Unable to manage my diabetes.... :(

i am not able to manage my diabetes... its reaches 258 at night... i exercise like a bull gone wild for 30 to 40 minutes after which it comes to around 200 , 106 in morning at 7, 150 after walk :(n moreover its 309 after breakfast even after taking 35 units(human mixtard 30/70)....though i jst hve 1 chapati wth a cup of milk :( tht to without adding any flavour to it:(.....

I think the mixed insulin is very hard to use? W/ the two kinds of insulin, basal and bolus, it's *very* important to have them matched closely to your body. I think, based largely on the people posting about it as I never took it myself, that it's almost impossible to match the 70/30 ratio perfectly which, in turn, almost guarantees the sort of numbers you are reporting?

I have a pump and try to run about 50/50 between basal and bolus insulins. If you can get to a doctor reasonably quickly, do you think you could switch to R/N or ---log/Lantus/ Levemir? Either of those combos will at least give you the tools to figure things out precisely? It's still quite a bit of work to get things set precisely, and then they may change anyway, but figuring out your doses more precisely should give you some improved results quickly?

Another suggestion I'd have would be to locate, either at a library if you can find it, or maybe on Amazon or whatever sort of book vendor you can find, a copy of "Think Like a Pancreas" by Gary Scheiner and/ or "Using Insulin" by John Walsh. I got both of these books when I got my pump and they sort of are "manuals" about how to figure out your numbers. The doc can give you an idea but if you want to take it to the next level and do really well, I think you need the other insulins and some good instructions about what to do with it?

You are managing. Don't ever feel like you aren't managing. You are keeping on top of your bg's over time and that is 99% of the management right there.

Now that doesn't mean that all of your or my bg's are perfect all the time. Just being halfway decent most of the time is a huge success story, and a success story that we should be proud of achieving when we achieve it.

To feel that you or I am a failure just because some numbers are out of range, does not mean that we are out of control or we aren't managing. Anyone who tells you that, just kick them out.

Premixed R+N insulin is rarely a perfect match to any T1's needs. A MDI regime can be much more amenable to the tight standards lots of folks promulgate. About 25 years ago I switched from large shots of R+N to much smaller doses of R and N individually as a MDI regime, with great results and felt way more in control.

Don't let anyone fool you but those are not uncommon numbers for insulin dependent diabetics. Some days can be better but overall its not uncommon for anyone with diabetes to experience those numbers. I had a 323 today, Now I am down to 76. As the others mentioned I get off any premixed insulin. No matter how you slice it, its a devastating disease to keep battling and a better treatment is urgently needed,

Hi Sweety1691: As the others have mentioned, it is very difficult to have good control when you are using the mixed insulin. Would it be possible for you to get a fast-acting insulin and a long-acting insulin (Levemir or Lantus)? I think that would really help. I don't think that you are unable to manage your diabetes, I just think that you don't have the right tools to do the best job possible.

please try the newer insulins, especially the rapids (novolog, humalog, aprida). have you thought about a pump, cmg? I just this morning switched from novolog to humalog, it's been great so far. I still wait about 15 minutes after bolus to eat..but so far, it's been great and I start my pump on tuesday. you have to figure out why you're going so high, is it after meals, fasting, both, etc...and adjust your basal/bolus regime to that. good luck!

Human mixtard 30/70 doesn't work, at least on you.
You can't do a good work with bad tools, it's not your fault, your therapy is broken.
Are you type 1 or 2 ? I presume type 1.
There is any reason why you don't use lantus or levemir as basal ? And humalog or novorapid or apidra as bolus insulin ?
Is it a coverage/price problem ?
Ask this to your endo and if you are not satisfied with his response, change him.

I would second the folks who say try using different insulin, but I do not know if what we're recommending is actually available to you in India. If it is, then go for it — it will definitely be better than what you're using. If it isn't, then I would suggest that you need to experiment with an ultra low-carb diet — and given how much I love Indian food myself it hurts to even suggest this, but it means giving up rice, breads, potatoes, and anything sweetened with sugar and focusing on legumes, meat, and leafy vegetables above all. So instead of your chapati, some lentils with spinach, maybe. (My parents had an Indian exchange student living with us when I was just a small child, and chapatis are comfort food to me... so I really hate saying that... but it might help.)

Did a quick search on insulins in India, and it doesn't look to me like there are any available products that separate short and long-acting insulins — Novo NOrdisk lists only mixed formulas. But perhaps trying one of those is the answer.

But DON'T blame yourself and don't give up! This disease is a tough one to figure out (and then just when you do, the weather changes and you have to adjust) but you will find the right keys to unlock your patterns if you persevere.

Totally agree AR about 70/30 I was on it for YEARS with just horrid results. You can't match your needs with it and it does gaurantee numbers that are ALL over the place. I think sweety1691, you might be better off with something like lantus or levemir for basal along with Humalog or Novalog for your bolus and correction. I think personally Lantus/Levemir and one of the logs if you are going to do MDI is the best way to go, however depending on one's financial situation and insurance they can be very costly. In that case definatly NPH and Regular seperately would give you much better control than a mix would.

