Re: Regulating 's blood sugar

May 15, 2005

Marvin, you are absolutely

right. I am torn between my doctor who tells me to take humalog four at each

meal and add the sliding scale depending on the reading. Harry is trying to

help me do it right.

normally I take four units at a meal. and the sliding scale is if the

reading is six to eight take one extra, eight to ten take two extra, ten to

twelve take three extra as so on every two units take one extra unit of

humalog.

it was so difficult to get a doctor that knew anything about diabetes in

this town. I do not want to offend him, I really need his help but I am

going to half to educate him. I feel like I am walking a fine line her. any

comments you have are welcomed. thanks,

Re: Regulating

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>> 's

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>> blood

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>> sugar

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> harry, i just did my nine p m reading

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> b s four point six

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> lantus eight

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> my husband would not help me lessen this

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> amount.

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> he

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> feels

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> i

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> am

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> trying

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> to

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> fine tune this too much. well, yes, of

> course

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> i

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> am.

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> he

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> sometimes

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> takes

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> a

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> while to accept thing. karen

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>> >>>>>>>>>>>>>>>>>>>>>>>>>>>>

May 15, 2005

harry, o k i am back from the weekend and ready to get on track. i think i

am missing something in my understanding of how you do the insulin dose so

lets start from scratch please.

Sunday pre supper b s

6.7

humalog four

carbs 4 regular soda cracker with cheese seven point three with chicken

broth one cup

karen

Regulating 's blood sugar

>>>

>>> ,

>>> Your mail delivery system still marks me as being a spammer, and it

>>> rejects

>>> all the replies I send to your messages. This mnakes it very difficult

>>> to

>>> try to help you regulate your insulin dose from meal to meal and day to

>>> day.

>>> As a general rule, I am only able to send one reply to a single message

>>> from

>>> you. If I try to send two messages to the same message it is classified

>>> as

>>> spam by your mail delivery system and subsequent messages for that day

>>> are

>>> also undelivered or rejected as being spam. Instead of doing it

>>> privately,

>>> I suggest we do it publicly on this list serve, and this would make

>>> interchange of messages go faster and more smoothly. It would also

>>> provide

>>> fellow list members to see what we are doing.

>>>

May 16, 2005

How many grams of carbs was that?

Regulating 's blood sugar

>>>>

>>>> ,

>>>> Your mail delivery system still marks me as being a spammer, and it

>>>> rejects

>>>> all the replies I send to your messages. This mnakes it very difficult

>>>> to

>>>> try to help you regulate your insulin dose from meal to meal and day to

>>>> day.

>>>> As a general rule, I am only able to send one reply to a single message

>>>> from

>>>> you. If I try to send two messages to the same message it is

>>>> classified

>>>> as

>>>> spam by your mail delivery system and subsequent messages for that day

>>>> are

>>>> also undelivered or rejected as being spam. Instead of doing it

>>>> privately,

>>>> I suggest we do it publicly on this list serve, and this would make

>>>> interchange of messages go faster and more smoothly. It would also

>>>> provide

>>>> fellow list members to see what we are doing.

>>>>

May 16, 2005

Harry, i would like to resend as follows.

Sunday pre supper b s

6.7

humalog four

carbs 4 regular soda cracker with cheese seven point three with chicken

broth one cup

two sugar free chocolates, ten carbs, total seventeen carbs

nine p m evening b s five point nine

one piece licorice, nine carbs

lantus eight

karen

Regulating 's blood sugar

>>>>>

>>>>> ,

>>>>> Your mail delivery system still marks me as being a spammer, and it

>>>>> rejects

>>>>> all the replies I send to your messages. This mnakes it very

>>>>> difficult

>>>>> to

>>>>> try to help you regulate your insulin dose from meal to meal and day

>>>>> to

>>>>> day.

>>>>> As a general rule, I am only able to send one reply to a single

>>>>> message

>>>>> from

>>>>> you. If I try to send two messages to the same message it is

>>>>> classified

>>>>> as

>>>>> spam by your mail delivery system and subsequent messages for that day

>>>>> are

>>>>> also undelivered or rejected as being spam. Instead of doing it

>>>>> privately,

>>>>> I suggest we do it publicly on this list serve, and this would make

>>>>> interchange of messages go faster and more smoothly. It would also

>>>>> provide

>>>>> fellow list members to see what we are doing.

>>>>>

May 16, 2005

Monday may 16

Pre breakfast b s five point four

Humalog four

Carbs, dry fiber cereal with milk, thirty carbs

Re: Regulating 's blood sugar

>>>

>>>> harry, i just did my nine p m reading

>>>> b s four point six

>>>> lantus eight

>>>> my husband would not help me lessen this amount. he feels i am trying

>>>> to

>>>> fine tune this too much. well, yes, of course i am. he sometimes takes

>>>> a

>>>> while to accept thing. karen

>>>>

>>>

May 16, 2005

Congratulations on having a good fasting bs today! Humalog 4 and 30 grams

of carbs is a 1:7.5 ratio.

Re: Regulating 's blood sugar

>

> Monday may 16

>

> Pre breakfast b s five point four

>

> Humalog four

>

> Carbs, dry fiber cereal with milk, thirty carbs

>

May 16, 2005

The most important person to trust in this process is . Following the

data in your charting and dosing accordingly to the bs and the carb grams

consumed will convince you of who is the best judge of your body. It will

also provide you with flexibility on carb consumption and insulin dosing.

This is why it is so important to master the ratio rule.

Re: Regulating 's blood sugar

>

>> :

>>

>> This is none of my business, but I am very curious how you are currently

>> calculating the amount of humalog that you are taking with your meal. I

>> assume that you have a target blood sugar reading, let us say 100 - which

>> would be 5.5 under your system. Therefore, you would take enough humalog

>> to

>> cover your current meal carbs. In addition, your humalog would be

>> adjusted

>> for a beginning reading higher or lower than your target blood sugar

>> goal.

>> This is the way I try to do it, sometimes more successfully than others.

>> I

>> do not see a pattern like this and I am just curious how you are

>> approaching

>> the issue. Again, this is none of my business, so feel free to ignore my

>> intrusion. I look forward to continuing to be educated.

>>

>> Marvin

>>

May 16, 2005

harry

Pre lunch b s ten point six

Humalog six

Lunch two slice low carb bread, eight carbs each, two eggs and two weiners

fried

Total twenty carbs

i could not find the weiner on the carb file. i know eggs are two eggs one

carb?

karen

Re: Regulating 's blood sugar

>>

>>> :

>>>

>>> This is none of my business, but I am very curious how you are currently

>>> calculating the amount of humalog that you are taking with your meal. I

>>> assume that you have a target blood sugar reading, let us say 100 -

>>> which

>>> would be 5.5 under your system. Therefore, you would take enough

>>> humalog

>>> to

>>> cover your current meal carbs. In addition, your humalog would be

>>> adjusted

>>> for a beginning reading higher or lower than your target blood sugar

>>> goal.

>>> This is the way I try to do it, sometimes more successfully than others.

>>> I

>>> do not see a pattern like this and I am just curious how you are

>>> approaching

>>> the issue. Again, this is none of my business, so feel free to ignore

>>> my

>>> intrusion. I look forward to continuing to be educated.

>>>

>>> Marvin

>>>

>

May 16, 2005

harry, what is the ratio rule? karen

Re: Regulating 's blood sugar

>>

>>> :

>>>

>>> This is none of my business, but I am very curious how you are currently

>>> calculating the amount of humalog that you are taking with your meal. I

>>> assume that you have a target blood sugar reading, let us say 100 -

>>> which

>>> would be 5.5 under your system. Therefore, you would take enough

>>> humalog

>>> to

>>> cover your current meal carbs. In addition, your humalog would be

>>> adjusted

>>> for a beginning reading higher or lower than your target blood sugar

>>> goal.

>>> This is the way I try to do it, sometimes more successfully than others.

>>> I

>>> do not see a pattern like this and I am just curious how you are

>>> approaching

>>> the issue. Again, this is none of my business, so feel free to ignore

>>> my

>>> intrusion. I look forward to continuing to be educated.

>>>

>>> Marvin

>>>

>

May 16, 2005

One thing we know for sure. A 1:7.5 ratio always raises your bs reading

several mole points. It would be wise for you to figure out just how many

mole points we are talking about here, just in case you need to raise your

bs these several mole points. Now that you have dosed 6 units of humalog

for 20 grams of carbs, you will be able to see how many mole points are

decreased by a 1:3.66 ratio which is the ratio for Humalog 6 and 20 grams of

carbs.

Re: Regulating 's blood sugar

> harry

>

> Pre lunch b s ten point six

>

> Humalog six

>

> Lunch two slice low carb bread, eight carbs each, two eggs and two weiners

> fried

>

> Total twenty carbs

>

> i could not find the weiner on the carb file. i know eggs are two eggs one

> carb?

>

> karen

>

May 16, 2005

harry

Two hours after lunch b s eight point two

i will be busy for the rest of the afternoon as i have help coming to help

me organize products in one room of the house. signing off for now, karen

Re: Regulating 's blood sugar

>

>> harry

>>

>> Pre lunch b s ten point six

>>

>> Humalog six

>>

>> Lunch two slice low carb bread, eight carbs each, two eggs and two

>> weiners

>> fried

>>

>> Total twenty carbs

>>

>> i could not find the weiner on the carb file. i know eggs are two eggs

>> one

>> carb?

>>

>> karen

>>

>

May 16, 2005

I am glad you asked. I don't believe I have ever stated it as a rule, but

maybe I should have. I outlined the use of the ratio use in my article

Diabetic Doter. It might be helpful for you to reread that article several

times, which I do every week. I am always revising the article, so maybe

now I should try to state it as a rule and include the rule in the article.

