Is there a book or website with detailed example on insulin management?

Treatment Insulin
1

What I mean by that is having individuals skilled at using a pump or doing MDI give detailed examples of everything they do (food, injections, exercise) on a good day and the results they are getting from it....kind of like a snapshot of everything they do on a particular day. Seems like a lot of the books explain how to do everything individually, but don't really put it all together. It would just be useful to have someone with a solid system down detailing everything they are doing resulting in low BG and low A1C.

Links added by the TuDiabetes Administration

Think Like a Pancreas, by Gary Scheiner

Using Insulin, by John Walsh

Integrated Diabetes Services (Gary Scheiner)

2

Are you looking for something beyond what John Walsh and Gary Scheiner have written in various books? They feature a full boat of tactics, math, and personal testing.

I'm sure there's lot more that's been written by others. I'll see if others volunteer useful books. Perhaps you might consider a go at a book.

3

Think like a pancreas is a great book with some examples too.

5

I've read Using Insulin and Think Like a Pancreas (I could read a couple sections more carefully though), and they both provide great information, but it would be nice to see a few detailed examples with people putting it all together.

For example, having a full days worth of records (food eaten and impact, exercise and impact, lows, highs, maybe CGM graph) etc) from someone with good/great control.

6

I've been looking for something like this for a while now (going beyond the fundamentals). Too bad there isn't a shadow a good diabetic for a day program. To reiterate what uptown girl posted, all of the advanced micromanagement skills seem to fall into the YDMV range.

7

I'm not looking for a plug and play system and would never just copy what others are doing, but it would be nice to see what others are doing and the numbers they are getting from it. To use the analogy of driving a car. The books tell you all the rules for driving, how a car works, advice, etc, but that's not the same as actually seeing people drive cars.

What I'd like to see is the numbers from individual people even if it is only for a day. For example, their latest A1C, a brief description of the approach they are taking, and then a detailed data collection sheet from the day and perhaps a printout of the day's CGM data. Also, maybe a description of meals they are eating and why. No I wouldn't copy it, but it would give me a good idea of numbers to expect and work for using different approaches.

Honestly a plug and play system would be nice, and I think it could be done mathematically to some extent (with individual adjustments), but that's not what I'm looking for here.

8

I've often thought about posting a 24-hour CGM trace along with food, exercise, and other pertinent notes. I think that idea has merit, especially given your interest. Maybe others would agree with you.

I'm not a big fan of the "your diabetes may vary" aphorism. I don't deny, and will not argue, that each of our diabetes varies. What I don't like about that sentiment is that beyond the small truth of our diabetes variations is the larger truth that we are all human beings with a carbohydrate intolerance.

We're not trying to compare ourselves across species, for instance. The thing that attracts me to sites like this is the chance to interact with people who are a lot more like me than different. I've learned a ton here from people whose diabetes did not vary much from mine!

This YDMV shorthand is a bit tiresome. I understand its small truth but I don't find it useful. What I really want to read is about someone else's struggle with the same thing I'm struggling with and then read about how they solved it. Isn't that why you're reading this?

9

Yeah, that's the direction I'm leaning towards. Dr Bernstein goes into incredible detail with his system, and I think comparable numbers are probably achievable eating carbs in the 100 range, but maybe some people who are systematic enough are able to achieve really tight numbers (avoiding highs with few lows) while eating ADA levels of carbs. I'd also love to see how tight T1 people can be using a mixture approach with some of the older insulins.

Maybe we could try starting a board/group here with such a focus. Flatliners comes close, but it's mostly showing your results.

10

Lots of good suggestions. Another one is "Pumping Insulin". To me this was the book that opened the door to understanding everything about the pump and follow-on stuff (it is available for the Nook and Kindle but I would recommend getting it the traditional way as there are issues with some formatting on a few pages and it can be bothersome.

11

MDI- Insulin Pens -Novalog and Levmire

I think we first have to find out what you Know and Don't Know..and How Aggressive you have been !

1. Do you know what your I:CR ( Insulin to Carb Ratio) Is?
Such as: How many Unit's do you take to Treat 36 Carbs at a Pre 100 BG reading?
-And if you don't know the Exact # of Carbs, do you guess and eat it anyway? Or Follow the Golden Rule- If you Don't know the Total Carbs, you Don't Eat it!2.
- Do you Know what your CB Correction Bolus Factor is? To treat a 200 BG , 3 hrs or longer after eating?
2. When you have a 175 BG at Your Mealtime, do you still Eat anyway? Even if you take a CB for that and the Correct Bolus for that meal? Or do you wait until you get down to no higher than having a 150?

