Is this typical?

[Wshelledy]

I was put on insulin within the last month because my A1c was 11.9. The dr said to start at 15 units twice a day (novalog 70/30) and to increase until my fasting bs was below 130 and post prandial was below 150. I increased all the way to 26 units before I hit targets. But within a few days of using that dose my tests were below 100 and I got the shakes. I have been decreasing my units every dose but my readings have continued to drop. Last night after dinner my reading was 97 after using 17 units. I knew that it would significantly drop over night as it has since the first 5 days. I ate a second meal before bed of 2 pieces of whole wheat bread peanut butter and about a tablespoon of jam. My fasting reading was 107. I don't want to have to eat a 4th meal before bed. Any suggestions on how to manage this?


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[Daibell]

Hi. You seem to be doing the right thing in gradually reducing the insulin as your BS has gone down and reducing it enough to avoid hypos. If you are a 'normal' T2 then with a low-carb diet and possibly some meds such as Metformin you may be able to keep the insulin quite low. It's possible you are a mis-diagnosed T1 and if so you will need to continue the insulin and possibly move to the Basal/Bolus regime if better BS control is needed. Can I ask what your BMi/Weight is as this may influence your true diagnosis?

 

[Kristin251]

As your bg is coming down from high levels and nownusing insulin the doses most likely will decrease as your body adjusts to lower levels of bg. It will require lower levels of insulin. I had to reduce massively after I bit it down and kept it down. Hypos along the way of course.
You are correct, we should use insulin to meet our food requirements and not feed insulin to avoid lows. If that's what you're doing then reduce insulin. Better to error on the side of caution and take less and gradually work up than the other way around.
Also the lower the carbs in a meal the less insulin will be required. If you have a low carb meal then take less.
Timing your insulin to meals works well.

I basically eat the same bf Andy lunch so I know my insulin dose. Dinner as well. I don't eat the same foods, just the same amount of carbs, protein and fat. Then I know my timing and my dose without fear of hypos. It did take loads and loads of testing to find my meals and doses.

Just be cautious. You're body is adjusting to lower levels and becoming more insulin sensative.

What types of meals do you have ?

 

[Wshelledy]

Hi. You seem to be doing the right thing in gradually reducing the insulin as your BS has gone down and reducing it enough to avoid hypos. If you are a 'normal' T2 then with a low-carb diet and possibly some meds such as Metformin you may be able to keep the insulin quite low. It's possible you are a mis-diagnosed T1 and if so you will need to continue the insulin and possibly move to the Basal/Bolus regime if better BS control is needed. Can I ask what your BMi/Weight is as this may influence your true diagnosis?

I'm diagnosed as type 2. I took metformin for many years but over time the side effects got worse and worse. At that point my A1c was around 6. It seemed to stay steady after discontinueing but after a big change in my exercise routine it shot up. I suspect I need separate long term and short term insulin meds. The long term seems too much. I say that bc if I don't eat a large meal before bed my morning levels are in the low 70's. Not sure about bmi but I weigh about 157 lbs. My goal is 145. Thanks for your response!

 

[Wshelledy]

As your bg is coming down from high levels and nownusing insulin the doses most likely will decrease as your body adjusts to lower levels of bg. It will require lower levels of insulin. I had to reduce massively after I bit it down and kept it down. Hypos along the way of course.
You are correct, we should use insulin to meet our food requirements and not feed insulin to avoid lows. If that's what you're doing then reduce insulin. Better to error on the side of caution and take less and gradually work up than the other way around.
Also the lower the carbs in a meal the less insulin will be required. If you have a low carb meal then take less.
Timing your insulin to meals works well.

I basically eat the same bf Andy lunch so I know my insulin dose. Dinner as well. I don't eat the same foods, just the same amount of carbs, protein and fat. Then I know my timing and my dose without fear of hypos. It did take loads and loads of testing to find my meals and doses.

Just be cautious. You're body is adjusting to lower levels and becoming more insulin sensative.

