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miketurco

First day on novolog

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miketurco

I'm on the road for work and that's probably not the best time to start a new insulin plan. I didn't want to be alone in case i went low. So what I did was hit the clients place a few hours early. Yawners! I had to wake up at 7 freakin 30 this morning.

 

Anyhow, I did go low, but at 63 it wasn't that bad. I took one glucose tab and that brought me up to 77 Within 10 minutes. I didn't go low for two hours after taking the novolog, though. So what I'm going to do tomorrow is reduce my morning lantus.

 

Woa. At the end of that last sentence I got hit with a 54. No worries, I had candy and am back up to 87. And have plenty more candy if needed.

 

This is a learning moment for me right now. Yipee?

 

The reason I started novolog is because of my dp. I feel that if I can chop the top off my morning highs, I'll do better throughput the day. One of my goals is actually to cut down on insulin. If I Can control my mornings with quick acting, I'm thinking I'll be able to cut back on my basel.

 

Anyway, woke up at 7:30, 34 units of lantus at 8 and hit the door. Got to the clients, took 10u of nov at 8:50, then a protein bar at 9. (6g net)

The whole day went really well in terms of readings except for the two lows.

 

[sigh] I ate too much candy. Am up to 157 and will probably go higher.

 

Diabetes is such a pain in the tush.

 

Sorry if I sound scattered. This is what they call sugar blogging and I'm determined to wrote my way through this.

 

Yes, so... I digress. Shooting up from a low to triple what I was a little while ago seems to have given me quite a buzz.

 

Bottom line: the novolog, I think, will chip the top off my morning dp, and that's something I need to do. I'm going to drop my morning lantus down by, say, 6 units in the morning and take the novolog down from 10 to 8. I'll post back and let you know how it goes. Sorry for the screwy post, but it seemed like a moment in time worry capturing.

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NoraWI

Ummmm... what made you start with 10 units of Novolog? For that 9g bar, that would make it more than a 1:1 ratio. I would go down to 2 units and then go up slowly from there. Don't play with the Lantus until you are good with the Novolog. Change one thing at a time.

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Sobriquet

I agree with Nora - when i was working out my DP, i started with one unit, no food and watched how it worked for a couple of days.

I can't comment on lantus, but if your basals were fine before, it would be silly to change them to adapt to a short acting insulin.

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GrammaBear

Lantus is the stuff that keeps you steady during the night.  Novolog is supposed to be for meals and snacks.  You likely will not be successful in chopping the top off your DP with Novolog.  What you will do is to continue to go low with that many units of Novolog.  Who started you out with that kind of a dose for Novolog?  Novolog can either be the best thing or the worst thing that happens to you.  It is how you use it that determines your success or failure.  Be careful with it or someone will find you unconscious on the floor.

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jwags

Wasn't your last A1 c in the 6's? I am surprised your doctor prescribed Novolog tomdeal with DP. Have you had a c-peptide test done lately? If you still make insulin adding Novolog could give you unpredictable results.

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macksvicky

I know we are all different, but, Lantus (for me) works very well for DP and as long as I stay with low carb I can pretty much keep my numbers stable all day long and don't wake up to a higher reading in the morning than what I had the night before. I did have to split my dose between morning and night to cover for the whole 24 hours and I ended up using less too.

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jwags

Mike, are you exercising? Exercise and LCHF diet work wonders on DP as well as metformin. With the Novolog you are not preventing DP but just reacting to it. How much Lantus are you taking? I agree with Vicky that the right amount of Lantus and LC and exercise may prevent DP spikes. What you don't want to do with Fast acting insulin is get on a roller coaster of lows and highs. What exactly are your BG and A1 c goals?

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miketurco

I have a stand up desk plus I walk. I think I went low last night due to exertion. Long (boring) story on that.

 

The doctor took me off Actos and told me to titrate lantus. The dp came back pretty strong, for example my fasting will be 110, then I'll hit the 150s within an hour and not come down to that 110 again until mid to late afternoon. And I'm not happy with that. Don't want to go back to Actos because there's been a lot of cancer in the family.

 

A few months back I was dx'd with ckd. So I've been working like crazy on my bg and bp. I think the doctor was wrong on that, and we can discuss that situation in another thread maybe.

 

My ultimate, long term bg goal is to mostly stay under a hundred, which would put me in the fives club. Short term, my goal is to take the edge off dp.

