I was told by Endo not to take Humalog before bed for a high BG or between meals...However, when I am high and cannot correct and only eat protein between my meals then my ketones (urine) go high....Any thoughts on this? Also.....Anyone out there regularly test their blood ketones.....I have been....not sure if this causes me more anxiety or it's more helpful....Any thoughts on that as well?
Incorrect not to correct highs between meals. Sadly, doctors have inflated hypo phobia & little concern for the cumulative damage of highs. Of course, you need to know your ISF to correct.
Protein effects BG. About 58% of protein is converted to glucose. So, eating protein is sending high BG higher.
How often is BG high that you test ketones? What do you do when ketones are high? Only helpful if do something. What's important, of course, is dosing insulin to food to prevent highs. If you're consistently high, time to adjust doses & what you eat.
I've never tested for ketones.
I don't know your history, why you call yourself brittle or the reasons for this advice. I guess a question is how much advanced experience do you feel you have concerning proper insulin management? Do you know how to do basal testing, change your dosing ratios? Do you know the peaking and duration of actions of you insulins?
You should only check ketones when you continue to be above 250 mg/dl when fasting and are concerned about the onset of DKA. Are you regularly running your blood sugar up that high?
So then, if I am between a meal and am supposed to have a snack....what do I eat? I am advised only to take Humalog with meals. I just found out about ketones in the last 6 months or so ago...I was just admitted to hospital last week because of Diabetic Ketosis...NOT Ketoacidosis....not enough carbs not enough insulin. I AM a Late onset type 1 as of 23 years ago....it never went away...found out my great grandfather, whom I never knew lost both legs from it...nobody else in my family has diabetes...no I have no support that understands the disease.....my C-Peptide 2 months ago was .10. I acquired Diabetes first with my 3rd pregnancy, 23 years ago, and it has graduated into Type 1. I have never been really heavy...I'm average but have lost 21 lbs. since April of this year because the disease I guess has gotten worse and my dosing is all wrong and ketosis. I have become afraid of food and afraid to give myself insulin as I have experienced lows and have never known anything about I:C ratios, basal testing or ANY of that. I never had an Endocrinologist until within this past year...and now...I've been doing it all on my own....A1c was 11 last time they checked. I have just recently started doing the blood ketone testing and urine testing along with blood sugars -10 times a day....some of the fear comes from when I hit a vessel last August, injecting Lantus...I knew I hit a vessel because I tasted the insulin in my mouth right away...I Dropped from 280 to 48 in 20 minutes...drank maple syrup, called 911 then over corrected of course.....That's a long story short....
See my response to Gerri for a briefing on a small portion of my history. As far as basals, bolus, I:C ratio, MDI, pumping, ketones, etc. goes...I never heard the words before a couple of months ago. Brittle is what I was labeled by a Dr. a couple of times because it was up and down and up and down for no 'apparent' reason...as far as peaking.....I dose, I eat, I spike a little, level out and the drop is usually in the 3rd hour, not the 2nd....I never attempt to correct at a 2 hour test. Fear of food and insulin has become a problem...usually have tried to stay high side blood sugar for fear of low...now I am trying to overcome the anxiety of whether to eat or not to eat, to bolus or not to bolus and I have an eating disorder now....fearing food that I need. Hungry most of the time. Good news is that yesterday and today I have taken a little more insulin and managed to eat 20 carbs for breakfast, lunch and dinner, instead of like 10 or 15.....the urine ketones have dropped but since learning about blood ketone testing I am obsessed with that as well (very expensive). I want very much to manage this and enjoy what life I have left...it's kind of hard to do on your own after realizing I'd been in the dark about it for so long.
Ree, as others have said, this is ridiculous advice. The only time this makes any sense is when the patient is simply unable to responsibly and safely manage their BG with insulin.
Doing so requires more than blindly guessing and shooting insulin. But it's not hard, and the math is grade-school.
You need to know three parameters personal to you: How many grams of carbs are covered by a unit of Humalog (the IC ratio); how many mg/dl (or mmol/l) a unit of Humalog reduces your BG level; and the length of time Humalog keeps working once injected (duration of action).
Then, if you have a smartphone, download an app that can help with the insulin accounting, to avoid stacking.
With that, you can administer insulin any time for a correction. And you should be.
