New Endo and Insulin Frustration

I have recently started seeing and Endo, and she wants me to send my blood sugars in every week so they can adjust my insulin doses accordingly. I have been doing this for the past 5 weeks now and EVERY week she lowers my insulin doses. I am very paranoid about high blood sugars and since she started lowering doses my sugars have begun creeping up.

She is very concerned about my basal insulin and has lowered it from 12u to 4u now over the past 5 weeks. She says that my bg should remain stable between meals without snacking. My 2hour post meal b/g are usually between 150 and 180- but then 4 hours after they tank to 70's, even with only 4u Lantus. But at night my blood sugar steadily rises and falls between 80 and 120. I lead a very active lifestyle and I feel very strongly that the reason my sugars tanks 4 hours after eating is because I am so active that I drive my sugar that low. If she keeps lowering my basal rate then my b/g is gonna shoot up.

Additionally, she changes everything so frequently and so fast that I do not think my body has time to adjust, I know mentally I don't have the time to adjust my diet and figure out when to eat how much and what type of food before she changes it again. It's wrecking havoc on my life and my emotions and making my doubt whether or not they are going to approve my insulin pump.

I chose to go to the Endo because I thought I wasn't getting the care I needed, now I am frustrated and feel like it's not even worth taking 4u units. I just want this all sorted out and I am tired of constantly having to change EVERYTHING EVERY week sometimes 2-3 times a week. I just don't know what to do. Sorry for ranting but I don't know where else I can vent that it might be helpful.

I have a general rule to not change doses unless I see a pattern for three days or more. I agree that if you are requiring snacking inbetween meals to keep BG up, you may need a basal change - but maybe you ened more at nigth than in the day and your Lantus dose can be split to two doses to accomodate this (AM and PM). SOmething to defintiely discuss with your endo. It is hard in the honeymoon period to make changes - the only thing constant with diabetes I feel, is change. Just when you think you have it figured out, it changes. And I rarely get 2 days of the same - meaning I eat one thing one day, same insulin dose, same activity and the next day, same thing - and my BG's are totally different. I would get the book Using Insulin by John Walsh - it is a great book and can give you guidelines on helping to adjust your own doses. Once you are more comfortable, you will likely be adjusting on your own - especially giving your activities. If you are not happy with what is happening, maybe you can change endos as well.

I usually only change things if a number is off for a couple of days in a row. I also try to change things one number at a time, like breakfast/ lunch/ dinner and then the fasting ones. I'm not sure how to fix 150---->70 but I might "cheat" by eating a lot of snacks in my goal to load veggies, nuts, etc. as small snacks? I'm not a big fan of "deleting" basal insulin though, as I like to keep that going all the time.

your 2 hr pp seems high to me. Just my opinion ofcourse. No food on board and tanking to 70 would be about right. Its normal. You have no food to keep the bs elevated. Like i said before you really do need to snack a little bit. 4 hrs inbetween something to eat, even small, is too long. Your night numbers look good though! It maybe that your 4 units of lantus is actually doing the job but your bolus is too low. Just a though ofcourse!

Hi - Your basal shouldn't be used to manage your 2 hour post meal spike. It sounds like your endo is trying to get a good handle on your basal before working on the other pieces which is pretty standard practice and I wouldn't worry about your b/g shooting up because your basal is set too low. If that happens, you can always add a bit back.

Getting your ratios set the first time takes some time but you'll get their and then things will feel more manageable. It gets easier and you'll get stronger now that you've been diagnosed properly and are receiving appropriate treatment.

Good luck,


Maybe it's your bolus that is off? It sounds like your endo is trying to get the basal amount straightened out before dealing with the bolus amount (like adjusting your I:C ratio). If you're newly diagnosed the problem is that your pancreas is likely still producing some insulin, which is throwing things off.

I don't think adjustments should be made so quickly, though. You're not having lows that are result in unconsciousness, and I assume you're catching your lows and treating appropriately.

Also - I try not to change things up unless I notice a significant pattern. For example, my AM blood sugars are generally superb. But this morning I woke up at 219. Have no idea why. I corrected and went on with my day, but I won't do anything about my basal rates unless this pattern persists for several days in a row (and I am certain I'm not sick or something).

Like the others, I only make changes after 2 or 3 days of observing. I just started a pump and my endo waited 3 days to make adjustments to my basal.

