I've been on this journey now for 16 years....seems like forever. But I didn't really feel in control of my own disease until I started on humalog and then lantus. In the beginning, I said I would never give myself a shot, last year I ASKED and then told my CDE and PA that I was going to go on Lantus to get my numbers down. The orals weren't doing it for me anymore. With the first injection I gave myself, I had the thought that finally I --- Cathy ---- was taking control of my own destiny.
Now I have another point to take on as MY control. My dietician is a very slim 100 lbs soaking wet, if you get my meaning. She seems to think, and I am sure can show me research to back up her thinking, that on Lantus, I need to have 45 carbs per meal and 15 per snack. I have lost over 100 lbs now, and in the two weeks I did what she asked with the number of carbs, I gained 10 lbs. NO THAT DOESN'T WORK FOR ME. I was eating 30 and 15....wasn't hungry, didn't have cravings for foods or "treats" I shouldn't have or allow myself many of...and to be honest, I have all but knocked her block off for not acknowledging my weight loss. So another rogue diabetic I've become, it's 30 and 15 for me. I feel more in control, happier, less fearful of gaining weight back ---- which would be a great stressor for me.
When I am in control of me, things go much better, I am happier, I am not stressed out. Why do I tell you this? Because too many of us seem to take what our doc, endo, CDE's say as gospel, and not pay attention to our own bodies and intuition and education. EOS
I'm 23 years in and do not feel in as much control as I would like. Each step has brought me closer - a pump is better than six shots a day of Lantus and Humalog which was better than three shots a day of NPH and Humalog which was better than two shots a day of NPH and Toronto (regular). But, to me, being in control means being able to reasonably make my blood sugar go where I want it to go. Not perfectly, but at least in the right ballpark. There are some days where I feel like things are going pretty well, but there are just as many days where I have no idea what is going on amd feel like I'm just hanging on for dear life. If I can make those days few and far between (I know they will never disappear entirely), then that would make me feel in a lot more control.
The first time I felt "empowered" with this disease was after reading the book, Think Like a Pancreas. I honestly can't put into words how much this book changed my view on this disease and how I could manage it.
I would have to say that it was when I read Bernstein's book and acted on what I learned:
starting on insulin (which, like you, I had to go in and demand; no one was offering it or suggesting it).
switching to low carb.
Those two things together are the greatest game-changers I've ever experienced. Nothing else is even in the running.
Your experience with your dietitian is both instructive and common. Instructive, because it highlights once again the YDMV principle -- you need to do what works for you, not what someone else has memorized as a rote one-size-fits-all formula. You're the one who has to live with the results, not them. Common, because it's symptomatic of a general disconnect between us and them. Take a look at this link.
It's been 31 years for me, and I don't know if I'll ever really feel confident that I'm in good control. Even though my A1C's have run in the 6's to 7-ish for the last 15 years or so, I still have times where my numbers are wonky, sometimes for no reason I can figure, so I feel like I always need to be vigilant.
Dietitians are always scrawny, which makes sense when you realize they are totally afraid of most foods. I'd be really skinny too if I thought of most foods as poison. You don't say whether you are Type 1 or 2. As for her advice, I feel like 45g of carb per meal is way too much on any regular basis. I've had much better control with my BG's by keeping meals in the 20-30g range at most, sounds like that was working well for you too. Lantus is a basal (baseline) insulin, so it's not tied to your meals, therefore if you are taking a fast-acting insulin for meals rather than Type 2 relying on your own insulin, you can eat zero carbs at a meal if you want to, or 100g. In theory it shouldn't matter how much carb you eat at meals, that's what your fast-acting insulin is for.
With all of this said, you might want to consider going on a pump. I found that Lantus didn't last a full 24 hours in me, maybe 18-19 hours, and dividing it into two daily doses caused even more issues. Once I went on the pump, it was so much easier to control my fasting BG periods because I can set different basal rates for different times of day.
