Re: steadly falling bgs

[Guest guest]

>... I'd like to have a good discussion about insulin types and dosing.

***What I've noticed in the time (long) I've been on this list is this:

Most of us now on insulin seem to have started at dx with either diet and

exercise or meds. Very few of us went straight on insulin. This works

great for some, but for others (me to) it's ever increasing meds until the

pancreas doesn't function much at all and insulin becomes necessary - or is

chosen for tighter control. Most of us on insulin were started with the

70/30 combo, and I think this is because the doctors feel safer with it,

i.e. we won't screw up too bad. My doctor was reluctant to put me on

insulin, I think because he worried I'd overdo it, or not pay attention, or

whatever. He has lots of patients who aren't even close to motivated. For

me, once I figured out how insulin works (reading the little pamphlet in the

boxes), and researched a bunch about it, I switched to R and NPH, since

that's what's in the combo I started with. My control got better, but I had

nightime hypos and/or high fbg's. First I switched to H - much more

convenient and shorter action for matching carbs before meals, and then

after more reading, and a lot of sharing my another member on this list

going through the same thing, I switched to UL. My control, averages,

glucoprotein and all just keep getting better. So for me, this is what

works. But, there is an considerable learning curve, and a lot of testing,

record keeping, etc. involved, and I believe a person should get really

familiar with the workings and control (or lack of) with the meds of the

moment, before starting anything new.

I'll also say that being the independent creature that I am, I did all this

without my doc (after the initial 70-30), but kept emailing him info, so

he'd know what and how I was doing. He's an advocate of low carb, and just

kept saying to be careful. Now he tells me if I'd eat even less carbs, I'd

use less insulin :-) I just kept asking specific questions here and used

the LC archives (public) for the technical stuff and any time I made a

change, I was very conservative.

As Susie said, this is a self managed disease, and we must do what works

best for us - not what non diabetic doctors think might be safe and

conservative for us.

JMHO,

Barb

--------

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Premium Oldenburg sport horses

and fancy sport ponies for sale.

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> So often I'll hear diabetics report problems such as spikes, hypos, etc.,

> and we'll say you probably need to adjust your insulin, and they go, " The

> doctor hasn't ordered it, and I can't get in to see him for awhile " or

> similar. Diabetes is *your* disease ... you choose to eat wisely, you

count

> the carbs and match your insulin to your carbs. It's really important for

> people to understand not only the dosing but the timing. I hope all of you

> visit Eli Lilly's site to study their action graphs, even if you're not on

> insulin: http://www.humulinpen.com/02-products/tap.html (just lie and

say

> you're from the US)

[Guest guest]

Susie,

I'm not going to knock NPH. I'm doing really great using it. My body

doesn't react to it like everyone else's. I haven't had a hypo for months

now. When I wake up in the mornings my BG is usually between 80 and 100. I

take my insulin 30 minutes before I eat which makes it's peak between 30

minutes to 1 hour later. The next peak is in 7 hours but not as high as the

first. My BG will be at it's highest about 5 hours after eating and then it

goes down steadily after that. Then it's time to start over again. I have

gone the whole route of testing every 15 minutes all day just to see exactly

when and why my blood sugar reacted to different types of foods and how long

it took for the insulin to actually take effect. I always take my insulin

30 minutes before breakfast and 30 minutes before dinner along with my 5 mgs

of glipizide. My blood sugar rarely ever goes above 130. I know that

different people react to foods and/or medications differently and at

different rates. My body has a slow absorption rate and even when I was 16

years old I had a tetanus shot which took exactly 2 weeks before the

reaction set in. I almost died and was in the bed for 6 weeks unable to

walk. I could only swallow small amounts of liquids at a time. It caused

my heart to become enlarged to 3 times it's normal size. The same thing

happened after back surgery. It took 2 weeks before the severe reaction

started. I was in the hospital 3 times just because of the papaya

injections into my back to dissolve the crushed disks. It was very bad.

So, my point is that YMMV. I say that NPH is working with me. My doctor

can't believe how great my numbers are but I have proof in my diary which I

take to him each time. I try to stay below 50 carbs each day but sometimes

" goof off " just a little and may have up to 100. I call myself going " low

carb " but sometimes it's in the medium range. I eat nothing white. I ate

my first baked potatoes in 2 years a couple of weeks ago along with some

fried shrimp when I went to Galveston. Now who could possibly resist when

they are looking out at that beautiful gulf watching the waves coming in. I

was extremely cautious of what I ate the rest of the day and by bedtime

everything was back to normal.

Love to all,

Tootie

P.S. I try to eat at 8:00 A.M., 1:00 P.M. and 7:00 P.M. When I'm on that

schedule I don't feel the need to have any snacks in between. I think the

snacks is what gets us in trouble.

My Groups | diabetes_int Main Page | Start a new group!

Carolyn Kaminski wrote:

<< Well gang it's me again and I am pleased to report that the numbers are

dropping. >>

So often I'll hear diabetics report problems such as spikes, hypos, etc.,

and we'll say you probably need to adjust your insulin, and they go, " The

doctor hasn't ordered it, and I can't get in to see him for awhile " or

similar. Diabetes is *your* disease ... you choose to eat wisely, you

count

the carbs and match your insulin to your carbs. It's really important for

people to understand not only the dosing but the timing. I hope all of you

visit Eli Lilly's site to study their action graphs, even if you're not on

insulin: http://www.humulinpen.com/02-products/tap.html (just lie and

say

you're from the US)

Okay ... I study the peak action of NPH, and it seems to me that if that

is

the insulin the *patient* (not the doctor or his/her assistant) actually

prefers for some reason, then the only way to get good results is to shoot

once a day, and eat once, two or three hours later. But if a patient is

low-carbing, why use NPH? I guess that's my real question. Why would any

patient choose to continue using a " peaky insulin " when she's having such

crappy results with it? Carolyn, isn't the problem the NPH? And isn't

another problem that you're " waiting for your doctor to fix you, " rather

than grabbing hold of this monster and punching it in the face?

