I have been diabetic since 2000, and always used insulin since I was diagnosed.
My doctor has been updating my dosage each visit, i was taking 60 units of Levemir(at bedtime) and 15 units of Novolog before meals but since I recently took 240 units of Novolog and it didn’t lower my sugars more then 20-30. My sugar was about 450 that night. He has me now on 50 units of Levemir in the morning and 40 units of Levemir at night. Sticking with the 15 units of Novolog before each meal. He thinks the insulin might not be getting absorbed as well as it should mainly due to high cholesterol.
I am just curious, I have been rotating my injections regularly and it seems to take little effect. Any advice or ideas?
I have been diabetic since 2000, and always used insulin since I was diagnosed.
It sounds like you are very insulin resistant. You are taking 15 units of novolog before each meal no matter what you eat? Are you familiar with carb to insulin ratios? How many carbs do you eat per meal? Have you tried a lower carb diet?
Sorry about all the questions.
my doctor advised me to do 50 units of levemir in AM and 40 at night. And 15 units of Novolog before each meal. Never heard about those. What is it? I have tried to keep my carbs down but never been really taught how to count carbs or what a “good diet” is.
oooo goodness, well don’t feel bad I have been diabetic for 42 years and just learned about carb counting about 8 or 9 years ago. Previously I would just shoot and eat the same amount of insulin for any amount of carbs, like you are doing now.
You need to start looking at labels at the carbohydrate grams and for me every 15 carbs raises my bgs 50 points, AND EVERY PERSON IS DIFFERENT. (YES CAPS ARE ON)
You need to do a lot of testing to figure this all out and you need to have a normal bgs going into a meal and you need to make sure your Levemir is keeping your bloodsugars normal when you don’t eat.
I cannot write here all that you need to do, but you need to start small, perhaps when you are going into a meal with a normal bgs then eat perhaps only one piece of bread with some lunchmeat, that would bring you about 15-20 carbs (adds up fast) Then you have to some how figure out how much novalog to cover for that 15 carbs. I take 1 unit of insulin for 5 carbs so for 15 carbs I take 3 units of novolog. Does that make sense, then 1.5-2 hours later you need to test your bgs to see if you are in normal range then you can figure out your carb to insulin ratio.
You really need to see a CDE for additional help, because EVERYONE IS DIFFERENT.
You might have to do some fastings first to see if your Levemir is correct. You need to test every two hours with no eating to see if your bgs are normal on your Levemir.
But please find a good CDE that can help you, but realize that carbs are what raises your bgs and if you are eating high carb meals your bgs will be high if you are not covering it with proper doses of insulin.
What is a CDE? And where can I find one? Are they expensive? I am on a tight budget, with my wife being on short term disability, we still got the insurance from her work but income got a cut for the time being till she goes back. I am thinking about looking into a Endo instead of my GP to manage my diabetes, he treats a lot of diabetics but I am not sure if I like the treatment I am receiving. I need a lot of education about my diabetes and correct me if I am wrong but there has to be a better way to treat my sugars then keeping dosages at the same basic level. Adjustments and training on ratios are definitely something I need to discuss with him. He did not even ask me to see my meter when I saw him yesterday And last time I saw him the nurse was the only one who really looked at my results
You can find soooooo much info on the internet to help you and with diabetes it is trial and error. A CDE is a certified diabetic educator.
I feel like your doctor has you on the right track with the split dosage of Levemir, that is a good sign, but you need to start by fasting at breakfast and testing every two hours to see if that dosage is keeping your bgs in normal range, then the next day fast over lunch, etc.
Not all endo’s and even CDE’s are that great either, but… since you were not told about carb counting you do need to seek help.
I went to one endo and he told me what I just told you and I was on my own. I since fired him, since when I was struggling he was pretty useless.
Start off with some fasting to see how your bgs range and tweek your Levemir by increasing or decreasing a unit at a time and start off with a small carb meal and start high with 1 unit of novolog for 15 carbs, that is how I started, then test at 2 hours if your bgs is not in normal range you know you need to next try 1 unit for 10-12 carbs.
