I'm not sure if I'm posting this in the right spot or whatever, but I'm giving it a shot anyways.
I am 18 years old and have been type 1 most of my life. I'm on lantus and humalog shots and I have always had great control until about two years ago. Lately, I can never seem to get steady; I am on a constant rollercoaster! Its mostly highs that I just can't seem to bring down (I'm talking 300-600). Let me just explain my routine a bit before I go on...
I wake up every morning at 5:30 at 300+ ALWAYS! After I cover, I work out, eat breakfast, go to school, and its usually 150+ at lunch. I stay steady 200s throughout the afternoon, workout again, and its still up there when I get home for dinner. My endo told me to check for ketones regularly and I have them pretty much all the time. I cover before bed, and then the cycle continues.
I know, I know, the obvious answer is to take more insulin. Been there, done that. I've tried cutting back on my insulin as well due to the possibility of spiking from unknown lows, but that didn't work either. I don't eat very many carbs, nor do I really want to. I'm sure a lot of it has to do with being a teenager with all the stress, hormones, and lack of sleep, but I've seriously tried everything. Its getting really scary, and I was in DKA this summer because of it. My A1C was 15! I'm almost embarrassed to get another one because of it. I really am trying...it just isn't working!
I understand there's not some magic formula to this disease, and that a lot of it is just trial and error, but I'm getting extremely fed up and I could really use some help/support/anything!!
I know it can be really hard being a teenager. But it really sounds like you are not taking enough basal insulin. Every time you correct, in the morning, before every meal and then before bed. Those corrections are generally all compensating for your basal insulin not keeping your fasting levels controlled.
I know that this is all difficult and frustrating, but I would hope to encourage you that you can get this under control. The difficulties that you are having will pass. You will become smarter about your diabetes, depend less on others and get things under control. You just have to decide to take ownership over things.
Sorry sweety totally know what your going through. Watched my son go into DKA last Sept and was also @ 15 for A1C. Theres alot of things that run through my mind of Questions to ask but wondering is this also affecting the weight? I incourage my son to drink lost of water which help keep the number down. Know one should look at you and Judge. Its not easy. Research if you have the time and keep up the exercising. Probable is the body changing to. Your young and I here that is part of the ups and downs through this age. My son has only been told he's diabetic since 2005 after a football injury. Told type 1. Now after DKA they said he was probable type 1 all along. Not sure why but bad things happen to good people. He's 22 now and got married rite before the DKA happened. Left him with Neuropathy and gastroprethisis. Not sure about my spelling but its not been pleasent. I will watch your comments to see how things are going for you. Keep smiling:) believe its gets better. Get more sleep so the body isnt so stressed.Kimberly
I'd agree with Brian that your basal insulin is off. John Walsh suggests that if your total corrections on average exceed 8% of your total daily dose of insulin, you should think about adding some of that insulin back into basal or bolus. Since you're waking up high, I'd suggest first adding back to basal.
Maurie
Sorry you're having a hard time, and good for you that you know you need to change. I had fairly good control as a kid, but things went out of control when I was a teenager.
I would agree that it sounds like your basal is off. Contrary to what it says on the bottle, when I was taking Lantus, i found 2 shots a day worked much better than 1.
Good luck.
hello sarahemilie. i am pretty new to his but i thought about basal insulin as well.
im sure with a bit of time youll have everything where it needs to be. you sound like youve got a good head on your shoulders. i hope you are able to get your numbers into an acceptable range! good luck!
The question is: does the lantus cover 24 hours or not? You should test that with two 1/2 days of fasting. On the first day you do not eat anything for the first 12 hours. On the following day you fast for the other 12 hours. The lantus should keep you steady in the fasting times. Please google for "basal rate testing" for details. When do you inject your daily lantus dosage?
I agree with Holger (and the others on basal). Fiften years ago (pre pump,) I started on Lantus. My endo (who was a diabetes researcher at t major hospitle, told me flat out that it did not cover 24 hours. The total dose (in my case was 15 unitis) should be taken in two halves: 7.5 in the morning and 7.5 in the evening. Try to space them 12 hours apart.
Actually, this is the reason I went on the pump. With lantus and humalog, I was taking a minmum of 5 shots per day, more if I needed a correction. The pump really helped my control. I take less than 15 units of novolog each day now.
Also, being a hormonal teen caused me gigantic problems. I would suspect this is part of your problem?
Goood luck--and remember, this disease is never an easy journey. You will learn as you go along, as things change, etc. Just look at these times as a learning experience.
Thanks! I'll up my basal and see what happens
Thanks for the support! I think that's what I need more than anything at this point. To answer your question, it hss effected my weight a little, which of course is frustrating, but not enough to really freak out about it. I'll keep exercising and try to get more sleep like you said!
I've often wondered about the 24 hour converage due to my extremely high mornings so I'll definitely look into that!
I inject my lantus in the mornings; I'm currently taking 20 units.
Thanks! Support is so great; its nice to be reminded I'm not the only one out there!!
Did you just split the Lantus in half, morning and night? Or what?
Thanks! I adjusted this morning, and it may all be in my head, but I feel like it might already be making a difference haha
When I was on shots, I was taking my Lantus in the morning and walking up a bit high. My endo suggested switching over to taking the shot before bed rather than splitting. That actually worked for me; as I recall, I bumped up my dinner time bolus a bit to help cover the last few hours.
As I recall, I eat late, so I'd take a shot after I woke up, and the other before I ate dinner. I was taking 5-7 shots / day for several years, and eventually switched to the pump.
As long as they're about 12 hours apart...
If you inject in the morning then the potential gap in coverage would be one or two hours before the injection. You could wake yourself two hours earlier to investigate that. I would expect normal numbers then that will rise sharply because the coverage of the lantus has ended.
To inject before bed might be a better approach. But I would recommend another approach. Divide your Lantus in two equal dosages. If you inject 20 then inject 10 in the morning and 10 before bed. The first day of this transition will be a mess because you are 10 units short. But after the second shot before bed the two 24 hours injection will overlap nicely. The advantage of this continuous pattern is that there will be no gap in coverage anymore. At least 10 units will always be there to act as basal. It is more work but it is worth the effords. Like always it is recommendable to increase the test frequency for these adjustments.
Honestly, I used to have this problem until I switched to the pump. If I'm having problems like what you are having, I can just give myself 10% more basal or what have you over a certain period of time to see if it works, and then make a permanent change to my basal rate.
When I went off the pump this past Spring, I started taking my Lantus in the morning. I kept waking up with high numbers, so I kept upping the Lantus dose (I would wait a few days with each increase, just to see if it would level off). Still waking high, I started changing the time I would take it....later in the morning and then eventually in the afternoon. The afternoon one worked for my morning numbers, but I would be high before lunch. I finally started splitting the dose 50/50. I now take half at 10am and half at 10pm. And...I'm not taking as much as when I took it all at once.