Hi. I am new to this site but I am hoping that some fellow diabetics may have a better insight (tips/tricks) for regulating BGL then my doctor. I currently do not see an endocrinologist and before anyone jumps on me for that it is because my health insurance through work does not cover diabetes so I can not afford the $200+ dollar visits. My BGL is usually 180-250 and at times will rise to 330ish (corrected with insulin ASAP). I can not seem to get my BGL to go down any further than this. It is also around 230 when I wake up every morning and I take my Levemir at night like I am suppose to and check my BGL and do any corrective does needed but no matter what I do my BGL stays between 180-250 and I know this can not be good for me. Anyone have any tips or tricks that have worked in the past that maybe I can run by my doctor to see if they would be okay for me to try? I am slowly losing my mind trying to regulate my BGL. Thanks!
Welcome to the sight! I wasn't seeing an endo or any doc for a long time and then went through a couple of GPs so I won't jump on you about that. You are right to be concerned about the BG levels. It might be useful to try a book for a "crash course" in T1D. "Your Diabetes Science Experiment" by Ginger Vieira, "Think Like a Pancreas" by Gary Scheiner or "Using Insulin" by John Walsh are all excellent primers that will tell you how to figure out if your dose is correct (if your BG is elevated all the time, it probably isn't...) and then what other things you can do to get your BG balanced.
Short-term, you might try a different time or perhaps splitting the Levemir, to get better coverage. If my fasting BG are high, I would try maybe 10% more basal and see what happens. If it's at all possible, do this some day when you don't have anything crazy going on, if you have any of those, so you can 1) be *CAREFUL* and 2) see what happens without wondering if exercise or stress or whatever is messing with it. Is this like a new insurance plan for you? It's sort of unusual for diabetes not to be covered at all.
Welcome to TuDiabetes, Bailey B! There is a lot of good advice to be found here.
My initial take is that you probably need to increase your basal insulin dose (aka - Levemir). A lot of T1Ds on Levemir also split their single dose into two taken 12 hours apart to ensure 24 hour coverage. In addition, you might need to adjust the insulin to carb ratio (I:C) when you take your bolus insulin. I would also ask what you are using for your insulin sensitivity factor (how much does one unit of fast acting insulin reduce your BGL)?
Overall, I think that you need to get a handle on the Levemir dose first. I like what AR23 said above, increase your dose by 10% and see what that does for you over 2 - 3 days. If still too high, repeat the increase.
I see that the recommended "starting" Levemir dosage is 1/3 of your total daily dose (TDD) of insulin. Are you taking 150 units per day?
How often are you testing?
Unfortunately since your insurance doesn't offer diabetes coverage, you will have to be your own endo. For me, I try to be as educated as possible and use my endo as an advisor. After all, I am the one who is living with T1D 24/7, my endo sees me a few times a year for maybe 15 minutes each visit.
Certainly it is not your fault that you are a diabetic. That's not helpful to treating the condition in any way!
Again, I would look at getting the books mentioned above. "Think Like A Pancreas" was an excellent book for me, and I still use it regularly.
Also, you might want to click on the "New to Diabetes" link on the TuDiabetes page for discussions on terminology, but you can always ask questions on the forum and someone will respond.
I agree with the others that you need to buy one of the books and get in the habit of tweaking your own doses. You obviously are not taking enough insulin to control your blood sugar and you need to get your blood sugar in control.
Second, though you are Type 1, it sounds from your doses that you have developed a fair degree of insulin resistance. You need to talk with your doctor about perhaps adding something like Metformin or symlin to help you with the insulin resistance. Also if you have gained weight you need to work on losing it, though I know that is hard to do. That will help greatly with the IR. Perhaps consider lowering carb intake which will help both with weight loss and allowing less insulin to be effective for meals.
I have to say I've never heard of someone who already has an insurance plan but the plan disallows a particular condition! You might want to check into this further or see if there is something you can add on or switch to. Also, and I know this is complicated, but you might want to begin to see the impact the ACA will have on this coverage as some aspects of that are coming into play next month. But ultimately, by reading the books and asking questions on here, then going back to your doctor and EDUCATING HIM or HER you should be able to get a handle on this.