Remember when trying to use a ratio short-acting insulin, one must be aware

that it is a balancing act in conjunction with a basal long acting insulin

like Lantus. The key to using the ratio is to know how one affects the

other under varying conditions and circumstances, but only three things are

consistently under your control. I think I should have said four things are

consistently under your control, but the latter one has only been mentioned

once, I believe, in a previous message to the list serve. These things are:

grams of carb consumption, dosage of short-acting insulin like Humalog,

dosage of long-acting insulin like Lantus and exercise. I will talk no

further about exercise in this message, but will talk more about it later in

a seperate message to the list serve. Consistency is the key to mastering

the ratio rule. You can consistently use the same units of Lantus. You can

consistently use the same units of Humalog. You can consistently eat the

same number of grams of carbs. Usually, by doing these three things

consistently at each meal and every day for a few days, one can tell how the

dose of Humalog in a fixed ratio to carbs consumed affects the two hour post

prandial bs reading. Then the insulin dosages can be adjusted accordingly

to see how it works. This may involve adjusting both types of insulin used

both the long-acting insulin and the short-acting insulin. Charting the use

and results will show you a clear picture of what is going on. Of course

this assumes that the individual diabetic is in charge of his/her charting,

dosing of short-acting insulin and dosing of long-acting insulin, as well as

the number of grams of carbs consumed at each meal. Doing this for a few

days can usually yield the prescribed dosage and carb consumption required

to be close to your target goal, which Marvin pointed out would be a good

idea. Being consistently inconsistent at the use of the parameters

mentioned above will assure a long time needed in order to figure it all

out. So do this consistently. Set your target goal. Marvin suggested a

5.5 mole reading, which is a good start. I would prefer a 5.3, simply

because this half way between the range of 6.6 moles and 4.0 moles, which

are close to the outter limits of the normal blood glucose level

measurements. Remember we try to stay within the normal range when dosing

Humalog. In your case this would give you a target variability of 1.3

moles. In USA measurements this would bve a variability of 23 points. When

you can stay within the range of variability of your target goal the vast

majority of the time, you can then consider yourself a master at blood

glucose level control. Personally, I would guess that I achieve this over

90% of the time. This statement is also borne out by my past two A1C

readings of 5.3. So I urge you to be consistent, especially about carb

consumption and Humalog dosage. Dr. Bernstein recommends starting out with

a 1:15 ratio, which would be 1 unit of Humalog for 15 grams of carbs

consumed. From there you work up using more insulin for the 15 grams of

carbs consumed, until the correct dose of Humalog has been determined. This

means keeping the grams of carbs consumed the same and only changing the

dose of Humalog, and not changing both. When you change both, you also

automatically change the ratios being considered. Only once you have

mastered the use of one ratio is it recommended to change both the carbs

consumed and the dose of short-acting insulin to handle them. So do

yourself a favor and consistently consume 15, 16, 17, 18, 19, 20 and so on

grams of carbs per meal until you have mastered your dose of Humalog. Pick

one of these number of grams of carbs that is comfortable for you and stick

with it. I will point out, however, that if you consistently use 4 units of

Humalog do deal with this 15 grams of carbs consumed, you will consistently

run very low or even lower bs readings in or near the danger zone from what

I am able to tell so far from your posts here. So you will have to learn to

trust what you see in your charting or trust your doctor. ly, I would

rather trust you.

Re: Regulating 's blood sugar

>>>

>>>> :

>>>>

>>>> This is none of my business, but I am very curious how you are

>>>> currently

>>>> calculating the amount of humalog that you are taking with your meal.

>>>> I

>>>> assume that you have a target blood sugar reading, let us say 100 -

>>>> which

>>>> would be 5.5 under your system. Therefore, you would take enough

>>>> humalog

>>>> to

>>>> cover your current meal carbs. In addition, your humalog would be

>>>> adjusted

>>>> for a beginning reading higher or lower than your target blood sugar

>>>> goal.

>>>> This is the way I try to do it, sometimes more successfully than

>>>> others.

>>>> I

>>>> do not see a pattern like this and I am just curious how you are

>>>> approaching

>>>> the issue. Again, this is none of my business, so feel free to ignore

>>>> my

>>>> intrusion. I look forward to continuing to be educated.

>>>>

>>>> Marvin

>>>>

>>

May 17, 2005

harry

Pre supper b s three point two

Supper soup and cracker total carbs forty five

Humalog five

Nine p m evening b s six point nine

Piece of cheese

Lantus eight

karen

Re: Regulating 's blood sugar

>>>>

>>>>> :

>>>>>

>>>>> This is none of my business, but I am very curious how you are

>>>>> currently

>>>>> calculating the amount of humalog that you are taking with your meal.

>>>>> I

>>>>> assume that you have a target blood sugar reading, let us say 100 -

>>>>> which

>>>>> would be 5.5 under your system. Therefore, you would take enough

>>>>> humalog

>>>>> to

>>>>> cover your current meal carbs. In addition, your humalog would be

>>>>> adjusted

>>>>> for a beginning reading higher or lower than your target blood sugar

>>>>> goal.

>>>>> This is the way I try to do it, sometimes more successfully than

>>>>> others.

>>>>> I

>>>>> do not see a pattern like this and I am just curious how you are

>>>>> approaching

>>>>> the issue. Again, this is none of my business, so feel free to ignore

>>>>> my

>>>>> intrusion. I look forward to continuing to be educated.

