With respect, the number of diabetic patients who you talk to are either in denial or in the minority! A drop in the ocean. There are millions and millions of diabetics out here in the real world and we are not all perfect or happy with our lot.
I wonder if your endo (I presume it was him or her that told you that you NEED to be under 120 post meal) is unrealistic in those aims! I too feel bitterly angry when they give you these figures willy nilly and then slap your wrists when you cannot acheive perfect numbers 24/7!
50 to 60 sounds too low, no wonder you are feeling like something brown and messy and smelly!
How about lightening up on yourself and letting your sugars run a little higher for a while and see how you feel, after say 3 months.
I was sort of like that before I got my pump, I was either low, recovering from a low, going to be low soon, rebounding after a low or mysteriously neither low nor high. I overshot insulin for a long time, using it like something you’d buy in the parking lot at a Grateful Dead concert, and ate to catch up. That was when I was bigger. I didn’t quite have the same sort of anger feelings that you are describing Gary, b/c of my extensive partying history of sort of going “be cool” but had a really hair-raising time of it for a long time. I think that insulin is worth considering a “hard drug” like coke/ heroin/ maybe LSD more than a soft drug like beer/weed, which also can be very debilitating if you don’t stay in control. It definintely gets its hooks into you and seems to have some fairly potent mental effects that make me feel really strung out when I run too low too often.
Along with the pump, the thing that helped me the most was getting into exercising which has become important enough to me that I will adjust my food/ insulin schedule so as not to get in the way of it. It is still very challenging and I’ve had a couple of screw ups in the last years while getting nice A1C results but I don’t blame either the exercising or tight control for the screw ups, I let other factors get in the way of doing what I knew I needed to do (“I have been drinking a lot, I’ll take a night off from that…” EVEN THOUGH I BOLUSED FOR 20G of carbs in some Negro Modelo Dark!!! ARGH and then the Mother’s day debacle I’d blogged about more recently, leading to $15K in worthless cardiac tests because no doc wants to commit to “maybe you were so loaded on insulin that your heartbeat was irregular?” type of diagnosis?).
Even if it’s moderate exercise like walking instead of idiotic stuff like jogging through blizzards in spandex pants, endorphins provide a pleasant buzz that goes a long way to offset the “dark side” of hypoglycemia. A lot of times, when I feel depressed, like something’s not going right, I’ll test and discover I’m running low. Insulin is obviously necessary but it is wicked stuff. Exercise is a very useful antidote and can serve as a focus for something beyond BG.
Being terrified of hypos, I absolutely cannot imagine wanting to be strung out on insulin. But just curious – is that what caused weight gain you mentioned?
Well, there are a lot of reasons but, in general my (non-doctor…) plan was to take enough insulin to make sure my BG didn’t go up and, when it went up, to take more insuliln, including not-infrequent IV R shots for years. This, in turn, caused hypos which I’d perhaps overtreat and so on and so on and so on. I didn’t pay attention to counting anything until I got my pump. I did ok w/ A1Cs in the 5s and 6s most of the time but it was a grueling lifestyle.
You have had diabetes for a long time … was it always like this? If not, I wonder what’s changed.
I’ve found with tighter control I feel high at lower numbers than I did before, but I still feel fine a certain amount outside the normal range, and even when I feel high it’s more annoying than life-ruining. Although I have found I get unreasonably exhausted when I’m at 14-15 to the point I can hardly stay awake, while previously being that high didn’t bother me at all, but I count this as a good thing because it makes me want to avoid going that high.
I’m a type 2 and dread the day my endo puts me on insulin. I participated in a drug study for the 48 hour human insulin and never did get good control. I seem to do best on glucovance alone; my overeating is more easily controlled, exercise doesn’t bring on lows and mood swings are fewer and much less intense. The only problem (according to my endo) is that I can’t get my A1c below mid-6.0s. He keeps prescribing additional meds that take the BS lower and throws the whole hard-won balance out of whack. We added Victoza a few months back and once I got up to the highest dosage I couldn’t move out of bed without experiencing a low. The resulting depression nearly put me in the hospital. I went back down on the dosage and was fine; but when I see him next month I am going to have some strong words about this. I don’t like being ‘high’–over 150 and I’m sluggish and slow–but the constant lower BS levels are no fun either.
The emotional component is real, Gary. You’re not dreaming it. Stable blood sugar levels, even if slightly higher than desired, contribute to stable mood. This may not be your experience, but for me, the size and speed of the ‘drop’ has a lot to do with my mood–whatever my blood sugar is doing, my emotions are sure to follow. Exercise helps, as does making careful food choices to treat a ‘drop’. I resist taking emergency sugar if I can help it because my BS is sure to spike as result; a tablespoon or so of no-sugar peanut butter followed by a large glass of cold water will get it back up without going high but resisting the anxiety and urge to eat more in order to get it back up quickly, well, that’s where I have the difficulty. Deep breathing helps calm me in the middle of a drop, particularly after I treat with food and helps me stay calm until the food takes effect.
