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foxl

okay now this is SQUEEEEZED!

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yannah
LOL, OMG such the wrong question for me this morning!!! :eek:

 

My husband cooked some salmon last night, and when I went to warm up my skillet for eggs, the stench hit!!! :puke: And it will not leave the kitchen now. I would not eat fish, because I hated it, BV.

 

But ... I went Veg at 15, so I think I would have tough time eating any flesh now -- ethically and psychologically. I feel like dairy and eggs are a compromise, as it is, the way the animals are treated ...

 

I think you are a smart lady with strong convictions and the diet is not the issue. something else is going on.

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foxl

Instead of bleeding all over the board with my problem, here is my main (I think) question ... I KNOW my numbers are "not that bad," but over time (over 3 mos?) a pattern of deterioration is emerging.

 

I have a pattern of high am fasting, then a "notch" sometimes even under 100, around 10:30 or 11 am, then run high all afternoon and evening, and sometimes exercise drives it down, like last night got down to 84 at bedtime, had < 2 TBS PB and this morning was 148.

 

So ... do I consider this a baseline deterioration, that would be helped by basal insulin, or postprandial that would be helped by another oral med (ie, Januvia, which though it stimulates insulin release, does so indirectly and in a controlled way), or maybe bolusing?

 

This Endo clearly leans toward oral meds ... and really from my reading of the literature, there is NOT strong evidence that insulin is superior to oral meds in preserving beta cell mass.

 

That 10:30 am "notch" could give me a very tough time regulating a basal-only regimen!

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jenb

Hi Linda, I really think that the evidence points to trying a little bolus insulin. It appears to me to be the only way to directly impact your increasing post-prandials. Oral meds that cause your poor pooped-out pancreas to produce more insulin would seem to defeat your purpose. Try it. If it doesn't satisfy, you don't have to continue.

 

Jen

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foxl
Hi Linda, I really think that the evidence points to trying a little bolus insulin. It appears to me to be the only way to directly impact your increasing post-prandials. Oral meds that cause your poor pooped-out pancreas to produce more insulin would seem to defeat your purpose. Try it. If it doesn't satisfy, you don't have to continue.

 

Jen

 

Thanks, Jen! So ... what about that DP, though? Or will the bolus for meals assist with that?

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jerryn
Before dinner: 116

 

Dinner was: a 2 egg omelet with cheese (maybe 1.4 c) and a veggie sausage (6 g) and a bit of chile verde salsa (4 g max) ... so I called it 12 g. And 2 tiny squares of G&B chocolate, so I called those 2 g? So if I am not kidding myself, call dinner 14 - 16 g carbs, total.

 

After dinner, 30 min exercycle workout, with intervals, and cycle said 120 calories.

 

After workout, 3 hr, postprandial: 114.

 

Should I be VENTING???? Because I want to!!!! @#$#%$%&*:mad::(

 

Worse yet, same workout, I was still taking niacin, dropped me 50 pts last week. NOT predictable, at ALL!

Anyone.. correct me if I'm wrong because I would say that's good! ... Look at it this way.. at least your glucose levels are FLAT! And low end flat is good. No headache from coming down later, and 114 is Good!

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foxl
Anyone.. correct me if I'm wrong because I would say that's good! ... Look at it this way.. at least your glucose levels are FLAT! And low end flat is good. No headache from coming down later, and 114 is Good!

 

Jerry, as I said, this is a TREND. My control has been deteriorating over the last 3 - 4 months, to get here. And what happens, physiologically, in the next 3 - 4?

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lorilei
Hi Linda, I really think that the evidence points to trying a little bolus insulin. It appears to me to be the only way to directly impact your increasing post-prandials. Oral meds that cause your poor pooped-out pancreas to produce more insulin would seem to defeat your purpose. Try it. If it doesn't satisfy, you don't have to continue.

 

Jen

 

agreed again...i am not a fan of those meds which cause our pancreas' to work harder..it is different than stimulating a lazy beast..imho i feel as though preservation through support by insulin is definately a viable option..it is the way i went too...good luck and i can fully understand that need to be almost hypervigilant as your body starts to change...it is very frustrating to realize that we no longer have any other tricks in our dietary/exercise bag...but i guess we have had a bit to come to terms with this run away train and time to plan how to reign it back in...

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foxl

Wow, Lori, you are summing up my thoughts and feelings so well!

 

Thing is, there are articles Januvia (and Actos for that matter) can help preserve the pancreas ... now yes there may be Big Pharma sponsorship ... and what if they ARE mistaken? On I go ... GAH! Such a waste of good worrying!:T

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lorilei
Thanks, Jen! So ... what about that DP, though? Or will the bolus for meals assist with that?

