Now what?

I put this on the end of my previous thread, but I was afraid it would get lost so I am reposting it here.

I’m trying to adjust to the Apidra. I started yesterday with only one unit because I’m scared of the fast-acting insulin. The one unit didn’t bring my numbers down, if anything they were higher. I wondered if this was because I was told to d/c my oral med and was still not on enough apidra. Yesterday was all in the 200s and my bedtime was 351! I wondered if maybe my Lantus had expired, so I plan to use a new one tonight.

Today I went up to 2 units (my doctor said 2-3). At breakfast I again went up from 106 to 248. Then I was 351 again before lunch. At lunchtime I took the 2 units and ate a salad and a wedge of cantalope. My numbers started to come down and after 2 hours I was 117. (good!). But by time for dinner I was down to 70.

I couldn’t decide what to do about my shot at dinner, so I decided to just do one unit. I ate a black bean salad. A half hour after dinner I was down to 52 and I got scared and took 3 glucose tablets. Now of course 1 1/2 hours later I’m back up to 248!

What the hell happened? Why did the 2 units take me down so far from the 351 when at breakfast it took me up? I don’t get it! Did I handle it right or should I have waited for the food to kick in and take me up from the 52? I’m so confused. I guess I just need to keep doing the 2 units for another couple days, keep testing and see what happens. I was kind of hoping I would respond in a way that made sense!

I’m normally high for at least 6-8 hours following a low, or at best I’ll have super unpredictable numbers… so if any of those numbers were “rebound” highs, that could explain it almost completely. I had a super bad day yesterday, starting out at 267… I was ALL OVER the place, from 42 to close to 400, and I attribute my high fasting to a low I didn’t wake from in the night, and it just messed with my entire day. Today was way better, my highest # was 160-something and my lowest was 77.

Remember that testing is just a tool, and while you might not like the #'s you saw today, don’t rush to make too many changes at once - wait at least a few days to make sure it’s a trend.

I’m so trying to make sense of this. The day I finally get my numbers in range I think I will throw a party. Anyone been having an urge to travel to Guatemala? Great ruins, colorful indigenous culture, fabulous textiles! LOL.

I’m a logical person, I like figuring things out, I like things that make sense. I have a good friend who told me I can’t expect to understand all the nuances of diabetes treatment like all of you who have been doing it for so long. I didn’t like that my new endo just told me to take 2-3 units of Apidra before meals and went on vacation for two weeks. I wanted an I:C ratio and a sliding scale based on my numbers before meals. I WANT to count carbs! And my friend said I’m not there yet, start simple. So I did and I expected to reach a magic number where it would all fall in place. What you seem to be saying, Sarah, is it isn’t always logical and predictable? There are many variables that affect our BG. So, like my friend says, I should just try the Apidra and note my reactions and eventually there will be a pattern?

Gerri gave me some good advice on the other thread and at first I found it more confusing; so many things to think about.(sorry if my response was scattered!) But maybe I can sort through it: If I have insulin resistance in the morning I need to eat less carbs then and a tad more insulin. At lunch maybe I don’t need as much insulin and I can eat a bit more carbs. I need to play with the dose and food until I find patterns, right? I’m still not sure what to do if I find myself again at 70 before my meal. My inclination is just to not use the bolus that meal. Ok, thanks ladies, back to the drawing board. Sigh.

Hey, after I read your last paragraph, I thought “she’s really starting to get it!”

It may not work to completely avoid a bolus before a normal-size (for you) meal if you’re under 70 mg/dl before the meal. The food you eat will keep breaking down into glucose for at least a couple of hours after you start eating (building to the post-meal peak, which can be from 1-2 hours after a meal–and even longer for meals that contain lots of carbs and lots of fat, like pizza). If you don’t take any insulin to cover the meal, you’re likely to go high later. Especially if it has been at least 4 hours since your last shot of Apidra.

There are several approaches to treating a before meal low, including these two:

  1. Treat the low with some pure glucose and test 15 minutes later to see if it’s rising. Then bolus. Then eat meal. This may be the textbook approach, but who has the time to wait?
  2. Bolus for meal amount and start the meal right away (or bolus after you start eating if you’re worried). Be sure to eat/drink some carb immediately. Then be sure to do a 1-2 hour post-meal test to see if everything has smoothed out.

And remember, don’t make too many switches all at once, or worry about all the subtleties, such as dawn phenomenon, until you have seen some patterns. Tell the logical side of your brain that fewer variables, more extensive data collection makes for better decision-making :wink: