Re: Protein, the test

February 16, 2001

In a message dated 2/16/01 10:33:50 AM Pacific Standard Time,

fencible@... writes:

> drmarion12@... wrote:

> >

> > Wait.....If Dave doesn't know why he has a hgh f.b.g, how can he keep

> > increasing the NPH. It may be that dinner wasn't covered properly. Also

> a

> > low in the 3.a.m. time may cause a rebound.

>

> I eat dinner early, around 5pm. I did have a snack of an apple at 9pm

> but that was all until 8am, when it was 139. I have been doing good and

> it's been between 97-114 in the morning, but all of a sudden 139. I

> tested three times and it was within one point.

>

> I wanted to test at 3pm and figured I'd be up, but nope.. got up at 2,

> thought it was too early, and then didn't get up until 5 and went back

> to bed. Felt fine both times so I didn't test.

>

> >

> > I think it is prudent to wait and check content of dinner and try to cover

> > dinner with correct insulin and then see if the basal dose is correct.

>

> I think that is maybe the problem. I am not covering any meals with

> insulin. I'm on Glucophage, and only NPH at bedtime to try to get the

> morning readings down. I see the doc next month and I'll see if she will

> let me cover meals with H or R. (give me a prescription).

>

> >

> > When I got Gabe''s dinner insulin somewhat right, his basal need dropped

> from

> > 10.5U to 7.5U at bedtime. That is a big drop for a 67 pound kid.

>

> It is.

>

> >

> > Be careful with the NPH. It is better to use a little H to lower 139 in

> the

> > a.m. than take a chance of a severe hypo in the a.m. with too much NPH.

> If

> > you got 118 one day, you can see that you are taking close to enough NPH.

>

> Agree. I wish I had some H. I got a free coupon from Lilley, but you

> need a prescription so I'll have to wait to see the doc.

>

> > Something else was causing the 139. ALSO THERE IS RANDOM VARIATION OF

> 25% in

> > each shot's effectiveness. 139 could be 25% more or 25% less with the

> same

> > shot.

>

> I didn't know that. I always use the abdomen to inject.

>

> >

> > Just raising the basal insulin without looking at the big picture, I

> think is

> > dangerous.

> > It almost killed Gabe.

>

> I've got a couple of pounds on him so I think I am not quite as much at

> risk.

>

> This is really teeing me off. Just when I think I've nailed it.. powie!

>

> --

> Dave - 1:27:48 PM

> T2 - 8/98 Glucophage, NPH

> -

The shot variation is between shots even injected at the same site at the

same time of day. It has to do with absorption.

CALL THE DARN DOCTOR. That is what they are for. Explain that you want to

try using H. Boy, those doctors have us all bamboozled. You will be

surprised that you are thinking more about your b.g. than she is.

n

February 16, 2001

In a message dated 2/16/01 10:38:10 AM Pacific Standard Time,

fencible@... writes:

> My bedtime is at least 6 hours after dinner. It's funny but it's almost

> as if the 18u had absolutely no effect on me, where it had been working.

>

> I have been waiting 2-3 days before increasing by 2u.

>

> --

> Dave - 1:33:48 PM

> T2 - 8/98 Glucophage, NPH

> ;

I don't think raising every 2 days is safe. It simply takes longer than that

to see what is real and what is random. An 18 unit injection can be off by

25% and that is a lot of b.g. points.

Does your doctor want you to adjust every two days???

n

February 16, 2001

Dave;

Gabe had a normal reading and ate a small snack last night. I covered it

with H (plenty to cover a small snack). He was 140 at bedtime. I checked

him at 1 a.m and he was 114. He normally doesn't eat a bedtime snack, so I

was worried about the 2H being too much. This a.m. was 217!!!. The H

worked, but finished before even a small snack was digested. THe snack

probably showed up in the b.g. in the early morning hours when only basal (U)

was present to cover and basal cannot cover food.

My guess is that some of your food is showing up in the a.m. as a slight

elevation in b.g. The difference between 114 and 139 is very easily

explained as RANDOM ERROR. Please be careful. The a.m. hypo is much more

dangeres than 25 b.g. points.

