What's "normal" as we cope with gaining control?

Type 2
1

i’m back on the bandwagon after being off of it for some time. i’m being treated with actosplus! (it needs an exclaimation point!), lantus, and humalog. oh and diet and exercise, of course. i take a boatload of insulin – 250 units of lantus daily and a sliding scale of humalog 6/9/12/15 units depending upon my reading. i test about eight to ten times per day. i’m a bit of a fanatic about trying to get things under control.

well, i had my first low in a year the other night. 31. i ate 15 grams of glucose tablets and waited 15 minutes as i’m told to do. in the meantime, i shivered and sweated and felt dizzy and scared. it was 42 after 15 minutes so, of course, i overcompensated. i took 30 grams this time, thinking it would raise it about 20 points this time, and i ate a big bowl of cheerios with soymilk. i felt much better. but my blood sugar was 220.

i can’t win! this happened again last night. it was 45 and i did the right things and it seemed to not want to go up. i nearly went to the er. but i’m a type 2, right, i can handle this stuff! right?

and then my diabetic nurse tells me to test for ketones if i’m over 250 for a few readings in a row. i haven’t found any ketones yet, but i test faithfully when the circumstances call for it. she also told me i should have a whattacallit kit. glycagon. both of these i’ve read only type 1’s need to worry about. is that true or is she right? i’ll ask my np about both tomorrow at my appointment.

additionally, my np and diabetic nurse both want me to get on the pump. i want to get on the pump. i wish somebody would start the process of getting me on the pump. but my np isn’t comfortable doing it, so she wants to refer me to an endocrinologist first.

i’m so eager to get things under control now that i am a believer in good control again. i’m very impatient! anybody else feel this way? anybody else confused by what they are reading about type 2 and stuff like ketones, etc.?

should i feel this frustrated and confused? i guess i’m asking – am i normal?

i get nervous about showing my readings to my np. i am a basketcase before an a1c. my last one was 11.4. yikes. i’m sure the next one will be much better, but i’m still sick to my stomach thinking about it.

i do have a psychotherapist lined up, which should help some. to have that outlet. i also journal about it and i’ve started a blog, too.

what sorts of emotions/feelings are you having or did you have as you went on the journey toward better control of your blood sugar?

2

Afraid feeling frustrated & confused is quite normal. It will get easier & better. You can do it!

If you’re using insulin, there’s always a risk of lows regardless of type. 250 units of Lantus is a lot. Anyone on insulin should have a glycogen injection kit. Hope you never need to use it.

About the 15-15 guideline. It all depends how low you are & where you need to end up. People have different degrees of sensitivity to carbs. If I ate 15 grams of sugar, it would raise me 150 pts. Also, it can take up to an hour to see the effect, so try to wait it out. As long as you see it coming up in 15 minutes, BG can continue to rise. We’ve all over-corrected–you’re not alone. Lows are scary. Hard not to eat everything in sight when the awful feeling of lows hit. You’ll need to experiment to see how much 15 grams effects you to know for next time.

With high enough BG, either type can have ketones. Drink a lot of water when you have highs.

Since you’re on insulin & hope to get a pump, you should learn to count carbs to graduate from the sliding scale. Basing insulin doses on carbs is the only accurate way to do it. The lower carb you eat, the less insulin you’ll need.

Check out Jenny’s site & book http://www.bloodsugar101.com. Wonderful!

3

  1. Lows are frustrating. I almost always go high even when I don’t overtreat them (aka a “rebound” high, caused by the delayed release of glucagon by my pancreas)… for me, it’s just become so typical of a low that I actually expect it. As far as overtreating lows… if I am super low, like under 40, I’d rather be “safe” and know I’ll end up high later, than to potentially stay hypo by waiting with the 15/15 rule. Depending on why I am low, that may be too little, too late, if that makes sense… I’ve had a few instances where I was worried 15g wouldn’t really help enough, and I’m sure it wouldn’t have. So, my personal rule is, for lows in the upper 40’s or in the 50’s, 15g is fine, and I do my best to wait it out (if I can’t though, I’ll have an extra 4-5g carbs, not another 15g). Anything lower than that and I can have whatever I want, and as much of it as I want… becuase I’d rather be a bit high than in insulin shock :slight_smile: I usually give a moderate correction with insulin an hour or so later, and then gradually correct back down to normal - the whole process usually takes 4-5 hours, but I’d rather get back down slowly than risk another hypo. Usually it takes 2 corrections 2 or 3 hours apart.

  2. T2’s can have ketones and potentially go into DKA, but that’s unlikely for most. If you do have ketones, just push fluids, eat some carbs, and you may need more insulin to bring your BG down (plus what you need for the carbs). I guess as a T1 I am almost lucky that I’ve been ketotic often enough to know what it “feels” like (nausea, headache, etc), and I usually know before I test if that strip is going to turn purple or not… so I won’t necessarily check just because I have a few high readings in a row (or say, all day), but I’ve had large Ketones with relatively normal BG levels… and it was based on how I felt that prompted me to test. For me high ketones with normal BG levels is an early sign I’m getting sick with something… it’s a bit of a stress response, with my body telling me it needs more fuel (carbs) than I’m consuming. Trace or small amounts really don’t mean much… everyone, diabetic or not, produces ketones when they burn fat, but usually not in large amounts - you only worry if the test turns dark purple (very obvious). Moderate or Large ketones for more than 12 hours is a sign to go seek help, as is any time you are vomiting with moderate or large ketones (which may not actually be DKA, but you can’t stay hydrated that way).

  3. Anyone using insulin should have glucagon… it’s just a safety thing. You may never actually “need” it (I never have), but if you did, you’d certainly want to have it handy, and make sure that anyone you live with knows how to use it and when/why they might need to. It is important to know is that glucagon will not work well if you’ve been drinking, especially if you’ve had more than a couple drinks (the liver prioritizes alcohol processing over glucose regulation, and may not react to injected glucagon), or if you’ve been having a lot of lows and your glycogen stores in the liver are depleted (which is unlikely for most, but possible).

4

Your lows seem very, very, scarily low, and I would think overcompensating and going high for a little while might be worth it. I know whenever I go low I tend to do that too, but then when I get back to normal living it goes down again.