Addicted! ...and titrating down.

[SWUSA_]

I was just awarded the trophy "Addicted!" for posting a lot. While I am always glad to get awards it made me stop and think. Why do I post so much-I think I m addicted to the support here. It just feels so good to exchange posts with people who are struggling with some of the same issues that I am.
The issue I was focused on when I started about four months ago was getting tighter control of my blood glucose which had crept up as I began having more care duties for a disabled family member. I found lots of good advice here which led me to reduce the number of carbohydrates I was eating and also to limit the amount I eat at one time to no more than 40 carbohydrates per meal. This is resulting in weight loss which is needed, I am also reducing the amount of calories per day to continue this weight loss.

I have a couple of issues with weight loss-not the least of which is that I am taking insulin and metformin. I expect that as I lose weight I will need to reduce the amount of insulin and metformin I take. My new doctor was appalled when I told her I had reduced my insulin 2 units. She thought she was in charge of this. My old Diabetes team gave me goals in fasting blood glucose and HA1c measures to hit and suggestions about how to titrate my medication levels and where to start. My conversations at appointments revolved around my readings and the need for any adjustments in the amount of medication I was taking or changes needed to prescriptions. Doctors after all do control our access to insulin. Can you imagine anyone injecting themselves with insulin if they did not need it? I guess it is both a lifesaving and dangerous substance.

I also get attached to numbers-I always have-The Count was my favorite Sesame Street character-although Cookie Monster was a close second. My new sticking point is 13 stone, 1 lb. I just learned to take my weight in stones and I have always liked the number 13. My grandmother's birthday. 13 is a nice sturdy number and I like to think of myself as sturdy.

So...I am titrating down. A recent abscessed molar brought my need for insulin and my weight back up a little. I have overcome both setbacks and am now looking forward to going below 13 stones this week.

Has anyone else had the experience of reducing their medications taken for Diabetes as they lose weight?
How did it go?
Was it a smooth downward trend or did you have ups and downs?
Thanks for all advice and experience shared on Titrating down insulin and metformin.

 

[Kristin251]

Reducing my carbs also called for reducing my insulin which resulted in weight loss. So yes.

 

[SWUSA_]

Reducing my carbs also called for reducing my insulin which resulted in weight loss. So yes.

Do you mean your bolus units decreased or basal decreased, or both? So you decreased your insulin then you lost weight? Or did they both happen at the same time?
Were there several adjustments?
My experience over my 25 months of injecting insulin has been to titrate up at 2 to 3 units at a time to get a fasting glucose number of 100 to 120mg/dl. Those were my original instructions.
I changed healthcare systems and doctors about 1 year ago and the new doctor asked me to try for "a little lower". When I found this forum in October I started reading more and found that 80 to 100 is an acceptable target. I got there by reducing carbs-not adjusting insulin up further. I started exercising a little more and started having some lows-so I reduced my basal by 2 units. I got an infection, took antibiotics, had pain and some slightly higher numbers so I brought it back up 2 units.
I am over infection, pain and antibiotics and am starting to walk again for exercise. I anticipate some lows again. When that starts happening I plan to bump my insulin back down two units. That is my plan for now.
I assume that since the original dose is calculated on mass and glucose tolerance that as my mass decreases so will my insulin needs. My glucose tolerance may also decrease so that would also cause a decreased need for insulin.
Of course maybe I am overthinking this whole thing. Maybe I should just wait and see what my bodies reaction to being lighter is- I have not weighed less than 5 lbs of where I am at now for at least 30 years.

I have not wanted to weigh less-I associate being thin with being sick. We have several people with Type 1 and several with Type 2 in my family-getting thin suddenly is not a good sign.

 

[SWUSA_]

Well-I tested shortly after posting this last night and found I was over 300mg/dl.(18 mmol). Took my insulin and metformin and went to sleep. I had been sleep deprived for a few nights trying to get ahead of chaos here.

I tested this morning and was at 107 mg/dl (5.9 mmol) before eating anything. I have given family breakfast and will now test after my coffee with 1/4 cup 2% milk as first retest of what I knew before last course of antibiotics. Diabetes-always throwing you a curve ball never a straight on pitch.
125 mg/dl (6.9 mmol) 10 minutes after first sip of coffee. I am having a second cup and oatmeal and then will test after. I would call that not much of a rise for coffee but my normal reaction to the milk.
The minutae that results in good control for me.....

