Struggling

I'm really struggling right now.  Last year I changed over to Insulin (Novolog and Lantus Solostar).  But this past Dec my numbers went way out of whack and I just can't seem to get them down.  In Dec I was in the danger zone 250-400.  In Jan it was down to 200's, in Feb it was down to 150-225.  But I just can't seem to get lower than that on average.  I have had some lows (for me) 60-70.  My doctor wants me at 120.  Others things that are going on:  MAJOR STRESS:  Fiancial concerns:  had to replace A/C (Texas without A/C is nuts), huge car repair, then plumbing issues.  Job concerns:  Company is going to be laying off some folks, others are going to have furloughs (don't know how many days a month) and possibly reduction in salary; plus another department was collapsed into mine with no additional help to perform their functions (work load tripled).

Exercise is a problem with my bad leg and now the center I was going to is closed.  Do not have the money to join the other centers.  Trying to walk a bit more and do some exercises at home.

Sample of what I get daily:

Breakfast:  oatmeal with some protein (turkey bacon, turkey sausage or peanut butter)  and coffee with cream

Lunch:  Vegetable or chick soup, and an apple

Dinner:  4oz meat (usually chicken, sometimes beef), green beans or fresh tomato, or salad is asian vinegar dressing (2 table spoons)

Snack:  fresh fruit and some cheese, or a slice of sour dough bread.

Things cut out:  all breads except the 1 slice of sour dough, rice, potatoes, all other starches and sweets.  In other words everything white.

Any suggestions and encouragement would be helpful.

Marburg

Post Edited (Marburg) : 3/10/2011 3:18:35 PM (GMT-7)

Marburg, could you maybe be a LADA? Found a really intense article about this that may help clarify this for you.

LADA - Slow onset Type1 Diabetes

This may explain why even on such a severely restricted food plan you can't get into the 120 range and stay there. Can't do much but I'm sending prayers your way.

Marburg, I am so sorry for all your stresses. You certainly have way too much going on right now.

I am not a diabetic, but my DH is. He was dx at 34 w/ T2, put on Diabinese. He was 'ok' for a short while, then he had so many problems. He was sent to several drs, but not one was an endocrinologist. He got so sick shortly after we had our 2nd child. The dr finally tested him for T1 and he found he had 'it'. He ended up in the hospital for almost 2 wks. It was a miracle that he 'walked' out of the hopital at all.

All the suggestions that have been offered by Lainie and Sherrine are great, they may help you so much.

Jeannie, that article was awesome. Wish we had know that 28 yrs ago. But so glad when you shared that info w/ me a few yrs ago.

Marburg, my prayers are w/ you.

God bless.  Alice.

I think a specialist (endocrinologist) is the one to see.  And there are so many of them but make sure the one you see treats diabetes as its primary specialty.  The reason I think this is important is that he/she would be more familiar with difficult cases.  If your body is decreasing its production of insulin then you might be on the way to type 1, in transition, and I've read that it's hard to regulate the blood sugar while the body seems to be flipflopping in its insulin production.

Oatmeal is most likely what's making your blood sugar high.  I doubt it's the coffee unless you're putting sugar in it (which I doubt).  In any case, test to see which one it is by elimination.

Good luck, Marburg.  We're here for you.

I'm sure this is frustrating for you.  In the meantime before you see an endocrinologist, keep a log of your blood sugar and what you eat if you're not already doing it.  Ask the doctor if your body is still producing insulin.  (There's the c-peptide test which measures that.)  Keep a list of questions to ask when you're in the office.  I'm sure you know all this but just wanted to remind you.  I think your experimenting trying to find out how food is affecting the blood sugar is important.  Good luck with that.  Keep us updated.

 

Well--oatmeal caused a rise of 50 points. Coffee had a 5-10 point rise. The problem appears to have been caused by Flonase. Turns out Flonase is cortisone based. When I used it I saw a 100 point increase. Now that I think about it, my Dad was on Flonase and had numbers in the 300's.

Going to have to find a different allergy/asthma med.

Numbers are still higher than they should be but look like they are coming down.

Marburg I'm glad you found out the cause of the rise. I know certain medications create havoc to my bs levels.

Take care
Rose

Hi Lanie, grandmaroses and Miss Blossom,

Thank you for all your comments. I've also tried taking my doses of insulin at a different time. It seems it works better if I take the morning dose at lunch time and 1 evening dose at dinner time and the other evening dose at bedtime.

