The last few days, foods that I eat on a regular basis - vegetables and cheese (including black beans) or today a “Schwarma box” (salad, lentils, chicken, etc - middle eastern fare) or even greek yogurt (natural, with flax seeds) have all caused me to spike and spike badly - over 100 more than usual for the bigger meals and about 60 more than usual for the yogurt. I bolused with humulog at my usual 1:10 ratio and waited about 20-45 mins which has always worked in the past).
I have been kind of fasting for the last couple of weeks, eating a big meal at lunch and a smaller dinner, or nothing at all in the evenings, and for the first week and a half, my numbers were better than ever, but now, doing exactly the same as before, they’re obviously out.
My thoughts thus far:
Could this be because i have only been eating once or twice a day? Although i am now nervous about eating before work (i teach English to adults at night as one of my jobs) as high bg really ruins my concentration.
Is this just a carb-ratio change?
Are my basals behind this and i just can’t see it because i ate? (I use NPH - once at 8am and once at midnight). My overnight readings are quite steady, so it looks like the basals are ok…
Is this a hormone thing - as I had a miscarriage a month ago, i have no idea where my body is up to cycle-wise, but normally hormones mean everything goes up, especially overnight. Or can it just effect carb sensitivity?
I’m sorry for all these noob-y questions - I have been diabetic for 18 months now, and i was just starting to feel like i had a small handle on this wonderful new world. I guess the D wants me to remember who’s boss…
Why are you still using what I tend to always think of as “Satan’s insulin”? If that’s what you’re using I would expect weirdness rather than being surprised by it. Why haven’t you moved on to one of the “newer”, more predictable basal insulins such as Lantus or Levemir?
I personally think spending too much effort digging for a reason for weird BG results can be unproductive. People tend to be very bad at this since we are likely to connect two events which have no connection simply because they happened around the same time. Better to get through the weirdness and only treat it as a change worth making permanent changes for if you see a pattern develop longer term.
I know how annoying that is…I’m having similar issues with breakfast lately, and I’ve had diabetes for over three years. Things just change: I’ve changed my I:C ratios and basal rates many times since I’ve been diagnosed. One way to figure out whether your I:C ratio or basal insulin is to blame is to skip a meal and measure your blood sugar over the course of a few hours. If your numbers stay steady, then your I:C ratio is the problem. If you find your numbers creeping up without any food in your system, then your basal insulin needs adjustment.
Have you read the book Think Like a Pancreas? If not, check it out. It explains how to adjust basal and mealtime insulin for both insulin pumpers and those on shots. And it does so with humor and without implying that you have to be perfect all the time.
Doesn’t really work that way with NPH since NPH is more like regular insulin. It will peak and then “trail off”. It does this more slowly than R insulin, but it’s by no means flat. That’s why it sucks trying to use it as a basal insulin.
What I hated most about NPH was that the time when the peak would occur could vary depending on how active you were. At least that’s how it worked for me. I was totally serious when I said that with NPH I would expect weird BGs. I would be much more surprised by consistently predictable behavior when using NPH.
I would encourage you, if you have any choice in the matter, to switch from NPH to Lantus or Levemir. I don’t know what your economic situation is so I apologize if this suggestion is beyond your reach. NPH has a nominal prominent peak around six hours that has a notorious history of producing hypoglycemia. Whole books could be written about the grief and damage that NPH has left in its wake. I used it for three years and then went on a pump.
I know people have been able to manage NPH well, but I agree with @irrational_John, the variability of NPH’s peak and the complication of exercise can really make it tricky to get right. And not getting it right can have dire consequences. NPH forces regimentation with meal timing and consistency. Eating the same thing at the same time each day helps but does not eliminate hypoglycemia troubles.
If I didn’t have access to the modern analog insulins like Lantus or Levemir, I would look into the longer acting Lente or Ultra-Lente. I’m not even sure these insulins are produced any more. Good luck with this challenge. I hope you have other options.
“Satan’s insulin,” or “the insulin from hell,” or “Thrice Accursed NPH,” these are all acceptable terms.
I suspect @Kokos, being new to The Club No One Wants To Join, is just going with whatever her physician recommended, or it may be a question of insurance coverage since NPH is generic and a lot less expensive. Which raises the question of what she is bolusing with. Kokos, you aren’t using R insulin as well? If so, are you truly stuck with this treatment for some extrinsic reason (cost, availability)? Because there are much better methods that would help you get a handle on things.
[quote=“Kokos, post:1, topic:47970, full:true”]
My overnight readings are quite steady, so it looks like the basals are ok… Is this a hormone thing - as I had a miscarriage a month ago, i have no idea where my body is up to cycle-wise, but normally hormones mean everything goes up, especially overnight. Or can it just effect carb sensitivity?[/quote] This hormone thing is so very likely! I am sorry that this happened to you.
It is also possible that you have been in a honeymoon period and that is ending. If your basal is working then YAY, now the carb ratio may need some changing.
I think you will be able to get back your handle and be the boss of your D. You will learn to roll with the never ending changes that occur. Take care!
i experienced this when i was going through menopause. my BGs got so whacky and seemed unexplainably out of control. i am sure your hormones are still raging and could be the simple part of your problem. of course, i tend to agree w/ everyone else about the NPH not being very effective. i would switch to lantus or levamir for better control. which insulin do you use to bolus for your meals?
also, i am on the pump, so that changes everything. are you doing MDI right now? you might want to consider using the pump to get better control. and one other thing that has helped me is eating at least 3 meals per day. try for the same time so that you have a good regiment. your body will adjust nicely, w/ hope. best of luck.
