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Medical Forum / Diseases and Disorders / Diabetes / April 2008Call to nurse
I called her today and told her of the odd readings I am having. The hypo, the few normal numbers and the mostly much increased numbers since starting insulin. She wants me to do additional testing before meals and at 2:00 a.m. to see if I am having some hypos in there. She's not really sure what the problem is. She thinks maybe I need to take the insulin at some other time of day than bedtime. Guess we'll just have to wait and see. In the meantime, she said I should *not* cut back on eating carbs because that will just cause liver dumps. Grrr... I can't win. Hi Julie, Since you are having a few hypos, I can actually see the nurse's point about not cutting down on carbs. So, since she thinks you may need to take the Lantus at a different time of day, I guess that means its effect is not as "consistent" throughout the day as it was hoped it would be. Are most of your higher readings occurring later in the day? That might fit her theory...the lantus runs out the closer time it gets to when you'd take it again. However, another question is how long does it take to peak? Were you able to get a prescription for my strips?  SignatureBest regards, Michelle C., T2 diet & exercise BMI 21.5 >I called her today and told her of the odd readings I am having. The hypo, >the few normal numbers and the mostly much increased numbers since starting [quoted text clipped - 5 lines] > In the meantime, she said I should *not* cut back on eating carbs because > that will just cause liver dumps. Grrr... I can't win. > Hi Julie, > Since you are having a few hypos, I can actually see the nurse's point [quoted text clipped - 6 lines] > However, another question is how long does it take to peak? > Were you able to get a prescription for my strips? The hypo came after dinner. 2 hours after to be exact. The normal numbers were after dinner, before bed and in the morning. Was taking the lantus at 11:00 p.m. I got a prescription for the contour meter for 6 strips per day. > > Hi Julie, > > Since you are having a few hypos, I can actually see the nurse's point [quoted text clipped - 12 lines] > > I got a prescription for the contour meter for 6 strips per day. Is this a hypo every day, or a few times a week, a few times a month, ??? And how hypo? 30? 40? 50? 60? I'm not trying to draw too fine a line... but I need some numbers to relate to :-) Tim. On Apr 25, 3:26 pm, "Julie Bove" <julieb...@verizon.net> wrote: > "Michelle C" <bookb...@frys.com> wrote in message > [quoted text clipped - 16 lines] > > I got a prescription for the contour meter for 6 strips per day. Is this a hypo every day, or a few times a week, a few times a month, ??? It was just one. And how hypo? 30? 40? 50? 60? 55. Dinner consisted of a turkey and rice cheese sandwich with lettuce and tomato and 2 bell peppers. The sandwich had about 32g of carb, including the rice cheese. I'm not trying to draw too fine a line... but I need some numbers to relate to :-) My other "normal" numbers were in the 70's and 80's. Had one 130 and one 180 but the rest were in the 200 and 300's. > "TimShoppa" <sho...@trailing-edge.com> wrote in message >> I'm not trying to draw too fine a line... but I need some numbers to >> relate to :-) > > My other "normal" numbers were in the 70's and 80's. Had one 130 and one > 180 but the rest were in the 200 and 300's.- Hide quoted text - My personal opinion, and the way I'd approach it... if "the rest" (still don't get a sense of the proportion) is a bunch of 200's and 300's, I'd work on those numbers. May mean more than one shot a day, probably something shorter-lasting. There's obviously a fear of hypos but one 55 in a month is not a big deal, IMHO. Just turning up your single Lantus dose may not be the best solution. Of course I've been on more than one shot a day for 26 years... trying to do it all on one shot a day I could not do nearly as well as what you're doing! Tim. On Apr 25, 5:24 pm, "Julie Bove" <julieb...@verizon.net> wrote: > "TimShoppa" <sho...@trailing-edge.com> wrote in message >> I'm not trying to draw too fine a line... but I need some numbers to >> relate to :-) > > My other "normal" numbers were in the 70's and 80's. Had one 130 and one > 180 but the rest were in the 200 and 300's.