Look at the various insulins ... count the hours in them ... imagine

eating

meals, and the carbs in them kicking in 1-2 hours after you eat ... allow

time to sleep ... I'd like to have a good discussion about insulin types

and

dosing.

Susie

Public website for Diabetes International:

http://www.msteri.com/diabetes-info/diabetes_int

[Guest guest]

Barb, thanks for that post. It's a keeper! I have been mulling over Eli

Lilly's shocking statement on their web site that patients aren't getting

better numbers on H than on their other insulins, and then it hit me it's

because they're not encouraging improved control via low-carbing. Their

patients are still rollercoastering because Lilly is not going to promote an

approach that you could call " anti-insulin " - a product that makes them so

much money.

Susie

[Guest guest]

Tootie wrote:

<< I always take my insulin 30 minutes before breakfast and 30 minutes

before dinner along with my 5 mgs

of glipizide. >>

That was interesting, Tootie. But nowhere in your discussion did you account

for the action of the Glipizide. Your NPH shouldn't be having a double-peak.

The one at seven hours sounds like the NPH. Different people react

differently, but the Lilly chart shows it peaking at 4-7 hours for most

users. I don't know if you're on extended release or immediate release.

Immediate release Glipizide is taken 30 minutes before a meal. Diabetes

control is a moving target. As you continue using the Glipizide, there is a

strong chance your pancreas will continue deteriorating from overdriving it.

I imagine you and your doctor have discussed your weaning yourself from the

Glipizide, in light of all the discussion of it in this group.

Susie

[Guest guest]

>the stress of modern life is a major factor in our disease level.

Eliminating stress would be a great releif for many of us but sometimes that

is just not possible.

> under the house

now that would definitely stress me out big time

too many echy bugs! definitely stressful

Carolyn

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[Guest guest]

In a message dated 00-09-02 13:08:52 EDT, you write:

<<

As Susie said, this is a self managed disease, and we must do what works

best for us - not what non diabetic doctors think might be safe and

conservative for us. >>

As another on this list using insulin (I think Barb was referring to me in

her post) my experience has also been better control with insulin (but I'm

still tweaking). Everything she said was right on the button -- you just

need to make tiny incremental steps and keep good records and keep your doc

posted on how and what you're doing. Of course it helps to have a

supportive doctor. I'd go so far as to say if yours isn't, time to change if

at all possible.

The latest " tweak " I'm tweaking is testing to see if I now need to dose

separately for protein. When I started insulin I seemed to have enough beta

cells left to cover that action but things (again) have changed on me and

we're trying to find out why. I'm not taking any pills at all now -- I've

been totally off Glucophage for about six weeks, I think. The protein test

will consist of an all-meat meal with hourly testing until its action is

finished (I think eight hours is the operative number). If have to dose for

protein it will mean adding R to my insulin regime, if I recall correctly. (I

already take U for basal, H for meals). Vicki, now (almost) type 1...

[Guest guest]

Tootie, you're the first person I' ve read about on this list who has peak at

5 hours. I'm also having this problem (see earlier posts) and Ive been

wondering if it's gastroparesis but I have absolutely no symptoms of it. I

eat a really big meal - usally 5-7 ounces of meat, chicken, fish, 2 veggies,

a salad, even about 30 grams of nuts (trying to keep weight up) but

absolutely no feeling of fullness or belching. Could this just be due to

body's slow absorption rate? Do you have symptoms of gastroparesis? (I know

you have multidinous other problems)...even though I take H insulin for

meals, it doesn't kick in until 25 minutes, not the usual 15...could this be

another manifestation of slow absorption rate and not gastro? Vicki

In a message dated 00-09-02 13:41:43 EDT, you write:

<< My BG will be at it's highest about 5 hours after eating and then it

goes down steadily after that. Then it's time to start over again. I have

gone the whole route of testing every 15 minutes all day just to see exactly

when and why my blood sugar reacted to different types of foods and how long

it took for the insulin to actually take effect. I always take my insulin

30 minutes before breakfast and 30 minutes before dinner along with my 5 mgs

of glipizide. My blood sugar rarely ever goes above 130. I know that

different people react to foods and/or medications differently and at

different rates. My body has a slow absorption rate >>

[Guest guest]

In a message dated 00-09-02 22:01:09 EDT, you write:

<< Just a thought, but wouldn't it be nice if we could plug ourselves into a

computer some how at the beginning and end of each day and let it figure out

what our body is doing and what to " fix it with " .

>>

Boy, don't I wish! For me, a math impaired person, the absolutely worst

thing about diabetes is the constant and necessary calculations that have to

be made. However, Ron Sebol has designed a computer program for me where I

input all the nutritional information, portion size, etc. and it does spit

back the amount of insulin to take. However, my baseline figures are

constantly changing so we haven't got it quite right yet. (And we've been

working on it for nearly six months now!) Vicki