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Mirsy

a little insulin at bedtime

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Mirsy

My 75 yr old husband has type 2 and his last AiC was 7.3.  Kaiser is now suggesting he might want to try a little insulin at bedtime to lower his morning readings which are usually high.  Can anyone tell me if this is a good idea or will it make things worse.  Thank you very much for your input.  Mirsy

 

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Mirsy
18 minutes ago, Mirsy said:

My 75 yr old husband has type 2 and his last AiC was 7.3.  Kaiser is now suggesting he might want to try a little insulin at bedtime to lower his morning readings which are usually high.  Can anyone tell me if this is a good idea or will it make things worse.  Thank you very much for your input.  Mirsy

 

 

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keenast

Does your husband follow a certain diet? i.e. low carb/high fat? What his daily carb intake?

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TX_Clint

IMHO It's a good idea. I take 30 units of Basaglar (basal insulin) at bed time every night. I also take 2000 mg of metformin daily. My latest A1C was 5.6. I also eat a very low carb high fat diet. It won't make things worse. Just make sure to monitor his bg levels and make slow changes to the insulin dosage.

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Mirsy

Thank you so much for your replies.  He has one piece of double fiber toast w p.butter, a handful of walnuts and a few blueberries for breakfast, for lunch 1-1/2 pieces of double fiber bread, turkey, lettuce, dinner is usually salad, fish or meat and a veggie.  We now have another worry.  He saw the eye doc yesterday to set up a cataract operation.  They did a lot of tests and told him he had diabetic retinopathy and that would be have to be addressed before the cataract fix.  Kaiser always says his bs is under control but obviously it is not if he has the retinopathy.  I am wondering if maybe the insulin at  nite would be helpful for him.  He is very thin and it bothers him.  If he could eat a little more w/o getting the high blood sugar it would be good.  Anyhow it is so helpful to get advice from people that are going through the same thing.  As you all know it is a huge worry.  Thank you so much for your help.  Mirsy

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TX_Clint

He needs to eat more. DO NOT be afraid of fat. I don't see enough fat in his diet. Basal insulin will not address after meal spikes but will lower fasting bg levels and help with the morning fasting reading.

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Kit

I see very little protein in his diet as well.  Which means he is literally eating a high carb diet.  Of course he's not controlled.  And yeah, doctors often have diabetics run in ranges which cause damage.  And no, that is very much not right, but they do it anyway.

 

Because

 

1)  Most doctors, unless they specialize in the subject, know very little over the general population on the subject.

2)  Doctors are terrified of hypos (law suit!) but do not have the knowledge of what things actually cause hypos or even what range is actually hypo.

3)  Diabetes is a progressive disease (WRONG!) and so complications are inevitable.  And those complications can take 10-20 years to show up, so things like retinopathy and kidney disease can't be blamed on them.  So no chance of law suit.

 

So yeah, let those patients run high, even if its utterly unnecessary.  I once had an A1C of 4.9 and had a doctor screaming at me that there was no reason for a diabetic to have an A1C of under 7.0.  I don't know why she was so offended by me having good control over my numbers.  I really hope she enjoys murdering her less self educated diabetic patients.  Because that is exactly what she is doing when she says BS like that.

 

An A1C of under 6.0 is what most of us here aim for.  This is the point where the chance of complications becomes close to those of non diabetics.

 

Some guidelines that can help hit that goal.

Under 100 fasting and before meals

Under 140 1 hour after a meal

under 120 by 2 hours after a meal

 

Another thing to note is that A1C doesn't tell the entire story.  It doesn't show a difference between someone who runs relatively stable and someone who wildly swings between extremes.  They can end up with the same average, but the second is being damaged while the first is not.  Damage is happening by the time you hit a BG level of 140.  I personally aim for never going over 120.  I had the fun of watching my brother die over a number of years from a series of really horrible diabetes complications and have no desire to go through that myself or put my husband through the utter heck of watching my body rot around me.  So I've got a lot of motivation.