I appreciate everyone’s comments… however, just for clarity, I am not a ‘roll over and take it’ kind of gal. I have not just taken whatever the doctor has offered - i looked into the insulins available, and went in with a list, to ask what and why. It is indeed a matter of what my insurance will cover, and if i get pregnant, whether or not it will cover me and the baby… basically, my endo point blank refused to prescribe me anything else until we are no longer trying to have a baby - for the safety of the baby. Fortunately, humolog has recently (!) been approved which has made life a LOT easier, as i don’t have to wait an hour between bolus and eating. Humulin and restaurants are not a happy combination.
And before anyone says it - endos (diabetes doctors ‘Diabetologen’ as they are called here), are distributed according to population- patient spread (controlled by the government/insurance companies). It if were to change my endo (who is lovely - she is super supportive - available by email or phone 7 days a week for emergencies - but only in German, and sometimes i want to talk about this stuff in my own language, which is why i am here) i would have to travel quite a distance, and i don’t have a car. As a freelancer, the longer i spend in public transport, the less money i earn - it’s not practicable.
So far, i have not had too many problems with NPH, once i worked out where the peaks were of course. That’s why i don’t eat breakfast - the need for insulin, combined with my DP, the NPH peak was too unpredictable, and who wants to be preparing food in the morning anyway?
Like i said, i really appreciate everyone’s help, but i have to make do with the tools that are available to me, and NPH is something i am stuck with for the time being. Once we either actually have a baby or stop trying, my life with diabetes is going to get a lot easier - it just added to the sadness (once i got over the initial grief) when this pregnancy didn’t work out. I have to wait, yet again until i can get proper insulin… i felt like life was just seriously kicking me in the teeth… but that’s getting into a whole other bunch of bad feelings.
I looked into buying my own supplies, but i really can’t afford it - I have been told i’m intelligent, so I figure my brain can save me some money by working out how to do this correctly, fortunately, there are resources like this to help out.
couldn’t your doctor make a case for you that you have complications w/out having an insulin pump? maybe he/she could push through the insurance system and let them know that it is a dire need for your health. just an idea. worth a try.
Thanks - we did try. A lot. In my pregnancies, etc - but they say that my bg management is good enough without it. Basically i either have to give myself constant lows that require hospitalization (preferably because i passed out in dangerous places like crossing the road) or keep getting admitted to hospital with repeated KHAs, or develop severe complications (requiring amputation) and then they will consider it.
All of those options require hospital - and the food there is terrible - so i’ll struggle on with my pens!!!
[quote=“Kokos, post:10, topic:47970”]
It is indeed a matter of what my insurance will cover, and if i get pregnant, whether or not it will cover me and the baby… basically, my endo point blank refused to prescribe me anything else until we are no longer trying to have a baby - for the safety of the baby. Fortunately, humolog has recently (!) been approved which has made life a LOT easier, as i don’t have to wait an hour between bolus and eating. Humulin and restaurants are not a happy combination.
[/quote]I am glad to read this, it causes me to afford your endo some cred
[quote=“Kokos, post:10, topic:47970”]
I have been told i’m intelligent, so I figure my brain can save me some money by working out how to do this correctly, fortunately, there are resources like this to help out.
[/quote]Seems you are indeed quite intelligent. I said it already but I think with knowing how our hormones play a part and being able to roll with the endless changes you will get it figured out. I hope you will be able to deal with the feelings, that would help more than anything in my opinion.
While lantus or levemir is superior to NPH, you can still have success by increasing the number of injections per day. If you can manage 3 or 4 shots of NPH per day, you can dramatically reduce the variability and randomness of the peaks. I found reasonable control by injecting around 7am, noon, 5pm and 11pm. The peaks aren’t quite as severe and the overlaps are longer. The downside is the increased number of injections. I couldn’t control nighttime lows when only doing 2 injections per day.
While pregnant i did have an extra shot in the afternoon.
When i am not pregnant, i kind of cheat - i still have humulin insulin which has a longer working profile - so i use that for lunch, which when combined with what seems to be some residual insulin production that occurs in the mid-late afternoon for me, generally keeps me stable until evening.
If things are getting out of control (above 120 or so) i also just go for a walk in the afternoon - or jump on the elliptical machine (i work from home in the pm, so i’m very lucky).
OK - it was hormones. Seems the old body is getting itself back on track.
Thanks for the advice, and for helping me realise what was going on!! It should have been obvious, but it has been four crazy bg months since last time, so it just didn’t click.
I keep telling my husband in our next lives, he has to be the woman.
I’d even keep the diabetes!
How much NPH are you taking? I did an N=1 experiment while I was waiting for my pump. I’d reread Bernstein which reminded me of the bit in there about shots > 7U having greater variability in absorption rates due to the more varied fluid dynamics of larger injections. I was taking maybe 18-25U/ shots so I tried splitting one shot of say 20U into 4 shots of 5U each and, for the very short period of time I did this, it seemed to work interestingly. Unfortunately, when we moved, I threw out my log so I don’t have any notes or anything…
I take 6 or 7 units in the morning, depending on my activity, walking = 6 cycling = 7 (cycling makes my bg go up, i think i get nervous, because i’m no speedster)
If i’m doing the afternoon shot - 3 units
Night- 5 units if dinner included wine and 6 if it didn’t.
When i got pregnant, from one day to the next, i went up to 11, 4 and 10 (then down to 9 at night) - so i’m still tweaking after that - I’m trying to lose the couple of kilos i put on while pregnant (due to an unfortunate combination of being put on bed rest while taking -for me- lots more insulin) so i’m trying to keep the insulin levels (and bg) low, as just limiting calorie intake isn’t working.