I saw a new endo on 10/20/09. This is the first endo I have seen in…well, years. I was under the care of my pcp and I promised myself that once I was out of grad school and a little better off financially that I would start taking care of myself more. So I went back, got the looks and the lecture from the endo (I knew it was coming and I accept my lack of care). I have tried to do as well as I could while not letting my D interrupt my life–which I know you all know how far that could have gotten me.
Anyway-I’m dedicated. I’ve walked the straight line for about 11 days now (baby steps!). My A1C was 10.1, but all of my other blood and protein tests were excellent. I’m not pumping yet, but will talk to the endo in January. I’m on lantus and humalog (sliding scale). I am also on Metformin now. For 10 of the last 11 days, I’ve had low BGs (some days up to 3 lows). My scale was adjusted on Friday.
I understand that my body is going through a big change right now with the lowered BGs, but the hypos have made it worse. I spent yesterday pretty much just lying around as I started getting light headed. It’s not something that worries me so much…I really feel as though I’ve just stressed my body with 40-50 BGs every day/multiple times a day. But my question is this–have any of you gone through this transition period-and how long should I expect it to last? I rested as much as I could this weekend, but I am back to work tomorrow–and I work multiple jobs…so I can’t take off.
I know that I’m getting on the right track, but the on-ramp is a bit rough right now. Just looking for some shared experiences to get me through.
If you’re having that many lows in one day, something needs to be adjusted. I will grant there is a break in period, but you shouldn’t be having so many lows in one day. Either your very sensitive to the insulins or you’re taking too much.
I’d call my doc in the morning and discuss this with him/her. Do you record your blood sugars on some sort of chart? Keep track of what you eat, how much insulin you take at that time and any exercise for several days to plot where your sugars go.
The pump takes some serious effort and work, but its worth it. Be ready for another adjustment, and I’d give it 6 months before you make any decisions one way or another with it.
Have you never been taught how to adjust your own doses? That would be the first place I’d start, honestly… because mine do not stay the same from week to week (sometimes day to day!)
Books like Using Insulin or Think Like a Pancreas can help you on your way… learning to use insulin effectively and not relying on someone else to make changes for you is probably the most important step you can take towards managing your diabetes effectively. It’s just as important as testing often.
I agree with Cara on this one. There is an adjustment period but lows are not to be taken lightly. If you’re experiencing that many lows in one day then something needs to be changed pretty quickly. It can be such a long process getting everything set up the way it should be so please don’t rush into it. I always feel like it’s better to start out with your sugars running a little high and then gradually adding insulin until you get within range. At least then you’re not running the risk of getting low in the middle of the night or at a time when it’s not possible to treat it fast enough. Just my opinion Hang in there. The first (and sometimes hardest) step is committing to it and you seem to have done that. We’re always here to help you with the rest!
Congrats on the change towards taking better care of yourself! True that the first steps are the hardest.
Hypos are no fun & they can be dangerous, especially if you’re asleep or driving. You shouldn’t be having this many lows. As the others have said, your doses need adjusting. It’s either the insulin or the combo with Metformin. Please speak with your endo right away.
Sliding scale is not the way to accurately take insulin. It really is shooting in the dark. As soon as you can, learn to count carbs so you’re able to inject appropriate dose to cover meals, in addition to correcting highs. Your endo will be able to refer you to a CDE to help you with carb counting & calculating your insulin:carb ratio, which can be different for different times of the day.
By keeping records of readings & doses, you’ll be able to make your own adjustments.
I was on a insulin carb scale prior to this new endo. But because she diagnosed me as insulin resistant, we are starting back with the basic sliding scale rule…and trust me, it’s been hard to resist altering her instructions. I feel like I eat to cover my shot, not the other way around. But I’m trying very hard to play by the rules.
My endo did decrease my baseline dose on breakfast and lunch, which has evened things out the last couple days. Actually–knock on wood-- I’ve not had a low today…which is the first in about 11 days.
I guess I gave you all a lot of backstory, but my ultimate question was more about the lows and the effects I’m feeling with them…even tho I’ve not had one today, I feel a bit like I’ve been put through a lot with the constant lows and wondered if anyone shared the same experience. I’ve never been this laid out by lows before. Just sort of checking to make sure that it is normal to feel this way after the lows.
And yes, I’ve kept a log of every BG test and every morsel that has crossed my lips with a nutritional breakdown. I faxed my endo 7 pages worth of material for 6 days worth of stuff.
I’m faxing material again this week and meeting with a nutritionist the week after. So I’m working away at it–but these last few days have been rough.
Thanks for the support. It’s nice to touch base with people who actually live with this stuff, ya know.
