[Jeremymc1]

I posted this under Introduce Myself, thought I should post in the right place :smile:

I am a newly diagnosed T1 and am on Lantus (5 units per night right before bed) and Novolog (now 1 unit per 15g carbs - was 1:20, but that was not helping).

Went to bed last night with BGL at 104. No food for two hours before bed. Woke up this morning at 114. Had a cup of tea with two packets of Stevia and a splash of Soy milk. Two hours after waking, BGL 132. What the heck?

So, my question is, do I up my doseage of my Novolog with my breakfast to bring my BGL down? As I have not had my Novolog this morning, it would not be stacking.

Also, I am taking my Novolog about 20 minutes before I eat. Yet an hour or two after I eat, my BGL is consistantly up 20-30 points. Eventually, as in 4 hours or more, it starts coming down. Any ideas?

Any advice is appreciated!

Thanks,

Jeremy

 

[breezeonby]

I posted this under Introduce Myself, thought I should post in the right place :smile:

I am a newly diagnosed T1 and am on Lantus (5 units per night right before bed) and Novolog (now 1 unit per 15g carbs - was 1:20, but that was not helping).

Went to bed last night with BGL at 104. No food for two hours before bed. Woke up this morning at 114. Had a cup of tea with two packets of Stevia and a splash of Soy milk. Two hours after waking, BGL 132. What the heck?

So, my question is, do I up my doseage of my Novolog with my breakfast to bring my BGL down? As I have not had my Novolog this morning, it would not be stacking.

Also, I am taking my Novolog about 20 minutes before I eat. Yet an hour or two after I eat, my BGL is consistantly up 20-30 points. Eventually, as in 4 hours or more, it starts coming down. Any ideas?

Any advice is appreciated!

Thanks,

Jeremy

I don't know how long you have been on Novolog, but if you have enough readings that show a spike towards 4 hours after eating, then you could try taking your insulin earlier than 20 minutes before you eat, try checking with your doctor before you do this.

 

[Richard157]

Jeremy, I need 1 unit of insulin for every 4 carbs I eat for breakfast. that is called a 1:4 insulin:carb ratio. I tend to go much higher after breakfast than with my other meals. I think you are experiencing some late "dawn phenomenon". Are you familiar with that? It usuall occurs befor getting up in the morning, but it can still be occurring for some people after breakfast. That is especially possible if you are an early riser. It has happened to me in the past.

Do you know how much one unit of fast acting insulin will lower your BG? You could take an appropriate amount of insulin befor breakfast to prevent that 132 from happening, and give you a more reasonable number. Your choice.

 

[Jeremymc1]

Jeremy, I need 1 unit of insulin for every 4 carbs I eat for breakfast. that is called a 1:4 insulin:carb ratio. I tend to go much higher after breakfast than with my other meals. I think you are experiencing some late "dawn phenomenon". Are you familiar with that? It usuall occurs befor getting up in the morning, but it can still be occurring for some people after breakfast. That is especially possible if you are an early riser. It has happened to me in the past.

Do you know how much one unit of fast acting insulin will lower your BG? You could take an appropriate amount of insulin befor breakfast to prevent that 132 from happening, and give you a more reasonable number. Your choice.

Thanks Richard. Yep, I am familiar with the "dawn phenomenon". I was thinking that it might be that as well. I do get up around 6am every day. I was started out with 5 units of Lantus before bed and 1:20 insulin:carb ratio. I found that this did not really do anything for me. I adjusted to 1:15 and am now doing 1:10. Maybe I am not clear how the insulin should work...I take my Novolog before I eat, now about 10 minutes. Even if I barely have any carbs, like salmon and asparagus for dinner, my BGL will spike and not come back down for 4 hours. Is that normal? For instance, as an experiment I took 8 units with my dinner tonight. Asparagus, salmon patty (with a trace of panko) and water to drink. BGL went from 104 to 142 within an hour. The salmon patty has about 6 grams of carbs, the asparagus about 6 grams (9 spears) for a total of 12 grams. As I wanted to be closer to 80 BGL, I included some correction (I was told 1:25 but again, the high ratios do nothing for me) so count a unit for that. Based on my 1:10 ratio, that is 2 units, which leaves 6 extra units. We will see if I head south a bit faster. Early this morning, before breakfast, I took in 6 units to correct a 121 reading (quite a bit more than my prescribed dose). I had eggs for breakfast and water. Spiked up to about 148 then finally back down to 111 four hours later (I tested every hour).