 

I recommend switching things up for a week.

 

Have a nice steak (my favorites are ribeye or new york strip because they have the best flavor).  Serve with a generous side of roasted vegetables.  I personally adore asparagus with steak.  or Brussels sprouts.  YUM!  Toss in some onion and mushrooms as well for a little additional variety.  Maybe a side salad as well if he'd like more food.  Be careful on the dressings.  Avoid the low fat ones, they are full of sugars and starches.  Be careful with vinegrettes, they are often full of sugar.  I recommend avoiding any dressing with more than 2g carbs per 2Tbsp serving.  I personally tend to make my own dressings as I have full control over what is in them.

 

I can eat a meal like this (8oz ribeye, roasted veggies, and a salad) with a very minimal rise in my BG numbers (like 10 point difference)

 

Or things like egg scrambles.  They're usually quick and easy to fix, one pan, easy to clean up.  I saute up a pile of veggies.  Options are things like spinach (or other greens), onions, peppers, mushrooms, zucchini, asparagus, or similar.  Add in some cheese and/or maybe cooked bacon or sausage.  Then add in beaten eggs and scramble until they are all done.  Very yummy, very filling, and again has very little affect on my numbers.

 

Give him a few days to a week on a diet like this.  You should see his numbers drop and he will be a lot better satisfied with what he is eating.

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don1942

I’m with Clint on this one. A little (start with 10 units) basal insulin should help reduce early morning highes. 

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Mirsy

 I will try for a week to give him more fat but he also has protein spilling into the urine so I'm not sure if that would be good for his kidneys.  We have Kaiser Ins. and they have never let him see an Endocrinologist.  Maybe more fat and the insulin at nite will be a good start.  Something has to change because the plan they have him  on now is obviously not working.  Glad you are all on a better path right now and hope my husband will also get more help.  Thanks so much for your input!  Mirsy

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Kit

Protein doesn't damage your kidneys.  High BG levels damage your kidneys.  (High blood pressure will as well.)  Protein spilling into your urine is a side affect of the damage caused by high blood glucose levels.

 

Now if he bad kidney damage, then there are other concerns.  But protein does not damage kidneys.  Its a myth.  My brother had severe kidney damage.  He did have to limit his meat intake.  But that was because of the phosphorus levels of meat.  The method of dialysis he was using did not clear out his high levels of phosphorus and he could only take so many phosphate blockers a day, 

 

However, he was also taking protein supplements.  It was a funky kind of gel in a plastic packet.  He had to take it a couple times a day to keep his protein intake up without increasing his intake of phosphorus.

 

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Mirsy

Thanks Kit for the info.  I will keep it in mind.  So good that there is a forum like this to help people like me!::))

 

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meyery2k

I would strongly agree with Kit.  Diet had a profound effect on diabetes for me.  I have been able to get to the same numbers as a non-diabetic with diet and exercise alone.  The low carb high fat diet also helped reverse morbid obesity and I have been able to enjoy activities that I had not in years.  It turned back the clock.  At 53 y/o I am accomplishing things I simply couldn't at 40.

 

Basic exercise also comes into play.  I lost 75 pounds by simply walking.  My goal was 10,000 steps a day using a Fit Bit.  Many phones also have step counting ability.  Is it accurate?  Not really important.  The idea is it got me out there and into the habit of exercise.  I now get quite cranky if I miss more than a day of workout.  I understand weight isn't a problem here but exercise builds muscle and improves muscle tone.  Muscle is denser than fat so your husband could potentially gain some weight and look great.  I now weigh 220 and much of that is muscle.  I have some abdominal fat which I can never really get rid of.  This is likely due to metabolic syndrome.

 

Perhaps start with the small amount of basal insulin, work on diet and exercise, and you might find the insulin will not be necessary.  If you look around this site, there are many example where people started with double digit A1c and eventually did this.  My personal data was A1c of 8.5 at diagnosis and fasting BG of 312.  Within 1 year, I had the A1C down to the 4's and consistent fasting readings under 100.  I no longer needed to take Metformin or any medication for diabetes. 