It's also not uncommon for your basal needs to be different between the night and daytime. I have this problem and it's the main reason I went to a pump after 25 years of shots.

Be patient. I need to follow my own advice, of course. :) I know it's hard because you want to "fix it" but the name of the game with diabetes is change. I honestly think diabetes has made me more adaptable to change in other areas of my life, like work.

I agree with your endo that your bg should remain stable between meals without snacking. That's when you know your basal is set correctly. Of course, you will have days that are exceptions to that but you shouldn't have to eat to stay stable.

Hang in there and try not to get discouraged.

Also remember your meter could have lied to you. I test two or three times if I get a strange low or high. I have seen my meter read 75 then 110… uhhh that seems to be too much so I tested twice more and go near 75 both of those. It could be you have residue on your hands also. Make sure your hands are clean and if you are using alcohol Swabs just be sure it is fully dry before testing. It will cause false readings. And follow all the other wonderful advice already given.

First of all i do not believe I am honeymooning. I’ve had diabetes for 4years. I began taking insulin in November. I AM a type one. I was misdiagnosed type 2 initially but my endo did the labwork and it’s definately type 1. She said if I hadn’t cut my carbs like I did and exercise as much as I do and drink as much water as I do I would have probably gone into DKA years ago. Anyways, I did a basal test today. I took 4u Lantus last night at 8p 2hrs after Novolog and dinner. I was 106 at 10p. Then dropped to 94 at 2a. Since then I have held steady in 80s since 2a. It’s almost 1p today. I have had no food no Novolog since last night at 6p. And my sugar has not dropped low.

It has to be the duration of action (ie the tail) of the Novolog that is causing this. It’s the only thing that makes sense to me at this point.

I believe Novolog lasts longer than Humalog...That could be the problem. Can you try Humalog? It lasts about 4 hrs. Sounds like your fast-acting is the problem. ??

Some people can honeymoon as long as 20 years or more.. honeymooning just means your body still kicks out some insulin occasionally..

There are studies of people who have had T1D for years and it was assumed that there was no insulin production left; but lo and behold, there was..

Sounds like you are doing a good job figuring it out, but I like Walsh's Using Insulin book a lot too.

Another thing to consider is that a basal test "must" control for exercise. If you exercise every day, you must do the basal test with exercise. It is normal to have a reduced basal demand during exercise and up to 48 hours afterwards. Some people may find that they need markedly different basal settings for exercise days as well as the 1-2 days following exercise.

Ok, I have done something similar to what your endo is doing. I was training for triathlons and was taking so much insulin and eating so much and same thing a few hours after eating I was low - eat more = feel better.
BUT when I lowered my insulin (from 10units to 5 units) I had MUCH better control. I didn't go low after meals any more and I wasn't waking up low. Highs aren't good but lows are much worse.
If you are really active you can probably afford to lower your insulin by a lot and just eat a bit less. The bonus for me was that I got much better control and wasn't constantly eating all day any more. My fabulous endo said I was chasing my insulin. Eating to not get low. That's not what eating is for.
Trust me - your endo is right - you need less insulin and you shouldn't have to eat after a few hours post meal.
If you don't have time to do this and track everything then you are going to have serious problems. I tracked everything I did, ate, injected and the time for 8 months daily. It's the way you learn what is causing you to go low. It's the way to see patterns over several weeks. You need to do this so you can live.

I am now down to 4u Lantus. And 6-10u Novolog daily with meals. I have not had a low in 4 days so I guess that’s good. I also haven’t had a 2 hr post meal below 180 in that time. So I think my basal is good now but the bonus need adjusting. I have been tracking everything for months trying to get this all figured out. I fax my previous weeks reading on mondays and she usually calls on tuesday mornings so we shall see what she says tomorrow.

I’m also still waiting to hear about my pump. Pump company is still waiting for the doctors office to fax paperwork back. It’s been a week waiting on that, and two weeks since the process began. I’m getting really frustrated, worried my insurance isn’t going to cover it.

Now that the basal is stable, you can start doing some trial and error on the boluses using 7 gram (small) amounts of usual foods you eat. After you've figured how much to give yourself for small amounts, then you can take bigger amounts. When she sees you are tracking your carbs well, counting well, she'll no doubt get out of the process and you will handle it yourself. It's Carb Counting 102.
And when you're above 180, it's a good time to give 1 unit short acting insulin, being careful you're not stacking insulin on top of a prior dose, and see how far down you go by 3 hours (no foods, nothing else during that time). You will then know what a unit does to you if you don't know by now. And you will know what to give yourself for corrections. Good luck! You're making progress! Fits and starts are normal! Repeating the mantra may reduce the worry!

