[Southcoast June]

Okay, so I've lost 34 pounds in 1 1/2 years, cut out a lot of the stuff that was making my readings skyrocket, and putting in foods that are healthy and good for me. Result? My A1c jumped to 7.8 from a 7.1 of 6 months ago. (Yes, I go every 3 months to my endo.) My average readings are still around 180 to 200.

I have to admit I am NOT disciplined about my daytime treatments. When I'm at work, I rarely test, and even more rarely inject if I am high.

I tested one day around 1:00 and had a reading of something like 245. I injected 3 units Humalog and 3 hours later I was crashing!! I am very active both physically and mentally, so I'm sure the 3 units was too much considering my activity. As a result, I'm reluctant to inject anything during the day. If I'm home, it's a different story.

I have been eating more fruit, and we all know what affect that can have on BG readings, but it beats the cookies and chips I used to binge on. It seems I can't reach a happy medium. I have just been increased from 24 to 28U of Lantus, and that has helped a little, but it's only been 3 weeks, so I am not sure if that will be the solution all by itself. Some changes I have made:

Much less pasta (my passion!!). I used to love spaghetti and meatballs, macaroni salads, lo mein, etc. I limit that to a few times a YEAR now. Big difference.

Dramatically less red meat: (another passion) Summertime outside cooking meant lots of juicy steaks and hamburgers. Now, it's more chicken and fish

More salads -- mixing greens like spinach, different kinds of lettuce, cukes, squash, broccoli, scallions, "lite" dressings (always with NO sugar, do you realize how many DO have sugar in them?)

Italian ices (sugar-free) and jello instead of pastries.

Could I still be doing something wrong? I don't drink alcoholic beverages or any sodas, ice teas, lemonades or anything like that -- just bottled water and hot tea (on occasion).

[jenb]

I'd start with some testing of your basal to make sure you're taking the optimal dose at the right times of day. Also, verify your correction factor. If 3 units of Humalog caused a crash, sounds like you need to do some experimenting to find an accurate CF.

You won't like this, but you probably need to be more pro-active with BG readings throughout the day. This will allow you to find out when you're rising (or falling!) and will help determine what foods may be the culprits. It will also enable you to nip the increases in the bud by giving corrections earlier rather than later.

As for food, if you've reduced/eliminated the starchy carbs sounds like you're on the right track. Watch out for the carb load in fruits though. I've not been able to give up red meat...but it doesn't seem to be a factor either in my weight loss or BG control - thank goodness!

Jen

[xMenace]

It's tough to test your basals on mdi, but there is much you can do. Skip each meal on three separate days and test hourly or better to build your profile. Try a couple of half-nighters too. Stay up till 3 or 4am testing, then another night get up at 3 or 4am and test.

Test the **** out of each meal. Pick a standard meal and stick to it every day. Adjust your boluses until you find a profile you like. Test every hour. once you find the amount and timing that works, try larger and smaller meals sizes.

Then you can go back to cruising.

[poodlebone]

Do you have insulin:carb ratios to use to figure your doses? Do you count carbs? Do you have a correction factor worked out or do you just guess at how much of a correction to give when your BG is high?

When you go high during the day you also need to take into consideration when your last injection was. If it was only 2 hours prior, it means you still have some of that insulin working and wouldn't need a full 3 unit (or whatever) correction.

You should really take the time to test more often during the day. If you're high but are afraid to correct because you don't want to drop low later, then don't correct and test again in an hour to see if you're still high (or higher) or if it's coming down.

I used to eat tons of junk food too. I'd eat large portions of pasta and carby foods. When I changed my eating habits I took a lot less insulin. I then started using a pump and paid even closer attention to portion sizes and was able to lose weight. I know a pump isn't for everyone and it certainly doesn't fix problems caused by user error (like not testing, not carb counting etc) but it does allow finer control. If I'm high, my pump will calculate how much insulin from my last bolus is active and won't suggest a full correction so I don't go too low later. It's possible to get good resultsn on MDI as well but you do have to test, count carbs, know your ratios, and calculate how much insulin you think may still be in your system since your last injection.