- Hide quoted text - My personal opinion, and the way I'd approach it... if "the rest" (still don't get a sense of the proportion) is a bunch of 200's and 300's, I'd work on those numbers. May mean more than one shot a day, probably something shorter-lasting. There's obviously a fear of hypos but one 55 in a month is not a big deal, IMHO. Just turning up your single Lantus dose may not be the best solution. Of course I've been on more than one shot a day for 26 years... trying to do it all on one shot a day I could not do nearly as well as what you're doing! I woke up to 96 yesterday but after that it was all downhill with numbers climbing to over 400. I just don't GET it! How could adding insulin cause my numbers throughout the day to go much higher than they were? The nurse thought my body quit producing insulin, but I just don't know what to think. I will see her on Thu. In the meantime, I will keep eating that snack that I had to get the 96 and see what happens there. >I woke up to 96 yesterday but after that it was all downhill with numbers >climbing to over 400. I just don't GET it! How could adding insulin cause >my numbers throughout the day to go much higher than they were? The nurse >thought my body quit producing insulin, but I just don't know what to think. That's an incredibly simple blood test! Get fasting insulin and fasting bg, and you can use the HOMA equation to work out your insulin resistance. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>I woke up to 96 yesterday but after that it was all downhill with numbers >>climbing to over 400. I just don't GET it! How could adding insulin [quoted text clipped - 6 lines] > fasting bg, and you can use the HOMA equation to work out your insulin > resistance. How do I get that? Hi Julie: >>>my numbers throughout the day to go much higher than they were? The nurse >>>thought my body quit producing insulin, but I just don't know what to [quoted text clipped - 5 lines] > > How do I get that? The HOMA calculator allows a substitution of C-peptide for fasting insulin. It is easier to get a C-peptide in many labs. Let your doctor figure it out. Chris J. was trying to use an older version. HOMA Calculator v2.2.2 released 12 December 2007. http://www.dtu.ox.ac.uk/index.php?maindoc=/homa/index.php Download the HOMA Calculator The HOMA Calculator uses the HOMA2 model to estimate beta cell function (%B) and insulin sensitivity (%S) for an individual from simultaneously measured fasting plasma glucose and fasting plasma RIA insulin values. Fasting specific insulin or C-peptide values can be used instead of RIA insulin. The HOMA2 model is calibrated to give %B and %S values of 100% in normal young subjects when using a suitable insulin assay. See Background and FAQ for further details. * Windows * Mac Classic and MacOS X Download the Microsoft Excel spreadsheet implementation of the HOMA Calculator This worksheet, which incorporates the HOMA Calculator as an Excel function, estimates %B and %S values for many individuals simultaneously. * Windows * Mac OS X Frank > Hi Julie: > [quoted text clipped - 12 lines] > insulin. It is easier to get a C-peptide in many labs. Let your doctor > figure it out. Chris J. was trying to use an older version. If he will... > HOMA Calculator v2.2.2 released 12 December 2007. > http://www.dtu.ox.ac.uk/index.php?maindoc=/homa/index.php [quoted text clipped - 20 lines] > * Windows > * Mac OS X Sorry, that's waaay above my head. I don't even know what a spreadsheet is. > I woke up to 96 yesterday but after that it was all downhill with numbers > climbing to over 400. I just don't GET it! How could adding insulin cause > my numbers throughout the day to go much higher than they were? The nurse > thought my body quit producing insulin, but I just don't know what to think. I don't have a lot of deep insight into your particular situation, but relating from personal experience: 1. 14 units of Lantus a day is not a large amount of insulin. That's about 40% of my total insulin dosage every day. 2. Controlling a whole day's worth of bg's - say 4, or 6, or 8, or 10 measurements - with a single shot of long-lasting insulin is hard. 3. For me, Lantus doesn't last 24 hours. I split my dose between two shots a day about 12 hours apart and do much much better than when I tried to get through on a single shot. 4. Your Lantus dose is not particularly large, and smaller Lantus doses (well, doses of any insulin) get absorbed more quickly than larger ones. I strongly, strongly urge you and your nurse/doc/etc. to not get too worried about a single hypo in a month. Yes, hypos are a worry. But don't worry about them so much that you end up doing nothing about the numbers in the 300's/400's that you write about! There are very straightforward ways of dealing with them with insulin, but probably not with just a single shot of Lantus a day. You will want to research MDI and pumps. Tim. On Apr 28, 1:27 am, "Julie Bove" <julieb...