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chadha

Change from Regular to Humalog

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chadha

Yesterday I started with Humalog after my doc replaced. Prior to yesterday I was on huminsulin R and underwent to hypo multiple times due low carb diet, not completely low carb diet.

 

So when I switched to Humalog I didn't tell my doc that I have reduced my carbs, was afraid that he might force me to go back to high carb diet. He told me to use the same as they were before with R. So I had to make dose adjustment on my own which left me with problems.

 

I have been having troubles adjusting doses and the Bg that I maintained is going away from hands resulting in Highs n highs, one after another. Post prandial figures today in the breakfast went to 270/254.

 

Dont know what to do. :(

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NoraWI

I have never taken R, Chadha, but remember others who said that one has to take it far in advance of eating. One has to match the carbs with insulin and also match the curve of the blood glucose rise. If you take Humalog at the same advance time that you were taking R, then you miss the peak of your BG curve entirely and end up high. Try taking your mealtime insulin about 1/2 hour before eating. It may not be the dose but the timing that is off. If that doesn't work, then it's time to refigure your insulin to carb ratio.

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patricia52

Thirty minutes my be too soon. For me I took Humalog 10 - 20 minutes befor eating. It even worked if I took it right after finishing my meal. Apidra works a little faster.

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Cora

The other thing to keep in mind is that because in some people R would last a long time, it may have been covering some of your basal needs. I would double check your basal insulin first to make sure you are taking enough. Then you will have to re-test and maybe re-learn your insulin to carb rations.

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Uff Da

Get the book "Using Insulin" by Walsh. Or "Think Like a Pancreas" by Scheiner. (I haven't read the latter one, but understand from others on this site that it covers much of the same territory as the first book listed.) See if your local library has either - in that case you might be able to pick one up today. If not, I'd recommend ordering through Amazon or wherever you choose.

 

My endo prescribed insulin, both a basal (Lantus) and bolus (samples of Humalog, then prescription Novolog). Then, after seeing him just once, he turned me back over to my PCP. I have little faith in my PCP re diabetes, so I've done all my adjusting of insulin myself using the information in the book above, the information on this site and just crunching my own numbers. I saw the endo in late March. I haven't seen my PCP since, but will take a blood test next week and see her the following week. My original A1c was 11.5, my last A1c while on practically a starvation diet and the useless oral meds she had prescribed was 7.6. But I fully expect that my A1c next week will be in the low 6's, or possibly even 5.8 or 5.9. (Since I rarely take my pp readings, it is hard to tell how much those will influence.) In my case, I had to reduce the basal the endo started me at by 25% and increase the insulin:carb ratio by 200 to 400%, depending upon the time of day. I did it gradually over a period of a few weeks, to minimize risk. I feel that my diabetes is in about as good control as one can expect.

 

I tell you all this to assure you that a patient can do it.

 

You might also want to test to see how much the bolus insulin will drop your BG in 30 minutes before eating. Try that only when your starting BG is over 100, though. When I tested with 6 units of Humalog, it dropped me only nine points, so for me waiting half an hour or even a bit more to eat when I was running high has worked well. Too much longer and one can go low, though, so don't wait too long.

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chadha
I have never taken R, Chadha, but remember others who said that one has to take it far in advance of eating. One has to match the carbs with insulin and also match the curve of the blood glucose rise. If you take Humalog at the same advance time that you were taking R, then you miss the peak of your BG curve entirely and end up high. Try taking your mealtime insulin about 1/2 hour before eating. It may not be the dose but the timing that is off. If that doesn't work, then it's time to refigure your insulin to carb ratio.

 

Now since I don't have the right TDD so I dnt know the I:C ratio either. I used to take R 30-45mins before and I take Humalog 10-15mins before as told by my endo n I even read it in Dr Bernstein's book.

 

But, NoraWI, I still want to know how can I miss the peak if I take the insulin not at right time.

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chadha
Thirty minutes my be too soon. For me I took Humalog 10 - 20 minutes befor eating. It even worked if I took it right after finishing my meal. Apidra works a little faster.

 

Yeah, even I read in many websites that rapid acting can be even taken after dinner.

I take10-15mins before my meal. I thought Humalog is the fastest one.

