Dave, I am sorry that you are having difficulties with your teenage daughter--ugh. Mmmm, Skinny Cows....ice cream sandwiches used to be one of my fav things. It is indeed very difficult for most Type 1s to do MDI because of the low doses; I usually suggest that the insulin pump is a better way to go for Type 1s who require low doses.
Thanks for the good wishes, Melitta. It's a very tough time with her right now. This weekend she was sick saturday morning with a 101.7F fever, felt horrible. I gave her some Ibuprofen. Fever came down, she felt much better.
Wanted to go hang out with friends. My wife and I both gently told her no, she needs to be quiet and rest, and she doesn't want to give this to one of her friends...
Long story short, we eventually relented and let her go meet friends for 1-2 hours at Starbucks, then come right home.
I'll leave out all the intervening drama, but what happened is she refused to come home, refused to tell us where she was, and ended up spending the night at a friends house. We had constant contact via SMS text, but you can imagine what a disaster of a weekend it was for this loving Dad, across just about every emotion. (I picked her up Sunday). We're working through this -- she's fundamentally a good kid, but is really challenging us right now with independence. And she's not ready for that much independence, as this little episode clearly showed.
So, on top of being naughty with the sugar in the first place with that ice cream, I was running on fumes (no sleep the night before), severe stress, anxiety, anger, fear, some tears, etc. etc. etc.
My body was perfectly set to ignore insulin entirely.
And it did :-)
Oh nooo they gave you the sliding scale bs. I agree with the others you might have to figure out some carb counting and I'm not sure if this recommended but try to create your own insulin to carb ratio. I THINK the Think like a Pancreas book actually has a guide on this. Like others said, 4 units of insulin for a meal might be too much. For me that's my usual amount but my i:c is 1:15 which covers a 60 carb-ish meal and most of my meals are around 60-80 carbs now (trying to gain weight which means eating more food) so I'd say that's not a whole lot of insulin when some people would need a whole lot more than that. I think your starting i:c could even be based on weight then adapt from there? Going by the think like a pancreas book I really hammered out my basal and bolus rates after my surgery reading that book and I think it's as close as I can get to perfect. It'll probably change soon but at least I know what to do.
The problem of the sliding scale is that it says "Oh, your blood sugar is below 126 mg/dL? Well that means no insulin for you even if you're eating 80 carbs!" Which is a lot when you have little to no insulin production. I could honestly understand like not using insulin below 80 mg/dL with a low carb meal but come on. It's indeed a fear of hypoglycemia when you have the tools to treat that and it's probably safer to be low and catch it right away than be high and let it happen.
you written this so well and confirmed what I was already suspecting.. that it's stupid not to bolus just because you're low..
so many of you now recommended me this book that I made a decision and ordered it just now :)
I'm also having another meeting with my educator on Monday and I'll try to convince her to let me do the carb counting method.. My endo did some calculations based on my weight, but than just wrote 4 4 4 4 on my chart.. ha.
The amount of insulin you'll need really depends on you. Some people need a lot and others are very sensitive, so first you need to figure out how sensitive you are. Then you'll need to fine tune your basal and bolus amounts. Basal should cover the background glucose your body produces when you are not eating and bolus takes care of the carbs from food, and bolus depends on the food you eat. Personally, I would start off lowering my carb intake to make things easier initially. I'm not saying cut out carbs, but cut out and cut back on high carb stuff (bread, soda, milk, juice, potatoes, popcorn). Then you can increase it once you get a feel for things.
Second thing is that you need to read some books, and ultimately be in charge of your own BG management....
Think Like a Pancreas
Using Insulin
My Diabetes Science Experiment
and Dr Bernstein's Diabetes Solution are good books.
Dr Bernstein's book and approach is controversial, but he has a lot of good information in the book....just don't take it all as gospel.
I agree, the amount of insulin is very variable to each individual, a large dose for one is a small or normal dose for another and unfortunately for you and all of us, dosing is going to vary from times of day, to day to day to seasons to 50 million(slight exaggeration) other things that can affect your bg levels.
Hi Krisa:
I find it disappointing that your doctor "reluctantly" decided to put you on insulin. This flawed conventional wisdom that insulin should only be considered as a matter of last resort only hastens the destruction of beta cells. It frustrates me that so many doctors still subscribe to this myth. Good for you that you insisted.
As the others have said, the rigid sliding scale approach is useless and will not get you the control you desire. However, I would not dive right into a full carb counting regimen either yet. What you will see is that not all carbs are the same and trying to master this without fully understanding it will be extremely frustrating. I slice of bread with 12 carbs and half a plate of vegetables with 12 carbs will have a completely different effect on me. In fact, the former is so quick and volatile, I just don't eat it at all. My point is, we all have different metabolisms, and you need to master understanding yours first.
