I want my locked ward CGM!

Perfectly Paleo-Bernstein (not one speck of cheating) for the last four days. Meat, green veggies like broccoli and lettuce, water.

Tested at 10:30 this morning: 227 mg/dl (???)

Injected 48 IU of Lantus. Ate some home-cooked meat (no hidden ingredients!) and nothing else, before my guitar class (nothing but water and a few ounces of meat since last night).

Tested at 2:30 this afternoon: 279 mg/dl.

WTW?

I have no idea what my body is doing – or why, or how – about 95% of the time, no matter what I read or what others tell me.

IT MAKES NO SENSE.

Put me in a room with a bed, a potty and a treadmill, wired for cameras and sound. Weigh and measure every gram of food and slide it under the door on a tray. Measure every step, every sip of water, every blip of blood glucose.

Sign me up and let the scientists figure out whatever in the heck is going on with my freakish body, PLEASE. Because IT MAKES NO SENSE.

Don’t tell me that meat has no carbs, because apparently my body can change chuck steak into pure glucose – and Lantus insulin into pure water – on a whim.

(Remember: I’m the girl who dropped over 100 points, to 36, an hour after a Lantus injection of almost the exact same dose one morning last July. Same scenario then, except I had nothing to eat – just water.)

Am I to conclude that Bernstein + insulin works for everyone else on the planet, but not me? Why not?

My first reaction is that you have a weird liver that doesn’t recognize that you have eaten (or maybe you actually HAVEN’T eaten enough), and it dumps glucose because it thinks you are starving. And you’re right – the body DOES convert part of the protein you eat into glucose.

Second reaction is that you need a bolus insulin. Lantus is long-acting, and only for basals (the insulin you need merely to survive), and if you eat, won’t cover the meal. You should have some Novolog, Humalog or Apidra – they are all fast-acting insulins, and used to cover meals. It’s obvious that your poor overworked pancreas just can’t handle secreting insulin for food. You need to have a good talk with your doc about that.

The sudden drop you mention may be a freak thing – I’ve had things like that happen occasionally. When I was on R, I injected one morning with a BG of about 120, and then started eating breakfast, and suddenly felt low – I was 57. I may have injected into a blood vessel, but there were no signs of that – no blood, no nothing. Stuff happens!

Your Lantus could be bad. This can happen. Bring it back to your pharmacy & ask for a replacement. When I was on Lantus, I noticed a definite loss in potency by day 26. It was pretty much useless by the 28th day. Another possibility is that you’re getting ill. I see an increase in BG before I feel sick or have symptoms. Around 58% of protein does turn to glucose, but that shouldn’t account entirely for your readings. Sorry! Know it’s beyond hair pulling!

Thanks, Natalie, but how am I supposed to bolus for meat?

I do use Novolog for carbs, but all my instructions say that meat has no carbs, and that I’m supposed to bolus for carbs only, not fats or protein.

What would be the amount to inject for meat? How would I calculate it? How long does the conversion from meat to carbs take? What would be the timing for the injection? Is it a reliable thing? A variable thing? I just don’t know enough yet to feel safe bolusing for pure meat (nothing added).

One more thing to Google, I guess. Maybe some people have a quicker/stronger protein-to-carb conversion than others, and I’m “blessed” in this way. Gah.

Thanks, Gerri. I guess it’s possible that the Lantus is bad. I’ll try a new pen on the next injection. This one is only a few days old, though, and the temp in my apartment never goes very warm or cold (Seattle is a 54/44 kind of town this time of year.)

I guess it’s possible that I’m sick or getting an infection. I don’t feel it yet, but I have been pretty darn extra-strength depressed the past week to ten days. Maybe it’s stress? Or hormones? Or the fact that I didn’t stand on my left foot when I injected my Lantus? Or maybe I need to knock heads at my HMO to give Levemir or the pump a try. I think Lantus just…hates me. I’ve seen more highs than I can count. I’ve seen 30’s to 50’s. But I have almost never seen a reading between 80 and 110 while injecting Lantus.

Either it barely works or is sends me crashing. What’s up with that?

Do you know how many ounces or grams of meat you ate? Realize it’s not many carbs, but did you take any Novolog for the veggies? About 58% of protein converts to glucose (which I wrote below), but much more slowly than carbs of course. How long after eating did you see the rise? That’s how to figure when to take your bolus. Yes, it’s reliable.

This is where Total Available Glucose comes in. It’s a way to calculate the eventual glucose output from protein and fat as well as carbs. There is a group called TAGgers United, and they could surely answer your questions. Seems to me that something like 40% of protein and 10% of fat get converted to glucose, but I could be wrong – the people in that group know a lot more about it than I do. The conversion raises BGs slower than carbs do, so timing of the bolus might vary, and you might need to split the bolus. There is a book called T.A.G. that you can order, too, if you want to get into all the details.

apparently my body can change chuck steak into pure glucose

Yes, you are 100% correct. My body will take a 0% carb meal and shoot me up 50mg/dl or more. The thing is once you stop eating carbs, your digestion starts to take more glucose from protein and fats. Normally your body will turn over 40-60% of protein and about 10% of fat into glucose. Protein over 4 hours and fat over 10 hours.

With a plain protein meal like that, your body could very well be extracting all the glucose it can get, especially because it isnt getting it from carbs anymore. Your tests are about 4 hours apart which fits the bill as well. Think about your new WOE, from a metabolism standpoint more than anything else. Your shifting the way your body gets it glucose and energy, that will make things totally different in terms of glucose management.

I need to get new batteries for my food scale. I can weigh meat on that after I get the new battery.

I do inject Novolog for veggies, normally (99.9% of the time) unless it’s just one lettuce leaf (less than one gram of carbs).

