Hello Zoe:
Would it help if you knew the meter readings are off by as much as 30 percent at any given time?
How do you address the fact that too tight guarantees lows? And lows at the wrong time or wrong circumstances will kill instantly…
With respect 140 is laughable… but if you want to worry about such relatively low numbers you can… there must be a far better method than the approach we are all using and a better middle ground
Stuart
Hello Zoe:
I wish I could “drink the kool-aid”… but, I intimately understand her apparant view. I fear I likely agree with it.Thank you for the link, I will explore further.
In what way do you find her views, her perspective “too simplistic”?
Stuart
Hello Jeff:
I have a riddle for you then.
What does it mean when in spite of the hyper-vigilance, your zealous best efforts, complications still occur anyway?
What then sire?
Stuart
Meter readings off by 30% at any given time? What meter are you using? My meter (a onetouch ultra) test pretty darn close to the lab each time Im there. Id say within 10%, but not 30%.
Addressing too tight control guarantees lows is by using the theory of small adjustments make for small fluctuations. The only time I seem to have major lows is when I have large boluses. Either that or hit a spot with some insulin build up.
What makes you think 140 is laughable? Is there some theory you put in place of tight control in order to avoid complications? Id be curious to hear it.
It would be horrible. Of course it would be horrible. What does it mean? It means we don’t know enough about how to avoid the complications. That more needs to be learned.
But I got to give it all I’ve got. The reverse is unthinkable to me: “You may get the complications anyway, so its not worth it to deprive yourself of that Snickers bar.”
One can get trained for all kinds of jobs and become unemployeed. One can save money and loose it all to some market bloop. One can wear seat belts and get hurt bad in an accident. Doo doo happens.
But we have to do it. We have to heroically go after good control, with the best science we can get, the best discipline we can muster, the best plans and continency plans we can devise. Not “what is the amount of dessert I can get away with” but instead: “how can I improve my diet and exercise to make normal blood sugar easier to achieve. What more can I do to be healthy.”
I shouldn’t talk for anyone but myself. I am not going to be tempted off course by “life could suck anyway”.
Thanks again Holger, for some one like me who’s been on this for just 2 years it’s invaluable to have access to the experience of wiser T1s. I have a question about night time BG. For me it’s really exhausting when my bed time BG is high. (Above 130) It’s confusing because we’re supposed to eat at bed time to avoid lows during the night, but I can’t do that when I’m above 130, so I take a shot (I’m on MDI) then I have to wait 2 hours until it drops, eat something and go to sleep. Of course this is very tiring.
Any advice on this ?
Much gratitude.
Santiago
For some folks, they will get complications even with good control. It’s all a matter of our genetics. Control is, for the most part, keeping your glucose within a healthy range. I used to have some good 6s, but I was also careening through 40 here, 360 there, etc. My A1C was good, but it didn’t tell the whole story. Now I’m wired and that constant feedback has made me able to even out my peaks and valleys. Tight control, generally speaking, means that you’re doing pretty well at staying within the lines. Unfortunately, it is not a GUARANTEE that you won’t develop complications, but it does help to slow the progression down. Control and complications aren’t and either/or. There are lots of folks out there who have only a nodding acquaintance with their diabetes and they are complication free.
“Control” is really just a bunch of best practices to get you through the day.
Here, here. All the 50 year folks who had lack of control and are complication free are a testament to your sediments. There is an interesting conversation about C-peptide presents and lack of complication happening in the T1 forums now. Wish I knew the trick to get away clean. =^)
I’m confused, Santiago; why would you take a shot, wait 2 hours, eat something and go to sleep. If your blood sugar is 130 or 140, why not just go to sleep? My guess is at that level, you are not in danger of going low during the night unless you still have active bolus in your system.
When you say “we are supposed to eat at bedtime to avoid lows during the night” - that is not true for everyone. Only if you find that your particular pattern is that unless you eat a snack before bed you will go low. I am fine going to bed anywhere from about 80 to 140. If I am lower than that I’ll raise myself up with a couple glucose tabs so I don’t run the risk of lows during the night. If I am significantly higher I will consider taking a correction shot to bring it down, but the problem with that is that it’s not safe to go to sleep with rapid insulin still acting in your system.
I inject my lantus at 10 pm, I’m afraid I’ll go low during the night, I don’t think my levels would stay without dropping for 7 hours during the night, but I’ll try it next time. Thanks Zoe.
For me, good control around 6.3 ish, without massive highs and lows. It took a bit of tinkering with my basal rates and insulin/carb ratios, learning the dual-wave bolus feature, getting into the habit of eating every 2 - 2.5 hours, to list just a few of the variables, but it’s worth the time and effort. I don’t try to get any lower than that. From what I’ve gathered, the difference to my long term well being isn’t greatly changed for teh better by getting to 6 or lower, and I can actually be more apt to have the kind of hypos I’d never want (the kind that would be the last one I’d ever have, for example!).
At minimum I test upon waking, before lunch and dinner, before going to sleep at night, and before driving. So on average 6 times a day. I also use the CGMS function of my pump with sensors every couple of months for a week to see if there are any changes to my bgl trends, and adjust if needed.
As has been mentioned, diabetes is really an individual disease.We all have different metabolic rates, etc. So you have to tinker bit by bit to find what works for you. Remember, small changes over time while get you better results than trying to do it all at once.
