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stinastina

Help with Novolog and Lantus

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JohnSchroeder

Ah, Stinastina is type 2.  With all the insulin talk I assumed we were talking type 1.  For Type 1 at least, you want it to be steady when fasting.  Obviously going to bed at 200 is bad, but the point was that getting your basal right means your blood sugar will stay the same when fasting.

 

Thanks Hammer!

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stinastina

Have I told you guys today how informative and helpful every one of you are? Well, you are.... Thankyou

 

Yes, indeed ! There is always a wealth of knowledge from the folks here.

 

 

Hammer, when I'm testing the corrective dose, how long do I wait after bolus to test - the same 2 hours and 4 hours ?

 

Oh and what number do you do corrective dose at ? 

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Hammer

Yes, indeed ! There is always a wealth of knowledge from the folks here.

 

 

Hammer, when I'm testing the corrective dose, how long do I wait after bolus to test - the same 2 hours and 4 hours ?

 

Oh and what number do you do corrective dose at ? 

Knowing how many hours after you've eaten to bolus is another thing that you need to experiment with.  Since not all foods spike you at the same time, testing is the only way to know when you should take a corrective shot.  I typically test at the two hour mark, but you might want to do a BG test first at the two hour mark, then wait another hour to see how your BG levels react.  Again, what I do might not be what you should do, since we are all different.

 

If I test at the three hour mark after I've eaten, I will take a corrective shot if I am over 130, but I rarely go over 130.  If I see that I am at 130, I'll take 2 units of Novolog and that will bring my numbers down to under 100, but you might need less insulin (or more insulin), so you have to experiment a bit to find out the doses and after meal times to test.

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stinastina

More questions !

 

I feel like I need metformin. I take double the recommended Novolog so bg does not rise and numbers really aren't that good anyways. I'm up to 24 u of lantus. I pretty much am in the 160-180 range no matter what I do. I just don't feel like my numbers are going down. I could take 10u of novolog and be at the same number next meal. It's disappointing.

 

I could take a glimepiride and be down in the low 100s ! But I'm not allowed to. I have 2 more weeks until my next appointment. Would it be bad to take my met ? Will they know from bloodwork ? I don't feel comfortable riding out another 2 weeks with the feeling I'm insulin resistant and need my metformin.

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Uff Da

So if you go to bed after at least four hours without food or Novolog with a BS of say, 150, are you still at 150 at 3 or 4 AM? And what is your BS later, say at 8 AM - again without eating? When you say you are in the 160-180 range no matter what you do, does that really mean all night and you never get much lower in the daytime? Also trying to determine how much of a dawn phenomenon you have.

 

I really can't comment on the metformin - other than to say that I'm surprised the doctor took you off it, since you are a type 2. 

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stinastina

So if you go to bed after at least four hours without food or Novolog with a BS of say, 150, are you still at 150 at 3 or 4 AM? And what is your BS later, say at 8 AM - again without eating? When you say you are in the 160-180 range no matter what you do, does that really mean all night and you never get much lower in the daytime? Also trying to determine how much of a dawn phenomenon you have.

 

I really can't comment on the metformin - other than to say that I'm surprised the doctor took you off it, since you are a type 2. 

 

I've never checked around 3 am but in the morning I'm usually about 10-15 points higher than what I went to bed at or close to it. I never get much lower in the daytime and I've been doubling my novolog dose. I'm supposed to take 4 units but I've been taking 8.

 

The funny thing is when I was in the hospital, I was on no meds for about a week and my bg was around 150. I ate mostly protein and veggies because they don't serve much fat. I had chocolate ice cream daily which was about 20 carbs per serving. I also had cottage cheese once in a while but it tasted low fat. I thought maybe I was cured - lol. Then they told me the only treatment for the dka would be sugar and insulin which they infused me with about 3 days and my numbers went up. I was in the 200s when I left the hospital.

