Saturday we thought we had it figured out. '-((
I didn’t set any levels because we have no idea as to what they are. That’s one of the things we’re trying to figure out. We’re changing the insulin from 50 units of rapid and 8 of basal to 34 rapid and 14 basal (as of yesterday) And yesterday was a very bad day.But I feel like we’re getting closer. I’m hoping that more basal will help level out the big swings.
We’re going to Paris for a long weekend tomorrow and will be back on Sunday. That is scary, being out in the real world so soon, but we are meeting family there. Our plan is to let his BG be a little on the high side, (just a little), and not to worry about it (too much)
I did change the levels as to what our current target is if that helps.
The levels for the carbohydrate factors are very important. This way you always show the same behaviour to carbohydrates (even if the factors are incorrect). So you want to eat x gram of carbs then x / carb factor = y units of rapid insulin will be injected. Futhermore you should measure the carbohydrates exactly. This must be done very strictly and reproducible otherwise we can not figure out if the carbohydrate factors need to be adjusted and when.
If you look at the data you will find that many exist where the level before and hours after the meal was nearly the same. This means that the insulin for the carbohydrates was nearly correct. So 168 at 19:00 and 157 at 23:00 are to high but the level has been the same. This means that only more correction insulin is needed to reach normal levels - like 2 units of correction instead of 1. So after noontime I guess that one units of correction insulin will not bring you down by 30 mgdl. It seems that the sensitivity to insulin is lower - maybe around 20 mgdl. So the calculation for the correction will look like this:
correction units = (current value - target value) / 20
correction units = (168 - 120) / 20 = 2.4 = 2
If you want to Glucosurfer to help you in your calculations then set the ‘Insulin effect mg/dL’ to -20 from 12:00 to 23:00.
These are small steps but I think we can figure it out. I wish you a good time in Paris.
Hello Katie, Sunday 9.8.2009 looks very promising. It seems that the Lantus dosage of 18 is doing a good job - despite the spikes the following day. What do you think?
We think it looks good, too. Two things happened yesterday that might explain today’s spikes: He cut his hand working in the shop… I don’t know if that sort of thing can effect his levels. But, he has a new pen for the Lantus and he thinks he didn’t quite get the full 18 units last night. He said there were a couple of drops on the needle when he pulled it out. He’ll be more careful tonight.
Thanks for checking.
I see that V has switched to the double injection strategy for Lantus. I think this is a very good decision. Sunday (2009-08-16) looks very good. More fine tuning with the Carbs per Insulin ratios is needed but I guess you are already working on that…
Hello Katie, I can not quite understand what happened on Wednesday (19. August). He has 351 mg/dl and is about to eat a pizza with 120 gram of carbs. Where is the correction and why only 5 units of rapid insulin?
351 - target value = 351 - 120 = 231 mg/dl too high / 30 mg/dl per unit = 8 units of correction just for the high value
He eats 120 gram of carbs so he will need
120 / 15 = 8 units just for the carbs
The total dosage must have been 8+8 = 15 to 16 units. This means he has missed to apply 10-11 units of rapid insulin.
I guess he was afraid of going low again. But I think he should handle things differently. I would never eat when my BG is higher that 250. I would bring it down first. Two hours later I would retest and if the correction (the 8 units for example) would have worked I would eat something. In addition I would never eat something that high in carbs in this situation. Pizza is sometimes unpredictable and lasts very long so it was very likely that things do not even out that easily. I hope you and V do not feel offended by my reasoning.
It was a bad day - but, we had guests staying with us, we were out for the day, which means out for lunch, I only figured out the carbs for the pizzza after the fact (that night). He was a bit afraid of going low as it was hot and he was driving. Next time - a salad and half the pizza,
Oh, he didn’t take a reading before lunch - the 351 was an hour after lunch, so that was deceptive. We were basing the bolus on the reading of 95 - which had been 2 hours earler. I probaly should have done a guess for the reading in the program
Sometimes normal life really gets in our way. I can perfectly understand that. After years with D we will have an arsenal of experiences and this will help to better cope with it. Sometimes this will work out and sometimes we will fail and learn. So we try to make it better the next time…
I have got the impression that V is leaving the biggest trouble behind. The numbers have improved significantly. The last low in the night seem to be caused by a misjudgement of food. This is why I try to avoid eating something before bedtime that needs rapid insulin. It never worked out for me…
We had fr4esh sweet corn from my garden, and I could only make an educated guess as to the carbs - I used info from the internet, but it all depends on how ripe the corn is as to sugar content.
