About to lose my mind


(Steven) #1

Okay, so I want to make this a very detailed thread because I swear i’m going to lose my mind if I don’t figure out what is going on.

I will start with yesterdays food, insulin and reading and follow into today because i think the more information available the easier it is for someone to help.

Yesterdays timeline:

4:26 am: BS 104 - Meal of 1 serving oatmeal with 1 cup frozen strawberries & 2 pieces plain lite wheat toast. 54 carbs. Took 5 units Novolog prior to meal.

5:48 am: BS 198

6:39 am: BS 217

9:32 am: BS 199

11:14 am: BS 180

11:38 am: Meal - exactly the same meal as breakfast 54 carbs and 5 units Novolog.

went to bed: i work nights

7:26 pm: fasting BS 206

7:39 pm : went to gym, 1 hour 2.5 miles on treadmill - BS after 207

9:39 pm: BS 215 - Meal of grilled tuna steak (2 tbs tartar sauce with lite mayo) with 1 cup brown rice and 1 cup mixed veggies (broccoli, carrots, snap peas) - 6 units Novolog

11:43 pm: 18 units Lantus

11:44 pm: BS 257

1:02 am: BS 261 - correction dose Novolog 2 units

3:15 am: BS 257 - correction dose Novolog 2 units

5:16 am: BS 153

6:19 am: BS 114

6:49 am Meal 3 fried eggs (fried in olive oil) strawberry smoothie( 1 cup strawberry, 3/4 cup nonfat greek yogurt, almond milk) 2 pieces lite wheat bread with reduced sugar jelly. 55 carbs - 6 units Novolog

8:02 am: BS 142

9:09 am: BS 106

9:15 am: snack Glucerna mini snack bar - 11 carbs

10:04 am: BS 82

10:15 am: snack mini strawberry smoothie 20 carbs

10:27 am: BS 73

11:06 am: BS 117

went to bed

6:48 pm: fasting BS 143

7:24 pm: Meal Lite turkey sandwich ( 2 pieces lite wheat bread, lite mayo and 4 pieces lite deli turkey) 1/2 cup 1% fat cottage cheese, berry smoothie (1 cup mixed frozen blueberries, strawberries, raspberry and blackberry, 3/4 cup nonfat greek yogurt, almond milk) - 6 units Novolog

8:29 pm: BS 233

9:23 pm: BS 254

I am so confused why it’s like my Novolog isnt working and then in early morning it’s like it all kicks in and I go low. This is a similar pattern daily and I go to the gym 7 days a week.


(Bill) #2

Steven,

Did I read your data correctly? You’re taking Lantus one time per day?

Now, let me preface my remark with this disclaimer - I don’t take Lantus anymore. It would unload on me - I would experience a very long peak that produced very severe and prolonged hypoglycemic episodes. I just had to stop using it and went back to UltraLente until I started using a pump.

Now, back to my answer. It would appear to me that your Lantus is peaking in the morning hours, and it does not appear to be doing enough for you at other times.

You might visit with your physician and talk about splitting your Lantus into an a.m. and a p.m. dose. You have a good sense of when it is prone to peak (about 11 to 12 hours after you take it). Taking the a.m. dose so it peaks in the evening may solve some of your problem. But visit with your physician.

I used the above two-dose regimen and got “closer” to the management I hoped for. A single dose per day left me with highs like yours, except they went much higher (>350 mg/dl).

Something to think about.

Bill


(Steven) #3

Bill,

Thanks for the response and it is something I did think about. I used to take split doses but my DR basically said it doesnt really make a difference because it is a constant. I firmly believe there is no constant with Lantus, there is a peak and drop off for sure.

Thanks again.


(joe) #4

@Steve2967 Hi Steven,

ditto what @BillHavins Bill said - but further questions:

trying to figure out what you are using as “correction” and carb ratio? looks like 1 unit for 10 grams of carbs (suggests to me that is moderately aggressive also suggests you aren’t all that sensitive to insulin) but I don’t get your correction number… you have a 261 at 1 AM with mathematically no insulin on board and your correction is 2 units for a BS of 261? then 2 hours later at 3:15 AM you stacked another 2 units? am I reading that right?

If you’re upper target is 120 mg/dl it would mean you are using a sensitivity of 261-120 = 141/2 units = a sensitivity of 70.5 which suggests you are very sensitive to insulin and does not agree with your carb ratio above.

Please consider buying the book “Think like a pancreas” and spending some time to fine-tune your carb ratio and sensitivity numbers, as well as working towards a better basal strategy (such as splitting the dose). it’ll go a long way in mealtime bolus and in figuring out what your correction factor needs to be based on data. a rule of thumb is that your basal insulin ends up being about 50% (max) of your total insulin intake example at 18 units of lantus… your total insulin should (kind of) add up to 40+ units of insulin per day.

cheers good luck!


(Bill) #5

@Steve2967,

I agree with what @joe has written. But remember, as both Joe and @Dennis often write, managing diabetes is like a continuing science project. You have to find your own solution (with the guidance of a competent physician).

As an example of, “Boy! That’s crazy!,” my basals today will total right at 19 units of Humalog. And my boluses? A total of four units. There are some of us who are, well, “different.”

Good luck to you.

Bill


(PeteTheDiabetic) #6

Hey guys, I think you both pointed something out that seems to be ignored often. We are all human and humans are all different. I have been type one for 46 years and know that there are many times when we cannot explain the way our sugars drop, or climb when we didn’t expect it to. And having taken 6, or 7 different types of insulin, they all work a little slower, or faster, or sometimes not very well at all. It is all about balancing on a wire with the weight(s) of your world on your back.


(Sally) #7

Novolog made me absolutely crazy. I have had diabetes for 55 years and have maintained very good control with all kinds of insulins trying new ones as they were developed. But novolog did me in. I could never figure out what was going on. I had spikes for no reason unpredictable lows…I felt like a newbie. Now I am on fiasp which is the best fast acting insulin yet. It covers meals well and then it’s gone making it very easy to cover meals with no post meal highs. Maybe it is my body type, tall skinny and active but it sure does work for me. I would ditch the novolog.


(Chris) #8

This is Chris and I have been taking insulin every day of my life sense 1966. For the most part I only take one shot in the am early around 6. I use the cheapest insulin that I can find, and mix 15units of NPH with 15units of R. It is a very rare day when I get readings over 150, and mostly it is necessary for me to eat small and often. Am now 65 years old and have just started using the lowest power cheater glasses to do any prolonged reading. Have done eye exercises on a fairly regular basis for the past 35 years. It seems to me the more expensive the treatment the higher the frequency of problems.