Can't Get Insulin Doses Adjusted Correctly

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Can't Get Insulin Doses Adjusted Correctly


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Old 05-04-2010, 04:47   #1
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Default Can't Get Insulin Doses Adjusted Correctly

I am having trouble getting my insulin adjusted correctly. Last weekend I went through an entire day with my blood sugar readings in the 170's, which is really high for me. I adjusted my basal insulin and today I dropped down to 29 at 5:15PM and had no signs of being low. I had no trouble bringing my blood sugar back up to 80 with 6 glucose tabs. I don't know what is going on but I haven't had this many ups and downs in months. When my basal insulin dose is too high then I go low in the late day, when my basal dose is to low then my fasting is to high, I don't know what to adjust.

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Breezeonby {Female}
Medications: Metformin ER, Lantus, Novolog
Zofran for Gastroparesis
Gabapentin-Neuropathy
Zocor 40MG, Fish Oil 4000MG
A1C/5.2% April 14, 2010
A1C/5.5% June 1, 2010
A1C/5.2% October 6, 2010
A1C/5.0% February 7, 2011
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Old 05-04-2010, 09:05   #2
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Originally Posted by breezeonby View Post
I am having trouble getting my insulin adjusted correctly. Last weekend I went through an entire day with my blood sugar readings in the 170's, which is really high for me. I adjusted my basal insulin and today I dropped down to 29 at 5:15PM and had no signs of being low. I had no trouble bringing my blood sugar back up to 80 with 6 glucose tabs. I don't know what is going on but I haven't had this many ups and downs in months. When my basal insulin dose is too high then I go low in the late day, when my basal dose is to low then my fasting is to high, I don't know what to adjust.
I wish I knew what to tell you I know *my* basal rate need changes at different times of the day. I really dont know how to achieve that using Lantus tho. When do you see your endo again?

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Type 2 since age 16
A1c in March 2010 12.6%
current A1c 6.3%

Currently taking:

Metformin 1000mg twice a day
Neurontin 300mg three times a day
Cymbalta 30mg a day
Symlin injections 60 mcg before meals
pumping with the minimed Revel and novalog
Milk Thistle twice a day
Fish oil twice a day
Nexium once a day
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Old 05-04-2010, 17:48   #3
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I wish I knew what to tell you I know *my* basal rate need changes at different times of the day. I really dont know how to achieve that using Lantus tho. When do you see your endo again?
I don't see an endo. Just an internist and he usually leaves it up to me to adjust my insulin. He really is not much help when it comes to insulin. I have asked him if I need to see and endo and he says "no". In this neck of the woods, you need a referral to see an endo and I can't get that from my internist.

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Breezeonby {Female}
Medications: Metformin ER, Lantus, Novolog
Zofran for Gastroparesis
Gabapentin-Neuropathy
Zocor 40MG, Fish Oil 4000MG
A1C/5.2% April 14, 2010
A1C/5.5% June 1, 2010
A1C/5.2% October 6, 2010
A1C/5.0% February 7, 2011
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Old 05-04-2010, 17:57   #4
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You have 2 choices
use the higher basal and remember to have your snack (Not what I would do)
or
use the lower Basal and bolus to get your BG down (this is my choice).

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Old 05-04-2010, 18:06   #5
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Originally Posted by breezeonby View Post
I don't see an endo. Just an internist and he usually leaves it up to me to adjust my insulin. He really is not much help when it comes to insulin. I have asked him if I need to see and endo and he says "no". In this neck of the woods, you need a referral to see an endo and I can't get that from my internist.
wow...a diabetic on insulin...and you *dont* need to see an endocrinologist? Not too sure I agree with that...but...

I would have to agree with using the lower basal and just bolus to correct highs. That seems safer to me than bottomiing out too low.

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Cheers,
Pam
~*~*~*~*~*~*~*~*~*~*~*~*~*~*
Type 2 since age 16
A1c in March 2010 12.6%
current A1c 6.3%

Currently taking:

Metformin 1000mg twice a day
Neurontin 300mg three times a day
Cymbalta 30mg a day
Symlin injections 60 mcg before meals
pumping with the minimed Revel and novalog
Milk Thistle twice a day
Fish oil twice a day
Nexium once a day
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Old 05-04-2010, 20:30   #6
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Originally Posted by onaughmae View Post
wow...a diabetic on insulin...and you *dont* need to see an endocrinologist? Not too sure I agree with that...but...

I would have to agree with using the lower basal and just bolus to correct highs. That seems safer to me than bottomiing out too low.
I have never seen an endocrinologist and I have been on insulin for 5 years. What am I missing out on by not seeing one? The internist that started me on insulin in 2005 said I didn't need an endo either. So I have been to 2 different internists who said I didn't need to see and endo. I don't really agree with this either, but my hands are tied.