My allergy meds are still messing with my numbers some, but I've stopped the Flonase. I

As for my eating schedule it's almost impossible to do the 2-3 hours small meals. I'm lucky if I get 15 minutes at work to eat lunch. So--that remains a challenge because breakfast is at 6am, lunch at 11-noonish, and dinner not until after 7p. I try to save a piece of fruit for afternoon.

Will keep working at it.

Hi Rose,

No. I take 2 kinds. The long acting is bed time only. But I also take a fast acting twice a day. The fast acting is supposed to be a breakfast and dinner, but I find I get better results if I take my morning dose at lunch (I split it my morning dose if my numbers are high and take the other half at noon) and my evening dose at dinner.

No I didn't get any official training on how to adjust my dose.  I was simply told by a nurse how to take the shots.  I'm waiting to see if my doctor will let me take the Long acting at night, and go ahead with the fast acting before each meal.  My current schedule is to take the long acting at bedtime and 5-7-9 units of fast acting at breakfast and dinner.

I did experiment on my own by splitting my morning dose in half (3-5) and taking the other half at noon, and the second full dose before dinner and came up with lower numbers.  Using this format, my numbers seem to be running 72-126 in the morning.  Noon numbers are 100-154 (still a bit high) and evening numbers are 140-180 (still higher).  However, overall these numbers are a lot better than what I was getting (over 200).

 

Sorry to hear you're having such difficulties lately, Marburg. I, too, am on both a long-acting and rapid insulin but, I count carbs and constantly adjust my rapid insulin doses throughout the day. Often called the "poor man's insulin pump", this type of regimen is called intensive therapy.

I'm what they've termed a "brittle diabetic" (meaning my BGLs fluctuate wildly even with strict monitoring). I found myself NEEDING to understand things like my basal/background insulin requirements (this is where the long-acting dose comes into play), my insulin to carb ratios for different times of the day (most people are more or less sensitive to insulin at different times of the day), and most importantly, what my insulin correction ratio is (to correct high BGL levels). A really good site that helped me a lot with some starting points and those calculations is the Insulin Pumpers How-To web site, as follows:

http://www.insulin-pumpers.org/howto.shtml

Don't be turned away by the title being for pumpers. The same theories are used for MDI (multiple daily injection) regimens.

I won't lie, there is effort and education involved but, it's not as daunting as it first seems, especially if you take your time and do it step by step. Once the baseline (long-acting) insulin requirement has been established, the adjusting of rapid insulin for meals and/or correction doses, becomes a lot easier. The background insulin requirements are rarely adjusted once established but, there's a LOT of room for improving BGLs throughout the day with adjusting Rapid insulin requirements.

With some understanding of my insulin's action profiles as well as my own body's sensitivities, being on a CGMS (continuous glucose monitoring system) for 5 days also really helped my narrow down my specific daily requirements. Just for example, I inject 12 units of Levemir in the morning. Depending on my BGL and what activity I've planned, I'll breakfast with an I:C ratio of either 1:8 or 1:10 and usually eat about 15 grams/carbs. I'm most sensitive to insulin at lunch so, my I:C ratio is 1:12 and I usually eat 15-36 grams/carbs. Dinner is also 1:8 or 1:10 depending on BGL, what's for dinner and what time we eat. Sometimes an evening snack, sometimes not, all depends on the dinner routine but, this is where I have to be most careful with my Rapid dose - I DON'T want to go hypo during the night because of an insulin overdose. My BGL tends to drastically drop between 2:30-4:00AM (probably due to my 9:00PM, 14 unit Levemir shot "peaking" even though it's not supposed to), so, I really have to be careful.

Also, I could not do what I do without logging. Over 6 years as a Type 1 and I still log everything. If it's not measured, it's not managed - plain and simple, for me anyway. I couldn't find my patterns any other way. Well, OK, maybe with a CGMS but, I'm not ready to be hooked up yet

Cheers,
Kris

Sorry, I can't remember but, you're Type 2, right? If so, it's possible you might be Insulin Resistant (IR). Do you take Metformin or other Diabetes drugs along with the insulin?

