So I started insulin

There are several things that I find disturbing in this scenario.

First, it does not address the basal issue. If you are consistently high when fasting, taking a fixed quantity of fast acting insulin before each meal won’t begin to fix what’s wrong. Fast acting insuiln only lasts long enough to deal with the meal; that’s what it’s designed for. What about the 8 or 10 or 12 hours when you are not eating? What are you supposed to do then—just live with the highs?

But the whole methodology of the sliding scale is just . . . absurd nonsense. Dosing according to your BG level BEFORE eating is based on the idea that a salad and a hunk of chocolate cake are equal.

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mine is 1:9 in the AM and 1:15 in the PM.

When is your next appointment? I would make it really clear you want to go on a carb counting regime ASAP. does this endo have CDEs in the practice? I’d ask for a referral.

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The higher end bloodsugar meters with Freestyle and AccuChek have carb to insulin calculators but it requires a doctors code the first time to program it. You could also download an Insulin to Carb Calculator App to your Smartphone. Then fool around with different Insulin to Carb Ratios and Insulin to Blood Sugar Reduction Factor. I’m trying the Afrezza breathable insulin which peaks on 15 min. And out of your system in 2 hours. It seems to require follow-up doses and is expensive. They should be lowering the prices. But Afrezza eliminates the insulin overlap with other bolus’ lasting up to 6 hours. Can cause lows later with overlapping unless using Afrezza. Tresiba is also better than Lantus and instead of taking it once per day, I find it better split twice per day.

@David_dns the Lantus is my slow acting basal insulin and thats the one the doc increased to 7 units a day from 5. And, based on his instructions, I’ll be increasing that to 9 starting tomorrow. I totally agree with you about the sliding scale method. Its stupid and it definitely doesn’t work. I have to call him on Friday and I’m going to discuss the I:C ratio this time.

@MarieB My next appointment is in October - too far away! Thats why I’ll address the I:C ratio on my next phone call. Also, I travel an hour and half to this endocrinology group because they are one of the best. I could have chosen more local endocrinologists but I wanted someone current and up-to-date, best technology, etc. Perhaps I should save the gas money and stay local… I’ve been rolling that idea around in my brain…

On another note: I had a terrible low over the weekend. Only the second that I’ve had and the lowest - 52. Not fun. If I can avoid that forever, that would be great! Ha!

Thanks for all of the replies :slight_smile:

So far my numbers have been all over the place :frowning: The Diabetes Educator told me to only check at 2 hours. I typically check at 1 and 2… I’m seeing a lot of 12-14 numbers at 1 hour and 8-14 at 2 hours. I’m trying to keep carbs to 30g per meal so I think the Apidra needs increasing at mealtime (I’m currently on 4, 4, 4, 8 Apidra and Lantus)? My waking numbers have been ok, not great (4.5 - 9.9).

So far the DE wants to keep at the 4, 4, 4, 8 and that anything less than 10 at 2 hours is good. I was also told not to take anything for a snack, just have it without insulin… I know I would be high if I didn’t take anything so just not snacking.

I know its early days but what do you guys think?

Thanks again, Paul.

$0.02

10 equates to about 180 on the scale used here, and for me that would totally unacceptable. I suspect the DE wants to bring you down gradually, which has some merit. But if that’s not the case–if they tell you to keep using that number indefinitely–then you need to go to bat for yourself. Clearly the dosages you are presently using are insufficient to get you down into something resembling a normal range. If that remains the case for long, it should cause alarm bells to ring.

As for a rule of thumb like “don’t bolus for snacks”, that makes no sense at all. “Snack” and “meal” are arbitrary labels with no concise definition. Food is food–if it raises your BG, you need to get it back down again. Simply calling it a “snack” won’t stop your blood sugar from rising if it wants to.

As you say, it’s early days yet. Just be sensitive to these issues and if things don’t improve as you and the DE gain experience with your individual response to food and meds, then you may need to take control at some point.

One other thing raises a red flag—those fixed doses (4-4-4). Unless you are eating exactly the same amount of carbohydrate and protein at each meal, that makes no sense. If you consume more carbs, you need more insulin to counteract them. If you eat fewer, then you need less. Using a fixed dose for every meal is based on the assumption that a piece of chicken and a slice of cherry pie are equal.

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Hi David,

Thanks for the quick reply. I agree with your points and it just confirms how I feel. I dont want to step on any toes so right now I’ll let the DE dictate how it goes but I think if I’m still seeing the 10-14 numbers on the 4u of Apidra I’ll start adding 1/2 unit increments.

Actually, I think Lantus can sting whether warm or cold. That was certainly true for me, not always, but sometimes and one of many reasons I dislike Lantus as an MDI basal.
More comments/info on this thread: switching-from-lantus-to-levemir/51789

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Tresiba makes both lantus and levemir look like relics of history in my estimation…

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I understand not wanting to step on toes, but I’d be gosh-damned if I let my fear of offending someone make me continue to waltz around most of the day with a BG in the 180s or so. It’s your body incurring the damage caused by sustained highs, not theirs. If you are dead-set against making adjustments on your own without your CDE’s approval, I’d call her yesterday and tell her that you have no intention of continuing another day with sustained highs. And I agree 100% with whoever said that telling you not to bolus for snacks is a major red flag indicating that someone is seriously inept, to say the least. And using fixed doses for meals? Who the heck does that any more? Endocrinologists from the Dark Ages that have all died by now, that’s who. Seriously, if I were you, I would run (not walk) to another endocrinologist who has some iota of knowledge about how to manage diabetes…