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chadha
The other thing to keep in mind is that because in some people R would last a long time, it may have been covering some of your basal needs. I would double check your basal insulin first to make sure you are taking enough. Then you will have to re-test and maybe re-learn your insulin to carb rations.

 

You are right Cora. Actually since R takes the residual effect of last dose in the next meal also so many times it leaded me to hypos and that's why I had to replace it with R and another prob was it took much time to cover the carbs after every meal. So with R, at least for me either it is always high or low, I never maintained steady figures. ButI think Humalog will give me a leverage to avoid all this.

 

As I started Humalog yesterday only so I checked my BG before taking my basal at bedtime, was 120 so I started with 2u less than I used to take after R. My fasting was 210.

 

I guess I need to check so many times these days. I have already checked 8times today and likely to check one more time at bedtime.

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Uff Da
Yeah, even I read in many websites that rapid acting can be even taken after dinner.

I take10-15mins before my meal. I thought Humalog is the fastest one.

 

10-15 minutes before the meal is probably a safe place to start until you have more experience and time to test out your own personal reactions. While I was on an eight-day trip shortly after going on Humalog, I had to eat most of my meals out in restaurants and being very insecure about what I'd be eating and about injecting in a public place, I most frequently waited until after the meal when I got back to my motel room before I injected. That worked - but I often ended up with BGs in the 200s before it started going back down, too. It was safer than going low, however.

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chadha
Get the book "Using Insulin" by Walsh. Or "Think Like a Pancreas" by Scheiner. (I haven't read the latter one, but understand from others on this site that it covers much of the same territory as the first book listed.) See if your local library has either - in that case you might be able to pick one up today. If not, I'd recommend ordering through Amazon or wherever you choose.

 

My endo prescribed insulin, both a basal (Lantus) and bolus (samples of Humalog, then prescription Novolog). Then, after seeing him just once, he turned me back over to my PCP. I have little faith in my PCP re diabetes, so I've done all my adjusting of insulin myself using the information in the book above, the information on this site and just crunching my own numbers. I saw the endo in late March. I haven't seen my PCP since, but will take a blood test next week and see her the following week. My original A1c was 11.5, my last A1c while on practically a starvation diet and the useless oral meds she had prescribed was 7.6. But I fully expect that my A1c next week will be in the low 6's, or possibly even 5.8 or 5.9. (Since I rarely take my pp readings, it is hard to tell how much those will influence.) In my case, I had to reduce the basal the endo started me at by 25% and increase the insulin:carb ratio by 200 to 400%, depending upon the time of day. I did it gradually over a period of a few weeks, to minimize risk. I feel that my diabetes is in about as good control as one can expect.

 

I tell you all this to assure you that a patient can do it.

 

You might also want to test to see how much the bolus insulin will drop your BG in 30 minutes before eating. Try that only when your starting BG is over 100, though. When I tested with 6 units of Humalog, it dropped me only nine points, so for me waiting half an hour or even a bit more to eat when I was running high has worked well. Too much longer and one can go low, though, so don't wait too long.

 

I heard about "Using Insulin" by John Walsh a lot, and even "think like a pancreas" but not as much as the former one. My local library hasn't such book that I'm definitely sure of. May be will have to order it online.

 

I'm currently on Humalog(bolus) and Lantus (basal). I had no clue about PCP so I had to google its full form :) .

How much time it took you to adjust ? My last A1C was 9.5 in March but that time I was i. Sugar water with daily high 200s n even 300s. But after I took the charge and reduced my carbs in the end of May things were almost right for me.

I red somewhere Walsh's new book is "pumping insulin" , is it the new version of "Using Insulin" ? Can you get me the same links that you used on this site? I actually tried but didn't get the results.

 

I hope I may also learn to adjust the doses n learn I:C ratio.

 

Not a bad idea. Even Dr Bernstein wrote in his book that one can know when the bolus starts working by keep checking when BG drops.

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Uff Da

"Pumping Insulin" focuses on using an insulin pump, so it likely wouldn't provide the information you need for injections with insulin pens or syringes. I'm not sure what the links rules are on this board (and am too lazy to look it up), but just go to the website of your favorite book seller and do a search for Using Insulin Walsh and I think you'll find the book I used in learning much of this.

