Struggling T2


#1

Hey guys!

Since being diagnosed in earlier this year I have been on a vast range of meds. None of which can control my BGs. I’m 32, active fit lifestyle and healthy eater. My fasting BGs are in the 200 and I range between 200-390 for the past month or so. I’m currently on 30 units of Lantus and 11 units of Humolog at each meal. My numbers just won’t budge…unless I don’t eat, which isn’t good. I have a super active job and life. I meet with my Endo next week and I wanted to know if anyone had any ideas or opinions on CGMs and pumps. How have you had this discussion with your Endo? Is there any protocol that makes you an ideal candidate?

A1C April was 7.4
A1C Sept 7.9

So I’m trending in the wrong direction. I’ve tried metformin, glipizide, Jardiance, Bydureon and have been on insulin the entire time. I have a thyroid ultrasound scheduled in a few weeks. I don’t have any antibodies, but I can’t seem to figure out why I can’t get into any type of control.

Ideas?


#2

You could try and go low carb this does marvels for many.


#3

This doesn’t sound like a typical Type 2 presentation to me. Do be aware that you can test antibody negative and still be Type 1. Antibody tests are neither perfect nor comprehensive in their coverage, although they do a pretty good job at the population level.

However, ultimately the Type doesn’t actually matter if you can’t get your BG under control. If you’ve been on insulin since diagnosis, does that mean basal and bolus? It sounds to me like you either need to get basal rates figured out (if you’re constantly running high) and/or you need mealtime insulin.

In the short run, drastically cutting carbohydrate consumption (down to what feels like starvation levels) and doing heavy exercise that depletes glycogen can be useful. By “heavy exercise” I mean the big stuff: sprints, rowing, deadlift, squats, Olympic lifts. They are really good at helping the body to divert excess BG to the muscles.

I’d definitely be bringing up your concerns with your endo. Getting the A1c down to where you want it to be (what are your goals there?) is really important, and your endo should support you in that.


#4

Thanks Anthony! That’s the kicker. I eat very low carb.


#5

Thanks David! Yes I’m on basal and bolus insulin. I exercise 4-5 days a week. I will make sure to bring this up next week.


#6

Yeah, if you’re on basal/bolus and eating very low carb, it doesn’t really matter if you’re Type 1, 2, MODY, or some other of the wide variety of reasons we have diabetes. What matters is getting your BG to where you want it to be.

What I’d do is decide on a target A1c that you want to achieve. I say this, because some doctors (and many patients) are perfectly happy with “something between 6.0-7.0%.” Many of us feel this is a bit outdated, and shoot for much tighter control (under 6.0% or even lower in the 4.5-5.1% range). I aim to have no 75 minute postprandial BGs over 140 mg/dL and my A1c below 5.0%.

My doctor’s weren’t thrilled with that originally, but they’ve gotten on board over the last few years. Ultimately, we (the patient) have to determine what our treatment targets are, and our doctors help us to achieve those (assuming they aren’t totally insane, of course).


#7

I like the way you think - I work WITH my doctor on my treatments, etc. and make many of my own choices - he does not like that I eat very low carb and do intermittent fasting - but it works for me - he said I should be on BP Meds & a Statin when both my Blood Pressure and MY Cholesterol are in the normal range - I don’t want to be on unnecessary meds and if I get tested all the time and take care of myself - then I’m okay.


#8

It really sounds like you need more insulin or you have a hormonal issue that you don’t know about. Type 2’s hallmark is insulin resistance so your Dr. may recommend increasing your insulin. You say you are on 11 units of humalog per meal. Is that constant or do you carb count and adjust? Many people also dose for protein. Do you go low at all with those doses of insulin or are you just always high?


#9

The Diabetes Solution by Dr. Richard Bernstein is a great book. In it he recommends boluses not to exceed 7 units, so if you’re taking 11 with meals, it should be done in two boluses of 5.5 units each (or three or four small shots even to total your 11 units), rotating where you inject of course. Also, the same is true for your basal; dose in increments of 7 units or less. He refers to this as the law of small numbers. Regardless of your type, 1 or 2, this, smaller shots, will help with insulin absorption.

I’m wondering what @Firenza asked, if you’re counting carbs and use an insulin to carb ratio for your meals or just giving 11 units regardless of what you eat?

You may want to consider doing a basal test too. Gary Scheiner wrote a great book called, Think Like a Pancreas. You can learn how to basal test by reading his web page

I recommend both books. Once you’re done with them, then Using Insulin and Pumping Insulin by John Walsh (and a few others [edited to add: authored the book with him] I can’t recall their names) are some other great reads.


#10

Impressive goal and achievement.

In my first two years after diagnosis, I used to aim for anything below 6.0, later, my goal was to stay between 6.2 to 6.5. Now my goal is to get and STAY below 7.0.

I had heard that diabetes was a progressive disease and my body seems to be working hard to make that true.


#11

Thanks so much! If I eat carbs its a super small amount, no more than 15 per meal which doesn’t seem to add up with my numbers being so all over the place.


#12

Hey, yes I carb count and its a solid 11 units per meal, pending my BG reading before I eat…I add insulin if I’m over 200, 1 unit per 50 I’m over if that make sense.


#13

Yes, I’ve seen that too in just the few years since I’ve been diagnosed. My “goal” to have a normal BG profile may be unrealistic and unsustainable in the long run, but I’m trying :slight_smile: If it doesn’t work out, I’ll adjust and try a new set of goals.


