I was diagnosed in Oct of last year. I’m a lean person (125lb) After having hell trying all the oral meds and losing weight i was put on Novolog. My Endo ordered the test for GAD, C-Peptide and Insulin. I did the test 2 hours after meal and results were with high level of insulin and top of the range for c-peptide. My GAD result was 0.1 above the accepted range. My per meal carb is about 120 to 175 gram. I’m having a problem with my post 3 and 4 hour reading. My novolog peaks after 1 hour of injection and i had few close call of hypo. Increasing my novolog will most posivley give me hypo in first hour. My 2 hours reading are under 180. but my 3 and 4 hours number are over 200. If i do lite snack my premeal numbers return to around 85 - 125. No snack and number can stay high. Some times my number will be under 130 for 1st and 2nd hour and than around 190 for post 3 and 4 hours number. I asked my endo if i can mix novolog and regular insulin to bring my post 3 and 4 hours number down. He ask to try lantus but I’m afraid it will give me hypo since my body still brings high number down after few hours on it’s own. My meals are heavy in carb and each meal has about 20 to 30 gram of fiber. Has any one ever mixed novolog and novolinR for post meal number and what was the result?
Mixing Novolog and Regular should work. But you are likely to have more joy with reducing your carbs. It sounds like you are very insulin resistant, and the easiest way to deal with that is to reduce carbs. 120-175 grams of carb per meal is way too much for a diabetic. Eating like that will just make your insulin resistance worse. You should be getting more of your calories from fat.
My carb to insulin ratio is 1 unit per 20 - 30 gram of carb. What intresting is ratio works great with high number of carb but some how meals with less than 100 gram of carb does not comes out great.
Have you been to a CDE (Certified Diabetes Educator)? I agree with Mark, it seems you’re eating way too many carbs. I was told to limit mine to 30-45g per meal and 15-20 for snacks and I usually find it quite easy to stay on the lower end. This amounts to about 165-175g per day total. I have to admit though, sometimes I do cheat. I’m just trying to imagine what a meal looks like with 100+ grams of carbs.
I hope you find your balance and if you haven’t seen a CDE yet ask your endo for a recommendation.
A,
No insulin can match as many carbs as you are eating. And for that matter, even the insulin a normal person’s body makes usually has trouble with that kind of load!
If you bought into the idea that the body “needs” carbs, or that fat is dangerous, you really need to do some reading and research, because the more recent scientific thinking is that people with diabetes of all types do a lot better with a lot less carbs, and that it is carbs that push up the bad lipids and worsen heart disease, not fats.
I’m a bit confused from your posting what kind of diabetes your doctor thinks you have. Lots of C-peptide and almost normal GAD at a normal weight is an interesting finding. Do you have a family history of other thin people with diabetes and/or heart disease?
But whatever the diagnosis, please stop torturing your body with those carbs! And if your doctor told you to shoot for 180, find a younger, more up to date doctor. That’s VERY high and will lead to complications. The more up-to-date endos are saying 140 mg/dl should be the peak. I’ve done a bunch of research (on my web page at http://www.bloodsugar101.com which substantiates that number as a good place to start though lower is better.)
A,
I also had normal C-peptide at diagnosis, and antibodies at just over the normal level. My guess is that you are very early LADA and if so, you have a unique opportunity to preserve your remaining beta cells and avoid complete insulin dependence, at least for some time. The only way to do this is to keep your blood sugar under control, and that means staying under 140 all the time. You might want to try lantus even though you have some normal fasting numbers. Lantus is much less likely to give you a hypo than the faster acting insulins and there is some thinking that it is helpful in early LADA in giving your pancreas a rest from having to produce insulin constantly, since your body no longer stores any. But I agree completely with the other posts that you won’t be able to get good control without cutting back on carbs. Good luck. (By the way, one year post diagnosis I can still get by with very low carb eating and tiny amounts of insulin. I have fasting numbers around 90 and post meal up to about 130.)
Well talk about misinformed medical personal. I have to change my personal doctor for ignorance since she insisted i keep taking metaformin even after i told her i have gotten sever reaction to it. My Diabetic nurse think as long as my numbers return to around 130 premeal range do not look at the spike and ill be ok. My endo thinks i’m type 1 but all this test is contrary to his thinking. Some times people get offended when you know more than what they know. My mom has type 2 and she is over weight. My dad is thin and he has type 2 and heart disease but he has managed it on pills for last 15 years. I done the test for c-peptide and insulin after meal when i was on glipizide. Here are my test result.
My result Range
INSULIN 32 4-29 uIU/mL
C-PEPTIDE 5.9 0.5-6.3 ng/mL
GLUTAMATE DECARBOXYLASE 65 AB 1.1 <=1.0- U/mL
It’s seems though all the factors other than meals that affects diabetic like stress, illness etc i do manage well on my own and my numbers does not respond to it. I had almost no
vitamin D and now i’m takin 50000iu once a week for 11 weeks. Vitamin B12 is at low end of range. Other than blood sugar all my test are within normal range.
A,
If your dad was a “thin Type 2” it is very possible you may actually have one of the MODY forms of genetic diabetes!
That’s what I have, and it will produce completely NORMAL C-peptide along with extremely high post-meal blood sugars. It is genetic, and very few doctors know anything about it including endos and it is often misdiagnosed as either Type 1 or Type 2. . It took me years to get the right diagnosis and treatment.
I have written about it here: It’s Not Type 1 or Type 2 But Something New.