Not trying to tell you what to do–but you’re on to something with the recognition of how deeply your BS affects your moods. Recognize the anxiety for what it is–a by-product of your BS levels–and treat the BS problem. The mood will respond to that.
Some folks don’t pay enough attention to what their BS is doing through the course of the day and don’t realize when it is having an effect on their emotional well-being. Making the connection is a good thing–you’re much more in tune with your body than most–and means you have many more factors to consider in terms of what works for you and what doesn’t. Diabetes isn’t simple–you’re just playing with a much larger palette of causes and treatment options than most. Picasso rather than Crayola.
Linda, why the aversion to insulin? I’m a T2 who chose to go on insulin because of all of the nasty side effects of the oral meds for diabetes I was taking. I only wish I had done so soon. My diabetes is much easier to manage; the unpleasant side effects are gone, and I have not gained weight, but actually have lost weight. Anyway, whatever works for you, but being on insulin isn’t all that bad.
An interesting story. Here in the U.S., I had a similar issue with thyroid medication. There is a huge bias among docs against “natural dessicated thyroid” replacement hormone made from pig’s thyroid glands. Prior to the development of Levothyroxine (synthetic T4), the replacement made from pig thyroid glands was all that kept hypothyroid humans functioning…just as (I believe) the first insulins were made from pig insulin as well…and saved people who otherwise would have died.
In my case, I was hypothyroid because my body wasn’t converting the synthetic T4 into the T3 my body needed. So my T3 was too low and felt awful. The natural stuff made from pigs has T3 in it…and - voila, I felt better when I took it. But many Doctors will not prescribe it.
Gary…every one here has been talking about how you are feeling emotionally as though this is an emotional problem.
What I am hearing is something different.
I am hearing you describe something completely physiological and out of your control. Correct me if I am wrong, but I believe that what your are saying is that when your sugar is high it effects your sense of well-being and that you are very sensitive to SMALL swings in glucose.
While I am NO expert, I am in agreement with those who suggested that a psychiatrist could help…because psychiatrists are MEDICAL doctors who understand the physiological impact of diseases on the brain and on psycological well-being. However…what I would really think would be beneficial would be for you to have both an Endocrinologist and a Psychiatrist working together to help you.
Sadly, while most people DO fit the mold…and fall into the middle of the bell curve on most “factors” in life…for every “factor” and every “bell curve” that is generated…there are the outliers. I KNOW, because I AM an outlier in several areas and it does NOT feel good when you have the medical profession telling you “you cannot be feeling” a certain way or that a symptom “cannot be caused by X” when it really HAS been…
I have no idea where you live…but if there is a university with a med school nearby…it may be your best shot at finding a medical team better prepared to handle someone who is a bit out of the “mainstream.”
The average doc may go their entire career seeing only “average” patients. They may see only 2-3 “outliers” in their career and the probably gloss right over them…try to fit them into their box…
Sorry if this turned into a rant…
By the way…I am quite sensitive to changes in sugar. I know that many people are unaware when they go high…but if I am anywhere near 180 or above I truly feel it. I get headachey and feel as though I am in a tunnel. At 200+ my vision starts to go off… It is not pleasant…
So we are all different. I am convinced that if there are 20 million people with diabetes, there are 20 million versions of the disease.
Misjudging food intake/insulin dosage can produce a life-threatening low. That’s why.
I have ‘lows’ on metformin/glyburide but not life-threatening ones. On m/g alone, the lowest I’ve ever had was 69.
During a drug trial for long-acting insulin, I had a 39 and was home alone at the time–never had a single symptom of hunger and was within an hour of my usual mealtime. I’m not hypoglycemia-unaware: I’ve always been able to tell my BS was dropping before. Never was able to determine what brought it on. That’s what scares me about going on insulin.
I’ve had a good experience with metformin/glyburide; no side effects to speak of once I got past the inital GI upset–and that was several years ago.
My endo knows how I feel about going on insulin and I’m going to have the same conversation with him next month about Victoza. I’m not needle-averse by any means, but when I exercise I get light-headed long before I get tired and have to stop. I tend to eat more in response to tha and have gained 3 pounds…
BMD You always make a lot of sense to me. How did you manage when you first went on insulin? Did you take time off work? Did you avoid driving for awhile? As I’ve never had lows, I wonder what I would do if I was unable to check the sugars. Thanks
Linda, sulfonylureas such as Glyburide produce lows the same as insulin. I’m not sure how you personally define a life-threatening low, but for me any low that would cause one’s judgment to become impaired is life-threatening. For example, if one would have a low while driving a car, I would consider that a life-threatening situation.