 

My long term insulin plan is to get off insulin. Right now I'm at 70 something units of lantus a day, split dosage, and climbing. One $75 pen lasts four days and its getting kind of crazy price-wise. Plus, it's not handling the dp problem, it just isn't. If things continue the way they're going, I'll be back in the 190s again and do not want to go there.

 

High in the morning sailors take warning.

 

I like Nora's suggestion of starting with 2u and going from there.

 

Also, I've read a lot, (we all have.) Bringing high bg down is really hard. Keeping it from shooting up in the first place is the right way to manage it. I'm going to take a shot at the morning bolis (with a meal) thing. I believe it has the potential to help. I bought one 300 unit pen, a hundred bucks, and am going to go from there.

 

Yawners! I gotta shoot up and head to work :)

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miketurco

I have a stand up desk plus I walk. I think I went low last night due to exertion. Long (boring) story on that.

 

The doctor took me off Actos and told me to titrate lantus. The dp came back pretty strong, for example my fasting will be 110, then I'll hit the 150s within an hour and not come down to that 110 again until mid to late afternoon. And I'm not happy with that. Don't want to go back to Actos because there's been a lot of cancer in the family.

 

A few months back I was dx'd with ckd. So I've been working like crazy on my bg and bp. I think the doctor was wrong on that, and we can discuss that situation in another thread maybe.

 

My ultimate, long term bg goal is to mostly stay under a hundred, which would put me in the fives club. Short term, my goal is to take the edge off dp.

 

My long term insulin plan is to get off insulin. Right now I'm at 70 something units of lantus a day, split dosage, and climbing. One $75 pen lasts four days and its getting kind of crazy price-wise. Plus, it's not handling the dp problem, it just isn't. If things continue the way they're going, I'll be back in the 190s again and do not want to go there.

 

High in the morning sailors take warning.

 

I like Nora's suggestion of starting with 2u and going from there.

 

Also, I've read a lot, (we all have.) Bringing high bg down is really hard. Keeping it from shooting up in the first place is the right way to manage it. I'm going to take a shot at the morning bolis (with a meal) thing. I believe it has the potential to help. I bought one 300 unit pen, a hundred bucks, and am going to go from there.

 

Yawners! I gotta shoot up and head to work :)

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jwags

I rarely go below 100 and my doctor has not recommended insulin yet. If I don't eat right away when I get up I get that 30-40 pt spike too. I think many of us do. What is your A1 c and c-peptide? I hope you are testing a lot especially if you are injecting before driving. Are you still on metformin?

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miketurco

Still on met, for sure. It's an awesome drug! My last a1c was 6 but then I went off Actos and my bg shot up. My cpep was 6. something about 6 months ago, so the panc still works.

 

I now for a fact that if I don't do something my bg will continue to climb. It's the nature of the beast. Love you guys and I do listen! I'm just bull headed (I think that's the phrase).

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miketurco

Eating in the morning spikes me like crazy. The other day I had a small serving of fruit, like 5 carbs maybe, with some fatty fat for breakfast and hit 165, something like that. My present a1c goal is to maintain a 6, and frankly it is not looking good at all.

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jwags

6 is a great HbA1 c, I think you are overthinking this. In a perfect world I would like to be 83 all the time, too. But I am not. I have only hit the 80's a handful of times. Your HbA1 c of 6 tells me your average bg is good. Your C peptide tells me you still have a working pancreas.If fruit spikes you,mind something else to eat. I also find if I eat too few calories for breakfast I will spike. So I live with a higher 1 hour bg to get a lower 2 hour and avoid a liver dump.

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Stl-T2

You do not need to stay under 100 for an A1C in the 5s unless, perhaps, you are a high glycator.  An average BG (and I mean a real average, not an average of your tests) under 123 should give you an A1C in the 5s.  

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jwags

I am a high glycator and most of my A1 c's are in the mid to upper 6's, but my average bgs are around 100-110. I am OK with that for now . I think if you get your A1 c's into the 5's by having lots of lows, that is not a good thing. That is what the ACCORD study was all about. Over medicating to get low bgs is more dangerous than a little higher bg number.

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miketurco

I commonly hit the 150s in the morning and don't come down for quite some time. I think that 10u shot overdid it yesterday. In think like a panc, the guy says that your goal should be to get your bg as low as possible. He also says that your goal should be to not go lie more than once a week. Something like that, it's been a while since I read that book.

 

Both my brothers died young due to diabetes complications. I just married an awesome woman and want to live long and be healthy. I know my goals are really aggressive, and sometimes I do go over the top.

