Given insulin with very little advice

[ulidian]

after 16 years on pills I have now been placed on insulin, nova rapid and Levemir, at the induction nurse said 3 of the rapid each meal with 10 units of the levemir at night. She also said ajust as required, that,s it you are now flying solo. After a week i am totally lost, i rise at 13 have a low carb breakfast take 10 units of rapid and remain at 13, at lunch have a wholemeal sandwich with ham and 15 units of rapid, move to 15 and stay there until dinner which was a bowl of homemade vegitable soup followed by four fish fingers and a large glass of wine, 25 units of rapid. Later i will take 30 units of levemir, i weight 115kgs. How do i get my standing bgs down, should i take a few gilpizide? Am i taking enough insulin, oh it was somuch easier on pills but they were doing my kidneys.

 

[jack412]

go back to the nurse monday, it's her job to work with you, if you arent satisfied ask the dr for a referral to the hospital clinic

just for your information..what most would suggest here is to start with the miss a meal basal check
There is an online course for background and an idea to it. Free to register

http://www.bdec-e-learning.com/


This set of workbooks are worth reading and practising working examples of carbs and doses and corrections. Don't change dose without nurse approval


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-support.org.uk/info/?page_id=141

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 and math rules, but it has a good trouble shoot at the end

http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[ulidian]

Many Thanks

 

[jack412]

Many Thanks

now for the bad news...I'm 105kg..we have to get rid of the weight and hopefully you can get off the insulin for a few more years, you need to carb count/ reduce your bolus with this with your nurses help

http://www.dietdoctor.com/lchf it’s a long page and a video

http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm For me, the more carbs we eat the more carbs we want. they don’t give up easy.

http://lowcarbdiets.about.com/od/lowcarb101/a/firstweek.htm

http://www.lowcarbdietitian.com/blog/carbohydrate-restriction-an-option-for-diabetes-management


blood testing

http://www.phlaunt.com/diabetes/14045524.php

http://www.homehealth-uk.com/medical/blood_glucose_monitor_testing.htm

food counting

http://www.myfitnesspal.com/


Newcastle diet aims in 8+ weeks to mimic or better the rate of ~80% remission, for surgery T2

http://www.ncl.ac.uk/magres/research/diabetes/

http://www.diabetesforecast.org/2010/mar/weight-loss-surgery-and-type-2-diabetes.html


American diabetic association ( http://www.professional.diabetes.org/)

http://www.professional.diabetes.org/admin/UserFiles/0%20-%20Sean/dc132042%20FINAL.pdf [/url'][URL='http://www.professional.diabetes.org/admin/UserFiles/0 - Sean/dc132042 FINAL.pdf?utm_source=Offline&utm_medium=Print&utm_content=nutritionguidelines&utm_campaign=DP&s_src=vanity&s_subsrc=nutritionguidelines[/url']http://www.professional.diabetes.org/admin/UserFiles/0 - Sean/dc132042 FINAL.pdf [/url]

Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes;

therefore, goals should be individualized; fat quality appears to be far more important than quantity.

In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit

glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.[/URL]

 

[noblehead]

I'm a type 1 so can't really provide any links as I don't know of any that are specific to type 2's who take insulin, however you need to keep a detailed diary of your bg readings, food intake and insulin doses and go back and see your nurse and show the diary to them, if they don't show any interest then ask to be referred over to the care of the hospital diabetes clinic, they are more specialised in dealing with issues related to insulin and will look at your overall control with a view to advise.

