Do you know why Chuck Norris can’t develop Type 2 diabetes?
Nothing can resist the action of Chuck Norris.
If a patient “asks for insulin” it isn’t the patients willingness or capability to treat with insulin. When a doctor refuses to consider insulin treatment it is all on them. If the want to be conservative they can start slow and refer the patient to a CDE for training. I believe that many doctors refuse to initiate insulin therapy because they are insulin resistant and don’t want to assume any liability for the medical decision. But it isn’t just their decision. We as patients should have the ultimate say in the decision.
I too recently started meal time insulin and am on a set dose - 5 units of Novolog only if my BS is over 150 before the meal. It doesn’t make sense to me and its not working either (I’m going to contact my doctor today). For example: Last night before dinner my BS was 124. So,… no insulin. Had a slice of pizza (eek) and a tossed salad/blue cheese. I estimated approximately 40 carbs in total (35 for the pizza and 5 for the salad). I had a seltzer water to drink. Two hours later my BS was 215.
Now, the practical side of me thought I should take a couple of units of insulin regardless of the 124 because, well…, the pizza. But, I want to show the doc that I’m following his directions and it isn’t working, or, it isn’t a good plan for me anyway. Now I have the data to back it up.
Also, the 124 reading was really good for me. I’m rarely below 150 which I think is another issue that’s not being addressed by the doc. Is this a basal insulin issue?
Do I need to check my blood sugar before any snacks? Usually mid afternoon I have a handful of almonds and a low carb (15)/high fiber(6) yogurt. Do I need to test and dose for this even thought it’s not technically a “meal”?
There are lots of times I test myself before a meal and I’m 145 - 147. I dose at that - close enough to 150 for me. Also, I feel like I shouldn’t be that high so often anyway.
I hate this.
Walgreen’s carries Frio cases.
The practical side of you had the right answer. Of course it’s perfectly reasonable to want to have evidence to make your case. Well, now you do.
Basal insulin’s purpose is to keep blood sugar in a normal range when food is not in the picture. If you’re walking around with numbers like that without eating, that is a textbook basal situation.
[quote=“Becca8122, post:23, topic:54770”]
Do I need to check my blood sugar before any snacks. . . even thought it’s not technically a “meal”?
[/quote]Snack or meal (those are just labels, and highly flexible and subjective ones at that), food is food. If it’s going to raise your BG and your body doesn’t have the resources to control it sufficiently, then insulin is needed. Maybe more, maybe less, depending on how sensitive you are to that particular food, and the specific amount being consumed.
The real answer to balancing insulin and food is to count carbs, know your I:C ratios, and dose accordingly. That’s a skill you need to develop. Fortunately, it’s not difficult. There are plenty of resources available online and elsewhere to help you learn to do that. This book is one of the best:
Gary Scheiner, The Ultimate Guide To Accurate Carb Counting (Boston: Da Capo Press, 2011)
Another highly useful item is a “smart” scale that can weigh portions of food and tell you the amount of carb. When preparing meals at home, it can be very useful in helping to determine the correct amount of insulin. There are a number of them and they aren’t particularly expensive.
If someone’s I:C ration is 1:15 - does that mean that they take one unit of insulin per 15 carbs?
Yes, that’s exactly what it means. The tricky part is that those ratios aren’t constant; most people have different ratios at different times of day. For most of us, insulin resistance is higher in the morning than later on.
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You ask the right questions. It shows that you are interested on a level that indicates you are ready to take on more responsibility for dosing your insulin. As long as you continue with your doctor’s program of ultra-conservative “sliding scale” insulin dosing, you’ll continue to endure long bouts of life-dulling hyperglycemia.
Learn all you can about insulin dosing. In addition to the book @David_dns recommended, another book written by Gary Scheiner, Think Like a Pancreas, is a good basic book on treating diabetes with insulin.
Your doctor is simply trying to keep you safe. Unfortunately, his idea of safety will highly increase your risk of long-term diabetes complications while degrading your everyday quality of life. Learn as much as you can, as quickly as you can, and then put that knowledge into practice. You are your best doctor!
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Update: I sent the last seven days of finger stick data to my endo. and an e-mail with examples of how the 5 units if over 150 method wasn’t working for me. He called me right away. He said he wants me to do 5 units at all meals now regardless of finger stick reading. If I’m over 150 then I should add 2 more units, over 200 then add 4 more, and so on. Obviously the sliding scale. In my e-mail I suggested the I:C ratio but he didn’t speak about it nor did I bring it up on the phone (I will at my next appointment). However, he did say that he started me off slow because I’ve been sailing along pretty good on a honeymoon and he was trying to avoid frequent lows. He said it seems that my honeymoon is definitely coming to an end fast. I was glad he called me. He also increased my Lantus to 7 units from 5. My average fasting bs for the last 7 days is 170. Lets get that down!!
@Terry4 I’m going to buy the book you recommend. I’ve seen it mentioned in other posts and other folks have recommended it so, I think its time I read it.
I might transition to the I:C ratio method of dosing on my own. I’ll wait until after my next appointment though.
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 
So far my numbers have been all over the place 
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