I need some words of wisdom again

I just want to say thanks to all of my friends here on tudiabetes.org, i feel like i recieve more help, information, and sympathy from you guys than from my endo. i think i have depended and managed my insulin routine on the foundation of this website rather than the research i find elsewhere, you guys really are the most helpful resource!!!

the past few months have been so up and down. 2 weeks i have perfect numbers (70-120) the next i am hanging in the 200s, even with full corrections and exercise, and an extremely low carb diet. whats the deal!? i take a lantus pen and apidra. could it be that the pen is less reliable than a vial…maybe i should switch to vials? do pens go bad after 2 weeks…? this is so chaotic, and i am wondering if i should skip out on my upcomming a1c because i feel as if the bad weeks will negate the good ones. Any suggestions?

i work out 3 days a week, an hour of weight training and an hour of cardio, on nice days (which is NEVER in new jersey, i take 3 mile jogs) on good days i benifit from the work outs, on bad days my numbers wont budge.

Hey Andrea,
Maybe it could be womans cycle making changes,I know I would be fine and when its about to come be high or low for sometime.As my nurse says you have to be a little investigator whats changed?are u eating something else?
More or less its the tiny things that we dont consider that make the big changes.
Goodluck and stay strong because ur amongst some of the strongest ppl on earth.xxx

I wouldn’t skip the test. Even if it’s not what you want it to be, it will show you where you are and perhaps provide some clue as to how far off you are? The results may suprise you, in terms of reflecting those times when you are having perfect #s?

If I’m reading your workout regimen correctly, you are lifting an hour and cardioing for an hour 3x/ week? You might get better results from that if you do an hour of cardio one day and do the lifting on the next day, getting a workout 6x/ week but not as intensely might hit your BG more smoothly although it probably would mess up your schedule more?

You might want to check your basal rates and I:C ratios to see if they need some tweaking. But I have to say, I tend to have a similar pattern where I do fine for a couple weeks and then my numbers drift in one direction or another. No hormone issues to consider. I’m pretty solid with my basal rates now but have tweaked my I:C ratios to see if that was needed. I did that on MDI and was hoping the pump would end it, but I might just have to correct when it happens and hang in. Hope you get more answers.

Hi Andrea,

I tried the pump for about 3 months and then switched back to MDI, and at first it was working beautifully, but lately I noticed that the amount of Lantus I need varies dramatically from week to week, from 23 units to 13, and back up again. I think it’s probably a combination of my cycle, stress, or getting sick… but I haven’t found any predictable patterns yet that make this easier to deal with.

That is one of the benefits of the pump that I miss… that you can change your basal rate instantly as soon as you figure out it’s not working. The thing I don’t miss is the stress of not knowing if I need more insulin or am having some insulin delivery problems.

Anyway, I would love to hear if you figured out any answers to this.

btw- I feel the same way about my upcoming A1c test… I know it’s not going to be pretty

You have had some good answers but I am going to comment on the insulin part. I also use Apidra and have had some problems with that – I also found a blogger that was having the same problem I was. I switched from pens to vials last summer when I went on the pump. In December, I started having a problem with highs & could not figure out why. I changed my sites out several times and finally decided to open a new vial of insulin – when I did that, my BS came down. I had been using the vial about 10 days when I started having the problem. About 10 days later after I did a site change, my BS went up. I literally had my hand on my site to pull it out, but decided to change the cartridge again using another new vial of insulin – my BS immediately came back down. This same thing happened with a bunch of vials of Apidra – they lasted about 10 days. I did have one that only lasted 8 days. The person whose blog I found was also having hers last about 10 days in the beginning, but hers also got more sporadic.

My pump died and I am back to using pens again. I did have a vial that I used with syringes and it lasted 8 days before dying. I am keeping track when I open a new pen.

I know someone that had problems with Lantus in the vials sometimes only lasting 2 weeks. I do think Sanofi Aventis has some problems whether it is in the manufacturing of it or how their distributors store it.

I would keep a log of when you start a new pen. If your BS goes up, swap it out for a different pen and see if that helps. When I swap a pen out because I think it is bad, I put it off to the side in the fridge – I know if my BS comes down with a different pen, then it probably was bad insulin. If it doesn’t come down, it was either me or the whole box was bad.

take the A1C. it is what is. it’s only a number if it sucks it will only get better

Hang in there - you are doing all the right things! :slight_smile: Are you still honeymooning? That will cause those up down cycles.
Hormones also come to mind, some women will have 2 weeks of easier insulin sensitive numbers and then insulin resistance starts to climb up and up.

Other ideas:
Anaerobic exercise like weight lifting can bump blood sugars up a bit. It’s still great for you - just need a bit more insulin.
I love Apidra, but sometimes it’s challenging with high fat or high protein meals - almost too short of a duration.