I am thinking either I have a bit of insulin resistance or I need to up my insulin intake. One last thing, I do have a cold, was bad yesterday, but feeling better today. I have not exercised for two days. No medicine like Nyquil or Dayquil today (which has high fructose corn syrup).

Thanks for your advice!

Jeremy

 

[breezeonby]

Thanks Richard. Yep, I am familiar with the "dawn phenomenon". I was thinking that it might be that as well. I do get up around 6am every day. I was started out with 5 units of Lantus before bed and 1:20 insulin:carb ratio. I found that this did not really do anything for me. I adjusted to 1:15 and am now doing 1:10. Maybe I am not clear how the insulin should work...I take my Novolog before I eat, now about 10 minutes. Even if I barely have any carbs, like salmon and asparagus for dinner, my BGL will spike and not come back down for 4 hours. Is that normal? For instance, as an experiment I took 8 units with my dinner tonight. Asparagus, salmon patty (with a trace of panko) and water to drink. BGL went from 104 to 142 within an hour. The salmon patty has about 6 grams of carbs, the asparagus about 6 grams (9 spears) for a total of 12 grams. As I wanted to be closer to 80 BGL, I included some correction (I was told 1:25 but again, the high ratios do nothing for me) so count a unit for that. Based on my 1:10 ratio, that is 2 units, which leaves 6 extra units. We will see if I head south a bit faster. Early this morning, before breakfast, I took in 6 units to correct a 121 reading (quite a bit more than my prescribed dose). I had eggs for breakfast and water. Spiked up to about 148 then finally back down to 111 four hours later (I tested every hour).

I am thinking either I have a bit of insulin resistance or I need to up my insulin intake. One last thing, I do have a cold, was bad yesterday, but feeling better today. I have not exercised for two days. No medicine like Nyquil or Dayquil today (which has high fructose corn syrup).

Thanks for your advice!

Jeremy

Jeremy, you might learn a lot from a book by John Walsh called "Using Insulin". I have learned so much from that book. I rarely test 4 hours after eating since my blood sugar drops quick with Novolog and my 2 hour test is usually under 100. I do test new foods with a 2 & 4 hour test. I have gastroparesis and I do have some foods that do digest very slow and this causes a concern and that is where the 4 hour test helps me. If I had a pump that could soften the blow of the gastroparesis. If I were you I would start using a different IC ratio. Most doctors are comfortable with a 2 unit increase with the rapid acting insulin, that is with MDI but since you have a pump you can probably use smaller increases. Good luck and let us know if an increase works.

 

[Jeremymc1]

Jeremy, you might learn a lot from a book by John Walsh called "Using Insulin". I have learned so much from that book. I rarely test 4 hours after eating since my blood sugar drops quick with Novolog and my 2 hour test is usually under 100. I do test new foods with a 2 & 4 hour test. I have gastroparesis and I do have some foods that do digest very slow and this causes a concern and that is where the 4 hour test helps me. If I had a pump that could soften the blow of the gastroparesis. If I were you I would start using a different IC ratio. Most doctors are comfortable with a 2 unit increase with the rapid acting insulin, that is with MDI but since you have a pump you can probably use smaller increases. Good luck and let us know if an increase works.

Thanks Breezeonby. Yes, reading that book is on my to do list! As I have made adjustments with my IC ratio, I would test hourly, first hour, second hour, third, then fourth. My point is that it has been taking four hours for it to come down. By the way, I am not on a pump . I went from 1:20 and am now down to about 1:10 (even trying 1:5). As I said in my last post, my pre dinner BGL was 111. I took 8 units of Novolog. Had a small dinner with 12 carbs. One hour later I was at 143. One more hour and it came down to 104. I am happy with that, but it took way more than my 1:10 ratio . More like 1:2. One question I have is if maybe I need to bump up my Lantus dose at night (currently 5 units before bed). Or take it first thing in the morning.

