A very important point that has been missed on this thread is concentrating on Time in Range (TIR). Increasing your TIR has all kinds of beneficial effects which may or may not initially be reflected in your A1C, including fewer hypos and fewer hypers.
Over time, an increased TIR should result in a lower A1C, but I am more convinced every day that TIR is the more important measure.
Eliz... I've only been trying this for 2 days so far and it's the best control I've had in 26 years (other than the first honeymoon years)! My endocronolgist said every diabetic can be affected differently by insulins. That's what made me think the Lantus was not acting evenly for 24 hours for me. I would give Lantus late at night close to midnight. My problem was actually the Lantus working too strongly the first 12 hours and turning low in that period and then the afternoon would spike very high because the Lantus weaker for me after 12 hours. Many people turn high in the morning because they turned slightly low while sleeping, not enough to wake you up, but enough to get your liver to secrete glucose. Here's the secret that's working for me. I'm injecting Lantus twice per day at slightly more than half the daily dose. Eg. I used to give Lantus 14 once per day, but now giving Lantus 10 twice per day (once at midnight and once and Noon, keeping the times exact). You can fool around with the dosage, but it's working like a beauty for me! Also, I increased my Humalog Carb Ratio to make the Humalog less powerful, however I scale back the time before meals to prevent the after-meal spike. This alone without Lantus twice per day did not work but it's working like a beauty with Lantus twice per day. I'm from Canada so you'll have to do some conversions. But here's how I scale it back. If BS 5 to 10 mmol/L I inject Humalog 15 min. before the meal. If 10 to 15 mmol/L I inject Humalog 30 min. before the meal. If 15 to 20 mmol/L I inject 45 min. before the meal. My endocrinologist said it worked for someone else. So I tried it. You have to inject before the meal because making the Humalog weaker with higher Carb Ratio, which prevents a hypo 3 hours after the meal, but injecting before the meal is the secret to prevent a spike in sugar right after a meal. However this alone did not do the trick. It was not until I started giving Lantus twice per day (fool around with the dosage amount) and for me I had to increase the Humalog Carb Ratio making it a weaker dosage (1 Unit of Humalog for 6 Carbs up to 1 for 10, or whatever you're at... increase it to prevent lows after twice per day Lantus and injecting Humalog 15 to 45 min. before meal). I have an insulin calculator on my smartphone. This way you can increase the carb ratio even more if after a gym workout. Plus the pre-meal Humalog injection scaled before meals based on your blood sugar. It's working amazing! My sugars are almost flat-lining in a tighter range and there's no post-meal spike in the first 2 hours and no hypo between 2 to 6 hours after a meal. It's working like magic for me! I would get on Lantus twice per day with Afrezza, however I have to stick with Humalog for now until Afrezza is approved in Canada. With Afrezza you absolutely don't want to give before your meal. It's too fast acting. You should actually give it 15 min. after you start eating. Look at Mikep's thread on Afrezza. 30,000 views. But Lantus twice per day would work like a beauty with Afrezza. P.S. I trade stocks on the side and I don't know what's harder to figure out... the Stock Market or Controlling Blood Sugar!
Hi YogaO,
I use a Spibelt in yoga occasionally. I guess I just miss the flexibility of not being attached to something. Also, for some reason when I switched from MDI to my pump my weight blew up like a balloon. And it wasn't a crazy switch in A1C. I just can't seem to lose any weight when tethered to a pump. The extra weight bothers me when it comes to yoga and acro-yoga because I feel it inhibits my movement and just makes me feel encumbered. So besides not wanting to be attached to something in Costa Rica (and carry all of the gear associated with the pump), I also wanted to see if there was a way to use MDI to keep my mid-6 A1C and maybe also inhibit the water retention and weight gain that I experience when being attached to a pump.
I completely agree. I wish there was an easy way to get time in range. I haven't figured out how to get the data from the Dexcom to my Mac yet.
Hahah! Trading stocks vs. controlling blood sugar. The struggle is real. Thanks for sharing the info about the Lantus dosing with me. I think doing 2 shots per day and splitting them by 12 hours is exactly what I want to try. Like you, I would also always inject near midnight and get low, then wake up super high and then have sporadically changing bloodsugars at the baseline. Afrezza is super exciting but makes me nervous. I will head over to Mikep's thread and give it a look. Also- I have noticed a huge difference with "pre-bolusing" on the pump, which would be the same as if I was using MDI. I almost always pre-bolus at least 15 min before I eat, and give it even more time if I'm over 150. So many things to remember....I feel like I'm constantly cranking blood sugar numbers, carb ratios, correction ratios, basal rates, etc in my head. Good thing I'm good at math!