@verizon.net> wrote: > I woke up to 96 yesterday but after that it was all downhill with numbers > climbing to over 400. I just don't GET it! How could adding insulin cause > my numbers throughout the day to go much higher than they were? The nurse > thought my body quit producing insulin, but I just don't know what to > think. I don't have a lot of deep insight into your particular situation, but relating from personal experience: 1. 14 units of Lantus a day is not a large amount of insulin. That's about 40% of my total insulin dosage every day. 2. Controlling a whole day's worth of bg's - say 4, or 6, or 8, or 10 measurements - with a single shot of long-lasting insulin is hard. 3. For me, Lantus doesn't last 24 hours. I split my dose between two shots a day about 12 hours apart and do much much better than when I tried to get through on a single shot. 4. Your Lantus dose is not particularly large, and smaller Lantus doses (well, doses of any insulin) get absorbed more quickly than larger ones. I strongly, strongly urge you and your nurse/doc/etc. to not get too worried about a single hypo in a month. Yes, hypos are a worry. But don't worry about them so much that you end up doing nothing about the numbers in the 300's/400's that you write about! There are very straightforward ways of dealing with them with insulin, but probably not with just a single shot of Lantus a day. You will want to research MDI and pumps. It wasn't just the single hypo. It was also the normal numbers I've had. I was told these would *be* hypos if I upped my dose. But I think for now the only choice I have *is* to up my dose. I woke up over 200 and spiked to over 400 after breakfast again. Here it is lunch time and I am 277. I can't go on like this! As for pumps, it is not likely my insurance would cover one given that I am type 2. > It wasn't just the single hypo. It was also the normal numbers I've had. I > was told these would *be* hypos if I upped my dose. But I think for now [quoted text clipped - 4 lines] > As for pumps, it is not likely my insurance would cover one given that I am > type 2. Well, the next step up from just one-shot-a-day of Lantus would be some mealtime shots of a shorter-acting insulin. If your high numbers are following a regular pattern, then it's pretty obvious when to add the short-acting stuff. Don't worry about a pump - just get your docs on board with getting you what you need. Bring them the numbers. Point out the patterns. Don't let them get too wrapped up in a single hypo. Don't want to say this in a threatening way, but: lots of us who read this group have been doing this for a good chunk of a century now. I mean that in a reassuring way, that it's possible to do, if not easy. Tim. On Apr 28, 4:15 pm, "Julie Bove" <julieb...@verizon.net> wrote: > It wasn't just the single hypo. It was also the normal numbers I've had. I > was told these would *be* hypos if I upped my dose. But I think for now [quoted text clipped - 6 lines] > am > type 2. Well, the next step up from just one-shot-a-day of Lantus would be some mealtime shots of a shorter-acting insulin. Yes. If your high numbers are following a regular pattern, then it's pretty obvious when to add the short-acting stuff. Don't worry about a pump - just get your docs on board with getting you what you need. Bring them the numbers. Point out the patterns. Don't let them get too wrapped up in a single hypo. I don't see any sort of pattern. Now my numbers are up and have been up for three days. The only way they're going is up! Don't want to say this in a threatening way, but: lots of us who read this group have been doing this for a good chunk of a century now. I mean that in a reassuring way, that it's possible to do, if not easy. Yes. I am just frustrated at the lack of action from anybody in my medical circle. I feel like all I can do is test and report my numbers. >The hypo came after dinner. 2 hours after to be exact. The normal numbers >were after dinner, before bed and in the morning. Was taking the lantus at >11:00 p.m. > >I got a prescription for the contour meter for 6 strips per day. How low did you go? Were there symtoms? Cheers, Alan, T2, Australia. d&e, metformin 1500mg, ezetrol 10mg Everything in Moderation - Except Laughter. -- http://loraldiabetes.blogspot.com Latest:Valderee, Valderah. Or, I love To Go A-wandering... >>The hypo came after dinner. 