Have you done a fasting test to know how much one unit of NPH lowers your

sugar? If not, then how are you deciding how much NPH to take?

I am worried about you because you sound like me...before Ron beat me over

the head with how dangerous my behavior was; only the hypos are really

dangerous immediately; the high sugars require investigation, and patience

and analysis; you cannot make changes every day or two for high sugars of 25

points.

Stop changing the U and write down everything you eat for dinner and bedtime

snack. Also record exercise and any other factors like a slight headache or

sore throat or any other thing that would cause an elevation. Especially pay

attention to the amount of fat, fiber and protein as well as carbs in your

dinner. A small bag of peanuts will make a major mess in Gabes bedtime b.g.

, not from the carbs but from the fiber and fat. He can eat the same peanuts

at breakfast and lunch with NO PROMBELMO.

Honest......don't keep raising that NPH for now. Also, consider a fasting

test to see how the NPH works per unit at night.

n

February 16, 2001

In a message dated 2/16/01 10:46:19 AM Pacific Standard Time,

fencible@... writes:

> drmarion12@... wrote:

> >

> > Re 139 bedtime and 142 a.m. I am confused what is wrong with these

> numbers.

> > The purpose of basal insulin is to keep the bedtime and fasting numbers

> the

> > same, which it did. 139 and 142 are the same; just meter variation.

>

> I agree that they are not " high " , but I'm looking for non-diabetic

> numbers.

>

> >

> > Are you using NPH to get numbers down or as a basal?

>

> As a basal (overnight) for dawn syndrome.

>

> >

> > Also, doesn't the f.b.g. depend on what you ate for dinner and what time

> you

> > ate dinner?

>

> We always eat at 5 or just before, but I really don't know if the fbg

> depends on that, and whatever I might have for a snack at night.

>

> >

> > Also, where do you account for the random variation of each shot which I

> am

> > told can be up to 25%.

>

> That's the part I've never heard of and so never accounted for it.

>

> --

> Dave - 1:39:48 PM

> T2 - 8/98 Glucophage, NPH

> -

> Davors Daily Aphorism:

> When in doubt, think.

> --

>

118 is not a nondiabetic number either. I don't know what your C-peptide

test was but do you still have significant beta cell function that would

allow " nondiabetic " numbers without premeal insulin?? You have to know that.

Did you have the doctor do a C-peptide? It will tell you how much insulin

you are producing. If your beta cells declined or are declining, then you

can't manage with just NPH.

The difference between 139 and 118 does not make a " nondiabetic " versus

" diabetic " number, Dave. Nondiabetic's rarely have a f.b.g above 90 and I

don't believe you will achieve that with NPH alone.

n

February 16, 2001

>I just don't understand the sudden change in the insulin not working.

Well, let's see here... It could just be that your body is changing, things

aren't working as well, normal aging stuff (sorry!), and your pancreas isn't

working as well as it was. You could try a little H before your meals,

Dave, I would imagine this would help ALOT. It'll help the pp spikes, and

without those, your numbers would be better. This is all I can think of.

And you can keep upping your N by 2 units every few nights.

Barb

--------

February 16, 2001

>I've been upping the N until I got to 18u. Maybe I should go higher, but

>that seems like a lot. I'll ask the doc about the H, might help.

***Dave, there are some insulin resistant folks taking 100's of units of

background insulin. Please don't go by what some of us who aren't insulin

resistant are taking. Just keep increasing it until it works.

Barb

--------

February 16, 2001

Rainbow Farm wrote:

>

> The things I do for diabetes! I wound up eating late, so I had to set the

alarm and wake up to check most of these readings. Dinner consisted of 8 carbs

(1 pkg. asparagus) and 50 g protein (.60# shrimp) and decaf green tea.