What types of meals do you have ?

I mostly eat a low carb low glycemic diet. I have had to increase the carbs right before bed to avoid crashing. I try to eat about the same carbs but even reducing the units given post prandial hasn't given me stable readings. They keep going down. For example, lastnight's dinner had about 55 g ofcarbs. I took 17 units (down from18). My 2 hr reading was 99. The night before I also had about 55 and my reading was 106 with 18 units. I think these are ok but on the low side since the dr said < 130. But if I don't eat again before bed I wake up very hypo. I want to avoid the pre bed meal as I'm trying to lose about 15 lbs. I think the problem may be the combo drug. I wonder if I could take less long acting if my morning reading would be higher with out having to have the additional calories at bed. Thanks for your insight.

 

[Kristin251]

I do think there's too much insulin on board.
What time do you take your doses?
Could you move the premed one to dinner or earlier if you take a dose in the evening ? Then it would work on that meal and maybe wouldn't need the second meal.
You're on mixed insulin? I'm not familiar with that but sometimes moving WHEN we take insulin creates a whole new picture.

What are your premeal numbers?

 

[Wshelledy]

I do think there's too much insulin on board.
What time do you take your doses?
Could you move the premed one to dinner or earlier if you take a dose in the evening ? Then it would work on that meal and maybe wouldn't need the second meal.
You're on mixed insulin? I'm not familiar with that but sometimes moving WHEN we take insulin creates a whole new picture.

What are your premeal numbers?

I keep trying to post responses but it keeps saying its spam and refuses the post. Too many numbers maybe?

 

[Wshelledy]

Same problem with low number this morning...81 at 4:30 am. Had to get up and eat. I had 190 g of carbs yesterday with 30 of them right before bed. Not sure what to do. The insulin dose is at dinner time, about 12 hrs after the morning one. I only do 2 a day so I don't think I can change when I take it. All I know to do is keep reducing the dose. If this keeps up I'll stop taking the dinner one all together I guess. The hypos are hard on my body and my spirit. It makes me feel awful for hours.

 

[Kristin251]

Same problem with low number this morning...81 at 4:30 am. Had to get up and eat. I had 190 g of carbs yesterday with 30 of them right before bed. Not sure what to do. The insulin dose is at dinner time, about 12 hrs after the morning one. I only do 2 a day so I don't think I can change when I take it. All I know to do is keep reducing the dose. If this keeps up I'll stop taking the dinner one all together I guess. The hypos are hard on my body and my spirit. It makes me feel awful for hours.

I completely understand and feel your pain. 81 isn't a hypo but if it followed a high you'd probably feel bad. Not a fun way to start the day.

Your only alternative as I see it is to keep reducing insulin. Where did you start before dinner and where were you before bed?

It might be best to go to basal bolus rather than mixed. It had a completely different profile. I cannot take even the smallest amount of basal during the day or my sugars are irratic. I like my basal to keep me steady through the night and have the ability to change my bolus depending on when and what I eat. I have a lot more flexibility.

 

[Wshelledy]

I completely understand and feel your pain. 81 isn't a hypo but if it followed a high you'd probably feel bad. Not a fun way to start the day.

Your only alternative as I see it is to keep reducing insulin. Where did you start before dinner and where were you before bed?

It might be best to go to basal bolus rather than mixed. It had a completely different profile. I cannot take even the smallest amount of basal during the day or my sugars are irratic. I like my basal to keep me steady through the night and have the ability to change my bolus depending on when and what I eat. I have a lot more flexibility.

Thanks for the encouragment. The dr (general not endocrinologist) seemed to think anything below 90 is hypo. I feel she's not very well informed. My pre dinner number has not been high....around 110 or lower. My 2 hr post prandial was 99. Anything below 100 has meant that if I don't have a 4th meal I will drop into the low 70's or lower if I sleep 8 hrs. At this point I just have to us the combo. It cost about $580 (us). And I can't afford to buy anything else until this one is gone. It was supposedly a 1 month supply but that assumed 60 units a day. Today I dropped to 15 so it will last closer to 2 months. Thanks again for listening!

