? about insulin use and insulin resistance

I have a question about my insulin use.I got Using Insulin and Think like a pancreas and after following the formulas in them I have been cautiously trying to set my Basal dose. I am up to 23U Levemir at bedtime. I am trying to get my fasting numbers under 100 and an currently seeing numbers of 106-109. I get that I am to slowly increase my dose at bedtime until I see the numbers I am after. So far so good.But I'm having trouble with my bolus doses. SO far all the calculations I have seen suggest that for my very low carb diet(30g/day)my bolus doses should be in the 3-6 unit range. But my requirements seem to be much higher than that. I'm eating ~8gcarb at about 115-120 and after a dose of 10U of humalog I see a rise of about 10 points at the 1 hr mark, a very slight decrease to the pre meal rate at the 2 hr mark and then a leveling to the pre meal mark( smoewhere around 113 or so)I never seem to get below 100. I chose the 10U/meal bolus number after slowly stepping up by 1U after not seeing any changes at all at the lower numbers. Now if I eat a higher carb meal (say 55g carb) my BS soars up to the 190 mark and I feel like I'm shooting in the dark trying to find a dose to cover my carb intake.I'm afraid to go much higher than 12U because I'm afraid of a Hypo. My question is is this normal?(if there is a normal with T2)How am I supposed to calculate bolus dosing in a logical, methodical manner? right now I really feel like I'm shooting blind.
Is my insulin resistance really high? Might by liver be constantly dumping glucose when my bg goes below 100 no matter what I do? How do I manage this? Thanks.

I think you should take the next step and figure out a carb/ insulin ratio with your boluses, that way instead of picking a number of units and eating to it, you figure "ok, I have 7.5G of carb/ unit and this is 15G of carbs so I have two units. If I have another one, I'll have 4...and one and a half= 3", if that makes sense? As I've used a pump for a while, I have different ratios at different times of the day to "clean up" DP and get it out of the way smoothly and a bit less in the evening in the summer. My pump is limited to 10U so, if I run into a 120G burrito w/ a 30G margarita, I'll sometimes do two boluses. I really don't eat like that any more as I'm working on shaving off a few lbs but a ratio of carbs to insulin is the way to go. If you want a great, detailed explanation, Think Like a Pancreas (Gary Scheiner), Using Insulin (John Walsh) and Your Diabetes Science Experiment (Ginger Vieira, I think this book might be a bit shorter, which might be an advantage...) are all excellent "owner's manual" type of books that have step by step guides to figure out what ratios will work for you so you can dose and, perhaps more importantly, eat with confidence!! I

One of the difficult things when you have T2 is that exogenous (injected) insulin doesn't always act in a way that is intuitive. In fact exogenous insulin will often "supplant" our natural insulin production. If you inject a few units bolus for a meal it may seem like it does nothing. That is because your body still produces a few units of insulin and your your injected insulin simply replaces the insulin you would have naturally replaced. This means that it will be very difficult to figure out your "exact" ratio for meal boluses, but that is ok. Your goal should be to bolus enough to enable your after meal numbers at 3-4 hours to return to your pre meal numbers. I actually work towards getting my 2 hour numbers close to my pre meal numbers.

As to the high carb meal, if your blood sugar surges to 190 mg/dl at 1 hr but returns to pre meal levels at 2-4 hours, then you are doing fine. I wouldn't necessarily recommend that you eat high carb meals, but restoring your blood sugar levels promptly and safely to pre meal numbers is your goal. And until you actually have a hypo, you really are fearing the unknown.

The formulas in Using Insulin and Think Like a Pancreas are designed for T1 diabetics, unless they state otherwise. T1 typically do not have insulin resistance, which is as you know why your insulin usage numbers are much higher. You could ask your doctor about whether taking metformin as well as insulin might help lower your insulin doses.

Limited to 10U per bolus? Which pump is that? Not very T2 friendly.

My Omnipod will do up to 30. 10 seems pretty skimpy.

the default maximum bolus is 10. this is a safety feature. You can program it to go higher.

Most pumps allow, during setup, a user-specified maximum bolus amount. I suspect that AR has his pump set up with his personal maximum bolus amount of 10 units. The system maximum allowable bolus on the Animas Ping is actually 35 units. I think AR has a Medtronic pump and I suspect its maximum allowable bolus is probably in the 30-35 range.

This is a safety feature so that you could not for instance, intend to deliver 10 units of insulin but accidentally key in 100 units.

I can't take Metformin, which is why she suggested I give insulin a go.

Excellent point, Brian, and something that took me a while to dial in.

I don't make much insulin, so I have much more success with carb counting and using IC ratios to calculate boluses.

HOWEVER, unlike a T1 I do have a "floor", so to speak. It's around 1U/hr. This also seems to be my general basal level. So, it seems that anything 1U and below simply relieves my pancreas, but has no discernible affect on my BG. A 1U bolus, 1U/hr basal, none of it does anything.

This has worked to my advantage, as after nearly a year of 1U/hr basal on my pump to give my beta cells a rest, I've turned it off and they're doing a fairly good job of holding fasting BG now. I still have a basal program to cover DP, which is a problem for me, but this has extended my pod longevity from 2 days to 2.5-3, depending on how many carbs I eat. Most days, I can make it the entire 3 days now. DP basal chews up 16.85U/day, leaving ~150U for bolusing. At my IC 1:4 this allows for up to 200g carb a day (assuming no corrections), well above my target of 100g.

On a side note, this has been a double-edged sword: I like not changing so often, fewer "injuries" per month from infusion sites, build up of some spare pods, etc.

Downside is my sites get more irritated and sore being in an extra day :-(

Of course, all this goes to hell-in-a-handbasket if I get sick, which I am right now (minor cold). Instead, it takes a gasoline tanker of humalog to get me down 10 points :-)

Just want to add to the other people who have given good ideas that if you eat low carb, you need to count 50% of your protein.

So, without further information, maybe you IC is a little low considering that at 55g carb you are soaring!
Don't worry about what you need for your bolus. Everyone is different and the ratio can vary from 1:6 to 1:20 or whatever! Take what your meter says you need.

Actually, sorry guys, but I too am not yet easily attaining the 80! So maybe I should stop giving advice!

You can set a Minimed at the limit you want/need. It's for safety for the people with low bolus. Good luck, you really seem on the good track!

Ahhhh... that makes sense. The pod has this setting feature, which I'd forgotten about.

Your reminder also reminded me that I was pissed when I couldn't set it higher :-). That's before I really understood well the impact of carbs (I was new to insulin back then), and was following those excellent, thoughtful, hugely helpful ADA dietary guidelines, blissfully expecting to maw down 200-300g carb a day.

120g (IC 4) seemed rather limiting.

These days, following my loose goal of 100g/day, the biggest carb load in a meal that I've had in memory is about 80g, well within the 30U limit my pump's set to.

Actually, on the Ping, it would be hard to make the 10 vs. 100 mistake I gave as an example. One of the Ping's irritating features is that one must scroll up from 0.00 to whatever dose you want in a serial fashion.

The t:slim's parallel input access to create a prospective insulin dose is truly just plain good common sense. Scrolling is so 1980's!