About 8 months ago, my doc put me on a sliding scale of humalog ( if my blood sugars are 150- 200 I take 2 units; 200-250 is 5 units and 250- 300 is 8 units, if I go over 300 I call the on call nurse. I was put in this place because I was taking cortison for my rotten knees. Works very well to keep my sugars under control and me on an even keel. My last A1C was 6.2....So now I am wondering, it would be easier, more efficient for me, and maybe more theraputic to just take 2 units at every meal and not have to go through the poking and meter things when I am out and even at home. Has anyone else ever done this sort of scale and then moved on to an every meal t hing, and how did it work for you? Would like to suggest it to the team at my next visit, but want some other info to back it up.....Thanks.,
Both the sliding scale and the set dose you are proposing, are both very dated ways of dosing mealtime insulin. I'm surprised you've had such good results with your A1C. Do you basically eat the same thing every day? The best way to dose insulin is by an Insulin to Carb ratio (I:C). That way you are taking the right amount of insulin for what you are eating. If you eat a plate of pasta you need more insulin than if you eat a salad! Two units might be way too little for the pasta, but too much for the salad. If you want to be able to vary your foods and to dose accurately to be in range two hours after eating, you should learn to count carbs and figure out your I:C ratio (for example 1:10 ratio means you take 1 unit of insulin for every 10 carbs you eat. But we all have different ratios. You also need to figure out your ISF, how much one unit of insulin drops your blood sugar so when you are high you can add in a correction.
No, I definitely wouldn't suggest a set dose and I doubt anyone would. And "going through the poking and meter things" unfortunately is a part of being on insulin. You need to know where your blood sugar is at to correct highs, treat lows and to determine which foods work or don't. I highly recommend the book Using Insulin by John Walsh which will explain dosing.
I have counted carbs from day 1, over 12 years now. Lost 86 lbs, and have never had an A1C over 6.8 except for my diagnosing one. So must be doing something right, But what you are proposing makes great sense. I'll be sure to share that when I meet with my team. Mainly the humalog was to get through the 3 - 5 days that the cortison would be on board full strength....but it did so well that we've kept it on when my numbers are higher.....I'll keep you posted,
Zoe is right, the standard of care now is a basal/bolus regime where you adjust your bolus to match your meal. But you also use a basal insulin to keep your fasting blood sugar controlled during the day. Life is full of surprises, as a T2, I need to test before every meal and count carbs and adjust my insulin for every major meal (I can skip certain very low carb meals/snacks). And it is important to understand, you will likely need to replace the sliding scale with a basal bolus regime in order to manage your fasting blood sugars (particularly overnight).
Well before I started insulin I had come to accept the testing and injecting. I had injected for more than two years with Byetta/Victoza. So when I started insulin about 2.5 years ago, I just moved directly to a basal/bolus regime. What I would suggest you can do to minimize injections and testing is to follow a low carb diet. There may be a point where a very low carb meal/snack (i.e. 5 g carbs) is low enough that you don't need to worry about testing and injecting. And if you get really good at consistently matching your insulin to your meals, you may find that you don't need to test after every meal.
So I would actually recommend you discuss a basal insulin with your team as well. I use Levemir for my basal as well as Humalog like you.