Still Learning the Basics

Just for curiosity, what do y’all consider good control? We occasionally get a high reading and have been told not to worry about it. Rarely get lows. Recent 14 day average is 139. Things are getting better – we’re finally getting the carbs and the insulin in balance. No big spikes even over Thanksgiving. Do you all administer insulin based on what you’re going to eat or try hard to keep an even balance of carbs in diet? I can’t imagine a Thanksgiving dinner with 50 carbs! Is there a problem with doubling the Novolog dose for extra carbs? I’ve read the books y’all recommended and found them very helpful but there are still many questions. Thanks for your support.

You say you have “no big spikes” but your 14 day average is 139. If your 14 day average is 139 then that includes spikes considerably over 140 which is where complications start to form. Yes, I administer insulin based on what I am going to eat, and have computed my I:C ratio which is 1:7, 1:8 and 1:18 for the three meals. We all have different ratios, so the best way to figure yours is to start with 1:15 and then work backwards or forwards until you find the ratio of insulin to carbs that brings you in under target most of the time. You are right that an occasional high reading is to be expected, but the key is getting your number in target more often than not. What is in target? I use under 140 after 2 hours as that is where complications start to form; lower I like better! Many people use 120 for tighter control and some aim for numbers similar to non-diabetic.

Forget about Thanksgiving…it’s over and we survived! Work on how many carbs you are willing and able to eat on a daily basis. You will find a great variety in this community. I’m probably in the middle, I generally stay under 100 per day. Others use Bernstein which is 30 per day and others eat considerably more.

“Is there a problem with doubling the Novolog dose for extra carbs”. This question came up recently in another thread. I will give you my opinion and others will give you theirs. Is their a problem? A resounding, Yes, several problems! When you say “doubling the dose”, are you referring to a set dose the doctor gave you? Set doses don’t work very well, you want to figure your I:C ratio so you can dose for what you eat. That being done, there are certainly people who go with the “eat whatever you want and bolus for it” philosophy. In my humble opinion there are several problems with that idea: I see you are a type 2, for a type 1 we are at risk of developing insulin resistance if we do that. Your version of the D already comes with insulin resistance but you don’t want to make it worse, the more carbs you eat the more insulin you need, the more resistance you have, the more…etc. You also can gain weight eating that way and that makes diabetes management harder. In addition as you say “doubling the dose” is dangerous and unpredictable. It gets harder to compute the correct dose the higher you go and mistakes can be serious as in super highs or dangerous lows.

We are all different and we set different goals, and work hard to achieve the control we’ve set for ourselves. We all make compromises and none of us is perfect. Sometimes no matter what we do things go astray. But by computing your I:C ratios, figuring the amount you need to correct if you do end up going high, and setting blood sugar targets, you will be on your way to living with your diabetes and staying healthy and happy.

Thank you Zoe. This is very helpful information. At first I was sticking tight to what the doctor said but it was not giving me good results. I was afraid to adjust insulin doses. Now that I have learned that I need to work this out myself, your kind of advice is great! Even with 14 day average of 139 and hga1c at 7.3 the doc thinks I’m doing great. He wants error toward the high side rather than low. Still I think the numbers should be better. I am aiming to get 14 day average below 120 and a1c under 7 but the doc doesn’t provide much help to do that. So your support is terrific. I’m sure the goal will be reached. Thank you again.

You’re welcome, GHOM. I think that’s one of the great advantages of TuDiabetes; without it, many of us wouldn’t have the courage to deviate from what our doctors told us, even if we instinctively know we should. Yes, doctors do tend to err on the side of higher rather than lower results. Sometimes I think they are more afraid of hypos than we are! I was pleasantly surprised when I told my new doctor I’d done a home A1C test and it was 6.5. He said, “not bad, but you might want to get it a bit lower if you can.” I was impressed (and he probably didn’t get why!)

Yes, " poco a poco", little by little. Keep up the good work. When I was a kid they used to give you grades based on how much you’d improved. I think that was great!

If the doctors were diabetics they would not be so afraid of lows. The best US president in modern times said The only thing we have to fear is fear itself.

GHOM, UR doing great. Learn as much as you can. The book Using insulin by John Walsh and is invaluable to any diabetic who uses insulin. It can be found in many public librarries and is inexpensive on Amazon.
You will become the one to self-manage and make dosage decisions. Like Zoe, said, that set insulin dosage thing is rather archaic. Make sure your diabetic regimen decisions are informed choices. If your doctor is a GP wo does not have regular contact with many diabetics patients, or has not kept up with the newer modes of treatment; you will most llikely end up, in a relatively short time, knowing more about diabetes than he does.As you continue to “self educate” through reading books, on-line diabetic resources, and talking to us on tudiabetes.,It all will come together.
The diabetes learning curve is a long stairway .with a lot of little steps, that lead to greater confidence and better health!!!

God bless,
Brunetta

Great advice, thank you.

Yes, John’s book have been a huge help. My doctor is an endocrinologist and I already know more about diabetes than he does! Thank heavens for diabetes educators. They are in short supply around here so I’ve been struggling to find a good one – I’ll keep on it. I’ve had friends say that they are a better source than the docs. Thanks for your response.

Amen!