Another question

i keep reading that people are correcting their blood sugar levels when they see they are high..even as little as 2 hours after eating.  according to my endo i shouldnt even test at that point, and i have been told to not give myself any extra insulin unless i am high at meal times only.  my question is...should i seek another endo?

it just seems that so many people making changes to their levels shows that it is a necessary thing to do when you test high, but i keep getting a no from my doctor.  i tend to test anywhere from 221-300 2 hours after breakfast no matter what i eat, yet im still told not to give myself any more insulin.  this concerns me after some of the things i have read about ketones.

i am also concerned that i am told to still take my regular doses of insulin even if i have trouble getting my sugar up.  like tonight, i have crashed twice since dinner but i am suppose to take more insulin at bedtime???  beginning to wonder if i need to get a new doctor.

Each diabetic is pretty different with how they treat highs/lows. I generally wait until the 2.5 mark to test, unless I'm REALLY high and I know it's because I didn't take enough to cover my carbs at the previous meal or if I realized I forgot to bolus for a snack or some candy I ate. Different food also spikes your blood sugars differently. Some of your food will spike and then come down within half an hour, some an hour and a half later, etc.

If you test 221-300 2 hours after, but your blood sugar levels out an hour or so later, it's probably because of the food you eat at breakfast.

Also, if I'm reading your bio right, you've only been diagnosed for a month? The honeymoon period can be messy..some people still have insulin producing a bit, some don't.

When you say your endo tells you to keep taking your bedtime dose even if you drop, are you talking about short acting(ie Novorapid) or long acting(ie Lantus)? Even if I'm low at night, I take my long acting because that's what will get you through the night and keep you from spiking really high overnight. I don't see why you'd be taking short acting before bed unless you're having a snack.

Your endo is probably worried about something called "stacking". This is where you add more insulin when you still have some insulin on board. When you add more after eating and a bolus depends on how well you know yourself. I know that my humalog peaks at about the 1 hr and 45 minute mark and is gone by hour 3. So if I test high at the 2 hour point, I would usually take about half of what my insulin sensitivity factor required and that would then bring me down to normal before my next meal. Again, how you work this depends on your digestion, how long insulin lasts in your system, and how often you test. You will get a feel for it though if you put the work in.

As for the new doc, you have to decide how comfortable you are with this one. You have to make sure though that you educate yourself and have a frank, peer to peer discussion with the doctor. If you don't get the help and info that you need, then I would suggest that you move on.

 

Cora

Batts is correct.  In the morning sometimes the insulin doesn't work the same as it does after you have been up and in operation all day.  I get high bs after breakfast but it crashes down after about 2 hours.  If I took extra insulin because of my post breakfast high, no doubt I would have an insulin reaction!  It is a roller coaster ride.  300 is pretty high.  Maybe a symalin shot might help.  You might ask your endo about that.  

Tonya, what was your test result before you ate breakfast? Do you use carb counting to determine your premeal insulin dosage with fast acting insulin? I am assuming you are using two types of insulin. Is that correct? I need 1 unit of fast acting insulin for every 6 carbs, before all my meals and snacks.

Hi,

I was similar when I was first diagnosed. My educator told me not to correct because I may double up or stack and then over correct and go too low. Once I started on the pump I now correct as the pump is more sophisticated and adjusts based on how much active insulin is left based on my initial bolus for the meal.

My endo recently told me that they are getting other T1D's who are on shots to correct but they do it cautiously.

Anyway, I think it is that the take a cautious view on it, particularly in the initial stages. If you are running high too often you may want to discuss this with your endo to work out the best approach for you, everyone is different. Your endo should be able to explain these things further for you.