Don’t give up :slight_smile: It will work itself out.

Hi andrea. I have had a problem with vials of Apidra lasting only two weeks or so, usually mid-winter or mid-summer, not often, but leading to highs. Since I am very careful about keeping the Apidra cool when transporting it, keeping the vials in the vegetable bin in the fridge even after opening, certainly never freezing it, I have to think that at some point of time before I buy it someone mistreats it. Still its so much better for me than the others (Humalog and Novalog) that I keep using it. Maybe your endo will give you an extra bottle during an appointment if that turns out to be the problem, and if you explain it to him/her.

great advice and GREAT case study, i have always wondered about the true expiration date of the pens. my diet is extremely low carb so i do not find myself covering very often, which is why it takes a me a little while to finish an entire pen. they seem to only last about 2 weeks, i wish there was an easier way of telling when one dies, a color change or something. it would be more helpful. i think i am going to start marking dates on the pen with a sharpie. good idea. thanks!

so glad to see i am not alone. yes, i do miss the temp basal tool very much, but i am enjoying my vacation from the pump. i feel like most days i do have great freedom and control, just the stinky days are sooooo stinky. i will let you know what my a1c is but i dont think it will be too pretty either. and funny, my lantus is spectrum is exactly the same…13----23…wide range, huh!

you’re right, thanks!

i’m no longer honeymooning, this is my 10th year with D. but the hormone thing makes a lot of sense. Exercise of all sorts seems to bump me up for a quick minute and then send me for a quick drop.

Apidra is getting to be a bit tricky, i am wondering if the high fat content that you mention has a lot to do with it. i eat low carb and high protien. mostly grilled chicken, lite tofu, and fish of all kinds, egg whites too. those are not very high in fat but i usually have a handful of almonds between meals to keep me full during my extremely hectic days. school, work, long hours on my feet in the art studio. i know nuts are very high in fat (the good fat) but i often wonder if they are sending my sugars up in some way. also, i wonder if i cut them out entirely will i lose some weight. i have worked hard to lose nearly 20 pounds this past year, and i have about 5 more to go!

yeah, i feel like apidra is so high sensitive to temp change! i even worry if the sun is shining on it while i drive, or if the cabinet in which i store it is too cold! too much to keep track of! are the others just as fussy? i used novolog a while back but i cant remember

Hi Andrea - quick note - eating fat does not cause weight gain with a low carb diet. Adding fat helps stabilize blood sugars and keeps you nice and full (which you’ve noticed with the almonds) and can help you lose weight. I’m wondering if your insulin is set to cover a lower fat diet since you only sometimes eat almonds? Then, is it days you eat more almonds or more fat that your sugar goes higher? It’s easy to overindulge in nuts, and they do have some carb content. I eat a lot of fat and protein (only around 12 grams of veggie carbs per day) and my insulin levels are set to accommodate my high fat intake. Because of this, if I don’t get enough fat at certain times of the day I can go hypo, so I’m careful about that. Just wondering if you’re maybe having the opposite happen?

My sugar also will rise 3 weeks into the month, exactly when I ovulate. I need to take more lantus from my ovulation day until I start my period. This happens every month, and I used to think it was completely random until I started charting my temps and learning when I ovulate.

I stopped using Humalog years ago because it clogged my pump tubing at the entrance to the reservoir. I used Novalog recently, and while it was very temperature tolerant, it was just too slow acting for me. If I used it enough maybe I’d adjust, but I’d rather deal with the Apidra despite it’s temperature problem.

wow this is very interesting! i have always eaten healthy…you know, whole grains, veggies, lean meats, because i was trying to achieve a healthy lifestyle which i feel i have always done. once i decided to drop some weight i picked up the low carbing. so i am still learning! its hard for me to sit down and eat a steak because habitually i want to avoid fat. If im going to do low carb i want to do it correctly! Can you maybe send me a basic meal plan of yours so i can get an idea? only if it is not too much trouble.

I’ve never had a problem with Apidra, but I had several bouts with Lantus going bad. Never have this problem with Levemir. Janina told me that the plastic in pens degrades insulin more quickly. I only used pens for a short time because I didn’t like them, so I can’t compare if vials last longer. I use one vial of Levemir for 6-8 weeks before noticing any potency decrease.

wow, thats great to know. i think i want to sample levemir and see what happens. i do feel that vials are more reliable, something about the pens makes me feel like i may not be getting my whole dose…might be psychological.

With pen leakage sometimes, it’s hard to tell. I didn’t like that part & I had bruising with pens. Know what you mean about the pyschological factor I feel like that also. I can see the dose:) I have 1/2 unit syringes, so a pen offers no advantages. Levemir has been a lot smoother & level for me. It’s best taken in two doses, if you try it.