 

Would your husband consider joining this forum?  We all have diabetes here.  We don't judge.  When I finally swallowed a little pride and listened, the advice here seemed to pull a miracle.  Even my PCP opened his mind a little.  He was on the "eventually you will need insulin as diabetes is a progressive condition" bandwagon.  I lost so much weight so fast, he thought I was on meth.  I now look, feel, and act healthy.  My PCP refers to diabetes as being in remission.  He says he has never seen that happen.  It isn't that way for everyone since there are many reasons to present with diabetes.  My case seems to be that I am insulin resistant so keeping a consistently stable BG over time has proven to be the key for me.

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Mirsy

Thanks for the input.  He walks for 30 mins 2day and is an avid gardener.  Amazing that you turned your situation around so successfully!  Unfortunately my husband is NOT proactive.  He doesn't even use the computer!  He is really old school -:(.  So the burden of the research falls on me.  Thanks for trying to help.  Mirsy

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Hammer

You didn't mention it, but what are his morning wake up BG levels?  If he decides to try insulin, they will put him on a basal insulin, which, as was mentioned, will only lower his fasting glucose levels, it won't have any effect on his after meal spikes.  My nightly basal insulin is Lantus, but there are other brands.  Lantus is supposed to last for 24 hours, which it does for me.  If he does start using insulin, I'd suggest that to play it safe, maybe start him on 2 units a night.  Do that for three nights in a row, and if his morning wake up readings are still too high, then the next night have him take 3 units.  Do that for three nights, all the while checking his morning wake up readings.  Once his morning wake up BG levels are in the normal range, and the normal range can be anywhere from 70 to 100, (I prefer in the 70's for myself, but others may like them to be a bit higher), then his A1C should drop.

 

I see that he eats bread....how many carbs are in that bread?  Do you count how many carbs he eats a day?  Each of us here have our own set goal of how many carbs to eat a day.  I try to eat less than 50 carbs a day, others here try to eat less than 30 carbs a day, while others try to eat less than 100 a day.  The idea is to eat the fewest amount of carbs that you can tolerate.  If 50 a day is too little, then you need to increase it.  Keep in mind that carbs are addictive....the more you eat, the more you crave.

 

Anyway, keep us posted on how he is doing, and feel free to ask us any questions that you have, that's what we are here for.

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Mirsy

Thanks so much for your help and support.  The double fiber bread he eats has 15 carbs and 2 grams sugar.  His fasting bs's have been 152, 147, 137 and today 162.  I am feeling more hopeful today as we received an email from the eye doc who says they think my husband has a "macro aneurysm"  that ruptured and he can have the cataract surgery after they repair the aneurysm.  He went down to renew his driver's license yesterday and failed the eye test so they gave him an extended renewal for now.  The eye doc said the most important thing is to keep the bp and bs under control.  We see him next Monday and I intend to ask him if we should be seeing an endocrinologist instead of the pharmacist/care doctor since what she is recommending is not working.    I am thinking that the insulin at bedtime will be a good idea for him.  What do you think about seeing an endocrinologist?

 

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adiantum

@Mirsy, I think seeing an endo is  a great plan as I suspect he could be type1 or 1.5

Those fasting numbers are high.

 

 Is he really getting enough fats?

How many eggs a week does he eat . How often does he eat cheese, fatty meats

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meyery2k

This might not be a popular answer but I have found that any bread, even high fiber, does not play well with me.  Oddly, grains, rice, and flour have a worse effect on me than sugar or fruit.

 

An endocrinologist and testing for T1 or T1.5 is not a bad idea at all.

