After going through my regular doctor who didn’t have a clue I finally saw an endo (here in Guatemala which is a bit scary…LOL!) and have lab results and a treatment plan that feels right to me. I have suspected I am Type 1.5, not Type 2 (for lots of reasons). I have low c-peptide but am unable to get antibody results here.
The endo has me continue on the Lantus 10IU at night. She is taking me off the Glucobay tablets I was on (thank goodness!) and putting me on Apidra before meals. As I expected, contrary to what you all say she is just telling me to take 2-3 units before each meal. I have e-mailed her asking for a I:C ratio instead.
I have to say I’m kind of scared of the Apidra. I took it for three days a month ago prescribed by my PCP. But he told me 5 units. He told me to take it 20 minutes AFTER my meal. I had a few lows and asked if I could switch to 2 hours after my meal PRN based on if I was high (I heard that somewhere). He agreed and then I had a severe low where I could barely function to treat. I live alone and it scared the crap out of me. I was very close to losing consciousness.
So now I’m scared to take Apidra again, but 2-3 units is a lot less than 5 right? And if she doesn’t tell me a I:C ratio now (I go back 6/1) I can always start with just 1 unit and test, test, test. Plus taking it right before food is much better than taking it 2 hours or even 20 minutes after again, right? (I’m trying to reassure myself I will be ok!) I worry about being so sensitive to fast acting insulin. Thanks for any comments ahead of time.
Do you know much about carb counting yet? If not, I’d suggest getting a book and learning to do that. You will get better at guessing how much is in certain things with time, but when you know how much is in what you’re about to eat (or get better at guessing), it’s easier to figure out how much insulin to take, based on your I:C ratio.
That said, I would maybe start with 1.5 or 2 units with average (45-60g carbs) meals… and nothing with snacks. 5 units could be a lot for you (and probably too much), especially if you have some residual insulin production. If you’re really nervous about it, there’s no reason you can’t start with just 1 unit and see what happens… it’s not very likely that much would cause a severe hypo.
Yes, taking Apidra about 15 minutes before meals is correct. Though Apidra is also used to correct highs (though you need to be careful because you may still have some insulin from the previous injection still in your system), taking it two hours after meals regularly is like closing the barn door after the horse has escaped.
Start with a dose of 1-2 units with a small number of carbs. See if you can get syringes with 1/2 unit markings. Eating a 45-50 carb meal is high & it’s easier to gauge effect with less carbs. Yes, keep testing & record everything. You will be fine. Her telling you to take 2-3 units without even knowing what you’re eating is pretty useless. Count the carbs so you’ll know where you stand.
Changes to dose need to be made slowly. Take the same dose for three days to take a clearer idea of how things effect you.
Do you any idea around how many carbs you were eating when the 5 units sent you crashing? Realize that’s a tough question to answer:)
The good thing about Apidra is that it acts quickly & also leaves your body quickly. If Apidra ends up being too fast, there are other insulin brands & options, including Regular insulin that works more slowly.
Thanks, Sarah and Gerry. I definitely appreciate your support. It’s been hard not trusting my doctor, my endo or even the country I live in…lol. I started just now before breakfast with one unit and will see how it works for a day or two and test, test, test. I’m still learning about carbs and right now feeling pretty stressed. I have sort of felt I had to figure everything out and I’m having to take a step back and do one thing at a time. I figure most of you went through an adjustment process too and I can’t just skip over it.
Probably when I went crashing from the 5 units, Gerry I had been eating significant carbs. I really don’t remember (it was over a month ago) but I have been eating a fairly high carb diet as a vegetarian and only become aware and willing to adjust it in the last couple weeks. I’ve ordered a couple books and am finding carb and GI info online. Yes, I do have some residual insulin production. It was .70 at one lab and .38 at another.
A question about storage. The insert says to keep it in the refridgator until ready to use and then it is good for 28 days if kept below 77 F. It isn’t terribly warm where I live, maybe between 75 and 80 at the highest right now. With my Lantus I was putting it in the fridge during the day and then taking it out at night (I take it at bedtime. But I think it would be a pain to keep taking the Apidra in and out of the fridge to warm up, all day! Is that 77 degrees conservative, do most of you keep it out of the fridge? Also it says 28 days after you start. If I take say 6 a day then a pen lasts for 50 days!! Do you trust it for that long or waste 1/2 of it??