 

This two lows yesterday were nasty. Lesson learned. Weight loss is critical and I haven't been doing a good job of that, but haven't regained anything of the 50i list last year. My control of carbs is excellent. And I am going to continue to push myself. I do this in my business, I work hard on and in my relationships. I may be a little nuts, I admit that. But that's me. That's who I am.

 

Yesterday I took my normal amount of lantus plus 10u of novo and went low twice. So I backed off today, dropped my am lantus by 3u and took 3u of novo. I'm at 155 right now, which is where I usually am. I will probably stick with the same amounts tomorrow and slowly titrate to see where things go.

 

I made a mistake yesterday, lucky it wasn't worse. Learned a lesson, licked my wounds, made an adjustment and... Life goes on.

 

My thinking is that I shouldn't be fighting a 6 hour problem by taking insane amounts of 24 hour insulin. If I am successful at bringing down my morning numbers with a bolis, then I can cut back on lantus. In and of itself I think that is a reasonable goal. As to my bg number goals, I admit they're quite aggressive, but such are my goals.

 

Thank you all for your input. I do listen, and frankly you have all been right in the past and I've learned from you.

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jwags

Since your c peptide is above normal it means you are fairly insulin resistant. Your problems seems to be with liver dumps. If I were you I would try to figure out how to be more sensitive to your own insulin. Type 2's who are IR and are on insulin often gain weight, so be careful to use the smallest amounts possible. you say you walk, how far a day? maybe you and your new wife can start walking together. I understand you want to get healthy, but getting the lowest bgs you can is not always a way to do it. I try to get consistent bgs throughout the day. I may spike in the morning but the rest of the day I am fine. I keep experimenting with breakfasts to see which one works best. I get my best number with gluten free bread with guacamole or my homemade muffins. I need a certain amount of high fiber carbs to prevent my liver from dumping.

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Uff Da

I'm a LADA and much more insulin-sensitive than you, but a mere 7u a day of Lantus taken around 6 PM seems to keep me level from bedtime until about 4 AM, when DP begins.  I'd think that if your Lantus was keeping you level through the night, you wouldn't want to be messing with changing that number.  I'd just have added a small amount of the Novolog to handle the DP, maybe starting with 2u, as some have suggested.  I think the real key is "what level of Lantus keeps you level through most of the night?" 

 

You mentioned taking Lantus in the morning, but are you also taking it at night?  Have you ever done a basal test to see how long it lasts?  You may have mentioned this in previous threads, but if so, I either missed it or have forgotten.

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Forester

Mike, think about this.  Your c-pep indicates that you are still producing a large amount of insulin on your own.  The fact that you are still registering high blood glucose in spite of this strongly suggests that you are highly insulin resistant.  Your current adding of both long-acting, and now bolus insulin is likely making things worse, not better.  

 

Have you tried a fast?  There is some evidence that this may force a  'reset".

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miketurco

I'd be willing to try fasting, but am concerned about dumps. One thing that works really well for me is the Atkins fat fast. The thing is, I can only maintain that level of eating for a few days.

 

Besides lowing my bg, lowering the amount of insulin I take is my number 2 goal. I feel that if I get my morning dumps knocked down, I'll be able to lower the amount of lantus that I take. If I don't get on top of this, I'll end up talking 100 of lantus a day. That would be $25/day on insulin and I ain't got insurance. And plus, wow, that is a lot of insulin.

 

I can only do so much at one time. Beginning a fasting or ultra low calorie program while trying to titrate fast acting insulin would be over the top, even for me! Once I get the insulin figured out I can work more with dietary experimentation.

 

Uff, I'm taking something like 45u of lantus at night and 34 in the morning. I don't have my chart handy, but it's something like that. I'm trying to lower my morning dose and will increase my evening fix a little if needed.

 

I'm not walking nearly as much as I should be. I was laid up for a few weeks with a shoulder injury and since then I really haven't gotten with the program. I do use a standing desk, though. I'd go crazy if I had to sit down all day every day. There's another factor too, which is that I get very dizzy from my bp meds. I've come a long way with that over the past week, though. I discontinued one of my meds.

 

In terms of a goal and where I want to go with this... I've been thinking a lot about that. My short term goal is mainly one thing: knock the top off my dp. My theory is that if I can do that, the other (longer term) things I'm doing will fall into place.

 

Historically, when my bg is good in the morning, the rest of the day goes well too. When I'm high in the morning it usually leads to a rough day. It is this little tidbit that's driving my thinking right now.