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Mirsy

Thanks for your reply.  It seems like several of you think he might be T12 or 1.5 and not T2.  You think after 25 yrs Kaiser would have been able to figure that out.  We've asked our primary doc for a referral to the endocrinologist.  Hope he will do it.  If not we will have to pay cash and go outside of Kaiser which would be shameful.  Thanks all for your support!  ❤️

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Mirsy

Hi everybody,  My husbands primary will not give us a referral to an Endocrinologist.  He said retinopathy is a universal result of decades of diabetes.  He did say we should bring down the A1C to below 7 instead of 7.4.  I am thinking the best bet now would be to start the insulin at bedtime.  We see the eye doc tomorrow and I will see what he thinks.  I am going to ask him if we need to go outside of Kaiser to see an Endocrinologist.  Hope you are all doing well and thanks again for your support.  Mirsy

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Kit
12 minutes ago, Mirsy said:

Hi everybody,  My husbands primary will not give us a referral to an Endocrinologist.  He said retinopathy is a universal result of decades of diabetes.

 

What did I say? Doctors treat diabetic complications as inevitable. They are WRONG. 

 

13 minutes ago, Mirsy said:

He did say we should bring down the A1C to below 7 instead of 7.4. 

 

An A1C of 7.0 is an average BG level of 154,well over the damage threshold. 

 

Honestly I would do two things. 

 

1. Fire his doctor and find one who is not incompetent and who is willing to actually work with you on prescribing meds and giving necessary referrals. 

 

2.  Get his A1C under damage range. Aim for at least 6.0 of not try to get a little lower. 

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adiantum

I sometimes wonder if these doctors get a kick back from referring uncontrolled diabetics to specialists such as surgeons for amputations  etc.

They do everything possible to prevent patients taking control of their situation.

 

I suspect that same doctor  insists upon his patients to having a low fat,high carb diet as recommended by the ADA 

Mirsy please get your husband on a high fat/low carb diet to get his a1c down. It's  worked for us here.

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Mirsy

Thanks for the input.  I don't trust the medical treatment Kaiser has given my husband.  I feel like I have to research it all myself which I am also doing by reaching out here for info.   Yes, we will try more fat and less carbs and also the insulin at bedtime.  Thanks for the help.  Mirsy

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Hammer

Mirsy, a type 2 can become a type 1.5 over time.  We have members here who had that happen to them.  You can be a type 2 for years, then, you're body slowly stops producing insulin, which is what a type 1.5 is.  There are so many crossovers with diabetes.  You can be a type 2, which means that you are insulin resistant.  You can be a type 1 which means that you produce little to no insulin.  You can be a type 2, who is insulin resistant, and then stop producing insulin.  You can be a type 1, who produces little to no insulin, then develop insulin resistance also.

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Kit

Actually that is not correct.

 

T1 (or T1.5) diabetes is an entirely different disease from T2 diabetes.  They only share a common symptom (high blood glucose levels).

T2 diabetes is a disease of insulin resistance, the inability of the body to make efficient use of the insulin it produces.

T1 is an autoimmune disease.  The body's immune system attacks the beta cells in the pancreas which produces insulin.

T1.5 is also known as LADA (Latent Autoimmune Diabetes of Adults).  This is also an autoimmune attack which usually doesn't manifest until later in life.

 

To determine if you are T1 or T1.5, they will do blood tests looking for the various antibodies related to T1 diabetes.  A T1 will normally have many of the different antibodies.  They will also have very low or no C-peptide tests (which shows how much insulin your body is producing).  A T1.5 will usually only have a few antibodies (sometimes just one) and their decline will be slower.  Because of this manifesting later in life, and because it comes on slowly, many T1.5s are misdiagnosed as T2 diabetics.  They may be able to control things for a while with traditional T2 methods, but control will continue to get worse and worse with time as the autoimmune attack continues.

 

Now while a T2 could theoretically also develop T1.5 diabetes, T2 does not progress into T1.5.  Instead they are referred to as insulin dependent T2 diabetics.

 

The antibodies involved in T1 autoimmune attacks are

 

ICA

GAD-65

IAA

IA-2A

I think there's a 5th one as well, but I'm having issues finding it.

 

As I mentioned above, a C-peptide test is also performed to determine how much insulin the body is producing.

 

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