 

I had only three weeks from the time I went on Humalog to the time I left for my trip where I wouldn't have access to weighing and measuring foods or a computer to check on the carbs in individual foods, so I felt I had to at least have my ratios pretty close to right in that time or I'd be in heap trouble. I think I was quite successful. The only real changes I've had to make since then were when I changed from Humalog to Novolog and fine-tuning my ratios to better reflect days of higher exercise level. For me Novolog seems a little stronger than Humalog, as I was getting quite a few hypos for a week before I adjusted the ratio for that. And I'm still slowly figuring out just how much various levels of exercise needs to change the ratio, but feel that I'm really close to having that worked out, too.

 

The first thing I'd do is to check your overnight basal insulin. Walsh recommends that you start the test when your bedtime reading is between 100 and 150, check at least once during the night, then again in the morning. Walsh says your BG should fall no more than 30 mg/dl or rise no more than 15 mg/dl overnight if the basal is set right. If it changes more than that, the basal may need adjusting. Now that I have mine set right, mine is usually within ten points. I can sleep all night (which is a rare occasion) without worrying that I might go low. With the basal level my endo originally gave me, I had to get up in the night and eat (which I usually do anyway). But I like the safety of knowing that on those rare occasions that I do sleep through the night, that I won't go hypo.

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chadha
"Pumping Insulin" focuses on using an insulin pump, so it likely wouldn't provide the information you need for injections with insulin pens or syringes. I'm not sure what the links rules are on this board (and am too lazy to look it up), but just go to the website of your favorite book seller and do a search for Using Insulin Walsh and I think you'll find the book I used in learning much of this.

 

I had only three weeks from the time I went on Humalog to the time I left for my trip where I wouldn't have access to weighing and measuring foods or a computer to check on the carbs in individual foods, so I felt I had to at least have my ratios pretty close to right in that time or I'd be in heap trouble. I think I was quite successful. The only real changes I've had to make since then were when I changed from Humalog to Novolog and fine-tuning my ratios to better reflect days of higher exercise level. For me Novolog seems a little stronger than Humalog, as I was getting quite a few hypos for a week before I adjusted the ratio for that. And I'm still slowly figuring out just how much various levels of exercise needs to change the ratio, but feel that I'm really close to having that worked out, too.

 

The first thing I'd do is to check your overnight basal insulin. Walsh recommends that you start the test when your bedtime reading is between 100 and 150, check at least once during the night, then again in the morning. Walsh says your BG should fall no more than 30 mg/dl or rise no more than 15 mg/dl overnight if the basal is set right. If it changes more than that, the basal may need adjusting. Now that I have mine set right, mine is usually within ten points. I can sleep all night (which is a rare occasion) without worrying that I might go low. With the basal level my endo originally gave me, I had to get up in the night and eat (which I usually do anyway). But I like the safety of knowing that on those rare occasions that I do sleep through the night, that I won't go hypo.

 

I'm actually failing to cope up with adjusting the dose. Even after dinner figures a while ago were so high that it disappointed me a lot because couple of days back I was doing very well, at least in my opinion. So after dinner I ended up with very, very remote dose of bolus to correct high BG and then took basal.

 

Every now and then I go in hypo but I believe that was due to the R which left its residual effect even while sleeping along with basal. I hope everything gets normal very soon and I learn the things I need to.

 

Now that I'm on Diabetes Solution I will read Walsh's book after completing the former one. But priority/need suggests to read the latter first. I' getting confused, doesn't mean I'm in hypo right now. :)

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chadha

Now my sugar is resulting in 200s which was never seen in the last month. I don't know what to do. I'm really struggling to maintain the normal figures.

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ramon
Now my sugar is resulting in 200s which was never seen in the last month. I don't know what to do. I'm really struggling to maintain the normal figures.

I really believe the only way you can tackle this problem in my opinion is by doing this and in a way we can understand.

 

1-give us a pre breakfast reading

2-tell us how much insulin you took to bolus for the meal and what the meal consisted of.

3- Take a I and 2 hr post reading

4- same for lunch and dinner and a going to bed reading.