Blood Sugars are the same volatility as the stock market. You know how sometimes you did everything right but the blood sugar takes a wild swing up or down for an unknown reason. The same randomness as the markets. My blood sugar volatility is what inspired me to trade stocks. FYI... the plan I wrote was working like a beauty, but after a meal the 4th to 5th hour turned low. I might just get in the habit of drinking orange juice 4 hours after a meal. Then it should work out. I'm not on a CGM. I think the Dexcom CGM would do wonders for me being used to analyzing charts in the market. Would be fun to analyze blood sugar charts. I've been delaying getting on it because so expensive and no medical coverage for it. With CGM you just dose the insulin in the upper aggressive range and simply drink orange juice when the CGM beeps. That's actually how the Artificial Pancreas will work. They'll have a Glucose secretion feature where it injects glucose if the CGM shows a downtrend.
Hi, elizabetta. You´ve asked twice for an app that can do the math for you, and there is one. When I was on MDI back in 2012-2013, I used an app called RapidCalc.I used this app on my iPod Touch combined with an insulin pen that gave me 0,5 units of rapid acting insulin, - it was almost like using a pump.
RapidCalc lets you put your carb/insulin ratio and other stuff you know about how the insulin you use works for you into the app. Once you have done that the app works like a pump.
Example:
Before eating you measure your blood sugar, you put this number into the app, you put in the carbs you plan to eat and the app suggests the amount of insulin you should inject. At any time the app shows you the IOB. The app also suggest doses and adjustmenst if you plot planned excercise, previous lows and alcohol you´ve been drinking. You can read more about it here: http://www.gilport.com/rapidcalc/index.html
RapidCalc was then compatible with iPhone, iPod touch, and iPad. I have not checked it lately, but it´s worth a try.
Ah, another light shines onto the subject ...
Sorry, I can't really help there, my weight has been pretty stable whether on MDI or the pump. The single biggest change that helped me when I added a little weight was to drastically reduce the amount of food for my evening meal, while increasing my breakfast meal calories some.
Maybe I'll try that....Seeing my endo this Wed so I am going to be talking to her about all of the suggestions I've been treated to on this site.
Hi Siri,
I was out of town traveling so just seeing this response now. Wow! This app sounds perfect for me, especially the IOB part of it. Thanks so much for shining a light on this. I'm absolutely going to check it out.
The problem with the OJ dose 4 hours after the meal (for me), is that this will promote weight gain...I'm trying to lose and my endo has consistently said I have lows that are preventing the loss I'm trying to achieve. Hmm....Sorry just responding now. Was traveling for work. Your discussion of stocks is totally making me want to sign up for an Intro to Stocks class! It might take my mind off of obsessing over diabetes numbers so much!
In my experience (I integrated the IOB calculation into our App for the Glucosurfer) some Apps and even Devices have flaws in their IOB handling. The most common mistake is that the IOB is subtracted from the next insulin dosage for carbohydrates. But the correct approach is to just subtract the IOB from the calculated dosage for correction (if the BG is higher than the target).
@Holger, I started with Lantus. Novolog was added. Currently using Levemir twice daily with Novolog. About 2 years ago A1C number rose from 6.2 to 7.5. Last year, I was able to decrease it to 6.5, 6.2; with the most recent, 6.5 My current endo suggested switching back to Lantus. It is unclear to me that Lantus would be superior. Since I split my Levemir dosage equally, 5 in the morning and 5 in the evening, I âthinkâ that with Levemir, I may be able to adjust if my activity level were to change. In practice, I havenât done so. The endo thinks that I can get away with once daily Lantus or Tresiba.
With new products, there is always a learning curve. I wonder : âif it ainât broke, why mess with itâ. My endo wants to improve the A1C numbers.
I always appreciate the thorough and thoughtful comments from you and other members of this group. Thanks in advance.
I was using N and R until 2014. My A1C ran between 6.6 and 7.5, I was using the syringe. In 2010, my A1Câs stayed in the low to mid 6âs. I was still on N and R and the syringe. In 2014 I had cancer surgery and was switched to humalog and lantus my A1C still in the low 6âs. With the pump my A1C has not changed. It will go between 6.1 to 6.3. So for me it doesnât matter which I use, the syringe or the pump. N and R or lantus and humalog. Iâve had juvenile onset/type 1 since 1965.
Sorry for my late reply. I would suggest to try the Lantus under one condition: if you can proof that Lantus is not superior then your endo should accept that you stay on Levemir. I really wonder about the motive of your endo. We T1 diabetics invest sooo much more for good numbers. In comparison this one shot more is the least thing to think about.