 units of insulin. I still have problems from time to time, but they are nothing like what they used to be. My blood sugars are relatively stable, and I have a real sense of being in control.

Originally Posted by DCaplinger

... I don't eat a very big breakfast. The dietician told me she wanted me to eat 3 carb choices for breakfast. I generaly get about 42 grams at breakfast, which would put me right on her target. I end up spiking about 2 hours later, however, it's usually about 6 hours after I have had breakfast, before I can really eat again, because of my job. Unfortunately, that usually leads to me going near hypo stage by 11:00 am, fully one hour before I can eat again.

My education nurse has been trying to think of snacks that I can buy, ......

You really shouldn't have to "feed the insulin". What do you think is making you go low before lunch - the Lantus or all that Novolog you inject before breakfast? If it is the Lantus, you need to reduce the dose and look at other options for keeping your fasting numbers in check. If it is the breakfast Novolog, you can fix it by eating a breakfast that contains very little carb and reducing the bolus accordingly. I used to have a similar problem, and I resolved it by eating a breakfast that contains hardly any carbs. It means that I don't require a big breakfast bolus, so my morning blood sugars are very stable.

Originally Posted by DCaplinger

... my dietician wants me to consume roughly 210 grams of carbs per day. ...

IMHO, the last person you should be listening to is a dietician. Thery haven't got a clue. Putting an insulin resistant diabetic on a high carb diet is like advising an alcoholic that drinking alcohol will relieve their distress.

Originally Posted by DCaplinger

... The problem is, I've gained 40 pounds since this all started. Some of that is due to my smoking cessation, however, I know some is because the insulin is doing it's job at the cellular level (at least somewhat). ...

Feeding the insulin will make you put on more weight. So you need to adjust your insulin so you don't need to snack. In fact you should be doing what it takes to lose fat and build muscle. That is the only sustainable way to to improve insulin sensitivity.

Originally Posted by DCaplinger

.... I do understand what you mean about the possible resistance. What would be a good way to approach that? I've seen a few T1's here that also take metformin. Should I talk to my Endo about that? I'm wide open to ideas, and I'm listening. ...

Improving your body composition by losing fat and gaining muscle will improve your insulin sensitivity, reduce your insulin requirements and improve your glycemic control. Eating low-carb also helps. Cut out all the white foods - potatoes, bread, rice, cereals, pasta and anything made with flour and or sugar. It obviously reduces your bolus requirements and basal requirements seem to decline too. The combined effect of these two tactics is dramatic. You could also try using Metformin. I found that taking 500mg before bed reduced my fasting blood sugars and enabled me to reduce my bed time basal dose (I was using NPH at the time). There are other insulin sensitising drugs (Actos and Avandia), but I would keep away from them if possible.

Exercise, diet and Metformin should do it for you. But it will require hard work and discipline. Also, don't expect too much support from doctors, dieticians and CDEs. They don't seem to get it.

Originally Posted by DCaplinger

.... Thanks for being patient with me. I have a lot of questions, ....

Ask away ...

[DCaplinger]

You absolutely said what I was thinking of typing to begin with. I put little stock into the dietician and CDE (altough, I do like my CDE), because they keep saying that they will only go by what the American Diabetes Association guidelines say. I say bull***t. If I wanted that, I could go to their forums all day.

I'll ask more questions after this weekend is over. I need to develop an exercise program. Giving up some of those food will be very hard for me, as they are staples of the diet for my whole family. To cut myself off of them, would mean doing the same to them. If it's here, I'll eat it. At least, until I can learn not to.

Regards,

[BlueSky]

Originally Posted by DCaplinger

... Giving up some of those food will be very hard for me, as they are staples of the diet for my whole family. To cut myself off of them, would mean doing the same to them. .....

It is difficult, but you don't have to eat different food. If you look for them you will find lots of opportunities to compromise. If the family is eating chicken, potatoes and veg, eat the veg, take a second piece of chicken, and pass on the potatoes. If they are eating pasta and mince, have a half-portion of pasta and a double portion of mince. This reduces the carbcontent of traditional family meals.

An approach that has worked well for me is to focus on one meal at at time. The easiest meal to do your own thing with is breakfast. Eating your own foods doesn't impact on the family much. Instead of eating toast, cereal and milk, eat eggs, cheese and mushrooms. The rest of the family doesn't have to be affected. You get the biggest payback from eating low-carb breakfasts as we are typically more insulin resistant at this time of day. Doing this sets up the blood glucose well for the rest of the day. If you take food to work with you for lunch, you can choose what you want it to be. And just eat a reduced carb variation of what the family eats in the evening.