Hi Bailey,
I'm not sure what "diabetes coverage" is, but it sounds like your insurance is covering your basic necessities to control your condition and keep you on track for a lifetime. It's an absolute disgrace that diabetes can be singled out as a condition that will not be covered in any insurance plan.
However, it sounds like you have both short acting and long acting insulin at your disposal and you have access to an MD who can run the necessary lab tests to monitor your condition.
You have some great advice already on how to control your BG, but I would highly recommend getting your regular labs done if you have not already done so, or have missed out over the last 10 years. Not trying to alarm you, but running blood sugars in the 200s to 300s for ten years puts any diabetic at a high risk for long term complications. Regular lab tests will indicate possible issues even if you feel completely healthy.
The basic tests are:
A1c: Estimates average BG over the last 90ish days. Sort of the "dipstick" measure of how well you are doing overall with your control.
Urine Microalbumin/creatinine: Will give you an indication of your kidney health.
Comprehensive Metabolic Panel: A bunch of labs that check your kidney and liver function.
Lipid panel: Generally measures "cholesterol", but goes into a lot more detail and will calculate a rough Cardiovascular Risk factor.
Endos are trained to monitor the results for diabetes care issues but any MD should be able to order them and give to a general idea of your condition if anything is out of the ordinary.
Good luck!!
ACA is the Affordable Care Act, the major change to insurance in the U.S. created by President Obama.
I don't usually use "shock tactics" but I'm a bit appalled at your blase attitude towards your extremely high numbers which can create major health problems down the road. "You don't have time to read books"??? Do you have time to care for your health and preserve your life? You have asked for help and then seem to be a bit defensive when people make suggestions. You say your doctor is well educated on diabetes and yet he has allowed you to have dangerously high blood sugar for 10 years? I understand money and insurance can be serious obstacles but I suggest you do what you need to do - read books, learn about tweaking doses, learn about insulin resistance and what you can do about it, start a program of weight loss,perhaps consider a change of doctor, find out if you have thyroid condition contributing to your problems and treat it if so,learn about reducing carbs in your diet, etc. Many of us essentially manage our own diabetes, with only limited care from doctors who often know less than we do. I think you need to make caring for yourself a priority for yourself and for your family.
FWIW, I believe Metformin is part of Wal-Mart's $4 prescription program ($4 for 30 days, $10 for 90 days).
Also Bailey, do you have a Meijer's in your area? Their a little cheaper than Wal-Mart. Metformin is one of their free medications on their prescription drug list. I think they only give you a 100 pills for free per script, but if you are taking more than that in a month, it's 3$ for the extra. I take twice a day, so they are free for me through Meijers. They only started doing that this year. Check out their pharmacy section of their website, if you have one nearby. They are pretty comparable to Wal-Mart on other scripts too. But if Wal-Mart is what you have close to you, then like Mike said, hit that store up. :)
hey, Bailey, glad you've joined us. It is indeed very frustrating! but I think you've taken the first step, realizing changes need to be made. I think taking small steps is the way to go. a good log (I use cheap spiral notebooks) of all your food, doses, exercise, is a good first step.
My husband gets his Metformin for free from the grocery store (Shop-Rite). I've had type 1 for 46 years, and I've had no endo for most of that (although I do now). and btw,I'm a little embarrassed to say I've never read those books, but I'm sure if I did, I could get some insight. There is tons of good info here, videos, older discussions. let me know if you'd like any help finding stuff here. and welcome to the community.
Hey Bailey,
You've already gotten some great ideas about insulin and other meds that might help, so I don't have anything to add in that regard. For me, regular exercise is crucial for blood sugar control. Maybe you already exercise regularly, but if not, adding a 30-minute quick walk (or some other form of movement that you like) a few times a week might help increase your sensitivity to insulin. For me exercise makes all the difference in the world.
Bailey, after reading through the entire thread, I've come to a few conclusions. I apologize in advance if any of this offends you -- that's certainly not the intent. Rather, the intent is simple frankness.
- You clearly want to improve this situation, hence your participation here. That's a very positive move.
- You are in, to some degree, classic "diabetic denial" -- wanting to control the condition, but still not accepting what it will take to do it. I say this based on everything you've shared about how you've tried to control your BG. You say you're "not very good at carb counting"; "poor diet"; insulin dosing, based on what you've said here, is all over the map.
