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Hi, everyone. Diagnosed w Type 1 (age 54) at the hospital over holidays. High glucose (590s) and ketoacidosis. (A1c 13.3) I was prescribed Levemir and Novolog, but given inaccurate instructions from the hospital about how to use Novolog and sliding scale. My endocrinologist quit her practice - and, on my own, I was feeling pretty bad for weeks... rallying from 60s in the morning to 300's at bedtime. As I tried to figure out what I was doing wrong, I googled and came across this forum. It was here that I learned about needing a ratio, that I should be taking Novolog to cover each meal, and so much more. This great resource. Knowledgeable people here helped me know what to ask and how to make sure I was really communicating with a good endocrinologist. So a big thank you for the helpful insight. In a matter of days... using the medications correctly, my numbers are stabilizing... and I feel better.
 

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Welcome

We're always glad when this forum is helpful. The collective knowledge of the members here is awesome.

Can you tell us a bit more about what your present blood glucose (BG) levels are and what kind of eating plan you are on? Helps us to know you better as a diabetic.
 

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Hi Michelle, welcome to the forum.

Type 2 here so no real life experience on the insulin to comment on. Like you, from reading on the forum, I learned that those with experience know sliding scale is not the best way to go. Correction factors, carb/insulin ratios, carb counting for bolus insulin. Also lower carbs in meals means less insulin needed to cover and less chance of a roller coaster BG.

Again, welcome.
 

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Hi, VeeJay - since starting my new Novolog instructions last Weds, blood sugar has hovered around 105 before and after meals; between 75-90 in the morning after fasting. The hospital recommended 45-60 carbs per meal; however, I have found 30-45 is better. I take 3 units of Novolog before every meal, with a sliding scale (if sugar is over 140). I've only needed it twice. I know it's just four days but I am happy to feel so much better.

I limit gluten and whole wheat (sensitive), corn, and potatoes because they send me soaring. Brown rice, whole grain pasta/bread, quinoa, steel cut oatmeal, beans, legumes are good right now, with reasonable portions.

3-4 oz meat or fish for lunch/dinner, eggs a few times a week (I'm high cholesterol), lots of non-starchy vegetables & salads. I try to get dairy across the day (vitamin D deficient) - I mix it up, greek yogurt, 2% milk, regular cheese, half-n-half in coffee. I'm not a big fruit eater - so berries and apple for snack with raw almonds mid afternoon. Lots of water!

I don't eat out often, eat at the same time every day, diligently measure and track every carb (apps are helpful).

I miss chocolate. But sugar free pudding helps a lot!
 

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The hospital recommended 45-60 carbs per meal; however, I have found 30-45 is better. I take 3 units of Novolog before every meal, with a sliding scale (if sugar is over 140). I've only needed it twice. I know it's just four days but I am happy to feel so much better.
10-15 would be even better. You could search the forum or Google for Dr Bernstein's Law of Small Numbers.

Did the hospital check you for GAD 65 antibodies before pronouncing you Type 1 ?
 

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Actually, the hospital didn't proclaim the type. I was out of state visiting my Dad and kids when I got sick. Physician said ketoacidosis, rapid onset, and no weight issues pointed to 1. Possibly 1.5, since I have other autoimmune issues. They were most concerned about C02, rapid heartbeat, kidney, and liver. Urged me to see my endocrinologist as soon as I got back home. But she left her practice. I finally got in last weds, so Labs are still coming in. What I know right now, c-peptide is low, fasting BS was 128 (on Levemir), EGFR >60 (first test) other labs are coming back. Will google Dr Bernstein's Law of Small Numbers - thank you for the information.
 

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Hi Michelle, welcome to the forum.

Type 2 here so no real life experience on the insulin to comment on. Like you, from reading on the forum, I learned that those with experience know sliding scale is not the best way to go. Correction factors, carb/insulin ratios, carb counting for bolus insulin. Also lower carbs in meals means less insulin needed to cover and less chance of a roller coaster BG.

Again, welcome.
Thank you mbuster - that is what I learned here! The sliding scale was not working for me at all. My new endocrinologist confirmed what I was gathering from everyone here. I now have a ratio to start with, count carbs, use correction factor when needed. And stabilizing. Now am realizing... less carbs will be even better. (Hope I am replying correctly to you- and appreciate the welcome.)
 

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Thank you very much for the links to the books, John (and all). Wow... do I have a lot to learn. I am very grateful for this information.
 

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10-15 would be even better. You could search the forum or Google for Dr Bernstein's Law of Small Numbers.

Did the hospital check you for GAD 65 antibodies before pronouncing you Type 1 ?
Test results just came back this morning. Positive for antibodies. I have really learned a lot from this forum and appreciate the links to literature. I lowered carbs to 20 per meal with insulin and am no longer "afraid" of fat. And I and am getting consistent (mid 90s) pre-meal blood glucose readings. The 2-hour post-meal tests still run high (140-200). Does this means I am still eating too many carbs? I cannot adequately express my gratitude for the information and advice -- the combined experience of so many has saved me months and months of stress and time trying to figure things out.
 

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Test results just came back this morning. Positive for antibodies. I have really learned a lot from this forum and appreciate the links to literature. I lowered carbs to 20 per meal with insulin and am no longer "afraid" of fat. And I and am getting consistent (mid 90s) pre-meal blood glucose readings. The 2-hour post-meal tests still run high (140-200). Does this means I am still eating too many carbs? I cannot adequately express my gratitude for the information and advice -- the combined experience of so many has saved me months and months of stress and time trying to figure things out.
yes. Way too many per meal. Cut that 20 per meal to 20 per day and you'll see lots of improvement
 

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The 2-hour post-meal tests still run high (140-200). Does this means I am still eating too many carbs?

Plus, you may need to increase your bolus insulin to cover your carbs better. It's a balancing act. Lower the carbs, lower the insulin, but increase it if it isn't keeping your BG below 140. I have read here that those on bolus insulin make small adjustments and don't readjust until 2 or 3 days later.

Good for you for taking up the challenge of managing your diabetes.
 

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The 2-hour post-meal tests still run high (140-200). Does this means I am still eating too many carbs?

Plus, you may need to increase your bolus insulin to cover your carbs better. It's a balancing act. Lower the carbs, lower the insulin, but increase it if it isn't keeping your BG below 140. I have read here that those on bolus insulin make small adjustments and don't readjust until 2 or 3 days later.

Good for you for taking up the challenge of managing your diabetes.
Thank you both for the quick reply! Currently, my doctor has me taking 3 units of fast-acting before each meal no matter what (with a correction dose, if I'm higher than 150). I'll drop the carbs even more and see what happens. "Feeling good" feels good.
 

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In the end, its up to the individual to learn to manage their diabetes. The doctors can only assist, but can't be around to interpret each meal and test.

At some point it would be good for you to determine your insulin- to- carb ratio, so that you can be more precise with your pre-meal insulin and come close to the correct dose at first, so you don't need to chase rising BG with more insulin. I'm rather surprised that your doctor or DE didn't teach you about this.
 

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Yes. I went many weeks with no doctor at all after getting out the hospital. The educators gave me a lot of diet advice, meal plans, and printouts from ADA - which I tried, but it really was not working for me. My endocrinologist stopped practicing the week I was hospitalized. So it was unfortunate timing for me. I finally found a new doctor, and the ratio we discussed was 1:15, assuming 30-45 carbs per meal (so 3 units, with a correction scale at more than 150BG). However, that many carbs can take me well above 140 two hours after eating. So I'm still in the learning stage... but you are right: "in the end, it's up to the individual to learn to manage" -- that's what I intend to do. :)
 

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