We all went through an adjustment period & are still adjusting. I’d cry from the confusion of not being sure what to do, how to do it, frustration & info overload.
I keep my insulin in the fridge. You don’t have to warm Apridra up before taking it. Someone tell you to do this? Some people think Lantus stings less if it’s not cold when injected. I never found this to be the case when I took Lantus (am now using Levemir). The Lantus sting is because it’s acidic. Also, don’t put your insulin in the door of the fridge to be shaken up constantly.
If you use insulin daily, it expires when it expires. Lantus really does just last 28 days. I consistently found Lantus losing potency as it approached the 28 day mark. A new bottle of any insulin is the most potent. I throw out half used bottles every month. Hate wasting it, but no choice & I’m glad I don’t have to take large doses.
Thank you, Gerry. I appreciate so much the first couple sentences of your post. A friend of mine I’ve known many years who is a nurse said that it sounds like I’m expecting myself to be where all of you are who have dealt with this for 10-30 years! She was right. I need to learn from all of you but also be aware of my own process and take things a day at a time.
The Apidra insert says that about 1-2 hours to warm to room temperature, but it sounds like it is unnecessary. I’ll throw things out when expired, my glucose level is more important than money. I’m doing ok so far, doing a lot of testing and I will keep to the one unit for a couple days but it probably isn’t enough.
When no one was home I’d sit in the middle of the floor & cry from being overwhelmed. I felt that I’d never get it. I couldn’t stand my endo & he was never available to answer questions. When I went low carb my doctors didn’t support my decision, so I found one who would. I also felt stupid because I felt like I’d never sort through all the info I was reading & wasn’t sure I was giving my injections correctly, let alone the more complex stuff. Not the correct dose, just the actual shot. Found out that I wasn’t even testing properly because no one told me to wipe away the first drop of blood. A nurse saw me testing & told me the proper way.
Your friend is right. There’s much to be learned & it keeps changing, too. I’ll think that I’ve finally figured out dosing (ha!) & then it changes. I know how you feel in wanting to do everything right & right away. Diabetes is about self-management & so much is trial & error. If only there were tidy formulas!
Clearly, I never read the Apridra insert:) Promise you don’t need to warm it for several hours. Just take from the fridge & shoot.
FYI–Levemir lasts five weeks, as opposed to Lantus’ 28 days. Some people do better on one over another. I do much better on Levemir.
Thanks. I didn’t get much response to this post, (and none at all on the other board I frequent)…something I said…lol? and when I posted a serious question on another thread on here I was told it was supposed to be all in fun. Maybe when I am more stable I can joke around more; right now I’m desperate for information.But the two people who have responded to this thread have been very helpful, so thanks you guys.
As long as you got the info you wanted that’s what counts, right? Nope, not anything you said:) Please don’t take lack of response personally. Often threads get buried. A new discussion is started & it bumps another discussion off, so people may not have even seen yours. I’ve posted questions & not gotten even one reply.
I didn’t think of that. I realize that I am obsessively reading these boards lately, and most people probably don’t spend the same huge amount of time doing that! Hopefully as I get more comfortable with my diabetes management I’ll go back to the rest of my life…wherever I left it!
The home page only holds a limited number of discussions. I’ll see something that looks interesting, come back later to read & poof it’s gone. It can be searched & started again by replying.
I wonder if I handled this right. I’m trying to adjust to the Apidra. I started yesterday with only one unit because I’m scared of the fast-acting insulin. The one unit didn’t bring my numbers down, if anything they were higher. I wondered if this was because I was told to d/c my oral med and was still not on enough apidra. Yesterday was all in the 200s and my bedtime was 351! I wondered if maybe my Lantus had expired, so I plan to use a new one tonight.
Today I went up to 2 units (my doctor said 2-3). At breakfast I went up from 106 to 248. Then I was 351 again before lunch. At lunchtime I took the 2 units and ate a salad and a wedge of cantalope. My numbers started to come down and after 2 hours I was 117. (good!). But by time for dinner I was down to 70.
I couldn’t decide what to do at dinner, so I decided to just do one unit. I ate a black bean salad. A half hour after dinner I was down to 52 and I got scared and took 3 glucose tablets. Now 20 minutes later I am fine at 121.
What the hell happened? Why did the 2 units take me down so far from the 351 when at breakfast it took me up? I don’t get it! Did I handle it right or should I have waited for the food to kick in and take me up from the 52 (I’ll probably now be high again.) I’m so confused. I guess I just need to keep doing the 2 units for another couple days, keep testing and see what happens.
What was your BG before going to bed & what was it when you woke up this morning? If you have dawn phenonmenon, your morning numbers can creep up for hours after waking. Best thing is to bolus & eat as soon as you wake up. Sounds counterproductive if your BG is high, but eating prevents your liver from dumping more glucose.
What did you eat for breakfast & how many carbs was the meal? Did you have coffee? Caffeine causes BG spikes for many.
Apridra didn’t cause your morning BG to go up. You didn’t take enough to bring it down.
Many people are at their most insulin resistant in the morning, least resistant in the afternoon & resistant in the evening when most eat the largest & heaviest meal & are the least active. You appear to be relatively resistant in the morning & may have dawn phenonmenon at play. I take my largest insulin to carb ratio in the morning & eat the fewest carbs at breakfast because I have dawn phenonmenon.
What was your reading before dinner? What I do when I’m low before meals is bring BG up to my target (90), bolus & eat. You need to not overdo the glucose tabs. How many sugar grams per tablet? Most are 5. They start working within 15 minutes, but continue raising BG for around 1 hour. It’s the everyone is different deal again, but 1 gram of glucose raises my BG 10 pts. So, if my BG was 52, I’d take 4 grams of glucose (not 4 glucose tabs). With that many glucose tabs, dinner & 1 unit, you may be high again. I hope not.
If you’re not, you need to be counting carbs at meals so you know how to match insulin to meals.
You should speak with your doctor about dosing to correct highs. For me, 1 unit of Apridra brings me down 60 pts.
I could NOT figure out how to reply to the last post, because there is no button! I had to just copy the post, print it and use that for the points I wanted to answer. Can someone explain to me how to use this forum??
Thanks for your reply Gerri. I take Lantus at bedtime. My BG at bedtime was an astounding 351! I think either my Lantus pen was expired or else I am just so high because I was discontinued off the other med I was taking and am still not taking enough Apidra. I’m pretty sure I don’t have Dawn Phenomenon. (I actually thought only Type 2’s had that!) I am usually fine in the morning (70-100), but like I said the last couple days everything has been higher. This morning I was 122. For breakfast I had scrambled eggs and a piece of wheat toast (homemade).
I think you are right that of course Apidra isn’t making my numbers go up. I’m just not yet taking enough to bring it down. (or need to eat less carbs). I felt like my experiment was making sense until I got to lunch today. Yesterday I was consistently high because 1 unit is not enough (and I’m off the other med that was keeping my numbers 150-200). But I don’t know what happened at lunch. I have a feeling this is more complicated than just my doctor telling me to take 2-3 units! I see that you are saying I might be more insulin resistant in the morning and need more then? I do tend to be higher 2 hours after breakfast, so maybe I have to eat less carbs at breakfast but more at lunch? (I tend to like salad-y type things then).
If you were 70 before dinner are you saying you’d eat glucose tablets?? I really don’t like eating sugar unless absolutely necessary. Couldn’t you just skip the bolus instead?
My doctor hasn’t given me a counting carbs plan yet and she is gone for two weeks. I think I am not ready for that yet anyway.
Sometimes, don’t ask me why, they aren’t reply buttons. II just got to the top of the page to add a new reply. Or, I go to the last reply button on the page from a previous reply & start there. This seems to put the reply in the proper order.
It’s more common for Type 1s to have dawn phenonomenon, but Type 2s can this as well.
Your Lantus may not be expired. You take it at night. It takes hours to kick in, so it helped your morning numbers assuming your morning reading was significantly lower. Because you don’t need much insulin, your endo hasn’t suggested two separate doses of Lantus. Despite what the pharm lit says, Lantus doesn’t last 24 hours for most people. By bedtime the Lantus you took the night before was probably gone. The other thing about Lantus is that it does have peaks. Yes, it’s slow & supposed to be steady, but it does have small peaks.
It seems that you need more Apidra in the morning. But, take increases slow. As I mentioned, you need to keep at the same dose for three days to ascertain a pattern. Some days are just off days & you need to have consistency for your body to adjust.
According to my endo’s directions, I should take glucose to bring me up whenever I’m below 90, but I only treat lows below 70.