[Subby]

Originally Posted by xMenace

Test the **** out of each meal

This was my first thought. And each snack. And everything in between.

Seriously, I'm sure there are situations where a diabetic can overtest. But if you're just not sure where your high time and spikes are occurring, it's the only way to get good data. We can't tell you what might be causing your highs. Only your tester and careful observation can.

It's great to cut out a lot of the refined rubbish, well done. But don't make the mistake that it's just man made refined foods that are troublesome: you might find other foods like specific fruits spike you just as badly, if not worse. Without more testing you'll never know, and not be able to keep eliminating bad chioces and gravitating to good choices.

You mention a correction bolus that went wrong. Does that mean you don't take boluses for snacks during the day, is that what you mean? That in itself could be a huge cause of spikes and not getting the control you want.

The correction bolus that went wrong: I think you need to remember insulin use is a very finicky process. 3 ml might be too much and 2.5 units just right. But you've got to hold your head up and keep refining your approach to insulin use, if you want the better control.

I would get it wrong too if I guessed. In fact, often an adjustment might be heading me to hypo land, but I test a lot and would usually catch it. Another reason to up the testing: even with the best intentions, nothing replaces keeping an actual eye on results.

Do you use carb counting and an insulin to carb ratio to determine your food doses? I highly recommend you look into it if you don't. Guessing can work for some but the rest of us work better with a system.

Likewise, with correction dosages, many on us use what's called an Insulin Correction Factor, a fancy name for determining a suitable correction, no matter what your BG is. I recommend looking into that too! (I:C and ICF may usually go hand in hand as the tools to use, to determine your bolus needs each time).

Feel free to ask about these, better still, a book like "Using insulin" by John Walsh will give you a thorough grounding in how to use them.

Anyway, it's been a great improvement, and I'm sure it will continue if you keep hammering away at these issues. Well done.

[Southcoast June]

Originally Posted by poodlebone

Do you have insulin:carb ratios to use to figure your doses? Do you count carbs? Do you have a correction factor worked out or do you just guess at how much of a correction to give when your BG is high?

Wow, wow, lots of questions. I thank everyone for their input. Really. It gives me lots of options and things to consider. I guess I will have to test more often during the day. I do get so busy with phones, etc., that the day slips by so quickly sometimes.

I am still learning about bolus and carb ratios. I have not counted carbs very much, and I have to admit --- I do guess at dosages more often than not. I have come to realize that this is not just a guessing game (after crashing like I did), and that sometimes I need to be a little more concentrated on this situation.

You guys are great. Thanks again.

[Subby]

Hey, you're right about all the questions. It sure can be overwhelming when you sit back and consider all the options, approaches, factors... follow the leads or direction you feel you should, and remember to feel free to keep asking questions. We can get specific too, and understand you generally need to tackle one or two things at a time...

[SueM]

Originally Posted by Southcoast June

Wow, wow, lots of questions. I thank everyone for their input. Really. It gives me lots of options and things to consider. I guess I will have to test more often during the day. I do get so busy with phones, etc., that the day slips by so quickly sometimes.

I am still learning about bolus and carb ratios. I have not counted carbs very much, and I have to admit --- I do guess at dosages more often than not. I have come to realize that this is not just a guessing game (after crashing like I did), and that sometimes I need to be a little more concentrated on this situation.

You guys are great. Thanks again.

Hiya June,
I suspect your main problem is you do not know what the carb value of food is that you put in you mouth.
Learn about the GI index and sort your carb:insulin ratio plus your basal and you will be a lot better off.
diaTribe - Research and Product News for People with Diabetes this will give you the basic for basal testing.
Here how to start with your carb :insulin ratio once you have your basal sorted
Carb Factor From The 500 Rule
and heres the GI
The Glycemic Index

Congratulations on your weight loss too