Okay, so long story short, I'm a physically active 21 year old male in good shape (6' 165lbs) and I was diagnosed with type1 diabetes December 15th 2009. Basically I need help. My main question that I'm most concerned with deals with the honeymoon period. When I came out of the hospital my regiment was this
8 units novolog before breakfast (and correction as needed)
10 units novolog before lunch (and correction as needed)
12 units novolog before dinner (and correction as needed)
20 units of lantus before bed
Okay so now I'm only taking 8 units of lantus at night and last night I only took 7. Today has been awful. I dropped from a glucose of 100 at 10am while eating a snack of 24g of carbs to 70 within 45 minutes. I've been forcing myself to eat all day and no matter what I cannot keep my glucose over 100. That's when I feel comfortable.
Is this drastic of a dosage drop of insulin normal?
Should I stop taking insulin to see what happens?
I'm suppossed to get put on a medtronic minimed pump next week, has anyone else in the honeymoon had success with pumping?
I'm super frustrated and I just need to hear some advice from people who have been there. It would be really reassuring.
By the way, I wore a 24 hr glucose monitor this past weekend for three days in order to get my pump calibrated and had some great readings. They're going to think I'm crazy when I tell them what's been happening lately!!!
Sorry, but I am confused as to what you mean by “8 units novolog before breakfast (and correction as needed)”. Do you mean. this is your carb ratio? I am 17 and went through a stage when I was first diganosed where the actually called me a Type 2 for a while, which was my honeymooning period. I have been on a pump for about a month now and it does get better, I have had some problems also. I think however, that if your BG’s are still so out of control that you may need to wait to get a pump, until you get adjusted a little better, unless your endocronoligist thinks that pump therapy is what is best for your situation.
Let me know what happens, welcome to TuDiabetes, and stay healthy!
The 8 units pre-breakfast is typical MDI dosing in my opinion. Nobody ever mentioned to me (in practically 15 years of MDI) that I should adjust my insulin based on my carb intake. It was always a standard regiment of “this many units before this meal” and that was all. I didn’t even learn about insulin/carb ratios and insulin/bg ratios until the pump. If my BG was 200 I gave myself a shot of a couple of units and hoped for the best.
Honeymoon and pumps can be tricky in my opinion but not impossible and if you take very good care at knowing your BG at all times I could see the benefits to it.
Under no circumstances should you simply stop taking insulin. Always adjust based on your needs. If 5 units is too much, try 4, 3, 2, 1, until you find what’s best. This is going to be a complicated time in your life because your ratios will fluctuate from time to time and what was true yesterday may not be true the next day. For example if 1 unit drops you 100 points today, tomorrow it might be only 75 points.
Think of it like a car. Newer cars get better gas mileage. As they age it gets worse. That doesn’t mean you stop pumping gas into the car. (This isn’t a perfect analogy, but I hope you get what I’m saying).
Your docs shouldn’t think you’re crazy because of your recent numbers. Even after the honeymoon period is over you’ll experience days that just don’t seem to be right even if you’ve done everything the way you should. A CGM at this phase I think would be very beneficial to you.
Don’t let it get to you though. This might seem counter-intuitive but in a way it gets easier after the honeymoon period because your body will normalize. Going back to the car analogy, now it’s like your gas gauge is broken (or erratic). The same amount of gas somedays will take you farther than others. Eventually when the system breaks down completely you will reach a point where the gas will always take you as far as it did the day before (with random variations, but at least not as random as they are now).
Are you seeing an endocrinologist? Please ask them what your exact Insulin to carb ratio is. I:C. You would also want to know what your sensitivity is.
When our son was diagnosed, he had several downward changes to his insulin regimen before things stabilized and then he had upward adjustments after the honeymoon period came to an end. Now it is just adjustments here and there when we can see a pattern that needs an adjustment.
You are fortunate to be able to start pump therapy so quickly as it requires its very own learning curve. Easier to learn it from the outset than move from one type of therapy to another and have to constantly replace old information with new. I am sure that you will be well monitored for the first few weeks of pump therapy until your endocrinologist is confident that the basal and bolus setup is in order. At the time our son was diagnosed, his therapy was similar to Pavlos experience below. One was supposed to follow a rigid meal plan on a very rigid time schedule. With a new dietician about three years following initial diagnosis, we moved from food exchanges to carb counting and multiple daily injections, using Novolog and Levimir (similar to Lantus) and then finally, four years from diagnosis, on to a pump.
The pump has allowed our son incredible freedom that he did not have in the past. Like you, he is very active and adjustments for increased activity can be made quickly and easily. The other thing is that Levimir just never worked all that well for our son. We started with an evening dose that used to kick out after about 18 hours. Eventually the evening dose was split into a morning and evening dose to get better 24 hour coverage. In theory, Levimir or Lantus is supposed to provide fairly even backgroud insulin over a 24 hour period. With a pump, that uses only fast acting insulin, the basal settings can be changed numerous times if needed over a 24 hour period. It turns out on fine tuning that David’s basal settings change about 5 times over each 24 hour period. As an example his basal needs at 1:00 in the nightime are about double his basal needs at 10:00 in the morning. Without a pump, one simply could not fine tune, background insulin to this degree.
hang in there! It’s overwhelming at first. You need to learn as much as you can. Start with your endocrinologist. Talk to folks here. Read the following:
When you go for pump training you’ll be taught to match carbs to insulin. Unfortunately, many diabetics without pumps don’t get the same level of training. Right now your doses are standard, but are pretty much shooting in the dark. It’s more difficult while honeymooning. Had many days when I thought I wasn’t diabetic:) I took small amounts (1-2 units) & would plummet.