Ree, if you can handle the logging and simple calculations necessary to more actively control your BG, try to change your endo's mind. If that's unsuccessful, get another endo.
Also, the new endo gave me a regimen that I have had to come to terms with slowly...First a sliding scale with a goal of 150mg/dl....for every 50pts over 150 I take 1 unit of Humalog as a "correction" (I've noticed that can drop me as much as 65 pts)if no ketones are present (so far).....then 1 unit for every 10 carbs as a starting point...just a side note,,,,the other day I dropped to 165 (and I freaked out) so I ate 10 quick carbs and it threw me up to over 265....I am just having a hard time but I am determined to get this right. I appreciate the support here on TUDiabetes and a few other sites. Makes it just a little easier...I know there are many T1s that live productive and active lives and that is what I want to do. Also experimenting with the basal testing now.....I went to bed last night at 240 and woke with a 180....that was with taking 17 units of Lantus even though my body weight according to Lantus calculator should be 14 units.
have you read Think Like a Pancreas? It will help you understand the terms and the different insulins and their actions. It will show you how to find, set and correct your basal rates, Insulin:carb ratio as well as you Correction factor and duration of insulin action..
If you do your homework you will see that what your doc is saying is very old school. there are better ways to do this. If thy have called you brittle it is because you have not had proper education and proper advice on how to eat and dose correctly. Sounds like it is time for a new doc but check out this link first. You can get it for ereader or in paperback. Do you see an endo or is this your PCP?
I really think with a bit of effort you can do a lot better, feel better and no longer feel so much at the mercy of things. First, I would recommend that you get some books to read up on how to manage your insulin. Two good books are "Think Like a Pancreas" and "Using Insulin." And it sounds like you already have found that eating less carbs makes your control much easier. A good book which describes low carb diets and is a good reference for your bookshelf is "Diabetes Solution."
Now, let me make a few suggestions. First, you can drop the ketones testing. It is not useful and a waste. If you eat a low carb diet you will be in nutitrional ketosis which simply means you are burning fat. That is totally normal and actually beneficial, not harmful as you may have been told. The only time you need to check ketones is when you have a very high blood sugar (usually 3-400 mg/dl or higher) and need to check whether you may be entering Diabetic KetoAcidosis (DKA). The ketone levels are very different, nutritional ketosis is marginal or trace (0-3 mmol) versus high (15-25 mmol) for DKA. Nutritional ketosis is associated with normal ranges of blood sugars, DKA is only when you have high blood sugars. So unless your meter says "HI" I would just stop all the ketone testing.
And the snacking. You don't need to snack. It is in fact counterproductive because you actually should bolus for snacks. Just make it simple. Eat 2-3 meals per day separated by at least 4-6 hours. If you follow a low carb diet you should be able to get things pretty close so that by 3-4 hours after your meal your blood sugar has returned to where it was before the meal. If you feel so hungry you need to snack then choose very low carb foods, beef jerky, cheese, that sort of thing.
And next, your basal. You need to get your basal insulin adjusted to get your fasting blood sugars closer to a normal range. You should do this in steps and it would be best if an endo or diabetes educator helped step you through achieving this.
And finally, you need to work to feel comfortable and safe. If your life is filled with anxiety about all your insulin, your ketone level and the possibility of hypos you won't be happy. The incident you had with the Lantus is a known effect when Lantus is injected into a vessel, it suddenly acts like a rapid insulin. You can minimize this by taking extra care to pinch carefully and injecting in areas where you have abundant "padding." We all have stuff happen, we just need to learn from the experience and move on. Life is full of risks like riding in a car. I would urge you to face your fear of hypos and don't incur damage from high blood sugars just to avoid hypos. Keep things balance.
Hope that is helpful.
Food requires insulin, unless you're hypo. Nonsense that diabetics have to snack. That's a throwback to the days of NPH insulin, which was unpredictable & PWD had to make sure they had food in their system. Pitiful & maddening the bad & outdated recommendations were given. If you snack, take insulin. Eating is eating.
Ketosis is simply burning fat for fuel. People on very low carb diets are in ketosis regularly. The brain runs extremely well on ketones. Ketogenic diets are used to control seizure in children, for weight loss & there's research on its possible benefits in treating Alzheimer's. Never heard of diabetic ketosis. Please explain.
