Hi all! I’m new to the forum and new to diabetes. I was diagnosed about 7 weeks ago with LADA which I think is a confusing name so I just tell everyone I’m Type 1 because it’s easier to explain.
I have a couple issues:
I’m taking 18 units of Lantus but still can’t seem to get my waking under 100. I’m stuck at 102-110. Do I just keep increasing until I reach my under 100 goal?
I’m trying to figure out my bolus to cover carbs. I final figured out that I need a 1:10 ratio BUT when I check at 3 or 4 hours, my GL is way high - over 200 - and then I’m afraid to correct. Why is it doing that? I even tried splitting my dose - half at beginning of meal and half 2 hours later… When I woke up, my GL was 225! It seems that when I take a bolus it just ‘pushes’ my highs to later. Any thoughts on this? I finally just stopped eating carbs because I couldn’t figure it out but feel like I need to get it to work at some point.
Thank you all for your help. I look forward to hearing back. This is a very frustrating disease!
Welcome to TuD! I am glad you found this site so soon after your diagnosis–the support here will help you cope with the transition to the D-life.
I use Lantus myself and find that it really lasts only 20-22 hours for me. So sometimes I experience a blip in the time-frame you’re describing, often if I’ve had more fat or protein in my meal than usual. How many carbs are you eating and when do you give your pre-bolus? Are you checking your blood glucose (BG) a half hour or so before your meal?
Like everything else in diabetes, the insulin:carb ratios are simply guidelines, not hard-and-fast rules. So many of us use different ratios for different times of day. I am quite insulin resistant in the morning and tolerate fewer carbs and also pre-bolus nearly an hour before I eat!
Think Like a Pancreas by Gary Scheiner (a T1 diabetes educator) is a great place to learn more about carbs, bolusing, etc.
PS. You might want to talk to your doctor about using one of the longer-lasting basal insulins (assuming your insurance covers them).
Sorry you had to join our exclusive “club” but glad you found us. There are many good general practices for dosing insulin well. Do yourself a favor and try to get educated about those practices. Scheiner’s Think Like a Pancreas and Walsh’s Using Insulin are both good books to read.
Once you learn about the textbook insulin dosing rules, then you need to learn how insulin affects you. This means using your meter to log your blood glucose number at various strategic times. Do not be afraid to test frequently. It is the best way to learn how your body responds to insulin. I recommend testing when you wake up in the morning, at mealtime, two hours after eating, before, during and after exercising, and before going to sleep. It’s safe practice to test before you drive and anytime you feel strange.
Testing in this fashion will allow you to make conclusions about food you’re eating. You’ll discover that some food drives your blood glucose high and keeps it there. You can experiment changing your insulin dose to better match you food. You may also conclude that some food is just not worth the industrial doses of insulin required to metabolize it. Using your meter to guide your behavior is referred to as “eat to your meter.”
Yes, this is a frustrating disease but you can live well with it. The modern technology and practices of many here can permit you to keep your blood glucose in range for a high percentage of time, leading to more energy and a better outlook. It’s a lot of work, but it is so worth it. Good luck! Do not be afraid to asks questions. The collective diabetes experience here numbers in the thousands of years.
Thanks CatLady06. I bolus right before eating. I check my BG about 10-30 minutes before eating and then 2 hours after. If I eat any carbs I check, 1, 2, 3, and 4 hours after. I was shocked that my BG lloked good at 2 hours but then was really high at 4. I have the book, Think like a pancreas, but it is still all so new to me. I love pizza and that is the food I was eating while trying to figure out how to manage my bolus. Maybe my Endo just freaked me out about going low that I am not trying all the options available. I was hoping this forum would help give me some more specific pointers.
regarding your basal insulin instead of using lantus once a day you might consider “splitting” it (half in the morning, half in the evening). know some who do it and have full coverage (24h) that way
Understandable. Your world has been turned upside down. It will take a while to regain your bearings. Once the flood of all you want/need to learn slows down to a more pedestrian rate, you’ll have the time to approach it at your personal speed.
You have your whole life to learn how to deal with diabetes. Try to approach it with a regular and steady effort and your knowledge and ability will grow to produce very tangible benefits.
I wouldn’t be at all bothered by a FBG that’s just a few points over 100. In my case, if I took my FBG at 8:00 and found it to be 102, that would mean that at 4 AM, it was probably right around 82. And I wouldn’t have wanted it to be much lower during the night, since lower if I misjudged could risk going hypo.
You probably haven’t been at this long enough to know whether or not you have much of a “dawn phenomenon” (DP). Many diabetics find that our blood glucose increases in the early morning hours. You’ll need to get up early several times to see to what extent this might affect you.
