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joyr1110

increasing novolog?

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joyr1110

So using my current I:C/CF when I use 70 as my target BG, I still end up testing at 110-120 2 hrs after.

 

I'm thinking I should adjust, but don't know protocol for that. I've tried getting ahold of my CDE w/ no luck. I know she had said for the Lantus to increase by 2 units every 4 days until morning readings were right. Is there any handy rule of thumb like that for adjusting the fast acting insulin?

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Bountyman

Let me suggest a book, Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. The only "handy rule" that I know of is; More insulin, lower numbers. Less insulin, higher numbers.

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Cora

I would recommend the book "Using Insulin". It will give you good pointers. Be careful when shooting for 70. It's easy to overshoot and end up chronically low. You don't want that either. There is nothing wrong with 110 two hours after a meal.

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Uff Da

Why, may I ask, do you use 70 as a target? That gives you zero room for error on the downside without getting into possible hypo territory. I've never heard of anyone choosing such a low target.

 

I second the recommendation for the book "Using Insulin." It was my "bible" for the first month after I went on Novolog.

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joyr1110
Why, may I ask, do you use 70 as a target? That gives you zero room for error on the downside without getting into possible hypo territory. I've never heard of anyone choosing such a low target.

 

I second the recommendation for the book "Using Insulin." It was my "bible" for the first month after I went on Novolog.

 

I was using higher numbers as target....but I was still higher and unsure whether to try adjusting I:c or cf...or how much to do it by

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Uff Da

You won't be able to fine-tune your bolus insulin until you've finished adjusting your basal and tested it. What I did to get my bolus in the ballpark initially (because I ended up needing three to four times the ratio as the endo started me at) was to increase the I:C ratio just enough to up the injection one unit. Then I tried that figure for a few days before increasing it again. But I was getting after-meal readings well over 200, sometimes over 250. Remember that when you look at your 2-hour readings, that your bolus insulin is only half through working at that point.

 

If you are getting 110-120 two hours after the meal, are you thinking that you need a lower I:C ratio so that two-hour figure is higher? (If that's the case, again, one could make any change a small one and test a few days.) What was your pre-meal BG?

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GrammaBear

I found the book "Using Insulin" by John Walsh to be really helpful. You need to get the basal right first otherwise your bolus will not be right. It can be frustrating but well worth the effort. Using 70 as your target is sort of low potentially putting you really close to having chronic hypos.

 

Once you make a small change in your basal amount, I was told to wait 2-3 days using the new amount to see if it does what you want it to do. Even using a pump, any change I make is almost always small and then I wait 3 days before I make another small change.

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mom24grlz

Curious with a target of 70 at what point do you feel lows? Or are you hypoglycemic unaware? I'm happy with bs of 110-120 2 hours after a meal, but then Ashleigh's target number is 105. Btw i am a non diabetic, but a couple of weeks ago i decided to test my sugar throughout the day. I tested 11 or 12 times, and never went down to 70. For the most part my sugars stayed in the lower 90s. I think i had one number in the upper 80s. My highest was 123 taken 1 hour after eating pizza and breadsticks.

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joyr1110
Curious with a target of 70 at what point do you feel lows? Or are you hypoglycemic unaware? I'm happy with bs of 110-120 2 hours after a meal, but then Ashleigh's target number is 105. Btw i am a non diabetic, but a couple of weeks ago i decided to test my sugar throughout the day. I tested 11 or 12 times, and never went down to 70. For the most part my sugars stayed in the lower 90s. I think i had one number in the upper 80s. My highest was 123 taken 1 hour after eating pizza and breadsticks.

 

70 isn't my actual target I would like 80-95 area. At first I felt lows before I was actually low (the first few weeks after I got out of the hospital I was consistently above 300, except for middle of the night lows when I would wake up soaked in sweat, shaking, light headed and unable to walk. Now I generally don't feel it until I'm really low, I've felt fine but tested BC I was going to workout and been at 55. Usually I don't feel it until I'm in the 20-30 ballpark.

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Tanikit

For me my target is only ever reached if things are right 4 hours after I have injected - and 110-120 2 hours after meals is actually very good - what happens at 4 hours post injection and what are you eating to achieve these figures? 2 hours after I have eaten even if it is only 10g of carbs I am almost never below 135 and often as high as 162. I aim for 108 for a premeal reading. If I am in the 110-120 range at 2 hours post meal then I am often low by the 4 hour mark or are you snacking as well at that 2 hour point?