The only way we can help is by having a Very clear picture. We must know your menu and readings before and after all meals, its very important. What do you drink and what do you snack on. I know Indian folks love their tea, do you use sugar or sweetener, what kind of cream? Be honest and write every thing down. We can beat this,

I know we can.

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chadha

Ramon- I can give you a clear picture by all the things you mentioned there. The problem is today after breakfast I have only 2hr Post Prandial figures, 1hr isn't there.

Secondly as you may or may not be knowing ever since I switched to Humalog from Regular I started with half of the doses, reason, if I give I may violate the rules of the forum, so let that better be a secret. And so in the meantime my levels were elevated and I believe may have caused the insulin resistance.

 

So today I thought it is wise to increase a unit or two to gain control over figures n once it is acquired. Lets start with The Law of Small Figures.

 

Correct me where I'm wrong. Really need you.

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Uff Da

Did your doctor give you an insulin to carbohydrate ratio to start with? What I:C are you currently using?

Are you taking your Humalog just before meals?

 

The doctors will typically start you with a "safe" level of dosing. Then gradually they have you increase the dose as needed. So expect that your after-meal reading will be high to start.

 

For example, my doctor started me on Humalog with a 1:20 dose. (That level would be too high for some and too low for others.) Before the meal I was to take 1 unit of Humalog for each 20 grams of carbohydrate in the meal. I did that for a few days, and most of my after-meal readings were well over 200. So I felt secure in increasing the dose to 1:15, then 1:12, then 1:10, then 1:9, then 1:8, and so on until I got to 1:5 for breakfast and 1:7 for dinner.

 

Don't forget, your after-meal readings are supposed to be higher than your before-meal readings. The Humalog lasts about four hours in the bloodstream, so remember when you take your two-hour readings that the insulin still has about half it's work of lowering the blood sugar to go. Don't take so much insulin that your BG gets down to your before-meal level sooner than about four hours, or you will go hypo before the next meal!

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chadha
Did your doctor give you an insulin to carbohydrate ratio to start with? What I:C are you currently using?

Are you taking your Humalog just before meals?

 

The doctors will typically start you with a "safe" level of dosing. Then gradually they have you increase the dose as needed. So expect that your after-meal reading will be high to start.

 

For example, my doctor started me on Humalog with a 1:20 dose. (That level would be too high for some and too low for others.) Before the meal I was to take 1 unit of Humalog for each 20 grams of carbohydrate in the meal. I did that for a few days, and most of my after-meal readings were well over 200. So I felt secure in increasing the dose to 1:15, then 1:12, then 1:10, then 1:9, then 1:8, and so on until I got to 1:5 for breakfast and 1:7 for dinner.

 

Don't forget, your after-meal readings are supposed to be higher than your before-meal readings. The Humalog lasts about four hours in the bloodstream, so remember when you take your two-hour readings that the insulin still has about half it's work of lowering the blood sugar to go. Don't take so much insulin that your BG gets down to your before-meal level sooner than about four hours, or you will go hypo before the next meal!

 

My doc hasn't given me any I:C ratio. Actually, in India docs just simply set doses as per the requirement and ask to tweak whenever and as required. For example- taking less insulin when eating less or taking higher when eating something tha usual diet can increase or going out in the party.

 

I'm having problems to set the doses because every time I eat different food and so is the insulin requirement. Plus I'm have only some estimate how many carbs I'm eating.

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ramon
Ramon- I can give you a clear picture by all the things you mentioned there. The problem is today after breakfast I have only 2hr Post Prandial figures, 1hr isn't there.

Secondly as you may or may not be knowing ever since I switched to Humalog from Regular I started with half of the doses, reason, if I give I may violate the rules of the forum, so let that better be a secret. And so in the meantime my levels were elevated and I believe may have caused the insulin resistance.

 

So today I thought it is wise to increase a unit or two to gain control over figures n once it is acquired. Lets start with The Law of Small Figures.

 

Correct me where I'm wrong. Really need you.

 

Hey we like secrets;)

 

Ok lets try this, Can you give us your weight, height, and what you wont eat due to dislike, religion etc. What are your basal amounts and when do you take them?

Is it possible for you to eat the same breakfast for just one week and test before and 1hr and 2hr post meal.

