Advice/opinions needed please

Type 1 and LADA
1

My first problem is that my highest bg reading of the day is generally fasting, with my peak being sometime between fasting and after breakfast - so what I’ve done to keep my postprandial breakfast from being lots higher than my fasting is to adjust my Humalog up to 8 units with breakfast, which is always 196 calories and 3 carbs. It has worked really well so far with no hypos resulting from this and better bg stabilization during the day.

My other problem is that after supper, I find myself going hypo or coming really close most nights. I’m guessing I need to cut down my insulin with my supper meal (I generally take 6 units) - it’s usually my highest protein meal of the day. I take 23 units Lantus at night between 9:30 and 11:30 PM - then I take 2 units of Humulin R at bedtime. I also make sure to eat sugar free jello and a high protein/low complex carb snack (generally Planters Heart Healthy nut mix) before going to bed.

Add this in to the mix: I have been diagnosed with fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome. Currently, I’m waiting on a second opinion/diagnoses confirmation that my PCP set up with another doctor - I donated 10 vials of blood as well as a urine specimen (sorry if too much information), and the results should be back in the next day or two.

Now, in addition to three to 10 units of Humalog at meals (depending on carb load), 23 units of Lantus at night and two units of Humulin R at bedtime, I take Xanax .5 mg three times daily, Lortab 7.5 mg four times daily, Cymbalta 60 mg twice daily, Bentyl 10 mg four times daily as well as Elavil 100 mg and Amrix 15 mg (extended release Flexeril - brand new on the market) at bedtime. I also take 3 mg Melatonin at bedtime to help with sleep, and I’ve begun acupuncture treatments for pain management of my fibro.

A couple of times when I’ve been in severe pain from my fibro, I’ve had bg peaks anywhere from 244 - 292, and I always use my Humulin R to bring it back down using the sliding scale my doc gave me. However, I’ve also gone hypo down to 45 with severe pain as well. My doctor is aware of the highs and lows and changes my insulin dosages and other medications accordingly with hopes of better adjusting my bg levels. He is also aware that I practice a 1400 calorie/35g carbs/25g sugar/high protein diet and has approved it and the additional supplements I take.

Having said that, and knowing that my last A1C was 5.8 (down from 14.7 three months ago), is this something I should discuss with my PCP and other doctor or should I just keep self-managing it and keeping good records of bg readings, meals and daily exercise/activities? I’m still pretty new to all of this, as I was just diagnosed on October 30, 2008, and I welcome your advice, thoughts and opinions.

Thanks in advance for the help!

2

Hi Melissa,
I think you are doing fantastic and I would keep taking care of things myself. You are the person who knows most about how you feel. I too have big blood sugar swings with the amount of pain i have and many of our other family members who deal with heavy loads of pain on a daily basis do also. There are no two days alike and there is no way to predict how something will work out for you. Just keep balancing things out on a daily basis like you have been doing i know it isn’t easy but you have a lot of company here in the family and all of us understand. I think you are doing a really great job and will only add Bravo !!
My best to you.

3

You seem to have it beautifully controlled in the morning after bkfst. It’s 3 carbs, 45 g. That looks like 1 unit per 15g. I’m trying to figure out how many carbs you’re really taking at noon and supper to see what your ratio is then.
I suggest keeping to a specific number of carbohydrate grams at noon and again at supper a couple days in a row so you can find what your ratios for those times are. It makes it easier to ensure you don’t give too much insulin and have a hypo. Fruit grams and starch grams may even require a different ratio. High protein is not carbohydrate. Tally up the carbohydrate grams at noon and tally the humalog that covers it. Do the same with supper.
Could it be that your Humulin R for pain is still acting when you’re giving Humalog for meals? Just a thought.
You’re doing just right with the pain peaks. You keep chasing them like you’re doing. But always be aware of how long Humulin R works and reduce subsequent doses accordingly if you’re still within the action time of a prior dose.
Your A1c may be responding to your lows. Once you conquer those lows, don’t be disappointed if the A1c is higher.
How much exercise and when?
Keep after it all, and good luck and best wishes.
I haven’t gone after any of your meds to see if they also affect blood glucose, so I might have more to say once I’ve looked into them.
I suggest you tell your diabetes provider what you’ve been diagnosed with and what drugs you’re taking just so that person has it all in his/her records, and do it when you see the provider. No need to schedule for that purpose. No one is likely to be better at managing day to day than YOU. Best wishes through it all!

4

Saundra - Thanks so much for your sweet words! I really appreciate your support. Please know that I am here to support you and others who have pain too. hugs

Leona - When I say 3 carbs, I mean 3 g carbs - I rarely go over 35 g carbs each day. As for the Humulin R, it is only at bedtime and for sliding scale - and I’ve only used it three times for sliding scale purposes in the last three months; the one time I used it prior to a meal and still used Humalog with my meal, my bg went from 292 down to 82, and I did not go hypo at all that night. As for my meds, I know that Elavil can raise blood sugar (or lower it) and Cymbalta can lower blood sugar. I take Cymbalta with breakfast and supper and Elavil at bedtime. To give you exact exercise, meals, activities, etc. - here is the link to where I log all of this: http://www.livestrong.com/profile/txhoneydarlin/ - Simply scroll down and click on Go to txhoneydarlin’s diary » ; you can see a day by day history. I have not exercised much since being diagnosed with fibro; the pain has been too bad to do much. However, I plan to start raising the amount of exercise I do as I progress with acupuncture treatments. They seem to help with the pain a lot.

5

I agree with Leona that you may need to be more careful about stacking your insulin injections. I have been on both R and Humalog in the past (though never simultaneously) and it’s important to remember that they can remain in your system, actively lowering your blood sugar over the course of 4-6 hours, with the peaks falling in different places. Have you and your doctor discussed pump therapy at all? It may seem early since you’re newly diagnosed, but I can guarantee you that many of us find it beats using three different insulins at once.

While it’s normal to hit bad highs with pain, it sounds like the lows are your big concern right now. Do you use glucose tablets to correct the low? Do the lows tend to happen at the same time of day or is mainly a problem during your bouts of pain? You’ve done a WONDERFUL job lowering your A1c and trying to take charge of your diabetes in this short amount of time. Give yourself a pat on the back for how well you’ve done with all of these challenges and know that diabetes is a weird animal and a finicky mistress. Never the same two days in a row. You’re doing a great job.

6

Melissa, I never use Humulin R less than three or four hours after using Humalog unless it’s been for a sliding scale. When I was in the hospital, the internal medicine doctor that saw me suggested a pump - but both my PCP and my endo feel that he was wrong in suggesting it as I’ve responded so well to initial insulin therapy that they are talking about changing me from full-time insulin to part-time insulin with oral meds… I’ve only been diagnosed since October 30, 2008 - and right now, I think they both are sitting and waiting to see how I maintain. I may have a better idea after my visit to my PCP this Thursday.

As for my lows, I do have glucose tablets in my purse, but I’ve never had them close at hand when I’ve gone low - instead, I have had Sweeties candy or a Coke near by and have adjusted with that (thanks to hubby and daughter lol). The lows have generally happened postprandial supper - but tonight, I adjusted my insulin a bit and didn’t go low, which was a nice learning experience. I have generally gone high (except for that one time) with my pain.

Thank you for the pat on the back - it’s nice to get, and I appreciate your support. =)