Then, this morning he went very high, and the only thing we can think of is he forgot to take his morning bolus. He takes it after breakfast to help prevent the low an hour after eating, and, we were leaving to run errands… He may have forgotten.
If that is true, his bg was only 143 an hour after eating, with no bolus, which would explain why he has lows if he takes the bolus before, rather than after breakfast.
Hello Katie, the diary of V shows some improvements but there are some points worth to address. The mean values per hour show two problems:
P2: the peak around 22 pm is also happening every day. This peak is very likely responsible for the high in the morning. If this peak can be prevented the high in the morning can be influenced (at least it is likely). Here something must be wrong with the dosage for supper (green circle around 18 pm).
I have the impression that both problems could be related to a slower digestion of food. Maybe the used insulin is quicker than the absorbtion of the carbohydrates. This could explain the low in the morning and the higher BG more than four hours later. The insulin NovoRapid / NovoLog is a very rapid insulin. If the digestion is really slower than normal the carbs will reach the blood stream when the insulin is not effective anymore. In this case the insulin could be injected later. But this can be easily forgotten. Another approach could be to switch to slower insulin like Acctrapid (also from Novo/Nordisk). This insulin will reach its peak later and this would better fit to the digestion rate. I think you should discuss these possibilities with your diabetologist. Maybe there is a discussion group for people with digestion problems here…
I agree with the insulin being faster than the carb absorption. He injects after eating breakfast unless his numbers are high, and that seems to help. But waiting too long after eating is asking for trouble, as he will most likely forget. We’ll ask the doc about a slower insulin. In the meantime, we’ll just work on micro-controlling it and see how that goes.
Thanks for the sugestions.
Hi Katie, it may also be an option to do 2 separate injections (if V is OK with this). One when he eats and one 1-2 hours later if you think these highs are caused by the insulin being absorbed faster than the carbs.
When I was on MDI and ate foods that I digested more slowly (i.e. pizza), then I did this.
He does the same thing with pizza ;-))
We’re going to ask the doc if he needs to increase the digestive enymes he’s taking, as well. Maybe they’re not kicking in as fast as normal ones (ie: from the pancreas) do.
Hi Katie, what did your doc say about using slower insulin? Is he open minded for these ideas?
I would think that slower rapid insulin like Acctrapid can help here. It will kick in later and lasts around 4 hours. So it is active when most carbs seem to be absorbed. This is just a test and it costs one bottle of Acctrapid.
Let us assume it will reduce the swings (low to high) within one day. There will be less lows and therefore the likelyhood to overreact to a low is reduced (no overeating etc). The outcome would be much smooter. Then we only have to improve the late evening to have better results in the morning. This can be achieved by fine tuning the Lantus. But I recommend to take one step after the other.
What do you - and what does the community think about these ideas?
The diary can be found here.
Haven’t actually seen any doc’s for a bit. We’re meeting with the surgeon that did the TP on Dec. 15 and the regular doc for his 6 month on Jan 15.
He was on Humalog 30/70 to start and they were adamant about him eating the same food at the same time every day. We may have to do that, but we are hoping we can continue to be more normal. I’ve started recording every bite he eats - both carb and non carb to see if we get a pattern. Maybe we’ll get lucky and they’ll give him a pump ;-))
Well, for what I’ve read I just can say that I use Lantus too and sometimes I experience this unusual high glucose levels,my doctor told me that this happens because the Insulin’s effect is finished. And yes it is recomended to change to twice that’s actually what I’m planning to do.
Rember that if you change to twice a day, you just have to devide the amount of Lantus you use by half.
The double application of Lantus is already working and has shown some improvements. I am still sceptical about the morning highs and I got the impression that different basal dosages may be needed for daytime and nighttime. If this is the case I would recommend to switch to Levemir that only acts for estimated 12 hours. With this insulin you could increase the nighttime dosage to work against the highs in the morning.
It is also possible that the highs are caused by delayed digestion and that the NovoLog insulin needed to cover the carbs is not active anymore when the carbs arrive. This is why I recommended slower insulin like Acctrapid to cover the carbs.
It would be good if more members of the community could throw their wisdom into this discussion.