 

[Wshelledy]

Thanks for the encouragment. The dr (general not endocrinologist) seemed to think anything below 90 is hypo. I feel she's not very well informed. My pre dinner number has not been high....around 110 or lower. My 2 hr post prandial was 99. Anything below 100 has meant that if I don't have a 4th meal I will drop into the low 70's or lower if I sleep 8 hrs. At this point I just have to us the combo. It cost about $580 (us). And I can't afford to buy anything else until this one is gone. It was supposedly a 1 month supply but that assumed 60 units a day. Today I dropped to 15 so it will last closer to 2 months. Thanks again for listening!

Just wanted to say thanks! I took your comment about timing and applied it both to my dose as well as my snack. I ate dinner about 30 mins earlier and pushed the bed time snack about 1 1/2 hrs later. And it really was a snack not a full meal. It worked! Stable numbers this morning! I cannot thank you enough!

 

[Kristin251]

Just wanted to say thanks! I took your comment about timing and applied it both to my dose as well as my snack. I ate dinner about 30 mins earlier and pushed the bed time snack about 1 1/2 hrs later. And it really was a snack not a full meal. It worked! Stable numbers this morning! I cannot thank you enough!

Excellent news. Sometimes we just have to play around with meal and dose timing. Glad it's working.
Did you also reduce insulin further?

 

[Wshelledy]

Excellent news. Sometimes we just have to play around with meal and dose timing. Glad it's working.
Did you also reduce insulin further?

Yes, down to 13 units. Quite a difference from the 30 units prescribed. I really need an endocrinologist. The current dr doesn't seem all that familiar with the diabetes intricacies. She prescribed a new hypertension drug which it specifically says is not for diabetics. She even forgot to write a prescription to include needles for injecting the insulin she prescribed. I don't know how you feel about the medical system in the UK but the one in the US is very very broken!

 

[Kristin251]

Yes, down to 13 units. Quite a difference from the 30 units prescribed. I really need an endocrinologist. The current dr doesn't seem all that familiar with the diabetes intricacies. She prescribed a new hypertension drug which it specifically says is not for diabetics. She even forgot to write a prescription to include needles for injecting the insulin she prescribed. I don't know how you feel about the medical system in the UK but the one in the US is very very broken!

I'm in the US! How do I feel? They were hours away from killing me by mis/undiagnosis. I was 94 pounds of skin and bones. I'm 5'8. I had No muscle no fat. Zero. I did win a small monetary settlement with Aurora. How much money do you put on near death??
Your doc is rodiculous and cAreless and negligent just like my TWO were.

Now I'm with Frodtert and LOVE my endo but truly trust nobody with my health care.

That is quite a drop. But by example I was taking 5 lantus and now 1-2 BUT I was taking 7-10 bolus with meals and now 1/2. At DX they told me to eat 20 carbs per meal and I couldn't stop the rollercoaster so I went back to my vlc and needed to drop doses considerably but now I stay rock steady. Don't worry about reducing as you go along. The body is adjusting. It's better to run a little high then hypo until you find your balance

One thing I find that really helps is keeping all macros the same at each meal at each time of day. Then I know my doses and fear not hypos.
I always eat the same bf, lunch and dinner the same amount of protein and avocado ( keeps me very stable and not hungry). I don't eat carbs to speak of but I keep the veggies for dinner.

You'll work it out. It just takes loads of sticking and journaling. Do you keep a diary of what you ate and your bs levels before anencephaly after eating? That really helped me find my meals and stabilize bs.

 

[Peerless67]

Yes, down to 13 units. Quite a difference from the 30 units prescribed. I really need an endocrinologist. The current dr doesn't seem all that familiar with the diabetes intricacies. She prescribed a new hypertension drug which it specifically says is not for diabetics. She even forgot to write a prescription to include needles for injecting the insulin she prescribed. I don't know how you feel about the medical system in the UK but the one in the US is very very broken!