2 hours after to be exact. The normal >>numbers [quoted text clipped - 5 lines] > > How low did you go? Were there symtoms? 55 and yes. bah that stinks..hoep ya find the balance soon...on insulin its prob best to eat carbs but nothing says they cant be the slow acting..nutrient dense ones.. i suck at math if i ever have to take insulin and calculate boluses etc im doomed.. i am sure youll get the hang of it in no time tho! <hugs> KROM >I called her today and told her of the odd readings I am having. The hypo, >the few normal numbers and the mostly much increased numbers since starting [quoted text clipped - 5 lines] > In the meantime, she said I should *not* cut back on eating carbs because > that will just cause liver dumps. Grrr... I can't win. > bah that stinks..hoep ya find the balance soon...on insulin its prob best > to eat carbs but nothing says they cant be the slow acting..nutrient dense > ones.. That's the only kind I eat. > i suck at math if i ever have to take insulin and calculate boluses etc im > doomed.. I suck at math too. > i am sure youll get the hang of it in no time tho! > > <hugs> Thanks! > bah that stinks..hoep ya find the balance soon...on insulin its prob best > to eat carbs but nothing says they cant be the slow acting..nutrient dense [quoted text clipped - 13 lines] >>starting insulin. She wants me to do additional testing before meals and >>at 2:00 a.m. to see if I am having some hypos in there. Yet she only gave you 6 strips a day ...... >> bah that stinks..hoep ya find the balance soon...on insulin its prob best >> to eat carbs but nothing says they cant be the slow acting..nutrient [quoted text clipped - 15 lines] > > Yet she only gave you 6 strips a day ...... She didn't. The Dr. did. The two are not in communication. She only wanted me to test three times daily prior. I felt I needed to do more but she said no. *sigh* > "Ozgirl" <are_we_there_yet@maccas.com> wrote in message > > "krom" <thekromremoveremove@hotmail.com> wrote in message [quoted text clipped - 5 lines] > wanted me to test three times daily prior. I felt I needed to do more > but she said no. *sigh* I see the fact that your 'diabetes nurse' and your Dr. are not in communication as a major problem for effective treatment. Grr . . . . Take care. SignatureNick. Support severely wounded and disabled Veterans and their families! I've known US vets who served as far back as the Spanish American War. They are all my heroes! Thank a Veteran and Support Our Troops. You are not forgotten. Thanks ! ! ~Semper Fi~ >> "Ozgirl" <are_we_there_yet@maccas.com> wrote in message >> > "krom" <thekromremoveremove@hotmail.com> wrote in message [quoted text clipped - 10 lines] > > Take care. They are at two different hospitals. Same hospital but two different branches. > "Nick Cramer" <n_cramerSPAM@pacbell.net> wrote in message > >> "Ozgirl" <are_we_there_yet@maccas.com> wrote in message [quoted text clipped - 8 lines] > They are at two different hospitals. Same hospital but two different > branches. Sorry. As we were taught in the military, "No excuse, Sir!" Take care. SignatureNick. Support severely wounded and disabled Veterans and their families! I've known US vets who served as far back as the Spanish American War. They are all my heroes! Thank a Veteran and Support Our Troops. You are not forgotten. Thanks ! ! ~Semper Fi~ >>> bah that stinks..hoep ya find the balance soon...on insulin its prob best >>> to eat carbs but nothing says they cant be the slow acting..nutrient [quoted text clipped - 19 lines] >wanted me to test three times daily prior. I felt I needed to do more but >she said no. *sigh* I hesitate to mention the place, but I was in a pharmacy a few weeks ago, and was asking about the cost of their strips. The pharmacist told me, and I said that the next prescription I get, I'd be coming back, and in passing, commented that my prescription was not for enough strips, and that I'd ask the doctor for a larger amount. She said it was no problem, and that I didn't need a prescription. I mentioned insurance, and she said it was still not a problem; that she could write a prescription for me, and that the insurance company would accept it. As it turned out, I didn't need to go that route, because the doc increased my prescription, but I'll sure remember her words in case I need some and don't have a prescription. SignatureLarry, T2, Saskatchewan, Canada. DX 24 Aug 07. D&E Metformin 2000mg, Ramipril, Simvastatin Dx A1c 8.1 : Latest 5.1 (4 Mar 08) >>>> bah that stinks..hoep ya find the balance soon...on insulin its prob >>>> best [quoted text clipped - 37 lines] > increased my prescription, but