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Uff Da

Uff Da's General Diabetic Update

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Uff Da

I was going to post much of this in the morning fasting BGs thread, but decided since I hadn't posted with a general update in a long time, perhaps I should make it a separate thread.

 

BG this morning was 100. But my morning BGs this month have ranged from 58 to 167. My biggest problem has been that my Humalog insulin action from my dinner seems to be more inconsistent and generally taking longer. That makes it incredibly difficult to tell before bed whether I need to eat a snack or to make an insulin correction unless I wait over five hours from dinner bolus. And/or the time it takes for carbs from dinner to be absorbed is taking longer or is less consistent. At any rate, my fasting BG readings have been about the least consistent this month they have ever been since getting on insulin.

 

My blood pressures have been elevated in recent months. On Tuesday my PCP suggested that I change the timing of one of my meds to the middle of the night when I get up for a bladder call. She was hoping that might prevent the necessity of increasing my BP meds yet again. (Already increased them twice this year.) But so far it doesn't seem to be working. It will take another week or more to tell for sure, though, due to confounding factors.

 

But other than that, I seem to be doing well for an old lady of 75. Saw my ophthalmologist yesterday, who said no sign of eye problems from my diabetes. Cataracts still "moderate" so no need to do anything yet.

 

Don't know if I should be amused or annoyed with my ophthalmologist's reaction yesterday when she first looked at my chart. She said with this tone of utter disbelief, "You're a type 1?" I assume she was looking at the record her nurse had entered that my last A1c was 5.6 and those for the past 3+ years had ranged between 5.5 and 5.9. Guess she must not see that too often around here.

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jims_forum

Happy new Year Uff Da.  Thank you for sharing and pray you are doing well and Best wishes for New Year! Inconsistencies are always a concern and up the level of Worry! One never knows if this is serious or just little bumps in road!

 

 

 

I was going to post much of this in the morning fasting BGs thread, but decided since I hadn't posted with a general update in a long time, perhaps I should make it a separate thread.

 

BG this morning was 100. But my morning BGs this month have ranged from 58 to 167. My biggest problem has been that my Humalog insulin action from my dinner seems to be more inconsistent and generally taking longer. That makes it incredibly difficult to tell before bed whether I need to eat a snack or to make an insulin correction unless I wait over five hours from dinner bolus. And/or the time it takes for carbs from dinner to be absorbed is taking longer or is less consistent. At any rate, my fasting BG readings have been about the least consistent this month they have ever been since getting on insulin.

 

 

 

 

My blood pressures have been elevated in recent months. On Tuesday my PCP suggested that I change the timing of one of my meds to the middle of the night when I get up for a bladder call. She was hoping that might prevent the necessity of increasing my BP meds yet again. (Already increased them twice this year.) But so far it doesn't seem to be working. It will take another week or more to tell for sure, though, due to confounding factors.

 

But other than that, I seem to be doing well for an old lady of 75. Saw my ophthalmologist yesterday, who said no sign of eye problems from my diabetes. Cataracts still "moderate" so no need to do anything yet.

 

Don't know if I should be amused or annoyed with my ophthalmologist's reaction yesterday when she first looked at my chart. She said with this tone of utter disbelief, "You're a type 1?" I assume she was looking at the record her nurse had entered that my last A1c was 5.6 and those for the past 3+ years had ranged between 5.5 and 5.9. Guess she must not see that too often around here.

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meyery2k

Uff Da - I also hope you get a handle on this.  I must say that I admire T1s and 1.5s that can manage this so well.  It seems to me an incredibly difficult task. 

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miketurco

Nighttime insulin is always the trickiest for me. Never know if I'm high because I took too little or too much. I've found that a late night snack and smallish basal works best.

 

Great job with your a1c. And a good new year to you!

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Uff Da

Nighttime insulin is always the trickiest for me. Never know if I'm high because I took too little or too much. I've found that a late night snack and smallish basal works best.

 

Well, thank goodness I don't have to take rebound highs into consideration, as well. In the five-plus years I've been diabetic, I've never seen any evidence of it, and I've recorded lows in the 30s many times. Maybe I'd have a rebound if I ended up going lower yet, but I sure wouldn't want to count my life on it!

 

Actually, I think keeping a decent BG level through the night most of the time has been one of the major factors that has allowed me to keep my A1c as low as it has been. I try to avoid going to bed before I've waited long enough to get a reasonable idea of where my BG will end up for the majority of the night. That was easier to do when I was on Apidra, as the period of insulin action was about an hour shorter for me than Humalog. But insurance forced me to change to Humalog a year ago and I couldn't find an insurance company that would cover Apidra in my area this year, either. But I used to be able to get a fair idea of where my BG would end up about four hours after dinner bolus with Humalog. Now it seems that the minimum might be five hours. We are already eating dinner at 5 PM. I don't want to have to move it up any earlier.

 

I guess I could try doing more exercise in the evenings to get the insulin acting faster. Or rubbing the area of my injection a bit. I've read that that can speed absorption, but don't know how much one would have to do to have much effect.

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Uff Da

Typically I bolus between 1 and 15 minutes before dinner, though if my BG is getting close to 70 before dinner, I'll wait until after I've finished eating to bolus, especially if the meal is low GI, which it often is. If I suspect I may be high before dinner, I try to test earlier, at least by 4:30. That way if I need to, I can bolus earlier so my BG has a chance to drop a bit before I start absorbing more glucose. But that doesn't happen particularly often. I'm usually too absorbed in whatever I'm doing (including cooking) to test earlier than that.

