Oh, one more thing... I'm doing a basal that contributes 24U to the overall total that I don't have to use -- my existing beta cells work well enough to keep me stable. I just want to give them as much of a break as possible, so that they're working their best in an unforseen situation.
So far, so good. I can go completely insulin-free, eat a meal of protein/fat, and my pancreas can handle keeping my sugars between 100-120. I can't do that all the time -- it's not strong enough for regular, routine living -- but I'm being successful so far in keeping enough "margin" available with rested betas that in a pinch I can go on, even eat, and be fine until I can get back to my supplies.
One of the ginormous differences between T1 and T2, of course, and something that I have great sympathy for T1's regarding.
Hmmm... I upped my lantus to 5 units last night and still woke up with a fasting of 105. I would have thought I would start seeing some readings in the 90s by now. I wonder if I have symogyi (i have no idea how to spell this) going on. My post meal blood sugars have been higher than normal also which I think is really weird because I haven't been eating any differently. I have added the metformin back into my regime as well as the lantus.
I am puzzled. I know my blood sugars are not terribly high but they are not normal. Nothing I do is getting it down. Yesterday at lunch, I ate lentil veggie soup and a huge green salad with hummus as my dressing and got a reading of 171.
I wonder if I need some fast acting insulin to cover meals to be normal. John Walsh is still wanting me to try Victoza to see if that helps. Anyone have any experience with this one?
105 is not an overly abnormal fasting blood sugar. It will not damage your body. What did your PA,CDE),John Walsh ( the best of the best) say about your readings?Maybe you do need to take a bolus with your meals. Talk to him. I know that the salad you consumed has carbs.. Slow-acting carbs, but carbs indeed: Lentils, humuus, the other veggies; even tomatoes and carrots, have carbs. Carbs will make even the bg's of diabetics not on meds rise. And if the meds given are not the appropriate kinds nor dosages; if the exercise wasn't done at the time to off-set the carb intake, that after meal BG increase WILL happen. If you were dosing for meals, then you may need a minimal bolus for that to avoid the 171 spike. I know I do not eat hardly anything other than Jello sugar-free pudding and water without bolussing, even if it is .25 unit. ( I am type 1 on a pump, and it is possible get these small bolusses or to stretch out the insulin to cover slow-acting carbs, unlike with MDI). I know nothing about Victoza and very little about MODY.. I am sure Mr. Walsh and other Tudiabetes members do.
GailD, You are aiming for as normal range as possible. I think you are doing a great job. You asked: "I wonder if I need some fast acting insulin to cover meals to be normal". Maybe so, as discussed above. The "New normal" for you will be to test, trying trial and error tasks .. Take this experimentation period, the "trial" slowly, one step at a time. Try to see the "errors" as a chance to take the data you learned and apply it to the next "trial". Please try not to stress: That can make your sugars rise.
You are a busy mommy . Enjoy your babes and proceed one step at a time.
Thank you for your advice Brunetta. I am trying to approach this one step at a time. I have a type A personality so I’ve learned to slow down with my kids but the uncertainty of diabetes freaks me out.
I have to echo Brunetta. Blood sugar regulation is an extremely complex process; there are different needs at different times. (The more you learn about how involved it really is, the more astounding it is that a normal pancreas can just take care of it, automatically and invisibly.) You may very well find that you need both basal insulin (Lantus or Levemir) and bolus insulin to control the different scenarios properly. I did. And you definitely need to discuss these issues with Walsh -- when you have access to an expert like that, take full advantage!
I would just add one thing: a new or changed basal dose can take several days to settle in and stabilize. One day is simply not long enough to know the results with certainty.
You didn't say how long you were on met. It can take a month or longer to really have an effect.
Apparently, Asians don't work the same as others. My dr. said that we have a higher predisposition (along with African Americans) to having T2 and that we tend to carry our fat internally so may not appear to fat but are. Not sure I buy that. I was also very young when diagnosed and was gestational with both of my pregnancies. I also have high fastings no matter what I do. Once in a while I'm blessed with something in the high 90s but normally am around 120-125. I wish they would put me on insulin but they just keep telling me I'm fat (23% bodyfat is apparently fat)
Even at this point you have better numbers than many people so you have time to take this slowly. Good luck!
Have you been tested to see if you're Type 1, Whirlygig? I see you were diagnosed 14 years ago, so that makes it less likely, but not impossible. That's a new one on me "carrying fat internally" I don't know bodyfat percentages, but if you don't look fat, don't have a high bodyfat or BMI or actual weight....uh, it's kind of like "if it quacks like a duck". If someone told me I was "fat internally" I would....can't say it on the board but it wouldn't be pretty!
LOL, I know. I wear US size 1 or 2 pants and generally small shirts. I lift weights so am rather dense but still my bmi is about 24 so just barely normal. Being very short and pretty muscular messes with BMI. For a woman, body fat of 23% is in the normal/athletic range.
I had my antibodies tested and that was negative. My insulin production is very bottom of normal. I have always been active. In fact, I'm having sort of a veg morning but am about to go do my usual weekend 10 miler.
T2 runs in my family although no one beside me was ever diagnosed as young. It is in my genes though since my 21yo daughter who is also athletic and eats really well is now in the diabetic range although her drs. are ignoring that too since her A1C is low due to bouts of hypoglycemia.