Have you had your thyroid levels checked? It's not uncommon for the two to go together. I've been on thyroid pills for 25 years and had to have those meds adjusted when the "D" came along. Your doc can check for these (lab blood test) and an Endo certainly would.

I used to be on Lantus and never liked it. I found it stung and it's action profile for me was a roller coaster of high highs and low lows. Shortly after I started it, I moved from 1 evening shot to a 40/60 split dose, morning & evening. Doing that, (BTW, many of us do this) helped with the dips and valleys - especially the overnight lows - but it just doesn't compare with the Levemir I'm on now (which I also take as a split dose).

It's possible that your night time Lantus dose (75 units?) is too much and you're getting rebound highs, as reflected in your high morning BGL readings. Lantus gave me a wicked drop between 2-4am and I'd either wake up really high from the rebound (liver dump) or wake up to the low and eat my way to a morning high Those middle of the night lows can be brutal! Another reason to make sure your basal/background insulin requirements are as bang on as possible.

Sorry to hear the economy is taking another swing at you - that can certainly up the stress and BGLs as well. I hope you get to see someone more specialized in endocrinology/diabetes than a General Practitioner before the changes kick in. GPs are just that - general. You may need to see someone more familiar with your situation to help you with getting it under control. Even a Diabetes Educator/Nurse can be an excellent professional to help get you on the right regimen.

Other than testing regularly and logging everything (you'll want to give the new Endo or whoever the best info possible to work with), maybe doing some of the things suggested on the website I mentioned, will help you get some answers. It does involve close attention to diet and finger testing but the effort is worth it.

I'm curious to know how you're making out with your new Rapid insulin doses. That's quite a big jump, going up by 4 units. Any lows?

Cheers,
Kris

Hi Kris, 

Yes, I am Type 2.  I am Insulin Resistant and take Metformin along with the insulin.  My thyroid levels always check out fine.  I am normally a little deficient in iron and the B vitamins.  I also have IBS which makes balancing diet a challenge.  I am beginning to wonder if Lantus is the correct med or dose (my doctor wouldn't let me split it) for me.  And you are right, it stings.  I also find myself waking up at times between 2am and 4am with the shakes so you may be right there - I might be having some kind of rebound resulting in highs in the mornings. I find the fast acting seems to do better.  No lows on the fast acting (yet).  With the fast acting I'm seeing numbers from 92-117 in the morning and 100-146 between meals which is better than it has been.  Anyway, I finally got the referral for an endocrinologist and will be making an appointment today.

Phishbowl said...
Sorry, I can't remember but, you're Type 2, right? If so, it's possible you might be Insulin Resistant (IR). Do you take Metformin or other Diabetes drugs along with the insulin?

Have you had your thyroid levels checked? It's not uncommon for the two to go together. I've been on thyroid pills for 25 years and had to have those meds adjusted when the "D" came along. Your doc can check for these (lab blood test) and an Endo certainly would.

I used to be on Lantus and never liked it. I found it stung and it's action profile for me was a roller coaster of high highs and low lows. Shortly after I started it, I moved from 1 evening shot to a 40/60 split dose, morning & evening. Doing that, (BTW, many of us do this) helped with the dips and valleys - especially the overnight lows - but it just doesn't compare with the Levemir I'm on now (which I also take as a split dose).

It's possible that your night time Lantus dose (75 units?) is too much and you're getting rebound highs, as reflected in your high morning BGL readings. Lantus gave me a wicked drop between 2-4am and I'd either wake up really high from the rebound (liver dump) or wake up to the low and eat my way to a morning high Those middle of the night lows can be brutal! Another reason to make sure your basal/background insulin requirements are as bang on as possible.

Sorry to hear the economy is taking another swing at you - that can certainly up the stress and BGLs as well. I hope you get to see someone more specialized in endocrinology/diabetes than a General Practitioner before the changes kick in. GPs are just that - general. You may need to see someone more familiar with your situation to help you with getting it under control. Even a Diabetes Educator/Nurse can be an excellent professional to help get you on the right regimen.

Other than testing regularly and logging everything (you'll want to give the new Endo or whoever the best info possible to work with), maybe doing some of the things suggested on the website I mentioned, will help you get some answers. It does involve close attention to diet and finger testing but the effort is worth it.

I'm curious to know how you're making out with your new Rapid insulin doses. That's quite a big jump, going up by 4 units. Any lows?

Cheers,
Kris