4. Do you Have the Correct Overniite Long lasting Insulin that when you go to bed you won't be higher than 20pts above your Bedtime BG?
5. Do you Test 3-4 hrs After you go to bed? and have a Prewritten Chart made up of how many units to Take per your BG's are above 120? and Keep soft Candy, like Mini 3 Musketeers, Milkyway for 10 carbs and Mini Hershy Bars for 5 carbs?
6. Do you Know how many Carbs you should take Before you Go outside and do Each Kind of Regular Physical Activity you do? and of course, you do Test Before doing so, right?
-I need Min 5 cabs or a Glucose Tab for every 5 Min for what I do..outside.. and to have at least a 120 before going outside
Otherwise? I stay Inside and wait till I do have those BG's ..Noraly 15 Min after taking enough Carbs..

Do you keep PreFilled Juice that is 15 carbs, in the Fridge ready to go for going hypo?
And if Have a family? Tell them if they Drink it? You will Burn their Fingers! It's like stealing a Man's Beer !

And do you Test 1 hr, then every 1/2 Hour after Going Hyper- with a 200 BG and taking a CB? To be sure you took enough and Not too much to go hypo?

-Do you have a SF( Sensitivity Factor) you use for Testing 2 hrs after Eating and your High( above 140 )? and then what do you do after taking that? When do you test next?

And do you really think your Basal and Bolus Doseages, All your other Guides will remain Constant forever? Not change as you gain even 5 lbs ? Guess they didn't tell you that did they?

This Disease only has One Function..It wants to DESTROY every ORGAN in your Body!
Wonder why it gets so overwhelming trying to Not just Learn all these things,but Always Remember and Apply them? and why over 75% Don't and Give up and have such high BG's?

Oh, nd Lets not leave out these Test meters- They can be over 20% inaccuarte at anytime.. and 10% Lower than Blood Plasma is .. Make sure your Metere is the Newer ones that Test in Blood Plasma at least..

I test the aaverage of 10x a Normal Day and 12x on active days and even more..
I will test even ore after I Go too high and it can take 3-6 hrs of Over Bolusing and Taking Tests before i get my 200 BG's back down to my 90's...

Being a Man, I take the Approach of Getting MAD and Attacking this Disease! Stick that Needle in you to Attack that Dman Disease! It wants to Kill you , you know!

And all this Only gives me an Ave. of 6% A1c's! all these yrs !

And if they Tell New Insulin Diabetics they have to Do all this stuff and More?
It would be So overwhelming they would Give up..

and Imagine telling a Young Girl or Woan she has to test 10-13x everyday Now? Can you imagine how sore her soft Fingertips will be in a Week? And Imagine the Cost to the Insurance Co.'s for all those Test strips? 300-400 Strips per MONTH!

Thus All this and alot more Secret Information Can't be Put into Books and Be telling the Truth ..of what it Really takes to have a chance to Control this Disease..
Let alone tlling those that have it? Don't go having Children until you go get tested for seeing how many of the Known Genes that cause it.. More are more app. to Pass it on than others.. and should not have Children..

And have you finally realized that the Medical Profession hasn't got a Clue how to Take care of us? Why they even bother sending us to Endo's, let alone most Nurses, haven't got a Clue.. and if go into the Hospital? Be Afraid, be Very Afraid they taking care of your Insulin Diabetes.. You'll be lucky to ave 200's all the time..

Scarey and Crappy isn't it?

And wonder why having a 120 is best vs a Noral Non D level of 80-90's? Because we can No Longer Regulate our SUGAR for Energy..
Thus why we are So SWEETER than Non D's...
;-)

12

Awesome reply. So many of us have written our own books...though not published. The DOC has more information based on real life experience than any book one could buy and study. TuD is an excellent resource. Check out the discussions that might apply to you and read what works for the folks 'like you', and try what sounds doable, and like the rest of us...do what works best for you. No system is solid no matter how much control you take. What works for me might not work for you. I can attest that control is possible but not perfect.

13

Well done. You have good rules for life!

Medicos don't have a clue. They can pry my insulin vial from my cold dead fingers!!!

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14

Many people new to insulin management have this idea of control in their heads. I wonder if they would also ask the captain of an airplane if he is IN CONTROL of his plane? Honestly he will say that he has an arsenal of experience to handle difficult and very challenging situation.

For example landing an airplane in heavy crosswinds is a challenge. If the plane is slightly out of balance it might land with one set of tires first. By the book this should not have happened. But the pilot decided to continue the landing because of the coming storm or the remaining fuel suggested that a new approach had higher risks involved. In this perspective just blowing one tire in this type of landing might be a fantastic outcome.