- Until you choose to get precise about your management regimen, and accept that to control this condition you're looking at at least 6-10 injections a day (1x long acting, 3x meal bolus, 2x correction bolus on average), you will continue to struggle and fail. Accepting that this is what it takes is the first step.
- Getting BG under control with insulin will cause you to gain weight unless you modify your eating habits. Your body and metabolism will be working like a normal, non-diabetic, healthy person, who, if they ate the same food, would gain weight too.
- Forget about the weight to start with. Getting your BG under control is a critical priority that far exceeds anything else, given your BG history. So, if you aren't willing to take on both intensified insulin therapy AND diet issues at the same time (I know I certain wasn't), then don't worry about the weight gain at first. Spend a month focusing exclusively on learning how to count carbs, and dosing and timing boluses to get this under control.
- Understand that significant damage has already taken place, and it is certain that you already have some neuropathy even if you don't know it. Probably loss of sensation, if you're not aware of it (like having overt symptoms of pain and tingling, etc. that are obvious).
- If you don't get this under control immediately, and keep it there, at your age, your looking at a very high risk of some severe diabetic complications in the decades to come. All the fun stuff: Amputation, blindness, kidney failure, heart disease, etc.
- There is no "solving this casually" approach. As prickly as you seem to be about people recommending books and so forth to educate yourself, as long as you resist accepting the big step up in attention, work, and effort to control this, you won't
We all want you to succeed. You are welcomed in this community with open arms, hearts, and a desire from all of us to see you healthier. Many of us have gone through this too (speaking personally). We want you to have the psychological boost, and physical healthy feeling we all got when we got this under control.
You can't do it the way you're trying to. You are attempting to control this "on the cheap" (and I'm not talking financial... I'm talking effort).
I have never heard of, or encountered any diabetic that could not get their blood sugar down to normal, at all, no matter what. There are brittle diabetics that have major difficulty control large excursions, but they still can get it under control with the right attention and treatment modality.
You can get those sugars down to 85, but you'll have to learn and then follow the expert, enormously experienced advice of people here who have done this again and again.
If you aren't willing to become an expert in your condition, and fanatically calculate to control it, there isn't much we can do here to help you. The approach you're taking doesn't work, as you've lived yourself.
It sounds like what you are doing is, in fact, carb counting and using an I:C ratio
If 1:5 isn't working, you are more resistant than that. Try a lower ratio. Start with 1:4.
Remember to give Novolog about 4-4.5 hours to completely "clear" from your system -- that is, using the simple linear model, while not exact but good enough for MDI, assume there is still (4.5-time since last shot)*dose/4.5 units of insulin working on getting that high down. So, if you took 10U 3 hours ago, there is still (4.5-3)(10)/4.5 = 3 1/3 U still waiting to be "used up".
Let's say you've determined through experimentation that your correction ratio is 1U for each 10mg/dl over target. Target is 100. BG is 200. This would mean you take 10U to correct back down to 100.
3 hours later, you find you're still at 140. Well, 3.33U still hasn't finished working yet, and based on your correction factor, this should lower it another 33 points, leaving you at 107. In this case, I'd wait the additional 1.5 hours of insulin action before doing another correction. 107 is just fine if that's where it settles.
Different example: Suppose you're 250. That's 15U of correction to get to 100. You take it, and 3 hours later you're 200. Still have 5U "on board". That will only lower the 200 to 150, so stacking an additional correction dose is okay. With no IOB, you'd simply take (200-100)/10=10U. That would send you hypo, though, because of the IOB. Subtract out the IOB, and you have a second correction of 5U. Dose that, then check again in 3 hours.
That's how it's done. You've got to really step up the measuring, figuring, testing, etc. Getting this under control means managing this is 24/7 proposition. You're testing with a meter 10x a day. You're giving yourself injections -- probably on average 8, based on my experience.
AND, you're logging all of this, everything, so you can look back and see patterns, trends, etc. to then adjust your regimen.
It's a ton of effort at first. There's no getting around that. However, after not too long it becomes pretty routine.