My recommendation is to rather eat the same or very similar things for the first couple weeks for each of your meals and through trial and error around your dosing, derive what doses give you the best control. Try to make this as low-carb as possible at first to remove as much volatility as possible. For example, I quickly learned that I could cover 2 eggs and 4 slices of bacon with 2.5units of Novolog almost perfectly. Then when you've fine tuned your dosing for your three key meals, start to slowly change one variable at a time by experimenting with introducing one new food during one of your meals. Maybe try unsweetened yoghurt instead of the eggs, but keep the bacon, for example. Through this process you can start to derive an accurate I:C ratio while minimizing volatility. If all else fails and things get too out of control, you can always revert to your baseline meals with the doses you've previously fine-tuned.
The other exercise you need to go through is fine-tuning your basal. Most people find that there is no basal insulin today that truly lasts 24 hours, so splitting your dose in two and injecting every 12 hours will probably give you much better and consistent basal rates.
Good luck and all the best!
Christopher
I agree with not understanding why the doctor was reluctant to start you on insulin, it seems like the logical solution to me. Maybe the "exchange/ sliding scale" plan is more a way to ease into it and also see what sort of data they might get out of doing it. IF the amount of food were fixed, one might be able to work backwards to guess a bolus ratio out of some data but it doesn't seem like that's the plan. It's great that you are getting "Using Insulin" as that is like an "owner's manual" that will show you how to calculate all everything you need to figure out and perhaps be quite a bit more useful than the doc. If nothing else, you can cram it in in a week instead of 3-4-6 months or whatever is between your appointments!
thanks all of you for all the advice and help!
I'm currently doing fine, my a1c is 5.9% again, and my next endo appointment is in April (although I might change my endo meanwhile.. I'm not that happy with current one although she is helpful and nice, but also confused or something.. I might wait a bit to get my antibodies re-checked, though)
Christopher is spot-on. And just because your A1c is now better, don't let the doctor talk you into scaling back your management!
It would really help if you could get on a basal insulin like Lantus (glargine) and a fast-acting bolus insulin like Humalog, Novolog, or Apidra. Even if you don't start rigorously carb-counting, you can start to get a feel for how much bolus insulin various meals require.
Checking your antibodies is interesting and has implications for your longer-term prognosis, but doesn't necessarily have a huge impact on your near-term treatment. In other words, managing your blood sugar with insulin is helpful regardless of what's causing it to be elevated.
If you have access to a continuous glucose monitor, even just for one of the short-term trials (doctors often participate in these programs), that can be incredibly helpful for fine-tuning your regimen.
just waiting for the fifth hour now and for them to take my blood for the 8th time. I was called in to retest my antibodies, insulin, c-peptide… also sort of an OGTT again. my sugar went slowly from 6,8mmol to 11mmol at 2h mark. the head of department said that I have to take a pill so they can see if that helps BUT I DONT WANT TO GO ON PILLS. ugh. I kind of regret it that I let then do it. unless there’s something new with antibodiea, but this whole 5h thing wasnt necessary:/
I'm surprised that they have given you an OGTT. It is rarely used because it is so hard to do. I'm a bit confused about your diagnosis. Are your doctors testing you antibodies for T1 or are they off looking for Hasimoto's again? It really is important that you get tested for the antibodies for T1. Our member Melitta has written a lot about getting properly diagnosed. The proper antibody tests are GAD, ICA, IA2 and IAA.
Hi Krisa,
Are they verifying the IA2 or IAA antibodies that were elevated before..I can't remember which one it was- just that it wasn't GAD? I thought you were put on insulin now so it's strange they are discussing putting you on a pill.
sorry,I have two threads opened.I think we talked already in my other one,although you might have changed your picture? anyway,no,they RE-tested my diabetes antibodies (I just hope they remembered NOT to test IAA again since I’m on insulin now,and they were the only one positive before anyway).
I think they are curios about me since it aeems I’m the only patient they have who presented like I did…
yes I am insulin…eh,it turned out the head of the department didn’t know about that(and she was in charge of the testing I went through on Friday).my doctor is awesome though,I visited her right after the testing and she said although the protocol is difderent,I don’t have to worry and she’ll let me stay on insulin. yay!
they want to use more sensitive methods to test my antibodies since I’m clearly not type 2 nor classical type 1
How are your readings now that you are on insulin? Did you wind up changing Endo's since you went on before April?
no, I changed my mind, because although she’s a bit confused/forgetful sometimes(no wonder), she’s doing an amazing job taking care of me out of the regulations!
my readings are much better, my a1c went from 6,6% to 5,9% in one month,I 'll see what my next one will be 
I’m soooo glad I pushed for insulin and started it this soon (my endo was just scared that I’ll have hypos,that’s why she was reluctant)…
best choice really,an now I can finally focus on my other health problems and also on other aspects of my life