 

[Kristin251]

When I was first diagnosed ( 3 years ago) with bs at 550 and put on insulin they had me eating 20 carbs per meal which was more than I ate per day for the last 25 years. I had lost 25 pounds rapidly prior to that. I mean in about a months time. I looked discustinly anorexic. Within 2 months on insulin and the carbs I gained it all back. I was taking between 5-8 units per meal and I think 4 lantus. I was always bloated and I don't digest carbs. I was using mostly sweet potato as my carb source. I could not get my bs steady at all. Big roller coasters and fears of hypos. So this was the first time I reduced carbs and both insulins and the weight gain stopped right where it left off. At this time I was taking one -1.5 unit of novolog with meals and 2 lantus. Then I reduced carbs inadvertently by stopping red wine and taking up vodka with lemon. Then I needed 1/2 -1 with meals, mostly 1/2, and one lantus. Then recently the wind blew and with the same meals I need more insulin. Bf is now 1/2-1 depending on where bs is. Then I need another 1/2-1 an hour later and sometimes another at around noon. Prior to this wind I only needed one does, not two or three. Lunch is usually 1/2 unless I eat more. Dinner is one as it's my largest meal, albeit still small in comparison to some people's. I also now need 2-3 lantus depending where I am at bedtime.
So when I stopped the wine ( carbs) I lost about 7 pounds without changing my food. I eat the same macros at each meal at the same times of day so I know my boluses until the wind blows.
Maybe my honeymoon is over now but I never really had any random highs or lows. My boluses worked pretty much the same all the time. I'm asking for a cpeptide again next week though my first was 1.1 I think.

I am vlc too, less than 20 day. That's the only way I can keep steady. I never digested carbs so I'm used to eating this way anyway. It's good for my tummy too. I'm usually between 80-105 at all times. I rarely see anything ever over 125. And I rarely fear hypos with lower doses. I always feared dying when I went to bed. I still get a few random lows when I take 3 lantus so I try to avoid that but sometimes 2 isn't enough. I don't know what I'd do without my half unit novolog pen. I wish I could get it in lantus but not here.

 

[daisyduck]

Metformin does not agree with me so I manage to keep my levels between 5 and 7 on diet alone. The overnight liver dump messes that up by usually providing me with 7.5 in the morning.
Hubby injects insulin twice a day so we have to make sure he doesn't go too low. I usually add a potato or bread to his meals... but.. if he does eat the same as me, he has to drop his insulin dose by several points. He had never been advised by his GP to do that though and I asked him to check with his DN at the last appointment if this was an Ok thing to do.. She was pleased with his levels and said to keep doing whatever he was doing

 

[SWUSA_]

I was 125 mg/dl ( 6.9) at 2 hours after breakfast, the same as 10 minutes after first sip of milky coffee. Tomorrow I will try the milk alone and see what happens-I expect the same results and a lack of caffeine headache!

 

[SWUSA_]

Well results of the 2% milk alone test were not what I expected-I decreased my BG by 2 mg/dl at 10 minutes after drinking 1/4 cup of 2% milk. I was also moving around getting ready to take us out at the same time so maybe activity changed the results. I had coffee afterwards and avoided the lack of caffeine headache.
I will retest tomorrow to see if this is repeatable. I bought whole milk this time because mom is losing weight when we really do not want her to lose any more-it's like she is dieting for me. So the repeat will actually be with whole milk rather than 2%. Chocolate whole milk is currently what I use to treat a low so this potentially has treatment implications for me.I usually drink 2% just because I have for so long-we will see if it has any effect on BG or weight for me to switch back to whole milk.
I know this seems a little like a side trail to original topic but it actually isn't-the point is I am trying to lose weight and maintain my BG in range while taking insulin. I will make all changes that I need to in a considered manner.

 

[SWUSA_]

I do not expect that I will be able to do without insulin and metformin entirely-I was diet and exercise controlled for over 40 years and very reluctantly went on medication when I could no longer maintain my BG and HA1C in range or slightly above suggested range-it all blew out for me a little over two years ago. I do expect that I will eventually lose about 20 lbs and that I will need to reduce my insulin when I do that. I have already gotten to a lower range with the medication and diet and exercise changes suggested here than I was able to do before finding the forum. I have not taken all suggestions-not all work for me, but I have found some things that often do.
The milky coffee debate is ongoing in other threads so I have decided to test in a more systematic way what it actually does to my BG.