 

Maybe I should just email the doc and ask for my met. I have to titrate it anyways otherwise I get an upset stomach - I start with half a pill for 5 days and then work my way up. By the time I go back, I will only be up to 500mg.

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Uff Da

Maybe I should just email the doc and ask for my met. I have to titrate it anyways otherwise I get an upset stomach - I start with half a pill for 5 days and then work my way up. By the time I go back, I will only be up to 500mg.

 

I think that may be your best alternative. I'm just really surprised that the hospital didn't continue you on it. It is common for a doctor to take a person with LADA off insulin once they are diagnosed with a version of what they are now calling type 1 and put on insulin, but a type 2 typically stays on met. Even when I was diagnosed, my endo said I could stay on met. I took myself off it because I have such a mountain of pills to take for other reasons, and whether or not I took it didn't appear to change the amount of insulin I had to take all that much. When I later saw the endo, he said going without it was okay with him, since I was doing fine with insulin only. At the time I was only taking six units Lantus daily (down from the eight he'd prescribed since that much sent me low in the night) plus I was taking a typical 4 units Humalog or Novolog at breakfast and 8 units at other meals.

 

I've since gradually raised my Lantus to nine units over the past three years. I assume that is necessary because I've lost more beta cells, so I need more just to keep me approximately level through the night. Plus I weigh about 30 pounds more. With added weight it is typical to need more insulin.

 

But an insulin-resistant type 2 would typically take more meal-time insulin than you are taking even with met. However, you didn't say how many carbs you are typically eating per meal, so if you are eating low-carb, that might not be out of line at all, since the "typical" type 2 doesn't really low-carb it the way many on this board do.

 

As long as you are arising with a BG only 10-15 higher than you went to bed, your basal sounds properly adjusted. It might be wise to check your BG a couple of times at 3 or 4 AM before you go back to the doctor, though. The reason for this is that it would be wise to know just how much of a DP you have. It seems logical to assume that if you go to bed at 160 and arise at 175 with your current basal dose, that you have 15 points of DP.  But what if you are going to bed at 160, drop to 120 by 3 or 4 AM, then increase to 175 by the hour of arising. In the later scenario, once you get your daytime doses adjusted so you could go to bed at 100, you'd go low in the night. I don't really think that's what is happening, but there are people who have a really high DP, higher than mine. And mine can be up to 50 points when I sleep in really late.

 

Make sure that the night(s) you check for your BG at 3 or 4 AM that you have had a normal and not an excessive level of activity the day before. Excessive activity can push one lower than usual in the night due to increased insulin sensitivity.

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stinastina

Some meals I have are lc - meat, dairy and veggies. And sometimes (usually the evening) I end up having more carby foods like potatoes or bread but it's not every day. I definitely take more novo at those times.

 

So 8 units per meal does not sound bad. I guess it just feels bad to me because I feel like nothing is changing. AND if I stuck to the sliding scale of 4 units per meal, my numbers don't change either. 

 

I was told to keep increasing my basal by 2 points every 3 days until I get a fbg of below 130. That doesn't seem like it will ever happen.

 

Well, I couldn't have met in the hospital because I had a ct scan with iodine. Then the treatment for dka is insulin only. I think they are still treating me for dka to make sure I stay stable for at least a month. Every time I stopped the insulin drip in the hospital, my blood work would get worse and become abnormal (immediately). I'm supposed to go back to met and the glimepiride at the end of the month.

 

I'm just feeling uncomfortable with these numbers and impatient at them not coming down. I will set my alarm for 3 am and give that a test and report back.

 

Thanks so much for your help.

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Uff Da

Duh! I just re-read what I said above and it is too late to edit again. Replace the word insulin in this sentence with metformin. I hate it when I do that! I guess you knew what I meant, though.

 

I'm just really surprised that the hospital didn't continue you on it. It is common for a doctor to take a person with LADA off insulin once they are diagnosed with a version of what they are now calling type 1 and put on insulin, but . . .

 

 

The 3 AM check may not be all that important if you don't think you'll be staying on insulin long-term. I'd forgotten that you expected to go back on glimepiride. 