The medical system in the UK is far from perfect, but I have experienced both here in the UK and in the US (pre ACA) and it was shocking to me. My wife (American) was taken to hospital and spent 4 nights in intensive care, some weeks later she received an itemised bill that was many pages long for some $48,000
People often ***** about our NHS but its problems are due to consecutive governments allowing its decay, probably with the long term intention of privatising it. People will truly know what they had if that ever happens.


Regarding your T2D I was being pushed toward injecting, I was taking 9 tablets a day and just struggled to get my BG under control. On August 1st I started a diet and stopped all my T2 meds. It was a struggle at first but it is the best thing I ever did. My fasting BGs was high teens to high twenties, now it is in the low 4s to mid 5s and I have not exceeded 7 for 2 weeks now for any test.
I am just learning that so many doctors are prescribing insulin to T2DM patients, it is disturbing to me.

 

[Wshelledy]

The medical system in the UK is far from perfect, but I have experienced both here in the UK and in the US (pre ACA) and it was shocking to me. My wife (American) was taken to hospital and spent 4 nights in intensive care, some weeks later she received an itemised bill that was many pages long for some $48,000
People often ***** about our NHS but its problems are due to consecutive governments allowing its decay, probably with the long term intention of privatising it. People will truly know what they had if that ever happens.


Regarding your T2D I was being pushed toward injecting, I was taking 9 tablets a day and just struggled to get my BG under control. On August 1st I started a diet and stopped all my T2 meds. It was a struggle at first but it is the best thing I ever did. My fasting BGs was high teens to high twenties, now it is in the low 4s to mid 5s and I have not exceeded 7 for 2 weeks now for any test.
I am just learning that so many doctors are prescribing insulin to T2DM patients, it is disturbing to me.

In the US its not just costs to the patient. It goes so far beyond that. Dr's and hospitals are trying to cut cost but that means their employees are over worked and under paid. That leads to SERIOUS mistakes. I wish we would go to a singler payer system more like the UK system. AHA is under attack and even it has serious problems. As far as the meds go...I controlled my diabetes for many years with diet and exercise. When that stopped working I did pills. After a while the side effects were unbearable. That's why I started the injections. My body needed help. I think if I had been treated by an endocrinologist I wouldn't have had so much trouble starting. The gp did no instruction what so ever...just wrote the prescription. I attribute that to the limited amount of time she is allowed to spend with each patient. That's just one of the many problems the system has here.

 

[Wshelledy]

I'm in the US! How do I feel? They were hours away from killing me by mis/undiagnosis. I was 94 pounds of skin and bones. I'm 5'8. I had No muscle no fat. Zero. I did win a small monetary settlement with Aurora. How much money do you put on near death??
Your doc is rodiculous and cAreless and negligent just like my TWO were.

Now I'm with Frodtert and LOVE my endo but truly trust nobody with my health care.

That is quite a drop. But by example I was taking 5 lantus and now 1-2 BUT I was taking 7-10 bolus with meals and now 1/2. At DX they told me to eat 20 carbs per meal and I couldn't stop the rollercoaster so I went back to my vlc and needed to drop doses considerably but now I stay rock steady. Don't worry about reducing as you go along. The body is adjusting. It's better to run a little high then hypo until you find your balance

One thing I find that really helps is keeping all macros the same at each meal at each time of day. Then I know my doses and fear not hypos.
I always eat the same bf, lunch and dinner the same amount of protein and avocado ( keeps me very stable and not hungry). I don't eat carbs to speak of but I keep the veggies for dinner.

You'll work it out. It just takes loads of sticking and journaling. Do you keep a diary of what you ate and your bs levels before anencephaly after eating? That really helped me find my meals and stabilize bs.