Eat the same lunch for the same week and test the same, dinner the same way. You should be able to find carb amounts for most foods on the net from here or abroad. This is the only way that I know of to give you the best advice that I think is right, if I'm not right then I'm sure others will jump in and warn about things I do incorrectly or because of experiences they went through. What I'm trying to say is that your questions and answers are very vague and incomplete and until we know and see the whole picture we really cant do to much. Do you snack and what are those snacks? What do you drink and how often? Do you still take sugar, milk and what kind. Give us a picture that we can work with and I'm sure we can come to a satisfactory conclusion. Keep a diary of what you eat and all the results and post them. We are very glad to help cause most of us have been where you are and one day you too will help fellow travelers. It's confusing I know but if you follow the rules it will at least put you in the ballpark. Now this doesn't mean you wont have to do any tweaking now and then but you should be closer to your goals. My goal is staying as close to 100 as possible but some times I go to 168 or as low as the 80's, but I have come to the conclusion that those are the days I knew I'm really fooling myself due to a life time of bad habits that are slowly been taken care of due to generous folks on this forum, who give better advice then the doctors I've had. You can do it and it might be a drag or sacrifice at first but it does pay off I promise you. Take care and keep posting so we can all learn from each other.

 

BTW redneck is a term we use for southern folk and we have a comedian named Jeff Foxworthy (u-tube him) who is a redneck himself but makes fun of them. Rednecks usually come from the south of the USA and folks from the north are referred to as Yankees. Not meant to be derogative to any unless you use the F word in front of it. Looking forward to your daily posts with the results of what you ate, all bg and unit readings. Hang in there Amigo. Its fun as you go along.

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chadha
Hey we like secrets;)

 

Ok lets try this, Can you give us your weight, height, and what you wont eat due to dislike, religion etc. What are your basal amounts and when do you take them?

Is it possible for you to eat the same breakfast for just one week and test before and 1hr and 2hr post meal.

Eat the same lunch for the same week and test the same, dinner the same way. You should be able to find carb amounts for most foods on the net from here or abroad. This is the only way that I know of to give you the best advice that I think is right, if I'm not right then I'm sure others will jump in and warn about things I do incorrectly or because of experiences they went through. What I'm trying to say is that your questions and answers are very vague and incomplete and until we know and see the whole picture we really cant do to much. Do you snack and what are those snacks? What do you drink and how often? Do you still take sugar, milk and what kind. Give us a picture that we can work with and I'm sure we can come to a satisfactory conclusion. Keep a diary of what you eat and all the results and post them. We are very glad to help cause most of us have been where you are and one day you too will help fellow travelers. It's confusing I know but if you follow the rules it will at least put you in the ballpark. Now this doesn't mean you wont have to do any tweaking now and then but you should be closer to your goals. My goal is staying as close to 100 as possible but some times I go to 168 or as low as the 80's, but I have come to the conclusion that those are the days I knew I'm really fooling myself due to a life time of bad habits that are slowly been taken care of due to generous folks on this forum, who give better advice then the doctors I've had. You can do it and it might be a drag or sacrifice at first but it does pay off I promise you. Take care and keep posting so we can all learn from each other.

 

BTW redneck is a term we use for southern folk and we have a comedian named Jeff Foxworthy (u-tube him) who is a redneck himself but makes fun of them. Rednecks usually come from the south of the USA and folks from the north are referred to as Yankees. Not meant to be derogative to any unless you use the F word in front of it. Looking forward to your daily posts with the results of what you ate, all bg and unit readings. Hang in there Amigo. Its fun as you go along.

 

Current weight- 58 kgs ( 2kgs after I reduced my carbs to significant extent)

Current height- 165 cm

Dislike/ religion bound- beef, pork, lamb. Only chicken is permissible. I'm a vegetarian and eat chicken very few times.

Basal insulin - Lantus Solostar 16-17u at Bedtime

Bolus insulin - Humalog lispro 9-10u before each meal

Lifestyle is sedentary. Most of the time I'm home. Usually sleep at 2-3 in the morning. Have always been been awake in the middle of nights mostly, not due to illness or some problem.

