Mealtime insulin?

So, I'm newly diagnosed with T2 diabetes (as of August 7th, 2012). For the past 8 years I have been getting my blood sugal levels and A1C levels tested at 3 month intervals due to metabolic syndrome indicators and I was seeing my Dr. every 2 weeks to monitor my blood pressure and attending chronic pain clinic for management of my scoliosis without medications. Prior to my August results, my fasting blood sugars have always been in the "normal range" (90-110) at my appointments and my A1C was consistently 5.1-5.6% range. At my appointment in August, my fasting blood sugar was 324 and my A1C was 9.3%. At first I was given Metformin, but not only did it have little effect on my blood sugar levels, I was experiencing bad side effects. I really don't like taking pills already, although I was making sure to take the Metformin every morning and evening as prescribed, I consistantly forget to take my other pill-form medications and was wary about starting a new pill after my Dr. told me to stop taking the Metformin. So after a long discussion and some persuading by myself and some information given to me by my best friend who is a T1 diabetic, I convinced my doctor to prescribe me Levemir. My Dr. started me at 10u daily, titrating at 1u daily to 45u and then 1u every 3 days after that until I reach 90-120 fbs in the morning. I am currently up to 70u per day, my fbs is still a bit higher than the target range (126-160) in the mornings, but 90-130 range 4-4.5 hours post-meal. However, my blood sugar is spiking 100-180 points when I check 2-4 hours post-meal... The past 2 weekly visits I have brought up the addition of mealtime insulin, but my Dr. seems to think I don't need it, she says that it is normal to have higher levels after eating and that I only need basal. I have read that bs levels above 180 can do permanant damage to my organs... I really want to avoid that, but I don't know what else to say to my Dr., any tips or advice?

I would do bolus for meals and lower your carb intake. I would correct also for anything over 130 and do exercise. Maybe you can discuss this with your doctor, and or consult someone else. Even at 120 range or so I sometimes do half units corrections and activities.

Hi Proxii -
As I read your note I wonder what other factors are at play. I am just a "finger sticker" so anything I tell you is based on my experience and should be assigned only as much value as it cost you :-)

I won't sing my whole song here, you can read it if you're interested at our website ( ), but I wonder if you have a very good grip on what is really happening. Over a 12-month period I went from over 60-90 units per day of insulin, some long-acting at night and some quick acting at each meal and I am now at 10 units of long-acting at night and none at mealtime. My A1c is 5.5-5.8 and I am now in charge.

My experience is:
1. Keep GOOD records of glucose levels, I did it before each meal and before bed
2. GOOD records of food intake, at every meal, including carb-intake and calories.
3. Daily weight and exercise
that is why I pointed you to the website, I wrote a windows based program to keep those records and help in evaluating the results.
The book-keeping sounds like a lot of hassle, but once you establish the routine it is not a big deal and the information allows good analysis

In my case just watching carb-intake resulted in a loss of 40-pounds which I believe was the source of my good results. I found that breakfast was my high-carb meal, I love toast w/peanut butter and milk as I read the paper each morning. dropped it from 45-50 carbs at breakfast to 26.
I also found that 2-oz of bourbon is only 1 carb, so I now have a nightly treat of 1 drink, on the rocks, because the carbs are all in the mixers :-)

Hang in there, kid. With a strong set of records, you and your doctor should be able to make decisions based on facts with minimized guessing.
Good luck! We're all pulling for ya!

With the help of my best friend, who is studying to be a CDE, my new GP and an Endo... I've cut out all grains and eat a primarily plant based diet for the past 60 days. I've lost 23 lbs, 3 inches off my waist and I've been able to cut all the insulin I was taking (70u Levimir, and Humalog 5-20u mealtime per meal). It's a pretty awesome feeling to be in Diabetic remission!

Paying attention is the name of the game.
You are now The Boss.
Good Job. Proud of ya!