Your consistently high BG could be the cause of weight loss because there isn't sufficient insulin to get glucose into cells. The body is starved. An 11 A1c is an average of 267 BG.
I hear you on doing it all on your own. That's my story & the story of most. I've found endos to be useless. They give same-size-fits-all advice & are horribly behind the times. Fine tuning doses is up to us to figure out through trial & error.
What works for many is eating low carb. Low carb=low insulin doses=less dramatic dosing errors. Hypos are very scary.
There's no point in testing ketones that many times a day. If you're BG is high from your meter, correct & drink a lot of water.
I have the book...that is how I found out about how basal shouldn't drop or raise you 30pts either way during the night and should (in theory) hold your blood sugar steady while fasting. I told my NEW endo this who was HIGHLY recommended and told him about the Dr. Bernstein book that I am reading and he said basically that everybody's body is different and you can't go by everything you read....He takes my insurance.....I thought I had good insurance or so I was led to believe and nobody is contracted with it or is in negotiations because it is covered california (go figure) but it is a good plan and is Anthem Blue Cross..my last Endo took it at first but had wasn't taking it any more...this other guy is my only choice at the moment. After my GREAT insurance ended (Cobra) I had to do something so this is what has happened.
Thank you....I was diagnosed with that in ER the other day.....I'd never heard of it either but thought WELL What do I know...they are the Drs.
I'm just a Squirrel tryin' to get a nut in this world. LOL
Using a sliding scale is utterly inaccurate. Forget that & count carbs. Know it feels totally overwhelming, but you can do it. Dropping to 165, which is already too high, doesn't require eating. That's twice normal BG. Problem is when the body is used to high BG, anything else starts feeling off. But, you will also adjust to having more normal BG.
Thank YOU so much...I appreciate ALL the input/feedback...this really helps....Regarding the ketones....that explains my weight loss....I am going to try and eat 20 carbs per meal...I was only eating 10-12...I did test the ketones in the blood and one night it was 2.4 mmol....I read some info on it and it said that I should contact health care professional but blood sugars were not over 300....
Along the lines of what Brian said - if you do not trust the Endo, how about a CDE a Certified Diabetes Educator with T1 experience. Your insurance may cover that since they tend to be Nurse practitioners. You might have more options that way then endos.
How are you set for test strips. Do you have enough to do your basal testing first, and then start to work on getting a IC, CF and duration of insulin(DIA) All of those are necessary to good control and understanding of how things work for you.
Learning to do this is important as things will change with time. As you see trends then you can work to make adjustments in a safe manner to get /keep you numbers in a more normal range.
A lot of us have been there and done that for may of the same reasons. D does not have to be all consuming and have bad outcomes. You can take charge of it rather than the other way.
The online D comunity is a great resource.
What is CF? I run out of test strips easily unfortunately....I think I spend more money on that than food. My RX is for Accuchek Smartview test strips but I go overboard with those so I use True Test strips and a True Result meter until my next RX is filled. Thank you so much for your help....
ONE last question.....If it turns out that my Lantus dose is consistently dropping me throughout the day....do I back off on the per meal Humalog?
CF is correction factor - how much 1 unit will drop your BG before it levels off.
How many strips is your prescription for? Current/newest ADA guidelines is for a minimum of 10 a day. If you do not get that then get you dox to write a new script.
When you start to count carbs and work on your IC ratio check out the Calorieking web site or myfitnesspal. They are good sites you can use to track all your nutritional macros carbs, fiber, fat, protein they all can effect how quickly you spike and how much insulin you will need.
When I first started counting carbs I was told to subtract half of the fiber from the carb count if there was more than 5 gms in the food. Over time I find that just using total carbs works better for me personally. Check out the section in Think like a pancreas to find out how to test to see what it should be for you.
Also when you start to track your foods vs you humolog dose be sure to record time of day of the meal. It is not uncommon to have different IC ratios for different times of day.
I'm also one who does not snack - i have my basal dialed in and can go 12-15 hours with out eating with out the fear of going low or high. It takes work but is done in splits. Overnight, them morning, then evening.
Gary S has a good explanation in "Think Like a Pancreas".
Thank you...I give injections and am not on a pump...maybe I should look into it.