 

Eating the same meal in the breakfast is possible because that is what I have been eating for over a month, i.e. veggie omelet, don't have any better option than this to avoid carbs in the breakfast. As far as lunch n dinner is concerned this is really not possible for me.

 

 

I snack only in the eve when I leave for walk. I take a cup of tea with artificial sweetener and 4-5 almonds to avoid fast acting carbs.I take cold coffee(sweetened with artificial sweetener) in the breakfast along with the veggie omelet but no bread involved. Every day I eat 2 chapatis in the lunch n dinner with some veggies, most of them contain less carbs. From the most reliable sources I have known each chapati contains somewhere close to 16g of carbs.

 

Following is the results of my yesterdays readings(pre meal n post meal readings) and what did I eat and how many units were taken by me.

Date - 10th July 2013

 

Before Breakfast - 219(may be because in the middle of night it was 63 which was overcorrected by milk n some snacks) (11H) in the breakfast followed by Veggie omelet, cold coffee(220ml) and 3 raw almonds.

Post meal 2 hours - 144 mg/dl

 

Before Lunch - 58 mg/dl which was corrected by a small chocolate

After half an hour or so it spiked to 79.

So then I took 9H and had 2chapatis with spinach n paneer.

Post lunch- 126 (2hours)

 

So in the eve. (2.5 hours from when I ate lunch) I left for walk, had a cup of tea and 5 raw almonds. Must have walked for more than 3kms. The distance has always been measured by my mobile app.

 

Before Dinner- 87.

Dosage - 9H

Diet- 2chapatis, spinach n mix veg( both were taken in small amt. ) and 200ml buttermilk which contains 2g of carbs as it is mentioned on the label.

Post Dinner- 137 (1hour)

 

Then I left for night walk with my friend, I sometimes go after dinner.

When returned and checked before bedtime it was 87 once again.

 

So instead of taking 17u of Lantus I took 15L and had 3-4almonds with 40ml milk.

 

 

So this Morning.

Fasting/before breakfast - 104- 10H

Followed by the same daily breakfast.

Post Prandial - 69(2hours) which was a lil while ago.

 

Thanks.

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Uff Da

It appears that lowering your Lantus may have been a good move. Your basal should allow you to go through the night without eating or having a low and it looks like it did that. If that happens several times, then you probably have your basal set right. And getting your basal right first prevents all kinds of problems with overcorrecting.

 

If you are eating the same thing and approximately the same quantity for breakfast every day, but your two-hour postprandial is lower than your before-breakfast reading, then your insulin injection was more than you needed. Humalog keeps lowering for four hours. Your 2-hour reading should be higher than your before-meal reading. Ideally, your four-hour reading would be about the same as your before-meal reading.

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ramon

Like miss Uff Da said, those are some pretty good numbers and you seem to be on the right track, good job. Be careful of the chocolate and snacks and over here buttermilk runs around 10carbs for 8oz, roughly a cup. Your insulin needs are not that high and why for awhile you ran in the 200's is really a mystery? Maybe a secret was involved :T but that's over now and it seems you are on your way to a better healthier life. I don't know what else to say. I just looked at my meter and I've been running from 112 to 130 but there was a 169 in there too. That's just the way it goes sometimes. Keep posting buddy, we like to hear from you.

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chadha
Like miss Uff Da said, those are some pretty good numbers and you seem to be on the right track, good job. Be careful of the chocolate and snacks and over here buttermilk runs around 10carbs for 8oz, roughly a cup. Your insulin needs are not that high and why for awhile you ran in the 200's is really a mystery? Maybe a secret was involved :T but that's over now and it seems you are on your way to a better healthier life. I don't know what else to say. I just looked at my meter and I've been running from 112 to 130 but there was a 169 in there too. That's just the way it goes sometimes. Keep posting buddy, we like to hear from you.

 

Actually I ran in the 200s because some people on the other forum asked me to lower my dose at least half of what I was on Regular so that disturbed my good figures for a while.

 

So as I read in the Bernstein's book the elevated blood sugar for a while may cause high blood sugar so I thought of lowering blood sugar by slightly increasing dose for a day or so and that brought the figures back to normal range.

 

Now that you and others have all the details you can correct me where I have been wrong.

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