Paul , how has it been going for you on insulin these last 2 weeks? I looked through your threads, and I am in the same sitution as you. Low carbs and exercise keep blood sugars down. Grains cause spikes. Primary care doc says I am a thin type 2. Endo diagnosed type 1.5. No insulin yet…wondering when. A1C 5.7, but limiting carbs and thin as a rail. Curious how you are managing. Thank you. Mandolin

Hi Mandolin,

After a rocky first week I’m starting to get the hang of it and I’m seeing some great numbers. My waking BG has been great, 5.5 - 6.5 and 2 hr post numbers have been great also, 4.6 - 8. I’m so thankful that I can now eat 30g of carbs per meal. For the last couple of years I was keeping my meals to 0-10g of carbs and still my numbers were 10 - 14 at 2 hours. I’m like you very thin at 6’-1" and 150lbs with very little body fat so I’m probably insulin sensitive and dont need much (I take 4 units of Apidra at meals and 8 units of Lantus at bedtime). My A1C had gone from 6.1 to 7.9 in the last 6 months so that’s why insulin was started. I was also diagnosed by my family Dr as Type 2 but when specialist saw me 5 years later he told me I’m Type 1 or 1.5.

I doubt with your A1c of 5.7 you will be put on insulin unless you find a Dr who believes starting insulin therapy early helps save some of your remaining beta cells. Please let me know how it goes and if you need any help just let me know.

Paul

Good morning Paul,

Thank-you so much for your response. Really appreciate it.

My story somewhat mirrors yours. Had a fasting BG of 101 eighteen months ago on a routine physical. Six months later had an A1C of 6.0 and given the type 2 talk by my primary care doc. Reduced carbs and lost 10 pounds in 2 months, not that I needed to. A repeat of my A1C this Feb. yielded a 5.7. I purchased a glucometer and only looked at arising BG and 2 hour post meal BG for awhile, then abandoned this thinking I was okay.

A functional medicine doc spoke to me about diabetes 1.5 and the use of GAD antibody testing. Well he order the GAD blood work and it came back positive at 157.9. His response–go home and meditate to cure yourself! And I am paying for this. Primary care doc said I was too old to be a type 1 at age 60. Well I am autoimmune hypothyroid well controlled on medication for the last 13 years. One autoimmune disease can lead to another. Primary doc asked for me to send him info on 1.5! Shouldn’t he be paying me for this? BTW, he teaches at a local medical college one day a week!

Oh well, off to see an endo. Had other antibodies checked out, and all negative. He wants me on 30 grams carbs per meal, mainly of whole grains. Well I am gluten intolerant (questionably celiac) for 15 years now. Even safe grains like rice spiked me about 150 quickly and would not come down for hours, telling me I do not have enough insulin to perform the job of eating well. Low carbs it is, and my numbers look reasonably good, but to what end? Beta cells are dying. I am now a bit underweight and cannot gain a thing. I eat 3 good meals of protein and vegetables a day with good fats and some seeds and nuts. No coffee because of heart palps. I must be insulin sensitive too as a 30 minute power walk can drop my BG by 40 points (US scale).

Like you, I am also very active and walk miles a week, and do weight training, eat organic foods, take care of myself. What a way to move into retirement! Not to mention the cost here in the US. I really fear that insulin will ruin my exercise life with low blood glucose. How are you adjusting your exercise? Does early insulin use spare beta cells? My endo would not give me an answer. Seeking a second opinion from another endo in mid-August.

Glad to hear you are doing better. Yes, the correct diagnosis is a boon. So adjusting to insulin is going well for you. Mandolin

Hi @Mando1, I can’t answer all your concerns here, but I can tell you we have plenty of members here who’ve been diagnosed w autoimmune type1 (aka type1.5 or LADA) who are in their 60s or older. we have a member here who is quite knowledgeable on the subject and she wrote this post, which is kind of a classic here

Hi Mandolin,

Sorry you are having to go through this. I struggled for 5 years to get a proper diagnosis and believe if I was properly diagnosed earlier the last couple of years would of been much better for me (0 carb meals are boring ). Wow, you suffer from palps with caffeine? I was diagnosed with SVT (Supraventricular tachycardia) when I was in my 20s and had heart pounding at 240 beats per minute. I would go to ER and given a shot of Adensine to revert. I learned that caffeine and alcohol were triggers and have been caffeine free for about 10 years now.

I hope you find an endo who is more knowledgeable than current Dr. When I was first diagnosed my family Dr also didn’t know what Type 1.5 and LADA were, I too had to educate her.

Please keep in touch and let me know how it goes…

Paul

Thanks for this MarieB :slight_smile:

Thank you MarieB. I have followed Melitta at various postings here at Tu Diabetes and elsewhere. I am aware that LADA is not rare, but try telling my PCP that. I have Hashi’s autoimmune thyroiditis and gluten issues, so this all goes together. Still I am very sad as this will make for a very different retirement for me. I have had 30 years of health issues and this is the only one I feel I cannot change. I have enough trouble eating and now diabetes. My endo is ok, but I will be seeing another one soon, supposedly more humane. Meanwhile I am on a low carb diet to keep my numbers good, but for how long until I have no beta cells? My real fear is that us older adults will be left out of research trials. Only support is from my husband and mental health care professionals. Other family and friends not so great at support, but this does not surprise me as this has been my experience all along for those who have chronic health issues. So I signed up here to at Tu Diabetes. Thank you Mando1

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With the FRIO cases, just be sure to not OVER saturate the gel capsule pouches (it says this in the instructions also). If you do, the pouch loses it’s effectiveness. Soak pouches only as long as the instructions dictate (I think it’s 5 min in cold water, but check to be sure.)

Congrats!

I do not get a lot of support from family or friends, either. You are here, though @Mando1 – THIS community will try and give you all the support you want/need!

Thank you Thas. Greatly appreciated. Mando1