#14

Please, @TC5683, do yourself the favor and reduce the amount of insulin you’re taking with each injection. It makes a huge difference. Another caveat that I believe a few others have mentioned before is the more insulin you take, the more you need. I’m not saying you don’t need what you’re taking already, or that you don’t need more. I’m saying to give it a try, to inject three to four units at a time, rather than the entire 11 (bolus) in one-fell-swoop or 30 (basal).

Low carb is wonderful, but lower to no carb might be better. Read up on keto diets. It’s a mixed group here, those who like it and those who don’t. My husband and I do like it and have found a lot of benefit from it.

Best of luck to you as you proceed forward though the maze of all things diabetes!

Edited to add: Do the basal test too. Until you basal is correct, you won’t be able to dose properly for food/corrections (bolus). Do you split your basal and give injections 12 hours apart? My husband found that he needs to take one shot at 8:30 PM and the other at 4:30 AM because the 12 hour split just didn’t work, neither did a ten hour split.

Edited to add: Another helpful caveat is to pre-bolus. Take your insulin about 20-45 minutes before you eat. For me, when I was bolusing for food (with keto I rarely need to bolus for food) if it was a fast carb sometimes I would bolus 45-60 minutes before I ate; if it was slower to digest for me, then 20 minutes was suitable. Then, there are the times I would forget to pre-bolus and I would just have to deal with the rise the best way possible. When I was first diagnosed, when I first learned about pre-bolusing (from tudiabetes) it made all the difference in the world. The doc wasn’t happy about it, but I explained a dinner roll or some sort of fast carb was always available to me, so I wasn’t worried about dinner starting a little later than initially planned.


#15

Are you only correcting if you are over 200? That could be part of your problem right there. The higher your BG is the harder it is to bring it down because of insulin resistance. I start doing corrections at 140 and if my BG has climbed into the 200’s I will need to do a more intense correction than 1 unit per 50 over.

Pre-bolusing might be a big help to you as well as getting your basal just right. Lantus frequently doesn’t last for 24 hours so splitting it may help you out a lot.


#16

Yea, those are the instructions I was given by my Endo. Only correct over 200. This is ALL new… hasn’t even been a year, so I’m doing the best I can with low carb and following my Endo’s instructions. I’m rarely in the 100s…my fasting for awhile have been 198 plus… Usually in the 200s and then that’s where I stay all day… I can’t seem to come down. I work out 4-5 days a week, I eat less than 15 carbs per meal and I’m still struggling… My hands and feet tingle often throughout the day, along with my eyes getting fuzzy/blurry… I know its because my BGs are too high.


#17

If your endo doesn’t help you make some changes that are effective then get a new endo. Fasting BG’s of 200+ are too high and require some serious intervention. Make a list of the issues you are having and some suggestions of your own and see what your Dr. thinks you can do to get your BG’s in line.

You have to be your own advocate in this and you will eventually be the expert on controlling your own diabetes with education and time. Read every book on diabetes management you can get your hands on. Most Dr.s seem to think that diabetes is A+B=C but more often it is A+B=kangaroo so being frustrated by the conundrums it creates is to be expected.


#18

Get yourself onto a CGM. That will give you blood glucose reading every 5 minutes as well as your trends over time. Armed with a CGM you can tweak what you eat, effects of exercise, how long before meals to take insulin, etc. The advantage of the CGM is you can continuously make small incremental tweaks and improvements to your diet and exercise and within a few weeks you will be amazed how much progress you can make. Even if you don’t want to permanently use a CGM, there are programs that allow you to have one for a limited period of time. What you learn will be invaluable towards helping you bring yourself into line to meet your goals. CGM’s aren’t perfect but for the 85-90% of the time they do their job without issues, they are an invaluable tool.


#19

I agree with CJ114. A CGM can help make control much more attainable. It does sound like you may not be taking enough insulin, I had a similar problem at first while working my way down from an A1c of 14. I took a few years to get where I am at now with A1c of 7.0 and trying to out guess my BS swings with food, activity and medication. My doctor pretty much allows me to adjust my both of my insulins dosage as I keep track of it closely. I operated power plants for 40 years, I try to think that my body is like a boiler and turbine - fuel in, energy out, it’s a balance between the two. I would work with your doctor and see if you can’t increase insulin intake by small quantities, like increase Lantus by one unit slowly over a three or five day period. Also keeping a detailed log is important for me, I use an excel spread sheet keep track of my BS at meals, after meals, what I eat, insulin intake, highs and lows and exercise. Sounds complex, but it’s easy once you get used to it and gives me a history reference on food and med intake. While I no longer run power plant control rooms, my new job varies greatly. Some days I am stuck to my office chair and some days I am climbing stairs or ladders some or much of the day. I NEED my CGM to adjust my insulin and to keep working.


#20

I’m curious about the standard 11 units of humalog at each meal.

It would be interesting to know you glucose when you rise, and before lunch and dinner as well as 2hr-3hr post meals. You might speak with your team about sliding that humalog and if your like me - I can’t resist a bedtime snack ( ice cream). Fat has been reported to slowdown glucose absorption/breakdown of carb to glucose

You might ask your team both about sliding and/ or post meal additional dose. If your dose is too small 10 min before meal and your glucose climbs… your liver freaks out and dispenses MORE GLUCOSE into your system so you can have the energy to fight it. It can go on for an entire day if you don’t knock in down. HYPOGLYCEMIA IS A BIG RISK. 200-350 for me is easily managed down. 400+ takes me 4-6 hours to resolve

Good luck to you. It’s all connected and challenging. I have been Type 1 for 42 years and I’m still learning