I take Lantus at 6 PM. I have my dose adjusted to where my BG will stay almost level between the time my dinner bolus and glucose from dinner are through (about 11 PM) until between 3 and 4 AM. From then, my BG will increase gradually until I bolus and eat. If I sleep in until 10:30 or get up and just dink around until then, I’ll find that my BG has increased 40-50 points.
The exact hours people are affected by DP and the extent of it varies with the individual, so you’ll need to do your own testing. But I wouldn’t increase my Lantus dose to get the morning reading down further until I knew what happened to my BG during the night.
Pizza IMO is about the worst food to use in trying to figure out your insulin to carb ratio. It is known for having a long, late rise in one’s BG. I suggest you do your calculations with more “normal” foods. And leave pizza as a very infrequent special treat that you can expect will cause your BG to go crazy.
I’ve given up pizza entirely, as even a single piece will cause my BG to go over 200, no matter how I try to adjust the timing of my bolus. If you like it well enough to go through the hassles of trying to figure it out, I’d save that for later after you’ve more experience. I would think it would be less frustrating to get a handle on how insulin works with foods that aren’t quite so unique in the BG curve.
Just be sure to time the Afrezza appropriately though, for pizza id wait a full 45 minutes or more after eating or before taking any dose at all and likely plan on re-evaluating if a follow up is needed at 2 hours out… if u just snorted a bunch of Afrezza when you first sat down to eat pizza it would act way too fast… People seem to have a hard time with that… The whole variable with it is the timing, the dose almost doesn’t really matter…
Ahh, pizza! Assuming it is regular pizza crust that messes up my BG for many hours after eating. I seem to spike around 4-5 hours later. Anyway, maybe start with something simple like a piece of bread where it’s not that many carbs (and a well-known quantity of carbs) and go from there to work out your I:C ratio.
The thing that struck me is that under 100 is very aggressive AND very difficult to do (without having lots of lows). Especially if you are doing multiple daily injections.
I would start with a higher goal at first until you get your sea legs. I also think that your insulin needs are not all that stable yet. I didn’t settle in to both basal and bolus until about eighteen months in.
I suggest you start by doing nighttime basal testing. (Follow the directions in “Think Like a Pancreas”). Oops. There’s a typo in MY copy of the book. Below is the CORRECT nighttime basal testing schedule. Read how to do basal testing from the book. Do the testing three or four times, so you can see if patterns are emerging.
Overnight Test
Eat and bolus no later than 7pm. Eat dinner, then skip evening snacks.
Check blood sugar at 11pm, 1am, 3am, 5am and 7am
Okay to eat and bolus again after 7am.
After that test for morning, afternoon and evening basal as well. It’s going to take a while, but you’ll sleep better knowing you have that right.
Once you’re finished with the basal testing, you can test to see if your bolus dosing is right. “Think…” has directions for that, too.
Afrezza notwithstanding–I have to defer to Sam on that one–but it is SO deceptive; I almost never get it right. And so goooooood. Not to mention being one of the most unavoidable foods in history. If you participate in any sort of community group, sports team, school committee, scout troop, your kids’ friends’ bday parties, godknowswhatall, there is a pizza-centric gathering in your future. Sigh. And pizza without beer? An abomination.
That’s how I was taught to do it when I was on MDI, but when I (much more recently) got a CGM I was surprised to find out how far in advance I needed to bolus in order to get out ahead of those post-prandial spikes. Some people say 15min, but for me it’s a good 30-40 at least, sometimes longer if BG is running on the high side due to work stress or whatever. But it is a much trickier thing to do if you don’t have a CGM, so I wouldn’t necessarily advise it. One thing at a time. It’s still early days and it’s actually not the end of the world if the bread in your sandwich bumps you up to 200-ish as long as the insulin hauls it down again. But for the longer, stubborner post-p spikes, there’s nothing quite like this pizza of which you speak.
Bingo, pizza is notoriously hard to bolus for, most use a split bolus. It may be better to simplify your diet for a while, till you get your head around it.
also the less carb you have the less bolus you need and the smaller any errors are.
this will help until you can get onto a diabetic course.
I would see if your hospital has a cgm reader you could borrow and self fund a couple of sensors. this will provide a wealth of info on when your bolus kicks in and how various foods work
As already pointed out, pizza is difficult to bolus for. It´s even something on PubMed on the subject:“Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system.” Link to PubMed.
I found an approach to pizza. I eat the toppings and throw away the crust. That seems to work pretty well. I can eat a large pie by myself. In fact that is the inspriation for my recipe for “Brian (BSC)'s Pizza Pie Pie.”
ps. The high fat content of pizza delays significantly the digestion of pizza making it particularly challenging for us. That is also why you can still be digesting it the next day and have a high blood sugar.