I'll sure remember her words in case I > need some and don't have a prescription. Here, only a Dr. and perhaps a PA can write a prescription. A pharmacist can't. When I got my new (supposedly free but wasn't) Contour meter, the pharmacy could not give me strips that would be covered by my insurance without a new prescription from the Dr. >>>>> bah that stinks..hoep ya find the balance soon...on insulin its prob >>>>> best [quoted text clipped - 39 lines] > >Here, only a Dr. and perhaps a PA can write a prescription. That's what I thought too. > A pharmacist >can't. When I got my new (supposedly free but wasn't) Contour meter, the >pharmacy could not give me strips that would be covered by my insurance >without a new prescription from the Dr. That's exactly why I did not name the pharmacy. Do I have to supply a "nudge, nudge, wink, wink"? SignatureLarry, T2, Saskatchewan, Canada. DX 24 Aug 07. D&E Metformin 2000mg, Ramipril, Simvastatin Dx A1c 8.1 : Latest 5.1 (4 Mar 08) >>>>>> bah that stinks..hoep ya find the balance soon...on insulin its prob >>>>>> best [quoted text clipped - 52 lines] > > Do I have to supply a "nudge, nudge, wink, wink"? Um... You're in Canada. My pharmacy can not do it. I did ask. >>>>>>> bah that stinks..hoep ya find the balance soon...on insulin its prob >>>>>>> best [quoted text clipped - 54 lines] > >Um... You're in Canada. My pharmacy can not do it. I did ask. OK... just thought I'd make sure you knew you could try. SignatureLarry, T2, Saskatchewan, Canada. DX 24 Aug 07. D&E Metformin 2000mg, Ramipril, Simvastatin Dx A1c 8.1 : Latest 5.1 (4 Mar 08) >>>>>>>> bah that stinks..hoep ya find the balance soon...on insulin its >>>>>>>> prob [quoted text clipped - 61 lines] > > OK... just thought I'd make sure you knew you could try. I already said I did. On 4/25/08 8:42 PM, in article es8514h84vv148r3br9gg6j6b12et487b5@4ax.com, >>>> bah that stinks..hoep ya find the balance soon...on insulin its prob best >>>> to eat carbs but nothing says they cant be the slow acting..nutrient [quoted text clipped - 34 lines] > increased my prescription, but I'll sure remember her words in case I > need some and don't have a prescription. We don't need prescriptions in BC anymore. The pharmacist just authorizes any amount we want and Pharmacare pays. I was leery at first but my endo told me not worry and if anybody balked he would give me a script for any amount I wanted. I usually buy 200 strips at a time so that I'm not always going to get more. SignatureMartha T2 Canada 1500mg. Metformin, 4mg. Avandia > On 4/25/08 8:42 PM, in article es8514h84vv148r3br9gg6j6b12et487b5@4ax.com, > [quoted text clipped - 47 lines] > amount I wanted. I usually buy 200 strips at a time so that I'm not always > going to get more. We don't need a prescription here either, but... If I get them without a prescription I pay out of pocket. I don't want to do that when my insurance will pay. odd.... in minnesota u can buy ALL diabetic supplies with no script needed..except maybe insuline ..but all the rest is on a shlf where u can grab and take to front and pay for like anything else... KROM > On 4/25/08 8:42 PM, in article es8514h84vv148r3br9gg6j6b12et487b5@4ax.com, > [quoted text clipped - 47 lines] > amount I wanted. I usually buy 200 strips at a time so that I'm not always > going to get more. > odd.... in minnesota u can buy ALL diabetic supplies with no script > needed..except maybe insuline ..but all the rest is on a shlf where u can > grab and take to front and pay for like anything else... Strips do not require a prescription here, unless you want them covered by your insurance and then they do. Insulin and needles require a prescription. > odd.... in minnesota u can buy ALL diabetic supplies with no script > needed..except maybe insuline ..but all the rest is on a shlf where u can > grab and take to front and pay for like anything else... Note the "and pay". I can buy all the strips I want, for any reason I want, just like soap & toothpaste or "anything else" -- but I have to pay full price. Minnesota or anwhere else in the USA. But if I want insurance to pay, I have to have a prescription. bj >> odd.... in minnesota u can buy ALL diabetic supplies with no script >> needed..except maybe insuline ..but all the rest is on a shlf where u can [quoted text clipped - 7 lines] > > But if I want insurance to pay, I have to have a prescription. Same here. And I have insurance so I'm not paying out of pocket. >> odd.... in minnesota u can buy ALL diabetic supplies with no script >> needed..except maybe insuline ..but all the rest is