[Eddy]

Originally Posted by DCaplinger

Also, when I asked him about running a C-Peptide, my Endo said he could do one, but he had a feeling he already knew what the results would be. I didn't feel like arguing then.

I've not had the c-peptide test, but I:

1. believe that would be insightful for you;
2. plan to argue my case of "to establish a baseline" at my next doctor's visit.

With your spikes, drops, and odd ratios, I think a c-peptide test would provide valuable information... even if it only confirms what your endocrinologist "already knows".

Originally Posted by DCaplinger

As far as the breakfast coverage goes, I don't eat a very big breakfast. The dietician told me she wanted me to eat 3 carb choices for breakfast. I generaly get about 42 grams at breakfast, which would put me right on her target. I end up spiking about 2 hours later, however, it's usually about 6 hours after I have had breakfast, before I can really eat again, because of my job. Unfortunately, that usually leads to me going near hypo stage by 11:00 am, fully one hour before I can eat again.

Do you go hypo if you skip breakfast and associated bolus? If so, your basal might be excessive [for that time of day].

What is your BG one hour after breakfast? If that's also high, I suggest eating lower-glycemic CHO at breakfast.

Originally Posted by DCaplinger

My education nurse has been trying to think of snacks that I can buy, that HAVE to meet the following for me to be able to eat them while on the job:

I like Kashi cookies. Fifteen to eighteen grams CHO per each, two-hour digestion time, and rather tasty. Mojo bars also are good, but a bit noisier and smellier.

Want something faster-acting? Dates. Yummy. The local Kroger has 8 oz. boxes (Amport foods, turquoise box with white and purple, baking section) for $2/ea. One-hour digestion time.

Faster-acting still? Raisins. Also yummy. I've not profiled them precisely enough to know the digestion time, but I know that they go faster than Novolog; I believe that they digest in about 40-45 minutes.

Originally Posted by DCaplinger

Right now, I'm taking glucose tabs when needed to prevent the hypo, but I can't follow the rule, because I can't follow that up in 30 minutes with some type of solid food. That's another reason why I worry so much about going hypo.

I've long since quit observing the "follow up with solid food" rule. My hypos are usually fast enough that, once dispatched with fruit juice (highly recommended: Juicy Juice boxes, available in 125mL/15g and 200mL/24g sizes) or soda, I'm good to go.

Yes, soda is usually noisy. However, you could have a small bottle that you let go flat, then consume as needed -- perhaps even refilling from a 2L to minimize both plastic waste and cost. I know that a mouthful of { 7Up | Sprite | Sierra Mist } boosts me about 25 mg/dL, and does so within 15 minutes unless I'm having a particularly brutal hypo.

I don't like glucose tablets. If someone finds some without the %^*& artificial colors, please let me know! (Bonus points for finding unflavored!)

[DCaplinger]

Okay, y'all... I know it seems I fell off the face of the earth, however, my internet access time has been restricted lately, because I've been far too busy to lounge around. LOL.

Anyway, I wanted to post a followup on this subject and get some more feedback.

Firstly, I really want to reply to some comments made in the previous post by Eddy. I totally agree and will push to get a c-Peptide test when I go in on my next visit. I am still being raised on my basal (I'm up to 43 units per day), however... I don't go hypo when I don't eat. In fact... my blood sugar seems to go up a bit through the morning if I don't eat. I'd say that's probably because of liver dumping, but that's just an uneducated guess.

I'm really starting to understand the whole ratio thing, but haven't been as successful with it as I want to be. I'm guessing a lot at what the total carbs are that I'm eating for some meals, and usually end up not taking enough insulin to cover. That being said, it wasn't until the past few weeks that I really realized what some of you were talking about with correction boluses. I just started doing those as well.

My diet is still too loose. I am still gaining weight, which I need to reverse, as I'm heavier now than I've ever been. Some of that is because I quit smoking, but at this point, I need to really focus on reducing my weight.

The good news is I still have yet to really hypo out. I haven't had a dangerous hypo, nor have I experienced hypo ****. I've had the shakes and of course the cold sweats, but otherwise, I've been good not to go too low.

Anyway... I still struggle some with my control. I stopped eating Cheese Danishes once a week. Now if I can just stop eating the Snickers in the afternoon on the drive home. LOL. I just don't get it... I managed to give up the smokes, so why is it so hard to give up the easier to give up bad habits?

Regards,