 

[phoenix]

I agree with the last post. You really should have more help from a professional.
When adjusting insulin, it's also normal to do it gradually by normally at most a couple of units at a time and thengiving each change time to show it's effect.
Fortunately she seems to have started you on a very low dose for your weight, because you probably still have some insulin of your own. You have though ramped it up very quickly to an amount that is slightly more than the ball game, high end average type of figure normally given ( weight in kg /0.55 = Total daily dose ) . There is a big range though and that is just a ball park figure, how much you will actually need will depend on you (on what you eat, your insulin resistance ( this can make a big difference) , other medications, and how much you exercise,
Most people have a reasonably even split between basal and bolus ( taking 40-50% as basal and 60-50% as bolus so at 35/30 you aren't too far out
http://dtc.ucsf.edu/types-of-diabet...s/type-2-insulin-rx/calculating-insulin-dose/

It really can help if during this period of recording that you keep to a reasonably consistent meal pattern/ carb intake.
In addition to mealtime checks (before and 2 hours after)test before bed, try to make sure that it is 4-5 hours after your evening meal (rapid insulin continues to work for this long) try to test in the middle of the night also and immediately on waking in the morning. Your basal is meant to deal with the glucose released by the liver and to prevent any big rises and falls overnight If it's set properly and you go to bed at 13mmol/l you shouldn't necessarily expect it to decrease or increase by much
This overnight test will give some indication of how well your levimir is working during the night.

 

[jack412]

totally agre and is why I suggested @ulidian contact and work with his nurse on insulin and weight
"go back to the nurse monday, it's her job to work with you, if you arent satisfied ask the dr for a referral to the hospital clinic"
"you need to carb count/ reduce your bolus with this, with your nurses help"

 

[Nyxks]

Sounds like me 11 years ago, Endro said your on Humalog and Lantus X amount with each meal and Y amount going to bed - never signed up for a class and no real information given to me just told you know what to do you've been dealing with your mom you know the basics (trouble was I didn't because mom had never been on insulin as a T2 just 100% diet controlled - way different then me being T1), but I managed though a LOT of trial and error. I was 180 pounds at the time at 5;11" with a body fat of 20%, way different to what I am now at 25% body fat.

I got the book "Think Like a Pancrus" it was a great help in understanding things to various degrees - plus I read a few other books that I could get my hands on in regards to type 1 diabetes and insulin use (i know there are a few books out there for t2 n insulin as i cam across them in my searches).

the 500 rule is what i worked on, but its not reliable for most T2s ... (from the pocket pancreas) 500 Rule for Users of Humalog and Novolog ... you Divide 500 by the total daily dose of insulin. The result is the grams of carbohydrate that are approximately covered by 1 unit of insulin. Example: If I take 40 units a day of Humalog. my carb-to-insulin ratio would be 1 unit of insulin for every 12.5 grams of carbohydrate. The equation is:
500 divided by 40 (total dose) = 12.5 (grams of carb covered by 1 unit of insulin) 1:12.5.

My endro for years wonted me to take 10 units of humalog with each meal (breakfast, lunch and dinner) for a total of 30 units of humalog a day he never figured in having snacks, his advice just didn't jive with what I was learning and figure out on my own that seemed to be working for me, and to this very day he still doesn't see why I do a sliding scale instead of a set amount of insulin with each meal - but I've learned his set amount I'll hypo more times then naught or go hyper when I treat myself, the way I've worked it out means I don't do that in most cases (i might on occasion, but its far less then on his methods).

Like all things, you do need to talk with your diabetic team and figure out what is the best course of action for your own personal treatment, since only you and they know your body well enough to give it effective treatment (in most cases at least - since as we all know doc's are human and not always as right as they think they are). Getting a dietician and working with them to figure out the foods that work for you and agiast you also will go a long ways to figuring things out (since you should have a meter to be testing 6 to 8 times on average a day now that your on insulin).

 

[Daibell]

Hi. Yes, the nurse recommended doses that were too low for your weight. The units you are now using and your weight tells me that the only way forward I'm afraid is some good weight loss. I suspect you have insulin resistance due to weight and T2s who go onto insulin when overweight can get into a vicious circle. So, reduce the carbs down to perhaps 150gm/day for starters and see if you can lose some weight. As this happens both blood sugar and insulin needs will reduce and there will be better overall control. The eventual aim is to adjust the Levemir to start the day between 5 - 7mmol and take enough rapid to keep the 2 hour meter reading below 10 mmol