Meal time Insulin

I was wanting to know it is normal to take a fixed rate of insulin or if its more common to be on a sliding scale. I have been seeing a PCP since November but should be going to see an endo some time this month. I am taking 10 units of Novolog with each meal and I still having highs. When I say highs I am talking about 230's-320's most days. I have been trying to stay under or around 45 grams of carbs for each meal but there are times I know that I have gone over but I know that I have not gone over 60 grams with is still in the range that they gave me. I believe that I am type 2 and over weight. I think that my PCP was going on family history and I know that they did not do a c-peptide test. Is this something that the endo will have done or that I should ask about?
Thanks for any information/help,

Neither one are up to date treatments. The best way to determine mealtime insulin dose is by using and Insulin to carb ratio (written I:C). That is, how many carbs does one unit of insulin "cover". That way you take the right amount of insulin for the food you are eating; pasta needs more insulin than salad! If you are consistently in the 230-320 range two hours after meals you are not taking enough insulin. Do get yourself a copy of Using Insulin by John Walsh which will explain this in detail. You determine your I:C ratio by trial and error. Many people start with 1:15. and then based on results increase or decrease until they find the I:C that keeps them in range most of the time. But you already have some information. If you are eating, say 50 grams of carbs for a meal (for even numbers!) and you are taking 10 units of insulin, your I:C ratio is 1:5. However if you are usually high with this dose, you might want to try 1:4.

A couple other factors. How is your basal dose? Is that doing well to keep you stable in the morning, at bedtime, and in between meals? If your basal is not enough you are putting too much stress on your bolus (mealtime) insulin to cover your basal needs. So make sure that is right first. Second, if you are starting high, where else can you end up but high? You need to add in a correction to your mealtime dose to account for a high number, or else correct and wait to eat.

Finally 50 carbs per meal is a lot, though some people eat that amount successfully. You might consider lowering your carb intake to better cover your meals. Also, many of us have trouble with certain foods such as white rice, sweets, cereal, pasta, pizza and potatoes. I would stay away from those foods as much as possible.

Dosing insulin is more complex than set doses and sliding scales are only a tad better. Get the book!!

Thanks very much Zoe. My basal dose is 36 at bedtime when I get up I am around 160's - 190's. My PCP never gave me a correction. That is why I am hoping going to an endo will help. I will check out the book also.

Sounds like your basal is too low as well. Good for you for going to an endo, as I'm sure it will help. But many of us find that books like Using Insulin and posting on here help even more! It's all about trial and error. If 36 units basal makes you wake up too high, try increasing it to 38 and watch the results for 2-3 days. Same thing with correction. You have to figure out your ISF which is how many points a unit of insulin drops you. Try a unit of insulin and see how much it drops you in 3 hours. Then increase it as needed until it returns you to where you want to be! I know it's lots of work, but it will get easier!

I think seeing an endo is a good idea. You probably aren't taking enough mealtime insulin to cover the food that you are taking in. It would be good to ask your endo for some carb counting advice, and an insulin to carb ratio. The endo will need to adjust this according to your habits, insulin resistance, weight, lifestyle, etc., so it will be a process. Counting carbs and adjusting your mealtime insulin is a very good thing, and it is far superior to a fixed dosage.

If you have insurance and the ability to handle it, a pump is a wonderful tool for control. It would be good to discuss a pump with your endo as well. Once you become accustomed to a pump, I hardly believe that you would ever want to go back to shots.

All the best to you....

Thank you very much Brian.

Are pump supplies a lot each month? Also I have heard pumps are over 10,000 does insurance cover a lot that? The insurance I now is good when it comes to covering stuff.

I don't know how much pumps cost. I think mine was around 6500 dollars and the supplies are around 175 dollars each month. My insurance is very good. I don't pay anything but my monthly premium. Most insurances have a co-pay. With a co-pay, the insurance company pays the bulk of the cost, and the insured pays some of the cost.

Usually, when a pump is recommended by an endo, you get to pick from the pumps that are on the market. When you choose a pump, the pump company will contact your insurance company and work with the physician to get the test results that they need, and will make the necessary arrangements to get the pump into you possession, and train you to use it. Choosing a pump is a four or five year commitment, so it is important that you choose the one that will be the best for you in the long run. Pump suppliers have entire departments that deal with insurance companies. They know how to do it, and make the connection quite seamless for the patient.