 

Linda..pick one type of insulin to start with..you may not even be aware of where your dp is stemming from...for me i went bolus first b/c my pp numbers were high ( i was going over 200on less than 40 gm/day so 15 per meal max)...i will say that i was all over the place at first and waited only three weeks max before i incorporated a basal to keep my flat...i cannot imagine what would have happened if i had waited too much longer...i have never been a fan of dka! (bad d humor)

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lorilei
Wow, Lori, you are summing up my thoughts and feelings so well!

 

Thing is, there are articles Januvia (and Actos for that matter) can help preserve the pancreas ... now yes there may be Big Pharma sponsorship ... and what if they ARE mistaken? On I go ... GAH! Such a waste of good worrying!:T

 

i don't recall januvia and/or actos coming up in my case...so i never researched them myself..i am interested to see what they say..

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fgummett
Thanks, Jen! So ... what about that DP, though? Or will the bolus for meals assist with that?
You have many options Linda... I'm currently exploring Levemir once a day (in the evening) to combat DP.. I'm only 2 days into it so I'll let you know ;) The Levemir profile suggests it should peak just when I need it most. That may give you a better start to the day... whether you would then need bolus and/or additional basal, I think only time and trial can say. If you did need basal and bolus... then there is the pump, which I'd argue allows the most flexible approach of all... although may not be ideal for everyone.

 

Seems like the first hurdle is the Doctor... I have found I can usually wear mine down if I am persistent and consistent ;)

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jenb
Thanks, Jen! So ... what about that DP, though? Or will the bolus for meals assist with that?

 

I'm a victim of that insidious DP too. I haven't found a basal approach that solves it, so....I tested until I found when the BG increase begins. Turns out that for me it's about 5:30 - 6:00 a.m.. I began getting up at 5:00 (6:00 daylight savings time) and doing a half-unit bolus of Novolog. This seems to do the trick. by 7:30 I'm still in the happy 75 to 90 range. I wish there were an easier way to deal with this on MDI, but at least I found a good work around.

 

Now...I am totally a morning person. If it were DH this routine would NOT work - he's a night owl and doesn't even realize there is a 7:30 a.m.:D .

 

Jen

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yannah

Linda, i am right with you. if I am 114 at 2 hours pp, even without a work out, I am not happy.

 

and for me, that would be a dwonward spiral.

 

and for me I would be panicking and feeling like my whole life was out of control.

 

my bs is very in range at the moment and very predictable, and that makes me okay.

 

I totally understand and a fasting of 145, would flip me out and I would be figuring a way out of it. and certainly without giving up my vegatarian way of life.

 

thig is, you will figure this out. I know this about you.

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Subby

I agree with the sentiment running through this thread that the most important thing would be to try insulin, and that whatever way (basal, bolus, basal/bolus) may well provide satisfactory answers for you at this stage. If that is what you want (and it sounds increasingly that way, hmm?) The only way forward is to jump on in! Now to find a doc who will let you go swimming.

 

Re your basal fluctuations sitting with long acting, there are always a few ways to skin an insulin cat. I've been getting luck dealing with my ridiculously curvy basal needs with 3 lev injections a day, and that includes catering better to execise days too. Took a while but that's what your inteligence and ingenuity is for - to find solutions to problems. There are answers there, to be found.

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foxl

Hmmmm ... I was hoping you would chime in, Subby!

 

I am willing to try, but, the doc? We will see. It may take me some time if I opt to switch -- it took 8 WEEKS for me to get in with this one, who I suspect is the junior-most partner in the practice!

 

 

I agree with the sentiment running through this thread that the most important thing would be to try insulin, and that whatever way (basal, bolus, basal/bolus) may well provide satisfactory answers for you at this stage. If that is what you want (and it sounds increasingly that way, hmm?) The only way forward is to jump on in! Now to find a doc who will let you go swimming.

 

Re your basal fluctuations sitting with long acting, there are always a few ways to skin an insulin cat. I've been getting luck dealing with my ridiculously curvy basal needs with 3 lev injections a day, and that includes catering better to execise days too. Took a while but that's what your inteligence and ingenuity is for - to find solutions to problems. There are answers there, to be found.

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warrenav

I'm sure that the other suggestions of insulin are good. However, one additional thing you could try to see if your daily response evened out some is to change to the ER/XR variation of the metformin. Although metformin isn't an immediate response type of medicine, while I was on regular metformin (TID) I still felt the response wasn't that even during the day. My impression after shifting to 4x 500mg ER first thing in the morning (with breakfast) was that the response was more predictable throughout the day.

 

Warren.

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foxl
I'm sure that the other suggestions of insulin are good. However, one additional thing you could try to see if your daily response evened out some is to change to the ER/XR variation of the metformin. Although metformin isn't an immediate response type of medicine, while I was on regular metformin (TID) I still felt the response wasn't that even during the day. My impression after shifting to 4x 500mg ER first thing in the morning (with breakfast) was that the response was more predictable throughout the day.

 

Warren.

 

Thanks, Warren -- that may be worth a try!

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