So sorry to hear about the problems with the system! They DID kill my SIL. She went to the ER with stomach pain. They did testing and said it was just a stomach bug. She insisted it couldn"t be. They ignored her and sent her home. She came back 4 hrs later. They refused any treatment at all. The triage nurse threatened to call the police if she didn't leave. She left on threat of arrest. She came back 4 hrs later, collapsed in the parking lot of a massive heart attack brought on by sepsis. Her appendix had ruptured. Turned out the first visit her labs were switched with the person next to her. So 1 person got unnecessary surgery and we lost a family member! This is the worst thing that has happened to our family but certainly not the only very serious mistake. As far as my eating...I would very much like to cut my carbs but if I have less than 190 - 200 g per day I go too low. I just don't think I can lose any weight eating like this!

 

[Kristin251]

So sorry to hear about the problems with the system! They DID kill my SIL. She went to the ER with stomach pain. They did testing and said it was just a stomach bug. She insisted it couldn"t be. They ignored her and sent her home. She came back 4 hrs later. They refused any treatment at all. The triage nurse threatened to call the police if she didn't leave. She left on threat of arrest. She came back 4 hrs later, collapsed in the parking lot of a massive heart attack brought on by sepsis. Her appendix had ruptured. Turned out the first visit her labs were switched with the person next to her. So 1 person got unnecessary surgery and we lost a family member! This is the worst thing that has happened to our family but certainly not the only very serious mistake. As far as my eating...I would very much like to cut my carbs but if I have less than 190 - 200 g per day I go too low. I just don't think I can lose any weight eating like this!

Oh boy!!! Unbelievable. Sorry for your loss.

If you cut carbs you HAVE to cut insulin. I would need piles of insulin to cover that many carbs.

You're type 2. Have you ever tried just a protein and fat meal WITHOUT insulin? Although if you're on mixed you'd still have insulin on board. Tough situation. Not for me to recommend but carbs require insulin and insulin requires carbs.

Before you were put in insulin did you ever try a VERY low carb diet? Under 50 max? I keep mine under 20.

 

[Wshelledy]

Oh boy!!! Unbelievable. Sorry for your loss.

If you cut carbs you HAVE to cut insulin. I would need piles of insulin to cover that many carbs.

You're type 2. Have you ever tried just a protein and fat meal WITHOUT insulin? Although if you're on mixed you'd still have insulin on board. Tough situation. Not for me to recommend but carbs require insulin and insulin requires carbs.

Before you were put in insulin did you ever try a VERY low carb diet? Under 50 max? I keep mine under 20.

For many years high protein lowcarb along with exercise is how I managed my diabetes. When that stopped working I started metformin. That worked and allowed me to eat a lot more carbs. But I started having terrible gastro problems from the pills. My A1c was still pretty low...about 5. The endo dr I had then was great! We ended up trying to go back to just diet and exercise with an almost no carb diet. It was working ok. But then the insurance company started denying almost everything from her office. She ended up retiring saying the insurance companies were not allowing her to practice good medicine. I floated around for a while but finally gave up on our system of medicine. I really was and still am afraid our system would kill me. I didn't see a doctor for almost 2 years. I let too many carbs sneak back into my diet. That's how I became insulin dependant. Now that I'm doing much lower carbs again Imay try just 1 dose daily and then eat mostly protien and fat to see how
I do.

 

[ickihun]

I found with mixed insulin when I low carbed I still got high bgs from protein. I reduced protein to be advised to add more fat to lose weight but weight never came down. Once I medium carbed and my bgs reduced with mixed insulin. Only with huge mixed insulin doses to keep my bgs in 4s or 5s did I start losing weight. I kept those bgs low and weight reduced more and more. I went onto seperate insulins and lower bgs fed my weight loss. 4s, 5s and odd 6s keep my weight reduction going. Added orilstat to equation and weight loss is still reducing but slowly.
Being on the correct amount of insulin and taking it at the correct time, is the key.
My mixed insulin was needed to be injected 20-30mins BEFORE food. I needed an injection with protein for supper.
I'm eating far less on seperate insulins. Far less fat too which slowed my digestion even more than my current slow one.