Continue to take your insulin. I can tell you what will happen & it’s not good.
Nah, they won’t think you’re crazy. What you’re experiencing is normal during the honeymoon phase. You’ll be fine!
One thing to mention is that when BG has been high, normal readings will feel low as your body adjusts to being normal. Don’t force it to over 100. Your doc should set target BG for you.
I have to tell you, although I am no type 1 insulin expert, your starting insulin regime just seems off. There are two books that you will find really helpful, “Think Like a Pancreas” by Gary Scheiner and “Using Insulin” by John Walsh. Walsh also has a book “Pumping Insulin.” Usually, you will be started on an insulin dosing split nearly 50% basal and 50% bolus. Your initial regime is more like 40% basal, 60% bolus, kinda heavy on the bolus. If you are an insulin sensitive young male, you very well might find that 8 units of novolog for breakfast covers 80-150g of carbs. Your efforts to reduce the basal may not be addressing the problem, it could simply be that you are taking too large a fixed bolus dose.
You really need to consul with your endo and get a relationship going with an educator. Once you get more educated on what is going on you are going to feel a lot better about things. You need to get your basal set to properly keep your fasting blood sugar at the right value, it is probably going to be higher than 7 units of lantus, but it may not be 20, it depends. Once you have your basal figured out then you take a bolus using an insulin to carb ratio (I:C) that helps you match number of units to bolus to properly cover the number of carbs that you eat. If you need to correct later on you will have another sensitivity factor to figure out how many units of bolus are needed for a correction. Once you pump is set up with the right factors it will become much easier. But understanding all of the details of how it all works, testing your response and setting it up is a bit daunting at first.
In answer to your questions.
Is this drastic of a dosage drop of insulin normal? Yes, initial insulin settings are often not correct and a honeymoon can mean that you may have a good bit of variability in your insulin needs.
Should I stop taking insulin to see what happens? Don’t stop taking insulin, only do that at the request of your doctor.
I’m suppossed to get put on a medtronic minimed pump next week, has anyone else in the honeymoon had success with pumping? I can’t really help you.
Look, I know that you were trying to get your blood sugar above 100, but remember a normal fasting blood sugar is 83 mg/dl. If you have been high, you will feel hypo at that level, but over time will feel better. You should treat a low below 70 mg/dl, but a level that is holding at 80-100 mg/dl should generally be considered fine.
Okay so here is the newest information. I went to drop off something at my endocronologist today and while she wasn’t there, I met with her physician assisstant. Now, instead of only 7 units of lantus at night she says to go with 6. Watch my numbers, and maybe drop to 5 after a week. Remember, I’m not taking novolog at meals right now because, for lack of a better term, unneccessary.
But the big thing that she addressed is all I am taking is 6 units of lantus at night, do I want to start pump therapy? One shot a day is not bad at all, therefore do I want a machine attached to my body 24/7. What are some of your opinions on this?
I went 37 years taking shots. In later years, I would adjust my dosage on what I ate, but now that I am on the pump (OmniPod) I find it so much better and you are not guessing about how much to take. The Pump tells you exactly! It’s awesome! Before you jump on board with the Medtronic Minimed…check out the Omnipod. It sounds like you are very active and keep in mind there is no tubing with the Omnipod system. But regardless, having gone from shots to the pump…you will like it and feel like you are in so much better control. Good Luck!!!
Good point. You can always get a pump later when you need it.
Whatever you decide, have your doctor or PA teach you about insulin:carb ratios & correction ratio. This is invaluable whether you get a pump or not. People with pumps tend to get much better training.
Timmy- Welcome to our family.
I’m about to leave the office so I have a very brief moment, but I wanted to recognize you first. I would say no pump until you get out of your honeymoon phase. But that’s just my opinion. Like you said, one shot a day isn’t a big deal.
That and on the pump, you would only be using Novolog (for example) and no Lantus. Even though I have my own demons against Lantus, if you go on the pump, they will configure a rate that will pump into you on a constant basis. And 6u is going to be spread pretty thin over the course of 24 hours. Like, say, down to 0.25 units per hour. It might help to stabilize you more throughout the day, but within a few weeks, your dosage needs are likely to change anyway.
I was diagnosed at the age of 21 (6 years ago…) and was put on about the same insulin regimin that you are.
No one mentioned insulin to carb ratios and carb counting at diagnosis because they didn’t want to overwhelm me. I too found out about it on the internet
So we have some things in common!!!
After diagnosis, my insulin needs did decrease (though I still needed to take fast acting insulin with meals, called a “bolus”). I think that I went from about 20 units down to 8 units of Lantus. When the honeymoon ended (I knew it ended one day when I woke up with an unexplained 400 mg/dl blood sugar about 3 months after my diagnosis), my Lantus dose increased to about 15 units.
We are all different in how much insulin that we need, but it sounds normal. I would NOT stop taking insulin. If you keep having lows reduce your Lantus 1 unit at a time.
You should measure your blood sugar two hours after eating and see if it is going up.
My endo had me wait until the honeymoon is over until I started on the pump. I know others that started right away on the pump. So it depends on your preference.
If I only needed to take Lantus at night, I would stick to injections unless you are having trouble controling your blood sugar that way.
But if you are anxious to start on the pump, it would not hurt you to start on it (assuming that your supplies etc are paid for).
first of all i must say>>> things will get better past the intial shock
i was 21 when it happened to me and believe me it took alot of work
and was stressful to get on a complete understanding of what i am doing
i took injections of 2 dif insulins for awhile before i got on an insulin pump
and blood glucose >>>at first is ok to be like a rollercoaster because it is
a change and a shock to your body.
