Hi, long answer short <g>

Bev, I'd like to see you communicate with your doctor every day or every
other day so that your numbers will come down a bit each day, rather
than waiting until...when?   Have him suggest a new regimen that gets
you into the target zone.  You should be getting decent control in under
a couple of weeks, at the outside.  Make sure you have Glucotabs for
lows, have one or two Glucagon kits and make sure a trusted person knows
how to use the kit.  Detailed instructions are inside and you should go
over them with that person.

If you are taking 8U + sliding scale, that doesn't do much good if you
are eating an amount of carbs that isn't covered by your insulin.  Is
this doctor an endo?

Dave

Realizing that you're a Type 2 and I'm a Type 1, nevertheless it seems
to me that the missing piece of the puzzle (as you describe your
regimen above) is estimating the amount of carbohydrates you're eating
at each meal. The adjustment for your BG reading is good, but the flat
8 units should also be adjusted, based on the carbs. The actual dosage
per grams of carbs should be worked out with your doctor or diabetes
educator. My control improved quite a bit after I began estimating
carbs and adjusting the insulin accordingly.

You said you were controlled with diet and exercise only for "a while", but
didn't say how long. When you lost control you tried meds, all different
types and they didn't work.

You could be an adult onset type 1 or LADA. Both are often misdiagnosed as
type 2. There are test your doctor can perform to determine if this is the
case.

In the meantime, you should be testing for ketones.  You could be in danger
of  diabetic ketoacidosis (DKA). DKA is a life threatening condition.

Sarah

Beverly wrote in message ...

". . . .My regimen is 8 units + 1 unit for ever 40 over 120 of fast acting
insulin before meals and 25 units of long-lasting insulin at
bedtime . . ."

   My regimen is:     How much do I shoot?   As much as I need
                                 How often do I shoot?   As often as I need
                                 What do I shoot?    Two modern insulins:
Humalog and Levemir

     And I tell the doc how much that is every six months.

Seriously:   The best insulin regime is some sort of variation of DAFNE or
FIT   (Dose Adjusted for Normal Eating,   Functional Insulin Therapy,
Flexible Insulin Therapy) wherein you adjust the before-meal-bolus to
accommodate both the before meal bG and the amount of carb in the meal.
You adjust your bedtime basal insulin  (Lantus I hope?)  so that if you have
a good sugar at midnight,   you have a good sugar at 7 a.m.

A conservative starting point for adjusting for carb would be 1 unit for
every 15 gram of carb.    However,  as a Type 2,  you could easily need
twice as much insulin.     Because of the Morning Effect, you could easily
need twice as much insulin for a breakfast as for a lunch.

If my 2-hour-after-eating sugar is unacceptable,  I shoot a "Corrective
Bolus" to bring it into line.   Basically,   that's 1 unit ultra-fast
Humalog for every 40 mg/dL too high but I make further adjustments if I
spike above 200.     You are Type 2 and could easily find it necessary to
shoot twice as much as I do.

Of course that means you routinely check your bG at 2-hours-after-eating and
use the information to both inject a Corrective Bolus as needed,  and to
improve your before-meal guesses at a bolus dose.

If you are stuck with the older Insulin R as a before-meal bolus the
"Corrective Bolus" trick is very difficult.   Since Insulin R is so slow,
it may just be starting to work well at 2-hours-after-eating and thus you
see a spike since your very efficient digestive system can do its job of
pouring the glucose into your blood faster than Insulin R can catch up.

I solved that problem by shooting my Insulin R up to an hour before I ate.
The modern,  ultra-fast Humalog and Novolog are much easier to deal with.

How long does it take to get into control?    I started insulin therapy with
the older Insulin R so it took me a while to get good control.  However,  I
defined 180 as "out-of-control".     I knocked out those crazy 200-300
sugars within 2 days.

Glucose Toxicity:     When my sugars are running high,  I see an immediate
Glucose Toxicity,  i.e.  an immediate need for more insulin when calculating
based on any of my standard ratios.   I literally need twice as much insulin
at 200 to move my sugars or handle food when compared to my needs at 100.
Whenever you do get a handle on this,   I suggest that your insulin needs
will also drop after you normalize.

Regular + NPH insulin:    You didn't mention your insulins.    Sorry if you
are stuck with R and/or NPH.  The older R + NPH  (Insulin R + Insulin N)
regimes are very difficult to manage.  The fast insulin, R, is so slow that
you have inject 1 hour before you expect anything serious to happen.
The slow insulin,  NPH,  is so fast that it won't last all day or night.   I
had to split my daily NPH into several small doses spaced throughout the day
to get tolerable performance.    I had to shoot my bedtime NPH as close to
midnight as possible in order to get a decent fasting bG.

Nurse CDE:   My personal opinion:  a nurse CDE  (Certified Diabetes
Educator) can beat any general doc in insulin management advice.   She does
that all day, every day,  and has the time to talk to you.    You tend to
find the CDE at the Diabetes Education departments of hospitals.    You may
have to look a bit to find a good one though my experience is that the
insulin trainers range from very good to excellent.

Umm. . .this is National Diabetes something-or-other Month which means
Diabetes Expos,  Diabetes Health Fairs,  etc being sponsored by many
hospitals.    (I am working the Diabetes Support Group table at one of our
local hospital's Fair this coming Saturday).    These functions are
generally loaded with CDE,   all available for advice on how to obtain
insulin training,  or how to get advice.   (No time to run through your
insulin experiences though,  they are working their own tables)

Regards
 Old Al

 I am a long way from normal

Beverly,

Buy yourself a copy of "Dr. Bernstein's Diabetes Solution" by Richard K.
Bernstein, M.D. and read the chapters on insulin dosing a couple times
until you get the underlying principles clear in your mind.

I ran into the same kind of lackadaisical treatment when my family
doctor put me on insulin at what turned out to be much too high a dose
and referred all subsequent questions to a nurse whose training was way
out of date.

Had it not been for Bernstein's book I'd still have no idea why I was
having hypo symptoms all the time. My endo, even if she doesn't always
have the answers does take phone calls when something disturbing happens
(like the new insulin where one shot pushed my blood pressure from
normal to 170/101) and is willing to discuss dosing options with me in
detail.

So get the Bernstein book. You probably won't want to change anything
your doctor ordered based on what you read, but reading this book will
give you a much better understanding of how insulin dosing for a Type 2
works and prepare you to ask much more intelligent questions when you
see your doctor that should hasten your ability to get control.

That said, I find your doctor's approach--charging for phone calls
between appointments VERY troubling and, in fact, likely to put some of
his patients into great danger since when something unexpected happens
they may not be able to afford to call for help.

It suggests to me that few of his type 2s will ever get to really
healthy levels of control because getting there might mean they would
have an occasional hypo that would require a phone call, so he's going
to be keeping them intentionally high.  Nice for him, not nice for the
patients, long term.

Finally, I'm scratching my head wondering about an endo who lets type 2s
stay in the 300-400 mg/dl range for any period of time before starting
them on insulin. My endo considers values over 200 mg/dl after meals in
a person who is taking full dosages of oral meds to be high enough to
justify starting insulin.

--Jenny

http://www.phlaunt.com/diabetes  Diabetes Info

http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood
Sugar Under Control