>>>>>

>>>>> Marvin

>>>>>

>>>

May 17, 2005

Humalog 5 and 45 grams of carbs is a 1:9 ratio. I strongly urge you to

stick to a set number of grams of carbs for each meal for at least a short

while, say a few days. Pick a set number of grams of carbs and stick to

them for every meal. Have your glucose tablets on hand so you can handle

any severe low bs readings, which are caused by overdose of short-acting

insulin. These two precautions are made to you so that you can finally

learn how much Humalog it takes to handle a set number of grams of carbs

consumed. Pick a target goal for your bs reading, and let me know what it

is. Consistency is the key to learning mastery. I know it is boring to do

the same thing over and over, but that is what is required to really know

what is going on inside your body. Inconsistency in carb consumption and

insulin dosage is a guaranteed way to make the mastery of blood glucose

control an interminable event. So do us both a favor and pick a bs target

goal and also tell me a fixed number of grams of carbs you are willing to

pick and stick to until we know what is going on. This means consuming the

same number of grams of carbs for every meal. Try to be within plus or

minus 1 gram of the number of carbs you choose to consume at all times when

talking about a meal. Be sure to count all of the carbs before you eat

them. Here is a rule of numbers for you to remember. Small numbers mean

small mistakes and large numbers mean large mistakes. At present I would

recommend you try using a 1:5 ratio, and let's see what that does for you.

This means if you consume 20 grams of carbvs, you will inject 4 units of

short-actging insulin Humalog. How do you feel about this recommendation?

Are you willing to try it for a while?

Re: Regulating 's blood sugar

>>>>>

>>>>>> :

>>>>>>

>>>>>> This is none of my business, but I am very curious how you are

>>>>>> currently

>>>>>> calculating the amount of humalog that you are taking with your meal.

>>>>>> I

>>>>>> assume that you have a target blood sugar reading, let us say 100 -

>>>>>> which

>>>>>> would be 5.5 under your system. Therefore, you would take enough

>>>>>> humalog

>>>>>> to

>>>>>> cover your current meal carbs. In addition, your humalog would be

>>>>>> adjusted

>>>>>> for a beginning reading higher or lower than your target blood sugar

>>>>>> goal.

>>>>>> This is the way I try to do it, sometimes more successfully than

>>>>>> others.

>>>>>> I

>>>>>> do not see a pattern like this and I am just curious how you are

>>>>>> approaching

>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>> ignore

>>>>>> my

>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>

>>>>>> Marvin

>>>>>>

>>>>

May 17, 2005

harry

Pre supper b s three point two

Supper soup and cracker total carbs forty five

Humalog five

Nine p m evening b s six point nine

Piece of cheese

Lantus eight

harry honestly i feel worse doing this experiments, the only reason i try is

because it was mentioned a brittle diabetic could be none brittle. but i

have less energy and seem to have less quality of life. the low blood

pressure thing gets in the way too. dont give up on me yet. thanks, karen

Re: Regulating 's blood sugar

>>>>>>

>>>>>>> :

>>>>>>>

>>>>>>> This is none of my business, but I am very curious how you are

>>>>>>> currently

>>>>>>> calculating the amount of humalog that you are taking with your

>>>>>>> meal.

>>>>>>> I

>>>>>>> assume that you have a target blood sugar reading, let us say 100 -

>>>>>>> which

>>>>>>> would be 5.5 under your system. Therefore, you would take enough

>>>>>>> humalog

>>>>>>> to

>>>>>>> cover your current meal carbs. In addition, your humalog would be

>>>>>>> adjusted

>>>>>>> for a beginning reading higher or lower than your target blood sugar

>>>>>>> goal.

>>>>>>> This is the way I try to do it, sometimes more successfully than

>>>>>>> others.

>>>>>>> I

>>>>>>> do not see a pattern like this and I am just curious how you are

>>>>>>> approaching

>>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>>> ignore

>>>>>>> my

>>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>>

>>>>>>> Marvin

>>>>>>>

>>>>>

May 17, 2005

Can you pick a target goal for your bs reading? Can you consume a set

number of grams of carbs at each meal? If you can do these two things, I

believe you can finally master blood glucose level control and beat this

brittle diabetic thing. All you have to do is make up your mind to stick to

it for a while until the correct dosage of insulins are discovered. I can

understand why you are feeling bad, because you are playing yoyo with your

blood glucose levels. I can ask you the same thing. Are you giving up on

my recommendations even before you try them or do you wish to follow your

doctor's prescriptions? I seriously doubt his recommendations will ever

lead you to mastery of blood glucose level control.

At least you have learned something about a 1:9 ratio, which is what Humalog

5 units to 45 grams of carbs is. This ratio will raise your bs by 3.7 mole

points, which is equivalent to 67 points in USA readings. To derive the

conclusion mentioned above just subtract 3.2 from 6.9, which yields a

difference of 3.7 mole points. I know very well that learning blood glucose

level mastery is a frustrating endeavor. I never said it is easy, and I

hope you do not think it is or will be either. No effort; no mastery. No

pain; no gain. I signed on for the long haul. One thing you can say about

me is I am not a quitter. When a person refuses to take my recommendations,

all I can do is point out exactly what they are doing. It is human to err.