 

Did they check your c-peptide in the hospital? That might give a clue as to whether or not you are going to be able to manage without staying on injected insulin. A type 2 going into DKA - that just seems like you are lacking insulin and I don't know where they think you are going to get it from if you aren't injecting. But hey, I'm no doctor and I suppose all kinds of crazy things can go on in the body to affect the total picture in a way that doesn't follow the usual pattern.

 

It is not at all unusual for the BG to climb 40-60 points an hour or two after a meal, depending upon carbs consumed. But if it is returning to the same pre-meal level within four or five hours, it sounds like you are taking the proper amount of insulin for the meal.

 

It sounds to me instead that it is the sliding scale you were given that is not doing the job. Sounds like you might need a correction dose larger than what the sliding scale is giving you. I'm not going to tell you what to do. But I think if I were consistently running high that at a lunch time, at least four hours after breakfast and breakfast bolus, I'd skip lunch and give myself a correction bolus that is one unit higher than the number of units indicated on the current sliding scale. I'd wait four or five hours without eating or excessive exercise and note exactly how many points my BG dropped in that time. Let's say it dropped 60 points and I'd taken three units. That would mean my correction bolus should be one unit for every 20 points BG over 100 (or whatever figure is used as the target) instead of the current figure sliding scale. (If I understand it correctly, your current correction as stated in post #1 is 1 unit for every 50 points over 100.) Of course, that would be only a tentative figure. One would have to test this more than once before knowing for sure. 

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stinastina

Duh! I just re-read what I said above and it is too late to edit again. Replace the word insulin in this sentence with metformin. I hate it when I do that! I guess you knew what I meant, though.

 

 

 

The 3 AM check may not be all that important if you don't think you'll be staying on insulin long-term. I'd forgotten that you expected to go back on glimepiride. 

 

Did they check your c-peptide in the hospital? That might give a clue as to whether or not you are going to be able to manage without staying on injected insulin. A type 2 going into DKA - that just seems like you are lacking insulin and I don't know where they think you are going to get it from if you aren't injecting. But hey, I'm no doctor and I suppose all kinds of crazy things can go on in the body to affect the total picture in a way that doesn't follow the usual pattern.

 

It is not at all unusual for the BG to climb 40-60 points an hour or two after a meal, depending upon carbs consumed. But if it is returning to the same pre-meal level within four or five hours, it sounds like you are taking the proper amount of insulin for the meal.

 

It sounds to me instead that it is the sliding scale you were given that is not doing the job. Sounds like you might need a correction dose larger than what the sliding scale is giving you. I'm not going to tell you what to do. But I think if I were consistently running high that at a lunch time, at least four hours after breakfast and breakfast bolus, I'd skip lunch and give myself a correction bolus that is one unit higher than the number of units indicated on the current sliding scale. I'd wait four or five hours without eating or excessive exercise and note exactly how many points my BG dropped in that time. Let's say it dropped 60 points and I'd taken three units. That would mean my correction bolus should be one unit for every 20 points BG over 100 (or whatever figure is used as the target) instead of the current figure sliding scale. (If I understand it correctly, your current correction as stated in post #1 is 1 unit for every 50 points over 100.) Of course, that would be only a tentative figure. One would have to test this more than once before knowing for sure. 

 

My c peptide was 1.8 at my first doctor's visit after I left the hospital. So it is in the normal lab range. The doc was telling me that the way farxiga works is it flushes the glucose out of the blood stream so there was very little need for me to produce insulin. I had been on the farxiga for a year.

 

I think I have always been insulin resistant and that I need the met to help my cells use the insulin. Does that sound right ?

 

So if my pancreas has been resting this past year, would it be normal for it to be sluggish in getting re-started ? Also, if I'm injecting insulin, wouldn't my pancreas just continue resting ? I know if I could take a glimepiride right now and the lowest dose, it will give my pancreas a poke, and I would be back in the low 100s.

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