I think the lack of sleep is part of the problem. He's been waking up in the middle of the night a LOT to correct either highs or lows, and then th stress of worrying if his correction was right or not keeps him from getting back to sleep. It's a vicious cycle.
ISF= Insulin sensitivity Factor. When you "test" it just make sure to take other variables (exercise , food etc) out of the equation. Once you are set on that number then you can determine what happens when you throw the variables back in. To test: take a correction without food and check frequently. By the end of 4 hours or so it SHOULD take him down close to 100 mg/dl. The book Using Insulin Zoe suggests will lay all of this out in nice easy to follow steps.
Glucose tabs ARE nasty. That is why you want them. Then you don't overeat it.
Splitting dose: You will never know unless you try. Do it and check to see. Nothing saying you can't go back to once daily if it is a disaster. More than likely his night time dose would be higher than his day time dose. Mess with it with endo's blessing (hopefully he would give it to you) and help. Diabetes is just a series of expiriments.
Insulin Sensitivity Factor - it means how much one unit of insulin lowers blood sugar, for purpose of correcting highs. We all are different.The way to figure it out, like the way to figure out all things insulin related is trial and error, trial and error. When he is significantly high he should take one unit and then test at 1, 2, and 3 hours to see how much he comes down. Don't try it before bed and try not to do it when you are still digesting food. Also, please be sure to take into account any IOB (Insulin on Board). Keep careful records of these experiments and in time a pattern will emerge. It may be different at different times of day. (Mine for example is 1:42 during the day and 1:62 at night.
Again, get Using Insulin! Not that we mind answering questions, it will just help with all this stuff. There is a lot to learn.
I don't know what brands you get in Canada, I use Dexcom. I don't expect them to taste good, they're medicine not candy! But other people use other things that have precise carb doses and can tell you what those are. Just stay away from "sweet treats".
The trick to adjusting doses without dangerous lows or roller coastering is to do it conservatively and methodically. Increase or decrease the dose as needed by one unit. Then leave it that way for say 3 days and see the results. Never change something because of one out of range reading, you will just yo-yo that way.
Ok, so if he went to bed at 5.5 (which would currently cause much anxiety...) he should wake up around 4.4 (where he currently feels low) or 6.6? Ok, that makes more sense as long as I'm doing the conversion right, which I'm feeling a bit more confident about.
I've heard it's easier to manage the flatter it is...which means that the more rollercoaster like it is the harder you have to work to flatten out :(
Ok, that helps a lot! I'm going to order Using Insulin, I've been reading Think Like a Pancreas and it is helping so far.
I'll pass on these suggestions and hopefully it will help him keep himself more regulated.
With the glucose tabs I think he'd settle for pallatable...the ones he got tasted like chalk. There was no way he was going to take those.
Theoretically, he should be 5.4-5.6. You want the basal to be flat, not going up or down.
This might have been an exceptional day for whatever reason but just to throw it out there that it's possible!
Going to bed at 5.5 (99) is a very good number. He currently feels low at 4.4 (79) because he is used to being much higher. When his numbers stabilize 79 won't be a high but a reasonable number for before meals.
But I want to say something a bit different about the 10% thing: We all have different experiences in how stable or volatile our Diabetes is, even with doing everything right. Some people almost effortlessly get numbers that barely move. Some people work their butts off and still struggle with unexpected highs and lows. Most of us are somewhere in the middle (I'm one of those). Your husband of course has a ways to go before he gets to his optimal control, but I personally hesitate to give ironclad rules (like shouldn't vary by more than 10%) because it can be discouraging. Now when I hear someone quote their blood sugar as "always between 85 and 100" I just shrug and know they have "a different diabetes than I do". In my early days it would have made me anxious that I couldn't achieve that. So in trying to do things like set basal, sure the 10% goal is a good one to aim for, but don't get discouraged if it doesn't always happen.
Ok, but for now he should still try for about 5.5? Should he be ignoring his body's warning when he's feeling low at 4, or should he correct for it because he's feeling low?
I think part of the problem is he keeps anticipating that his humalog should act faster than it does. So he'll be too high, bolus (is that right?) for it a little, then test 15-30 minutes later and be unsatisfied with how fast he's coming down. Then he's worrying about if he should bolus again, or if that will cause a crash.