on a shlf where u can [quoted text clipped - 8 lines] > But if I want insurance to pay, I have to have a prescription. > bj We usually get our meds at the base pharmacy for free..except for my Crestor and metformin er..which I get at the local grocery pharmacy and pay a co-pay. If I forget to get a prescription for my strips I will pay cash but will be paid by the college my hubby works for, he has a $2500.00 flex account a year, that has come in handy from time to time. >>> odd.... in minnesota u can buy ALL diabetic supplies with no script >>> needed..except maybe insuline ..but all the rest is on a shlf where u [quoted text clipped - 14 lines] > cash but will be paid by the college my hubby works for, he has a $2500.00 > flex account a year, that has come in handy from time to time. I *could* do that if there were one near here but there isn't. And last time I checked, nothing I was taking was on the formulary, nor were my strips. yep..i nevver said otherwise KROM >> odd.... in minnesota u can buy ALL diabetic supplies with no script >> needed..except maybe insuline ..but all the rest is on a shlf where u can [quoted text clipped - 8 lines] > But if I want insurance to pay, I have to have a prescription. > bj >On 4/25/08 8:42 PM, in article es8514h84vv148r3br9gg6j6b12et487b5@4ax.com, > [quoted text clipped - 42 lines] >amount I wanted. I usually buy 200 strips at a time so that I'm not always >going to get more. <falls over> It seems here they're now also starting to restrict Type 1s and other insulin users. Just as it's illegal to drive without wearing your seatbelt, so it should be illegal to prescribe insulin without sufficient strips. IMO. (of course no-one can stop you *buying* as many as you need - except possibly your bank manager) Yes many people dont know that some pharmcists can write scrips..i had a bad allergy attack and the one at walgreens wrote and filled zyrtec for me with no doc visit...if my doc messes up her scripts like writes a 20 day supply number instead of a 30 like sposed to they fix it no prob... Never hurts to ask KROM >>>> bah that stinks..hoep ya find the balance soon...on insulin its prob >>>> best [quoted text clipped - 37 lines] > increased my prescription, but I'll sure remember her words in case I > need some and don't have a prescription. > Yes many people dont know that some pharmcists can write scrips..i had a > bad allergy attack and the one at walgreens wrote and filled zyrtec for me > with no doc visit...if my doc messes up her scripts like writes a 20 day > supply number instead of a 30 like sposed to they fix it no prob... > > Never hurts to ask Mine can't do that. Can this vary by state? The only thing mine can do is give me an emergency supply of pills, up to three days worth if the Dr. isn't timely in his response to my need for a refill. dunno.. KROM >> Yes many people dont know that some pharmcists can write scrips..i had a >> bad allergy attack and the one at walgreens wrote and filled zyrtec for [quoted text clipped - 6 lines] > is give me an emergency supply of pills, up to three days worth if the Dr. > isn't timely in his response to my need for a refill. > Yes many people dont know that some pharmcists can write scrips..i had a > bad allergy attack and the one at walgreens wrote and filled zyrtec for me [quoted text clipped - 48 lines] >> increased my prescription, but I'll sure remember her words in case I >> need some and don't have a prescription. I know when we lived in England (a hundred years ago;) ) that if you needed something for pain, and couldn't get to a Dr. because it was to late you Chemist could give you a couple of pain pills to tide you over until you could get to the Dr. >I called her today and told her of the odd readings I am having. The hypo, >the few normal numbers and the mostly much increased numbers since starting [quoted text clipped - 5 lines] >In the meantime, she said I should *not* cut back on eating carbs because >that will just cause liver dumps. Grrr... I can't win. well, at least you got a better strip prescription, so you can get the data. Hopefully there will be a pattern there that you can use! Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>I called her today and told her of the odd readings I am having. The >>hypo, [quoted text clipped - 11 lines] > well, at least you got a better strip prescription, so you can get the > data. Hopefully there will be a pattern there that you can use! I thought perhaps that what I read about hot showers and hypos on lantus might be true. Although I was told it wasn't true, I was trying not to take overly hot ones. Thought perhaps I could track the lower numbers to nights with showers, but this seems not to be the case. >I thought perhaps that what I read about hot showers and hypos on lantus >might be true. Although I was told it wasn't true, I was trying not to take >overly hot ones. Thought perhaps I could track the lower numbers to nights >with showers, but this seems not to be the case. Worth the experiment. I'd log everything you do and eat and feel against your numbers for a bit. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>I thought perhaps that what I read about hot showers and hypos on lantus >>might be true. Although I was told it wasn't true, I was trying not to [quoted text clipped - 5 lines] > Worth the experiment. I'd log everything you do and eat and feel > against your numbers for a bit. Well, I didn't take a shower last night. Had nachos for a snack. First time I had them since starting the lantus. Went from 298 after dinner to 302 at 2:00 a.m. Am wondering if I might have had a hypo between the lantus and then because I felt most crappy. Woke up this morning at 8:00 and was 96. Again, makes no sense. >Well, I didn't take a shower last night. Had nachos for a snack. First >time I had them since starting the lantus. Went from 298 after dinner to >302 at 2:00 a.m. Am wondering if I might have had a hypo between the lantus >and then because I felt most crappy. Woke up this morning at 8:00 and was >96. Again, makes no sense. Well, the crappy feeling might have been from being that high that long; or from a spot of reactive hypoglycemia from the nachos. Then you had plenty of glucose swimming around when the liver did its morning status check, so it didn't chuck any more in to the picture. Your bg went down naturally. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>Well, I didn't take a shower last night. Had nachos for a snack. First >>time I had them since starting the lantus. Went from 298 after dinner to [quoted text clipped - 8 lines] > morning status check, so it didn't chuck any more in to the picture. > Your bg went down naturally. Back up to 353 after breakfast. I can't win. >Back up to 353 after breakfast. I can't win. Can you tell when your stomach's working? Would that be a better trigger for insulin use than when / what you eat? Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>Back up to 353 after breakfast. I can't win. > > Can you tell when your stomach's working? Would that be a better > trigger for insulin use than when / what you eat? Not really. However I was skipping lunch because I simply wasn't hungry then and I can't see the reason to eat if not hungry. But the dietician told me I would get a liver dump and then higher BG if I didn't eat. So that I had to make sure to eat one full serving of carbs then, if nothing else. The nurse said one other possibility is my body has just stopped producing insulin on its own. Doesn't seem likely given the timing, but I don't know what else to think. My numbers are climbing higher and higher and I haven't changed my diet any except to add lunch back in. My normal response to this would be either to not eat at all or just eat no carbs, but everyone on the diabetes management team has told me NOT to do this because it will give me a liver dump. *sigh* I just can't win. Nothing is working any more and I am in such pain from the neuropathy. I think I'll just crawl back in bed until time to make dinner. On 4/26/08 2:20 PM, in article %0NQj.148$Bd1.131@trndny09, "Julie Bove" <juliebove@verizon.net> wrote: >>> Back up to 353 after breakfast. I can't win. >> [quoted text clipped - 17 lines] > Nothing is working any more and I am in such pain from the neuropathy. I > think I'll just crawl back in bed until time to make dinner. Why doesn't the nurse make arrangements for you to see the endo more often? It seems to me, you need more help than the nurse alone can give you. I realize you are under a military health plan, but it does seem "penny wise and pound foolish". You probably should be seeing the gastroenterologist more often too. I wish you well. I know there isn't much you can do to get more care, but we can always hope. SignatureMartha T2 Canada 1500mg. Metformin, 4mg. Avandia > On 4/26/08 2:20 PM, in article %0NQj.148$Bd1.131@trndny09, "Julie Bove" > <juliebove@verizon.net> wrote: [quoted text clipped - 32 lines] > more often too. I wish you well. I know there isn't much you can do to get > more care, but we can always hope. I have never seen the nurse up until now. I was sent to her only to learn how to use