First: Thank you, thank you, thank you for all the wonderful help so far. I promise to stop soon - but finding this forum has been such a great help.
I’m trying to get lots of info for V’s hospital stay next week. I’m afraid that if I ask my questions of the doc or dietitian I will just be told that we can’t do what I want or don’t need to worry about. My feeling is they would like to give him a schedule, a diet, the amount of insulin he should use for it and send him on his way - no deviations allowed.
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I realize that we will not be having the same lifestyle that we had before, but we’d like to get as close to it as possible. (As in, not spending the afternoon at the shore sipping rose wine, but being able to have a glass with lunch)
The questions:
I have read, here and elsewhere, about the importance of A1c (is that right) numbers/test. I haven’t been able to determine how/what? Is this a test that you do yourself? Is it a blood test the doc/lab does? How often is it done?
How important is meal timing? I know testing is important, and I know long periods with out food is bad. Here’s our schedule - roughly
8am breakfast, work; 1pm lunch, work; 7:30pm snack, relax/(tv time); 9pm finish up the chores, make dinner; 11pm dinner, 12pm bed. This has been our schedule, for a variety of reasons, for the last 15 years.
V has about 90 carbs for breakfast, 60 for lunch, 15 for snack and 35 for dinner.
He was waking up with lows for awhile (keep in mind he’s only been out of hospital, on his own, for 4 weeks) so I started waking him up at 3am to test. We’re constantly adjusting the insulin, downwards and seem to be reducing the number of lows. He’d prefer not to be woken up - says if he’s low he’ll wake up and know it. Is this right?
The doc never said anything about handling highs, but V’s started giving a small amount of rapid when he has highs - like 4 units (he currently does 18 rapid at breakfast, 12 of 50/50 mix at lunch, 6 rapid for the snack and 12 of 30/70 mix at night).
The dietitian told us he should NEVER have a snack… Why not if he takes the insulin for it? (I kept asking her, she just kept saying no)
Wouldn’t he be able to get better control if he didn’t use the ‘mixes’?
Are we on the right track, trying to make the insulin suit the way we want to live and eat?
I know it’s a lot of work, but can it be done?
(You may not have guessed this, but I’m a bit of a Type A who really likes to make things work in a nice, orderly, proper way… everything in it’s place and all that… And I know his diabetes will never cooperate. I’m just hoping for a workable compromise that won’t put his life in danger)
Any answers will be much appreciated…
Now, I’m going to graph his carbs/bs levels to see if I can make some sense out of what works. I have the info for 3 weeks. His levels have been good for this last week - for the first time (Except for that 405 reading when he went off by himself to get some plumbing supplies… and stopped at the bakery… - I think that was a bit of an eye-opener for him)
Hi there - I’m surprised no one has come on yet to help. It’s the weekend here in North
America - so not sure how many will come on board this time of the morning (I am a morning gal - despite going to bed late - I love the mornings - plus I have a fresh bagel, cream cheese, capers, Gaspe smoked salmon to have for breakfast - plus my BG is very good for this type of carb eating today - only 4.0 mmol/L).With time eventually you will be able to go back to leading as normal a life as you had before - just give it time. Adjust to learning about diabetes - that’s the main thing right now.
So, V is using a variety of insulins from what I’m reading. I have a friend who does this in the States - and frankly - despite their thinking it is great (they keep their BG’s at 85 ALL THE TIME - with a variable of 20 up/down - too much work in my opinion as like V - they are using I believe 3 or 4 different insulins). The thing with this regime is that in my opinion they are a slave to diabetes - keeping that controlled. Anyway, if you want to read their reply about a blog I wrote on diabetes (posted it here with a link - check it out or go to this link with their reply to what I wrote - http://www.diabetes1.org/blogs/Annas_Blog/2009/7/2).
So, yes, I think eventually going on just two types of insulin might be the plan. That is what I did prior to going on the pump - which has given me even more freedom then I had - I now do not feel like a diabetic (had it 42 years) - even despite being hooked up to a “machine”. I am in control of what insulin goes into me - which is only one type. Now, until V gets used to having diabetes - the insulin injections is the route to go - but if he could just use a fast acting insulin for his meals (and by the way - drinking wine can make a person go low - e.g. hypo - usually when I sip wine … not looking out to the ocean mind you - but in my backyard - or on my sailboat after a sail as it’s illegal to drink and sail - just like driving I can go low - which is why it’s best to nibble when I drink alcohol - but this is what I do - others may say differently as we’re all different in how we manage our diabetes). As most people say to me - even before going on to the pump - I don’t act like a diabetic. Damn, shame since I would have gotten an Oscar for it. LOL - on the bakery after V went to get plumbing supplies. If he’d had X amount of units of rapid insulin to take care of the carbs he was consuming so he didn’t spike up so high - he could have had them - but then there would eventually be perhaps the weight gain (I know I would gain weight if I did ate croissants every day or so - love chocolate - or a brioche - along with a espresso).