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Breezeonby {Female}
Medications: Metformin ER, Lantus, Novolog
Zofran for Gastroparesis
Gabapentin-Neuropathy
Zocor 40MG, Fish Oil 4000MG
A1C/5.2% April 14, 2010
A1C/5.5% June 1, 2010
A1C/5.2% October 6, 2010
A1C/5.0% February 7, 2011
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Old 05-04-2010, 20:50   #7
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Quote:
Originally Posted by breezeonby View Post
I have never seen an endocrinologist and I have been on insulin for 5 years. What am I missing out on by not seeing one? The internist that started me on insulin in 2005 said I didn't need an endo either. So I have been to 2 different internists who said I didn't need to see and endo. I don't really agree with this either, but my hands are tied.
Not that I am saying there is something wrong with your internist....I just think its always better for a diabetic to see an endocrinologist. That is their specialty and they are more likely to be up on the latest treatments and they are more likely to aggressively treat your diabetes. I used my regular doctor for a long time....and since I switched to an endocrinologist I am in the best control in years. I dont understand why any MD would *not* agree with an insulin dependent diabetic needing an endocrinologist. My MD was more than happy to agree I needed one. To me...any MD that is treating you with insulin and takes the attitude that "you can figure it out yourself" and isnt "very much help" in your dosing and giving you constructive advice is not the person I want to be seeing. I agree that my treatment of my disease is a lot of *my* responsibility...but it should be a team effort with your medical team also. Too bad there isnt some way to get you in to see one.

Ok...off my soapbox now

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Cheers,
Pam
~*~*~*~*~*~*~*~*~*~*~*~*~*~*
Type 2 since age 16
A1c in March 2010 12.6%
current A1c 6.3%

Currently taking:

Metformin 1000mg twice a day
Neurontin 300mg three times a day
Cymbalta 30mg a day
Symlin injections 60 mcg before meals
pumping with the minimed Revel and novalog
Milk Thistle twice a day
Fish oil twice a day
Nexium once a day
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Old 05-04-2010, 21:28   #8
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In this issue I can not give information to you, because my experience and my disease has not been up there? I can only pray I hope you fine, and keeps morale. do not give up !!!!!!!! ok!

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Old 05-04-2010, 21:48   #9
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Originally Posted by onaughmae View Post
Not that I am saying there is something wrong with your internist....I just think its always better for a diabetic to see an endocrinologist. That is their specialty and they are more likely to be up on the latest treatments and they are more likely to aggressively treat your diabetes. I used my regular doctor for a long time....and since I switched to an endocrinologist I am in the best control in years. I dont understand why any MD would *not* agree with an insulin dependent diabetic needing an endocrinologist. My MD was more than happy to agree I needed one. To me...any MD that is treating you with insulin and takes the attitude that "you can figure it out yourself" and isnt "very much help" in your dosing and giving you constructive advice is not the person I want to be seeing. I agree that my treatment of my disease is a lot of *my* responsibility...but it should be a team effort with your medical team also. Too bad there isnt some way to get you in to see one.

Ok...off my soapbox now
I agree with you 100%. I don't think that I should have to figure out how to take insulin correctly on my own. It is a real challenge. I guess if my diabetes was really out of control and my readings were in the 200 and 300's all of the time then I probably would seek another internist who would agree to send me to an endo. The doctor that I am seeing has a wonderful bedside manner and sits and listens to what I say and it is hard to find a doctor that will listen to you all of the time. Maybe I should be more persistent in getting more direction from my doctor. I need to remember that my A1C should be an indication that I have better control than I think. Maybe I am being unrealistic, I know what type of blood sugar readings I want to see and when I don't I freak out. There are so many factors that affect your blood sugar readings and there will probably never be a time when everything goes the way you want them. There are many people who would die for an A1C like mine. I should just take a chill pill!

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Breezeonby {Female}
Medications: Metformin ER, Lantus, Novolog
Zofran for Gastroparesis
Gabapentin-Neuropathy
Zocor 40MG, Fish Oil 4000MG
A1C/5.2% April 14, 2010
A1C/5.5% June 1, 2010
A1C/5.2% October 6, 2010
A1C/5.0% February 7, 2011
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Old 05-04-2010, 22:56   #10
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For sure you are right..I would kill for your A1C! I want mine to be like that one day! And its true...not everyday is a good diabetes day. I ate something last night that was carby and fatty...I should have covered it with a double wave bolus (especially since I ate it at 2AM!) but for some reason I just didnt. My blood sugar was 146 when I woke up and it took me a good part of the moring to get it chased back down to 93 with an extra bolus after breakfast. Somehow this morning that fabulous hamburger with cheese and extra jalepenos at 2AM didnt seem as good when I realized I was paying for it this morning!

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Cheers,
Pam
~*~*~*~*~*~*~*~*~*~*~*~*~*~*
Type 2 since age 16
A1c in March 2010 12.6%
current A1c 6.3%

Currently taking:

Metformin 1000mg twice a day
Neurontin 300mg three times a day
Cymbalta 30mg a day
Symlin injections 60 mcg before meals
pumping with the minimed Revel and novalog
Milk Thistle twice a day
Fish oil twice a day
Nexium once a day
onaughmae is offline  
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