When you do have insurance that will cover diabetes, you are an excellent candidate for a pump and CGM, and should pursue those options. Those two technologies make dealing with all this really easy and convenient. In the mean time, if you have an iPhone or Android smartphone, there are many very good, free applications for helping keep records and manage diabetes. I used both OnTrack and Fitness Pal on Android for record-keeping and nutritional management, respectively when doing MDI.
I'm the same way Bailey. It's hard to find the time with work (hour drive each way) and chauffeuring the kids all over for college (no third car for them) and just being overwhelmed. I found that if I walk a little at lunch time (about 10 to 15 minutes around the parking lot) or trying to go to the YMCA on the way home and walk their indoor track for 30 minutes, helps me tremendously. I may do the latter twice a week if I can find the time. Otherwise, at lunch everyday, I at least try to get in that 10 to 15 minutes. Sometimes I sit in the pool at the Y and walk in the water and do bicycle leg movements. I'll tell ya, 15 to 20 minutes of that is like walking for an hour. LOL It really gets the body metabolism going.
I find that if I miss a day, my numbers go up a little. On rainy days, I try to find a mall nearby and go walking a little at lunch. I'll even go to the mall in the morning on the way to work, if I know it's going to be raining all day. Most malls open up for walkers at 6 or 7 am.
Just some ideas.
Oh, and one last one to fit in. Once an hour at your desk, stand up and stretch. Side to side, arms up, stretch your legs out...take a minute to do that. It helps to keep that blood flow happening. I have an alarm set on my phone to keep me attentive to this. It really helps me get through my day now. :)
Also, another trick is to take your mealtime shot 15-20 minutes before you eat, giving the insulin a "headstart" on the food.
First off, welcome to the forum and the site! :) You are in a great place with a lot of understanding support.
There are some excellent pieces of advice so far. I'm not sure if I can add anything to this other than what I've replied too on a few posts already. But one thing I can add is taking care of your stress. :)
I know it may be hard to find some time to do this, but if you are at lunch, maybe you can squeeze in a few minutes to do this for yourself. Try doing a few deep breaths for yourself. Take a deep breath in for about 4 seconds, hold it for about 6 and let it out over 8 seconds. Do this 10 times. It will help restore some oxygen to your blood stream and relieve some stress that may be going on through out your day. Sometimes (strangely enough) the bathroom is the best place to do this, because we are alone and no one is watching us. I do it at my desk twice a day and sometimes in the evening. It helps me to get refocused.
Stress can sometimes raise the BGL as well. I know it effects mine. Also, if you can listen to some softer music or find a pretty sunset/beach picture to put on your desk and refocus your thoughts while breathing in and out evenly and deeply, this can help too. Just don't scream "Serenity Now!" like George Castanza's dad on Seinfeld, that has an opposite effect. LOL
Hope I made you laugh a little (another good stress reliever) and gave you a good tip for helping to bring down BGL in another way. Every little bit helps. :) I'm actually going to look into a few of those books that acidrock23 suggested at the beginning of this post. :) While I get very little time to read, I do try to at least take 15 minutes before bed to read a little every night from some books that I have on diabetes on my Kindle. :)
Peace on your journey and welcome to site. :)
Dave Davis
Hi Bailey: I just wanted to chime in and give you a warm welcome to TuDiabetes. First, kudos to you for recognizing you need to improve your blood glucose control, and for reaching out to people here on TuD who really get it (fellow Type 1s) and who want to help you in any way we can. You have gotten lots of good advice. I do often recommend "Think Like a Pancreas" by Gary Scheiner and "Using Insulin" by John Walsh, and those books may be available at your local library. Regarding learning better methods of control, one non-book way to do it is an appointment with a good (and compassionate) CDE (certified diabetes educator), and those appointments are a whole lot less than a doctor! A good CDE can really help with management. Again, welcome, and this is a good place to ask questions and get support.
Hi Bailey,
Welcome to the site...tons of great advice on here. It sounds like the others have echoed my sentiments about which books to read when you can and finding your correct basal and bolus doses. Teh other thing I would add that helps me get better control is exercise--every single day. Start out with just 10 minutes a day, but be sure to stick with it no matter what. Just make it something you enjoy, then when you're comfortable with that, increase it by 5 minutes each day or each week. Walking, jumping, stretching, weight resitance, anything. Exercise helps regulate and bring down sugars.