Also, noticed the amount of carbs V eats goes down lower until dinner at 23h00 - that is a good thing - since going to bed at night - with him having taken a shot of insulin for the meal might cause a hypo at night. Does he take the insulin shot at each meal/snack based on what amount of carbs he is eating? My shots vary - according to my blood sugar reading at the time - as well as the amount of carbs I’m eating, along with what activity I maybe doing, temperature outside. I know, this all sounds so much work - but with time - it’ll be second nature. Another thing - even tho’ V is not on a pump - prior to going onto the pump - and I was MDI (averaged about 8 shots a day - but pen needles are much finer then regular needles - so ouch factor is mute - or I have a high pain thresh hold and no I’m not into chain and whips) - if you can get a copy of John Walsh’s book called Pumping Insulin - will help explain diabetes very well - and how insulin/carbs/etc. work. Even if I hadn’t gone onto the pump - this book is very valuable.
Here is a link showing rapid nsulin that most of us that only use two insulin to control our blood sugars via the multiple doseage injections method (MDI is diabetic world - I only took to coming to forums like Tudiabetes after going on the pump - whole new world for me - but learning even more then I did before - as I’ve pretty well always taken care of my diabetes myself due to lack of endo’s here in Quebec).
So, hopefully my dribbles here make sense and others I’m sure with far more experience or ability to convey their thoughts on “paper” will come forth.
So, hang on there - in no time you’ll be back to sipping a bottle of wine between the two of you - with the ocean breezes blowing on you - maybe I’ll join you for a ching-ching of the glasses as we enjoy the view. Ahhhh.
Thanks for all the info. The dietitian just told me to feed him lots of carbs - probably assuming that he would stay on the same units of insulin and be doing nothing until they saw him again - next week. But, he’s an active guy and, as he’s healing from the surgery and getting more active, he needs less insulin. I’m a little concerned with his diet and activity getting back to normal, and his insulin needs going down, that he may not get enough of the slow if we cut the ‘mix’ back to match the carbs.
And, no, we haven’t figured out the insulin to carb ratio yet, but I think we’re getting to that point. His bs has been all over the place since the surgery but we’re slowly tightening it up.
Please don’t stop asking questions. Ask whatever you need to.
Answers:
An A1c is an average of BG over 3 months. It’s a blood test done by doctor/lab. In the States there are over-the-counter tests you can buy to do check A1c at home, but they’re not as accurate. Depends on the doctor & patients, but usually A1cs are done every 3-6 months.
Meal timing is important. For most, 4-5 hours between meals, so that food is digested & bolus insulin is gone before the next meal/insulin dose. Too long between meals can cause lows because of basal insulin. Eating dinner & going to bed 1 hour later isn’t the best schedule. His lows could be from too much insulin with dinner. V isn’t testing two hours after dinner to know what his correct dinner dose should be.
Some people wake up from lows, some don’t. It’s good to be testing in the middle of the night at first to know what’s happening.
90 carbs for breakfast is a lot, or for any meal. Many people are the most insulin resistant in the morning. What’s his BG after breakfast? Lower carb helps with better control. Taking large amounts of insulin to cover large carb intake pretty much guarantees inaccurate dosing & swings in BG. It’s also a prescription for weight gain. More carbs=more insulin=weight gain=more insulin.
V needs to know the exact dose to handle highs. Usually people are told this from the start. Each unit of rapid should bring BG down a specific number of points. Doctors give people a ratio, depending on the type of rapid & based on their weight, to start with.
4). Snacks are ok, especially since there’s so much time between lunch & dinner. He can’t go 10 hours without eating.
Yes, there’s much better control without mixes. Rapid acting before meals & basal (background insulin taken once or twice a day) to control between meals. Much finer adjustments to doses can be made using two separate types of insulin than with mixes. More accurate doses means better control.
Gerri - I was questioning the high carbs as well when I was writing earlier and it dawned on me - that V is restoring their home - therefore - needs higher carbs for all the energy he’s expelling - plus he had lost considerable weight during his ordeal. The good thing is - the meal that is eaten in the evening - is lower - which is often the way in European countries - larger meals eaten earlier in the day - when you are more active - makes good sense - no? I know I would like to eat that way - but until hubby retires - and is at home - we eat the usual larger meal at night - but since going on the pump - and carb counting - he’s eating similar to me (abit more) - so our average meal carb intake is under 40g of carb.
Hey Katie - is V’s name … V for Victor? I was thinking more like V for Victory - as he overcomes his ordeal
Oh, didn’t know V is restoring a house–that is a lot of exertion. Hope he can eat like that & have decent after breakfast readings. Also hope he’s eating a good bit of protein at breakfast along with those carbs to keep him level until lunch. Hard to get a good handle on dosing to learn ratios when you’re eating a lot of carbs & taking a lot of insulin.