Hope that helps.

thanks for the input all.  as for taking insulin versus how many carbs...have no idea how to do that..i was told 1800 cal diet and make sure i have 4 carbs per meal and 1-2 per snack.  guess they are starting me on the no brainer diet..although i dont know if im hitting 1800 or not.  i was never good at counting calories.  i think i need to refigure out my carbs since some carbs come from starch and veggie...think i may be using too many starches which could be why i crash..but i make sure i have no more than 4 carbs total at a meal.  hard to do the snacks though.

i use humulin at bed and the r at dinner.   use both at breakfast then only use the r at lunch if needed.  i have found that cereal and toast definately raise my levels...even cheerios...even though the label on the box says it should be ok.

i meant why i spike not crash lol

It sounds like you need to talk to a dietitian. For someone not used to counting carbs and calories, this can be super overwhelming. I know people who have no idea what the difference between a protein and a carb is, simply because they have never needed too. Figuring out how different foods affect your blood sugar is quite a process.

Personally, I never count calories, it doesn't do you any good when trying to determine how much insulin to take. My blood sugar always tends to swing up about an hour after I wake up, whether I eat anything or not. I am on a pump, so I can adjust my basal to fix it. I wouldn't stress too much about this yet, since you are so new to all this, which can also be spiking your blood sugar, as if you didn't have enough to deal with, lol. Once your body calms down a bit, your endo will be able to work on fine tuning how much insulin you take, they are probably just being cautious because they don't want you to go low and pass out somewhere.

Best of luck!

You are on a fixed carb diet - meaning you eat the same amount of carbs at every meal and snack and take the same amount of insulin. You don't have the flexibility we have, at least not yet. After a few weeks, they will usually ease up and let you choose how much to eat.

The 1800 calorie ADA diet doesn't mean you are counting calories. What it means is that the amount of carbs you are told to eat at every meal and snack is based on a 1800 calorie diet, but you are still counting carbohydrates. Eating 4-5 carbs at meals means you are eating a total of 60-75g at meals and 15-30g at snacks. If you consistently eat this many carbohydrates, your total calorie intake for the day will typically fall around 1800.

There are many ADA diets - 1800 being the most common because it kind of falls in the middle where almost everyone can use it.

And to add my 2 cents... to what C added... The exchange diet you are on, eating 4-5 carbs as C says means 60 to 75 carbs.  You can find carb listings on just about every package you buy at the grocery store.  They tell you how many carbs are in a serving and the serving side.  I drive my wife crazy digging through the trash looking for the packages she has used to make a meal so that I can count.  It is quite humorous, but it does work.  I used to be on the ADA Exchange diet but my endo said to switch to carb counting because as long as I eat a balanced meal the carbs are all that I really am concerned with.  Good Luck.  You will figure it out.  Probably gonna take some time.  

They started Riley out on a foxed carb diet. She had to eat at the exact same times every day too cause on top of it they started her on NPH. I think its a really stupid thing to do to people period. Carb counting is easy adjusting ratios is easy. I do Riley every two hours during the day and she has yet to have a low from it. Even when she eats breakfast then checks at 2 hours does a correction with no food then two hours later she will still be high. She seems to be easing out of her hormonal period for this month so her numbers are starting to go down but since June 13th she has gone through 4 pens and we are about to open the 5th. She had two bad hormonal times. That lasted about 2 weeks each and she seems to have little to no reaction to insulin at all unless I stack it. By dinner time she is a ok number maybe just under 200 and shoots up again after that. Once the hormones seem to go away her numbers are good and I dont need to test her every two hours.

[quote user="Dan"]

Maybe a symalin shot might help.  You might ask your endo about that.  

[/quote]

She was just diagnosed and isn't even on carb counting yet, so I think it's too early to think about symlin. It would add another learning curve factor right now.

To answer your original question, your current care is simple and "old-fashioned" probably b/c you're just getting adjusted. But, if you are on the same plan (fixed diet, R) in a few months, I'd look for a new endo. I also agree that seeing a dietitian (some are also CDE's / diabetes educators) is helpful as you're starting out.

You absolutely can do it, and soon it will be as automatic as brushing your teeth.