For me 130 is a border line. If I am sure that no insulin is active in me I will go to sleep without eating something. I would expect to go down to 100 during the night. Other possibilities:
100 mgdl before bedtime: I would eat 1 slice of wasa original bread.
70 mgdl: one glucose tab plus the wasa bread.
With normal levels before bedtime how many carbs would you normally eat to prevent a low? Just to get an impression of the potency the Lantus has for you.
Thanks a lot, if I’m at 100 or below I usually have 1 glass of milk + 1 slice of integral bread (I count that as 20g carbs). Last night I was at 154 at 9:30 pm, so I had 1 can of tuna with corn (18 g carbs) applied 3 units of Apidra. at 11:43 pm I was at 79, so I had 1 glass of Milk (10) + 1 slice of integral bread (9) + 1 sugar free candy bar (5) for a total of 24 g. And woke up in a sweat at 3:38 am at 47. This has happened before, I think the fast insulin stays for more that 2 hours in my body. Thanks again
Yes, Santiago, rapid insulin remains in the body for about 4 hours so taking fast insulin before bed is really not a safe practice. Again, you are putting yourself on something of a roller coaster when you are at 154 before bed, eat and take Apidra, overdo the Apidra, go low and ate more (not sure if you bolused again - I hope not!). My suggestion is if you are at 130 or 154, just go to sleep, no need to eat and definitely don’t do fast acting insulin!
Your basal dose should not be making you go low during the night. If it does, it is too high. It would make a lot more sense to lower it by a unit and see how you do than to eat, bolus, go low, go high, etc. That roller coaster is bad for your body, bad for your nerves and all that extra food can make you gain weight.
Zoe is right. Do you remember gremlins? Do not feed diabetics after 20pm. Funny but true. You need to have a blood glucose before bedtime that is not influenced by residual active insulin. This value must be reliable to make serious decisions: Do I need a correction? Do I need additional carbs for the night (taking physical activity and current blood glucose into account). This is very important because we can not influence the progression of our blood glucose in any other way. Around 8 hours should work out perfectly on autopilot - that needs good preparation.
Thanks Santiago for the example but I need it more precise: How many carbs would you eat when the last meal was at 20pm and you have 110 before bedtime at 23:00pm?
Hi I think I’ve finally reached my “good control” after my doc added a 24 hour insulin along with my humulin R to cover on a sliding scale if I go high. Meaning most of the time I’m testing I’m running. Between 90 to120 tops. My numbers are now like if I didn’t have diabetes. If after a meal I do run high wich is seldome now, I’ll inject again. That’s the best we can do as diabetics
Yes Gremlins !! You guys are so right, I think this obsession with never being high is what sends me into the roller coaster, I always want to push it to the limit, I need to learn some moderation and just accept that there’s no way my BG will be like that of a non diabetic. I go crazy trying to be extremely precise.
About your question Holger, I would eat 15 carbs.
this is my methodology with pen therapy.
I never dose based on sliding scale unless it is accompanied by food.
My doctor gave me pre meal and post meal goals. After going hypo several times overshooting 70, I adopted a single goal of 120, which allows for 60± error without severe consequence for a 1 unit error.
I correct lows all at once, and I correct highs in ‘half correction’ intervals.
As a simple rule 10g of carbs will increase your blood glucose by 30mg/dl. So 15g should have the potency to raise your BG by 40 to 45mg/dl. I think this is quite a lot.
To me the problem of Lantus is that several goals should be matched with one shot:
a) 24 hours of coverage
b) the dawn phenomen most of us have (raise in the morning)
c) normal glucose levels without lows
In my view it is impossible to reach them all:
a) leads to a higher dosage to cover 24 hours => goal c) can not be met because of lows.
b) the rise in the morning (dawn phenomen) is often an argument to shoot before bedtime. But Lantus has a higher potency in the first hours and will cause lows at night => goal c) can not be met because of lows.
There is another goal that can not be reached easily with Lantus. What about high physical activity on one day. If you are in good shape the glucose deposits will be refilled later at night. This makes it necessary to reduce the dosage for the night. But how to meet goal a) full coverage and c) good control with a reduced dosage of Lantus?
In summary you have these options:
a) my recommendation: switch to Levemir. This insulin is much more stable and should be shot twice a day (every 12 hours). For the transition you take the Lantus dosage and divide it by 2. With more caution and more tests per day and two at night you can manage that transition. Your endo will also have some ideas about it. But please do not shoot Levemir once a day otherwise you can not meet all goals. Good control is the key and if this needs two shots per day than this the price to pay.
b) another option: you divide the Lantus dosage and apply it twice a day. This will lead to less active insulin at night and you can reduce the night dosage to prevent lows. Some TuMembers have good results with that. I am a little sceptical because Lantus is longer active than Levemir thus I see the risk of overlapping dosages (irratic reactions).
c) minimal option: if it is not very likely that you have a dawn phenomen you can shoot the Lantus at noon. This way you are awake on those parts of the day that will be covered with the more active part of Lantus. As a result you can work against lows actively - in contrast to being asleep.
Hello jeff:
A “different” riddle for you then perhaps:
How many lows are too many?
Stuart