I'd add that if they give you static about "you have decent results, you don't need a pump..." that your small basal doses would be a very good counter argument? I get shifts in basal needs all the time, struggle for a while and then change it to a new number. So far, when I do that, things fall into place nicely. W/ such small doses, even a 20% adjustment is pretty much impossible to get precisely w/ a syringe? I don't know if that's a medically accepted rationale for a pump but it should be.

I can’t bolus for 7g carbs. I am very very sensitive to insulin so I generally have to eat atleast 20g to bolus at all. That’s why the pump is so crucial at this point. I need to be able to dose for smaller amount f carbs and I can’t get the doses I need with a pen, which I have. And I doubt I could get that small an amount in even a syringe. I am workin on it though. As for correction boluses, I worry about dropping my sugar too low and I don’t know when it’s okay to give a correction bolus or how I do it without stacking. Hopefully that will all be sorted out very soon though.

My CDE says to inject 1u for every 60mg/dl I am over starting at 180. But is that okay to do 2 hours after a meal? Or is that too soon. Usually I do correction boluses with dinner. Ex: I ate 68g carbs with dinner. My pre glucose was 188 so i used 1:20 ratio which she gave me plus an extra unit for the high pre meal. So 4u total.

We all have different philosophies on correcting. I truly believe that prompt correcting is what has helped me have a low A1C despite not eating low carb. Yes, I will correct 2 hours after eating. The way to do it without stacking is to keep track of your insulin on board. Depending on which insulin you use your duration might be between 3 and 4 1/2 hours. I use Apidra and my duration is pretty reliably at 3 hours. So if I take a bolus of 3 units for a meal and am high 2 hours after when I check, I know I still have 1/3 or 1 unit on board. I will subtract this from any correction I do. With a pump of course, the wizard computes this for you and does it to three decimal places. I always look to correct if I'm over 140, and I correct to a 110 goal. But my ISF is 1:60 at night as well (1:40 during the day) so if I'm not too high I will see I already have IOB to correct and won't bolus unless I test again after the insulin is gone and am still high.

But yes with a high insulin sensitivity it's hard to bolus or correct for small discrepancies. I'm not as sensitive as you, but for dinner my I:C is still 1:21, so I'm grateful to have the pump to bolus for the actual amount.

You T1s are all so awesome. I have a difficult time as a T2 just counting carbs. I'm afraid if I ever need insulin and a pump and CGM, I'll also need a brain pump just to manage the math.

Have you read Using Insulin by John
Walsh, or Think Like a Pancreas by Gary Scheiner? both are excellent books which give a lot of insight into what your doctor is trying to do. I did not read your profile, are you newly diagnosed?
Well you will have to be your own science experiment for a while and test and journal everything until you see the patterns. b\Both books have charts and info to help with this.... Take a deep breath and small steps, Julianne.. Take small steps, then maybe take a break..Tell your endo you may want to take a little break from faxes and send in ..Too much stress WILL throw your blood glucoses off, not a good time to check basals and boluses when under stress. ( I know about that right now, Tufriends, due to my Dad's illness ,and travel and off-schedule tiring days)
The books will really help. Make copies of the charts in "Using Insulin" and share them with your endo and/or CDE. When you are ready, having a mind set of "Slow and steady wins the race"; begin to Log everything.. Write down when you exercise, how intense the activity, blood sugars before and after. Yeah, it is a lot of work, but highly worth it. I may be starting a new exercise regimen with a return to bicycling this summer. I will have to redo my basals snd bolus, becuse I expect that they will have to be lower with the exercise... but I own "PUMPING INSULIN" also by Walsh, which has good chapter on exercising...So it wil be another time I have to go back to the drawing board,,Which is life with trying to get well-controlled diabetes.

About the pump,,/do not get frustrated.. My doctor required that I show that I could carb count,log, correct, and c adjust dosages for 3 months before he would even write a prescription for a pump.. Then it took about 4-5 weeks to get the pump approved by my insurance and sent to me. It is a long process, but I find pumping very useful, particularly if you are active.

God Bless,

Tyoe one 43 years