Zoe your post makes me feel so much better about this whole thing. I feel like it's so important to get his diabetes under better control (he does too, trust me!) but I guess part of this is figuring out what 'control' means for him and how to get there.
I'm glad, Librarychick. No, he should definitely not bolus again if he doesn't come down in 15-30 minutes!! Yes, that is when the humalog starts acting, but its full action is 3-4 hours and yes, it's maddening to wait for blood sugar to come down. But remember that one high isn't dangerous; it's prolonged periods of time spent high that in the long term will lead to complications. Remember he needs to keep track of insulin on board or else he will be "stacking" which yes, can lead to a dangerous crash. First he needs to know the duration of his insulin. I use Apidra and count its duration as a little over 3 hours. Some people consider their fast acting as lasting 4 hours. So you divide to see what's left. If you take 4 units and the duration is 4 hours, than after two hours there are still 2 units left. So you need to keep that in mind when deciding on a correction.
I wouldn't correct for a 79 myself, but he may be miserable at that level. But again, he is obviously overcorrecting and needs to find something he is willing to use for lows that is at a predictable carb content and take just what he needs.
That makes much more sense! Thinking about it like 1 hours= 1 unit will help him understand the way things are working much better!
I think that he's gotten the impression that the humalog acts within the first 15 minutes and is basically done and trailing off (aka not doing anything useful) after the first hour for sure. Your example will help us make sense of this in a much more useful way.
I'm going to make sure we talk about this stuff tonight, the sooner we can get better corrections the sooner he'll start feeling better.
PS I should introduce myself a bit better, my name is Becky :)
I just need to add that you are a gem of a girlfriend!
Aw! Thanks :)
We've been together since before his diagnosis, and he's my keeper! D and all!
...I may also have a bit of a research addiction, lol. It's about time I put my penchant for searching and knowledge accumulation to good use!
Zoe ... silly question maybe ...you mentioned " I use Dexcom. I don't expect them to taste good, " are you referring to Dextro Glucose Tablets ?? other brand in Canada Dex4 ...also comes in a liquid, easy to carry around container . During my recent travels someone gave me a jel pack : Hypio-Fit 4.17 carbs ...and heaven knows who " donated " the package .
@ Becky google : glucose tablets, Canada . I purchase Dex4 at Shoppers DrugMart; most economical place I found so far ...under CAN $ 7,00 for 50 ...
Hi Becky. One hour only equals one unit if you've taken 4 units. I used that for an easy example. Let's just say for argument you choose 4 hours for your duration of action then you divide whatever dose he took by four hours. It gets hard when you are dealing with fractions of a unit because injections can only deal with whole units (unless you get 1/2 unit syringes). But you just have to wind up or down. No, it definitely doesn't stop acting after 15 minutes or one hour!
Oops, oops, oops, Nel! I meant Dex4! Not Dexcom!! Here in the U.S. I pay $5.99 for a container of 50. That's about the same as $7 CAN isn't it?
the graph sort of lays out the timelines? These need to be overlayed with food (exercise, stress, hormones, astrological events...who knows...), which produces similar BG curves, to try to get a smooth overall BG curve. It's no simple task. Even a small "oops" can throw things off and cause big hassles but it sounds like you know that? It's really awesome that you are working to help your friend!
LOL, "this dexcom is delicious but how many carbs is it?"
Ok, I think I get it now. Math is SO not my strong suit, lol.
So it seems like humalog lasts 2-3 hours (says their website anyways), so if he took 2 units of insulin we'd divide that by 3 = .67 (ect) per hour? (Sorry if this is still wrong. Like I said, not my strong suit.)
Thanks acidrock, I've been pretty slack about this for the past few years, since his diagnosis, but it needs to be a priority for both of us. We're a team afterall.
Zoe . dear friend ...NEL , only one l, another story ...short for petronella...one of the things I do not do is cross border shopping ...I admit ...( the US dollar almost equivalent to CAN same for Becky !!!)
Friend AC you make me laugh once again ...Becky ...keep your chin up ...pm me if you need some more CAN info ...please remember and apply : DTC for those , who can prove 14 hours weekly diabetes maintenance !!!