No, I absolutely would never skip a bolus dose. My BG would be sky high if I ate without insulin. Unlike you, I have virtually no insulin production. I treat lows with jelly beans. They’re 1 sugar gram per jelly bean & pure sugar. 1 jelly bean raises me 10 pts. I hate eating sugar, but that’s the only safe option for treating a low quickly & it’s not much sugar.
At the risk of sounding like a nag, you need to start counting carbs even without a carb:insulin ratio yet. Without this, you’re just shooting in the dark & have no records to show your doctor to assist with figuring this out for your next appointment.
My IC is 10 and I can take fast acting and it barely budges mine. I have not taken apidra yet but I think I am headed that way. Right now I take novolog in my pump.
Thanks, Gerri, can you tell I kind of panicked a bit there? Between having this thread in two different places and then not being able to find the “reply” button, hmmmm…do you think I might be a little stressed out?? If they had a meter for frustration tolerance mine would be at .35!
I replied to your comments on the other thread I started called “What Now” so I won’t repeat that here.
Yes, I’m getting that there are a lot of variables and there isn’t going to be an easy answer, but if I keep at it I will see patterns and learn what to do. Take glucose below 90? Yikes! I only treat lows below 60. I’m a bit edgy about sugar. I have fifteen years recovery from an eating disorder and don’t eat sugar…ever. I can take glucose tablets when I have to by telling myself it is needed “medicine” (even though it is of course pure sugar!).
You don’t sound like a nag; you just know want to do and are kind enough to share it! I’m keeping my stress level at a dull roar by taking one thing at a time, but I do have lists of carbs and have ordered a book, I’m just not there yet. Tomorrow I will look up the wedge of cantalope I had with salad for lunch because I thought that was enough carbs.
Everyone is saying stay at the same dose for a few days and a pattern will present itself. Remember those magic eye books that used to be popular where you stare at a bunch of dots and suddenly a picture emerges? That’s how I feel. I got a bit freaked out when I realized I needed to think about more things like different times of day and more about food, but I appreciate all the variables. I think I’ll skip Spanish class tomorrow. I don’t want to have to explain all this in translation!
Hey, Zoe. Hang in there. As you’ve found, it can be very complicated at first to adjust rapid-acting insulin-to-carb ratios. And, unfortunately, you can’t do it in just a few days. That’s because you need to build a record of blood glucose results for one segment of the day for at least 3 “regular” days to make sure patterns are consistent (and who every has a regular day?!). Although I agree your doc should talk to you about insulin-to-carb ratios, it sounds like she was just trying to give you a baseline dose to start with. Until you can meet again with her, you could aim for approx. the same number of carbs at each meal (say, 15-20 grams at breakfast, 45 grams at lunch and 45 grams at dinner–which it sounds like is closer to what you’ve been eating; many people eat fewer or more carbs, but ya gotta start somewhere and it’s best not to change too many variables all at once) and the recommended 2-3 units of Apidra. Then, to help yourself catch lows, test before the meal, 2 hours after the first bite, and 4 hours after the first bite. The 2 hours after number will tell you if you matched dose to carbs OK (goal from ADA is under 180 mg/dl at post-meal peak; goal from ASCE is under 140 mg/dl at post-meal peak). The 4 hours after number will show you if residual Apidra is continuing to work on lowering your blood glucose. Caution: those times are approximate because you may peak after a meal at only 1 hour and Apidra may last for a shorter or longer time in your body. But they are helpful benchmarks.
While you’re figuring this all out–yes, it someday will seem clear and simple
(hah!) --you may want to avoid vigorous exercise, because that can have blood glucose-lowering effects for several hours afterwards.
Best wishes! We’re cheering for your success (and always, always appreciate the effort you put into living with diabetes).
I know & I know how you feel. Panic is normal, even if it isn’t any fun.
I only treat lows below 70, but endo is insistent that maintaining a constant BG is the best plan. He’s right, but I just can’t bring myself to raise a 70 or 80 to 90. There’s a scary thing called hypo unawareness & it’s from experiencing so many lows that you can’t recognize them.
Do whatever you can to stop stressing. Easy advice, I know:)
Get a scale. The EatSmart is great. It shows carbs for 999 preprogrammed foods, along with a ton of other info. You need to make carb counting as easy as possible. What’s a quarter of an orange when every one has a different weight? There are also on-line carb counters, if something is not in your book.
Yes, exactly! Just like those patterns of dots. Remember also how when you relaxed your eyes the pattern appeared clearer?
