Insulin Newbie - on steroids - need help!

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Insulin Newbie - on steroids - need help!


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Old 02-21-2016, 19:23   #1
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Default Insulin Newbie - on steroids - need help!

I have a new wrinkle in my diabetes management and it's called evil steroids!

My history is that I was very sick at dx w/ an A1C of 14.7 which I brought down to 5.5 via low-carb. I've not had a piece of conventional bread (almond flour variations only, and occasionally), rice, potato, etc for 5 years. Have loosened up a bit the last two years, eating perhaps 50 carbs/day vs 30, and not taken any meds after dropping metformin after a year or two.

Have been diagnosed with a cancer that now requires me to take a monster dose of steroid (40 mg dexamethasone) once/wk for 6-8 months as part of my chemo treatment, and then I might have to take it at a lower maintenance dose. Turns out, this is something I can't low-carb my way out of!

I saw an endocrinologist, and asked for insulin. As an experiment, after taking the steroid, I had eaten exactly one slice of ham/cheese for lunch, the same for dinner, and my bg got up to 175. This is better than the low 200's when I ate the week before, but obviously not acceptable. After two days, my fasting was back down and okay at just <100, but that was after barely eating for 2 days. During the day, it was a bit higher than usual, but not too bad, and got over 140 just once briefly, more typically in the 110s.

Right now I have a million questions, because what I know about insulin approaches zero. The endocrinologist gave me the tools to start (Lantus pen, Novolog pen) but I'm frozen. Until I know more, and figure out how as an extreme needle-phobe to do the deed, I will continue walking past the supplies without acknowledging

Her instructions are to start with 10 units Lantus in the PM, and then bolus w/ Novolog on a sliding scale, though she showed being amenable to almost anything I wanted to try if it wasn't harmful. She is starting me on sliding scale due to my low carb intake, and likely just learning curve issue.

So now to some of my questions, and I welcome feedback on any/all of this, plus experiences from anyone who has had to deal with steroid-induced high glucose.

1. Understanding everyone is different, but asking anyway: how much is 10u Lantus likely to reduce my bg? I'm concerned that if my normal fasting for that morning would be 95, that Lantus could take me too low. Or no? I have so many new issues in my health life right now, that I want to avoid this new going-low potential as much as possible.

2. I'm needle-phobic. Naively, I thought an insulin pen would deliver insulin to me in a quick flash, not in a count-to-10 delivery method that also involved seeing the needle. Yikes! Is anyone familiar with any of these injection aids (http://integrateddiabetes.com/Articl...%20Article.pdf) or have input for someone with my pathology? She called in a script for what I hope are the thinnest needles possible - 4mm x 32 g - are they? All technique input is welcome.

3. Injection location. I get chemo injections in my belly, and so belly rotation for insulin might be more tricky. Or not. Will talk to my oncologist about this, but meanwhile: what alternate locations are easiest? I heard about the butt, but not being in Cirque du Soleil, how could I give myself one there? Does one not need to pinch? Are there places to avoid, or does any place where one can pinch-an-inch work?

4. Lantus. I read it can sting. Any tricks to avoiding this? (The sting is not the issue as much as its impact on needle phobia)

5. My hope was to be able to get away with Lantus only - and for two days - and manage the rest of the time without insulin. I was even hoping not to have to bolus, but based on my experiment that does seem unrealistic. Still, hoping only to bolus for two days, and my pathology about needles is so severe that I know I'll choose not to eat over injecting unless starving! That said, in time, I'm expecting to get over this hump.

6. Novolog. She said if my bg was between 80-150 to use 2u - if 151-200 4u - if 201-250 6u - and on from there. If my bg is let's say around 100-110 with the Lantus, and I'm eating a lunch with practically zero carbs, would I really need to bolus? (I understand all this will take experimentation ... just seeking informed opinion/guesses)

Thanks for reading and any feedback. Looking forward to the day when insulin is not such a mystery ...

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids


Last edited by moon; 02-21-2016 at 19:25.
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Old 02-21-2016, 19:46   #2
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((((Moon)))) So sorry about your new diagnosis and troubles. I take inhaled and nasal spray steroids for asthma/allergies. I'm pretty sure they contribute to my difficulty keeping bg in "normal" non-diabetic range although I am managing to stay well under 140 after meals, usually under 120. Also I don't take insulin at this point so I only know what I've read which is not much. Sorry I can't help, but you do have my thoughts and prayers.

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Old 02-21-2016, 20:12   #3
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((((Moon)))) I can't help re the steroids or insulin, but I will keep you in my thoughts and prayers. I am so sorry you have to go through this.