Just curious Beth - have you bought yourself a copy of Pumping Insulin by John Walsh and Ruth Roberts? It’s sort of the bible of diabetics IMHO, both multiple injecting and pumping. I used that book for about 3 years before going onto the pump - and it really helped me understand how to adjust my insulin requirements, instead of like you say “feeding your shot”.
I eventually managed to get my Lantus (basal) doseage right, but was still having probs with hypos at night, which made for horrible days at work. I’ve found since being on the pump, have less hypos, but like everyone else, hormones, stress (just wrote a blog about it the other day) - can screw things up. I’m telling you, I think all of us folks with diabetes are one patient lot with what we face daily (and it’s so nice that we can come here and get it off our chest!).
Anyway, keep on doing what you’re doing (and no - it wasn’t a long post), keeping record, talking to your medical team. I’m still looking for an endo that understands patients who are on pumps, as it’s still relatively new here where I live (Quebec, Canada).
Take care - and good luck at your jobs tomorrow!
Anna from Montreal - The Trials and Tribulations of a Diabetic
Hi Beth! Don’t worry about the long post. You are expressing your feelings and that is a good thing. I am sorry you got “the look” from the endo. I am praying for you and am here if you need me.
I don’t have any practical advice that hasn’t been given, but I wanted to say I am wishing you all the support and courage and hope your ramp is getting smoother and straighter really soon
Lou x
Beth It is great that you are getting back on the wagon of good diabetes care…You are to be applauded!!
However, “sliding scale” is really not the only way to treat insulin resistance… I agree with Gerri. Though I am type one but not insulin resistant; when I did use a sliding scale for me it felt like “shooting in the dark”. I gor too many lows and too many highs… I have also done that before on my own, when I indiscriminately blind bolussed and I almost always came up with lows…
I know if you have an endo you like, it is hard to question her instructions…But remember, you are a 'team"; and she is not living in your body; You have to work together to reach the common good of great health for you.
I’m sorry that you got “the look” from the endo, too. No one likes being guilted into taking better care of herself. The endo is part of the team – not a judge. It’s the endo’s job to listen to you, learn your challenges, and make recommendations. It’s too bad that you got a lecture instead of support.
Did you just start on Metformin? I’m wondering if that’s contributing to your lows. Have you been diagnosed as insulin resistant before? Just curious because it seems odd to me that you’d get “back on the wagon” AND have Metformin added to the mix.
Hang in there! And there’s no such thing as a post that’s too long. We’re here for you.
Sounds like you wanted some sympathy, not instruction, so I am going to attempt to provide this.
Congratulations on walking for 11 consecutive days! I walk 2 miles a day at lunch M-F, well, M-Th now that I have “Furlough Fridays.” Totally makes you feel better, but if you skip a day, remember you will need to either eat fewer carbs or take more insulin.
I recently started working to improve my control. I experienced THE SAME THING - feeling overwhelmend and sometimes depressed when I was too low. When your blood sugar is low, there is some kind of hormone imbalance that is created. I have read this can contribute to depressed feelings, but I don’t know. Just know you are normal. The other thing is that since your brain isn’t being properly fed, so things may frustrate you that wouldn’t normally. Most of us, I think, get cranky, though.
The most important blood sugars are the ones when you sleep and the ones when you are driving. I always check my sugar before I drive because of the lows.
One last thing, when your A1C is below 7, your endo will be doing backflips, because he/she will be so excited. Your A1C will be lowered from the blood sugars that are too low. I went from over 9 to 6.8 in like 3 or 4 months. My doctor had a huge grin and he was happier than I think I have ever seen him. The 6.8 was not good control, though. It included a couple of seizures and a couple of shots of glucagon(administered by others, of course), so please be careful with those lows.
Goodness-your meter wouldn’t read your BG! Yikes. That had to be scary! Thanks for sharing your story here–it sounds a bit like my own–esp. about the exercise…
Thanks everyone for your kind comments and help. It really meant a lot to hear some good advice,
I’m feeling much much better now…my lows have quit, for the most part, and my flutuation is pretty narrow. So yea!!!
I’m a big reader, so I ordered the books that were mentioned here and in other forums. I’ll be honest, the temptation to give up again and not follow structure is very present, so I look to this site for motivation…I think I have learned more on this site then at the Dr’s office! Thank you guys for taking the time to connect here-it means a lot to me!
Sigh–what a difference your outlook can be when you don’t feel so bad! Have a great day everyone!!
Congratualtions for biting the bullet and seeing the endo. So many with years of experience here that can help you. If your endo will not adjust insulin for you as soon as needed, I would start myself by lowering the basal insulin. I am just theorizing that since you are having repeated 50s daily, your basal insulin may be pulling you down (though it could be bolus). I would immediately start with adjusting the long acting insulin to see if that helps. Less long acting. Get “Using Insulin” by John Walsh. That book will be a great help. You can’t run around all day at work in the 50s.