 

If those are the readings you are getting then it explains the weight gain you have been talking about and also you are at risk for hypoglycaemic unawareness - seems like you are already heading there if you only feel a low at 20-30. When are these lows occurring - you need to get this sorted out - it is scary dropping the insulin you are taking and thinking things will go high (trust me I have just come through this - my last print out showed I had had 52 periods of hypoglycaemia in the previous 4 weeks) Now I almost never go low, have lost about 7 pounds and have an average blood glucose reading that is much much better than my last hba1c indicated. Sort out the lows first and measure at both 2 and 4 hours after eating but ignore the 2 hour reading for now and concentrate on getting the 4 hour one reasonable (aim for 100 if you want to)

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joyr1110

4 hours after I'm usually between 140-165. I was told normal is 70-130...so I thought those numbers were bad. I'm a bit of a perfectionist/control freak and thought if it was over 130 it was bad.

 

I'm eating pretty much the same way I did before DX, except I've scaled back from 30 net carbs a day to 20net carbs and cut out all fruit. Everything I eat is mostly either meat, or low glycemic veggies. Only exceptions being flax meal, almond meal, butter, mayonnaise, cheese, small amounts of nuts, home made salad dressings, and Heinz reduced sugar ketchup. I limit artificial sweeteners to 3 a day.

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Tanikit

Something is then not right on the timing of your insulin or else you are having to correct lows and causing it to be higher at the 4 hour mark - in general if things are set correctly you should either be somewhat stable after meals or you would rise at 1-2 hours post eating and fall again by 4 hours post. Extra fat can cause later spikes in blood glucose. Maybe you should list all the tests you have done and the amount of insulin you took for the last few days so we can see what patterns are around - then it would be easier to help.

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karatejoe

my bs was in the 200"s every meal at the 2hr. post meal. Then I cleaned up my eating and did better carb and portion control. Found my min. base of insulin to be 8. So now I take 8 units plus a 1:10 ratio. 2 hour posts are are 130 - 95.

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joyr1110

Well my numbers today made a liar out of me....granted I didn't test at all the exact times I normally would because I only got 2 hrs sleep last night...had a lot to do, and took a nap (longer than planned)...

 

5:12am- woke up 71

(Worked out 6-7am)

7:05- 146 ate

8:22am- 152 ate eggs/spinach/feta/tomato

11:11am- 93

1:08 pm- 117 ate shaved steak w/cheese & small bowl of salad no dressing

(Insert nap here)

6:30pm- 116 ate grilled chicken w/ spinach & butter

7:55pm- 104

 

Today they seem pretty stable (I usually do go up after workouts). I have a couple of things I'm going to test over the next few days to see what made them more stable today. Thanks for the help, you gave me some great ideas!

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Tanikit

I think that 07:00 and 08:00 readings are partly because of being a bit low earlier in the night (was it lower than 71 earlier) so that your liver kicks in and gives you more glucose. It may also be partly due to the exercise since that will also get some adrenalin and cortisol pumping and perhaps also partly due to dawn phenomenon. To check all those try to raise your glucose at the 05:00 reading by taking slightly less basal and then try not exercising one morning to see which is having the greatest effect.

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joyr1110
I think that 07:00 and 08:00 readings are partly because of being a bit low earlier in the night (was it lower than 71 earlier) so that your liver kicks in and gives you more glucose. It may also be partly due to the exercise since that will also get some adrenalin and cortisol pumping and perhaps also partly due to dawn phenomenon. To check all those try to raise your glucose at the 05:00 reading by taking slightly less basal and then try not exercising one morning to see which is having the greatest effect.

 

The last time I checked prior to those it was higher....that was at 10:40 the night before. It was a little high (my post dinner numbers usually are the highest numbers of the day) so I gave myself a correction bolus. I'm 99.9% sure that the 7 & 8:00 readings were from the workout. It doesn't matter what time of day I workout....if I don't eat and take 1/2 of what I'd normally bolus my numbers will go up from where they were.

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joyr1110

Oh and I had also worked out the night before from 8:30-930, which is probably why I was a little high (168) and needed to correct.

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