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Discussion Starter · #1 ·
Guys,

I need some help for my mom.

She's been a diabetic for last 25 years. She's on insulin and needs to loose 40lbs. Luckily no complications so far. But her BGs have been over 250 for a while. Her current medications include metformin, Januvia, supplements and the following insulin

1. With meals fast acting (novarapid) = 16 units x 3 times
2. long acting (i think levemir) at night (once) = 16 units

I've tried to replicate my low carb high fat diet on her. Her numbers have come down. For example we are seeing most readings in the 100s and some post meal numbers in the 80's and 90's. Which is excellent.

My problems/questions are

1. Since most of her premeal numbers are higher than post meal numbers I think we can reduce the meal time insulin doses, right ?

2. Though she sleeps around 100 every night, fasting numbers are very high. Last few fasting numbers were 230, 212, 185, 175, 211. She is getting frustrated with the fasting numbers, If this continues I don't think the will last on this diet.

3. I have to get her fasting numbers down. I know this appears to be DP but If I don't help her get these down I will not be able to convince her to stick on this diet. Can you suggest some quick fixes that show atleast some improvement ?

4. One of the things I am thinking is to ask her to reduce 2 units from her dinner shot and add it to the the bedtime(long acting) shot. But I'm scared of pushing her into a hypo

Your advice or comments are welcome

Tony
 

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Have you tried asking her to walk for 30 mins to 1 hour at night after dinner?

The 30 mins to 60 mins walking at night does help in morning fasting sugars levels.

Some of my Diabetes support group members do that every night..

The group members I am with are age between 55 to 73 yrs old and they walk every night 30 mins and morning 30 mins..
 

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Discussion Starter · #3 ·
Have you tried asking her to walk for 30 mins to 1 hour at night after dinner?

The 30 mins to 60 mins walking at night does help in morning fasting sugars levels.

Some of my Diabetes support group members do that every night..

The group members I am with are age between 55 to 73 yrs old and they walk every night 30 mins and morning 30 mins..
But last night she slept at 90 and woke up at 212
 

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But last night she slept at 90 and woke up at 212
IT happens to us that sometimes like : stress, anxiety, other meds involve, depression etc etc.. Does she walks after Dinner? and sometimes out meals takes longer to digest up to 4- 6 hours depending on the person's body.

Is she taking other meds than the ones you mentioned?
 

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Is she on a sliding scale on her meal time insulin or does she count the specific carbs and adjust her insulin accordingly? Also the higher morning numbers could be DP or it could be Somolgi effect caused by going too low and a huge rebound. Have her wake up several times during the night and record her bg. Have you read Dr Bernsteins's book Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site He has a whole chapter on Insulin. He advises splitting long acting insulin. I think he even splits his in 3 shots to avoid those morning jumps. Also different insulins may peak at different times, so sometimes changing insulins may be an option. Everyone is going to need a different amount of insulin to achieve good bg control. On first look with your moms's higher pre meal numbers it leads me to believe that her basal may be too low.
 

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Discussion Starter · #6 ·
IT happens to us that sometimes like : stress, anxiety, other meds involve, depression etc etc.. Does she walks after Dinner? and sometimes out meals takes longer to digest up to 4- 6 hours depending on the person's body.

Is she taking other meds than the ones you mentioned?
I just went through her stuff.

She has Januvia, Zyltan (losartan pottasium), Aspirin delayed release in her huge but not very effective arsenal (other than the insulin)
 

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Discussion Starter · #7 ·
Is she on a sliding scale on her meal time insulin or does she count the specific carbs and adjust her insulin accordingly? Also the higher morning numbers could be DP or it could be Somolgi effect caused by going too low and a huge rebound. Have her wake up several times during the night and record her bg. Have you read Dr Bernsteins's book Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site He has a whole chapter on Insulin. He advises splitting long acting insulin. I think he even splits his in 3 shots to avoid those morning jumps. Also different insulins may peak at different times, so sometimes changing insulins may be an option. Everyone is going to need a different amount of insulin to achieve good bg control. On first look with your moms's higher pre meal numbers it leads me to believe that her basal may be too low.
I have ordered the book online. I am aware of the DP and Somolgi effects. I am thinking of making her have an omlette just before she sleeps (protein). Do you think that'll work, atleast a bit ?

I've convinced dad that all of us will go for a walk after dinner.

Lets see
 

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Discussion Starter · #8 ·
She's slept at 140 after taking 16 units of her Levemir (increased it by two units) I made her take a walk tonight and she had a spoon of peanut butter before she slept. Hoping for something better in the morning
 

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Tony, would it be possible for you to have a talk with your mom's doctor and let him or her know what is going on with her? The doc might want to adjust her meds and/or insulin.
 

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Discussion Starter · #10 ·
Hi
Just wanted to update you guys. Mum's fasting was 178 today which is better than last several days. She had slept at 141 last night.

Her lab reports came back yesterday. HbA1c came at 8.0. Not that bad since I was expecting over 10. All other numbers like lipids, kidney,liver etc were in range

We are meeting her doc on Saturday
 

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Good to hear on that Tony, I wish every thing good for her and you!! have she started to walk at night the last few days in showing those 178 and 141?
 

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Discussion Starter · #13 ·
Guys finally some improvements on my mom's fastings last few days are as follows

145
150
136
135 (slept at 123)


This is definitely a big improvement from the 200's she had a few weeks back. Post meals are mostly always under 140.

Some more improvements are needed.

I got her diet changed to lowish carb. I think I have her to nearly 100-150 carbs per day which is much lower than earlier. She's not happily adding fats (because of the anti-fat mindset). But I think her HbA1c will drop in another 2 months and will motivate her further

I have not been able to get her to do heavy exercise but she is becoming more active. I made sure that on most days she does not sleep for upto 2-3 hours after her meals and walks around.

If her post meals numbers continue to be in the 120's or lower we might reduce 1-2 units from her meal time insulin shots
 

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Well done - it is not an easy path leading others to the light ;-)
 

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Novorapid is not just for mealtimes, it also works to correct your glucose. While you are trying to fix the fasting numbers, it would also help to take some fast acting first thing in the morning to get those numbers down.

Counting carbohydrates and using an amount of rapid insulin proportional to the amount of carbohydrates she eats is work, but that is how to get the best results after eating.

I don't know what is possible for you.

Best wishes,

-Lloyd
 
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