It is insanity to keep doing over and over the very same thing that causes

one to err. When you fire me, I am out of here. When you no longer want to

play the game of life, just let me know. Until then, I am hanging with you,

because I believe you can learn to trust , not Harry and not your

doctor. is the boss.

Re: Regulating 's blood sugar

>>>>>>>

>>>>>>>> :

>>>>>>>>

>>>>>>>> This is none of my business, but I am very curious how you are

>>>>>>>> currently

>>>>>>>> calculating the amount of humalog that you are taking with your

>>>>>>>> meal.

>>>>>>>> I

>>>>>>>> assume that you have a target blood sugar reading, let us say 100 -

>>>>>>>> which

>>>>>>>> would be 5.5 under your system. Therefore, you would take enough

>>>>>>>> humalog

>>>>>>>> to

>>>>>>>> cover your current meal carbs. In addition, your humalog would be

>>>>>>>> adjusted

>>>>>>>> for a beginning reading higher or lower than your target blood

>>>>>>>> sugar

>>>>>>>> goal.

>>>>>>>> This is the way I try to do it, sometimes more successfully than

>>>>>>>> others.

>>>>>>>> I

>>>>>>>> do not see a pattern like this and I am just curious how you are

>>>>>>>> approaching

>>>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>>>> ignore

>>>>>>>> my

>>>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>>>

>>>>>>>> Marvin

>>>>>>>>

>>>>>>

May 17, 2005

:

Do not beat up on your doctor too much. My internist initially gave me a

similar insulin regimen. I now determine my insulin dosage, in consultation

with my doctor, of course. The last time that I was in Jefferson in

Philadelphia, not a slouch hospital, I had a fight as the resident and GI

doctor wanted to use a static insulin dosage with a sliding scale

adjustment, just like your doctor. They do not have the time to teach you

carb counting during an office visit, assuming they understand carb counting

in the first place. They give you a reasonable static dosage with an

sliding scale adjustment for diet and exercise variations and let it go at

that. Unfortunately for those prescribing a static dose, you do not

normally eat the same amount of carbs at each meal. That is why it does not

work.

You are going to have to learn carb counting on your own.

I hope that you have started a carb log. I keep mine in Excel. I find it

easier to use columns in Excel rather than in Word. My columns are month,

day, meal, food, carbs, blood sugar reading, insulin dosage, and comments.

My wife keeps other info in her blood sugar reading log. This log will show

you the impact of various insulin dosages against your diet. It is very

revealing and you may wish to adapt it to account for exercise and hormonal

issues. You also have data with which you can perform impact calculations.

Good luck!

Marvin

Re: Regulating

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>> 's

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>> blood

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>> sugar

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> harry, i just did my nine p m reading

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> b s four point six

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> lantus eight

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> my husband would not help me lessen this

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> amount.

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> he

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> feels

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> i

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> am

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> trying

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> to

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> fine tune this too much. well, yes, of

> > course

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> i

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> am.

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> he

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> sometimes

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> takes

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> a

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> while to accept thing. karen

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>

> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>

May 18, 2005

marvin, thank you for your assistance. it does seem insane that we have to

educate the professional that should be educating us. karen

Re: Regulating

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>> 's

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>> blood

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>> sugar

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> harry, i just did my nine p m reading

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> b s four point six

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> lantus eight

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> my husband would not help me lessen this

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> amount.

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> he

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> feels

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> i

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> am

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> trying

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> to

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> fine tune this too much. well, yes, of

>> > course

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> i

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> am.

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> he

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> sometimes

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> takes

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> a

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>> while to accept thing. karen

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>> >> >>>>>>>>>>>>>>>>>>>>>>>>>>>>

May 18, 2005

would it be any benefit for you to see a dietitian who might be able

to give you some guidance towards your eating plan to help with your

circumstances.

I was having problems with having a lot of hypo's before bed and then waking

up wit high readings in the morning. Through the day my levels would drop

down and the cycle would start again. Eventually I talked to a educator

about my hypo's and she suggested to see a dietitian.

My whole way of eating changed. I learnt that I was eating too much of some

food and not enough of others. Here in Australia we are all mainly using

the new GI diet which you might not use in your neck of the wood. And it

has greatly improved my levels, weight and my HBA1c is dropping down. I

have another test in a few weeks and hope that

it has dropped further.

from down under

Re: Regulating 's blood sugar

> :

>

> Do not beat up on your doctor too much. My internist initially gave me a

> similar insulin regimen. I now determine my insulin dosage, in

consultation

> with my doctor, of course. The last time that I was in Jefferson in

> Philadelphia, not a slouch hospital, I had a fight as the resident and GI

> doctor wanted to use a static insulin dosage with a sliding scale

> adjustment, just like your doctor. They do not have the time to teach you

> carb counting during an office visit, assuming they understand carb

counting

> in the first place. They give you a reasonable static dosage with an

> sliding scale adjustment for diet and exercise variations and let it go at

> that. Unfortunately for those prescribing a static dose, you do not

> normally eat the same amount of carbs at each meal. That is why it does

not

> work.

>

> You are going to have to learn carb counting on your own.