Only a few months ago, the idea of figuring out the carbs in everything my daughter ate was really intimidating. My biggest issue (because I'm a bit on the analytical side) was that it's hard to figure out the carbs perfectly, especially if you're serving a cooked meal. Now we know that close is usually good enough because if she's having anywhere from 20-35ish grams of carbs, I'm going to give her the same amount of insulin, so I have some wiggle room...

My ten year old daughter just called me a few minutes ago because they are making rice crispy treats at her daycare this afternoon. Before she called me, she used the packages to figure out that a serving of rice crispies and marshmallow would be about 25 grams of carbs. She likes to confirm with me before she eats, but it's becoming easy for her to figure out the carbs in cooked meals.

You will soon be a label reading expert!

[quote user="Michelle"]

You absolutely can do it, and soon it will be as automatic as brushing your teeth.

Only a few months ago, the idea of figuring out the carbs in everything my daughter ate was really intimidating. My biggest issue (because I'm a bit on the analytical side) was that it's hard to figure out the carbs perfectly, especially if you're serving a cooked meal. Now we know that close is usually good enough because if she's having anywhere from 20-35ish grams of carbs, I'm going to give her the same amount of insulin, so I have some wiggle room...

My ten year old daughter just called me a few minutes ago because they are making rice crispy treats at her daycare this afternoon. Before she called me, she used the packages to figure out that a serving of rice crispies and marshmallow would be about 25 grams of carbs. She likes to confirm with me before she eats, but it's becoming easy for her to figure out the carbs in cooked meals.

You will soon be a label reading expert!

[/quote]

Yes Riley figures out her carbs too in most everything I cook. Somethings I still have to work at like casseroles and soups. Well not that it is hot I do not make them and she really doesnt like many that I make anyhow but its a little tricky.

[quote]

Yes Riley figures out her carbs too in most everything I cook. Somethings I still have to work at like casseroles and soups. Well not that it is hot I do not make them and she really doesnt like many that I make anyhow but its a little tricky.

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I know what you mean about casseroles and such, those are tricky. I don't make a lot of that type of food, but when I do I usually look for a recipe online that has the carb count already figured. Or, for things like my lasagne (which comes out of a very old cookbook), I look for another recipe online that has reasonably similar ingredient and the carbs figured. So far this has worked well for us. Sarah has been wanting my mom to make her this really yummy tuna cassarole recipe that's been around forever. The recipe includes such healthy foods as lays potato chips. I haven't found anything close enough to figure out the carbs on that one...

[quote user="Michelle"]

 

[quote]

Yes Riley figures out her carbs too in most everything I cook. Somethings I still have to work at like casseroles and soups. Well not that it is hot I do not make them and she really doesnt like many that I make anyhow but its a little tricky.

[/quote]

I know what you mean about casseroles and such, those are tricky. I don't make a lot of that type of food, but when I do I usually look for a recipe online that has the carb count already figured. Or, for things like my lasagne (which comes out of a very old cookbook), I look for another recipe online that has reasonably similar ingredient and the carbs figured. So far this has worked well for us. Sarah has been wanting my mom to make her this really yummy tuna cassarole recipe that's been around forever. The recipe includes such healthy foods as lays potato chips. I haven't found anything close enough to figure out the carbs on that one...

 

lol yeah I am sure that is hard. I do a mexican lasagna she loves I am sure I could find a recipe online that is close but thanks cause I didnt think of even trying for something like that.

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One really great tool I have found is this website: http://caloriecount.about.com/cc/recipe_analysis.php

It analyzes a recipe for you and gives you nutritional information, so it take a little of the guesswork out. 

I seem to remember that you're using Humalin and R?  Is that correct?  Those are different insulins than most of us take, so corrections may be a very different story for you.  I don't know.

Did you ever talk to him about the option of Lantus and Novolog?  Did the cost turn out to be too high?  (I'm remembering that don't have insurance that covers insulin, right?)  If he said Lantus and Novolog aren't the insulin's he wants you do use, a second opinion certainly couldn't hurt!

Actually, second opinions rarely hurt in any case!