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Discussion Starter · #1 ·
I met with a dietitian yesterday for the first time. Being new to diabetes, I'm still learning and I was surprized to learn I have been doing my insulin "wrong" the past 3+ weeks. Apparently, when you are first dianosed the doctors tell you to use a reactive method, i.e. you eat, check BG 2 hours later and inject the appropriate insulin units. I've been doing this and recording all my my values/units.

Well, she moved me to being proactive, i.e. where I estimate my carb intake, do a quick calculation based on my titrated history, and then I inject myself BEFORE eating. This makes a LOT more sense to me because I've been spiking as high as 200 when I was waiting to inject.

All the past couple of weeks I've been thinking the reactive method was pretty dumb and I've been telling my wife that I don't know why I just don't inject BEFORE my meal. LOL Now, you don't have to warn me, I do realize I need to eat immediately after the inject so I don't crash. :)

I'm kind of surprized that nobody here mentioned this proactive approach to me. Are most of you proactive or reactive? :confused:
 
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I don't bolus, so let's skip that part. What I'd like to address is your Lantus dosage, how you came to that number and has that been your basal number since you were prescribed Lantus. The reason I ask is that in prescribing Lantus it's recommended, by sanovi-aventis, that the initial dosage be at least 10 units. I've found most do 'basal testing' and once that number is established they move on to dialing in their bolus amounts. You, being new to this, may be uneducated on how all that works. So...I'd like you to read this and catch yourself up a little on how to set that basal amount.

Welcome to the forum.
 

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I'm not so sure we're better served by breaking it down like this anyhow, because there are exceptions, and prob'ly more than we realize. The one I know and you know too, is our Breezeonby, whose gastroparesis requires that she bolus quite some time after having eaten, simply because her digestion is very slow and if she were to bolus before the meal, she would likely go very low.

The point is to match the two in each individual patient, since ratios and timing are crucial, and yet so different for each of us.
 

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Discussion Starter · #4 ·
I don't bolus, so let's skip that part. What I'd like to address is your Lantus dosage, how you came to that number and has that been your basal number since you were prescribed Lantus. The reason I ask is that in prescribing Lantus it's recommended, by sanovi-aventis, that the initial dosage be at least 10 units. I've found most do 'basal testing' and once that number is established they move on to dialing in their bolus amounts. You, being new to this, may be uneducated on how all that works. So...I'd like you to read this and catch yourself up a little on how to set that basal amount.

Welcome to the forum.
The Lantus units are set by my doctor. She started me at 9 units at bedtime and after seeing my morning results after the first couple of week raised it to 11 units. It seems to have done the trick, I've been waking up to BG of about 90-100 whereas it was 150-200 with 9 units at bedtime.

Thanks for the link! I read the article and bookmarked the website for further study. :)
 

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Discussion Starter · #5 ·
I'm not so sure we're better served by breaking it down like this anyhow, because there are exceptions, and prob'ly more than we realize. The one I know and you know too, is our Breezeonby, whose gastroparesis requires that she bolus quite some time after having eaten, simply because her digestion is very slow and if she were to bolus before the meal, she would likely go very low.

The point is to match the two in each individual patient, since ratios and timing are crucial, and yet so different for each of us.
Thanks. I guess I'm a little different and I'm going to try the doctors advice. I'm thin, I exercise, I'm active and I digest food fairly quickly. Based on some extra BG checking I've done, I can see my BG level increase in as little as 30 min to an hour after eating. It seems to peak at about 1.5-2 hours.....and that's when I've been giving myself insulin. I keep detailed notes and explained this on my visit today. I guess that's why she's putting me on this proactive approach.

They gave me a much nicer and larger notebook today. I've been using the one they that came with my first test meter and it's small. I'm hoping I can really get down to collecting really detailed data as I move along. This should help me and my doctors figure out how I'm doing. :)
 

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One of our own members has a website for diabetes journaling . . . documenting your stats & printing up charts for your doc's perusal . . . my doc has been pretty impressed with my graphs anyhow. ;)

Take Control. Free Diabetes Software, try our Blood Sugar log -- Diabetic Journal

I believe he will be incorporating meter downloading to this site, and developing a food/recipe/meal planning database as well.
 

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I met with a dietitian yesterday for the first time. Being new to diabetes, I'm still learning and I was surprized to learn I have been doing my insulin "wrong" the past 3+ weeks. Apparently, when you are first dianosed the doctors tell you to use a reactive method, i.e. you eat, check BG 2 hours later and inject the appropriate insulin units. I've been doing this and recording all my my values/units.

Well, she moved me to being proactive, i.e. where I estimate my carb intake, do a quick calculation based on my titrated history, and then I inject myself BEFORE eating. This makes a LOT more sense to me because I've been spiking as high as 200 when I was waiting to inject.

All the past couple of weeks I've been thinking the reactive method was pretty dumb and I've been telling my wife that I don't know why I just don't inject BEFORE my meal. LOL Now, you don't have to warn me, I do realize I need to eat immediately after the inject so I don't crash. :)

I'm kind of surprized that nobody here mentioned this proactive approach to me. Are most of you proactive or reactive? :confused:
Hmm...this proactive or reactive approach confuses me to. I have gastroparesis (slow digestion) and I have to take my insulin after I eat and this works best for me, as a matter of fact I can bolus up to 2 hours after eating and be ok. When I first started injecting insulin, I was injecting my insulin at mealtime and within 1 hour I was going low. I was scared to inject insulin. I then talked to my doctor and he suggested that I get tested for gastroparesis, and sure enough my digestion is rather slow. There is a medication to help speed the digestion process up, it is called Reglan, but there are side effects that can become permanent and I will live with gastroparesis before I start having uncontrolled muscle movements that last a lifetime.
 

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Hi Thad - you do not have to eat immediately after bolusing. Even the fastest insulins don't start to effect blood sugar for a minimum of 15 to 20 minutes. In my own case, doing 2/3 of my calculated bolus 20 to 30 minutes prior to eating and the balance about 30 minutes after the start of a meal really seems to match insulin availability to glucose metabolism. The only way to find this out, of course, is to test, test and test again:D.

Jen
 

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Discussion Starter · #10 ·
I'll assume you're using the Solostar 3mL pen for your 11 unit basal injections?
Yes, I think that's what it is. Just attach a needle, dial in, and done.
 

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Discussion Starter · #11 ·
Hi Thad - you do not have to eat immediately after bolusing. Even the fastest insulins don't start to effect blood sugar for a minimum of 15 to 20 minutes. In my own case, doing 2/3 of my calculated bolus 20 to 30 minutes prior to eating and the balance about 30 minutes after the start of a meal really seems to match insulin availability to glucose metabolism. The only way to find this out, of course, is to test, test and test again:D.

Jen
Roger that! I've been buring through test strips. Thanks
 
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