>

> I hope that you have started a carb log. I keep mine in Excel. I find it

> easier to use columns in Excel rather than in Word. My columns are month,

> day, meal, food, carbs, blood sugar reading, insulin dosage, and comments.

> My wife keeps other info in her blood sugar reading log. This log will

show

> you the impact of various insulin dosages against your diet. It is very

> revealing and you may wish to adapt it to account for exercise and

hormonal

> issues. You also have data with which you can perform impact

calculations.

>

> Good luck!

>

> Marvin

May 18, 2005

harry

Nine p m evening b s three point three

Four soda crackers and cheese carbs twenty

Lantus eight

Wednesday prebreakfast b eighteen point two

Humalog ten

Carbs twenty one, two slice low carb bread with peanut butter and

unsweetened jam

Pre lunch b s three point seven

Humalog three

Carbs sandwich with two slice eight carb bread with thin slice onion and two

weiners, I know the bread is a total of sixteen carbs and the weiners I have

to guess, perhaps you can help me here, I would think a total of twenty one

carbs

karen

Re: Regulating 's blood sugar

>>>>>>>>

>>>>>>>>> :

>>>>>>>>>

>>>>>>>>> This is none of my business, but I am very curious how you are

>>>>>>>>> currently

>>>>>>>>> calculating the amount of humalog that you are taking with your

>>>>>>>>> meal.

>>>>>>>>> I

>>>>>>>>> assume that you have a target blood sugar reading, let us say

>>>>>>>>> 100 -

>>>>>>>>> which

>>>>>>>>> would be 5.5 under your system. Therefore, you would take enough

>>>>>>>>> humalog

>>>>>>>>> to

>>>>>>>>> cover your current meal carbs. In addition, your humalog would be

>>>>>>>>> adjusted

>>>>>>>>> for a beginning reading higher or lower than your target blood

>>>>>>>>> sugar

>>>>>>>>> goal.

>>>>>>>>> This is the way I try to do it, sometimes more successfully than

>>>>>>>>> others.

>>>>>>>>> I

>>>>>>>>> do not see a pattern like this and I am just curious how you are

>>>>>>>>> approaching

>>>>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>>>>> ignore

>>>>>>>>> my

>>>>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>>>>

>>>>>>>>> Marvin

>>>>>>>>>

>>>>>>>

May 18, 2005

> Can you pick a target goal for your bs reading? Can you consume a set

> number of grams of carbs at each meal? I see you are still playing yoyo.

> Humalog 3 and 21 grams of carbs is a 1:7 ratio.

Re: Regulating 's blood sugar

>>>>>>>>>

>>>>>>>>>> :

>>>>>>>>>>

>>>>>>>>>> This is none of my business, but I am very curious how you are

>>>>>>>>>> currently

>>>>>>>>>> calculating the amount of humalog that you are taking with your

>>>>>>>>>> meal.

>>>>>>>>>> I

>>>>>>>>>> assume that you have a target blood sugar reading, let us say

>>>>>>>>>> 100 -

>>>>>>>>>> which

>>>>>>>>>> would be 5.5 under your system. Therefore, you would take enough

>>>>>>>>>> humalog

>>>>>>>>>> to

>>>>>>>>>> cover your current meal carbs. In addition, your humalog would

>>>>>>>>>> be

>>>>>>>>>> adjusted

>>>>>>>>>> for a beginning reading higher or lower than your target blood

>>>>>>>>>> sugar

>>>>>>>>>> goal.

>>>>>>>>>> This is the way I try to do it, sometimes more successfully than

>>>>>>>>>> others.

>>>>>>>>>> I

>>>>>>>>>> do not see a pattern like this and I am just curious how you are

>>>>>>>>>> approaching

>>>>>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>>>>>> ignore

>>>>>>>>>> my

>>>>>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>>>>>

>>>>>>>>>> Marvin

>>>>>>>>>>

>>>>>>>>

May 18, 2005

Extend bars may be helpful in preventing the rebound effect in the morning.

At least that is what they claim it can do in 75% of the cases. If I

continually had trouble with the rebound effect as demonstrates time

after time, I believe it would be at least worth trying for a few days.

Re: Regulating 's blood sugar

>

>> :

>>

>> Do not beat up on your doctor too much. My internist initially gave me a

>> similar insulin regimen. I now determine my insulin dosage, in

> consultation

>> with my doctor, of course. The last time that I was in Jefferson in

>> Philadelphia, not a slouch hospital, I had a fight as the resident and GI

>> doctor wanted to use a static insulin dosage with a sliding scale

>> adjustment, just like your doctor. They do not have the time to teach

>> you

>> carb counting during an office visit, assuming they understand carb

> counting

>> in the first place. They give you a reasonable static dosage with an

>> sliding scale adjustment for diet and exercise variations and let it go

>> at

>> that. Unfortunately for those prescribing a static dose, you do not

>> normally eat the same amount of carbs at each meal. That is why it does

> not

>> work.

>>

>> You are going to have to learn carb counting on your own.