>

> BG TIME

>

> 120 predinner, 1 unit H 8:00 pm

> 119 1/2 hr after 8:45

> 155 1 hour after 9:45

> 147 2 hours after 10:45

> 139 3 hours after 11:45

>

> 77 fasting bg 6:00 am

>

> Notes and thoughts: Normally I eat dinner earlier. But it doesn't look to me

like I need to be dosing for protein with R, rather with H, if anything, OR eat

less for dinner, and have a protein snack before bed. I'm also going to tinker

a bit with my morning and evening U. I like good control, but I don't like

fbg's so low in the morning. It doesn't leave much room for error.

>

> I'm also thinking that I could probably go back to Glucophage now, but I

really like the fine tuned control I get with insulin, and it's something that's

natural to my body anyway, rather than a drug. I'm also pretty sure I could

maintain on very low carb, diet and exercise alone, and don't want to :-)

>

Not bad, but I'm surprised what you ate even made them move that much.

I'm between a rock and a hard place now. I've been taking NPH at

bedtime, steadily increasing it to get my fbg down. Got it down to 97,

and it has steadily increased. At 18u, it was holding at around 114 in

the AM, but this morning it was 139!! And it was 142 at bedtime.

It's almost like the insulin has stopped being effective and I'm

wondering if I contaminated it by using the same syringe 4 times or

more. I had high hopes for this insulin to work, but it seems to have

worked, and then stopped working.

--

Dave - 8:54:40 AM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

If you can't dazzle them with brilliance, riddle them with

bullets

--

Visit my HomePage:

February 16, 2001

n, to whom is this directed? It would sure help if you could quote a

little of the specific email to which you are responding.

TIA

Barb

--------

> Re 139 bedtime and 142 a.m. I am confused what is wrong with these

numbers.

> The purpose of basal insulin is to keep the bedtime and fasting numbers

the

> same, which it did. 139 and 142 are the same; just meter variation.

>

> Are you using NPH to get numbers down or as a basal?

>

> Also, doesn't the f.b.g. depend on what you ate for dinner and what time

you

> ate dinner?

>

> Also, where do you account for the random variation of each shot which I

am

> told can be up to 25%.

February 16, 2001

Rainbow Farm wrote:

>

> > I'm between a rock and a hard place now. I've been taking NPH at

> > bedtime, steadily increasing it to get my fbg down. Got it down to 97,

> > and it has steadily increased. At 18u, it was holding at around 114 in

> > the AM, but this morning it was 139!! And it was 142 at bedtime.

> >

> > It's almost like the insulin has stopped being effective and I'm

> > wondering if I contaminated it by using the same syringe 4 times or

> > more. I had high hopes for this insulin to work, but it seems to have

> > worked, and then stopped working.

>

> ****Hm-m-m-m. Dave, I use one syringe and needle for a day or two, so I

> doubt that's the problem. If you are overweight (don't remember), you are

> probably insulin resistant, and many insulin resistant folks have to take a

> lot of insulin. Is there any way you could lower your carbs at dinner for

> awhile, to see what happens?

oh yes, I'm insulin resistant for sure.. My numbers have not been bad at

all, and I've been testing a lot.

Yesterday 115 fbg, 97 pre-lunch, had a turkey dinner and 143 two hours

later. 125 at 1 1/2 hour after a turkey sandwich for supper at 6:38,

and then 142 at 10:49pm bedtime. Took 18u and this morning 139!!!

As for overweight, some, 204 when I should be 180 or so.

I just don't understand the sudden change in the insulin not working.

--

Dave - 9:45:42 AM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

It's smart to pick your friends, but not to pieces.

--

Visit my HomePage:

February 16, 2001

Rainbow Farm wrote:

>

> >I just don't understand the sudden change in the insulin not working.

>

> Well, let's see here... It could just be that your body is changing, things

> aren't working as well, normal aging stuff (sorry!), and your pancreas isn't

> working as well as it was. You could try a little H before your meals,

> Dave, I would imagine this would help ALOT. It'll help the pp spikes, and

> without those, your numbers would be better. This is all I can think of.

> And you can keep upping your N by 2 units every few nights.

I've been upping the N until I got to 18u. Maybe I should go higher, but

that seems like a lot. I'll ask the doc about the H, might help.

