Question for type 2's using insulin

[palas]

Hi
I've been diabetic for 2 1/2 years now and gradually over time my control and my blood results have got steadily worse, despite being put initially on metformin, then pioglitazone, then gliclazide all at maximum levels. I don't eat crazy, am not always good, but not stupid either, and to cut a long story short today was the day I had to start insulin (along with 1mg metformin twice daily.

My levels at my meeting with the diabetes nurse this afternoon were 23+. My last Hb1ac was about 84.

I'm on a long acting jab which she's advised me to give myself during the evening, but I had to give it this afternoon to prove I could inject.
That and Novo Rapid at meal times.

My question is - would it be prudent to give myself a couple of units extra with meals for the next couple of days to bring my levels down quicker? My diabetes nurse told me that 1 unit of insulin will bring the levels down by 3 mml. Does that mean if my level on my meter is, say, 10, and I account correctly for a meal, that if I give myself an extra unit it will come down to 7 ? Not used to mmls so don't quite know about them yet.

She seems to think I should only test before meals, and then adjust accordingly, presumably by giving myself extra if I'm too high.

Would appreciate some advice here please if possible.

Thank you
Carolynn

 

[jack412]

no, I would go slow and steady, get your basal done then work on bolus

This set of workbooks are worth reading and practising working examples only of carbs and doses
Don't change dose without nurse approval
There is an online course for background and an idea to it. Free to join and register
http://www.bdec-e-learning.com/

Workbook 1
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2
http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb list
http://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diary
http://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Basal testing
http://www.diabetes-support.org.uk/info/?page_id=120

Sick day rules
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf


A workbook with USA numbers, but has a good troubleshooting section
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[jack412]

now as you're T2, are you low carbing?
http://www.dietdoctor.com/lchf
http://diabeticmediterraneandiet.com/low-carb-mediterranean-diet/
http://www.lowcarbdietitian.com/blog/carbohydrate-restriction-an-option-for-diabetes-management
http://www.phlaunt.com/diabetes/14045524.php
http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm
http://www.myfitnesspal.com/

 

[palas]

no, I would go slow and steady, get your basal done then work on bolus

This set of workbooks are worth reading and practising working examples only of carbs and doses
Don't change dose without nurse approval
There is an online course for background and an idea to it. Free to join and register
http://www.bdec-e-learning.com/

Workbook 1
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2
http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb list
http://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diary
http://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Basal testing
http://www.diabetes-support.org.uk/info/?page_id=120

Sick day rules
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf


A workbook with USA numbers, but has a good troubleshooting section
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[palas]

Thanks Jack for that wealth of information. I'm interested to see what level I'm at in the morning. I've been high for so long it'll scare me a bit to be normal I think.

I'm not exactly low carbing - per se - but I'm going to be really good for the next few months until I get used to the insulin and write everything down and try to make do with less carbs than before. I've brought ingredients to do low carb bread, as bread is one of my weaknesses, and I can't resist a baked potato every now and again. I'm writing down meals I eat often with the carb value so I don't need to count all the time. I'm going to try to have meat or nuts for snacks, rather than fruit or biscuits. I thought I'd only have one meal a day with starchy carbs at the most. So if I do have porridge one morning I'll go very light on carbs for the rest of the day. Likewise if I do have a baked potato, then I'll go light for my other meals. I'm hoping that way I get some things that I enjoy but don't go OTT. Also weighing everything and cutting down portion sizes.

Carolynn

 

[jack412]

I don't know if you saw this link out of the multitude, but it helped me with carbs, if you do the dietdr link of LCHF, you don't need to count anything except some carb for bolus and odds are you wont need it much
http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm

 

[noblehead]

Carolyne, your nurse is referring to what we call a correction dose, meaning you give this together with your usual insulin dose for your meal to bring your bg levels down, so she suggesting that 1 unit of Novorapid would be enough to bring your bg levels down by 3mmol.

In type 1's the calculation we use to bring our bg down (correction dose) is called the The Rule of 100, it's a rough guide but it goes like this, if you add your daily basal and bolus doses together and divide 100 by that figure then the number you are left with is the amount 1 init of insulin will bring your bg levels down, so in my case it would be 100/34 = 2.94, so 1 unit of insulin would bring my bg levels down by 3mmol.

As your type 2 I doubt they use the same calculation, so I would do as your nurse suggested and report back with your results, from there they will advise you further.

 

[Daibell]

HI. Yes, I would reduce the carbs by setting a daily limit of, say, 150gm and eating variable foods within that. By keeping the carbs down you minimise insulin needs, weight gain and hypos. I wonder whether you might even be a Late onset T1 (LADA) if young and not particularly overweight?