>>

>> I hope that you have started a carb log. I keep mine in Excel. I find

>> it

>> easier to use columns in Excel rather than in Word. My columns are

>> month,

>> day, meal, food, carbs, blood sugar reading, insulin dosage, and

>> comments.

>> My wife keeps other info in her blood sugar reading log. This log will

> show

>> you the impact of various insulin dosages against your diet. It is very

>> revealing and you may wish to adapt it to account for exercise and

> hormonal

>> issues. You also have data with which you can perform impact

> calculations.

>>

>> Good luck!

>>

>> Marvin

>

May 19, 2005

harry

Pre supper b s three point four

Humalog three

Carbs, cut up mixed vegetables with chicken pieces, total carbs twenty five

For the carbs this is an educated guess

harry a one point seven ratio. does this mean that for every seven carbs i

am taking one unit of insulin? we have not decided what the ratio should be

have we? i do not mean to appear stupid but this is still all very new for

me. you are the scientist I am the total unscientific girl. but i am trying,

thanks, karen

Re: Regulating 's blood sugar

>>>>>>>>>>

>>>>>>>>>>> :

>>>>>>>>>>>

>>>>>>>>>>> This is none of my business, but I am very curious how you are

>>>>>>>>>>> currently

>>>>>>>>>>> calculating the amount of humalog that you are taking with your

>>>>>>>>>>> meal.

>>>>>>>>>>> I

>>>>>>>>>>> assume that you have a target blood sugar reading, let us say

>>>>>>>>>>> 100 -

>>>>>>>>>>> which

>>>>>>>>>>> would be 5.5 under your system. Therefore, you would take

>>>>>>>>>>> enough

>>>>>>>>>>> humalog

>>>>>>>>>>> to

>>>>>>>>>>> cover your current meal carbs. In addition, your humalog would

>>>>>>>>>>> be

>>>>>>>>>>> adjusted

>>>>>>>>>>> for a beginning reading higher or lower than your target blood

>>>>>>>>>>> sugar

>>>>>>>>>>> goal.

>>>>>>>>>>> This is the way I try to do it, sometimes more successfully than

>>>>>>>>>>> others.

>>>>>>>>>>> I

>>>>>>>>>>> do not see a pattern like this and I am just curious how you are

>>>>>>>>>>> approaching

>>>>>>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>>>>>>> ignore

>>>>>>>>>>> my

>>>>>>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>>>>>>

>>>>>>>>>>> Marvin

>>>>>>>>>>>

>>>>>>>>>

May 19, 2005

karen, what is this new g i diet? please explain further. thanks, karen

Re: Regulating 's blood sugar

>

>> :

>>

>> Do not beat up on your doctor too much. My internist initially gave me a

>> similar insulin regimen. I now determine my insulin dosage, in

> consultation

>> with my doctor, of course. The last time that I was in Jefferson in

>> Philadelphia, not a slouch hospital, I had a fight as the resident and GI

>> doctor wanted to use a static insulin dosage with a sliding scale

>> adjustment, just like your doctor. They do not have the time to teach

>> you

>> carb counting during an office visit, assuming they understand carb

> counting

>> in the first place. They give you a reasonable static dosage with an

>> sliding scale adjustment for diet and exercise variations and let it go

>> at

>> that. Unfortunately for those prescribing a static dose, you do not

>> normally eat the same amount of carbs at each meal. That is why it does

> not

>> work.

>>

>> You are going to have to learn carb counting on your own.

>>

>> I hope that you have started a carb log. I keep mine in Excel. I find

>> it

>> easier to use columns in Excel rather than in Word. My columns are

>> month,

>> day, meal, food, carbs, blood sugar reading, insulin dosage, and

>> comments.

>> My wife keeps other info in her blood sugar reading log. This log will

> show

>> you the impact of various insulin dosages against your diet. It is very

>> revealing and you may wish to adapt it to account for exercise and

> hormonal

>> issues. You also have data with which you can perform impact

> calculations.

>>

>> Good luck!

>>

>> Marvin

>

May 19, 2005

,

You can do better than that. What do you get when you divide 25 by 3? You

guessed you consumed 25 grams of carbs and you dosed 3 units of Humalog. It

does not take a guess or a guestimation. It only requires simple division.

I think it would be better to decide on whether or not you can stick to a

specified number of grams of carbs at each meal first, after you pick a

target goal for your bs. A ratio has never been chosen yet bby you as far

as I can tell. I have suggested you try a 1:5 ratio to see what it does.

You may ask what a 1:5 ratio is. It means if you consume 15 grams of carbs,

you would dose 3 units of Humalog. If you eat 20 grams of carbs you would

dose 4 units of Humalog. If you consume 25 grams of carbs you would dose 5

units of Humalog. The Humalog to carb ratio is always the number of units

of insulin injected to the number of grams of carbs consumed. So a 1:5

ratio, simply means that for every 5 grams of carbs you consume, you inject

1 unit of Humalog. Remember big numbers mean big mistakes and small numbers

mean small mistakes. Consistency is the key. This means sticking to a set

number of grams of carbs at each meal and a set number of units of Humalog.

As long as you do this, there is no danger of harming yourself as long as

you do a bs monitoring or reading 2 hours later. If you were to run near or

below the desired normal range, all you need do is take 1 glucose tablet.