My current I:C ratio is 1:4. I’m still not sure if that’s right, but it’s miles better than the 1:15 my doctor started me on.

So are you saying that if I eat an 8 oz steak, which is 40 grams of protein, then I’m supposed to bolus as if I ate 23 grams of carbs? And that I have to test to see when my BG goes up to chase it down with Novolog? How do I do that if I have a mixed meal and have already injected Novolog for the veggies? Do I need to do some testing with just meat?

Now throw variable insulin resistance into the mix? Do I need to test meat-only meals over a variety of days to see the impact of say, exercise days vs non-exercise days? How many tests to find the point where the meat is hitting my system as glucose? Every fifteen minutes? Every 30 minutes?

Without a CGM and a pump, how does a normal mortal keep up with this, really?

I feel like I’m living in a nightmare and I can’t wake up.

Herese a good visual representation of foods, glucose and digestion times.




OK, that makes sense, but I’m laughing, crying and banging my head on the desk, because I thought this WOE was supposed to make my life BETTER.



Now I’m finding out that my Novolog (which arches over a four-hour period) would be running out just about when the meat-glucose is hitting my system, so I’ll need two shots for mixed meals, right? Or I’ll need to test and test and inject Novolog long hours after I eat? Set a timer and try to remember to “cover” the meat in the meal?



How could anyone cope with this metabolic change without a CGM and a pump?!?

OK, thanks. I’m just going to go curl up in the fetal position now.

(This is…overwhelming. Maybe I’ll just stop eating altogether…groan.)

I’ve seen the term TAG. I just didn’t know what it was.



(It’s a pain in the butt, that’s what it is.)



Don’t mind me. I’m just drowning in an endless stream of information overload and shock that none of this has ever been mentioned to me by the people I pay thousands of dollars each year to provide me with medical care.

Of course, the first doctor who every prescribed Lantus to me swore that there was no reason for me to worry about hypo’s, either. Grrrrrr…

Im in awe of how they do it. Im a CGM and pumper. The CGM showed me what was going as I was getting the same thing, spikes hours after meals. It made no sense. So I went and got a dexcom and low and behold, my body really likes glucose from protein.



It gets better though. and becomes a lot easier. the fun ups and downs from carbs go away making your control a 4-6 our meal adjustment as opposed to a 2 hour one. Youll see what I mean in a few months. Your rises will look more like this one and less like the normal ups and downs,



What youll need to do it find the correct time to bolus for the protein separate from the carbs. That will allow you to correct for one thing at a time, lessening the effects of each variable.

Caustic aside: Medicare doesn’t want Type 2’s to have pumps, and doesn’t want ANYONE to have CGMs. And many insurance companies follow Medicare’s lead. They’d rather pay for amputations, dialysis and heart bypasses, etc. Do we need a better system, or what?

Well, yeah, if we all die ten or fifteen years early, think of the money they’ll save.

Logging your readings will show when the spikes hit so you’ll know when to take Novolog in advance of the high. Taking a bolus to cover the carbs & then another later to cover the protein, right. Setting a timer is a good idea at first until it becomes habit. I take split boluses & it’s not a big deal. I leave a syringe out as a reminder. Took experimenting that’s all. Basal isn’t going to handle postprandial highs, of course.

The best way to approach this is with consistent amounts of carbs, fat & protein to ascertain the pattern. Eating at around the same time also helps. Goal is to limit as many variables as possible. Should that fail, stand on left leg while injecting & throw salt over left shoulder:)

It will make your life better & you can do it without a CMG or pump. I do. Sure I screw up or Jupiter isn’t aligned with Mars, but the same could happen with devices attached.

JeanV, I had something called Cushing’s Syndrome from an adrenal tumor that was producing high levels of cortisol. For years prior to my dx and surgery to remove the tumor and adrenal gland, I was so sick and every rational thing that I did made no difference in the outcome because it was beyond anything that I could control. It was devastating physically and emotionally to try so hard and get so poor an outcome. Even though you have diabetes, keep in mind that there are other things that can influence your bg…cortisol is just one. Every Cushie has issues with bg, but in my case, I got Type 1 when they removed the tumor (because I no longer had extra steroids to suppress autoimmune). Seriously, you need to have your Endo look out of the box and do a screen on all of your hormones including growth hormone, sex hormones, and thyroid. Certain hormones like cortisol and growth hormone can only be measured for than moment in time and negatives do not mean normal. Have you had a problem maintaining a normal weight? Any issues with central obesity? If you are becoming ill, cortisol will rise, and the bg will shoot up. Pain will increase the catecholemines (sp?) and the bg will go up. Etc, etc. www.cushings-help.com Look at Symptoms and hit the >> for the boxes to expand.

Jeez. What a way to treat people.

Really, the pump with its magic bolusing has some major flaws. The scar tissue thing is a huge one for me. I fallow the thinnest cannula, which ever brand comes up with it.

Thanks, Sheila. I do have adrenal hyperplasia – and elevated normetanephrine (tested three times in the mid-700s while normal is in the low 200’s as I recall) – but I can’t get a doctor to tell me how it might effect my diabetes, or help me figure out what to do about it.



It’s one of those gray areas where the hyperplasia in my adrenals is not of the type that causes pheochromocytoma (which causes astronomical blood pressure elevation requiring surgery to remove the adrenal). My blood pressure has usually been low-normal, not elevated. So when they were running all these tests, I had this weird elevation in the normetanephrines, which should raise blood pressure, and yet I had lowish blood pressure. WTW?



The doctors I’ve consulted so far at Group Health kind of shrug their shoulders now when I ask about it.



I’ll look at the Cushings info. Thanks again.