Question for my T2 Mom

Type 2
1

Ok, I guess I am hogging up the questions here as of late.

Here’s the background, my mom has been T2 for many years (maybe 15-20 years?)

I spent a lot of time with mom this AM, who is transitioning from taking 30 u of 70/30, twice a day, to taking 30 u of Lantus in the AM and 8-10 u of novolog with each meal.

She’s been on this new insulin program for about a month, and is not seeing any better results, and I had encouraged her to ask for a change in her treatment, because her blood sugars are running out of range, and I’m feeling bad because its more injections for her, but she is not seeing better results.

Her a1c is 7.6.

Her fastings are running about 140-150. Her post meals are typically 140 or so, with spikes up to 190-200 for larger meals (because she is not taking enough insulin to cover, my guess)

She is being very good about writing down the amount of carbs she is eating.
She is spotty about post-meals blood sugar checks and I have encouraged her to try doing more checks. Her doc tells her she only has to check twice a day, and she’s got stockpiles of strips, so I told her there would be no harm in her checking her BG more regularly, and she’d get a better idea of what her BG is doing throughout the day.

She doesn’t get in to see her CDE for another 3 weeks, and is not feeling well from her BG running higher.

For instance, before we went out to lunch today, her BG was 202.

I actually had her take a couple of units extra novolog before lunch to correct the BG and cover her food. They have not taught her to do that like they did me when I was using a pump during PG. They have not given her a carb to insulin ratio or taught her about correcting for out of range, so I’m worried maybe I shouldn’t have done this, but there is no doubt that her sugars are consistently high.

So long background. But my questions:

  1. Do Type 2s use insulin/carb ratios and corrections? If you do, how do you manage it?
  2. Would taking her lantus at NIGHT rather than in the AM, help with her high fastings? If you take Lantus, when do you take it? Would it be harmful for her to experiment with taking it at night? Her CDE had mentioned that to transition to taking it at night, she should transition by on day 1, still taking it in the am. on day 2, taking 15 u of lantus in the AM, and 15 u of lantus at night. Then on day 3, taking 30 u of lantus at night. Does that sound right?

Thanks in advance!

2

Most Type 2s need a LOT more than 30 U of Lantus. My guess is that she needs to slowly work the Lantus dose up until it flattens the fasting bg. Then work on figuring out the insulin/carb ratio.

Doctors seem to routinely keep Type 2s at fasting bgs between 125-140 probably because they were trained in the bad old days and don’t know better. I hear from people with that kind of fbg on insulin all the time.

Type 2s SHOULD be doing exactly the same thing Type 1s do, but the insurance doesn’t pay for diabetes education and most doctors turn Type 2s over to some poorly trained nurse who does “One size fits all” insulin regimens designed primarily to avoid hypos. This is not hearsay. That’s what they gave me when they thought I was a Type 2.

Splitting Lantus into a morning and evening dose often works really well as it doesn’t always last 24 hours even in Type 2s. But first she needs to get a more appropriate dose level.

3

Hi Glassjules,
I agree totally with Jenny. She is right on target with everything she said. Your 15 units of Lantus in the am and 15 in the pm are starting points for your Mom. She won’t be able to control the BG with the Novalog alone during the day. After she has worked with the changing dosages for a few weeks if she still isn’t getting control she should ask the doctor is she can try Humalog. The novalog works great for some people and for some the Humalog works best. Also besides counting carb intake, maybe she could lower it a little bit and it may be a little easier to catch.

4

Thank you Jenny, Judith and Saundra. Your site is very interesting, Jenny, and looks very helpful! I know they are being conservative with her lantus, and I am just wondering how long they wait, you know? She’s sat and foundered with this for a month and that feels like a long time for her BGs to be high.

My mom is 77 and has a lot of health issues – she had quad bypass about 12 years ago, and is back to being winded after walking about 10 steps, knee and joint problems…I just really would like to help her get at least this aspect of things working better for her, I think she’d feel a bit better if her BGs weren’t always high…

How long do you wait before you ask for more help adjusting dose?

I’ve only dealt with it myself during pregnancy, when they are super responsive obviously, about things not working, in order to protect the baby.

5

Besides the other good advice you’ve received, ask your mom if she’s been snacking, and on what. Forgetting (or neglecting) to bolus for snacks kept my BGs up.

Terry

6

Many of us are a 1 unit to 10 carbs ratio, some are a 1:20 and the list goers on. If you have to wait a while before seeing the doctor or CDE you can try those. Start off at the 1:20 if it is scary to you. But start working the Lantus in twice a day. You are correct, she will feel better when she is able to keep her blood sugars lower. Don’t get discouraged if you don’t get a lot of response from the doctor, etc. Not too many are really serious about treatng type 2’s and getting them in good control. You have a good grasp on what she needs and you have a good number of people on here who really will be able to answer questions for you. The other thing I would say is don’t forget to work on the other health issues as well because they can mess up blood sugar readings too.