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Old 02-22-2016, 15:51   #4
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Ok. I have a few things in common with you, maybe some of those will help.

Steroids stimulate and stress the adrenals which then cause BG to rise, especially if you eat too near using them. If you can separate the steroids and food by a couple of hours or overnight.

You can support the adrenals with extra vitamin C and Vitamin K, both of those help reduce the effects of steroids. I drink the juice of a lemon and have a really large mixed greens salad or stir fried kale/stinging nettles.

4mm is the smallest needle available to the general public, hospitals do have 3mm. You could look into a really nice piece of technology, ideal for us needlephobes, the insulin jet injector, they work similarly to the 'hypo' spray in Star Trek and are needle free.

I really couldn't tell you how 10u would effect you personally there are a lot of variables muscle tone, fat ratio, activity level and metabolic rate, sorry. However Bernstein does have a chapter which helped me out, Chapter 18 on Simple Insulin Regimens.

Other injection locations which most of us ladies have some fat on, are the triceps batwing just under your arm and your inner thighs.

Sorry can't help on the bolus either it works differently for me, and I do my workouts straight after eating which helps.

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Old 02-23-2016, 13:45   #5
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(((moon!)))

I am diet controlled. So, no real help here.

I did find this explanation of different methods of insulin dosing.

Have you considered asking the endo if you could begin with just the Basal dose, then escalate to Bolus if Basal is not enough?

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avg BG: 90 - 95 before meals, 100 - 110 one hour PP, 95 2 hours PP

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Old 02-23-2016, 16:43   #6
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Quote:
Originally Posted by Auntyjuju View Post
If you can separate the steroids and food by a couple of hours or overnight.
Oh how I wish. The steroid is a huge dose and lasts 2-3 days, spiking me something like 70-80 points even with calorie restriction and near zero carbs.

Quote:
Originally Posted by Auntyjuju View Post
You can support the adrenals with extra vitamin C and Vitamin K, both of those help reduce the effects of steroids. I drink the juice of a lemon and have a really large mixed greens salad or stir fried kale/stinging nettles.
Thanks, I'll try this. Fortunately, my diet is high in greens and kale, and I've started freezing fresh lemon and lime juice in trays so to have ready cubes.

Quote:
Originally Posted by Auntyjuju View Post
4mm is the smallest needle available to the general public, hospitals do have 3mm. You could look into a really nice piece of technology, ideal for us needlephobes, the insulin jet injector, they work similarly to the 'hypo' spray in Star Trek and are needle free.
This sounded awesome! - until I learned it's basically not available in the US. There is also an issue of sterilization, and since my immune system is so compromised now, that's a bit of a concern. But - it seems brilliant.

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 02-23-2016, 16:49   #7
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Quote:
Originally Posted by gotsomeold View Post
Have you considered asking the endo if you could begin with just the Basal dose, then escalate to Bolus if Basal is not enough?
I'm seeing a diabetes educator this morning - to get answers to some more questions and hopefully help as I try to get over the needle hurdle.

Am thinking I'd like to start on basal in the AM vs PM so I can test test test and better monitor the impact. Maybe it will be possible for the two days steroids really slam my bg, to exercise calorie restriction and near-zero carbs, and use bolus only for those times when I truly need/want to eat a regular meal.

I suspect the needle issue will become tolerable in time.

Just need to get over this hump!

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 02-23-2016, 16:57   #8
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Hope it goes well for you, Moon.

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Old 02-23-2016, 19:22   #9
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I have the edge of claustrophobia. Hence I can kind of understand the way needles must make you feel. Still, when the kitten was trapped and crying in the crawlspace under the house, I went in and rescued it.

I believe you can do this! Glad you are seeking more input and information.

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LCHF diet-controlled T2
DXd myself with PP BG over 270
DX 12/13 with A1C 5.9
8/26/14 HbA1c 5.5
avg BG: 90 - 95 before meals, 100 - 110 one hour PP, 95 2 hours PP
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Old 02-23-2016, 19:26   #10
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Quote:
Originally Posted by moon View Post
I'm seeing a diabetes educator this morning - to get answers to some more questions and hopefully help as I try to get over the needle hurdle.

Am thinking I'd like to start on basal in the AM vs PM so I can test test test and better monitor the impact. Maybe it will be possible for the two days steroids really slam my bg, to exercise calorie restriction and near-zero carbs, and use bolus only for those times when I truly need/want to eat a regular meal.

I suspect the needle issue will become tolerable in time.

Just need to get over this hump!
We'll be here waiting to hear how it is going.

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