Gary please stop with the doom and gloom. Those doe NOT have to be common numbers a diabetic suffers with EVERY day. I very RARELY have numbers in that range and certainly not on a daily basis. Good control CAN be achieved with minimal numbers out of the norm, and I think a good number of us here can say the same. Yes there are days that are off, but I do not think we should except that high numbers EVERY day is the norm or that it cant be prevented. The whole key is really finding an insulin regimine that meets your needs and unfortunately a 70/30 mix isn't going to do that for anyone.

I agree with above comments. 70/30 N+R is terrible. Mixing the insulins averages out their effect. Regular is okay, but NPH is bad new, period, IMO. If Lantus or Levemir are unavilable, switch to Lente, or better yet UltraLente. And do not mix it with anything. Take 2 shots if necessary.

Gary is technically correct. From what I gather, most of us T1s have very poor control. With proper diet, treatment, and detrmination it is possible to achieve normal or near normal BG levels. It's not easy, but you can do it.

The way I see it If you can still enjoy life with sugars all over the map then your a better person then I. Near normal glucose is possible a decent percentage of the time but at a price to pay of many hypoglycemic episodes. Also if you don't mind being a pin cushion testing all day long and live a very structured simple life trying to avoid stress at all costs. To this day I am still baffled how many diabetics are rather ok living with it. I feel like I get run over by a mac truck nearly every day with a few peaceful moments here and there, I don't think I can ever accept the fact of my reality.

If you can afford the mixtard, you can afford to get NPH and R. And you can establish a proper basal (NPH) insulin dose to keep your fasting blood sugars stable during the day. And then when you eat, you can count the carbs in your meal and dose you bolus (R) properly. I really liked the book "Using Insulin" which helped me understand insulin management. Have confidence, you can get better control.

According to your profile, you have been diabetic (t1 i'm assuming) >30 years. You should be used to it by now.

Also, someone should mention no surprise that chapati(starch) + milk(lactose) will push you BG up very high.

Gary Im not trying to minimize your issues, I truly think u are miserable feeling...but maybe ACCEPTACNE is key. I mean life is unfair and its a crappy hand we've all been dealt, but we can either try our best, keep our blood sugars under as good of control as possible OR we can cry about it day in and day out, and nothing changes and we are miserable. I refuse to let D do that to me. I've been diabetic close to 30 years, but I refuse to cry and moan about it and let that consume me, Im going to live my life to the absolute fullest I can. Maybe if you just learned to accept your fate, maybe that would be HALF the battle.

Yeah, I don't even bother being bothered by it. it's there.

Sweetie - I agree with the others on seeing if you can change your insulin ASAP. I was on the 70/30 for a few days out of the hospital and felt like it did NOTHING for me - my diabetic educator switched me immediately and my numbers started to get better right away: it clearly makes a HUGE difference.

Also, as Sam points out a chapati and glass of milk will raise your sugars significantly. Having the dual-insulin system will help you to match your insulin needs to meals that have higher carb counts, but eating less carbs is really a big help, as well.

I see that you’re in Delhi - my family lives in India and I’m actually on my last day of a three week trip here. One of the biggest challenges I’ve had this trip has been the food: I love Indian food, but the carb content can be hard to measure because of things like sauces and high-carb staples like rice, dal, and roti. My best results here have been when I was able to have good protein in the morning, eat as many low-carb options the rest of the day, and get in some good exercise. This last week has been a bit more erratic since I have been traveling more, eating out more frequently, and haven’t been exercising nearly as much (if at all) compared to the first 2/3 of the trip.

One thing I have noticed since my last trip here is that a lot of foods at grocery stores have very good nutritional info compared to what was available even a few years ago - if you are having bread, etc, try to buy the kind that list more of the nutritional info: this gives you a much, much better sense of how many carbs you’re getting in a meal. I would also get a small digital scale to help you measure your carbohydrate portions. This will also help you to learn what certain quantities of food look like when you’re at a restaurant or at a friend’s house: you can get a good sense of what 100 g of cooked rice is or 50 g of dal.

These sound like pretty simple steps, and they really are - it’s finding the time and energy to focus on them and make them a priority that can be difficult. I’ve found that if I make this my priority, everything else goes better.

Best of luck!

I agree that changing to plain NPH and plain R that you can mix at whatever ratios you want will probably get better results, but I also think it's worthwhile to see what can be done with the insulin you've got.
First thing, with the doses you're using the food isn't matching. It sounds like you need to eat a different breakfast or take more insulin. You could either eat less breakfast or something lower carb or take more regular in the morning. Me, I think I'd simply eat less breakfast (maybe the milk without the chapati) and eat a bigger lunch (add the chapati to lunch).
Getting good overnight numbers with NPH can be a struggle but if they're mostly high, just increase the dose. The issue tends to be that they go low and high so it isn't safe to increase the dose without also adding a snack at some point... if that's the case, add the snack.
Can I assume you're taking insulin twice per day?

I think I recall doing okay with 70/30 for a little while, taking it 3 x / day.