MODY is supposed to be very rare, but I am coming to think that is because it is so often misdiagnosed. I hear from a lot of people who have it, and they are all over the other diabetes boards, probably because a gene test is available now. It may manifest at all different levels of intensity from mild abnormal post-meal blood sugars to something that looks exactly like Type 1 in a kid except that the insulin doses used are tiny.
It is also possible with both parents having some form of diabetes that you have a hybrid form. The research is starting to show that this happens.
If you start Lantus or levemir (I’d suggest Levemir as I’m finding it MUCH easier to use for MODY), use a tiny dose.
And yes, as many of us here have found the medical professionals are mostly clueless about diabetes treatment. For that you can thank the American Diabetes Association, which is still recommending dangerously high blood sugar targets, high carb diets, and seems to be more into preserving a large population of diabetics to enrich their sponsors, the big drug companies, than doing anything FOR people with diabetes.
The American Association of Clinical Endocrinologists recommended blood sugar target is under 140 at 2 hours, but there is so much evidence that staying under 140 at ALL times will prevent complications that it seems like a much better target. Getting fasting bgs into the 80s is ideal. That is what normal people have. And I know hundreds of people with Type 2 (and MODY) who attain that, sometimes starting with A1cs as high as 13%. If you stay under 140 at all times you will end up with an A1c in the almost normal 5% range.
You shouldn’t mix novolog with regular. If need be take lantus by itself and also take novolog by itself when you eat. Take lantus once or twice a day, without mixing with any other insulin type.
Dennis
Here is my dilemma with lantus. My body stills makes insulin. I eat about 140 carb meal for lunch and 6.5 unit of novolog. My post 2 hours number will be under 180 or less. Post 3 hours number will be higher than 200. After 4 hours I’ll have little snack or 1/2 cup tea, than 1 hour later my number will fall to under 125 at dinner time. My dinner is about 160 carb so i take 7 unit novolog. about hour later my number will be under 130 or some times close to hypo less than 75. 2 hour post meal number will be around 155 and post 3 and 4 hours it will be over 200. snack at bed time or no snack my fasting number will return to under 125 next morning. In the morning I’ll have tea and by lunch my numbers are back to under 120. If i take lantus my thinking is i’ll get hypo so best way to treat is the meal number and i’ll get happy number all day. I’ve done some testing and found that some times i do have phase 1 response where my number will dip after my meal in first 10 min than climb back. Other times mostly in afternoon i see no phase 1 but phase 2 response. (after snack or tea my initial number will climb than 1 hour later it will be down) and I’m afraid if i take lantus I’ll be in hypo that will be hard to overcome with just glucose tablet. My body can overcome hypo as natural response but why messed up that mechanism.
A,
I use lantus but take mine at bedtime because without it my fasting BG would be 300+. After a little tweaking (as instructed by my endo) I have found that 13units keeps my fasting between 80-100. More than that was causing overnight hypos and about 2 during the day. The combo of 13units of lantus and my 1u:10g of humalog seems to be my golden key. Since my visit to endo last week, my BG has been the best ever, staying between 80-130; with no hypo’s. I realize we are all different and require different treatments but you need good communication with your endo to find out what works for you.
If your endo suggested lantus, in my opinion , you should try it. (have him give you a sample) Lantus peaks during the first 12 hours and declines the second 12 hours. Since your fasting BG is “near” normal you may be better off taking it in the morning to keep those day time spikes down; however, you may also need to adjust your novolog. I’m also confused on your carb/insulin ratio… you said 1 unit 20-30 carbs. Do you stay with a consistant ratio?
As mentioned in most of the replies, we’re concerned about your carb intake…were you instructed by a CDE or your endo to consume so many carbs?
I agree with Jenny…you may need to look for another endo.
Kristy,
My carb ratio i have to adjust each day but stays most of the time in 1 to 20-30 range. reason for that if i increase the dose for correction when i have higher numbers or keep my carb ratio consistent i get hypo in my first hour and higher high later some times. As for carb intake i was loosing weight and i needed to maintain and up my weight. Even after 4 months of high carb i mange to gain only 5 lbs. I work with CDE and she is ok since getting on insulin from pills and eating high carb my A1C is 7.3.and not changed. Now i want it to bring down it to around 6. I’m not used to eating small portion and i tried it but my body does not responds to it. You can say it takes a trick to change the old habit. My concern is hypo since few times my premeal numbers are in 80is and 90is.and both endo and CDE thinks lantus is not a good option for now. They still not sure I’m LADA or Type 2. My GAD test is just above 0.1 of threshold that’s like he’s over the line or under the line and i have seen 2 different result for same test from same blood sample on other test.
Perhaps splitting your insulin dose may work for you? Have you asked your doctor about that? Maybe 1/2 your dose before meal and other half within 2-3 hour post meal. Or even “1/3” premeal and “2/3” 2-3 hour post; taking most of your dose post meal to catch the spike.
We’re you instructed on how and when to take a correction bolus dose?
I have only been on insulin almost 4 months, and it has taken that long to find my balance so I’m sure in time you will too. Good luck with it
Well it’s almost a month and i want to share my happy result. After initial hiccups with mixing and not getting result i’m injecting novolog pre meal and regular after meal at 40/60 ratio. My post 4 and 5 hours number are under 120 before it was over 200 and my fasting numbers are under 100 from 150. My carb intake per meal is still 120 to 195 carbs per meal. Next month I’m doing A1c test and hoping it will be under 6 from 7.3.
Congrats on improving your blood sugar.
But you really want your 2 hour number under 140 and ideally under 120. That’s what the American Association of Clinical Endocrinologists recommends, and there is a ton of data supporting the finding that blood sugars over 140 at 2 hours are associated with developing complications.