Sorry, but at least in the way that you conveyed it, what your dietitian said to you makes no sense. Correctly calibrated, you should not have to eat to match your basal insulin. With Lantus, as opposed to a pump, you might have to eat a little to your basal, at certain times of the day, because its effects are not constant and your body's needs are not constant, either. But the notion that being on Lantus requires X amount of carbs per meal or per snack is incoherent--can you think of a logical reason why that might be the case? Maybe you misunderstood her, and could ask her why being on Lantus would call for a 45g rather than 30g meal? But I would also not hesitate to ignore what pretty clearly seems like bad advice and do what works for you. My two cents, anyway.
Must agree. Allowing for the qualifications you mentioned, basal insulin is NOT about managing food. That's what boluses are for. Basal insulin is about managing your liver, primarily.
I am a type 2; 30 g carbs was perfect. No need for cravings in foods that I know aren't healthy for me --- M&M's. The lantus, which as I said, I've only been using for 6 months is great, thus far, but I can see that with time and age it could become less effective, and as I am at a low dose of 30 or 28....I feel confident that I've got time on my side. I do use humalog on a sliding scale with meals, so in that way I am lucky. I wouldn't get a pump, because I have a pancreas that is working, just not enough. Thanks for your info...
Her reasoning was that it's not enough to keep my body alive and functioning. It has NOTHING to do with my pancreas or how it is working. It's the amount that my body needs, to maintain life. UH,....I'm in a family of heart attack victims, and needed to loose that 100+ lbs and I need to keep it off. I didn't misunderstand her, as I had her repeat it several time, and we had a long fruitless discussion about weight vs diabetes. Nope I understood her perfectly.
Even though my control was adequate (very good in my GP's opinion) the first ten years or so, I never really felt "in control". I always felt controlled by the disease.
The first time I really felt in control was a year and a half ago when I started using insulin. I've been in control ever since.
I'll admit that this is my fad thing right now, since I just started exploring it, but I'll ask the question: Do you use IM injections as part of your toolkit?
The difference in how fast it works for me is the most exciting thing in my diabetes care in the last year.
Mixing pumping and injections is complicated, but with a good smartphone app, like Glucosurfer, it isn't difficult.
Something to think about adding if you don't do it to further refine your control, and make your BG "do" what you want it to more.
I felt in control pretty quickly after I got a pump, in 2008. I was dx'ed in 1984 and felt pretty in control like "oh, I know what I'm doing..." but was totally guessing for most of that time, although I'd occasionally "score" a 5.8 A1C or whatever and be like "see?". I was enrolled in a pretty strenuous Tae Kwon Do program and working out a ton and was really immersed in very positive philosophy (at the same time, non-competitive...Alfie Kohn...) and had a long history of, uh, partying, so it was not ever shy about "well, my BG needs to be fixed so I'll fix it!". Things totally fell into place for me. My A1C was 5.8 pumping, then I decided to run farther (1/2 marathons...) and deferred to my wife's concerns that I'd die in a ditch and got a CGM and it went down, like 5.2-5.4 and worked great, like less work and more normal BG! Over the last year or two, I had tried a couple of basals, one too hot and one too cold and tried splitting them in 1/2 hour increments and, woah, my A1C has been 5.0-2 for a year or so!
I haven't tried an IM injection. But I don't think "stubborn highs" are my main issue. It's more like I'll have to correct a high three times ot bring it down one day and have another high that crashes low before the insulin really even has time to peak. It's more like I wake up in the middle of the night low and two days later spend the entire nigh high without changing a thing. Or I'll be high after breakfast one day and the very next day have to treat a low for eating the same breakfast.
I'd feel more in control if I could be sure that a correction would take four hours to bring me down, rather than wondering if this time around it might only take an hour, or maybe it won't work at all and I'll still be high in five hours. Or that eating X food will consistently do Y to my blood sugar. Or that I'd have a pattern of highs or lows at a consistent time of day rather than a scattering of randomness throughout the week.
30g carb meals aren't enough to keep your body alive and functioning, but 45g meals are, and you need to sacrifice needed weight loss in pursuit of that goal? I'm sorry, but that's batsh*t crazy. If you have alternative options, I think it's time to fire her. The whole point of a nutritionist is not just to feed you one-size-fits-all advice you could just as well get on some internet site, it's to work with you to meet your needs.