As insulin dependend diabetics we always have to land our airplane in severest weather. There is no second approach: our bodies react very differently according to weather, previous carb intake, muscle activity, humidity, temperature, absorbtion rate of the skin, metabolic rate, heart rate and so forth. Understanding all the decisions of us - the captains - might be hard. We are very knowledgeable about our bodies and our decisions are tailored to his experience and needs. For you the same situation might look very different. Of course you are invited to fly with me but do not expect that you will learn that much for yourself. All you can learn though is that there are always repetivite challenges you have to overcome. Even with an a1c ranging from 5.8 to 6.3 it is an ongoing 24/7 process - that healthy people all too often like to entitle as "being in control".

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15

I agree, it can be really helpful to see what others do and what results they get but we are very different and each day is different, and each hour of each day and so on... I doubt the majority of people are going to get bernstein results on 100g also. I have only seen one person here post that she eats 100g and she had comparable numbers to me but with less lows and fluctuations I think. She also does tons of strenuous exercise and she eats only veggies/meat and no grains I think.

16

I've got a good feel for everything there except maybe how my body responds to exercise (I have read the theory) and that should get easier now that I have a CGM and a pump. My A1C is about 6 right now taking a lower carb approach, but again I think it would be helpful to see through data sheets with descriptions along with CGM pics of how some people with good control are managing their D using different techniques. Books are nice, but I wonder things like if there are T1s eating 50-60 carbs a meal who are covering it well enough to avoid both going into the 200 range and going low.

My basal rate is pretty much on target, and my ICR is about 1:20. I know the amount of insulin I need as correction bolus at different BG levels. The ratio changes a bit as I get higher. I've been taking a lower carb approach and try to avoid eating more than 25 carbs per meal (don't always succeed). My lipids are naturally very low with good ratios so I don't have to worry about that. I'm very comfortable with counting carbs and with what foods shoot me up, but I do get lazy on occasion.

Then I've been doing the 10+ finger sticks a day thing for a couple of years and my fingers are very thankful for my new CGM. Cost to insurance co?!! Only if we can somehow convince my doctor to prescribe 10 strips a day. I've been buying over half of mine online (good generic). I finally got my endo to prescribe 8-9, but my PCP was hammering me that I shouldn't use more than 3-4 a day.

With exercise my BG is fairly stable (in the short term) unless it is really strenuous, so I've tended to eat carbs as needed. It is covered in the books I have and I'll get it down once I'm on the pump. It can be a PITA using long acting insulin and having your basal needs drop way down. We'll see how things go with the pump.

My sugar of choice is Sweet Tarts (dextrose) in the roll, and then I have a Glucogon shot available if necessary.

As for changing ratios with age and weight, My T1 has been of the LADA variety and took a while to stabilize so I've been down that road at bit.

Yeah, I've already been through the mill with doctors. The good ones aren't in your way as much as the bad ones.

17

This is a great discussion that prompted me to order "Thinking Like a Pancreas" yesterday :)

18

I agree with Holger and meee, and I also agree with Terry that the phrase "your diabetes may vary" is overused. But I also feel it is a useful cliche in that it prevents us from trying to replicate a simple set of variables and being frustrated when it fails to produce identical results or worse, blaming ourselves. And there are SO MANY variables! Someone can say I use x I:C ratio, eat x carbs and do x exercise. But they can't possibly include what type of carbs, how much protein and fat, what time of day it is, where they are in their hormonal cycle if relevant, their stress level (if human), the temperature fluctuations in their locale, how long they have been diagnosed and so if they are on their honeymoon or if they are LADA and still producing some insulin, etc. etc.

I also always refer to "the luck of the draw" by which I mean some people seemingly do everything "right" (whatever that means) and still struggle with fluctuating blood sugars, and others are relatively "relaxed" in their management and get very stable results. Most of us find our homes somewhere in between. I think this is where the "YDMV" really comes into play and can lead to false expectations and disappointment. I don't do much self blame but do feel frustration when someone posts that they "eat whatever they want" and their A1C is 5.7. For me I would have gained 100 pounds and have an A1C of 8, or perhaps have one of 5.7 caused by extreme highs balanced out by extreme lows. Nothing about D is simple and their are guides but no road maps or GPS.

19

I feel the same way.. I wish I could eat whatever I want and have 5.7. in my dreams only most likely :)

"if they're human" love this comment Zoe, this is so true, we aren't robots... my dvm said that cats, due to there metabolism and fight/flight reactions can have very rapidly rising bg, but overall their bg ranges are around the same as ours.

20

Ack, let me correct that...my ICR factor is 1:4. I got in the habit of multiplying carbs by 5 for the projected impact on my BG and then calculate the insulin for that.