This one glucose tablet will raise your bs by almost 2 mole points. You are

absolutely correct in saying that a 1:7 ratio means that you dose 1 unit of

Humalog for every 7 grams of carbs you consume. The reason you should stick

to a fixed ratio is to see how it affects your bs at different times of the

day. You will discover that a fixed ratio has a slight varying effect on

your bs measurements in the morning, as compared to lunch time and supper.

The difference may be small, but yet it is still noticeable.

You can tell if your ratio is correct by comparing your pre-meal bs

measurement with your two hour post meal bs measurement. For example

suppose your pre-meal bs measurement is 5.5 and you have a 1:6 ratio, which

means you dose 1 unit of Humalog for every 6 grams of carbs you consume.

With this being the case, you then consume 18 grams of carbs. This means

you would dose 3 units of Humalog. Two hours later you take another bs

measurement and it 7.0, which is slightly above the normal range, but it is

still within a variability of 1.5 moles. Just add 1.5 moles to 5.5 moles

and you see what I mean. If the ratio or dose of Humalog to the number of

grams of carbs consumed causes your bs measurement to rise above the desired

level, then this means you need to adjust your Humalog dose by taking more

insulin for the same number of carb grams consumed. This means you could

try a 1:5 ratio, which increases the amount of insulin dosed for the number

of grams consumed. On the other hand lets suppose that this 1:6 ratio is

too much insulin for the number of grams consumed. Instead of a 7.0 moles

two hour post meal bs measurement, you got a 3.5 mole post meal measurement.

This means at least three things. It means you had a variability of 2.0

mole points toward the low range and in this case it also means you have a

bs measurement that is below the normal range, and it also means you are

running low bs and you need to take 1 glucose tablet to raise your bs back

into the normal range. It also means you need to adjust your Humalog dose

from a 1:6 ratio to a 1:7 ratio, which means taking fewer units of Humalog

for the number of grams of carbs you consume. Getting the correct dose of

insulin for the carb grams consumed takes trial and error. When I first

started learning how to do it, I just tried to stay within the normal range.

After much practice, trial and error and frustration I found I could stay in

the normal range practically all of the time. So then I chose a target bs,

which for me at first was 100 or in your measurements a 5.5. I got so good

at dosing Humalog to carb grams that I always practically stayed within 1.0

mole points of my target bs, which I consider very good, in fact excellent.

Today I can usually 90% of the time get within a half mole point of my

target bs.

My aim is to be within .3 or three tenths of a mole point of my target bs,

which is less than 6 points in USA measurements. As long as I eat at home

andavoid strange foods in restaurants and parties, I usually do it right.

However whenever I screw up it is because I consumed too many grams of carbs

and dosed too many units of Humalog by poor carb counting of what I ate.

After having said all this, I would recommend you save this message and read

it several times. Remember we have not even talked about the effect of

exercise on the bs. Remember, too, that there is another insulin involved

here and it is called your long-acting insulin Lantus. We can measure its

effect on your glucose level, too, but it is a little more complicated than

I wish to talk about at this point. I can help you with this, if I see what

your bs measurements are once you decide on a target goal and a fixed ratio

of Humalog to carb grams.

Remember we are involved in a balancing act, and it is like walking a tight

rope. I urge you to join me on the high wire.

Re: Regulating 's blood sugar

>>>>>>>>>>>

>>>>>>>>>>>> :

>>>>>>>>>>>>

>>>>>>>>>>>> This is none of my business, but I am very curious how you are

>>>>>>>>>>>> currently

>>>>>>>>>>>> calculating the amount of humalog that you are taking with your

>>>>>>>>>>>> meal.

>>>>>>>>>>>> I

>>>>>>>>>>>> assume that you have a target blood sugar reading, let us say

>>>>>>>>>>>> 100 -

>>>>>>>>>>>> which

>>>>>>>>>>>> would be 5.5 under your system. Therefore, you would take

>>>>>>>>>>>> enough

>>>>>>>>>>>> humalog

>>>>>>>>>>>> to

>>>>>>>>>>>> cover your current meal carbs. In addition, your humalog would

>>>>>>>>>>>> be

>>>>>>>>>>>> adjusted

>>>>>>>>>>>> for a beginning reading higher or lower than your target blood

>>>>>>>>>>>> sugar

>>>>>>>>>>>> goal.

>>>>>>>>>>>> This is the way I try to do it, sometimes more successfully

>>>>>>>>>>>> than

>>>>>>>>>>>> others.

>>>>>>>>>>>> I

>>>>>>>>>>>> do not see a pattern like this and I am just curious how you

>>>>>>>>>>>> are

>>>>>>>>>>>> approaching

>>>>>>>>>>>> the issue. Again, this is none of my business, so feel free to

>>>>>>>>>>>> ignore

>>>>>>>>>>>> my

>>>>>>>>>>>> intrusion. I look forward to continuing to be educated.

>>>>>>>>>>>>

>>>>>>>>>>>> Marvin

>>>>>>>>>>>>

>>>>>>>>>>

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Re: Regulating 's blood sugar

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