 

Regarding lows, none of those today! I'd rather bring my bg down over a period of time than try to do it all at once.

 

Long term, I plan to lose more weight, and yeah, I gotta get back on the exercise wagon. I see insulin as a way to keep my bg in check while I work on improving my physical condition. As I continue to get in better shape, I'm hoping that my insulin resistance will improve, that my need for insulin will go down, etc.

 

My diabetes seems to be extremely progressive, and that's another thing on my mind. If I don't get a handle on this 150 issue, I'll be back up to 190 in no time. I just know it. So if anyone is wondering why I've been approaching this with such immediacy and urgency, that's why.

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NoraWI

Well, Mike, I don't have to tell you this but an excess of insulin makes you gain weight. Your diet can use some nips and tucks since you did say you had fruit for breakfast. Consider having eggs and a meat. Also, I find that what I eat the night before has a BIG influence on my morning numbers. Portions count. I know that I am a T1 and you are a T2, but I do believe that this issue is probably the same for anyone (both the meal the night before and the meal volume). I know that in the urban culture the biggest meal of the day is the evening meal and that is not helping in your case. Switch over to a green salad with protein on it for the evening and try eating a "dinner" type of meal for lunch.

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jwags

Is there a reason you don't have health Insurance? That fine is going up every year. Can you get covered with your new wife's policy? I thought you had a coupon for the Lantus? I know insulin is expensive and that is the reason I have made so many lifestyle changes. I hope to delay it for a year or two at least. IR is made worse by excess weight, so whatever you can do to lose that weight do it. I have arthritis in my knees but I still get out everyday and workout. I bought a Fit bit and it really holds me accountable to get my 10,000 steps. It also pushes me to go beyond that. One day this week I a had 17,000 steps. I am still insulin resistant but I have it controlled and my DP is minimal if I remember to take my 3 doses of Metformin at the right times at night. If I sleep through and forget to take that 3-4 am dose, DP hits. My metformin only lasts 3-4'hours. So I need that middle of the night dose. I also agree with eating a big meal at lunch and smaller one at dinner. I usually have a green salad for dinner with some fat and protein in it. I buy those individual guacamole cups at Costco. I put them on my salad. It adds just the right amount of fat.

 

My BP med also makes me dizzy so my doctor cut it in half and told me to take it at night. So if I get dizzy I am in bed. When I took it in the morning I felt like Imcouldn't do anything.

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miketurco

Is there a reason you don't have health Insurance? That fine is going up every year. Can you get covered with your new wife's policy? I thought you had a coupon for the Lantus?

The cost of insurance plus the deductible has always more than the cost of my medication and health care plus the fine. Now that I'm married I can get on maura's insurance, and now that I'm using so much medication I think I've hit the break even point. The coupon for lantus gives maxes out at 100/month and I have to time it right. So lantus was fairly cheap when I first started using it, not so much any more.

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miketurco

Yes, the insulin does make it easy to gain and hard to lose. When I said "fruit" what I meant was two or three ounces of cantaloupe. I didn't do anything wild and crazy like eating a banana :)

 

As I'm experimenting with the new insulin I standardized my breakfast and am having a protein bar. I chose that bar because it makes it easy to repeat the same food every day and gives me some carb intake to go with the insulin. At 9g net, though, it's a bit too much. So tomorrow I'm going to halve that bar and eat something fatty with it.

 

I'm on the er metformin so it doesn't matter much when I take it. I was on regular met for a while and did experiment with the timing for dp but to no avail.

 

So far, I've reduced my lantus by 4 units, which is the same amount of novolog that I'm taking. So I'm not taking more insulin, that was never my intent. Also, my morning dp/bg seems to be down by 10 or 15 points both yesterday and today. It's hard to tell after just a few days, but it seems that I really am headed in the right direction.

 

So... In the next 24 hours I have three things to change. I'm going to up my pm lantus by 3u, down my am lantus by 3 units, up my novolog by 1 or 2 units, halve my breakfast carbs and add a little fat. I realize that is a net gain of 2 units of insulin, but it's going to give me a really good days point.

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jwags

Definitely get on your wife's insurance. You can do that because it was a change of life event. We have always had the high deductible and paid $800+ a month. I was always scared of what would happen if we had to have surgery. Very easily our nest egg could be wiped out. So yes, an $11,000 deductible is high but at least you know what your total out of pocket will be. Even on insurance your insulin will cost you a copay. It is usually a Tier 2 drug.

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