--

Dave - 11:00:43 AM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

The wise open their minds, but a fool opens his mouth.

--

Visit my HomePage:

February 16, 2001

..> I did have a snack of an apple at 9pm

> but that was all until 8am, when it was 139.

***Dave, this would definitely do it for me. Now I understand. Try a

protein snack, rather than a carb snack - or try no snack.

> This is really teeing me off. Just when I think I've nailed it.. powie

>>Welcome to the wonderful world of trying hard for good control, Dave!

Hehehe

As soon as we get it figured out, something changes. Well, I guess

otherwise we'd get bored??? Look how much time we are spending at this :-)

Barb

--------

February 16, 2001

Rainbow Farm wrote:

>

> >I've been upping the N until I got to 18u. Maybe I should go higher, but

> >that seems like a lot. I'll ask the doc about the H, might help.

>

> ***Dave, there are some insulin resistant folks taking 100's of units of

> background insulin. Please don't go by what some of us who aren't insulin

> resistant are taking. Just keep increasing it until it works.

She started me on 5u at bedtime, and said to keep increasing every

couple of days until I get to where it should be. It got there, and then

started going up again. So, I guess I'll try going to 20u and see what

happens.

I was thinking about splitting dose to morning and night.

--

Dave - 12:03:46 PM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

Marriage is one of the chief causes of divorce.

--

Visit my HomePage:

February 16, 2001

drmarion12@... wrote:

>

> Wait.....If Dave doesn't know why he has a hgh f.b.g, how can he keep

> increasing the NPH. It may be that dinner wasn't covered properly. Also a

> low in the 3.a.m. time may cause a rebound.

I eat dinner early, around 5pm. I did have a snack of an apple at 9pm

but that was all until 8am, when it was 139. I have been doing good and

it's been between 97-114 in the morning, but all of a sudden 139. I

tested three times and it was within one point.

I wanted to test at 3pm and figured I'd be up, but nope.. got up at 2,

thought it was too early, and then didn't get up until 5 and went back

to bed. Felt fine both times so I didn't test.

>

> I think it is prudent to wait and check content of dinner and try to cover

> dinner with correct insulin and then see if the basal dose is correct.

I think that is maybe the problem. I am not covering any meals with

insulin. I'm on Glucophage, and only NPH at bedtime to try to get the

morning readings down. I see the doc next month and I'll see if she will

let me cover meals with H or R. (give me a prescription).

>

> When I got Gabe''s dinner insulin somewhat right, his basal need dropped from

> 10.5U to 7.5U at bedtime. That is a big drop for a 67 pound kid.

It is.

>

> Be careful with the NPH. It is better to use a little H to lower 139 in the

> a.m. than take a chance of a severe hypo in the a.m. with too much NPH. If

> you got 118 one day, you can see that you are taking close to enough NPH.

Agree. I wish I had some H. I got a free coupon from Lilley, but you

need a prescription so I'll have to wait to see the doc.

> Something else was causing the 139. ALSO THERE IS RANDOM VARIATION OF 25% in

> each shot's effectiveness. 139 could be 25% more or 25% less with the same

> shot.

I didn't know that. I always use the abdomen to inject.

>

> Just raising the basal insulin without looking at the big picture, I think is

> dangerous.

> It almost killed Gabe.

I've got a couple of pounds on him so I think I am not quite as much at

risk.

This is really teeing me off. Just when I think I've nailed it.. powie!

--

Dave - 1:27:48 PM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

.... All the world's a stage, and I missed rehearsal.

--

Visit my HomePage:

February 16, 2001

drmarion12@... wrote:

>

> How long do you wait before you " up " 2 units. I think you are trying to

> control your dinner meal with your bedtime basal (NPH). This is kind of

> dangerous. NPH peaks and it may peak when the glucose from the food is way

> gone.

>

> H at dinner will bring your bedtime to normal. Then you will see that your

> NPH is way too high, so be very careful.......If you get a normal b.g. at

> bedtime and take the same dose of NPH, you might hypo in a.m.

>

> n

See previous post where I think I addressed most of this.

