26 June 2012
FINALLY have all the supplies together, and all measurements done. Ready to begin. Will do 1/2 unit of Novolog 10 minutes before a normal lunch and measure closely for 3 hours. Plenty of glucose on hand, but if calculations are correct it should remain unused. We shall see.
106 Pre prandial (lunch). 107 after 1 hour. Yes!
Later, same day.
Well, this is a learning experience and one that is going about as anticipated -- so far. As mentioned earlier, my strategy here is to start with deliberately low dosages and work up to the right level. 1/2 unit isn't sufficient, as I expected. The beneficial effect is there, all right, but too weak and too short lived. However, the traditional wisdom is that it can take 4 days for a change in insulin levels to show its full effect, so I'll continue this way through Friday. Then I'll review the measurements and consider bumping it to 1 full unit. Stay tuned.
27 June 2012 1207
Okay -- I know I said "no change before Friday" but that, like most things diabetic, is subject to adjustment based on experience. I have bolused for three separate meals, all far enough apart to be certain of no residual overlap, and the pattern is pretty definite now: one-half unit just isn't enough. The half-hourly measurements make that clear. No surprise, I deliberately started low.
Probably should mention that I am eating rigidly controlled meals, holding the protein and carb content as steady as humanly possible. So the insulin dose is basically the only variable.
Stepping it up to a full unit next time around.
27 June 2012 1630
Well. Much more positive results with 1 unit. Way too soon to assume a pattern yet; I will have to do this several more times to be sure. But here are the results from the first try at this dosage.
99 at end of meal
119 at the half hour
94 at 1 hour
108 at an hour and a half
109 at 2 hours
Getting close. It will be interesting to see whether this pattern holds up. May need some basal after all if the Novolog is always going to peak and then tail off this fast. But one test doesn't prove anything. Will have to do this for a while before drawing any conclusions.
28 June 2012 1108
1 unit is really helping. This process is most instructive as it continually refines my understanding of my individual pattern. For one thing, Novolog doesn't seem to kick in as quickly for me as for some people. It consistently takes 20 to 30 minutes before I can measure any discernible drop in BG. Even then it comes online gradually before really taking off. It does eventually take hold and climb to a strong peak, but the first onset is gentle. Everybody (and every body) is different. As we know so well.
And, of course, I am dealing with very small doses here. The behavior may be different with larger amounts. That's something to watch out for very carefully. [For those who haven't figured it out already, I am definitely "Type A". I like to measure everything in detail. No wonder I consider Bernstein a kindred spirit! :) ]
Anyway, here is today's breakfast:
Steamed broccoli (6 grams of carb)
Two egg omelet with spanish chorizo and cheddar cheese
Earl Grey tea with stevia
And here are the measurements:
128 after breakfast (some dawn phenomenon there; fasting was 92)
123 at 1 hour
114 at 1.5 hours
108 at 2 hours
Zeroing in. The pattern is holding so far. A couple more days like this and we'll see where we are. Meeting with the doc on Tuesday.
28 June 2012 1932
Dosed the same for lunch and tracked it the same way. Noticeably better numbers, even though the meal was larger and contained more carbs. Definitely some dawn phenomenon going on here.
29 June 2012 0948
Still on 1 unit, tracking results from today's breakfast. Better numbers than yesterday. Less Dawn Phenomenon, perhaps. Anyway the basic pattern is still holding. 109 at 1 hour.
Yes, you should see slight improvement over the next couple of days on your morning numbers. Like the diabetes nurse educator told me many years ago, its a cumulative effect, that's why you should always wait 4 or 5 days before making any changes, and by the way, also only tackle ONE change at a time. Don't add basal insulin until you get your mealtime dose well established, and don't change any other meds or your diet either. It just gets too complicated to figure out what caused which reaction, LOL!
Too complicated? Tell me about it! No matter rigidly you try to control everything, the inherent lack of precision and the variability of everything means we are always trying to hit a moving target. If you change more than one variable at a time, there is no chance at all of getting it right (other than by pure blind luck). I expect it will take weeks at the least to refine my regime to what it should be. That's only realistic; it took years to reach this point, one shouldn't expect to fix it overnight. And I never expected to nail it on the first try. That would have been beyond silly.
Plus, once I do have the right formula dialed in, I will need to check every week or two (forever) to see when the pattern changes, as it's bound to, eventually.
This is the learning experience to end all learning experiences. You know, it makes me wonder how much of physiology behaves just like this. I think I have more respect for doctors than I used to, despite the specific issues I have with many of them. I don't know that I would have the strength of character to spend much of my working life trying to hit moving targets.
Thank you, DavidSQ, for your last sentence, "I don't know that I would have the strength of character to spend much of my working life trying to hit moving targets." A responsible doctor works very, very hard to help us, each of us being unique.
Yes, Trudy, absolutely right. And not only "unique", but in a state of constant change and flux, which was my major point.
Trudy,
P.S. I probably should have mentioned that I recently changed doctors and I am very happy with my current one. He spends time, he listens, he thinks, and he doesn't have a preset agenda nor a fixed "one size fits all" formula.
Hi David. Since my husband is a neuro-physiologist, I think I understand what you were saying. So many people here on TuD have had bad experiences with their doctors; I always cringe when I read their stories. However my own experiences have been much better. I've had so many doctors that try to help me, my collection of autoimmune diseases interacting making for my own particular uniqueness. I'm sure that other folks with Type 1, and folks with Type 2, MODY, etc., are every bit as unique as I am, though for different reasons. I learn so much from TuD, but I learn from my medical team as well. I'm so lucky that my doctors encourage me to self-manage. In conclusion, I agree that there are no "one size fits all" folks; none.
Trudy,
I understand perfectly. I decided a while back to self-manage aggressively and my current doctor is all for it. I do my homework pretty thoroughly, too, and I'm sure that helps to boost his confidence level. We have a good working partnership, which is the way it's supposed to be. Like you, I too have read many of the horror stories here and elsewhere. Sounds like we're both very fortunate.
30 June 2012 1029
1 unit, day 3. Numbers continue to improve gradually. The effect is, indeed, cumulative. You can almost hear the beta cells heaving a sigh of relief . . . :)
30 June 2012 1119
88 at 2 hours. Any comment would be superfluous. Anyway, I can't think of an adjective strong enough to describe something that probably hasn't happened for a decade or more.
:)
30 June 2012 1805
88 at breakfast plus 2 hours
93 at lunch plus 2 hours
The pattern is holding with minor variations. Looking good. Next, dinner. Tomorrow will be day 4 at this dosage. Will reevaluate after that.
01 July 2012 1850
Today started out okay -- normal breakfast, 1 unit of Novolog, normal readings.
But then we went to a wedding and reception where I had to guess at the food content and guess at the bolus. So naturally I went low to be on the safe side (had to drive 90 minutes to get home).
So the day was pretty much of a loss measurement-wise. Things should be back to normal tomorrow.