I am insulin resistant (tried to go off met a few months back). Wish I could be on insulin since amaryl makes my insulin levels unpredictable and makes it hard to control my bg. When I go high there is nothing I can do but exercise even more. When I'm on a more even keel I'm stuck with taking the same pill that I take when I'm high and then fight lows. Regardless of what I am I wish I could just get treated to help with my problem rather than being pigeonholed and told the same things they always tell T2s, lose weight and get more exercise.
Yes, wouldn't that make sense: being treated to help with your individual problem. I've heard too many Type 2's being told to "lose weight and get more exercise" even when they are at a perfect weight or even thin and gets lots of exercise! One size does not fit all! I hope the trend of encouraging Type 2's to start on insulin sooner, rather than holding it out as a threat if they are "bad". "Bad?" (even when we're not!). What are we, toddlers? The whole "good/bad/punish and praise" concept is so infantalizing. Those who have doctors who say, "whatever you're doing, keep it up" or "you sound like you're struggling, how can I help?" are so lucky.
So… I have been slowly increasing the lantus over the past 2 weeks. My fasting blood sugars continued to rise the higher the dose. Two nights ago, i gave myself 8 units. I woke up with a blood sugar of 127! That’s the highest I’ve veer had it. Last night, no insulin and my fasting was 98. What is going on? I will call john Walsh on Monday to see what his recommendation is but this is counterintuitive to me. Shouldn’t my blood sugars have gone down with lantus?
Does anyone think I need meal coverage too? My post meal blood sugars are good because I don’t eat many carbs. Please help!
There are various possibilities here, and you definitely need professional consultation to get to the bottom of the situation.
One possibility is that you simply haven't reached the necessary dosage yet; you did say you are increasing it "slowly" -- which is indeed the right and safe way to proceed.
Another possibility is that you have a really powerful Dawn Phenomenon in operation. Some people do.
Yet a third possibility is that you are one of those people for whom Lantus simply isn't effective. Such cases are a small minority but they DO exist. Different people respond differently to any medication, insulin included. For example, Humalog is very effective for most people. For me, it does nothing -- might as well be a placebo. So that kind of thing does happen.
Those are three possible explanations for what is going on, and there are undoubtedly others. As stated, you need to keep working on this with professional advice. I know the amount of time this is taking is frustrating, but you'll get there. Really! :)
Thanks for the responses. This is very perplexing. Since my blood sugars aren't terrible, I think I will stop the insulin for now since it isn't helping me at all. Hopefully, I can get in to see John next week to discuss the next step.
I cannot tell what you are doing using insulin - type, speed, lasting time at dose etc. What I did was to curtail diet to 1200 calories per day ( and the correct number of grams of carbs)
Next I would up my exercise and for me that was 1.5 to 2 miles walking.
I would carefully check liver and see what the dawn effect and leakage is doing. One has to watch metformin dose in that it takes a minimum dose to catch livers attention. For me it was a solid 500mg dose or larger.
For me doses late at night helped to cram down the dawn phen. Typically, the liver starts cramming out the glucose from 3:00am and if insulin levels running low it can make blood glucose lift vertical.
There are two basic types of injectable insulin - fast acting to boost meal bolus and the longer acting insulin Lantos (basil insulin)that responds slowly and lasts a long time.
Some folks only need a boost of the basil insulin using lantos or equivalent basil insulin.
For others, they may need a meal bolus boost of fast acting insulin. Some folks could use both.
I would not give up but may need more data collection and digging with your Doctor to identify best regimene for you!
Update: I put in a call to my PA’s office to ask about the insulin situation and I am still waiting for a call back. Hopefully I’ll hear from him tomorrow. In the meantime I’ve tried some nonprescription supplements starting on Friday in combo with metformin. I ate dinner and took my bs two hours after. It was 86. I couldn’t believe my eyes do I took it again. 87. So I guess that’s right. I had a reasonable dinner. I wonder if all I need are these supplements. I wonder if my fasting bs will be high in the morning.
In case anyone is curious, I took bitter melon, fenugreek, cinnamon, and a diabetic supplement sold by my local health food store. As well as metformin. Anyone else use supplements only?
I am fully behind the use of supplements, having used them for over 33 years as a T1 diabetic. My endo, who is also a diabetic and my doctor since 1986, says I am the only person he knows who has to give a lot of thought to a 1u difference in bedtime long term insulin dose. I give all the credit to the supplements and a low carb diet because I already know the level of my own production is close to zero via the c-peptide test which I have only done three times. I wanted to see why it was that taking B vitamins always meant less insulin was needed.
Chromium has a definite positive impact as it is a cofactor that is required to attach with insulin at receptor sites. Sorry I lost the link to the scientific article that discussed that and even showed the molecular structure of the two together.
I am turning today into a fasting day, and I am needing only 5u total so far. I keep checking. I took 3u Lantus for overnight and 2u Humalog when the blood level went up to 8.5 mmol. I awoke at 6.9. That might been high for some people but having lows wile asleep is a big issue for me and far too risky. So if I had taken 4u before bed, I would have woken much lower. We all learn what patterns apply to our own case, so I have developed my own conclusions that a 2u dose will keep me level to morning, but if I had already been walking that day, I might not need any at all as the tail end of the previous dose would still be working.