My bedtime is at least 6 hours after dinner. It's funny but it's almost

as if the 18u had absolutely no effect on me, where it had been working.

I have been waiting 2-3 days before increasing by 2u.

--

Dave - 1:33:48 PM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

I've taken a vow of poverty. To annoy me, send money.

--

Visit my HomePage:

February 16, 2001

drmarion12@... wrote:

>

> Please explain: " sudden change in insulin not working "

>

> Gabe can eat the same exact meal and same insulin and get a different result.

Really? I thought it was pretty much stable after on insulin. Bummer!

>

> You need at least a week of " not working " to state " not working " . There is a

> great deal of random variation from shot to shot, site to site, time of day,

> prior meal and etc.

Well, the 139 is the highest, and only this morning. I guess I am a

little anxious for it to work right. So you think I should stay where

I'm at for a week? I really have concerns about taking more anyway.

>

> If you start writing down what you ate at dinner, you might find that your

> morning b.g. is more related to the content of dinner than anything else.

I didn't know that.

>

> If Gabe eats fiber or fat in quantities at dinner, it won't digest completely

> and will continue to digest into the middle of the night.

Amazing, I didn't think it would take that long.

>

> I hope you are not making daily insulin adjustments. You really need to

> watch it;

> take it from someone who was and regretted.

No, not daily, every 2-3 days.

>

> If you hypo, you have to make an immediate adjusment. But for highs you need

> to observe for a number of days and then make small adjustments and wait more

> days.

>

> Unless I am totally misunderstanding your message, which is always possible.

No, you seem to have understood what I was saying. I don't think I've

come close to a hypo yet, but I need that 3am test. I did it once, but

that was back around 8u, not the 18u I'm taking now.

>

--

Dave - 1:36:48 PM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

If it's stupid and works, then it ain't stupid

--

Visit my HomePage:

February 16, 2001

drmarion12@... wrote:

>

> Re 139 bedtime and 142 a.m. I am confused what is wrong with these numbers.

> The purpose of basal insulin is to keep the bedtime and fasting numbers the

> same, which it did. 139 and 142 are the same; just meter variation.

I agree that they are not " high " , but I'm looking for non-diabetic

numbers.

>

> Are you using NPH to get numbers down or as a basal?

As a basal (overnight) for dawn syndrome.

>

> Also, doesn't the f.b.g. depend on what you ate for dinner and what time you

> ate dinner?

We always eat at 5 or just before, but I really don't know if the fbg

depends on that, and whatever I might have for a snack at night.

>

> Also, where do you account for the random variation of each shot which I am

> told can be up to 25%.

That's the part I've never heard of and so never accounted for it.

--

Dave - 1:39:48 PM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

When in doubt, think.

--

Visit my HomePage:

February 17, 2001

Carol wrote:

<< I only ordered 2lbs of walnuts, guess I won't need as much insulin as

Dave <g> >>

But walnuts are very high-fat, so you'll need to do more " penance " on the

treadmill.

And Dave wrote:

<< Ha.. bulk is the only way to buy them! No more 3.99 for 6oz. >>

I really appreciate the info on the reasonably-priced nuts, Dave. But I

notice that some bulk items, e.g., things in some health food stores, don't

have nutritional labels. And I'm forever harping about us getting into bad

habits such as not giving carbs, fats and calories proper consideration when

the foods are not labeled.

Imagine how it was for our parents and grandparents, dealing with diabetes

when there were no nutritional labels.

Susie

February 17, 2001

Behave yourself, Dave! You're being naughty. <g> Get a grip, man!! LOL!

Teri

Re: Protein, the test

" Susie M. " wrote:

In fact, I had to forsake nearly everything in the

> store other than the flaxseed and nuts. It's no wonder we struggle so hard

> for good control ... even " health foods " are chock-full of things which

> spike us.

>

Yeah, but it's soooooo good!

--

Dave - 12:03:01 PM

T2 - 8/98 Glucophage, NPH

-

Davors Daily Aphorism:

All generalizations are bad.

--

Visit my HomePage: