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pingu82

Bolus insulin not working !! How to fine tune dosage ?

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pingu82

1 Year ago my glucose was normal Fasting 114 mg/dl

 

6 Months ago I was diagnosed with Diabetes and based on my c-peptide being low doctor said i have LADA.

 

Fasting - 318 mg/dl

PP - 535 mg/dl

HbA1c - 11.6 %

 

I was taking daily 20 Units of Mixtard 70/30(30 bolus and 70 basal) since then and my Glucose came down.

 

Usually my Glucose is

Morning - 90-120

PP 2 hours - 140-170

Night - 100-120

HbA1c - 7.1% (done yesterday)

 

But since a week (incidently that is when i opened a new cartridge) my bolus is not coming down at all, but my morning is still about 100-120 (8 hours after having my dinner)

 

Today I have taken 38 Units and yet now it is 190 (about 4 hours after eating lunch)

 

My questions

 

1) Has my pancreas deteriorated ?

2) Could the bolus of my cartridge have gone bad ?

3) Should I have a separate 50/50 insulin ?

4) Should I try metformin if I have insulin resistance ?

 

Also I would appreciate anyone who have been through this for a long time give me some tips as to how to fine tune dosage.

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Cormac_Doyle

Hi Pingu

 

First ... the answer to #2. The cartridge could very well have gone bad ... I would recommend grabbing a new pen / new cartridge and see if that makes a difference. This is the only *short term* answer

 

Secondly ... Lada/T1.5 is essentially a slow onset T1 diabetes where you progressively lose pancreatic function ... so the answer to #1 is a tentative yes. You may need to work with your pgp/cde/endocrinologist to increase your insulin dosage appropriately.

 

Thirdly ... separate basal/bolus insulins instead of a mixed pen? I would always recommend that you use separate pens. I have no idea about costs ... I make the recommendation from a flexibility/convenience point of view. The basal/long-acting injection is supposed to cover the insulin needs of your body when you are not eating. This ensures that your body has enough insulin to process the sugars in your blood that are there all the time. The bolus/fast acting insulin is designed to cope with the sugars in your food. When you are doing exercise, using less bolus insulin will allow you to exercise more easily. Similarly, you can eat mor freely, planning your higher-carb meals when you want them, rather than being stuck with only eating carbs at breakfast and the evening

 

#4 - if you think you have insulin resistance, you could try glucophage, but you should sort out the other things first.

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aggie168

Totally agree with Cormac_Doyle. Ditch the 70/30 mix. You should also ask for another c-peptide test to see where you are now on the progression of LADA... :)

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pingu82

Thanks guys !

 

Separating out the bolus and basal dose is a great idea, ironically something my doctor warned me against but as I am getting more confident in taking control of my treatment it makes more sense to do so.

 

As a coder its impossible to stick to a **** eating schedule.

 

I'll guess I should have c-peptide test soon. Last time I did both Fasting and PP C-peptide should I repeat it or just Fasting enough ?

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Cormac_Doyle

The PP C-peptide is insufficient without the fasting reading to act as a baseline.

 

a high PP reading tells you ???

- are your readings always high (possible insulin insensitivity / pancreas is working flat-out all the time)?

- are you "over sensitive" (and release too much insulin - in this case your fasting reading would be low, but your PP would be too high)

- is your pancreas burning out (low or unreadable fasting; low PP)

- is your pancreas mia (unreadable fasting and pp).

 

Going "lower carb" will give your pancreas a break, and may restore a more normal challenge/response profile over time in #1

Going "lower carb" will avoid "reactive hypoglycaemia" in #2

 

For #3 or #4, insulin is absolutely necessary.

 

If you have both an insulin requirement, and a marked insulin resistance, you may need to take medications for both issues like I do ...

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writerpaul

There's some good advice above, but here's a couple of simple things to try if it's just mealtime boluses not being effective:

 

- change the cartridge - insulin can and does 'go bad'.

- shoot for your carbs 20 to 30 minutes before you eat (assuming your pre-meal BG isn't low or near low). I had issues with post-meal spikes for a time, but giving the insulin time to get ramped up before the carbs hit the system resulted in a dramatically lower post-meal BG reading for me.

 

Good luck.

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pingu82

Hi All thank you so much for your advice !

 

I was also suffering a constant brain fog and blunting of my thought process ... I feel I brain is not sharp enough and I can't think through a complex problem... co-incidentally this happened at the same time I noticed my poor postprandial BG.

 

To identify the reason of my condition I treated my condition like a Medical trial :T and did the following : -

 

1) I standardized my diet. The same stuff and in the exact quantity for Lunch and Dinner until I find answers. I tested my BG 5 times a day.

2) I got another vial of Novomix (30% bolus + 70% Basal) -- No change 2 hours Post Prandial is 200 - 250 mg/dL

3) I got a fast acting Humalin-R and Took 5 Units 30 mins before food + 10 Units of Novomix -- No Change 2 hours Post Prandial is Still 200 - 250 mg/dL

4) I increased dosage Took 10 Units 30 mins before food + 10 Units of Novomix -- No Change 2 hours Post Prandial is Still 200 - 250 mg/dL

5) Maybe the absorption and peak time was an issue so I took 10 Units 90 mins before food + 10 Units of Novomix -- No Change 2 hours Post Prandial is Still 200 - 250 mg/dL ... WTH??

6) I was convinced that something wrong with Humalin-r may be the vial was bad

7) I got Actrapid (from Nova Nordisk same stuff as humalin-r) I took 10 Units 30 mins before food + 10 Units of Novomix -- Finally 2 hours Post Prandial is 150 - 170 mg/dL

8) I took 10 Units Actrapid 60 mins before food + 10 Units of Novomix -- Yipee !!! -- 2 hours Post Prandial is 120 - 140 mg/dL

 

So Finally I am doing this for the past few days : -

 

10 Units Actrapid 60 mins before food

10 Units of Novomix Just before eating Food

 

I eat 2 times a day + 3 Cups of Tea

 

So total of 4 insulin dosage in a day.

 

My Mornings has always has been Ok about 80-115 mg/dL

Just before Dinner always has been around 80-120 mg/dL

And 2 hours Post Prandial is 120 - 140 mg/dL

 

I still have that nagging brain fog.. I am not convinced that it is because of my BG .... but finally my postprandial BG is normal.

 

I'll continue my "medical trial" and try to work with my doctor (who thinks it is because of DM) to find a solution to my brain fog. Hopefully I'll find a solution soon !!

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Cormac_Doyle

Considering the fact that you have already started adding extra bolus insulin, I would ask your doctor to give you a prescription for Lantus or Levemir and drop the mix. This way, you can more accurately count the carbs and calculate your bolus directly without worrying about not giving yourself enough (or too much) slow acting insulin.

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aggie168
7) I got Actrapid (from Nova Nordisk same stuff as humalin-r) I took 10 Units 30 mins before food + 10 Units of Novomix -- Finally 2 hours Post Prandial is 150 - 170 mg/dL

 

1) If you are in a country with Actrapid, try to get Novorapid instead. Novorapid is a NovoNordisk's "rapid" acting insulin instead of "short acting" like Actrapid. It has even a faster action time so you do not have bolus an hours before meal. It is basically like the Novolog that goes into my insulin pump.

 

2) Yes, ditch the 70/30 and get the basel insulin Levemir.

 

:)

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TommyC1

You might want to read "Think Like a Pancreas" by Gary Schiener.

He goes into detail on setting your bolus and basal insulin's. As well as matching them to your diet (vs matching your diet to your insulin).

"Using Insulin" by John Walsh is another that get's recommended here.

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Lloyd

Also "calorie king" gives you the carb content of most foods, if you use it in conjunction with a food scale.

 

-Lloyd

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