Thanks,

Jeremy

 

[breezeonby]

Thanks Breezeonby. Yes, reading that book is on my to do list! As I have made adjustments with my IC ratio, I would test hourly, first hour, second hour, third, then fourth. My point is that it has been taking four hours for it to come down. By the way, I am not on a pump . I went from 1:20 and am now down to about 1:10 (even trying 1:5). As I said in my last post, my pre dinner BGL was 111. I took 8 units of Novolog. Had a small dinner with 12 carbs. One hour later I was at 143. One more hour and it came down to 104. I am happy with that, but it took way more than my 1:10 ratio . More like 1:2. One question I have is if maybe I need to bump up my Lantus dose at night (currently 5 units before bed). Or take it first thing in the morning.

Thanks,

Jeremy

Jeremy, I thought you were on the pump, :sorry: Your blood sugar seems to be coming down in a timely manner with your 1:2. I would take more Lantus at night, but only 2 units increase to start with and you need to allow 3 days to pass before increasing it anymore. Try that first and see what happens.

 

[Richard157]

You do seem to have insulin resistance. I have had that problem since 1998, and have to use ratios like 1:4 at breakfast and 1:6 the rest of the day. My insulin resistance was caused by weight gain. Are you overweight? That is the most likely cause of the resistance. I lost all but 8 pounds of my extra weight, but i will always have the insulin resistance. I have to take a type 2 med along with my insulin to deal with the resistance. You would probably benefit from a type 2 pill, like Metformin. I hope you will ask your doctor about insulin resistance. I cannot think of any other explanaton for needing a ratio like your 1:2, except insulin resistance.

 

[Jeremymc1]

You do seem to have insulin resistance. I have had that problem since 1998, and have to use ratios like 1:4 at breakfast and 1:6 the rest of the day. My insulin resistance was caused by weight gain. Are you overweight? That is the most likely cause of the resistance. I lost all but 8 pounds of my extra weight, but i will always have the insulin resistance. I have to take a type 2 med along with my insulin to deal with the resistance. You would probably benefit from a type 2 pill, like Metformin. I hope you will ask your doctor about insulin resistance. I cannot think of any other explanaton for needing a ratio like your 1:2, except insulin resistance.

Thanks Richard, I will definitely talk to my doctor about that. I do have a question for you. What does your corrective dose look like?

Thanks,

Jeremy

 

[Jeremymc1]

You do seem to have insulin resistance. I have had that problem since 1998, and have to use ratios like 1:4 at breakfast and 1:6 the rest of the day. My insulin resistance was caused by weight gain. Are you overweight? That is the most likely cause of the resistance. I lost all but 8 pounds of my extra weight, but i will always have the insulin resistance. I have to take a type 2 med along with my insulin to deal with the resistance. You would probably benefit from a type 2 pill, like Metformin. I hope you will ask your doctor about insulin resistance. I cannot think of any other explanaton for needing a ratio like your 1:2, except insulin resistance.

Sorry, did not answer your other question Richard. Yes, I could stand to lose more weight. I was diagnosed on Feb 10th of this year weighing in at 235 lbs. Today, I am at an even 220. I am 37 years old, about 5"10. I think I still have about 20-30 lbs to lose. I am exercising now and am sticking to a low carb diet, so I am confident that I will get there.

Thanks,

Jeremy

 

[Richard157]

Jeremy, you need to lose a lot more than 30 pounds. I am 6' 2" and weigh 215, and I need to lose 15 pounds. i suspect that you have IR (insulin resistance). A type 1 with IR is called a double diabetic and must take a type 2 med to handle the IR.

One unit of fast acting insulin lowers my BG 12 points. So if I am 150 and want to drop to 100, then I take the difference (50) and divide by 12 and get roughly 4. So I bolus 4 units as my correction. If I still had some insulin on board from a previous bolus, I would subtract that from the correction bolus.