Evening meal should be the smallest. We’ve got it backwards! I’ve tried to make lunch the largest meal, but never can.
Sounds like people are giving you great information… One things that I can say is to remember that you cannot let diabetes control V’s life. Yes, we all must follow whatthe drs, nurtianists, and educators say, but make sure they personally understand your individual life style and work with you (in this case V). I am a figure skater and they had my insulin to the point where I was going low every practice time and while at the gym. Finally after numerous phone calls and making them listen to me, we found a happy medium.
As far as the no snacks… If V wants a snack, he can snack and just remember that his number may b a little higher due to the snack.
He’s taking 16 units of rapid in the morning, down from 32 when he just got out of hospital. And he’s going low almost every morning - and reducing it… I actually did an accurate carb count and it was 127. - no protein.
The dietitian was really pushing carbs - If he ate what she wanted it would be 75 - 90 at every meal. He can’t eat that much.
And, we didn’t realize that our evening meal was the lightest. It’s the only one I ‘cook’. For me. it’s the largest but not for V.
I think I need to add protein and take away some carbs for breakfast.
I’ve laid everything out; I hope I can get some cooperation from the docs next week on tailoring the insulin to our diet rather than have them just say 'eat more carbs.
They wanted him to gain wait, because he lost a lot after surgery, so that could be part of it. But, he’s really happy with his weight, it’s steady, so I see no reason to force a gain.
A1C is really important, because unless you have a Continuous Glucose Monitor (sensor worn under the skin, takes nearly continuous blood glucose readings and sends them to handheld receiver device), there’s no way you can do fingerpricks often enough to “catch” all the highs and lows. The lab test result is given as a percent and gives a look at the most recent 1-2 months of blood sugars 'round the clock. In the U.S., the American Diabetes Association recommends an A1C under 7 percent (156 mg/dl) and as close to 6 percent as your doctor recommends (who may have a higher A1C target? People near end stage of life, elderly who can’t sense hypoglycemia, long-time type 2s with one or more heart conditions). The Clinical Endocrinologists recommend an A1C under 6.5 percent. Often, the A1C result will be paired with an estimated average glucose number that looks like the mg/dl or mmol number you see on your own meter.
Gerri is so right about figuring out the correction dose. This helps you prevent undertreating or overtreating out-of-target numbers (and we all get those :-). Keep in mind that as you finetune the correction ratio, you may find that V needs a slightly different ratio depending on time of day. For example, I use 1 unit of rapid-acting to drop by blood glucose 30 mg/dls in the morning; I use 1 unit per 50 mg/dls at other times of day.
Snacks are OK, but they aren’t necessary if V is the type of person who doesn’t like to snack. Snacks were necessary on old insulins, but the new long- and rapid-acting don’t require snacks as long as you adjust basal (background) long-acting doses and bolus (meal) rapid-acting doses to fit the person and his meals. It is easier on just two types of insulin! And, your instincts are good: the insulin and eating plan should be adjusted to YOUR lifestyle, not to some pre-determined formula. It’s a bummer for a type A person to learn, but diabetes can be unpredictable and the more work you do (actually, V should do the work so HE learns all this, hint, hint) to customize your doses and practices to fit you, the better.
Definitely! The more questions you ask, the better. You know we love to talk about diabetes!
Good info from the group! Definitely keep asking questions. If the docs, nurses, and nutritionists don’t want to answer them, find a new health care team. V deserves the best care and that comes from a health care team you guys trust and can work with. Hint on the snacks thing, if he chooses low carb snacks, his BGs will be fine. Back in the day the doctors called these “free foods” as in we could have a serving and not take insulin to cover it. Here is a link to a discussion where people helped create a top 23 list. There should be some snacks on this list he would like Just look at labels to see how many carbs are in each serving when picking the snacks. Some will have less effect than others, it is trial and error to find what works for V.
Endos typically begin with a ratio of 1 unit of rapid acting for each 15 carbs & adjust from there, using patients’ logs as a guide. People can have different ratios depending on the time of day. I need more insulin in the morning (I eat very low carb mostly protein breakfast breakfast–6 grams) because I have dawn phenonmenon. I have a higher ratio for lunch because I go low in the afternoon from physical activity.
Don’t know how much physical activity V’s doing, but 127 carbs is very high. Yes, better to lower the carbs & add protein. Protein does effect BG, but at a slower rate.
And I thought dieticians in the US pushed carbs! 75-90 per meal really is a lot unless someone’s an athlete.
Just look at labels to see how many carbs are in each serving when picking the snacks. Some will have less effect than others, it is trial and error to find what works for V.