I was Rx’d the sulfonylurea Glipizide for many years, and I will admit that my sense of having a low seemed much stronger when I controlled by BGLs with Glipizide. Also, the fast-acting (bolus) insulins such as NovoLog can be in your face in a hurry if you do not eat soon enough after an injection or if you do not eat enough, so I agree with you on that point as well. However, managing diabetes with a combination therapy of basal insulin at night and bolus insulin before each meal is very easy to do and can become very routine. Personally, I rarely have any lows at all now, and I rarely crack the 200 BGL mark on the high end. If the day comes that you decide or need to go on insulin, it’s not a big deal and nothing to dread.
Out of all the oral meds for diabetes that I have been Rx’d over the years, Glipizide did produce the least number of bothersome side effects for me. It made me sensitive to radiation such as strong sunlight and my computer screen, but other than that, it was relatively painless. OTOH, I never could tolerate Metformin.
Anyway, I was just curious about your comment. Oral diabetes meds seem to be working for you, so that is a good thing. I appreciate your shared point of view. Thanks.
Peetie, transitioning to insulin was very easy. My PCP wanted me to try Lantus alone at night and stick with my oral meds. Since oral meds were not working for me due to the side effects, I instead decided to see an endo who specialized in diabetes management. He was absolutely fantastic. He immediately took me off all oral diabetes medications and Rx’d Lantus (night) and NovoLog (before each meal). That therapy has worked perfectly for me.
In order to get my insulin injections to stable levels, he set my basal insulin injection initially at 28ml, and told me to either increase or decrease the basal amount 2ml once every three days until my morning fasting BGL was 110. I ended up at 25ml, so my endo’s starting point for me was pretty close.
As for bolus insulin, he set my initial injections to 8ml each before each meal, and he had me add additional NovoLog to the injection based upon my pre-meal BGL. For example, if my pre-meal BGL were 180, I was to add 3ml to the 8ml for a total of 11ml bolus. If my pre-meal BGL were 80, I could either eat more for my meal or back off of the bolus insulin a ml or two from the 8ml base. I also was to check my BGLs two hours after each meal.
To answer your question, Peetie, I never skipped a beat. I continued driving 100 miles round trip into Atlanta three times per week. The transition to insulin was very easy. BTW, I have felt a low coming on while driving on the Interstate before. What I do is either pull off onto the shoulder or pull off at the next exit. Then I test right there on the spot and either pop a hard-candy mint, inject, or snack on something if necessary, which I have only had to do twice. I test 7-10 times per day anyway, so I’m usually aware of where my BGL should be. It’s really not a tough transition at all. I love the better control DMI affords over oral meds.
One of the major things that T2s on insulin need to not do is to get into a habit of eating large meals and covering those meals with extra insulin. That is a quick way to gain weight. Also, since most traditional T2s are battling insulin resistance, they should incorporate exercise into their weekly routines. Walking a mile or two three times a week is all that is needed to significantly lower insulin resistance. It’s really not a hard thing to do. It just requires a little discipline, and it is something all traditional T2s should be doing anyway regardless of diabetic therapy.
Thanks BMD: That was reallly helpful… The endocrinologist wanted me to take the meds and the pen. “Once in the morning” he said. As I’ve posted before, I couldn’t afford all that so, I grabbed the Januvia instead. It came as samples,it always does the first time. I’m having constant cancer checks so I only took one half tab of Januvia and then I read that it could trigger cancer.
So… I’m only taking metformin now but I don’t think it does anything for me. I’m happy to be rid of the diamicron and it’s side effects. My numbers are still much better than they were before although I did see two 12’s. I’m just hoping I can make it to the next appointment with the endo in August.
One thing that is surprising on here is how it seems to be easy to get a doctor in the US. Here they are always “relocating”. One must be referred to a specialist and these referrals are tough to get. No locked in “Joels” of “Northern Exposure” fame.
I agree with the diet and exercise. I walk a great deal.
Thanks so much for the great info. I think I’ll see if I can try what you are doing.
Interesting Note: Harold Ballard, the late owner of the Toronto Maple Leaf, used to pull that trick with the insulin after overdosing on sweets. He always had poor health. Don’t think I’ll try that.
Just for accuracy’s sake, it’s units you’re talking about, not ml. There are 100u per ml of insulin – if you took 25 ml, you’d be taking 2500 units. And you really don’t want to go THAT low, now, do you??? LOL!!