I do a lot of things on my own, but since you were so unaware of this info. you should seek medical help.
Reading Dr. Richard Bernstein’s book Diabetic Solution changed my life. He clearly explains how low carb diets are our single greatest tool for control. If you Google Dr. Richard Bernstein there are several sites that have sections from his book, but reading the whole book is better. There’s info on most everything related to diabetes, diet, exercise & even recipes. Lots of web sites offer low carb recipes. It’s not hard to do & you’ll see an amazing improvement in your numbers.
If you’ve been on Novolog & Levemir for 8 years, you might ask your doctor about changing to another brand. I’ve heard of people becoming resistant to particular brands.
I’m on Lantus for basal & Apidra rapid acting, so I don’t know if this is the same for Levemir & Novolog. I stupidly didn’t realize that these both lose potency & were using them about week past their 28 day life. I was taking higher doses with little effect until I realized they just weren’t working properly. Also, no one told me to keep Lantus refrigerated.
Get an endo &/or a CDE, if you can. My doctor, an internist & my primary care doctor, got my insurance to cover me seeing a CDE by referring her as a consultant.
Are you taking any oral medications (like Metformin) for your diabetes? For some people, combining insulin and some oral medication (which helps with insulin resistance) is the best solution.
I would also recommend seeing an endo or a CDE, if possible. Most GPs don’t know about all available options-- so an endo will likely have more experience with similar situations.
my GP is also an Internal Medicine Doctor
TOO much insulin can also cause a reaction that pushes your blood sugar up.
But you really need to see an endocrinologist because internists do NOT understand insulin. And not just any endo, but a smart one.
If there is a good medical school in your region, try to see an endocrinologist who teaches there and practices at the hospital associated with the hospital. These endos are often far better than others you might find.
If you are extremely insulin resistant, there is a form of insulin U-500 which is much more concentrated. A friend of mine who was taking enormous doses of insulin visited a very good endo who put her on the U-500 and her total daily dose has dropped dramatically, even allowing for the fact that the insulin is 5 times more powerful than regular.
Also, I have never heard of high cholesterol causing slow insulin absorption. I think that is your doctor guessing.
And I second the suggestion to read Dr. Bernstein’s book.
im going to look into the book for sure. I also remember seeing a Endo in the same medical plaza as my wifes lupus doctor. She is suppose to be amazing with diabetes from what the pamphlet said. Will check into it right away!
PS- Looking into the Diabetic Solution right now, $24 isnt too bad but will have to wait a week or 2, plus i think will have to order online.
Good luck with the Endo. It will make a huge difference regardless of the knowledge of your GP. Specialists are the way to go. All of the suggestions that have been made a good ones. I use to take 8-12 units of insulin before each meal based on my blood sugar not what I was eating. I have learned since seeing an Endo, CDE and dietitian that carb counting and testing often makes all the difference in the world.
I look forward to hearing what you find out. Keep us informed.
by the way is it me or is the chat area not working right?
UPDATE Made an appointment with a Endo that is part of the big hospital network out here, i have heard really good things about her, sad part is I have to wait till Nov 6th to see her, gives me time to grab a better job and save up for the copay
I would definatly say that you are resistent…now i’m no doctor, but i had they same problem when i was on lantus. everytime i went to my endo he would raise it. then when i went on the pump i was hitting lows all the time due to my humalog sensitivity. soo we finally figured out that i was resistent to lantus…and that cause a few problems. maybe your doc could put you on a different long acting? hope you find an answer soon…
This site has many chapters from Dr. Bernstein’s book: www.diabetesincontrol.com/bernstein/ Good place to start until you can get the book. Your library may have it also.
Glad you got an appointment with an endo!
Just a thought, but keep calling the endo’s office to see if they get any cancellations. I had to wait forever to see my eye doctor, but called so many times that they finally got me in a lot sooner.