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miketurco

It's hard to hot the right balance. Sounds like dp and maybe you can try some of the standard suggestions. Sometimes things just are what they are. You've got a really good a1c and (I think) is better to wake up a little hough than go low when you sleep. Especially with the way your liver doesn't dump when it should.

 

Livers. Psh. Not there when you need 'em but always there when you don't.

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Uff Da

Oh, I definitely have DP. My tests have shown that it starts between 3 and 4 AM, and if I don't eat or bolus, my BG will climb about 40-50 points by 10:30 or 11:00. My DP happens whether I'm asleep or am up but fail to eat. So a lot of times if I wake up for a bladder call about 3 or 4 AM anyway, I'll bolus, eat breakfast, and go back to bed. I'm retired, so the hours I'm up or sleeping only matter on those days I have appointments. On three of my high morning BGs this month, I did rise late enough that a part of the unusually high reading (perhaps 20-30 points) would likely have been due to DP. But not all of it. And on one of the mornings I had a 167 FBG, the reading was taken at 6 AM, so DP would ordinarily not have accounted for more than 10-15 points of it. I usually target 100, to give me 30 points of room for error before going low.

 

I tried going for a 15-minute walk inside the house including about a dozen trips up and down the stairs after dinner tonight. And much of the time I tried rubbing the injection site. I'll test at four and five hours from bolus and see what difference I see. Even if BG those two times turn out to be the same, though, it wouldn't necessarily mean that my insulin had stopped all activity by hour four. I had a cup of bean soup for dinner, so it might just mean that the increase from food absorption past hour four equaled the drop from insulin in that hour. I'll have to try the same thing some night when I have a higher proportion of the evening meal as higher GI foods. It will be interesting to see if this activity after dinner makes enough difference to matter. I suppose what I really need to do to test this is to try exactly the same meal and same timing both with and without the exercise. Maybe I can do that some time this month.

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Kit

I have absolutely no experiance here so I can't offer suggestions.

 

However, I wanted to comment on your excellent approach with the scientific method.  It seems like an endless effort to minimize factors, try something out, see what happens, and repeat.  :)

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Uff Da

Yes, Kit, as others have said, diabetes sometimes gets to be an endless series of experiments with a sample size of one, since in many respects we are all quite different. We can often get clues of what might be worth trying from what others have found, but until we test it out ourselves, it is still one big guess. And of course the more variables we can control, the more likely the results will be accurate.

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Teshuvah

Well, thank goodness I don't have to take rebound highs into consideration, as well. In the five-plus years I've been diabetic, I've never seen any evidence of it, and I've recorded lows in the 30s many times. Maybe I'd have a rebound if I ended up going lower yet, but I sure wouldn't want to count my life on it!

 

Actually, I think keeping a decent BG level through the night most of the time has been one of the major factors that has allowed me to keep my A1c as low as it has been. I try to avoid going to bed before I've waited long enough to get a reasonable idea of where my BG will end up for the majority of the night. That was easier to do when I was on Apidra, as the period of insulin action was about an hour shorter for me than Humalog. But insurance forced me to change to Humalog a year ago and I couldn't find an insurance company that would cover Apidra in my area this year, either. But I used to be able to get a fair idea of where my BG would end up about four hours after dinner bolus with Humalog. Now it seems that the minimum might be five hours. We are already eating dinner at 5 PM. I don't want to have to move it up any earlier.

 

I guess I could try doing more exercise in the evenings to get the insulin acting faster. Or rubbing the area of my injection a bit. I've read that that can speed absorption, but don't know how much one would have to do to have much effect.

I use a Dexcom G5. Talk to your endocrinologist since it is a Tier 3 product it requires a doctor's certification. A Constant Glucose Monitor is an absolute need for a type 1 or 1.5.

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Uff Da

I use a Dexcom G5. Talk to your endocrinologist since it is a Tier 3 product it requires a doctor's certification. A Constant Glucose Monitor is an absolute need for a type 1 or 1.5.

 

Actually, I have no desire for a CGM.  Since I've been able to maintain an A1c of between 5.5 and 5.9 every test since going on MDI approaching four years ago, I really can't expect that it would help me maintain that much better control. I don't think it is covered by Medicare except for people who have already used one prior to going on Medicare. Having been retired for years, I certainly couldn't afford the entire cost out of pocket. And I really don't see that it would solve my problem. I'd still have to wait up four to five hours for most of my bolus insulin action to be over in order to determine the approximate BG level I'd be at for the majority of the night.

 

I'm sure CGMs are wonderful pieces of equipment for some people, though.

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Kenton

Which is why I miss Apidra/ That stuff started working in about 20 minutes for me and was over peak within 2 1/2 hours. Novolog takes about 45 minutes to start unless I grit my teeth and shoot it into my thigh. Then it starts in about 25 to 30 minutes and ramps down a bit quicker.

I never wanted a pump, I saw the look of pain as one guy at work slapped the port on and withdrew the needle. And saw a few times where he snagged the tube and pulld the port out.

Bleeds all over and he did not feel it . Looked like he had been stabbed.

And CGM's seem to need to be recalibrated so you are testing almost as often as you would have anyways..

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