the insulin. And the medical people I am seeing are not military. The gastroenterologist is not in with these people and told me to come back in 4 years unless there were problems. Problems, I presume being able to keep food down. Well, so long as I limit the amount of certain meats there seems to be little in the way of problems there. I think bottom line is nobody really knows what to do with me. My symptoms do not seem in any way typical. At least by what they (the medical people) are telling me and from what I have read here. I wish for me it were as simple as doing a low carb diet. I tried it. That didn't work for me at all. If anything it made my numbers go higher, and me, miserable. The only thing I can figure is that I must still have some other yet to be diagnosed medical problem that is complicating things. But I have no clue where to turn to try to find it out. I went on my own to the gastroenterologist. And even then, he is just surmising that I have gastroparesis. He could not do the appropriate tests due to my egg allergy. I know it has been said oatmeal can be used. But they don't use it there. *sigh* Numbers came down to 320 from 353 after lunch of 32 g of carbs. I say "came down" with a slight snicker because I'm well aware that's within the margin of error of my meter. Right now I am just feeling rather snappish and frustrated. >>> Back up to 353 after breakfast. I can't win. >> Can you tell when your stomach's working? Would that be a better [quoted text clipped - 16 lines] > Nothing is working any more and I am in such pain from the neuropathy. I > think I'll just crawl back in bed until time to make dinner. hmmmmmmmmmmmm i skip lunch most days (99.9% of them) because i'm not hungry i notice NO difference in my bg levels maybe test before lunch to see if your bg are low enough that a liver dump is a possibility Signaturekate type 1 since 1987 www.diabetic-talk.org >>>> Back up to 353 after breakfast. I can't win. >>> Can you tell when your stomach's working? Would that be a better [quoted text clipped - 23 lines] > maybe test before lunch to see if your bg are low enough that a liver dump > is a possibility I tested before and after lunch today. Numbers were lower after I ate. :( >>>Back up to 353 after breakfast. I can't win. >> [quoted text clipped - 6 lines] >that I had to make sure to eat one full serving of carbs then, if nothing >else. But your bg, with the gastroporesis, is not driven primarily by hormone patterns, but by what your gut is doing. It makes no sense to me to eat to stop a liver dump, if all you're doing is piling undigested food in your stomach, to guarantee a carb overload at some unknown later time when it kicks in... unless eating a little might have the effect of starting the engine, so to speak? I know so little about this, but I'm uncomfortable with your medical advice (from a zillion miles away!). >Nothing is working any more and I am in such pain from the neuropathy. I >think I'll just crawl back in bed until time to make dinner. {{{{{{{{Julie}}}}}}} That must be hair-tearingly frustrating!! Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>>>Back up to 353 after breakfast. I can't win. >>> [quoted text clipped - 15 lines] > about this, but I'm uncomfortable with your medical advice (from a > zillion miles away!). That is kind of what I thought too. And perhaps one reason why when I do have hypos, they can be so hard to recover from. Not always though. >>Nothing is working any more and I am in such pain from the neuropathy. I >>think I'll just crawl back in bed until time to make dinner. > > {{{{{{{{Julie}}}}}}} That must be hair-tearingly frustrating!! Indeed it is. Thanks! >That is kind of what I thought too. And perhaps one reason why when I do >have hypos, they can be so hard to recover from. Not always though. As I understand it, hypo recovery depends on your liver playing its part. I don't see a link with gastroporesis here - but there may well be one! Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>That is kind of what I thought too. And perhaps one reason why when I do >>have hypos, they can be so hard to recover from. Not always though. > > As I understand it, hypo recovery depends on your liver playing its > part. I don't see a link with gastroporesis here - but there may well > be one! I don't know enough about it. I only know if food remains in the stomach, BG goes higher. >>>That is kind of what I thought too. And perhaps one reason why when I do >>>have hypos, they can be so hard to recover from. Not always though. [quoted text clipped - 5 lines] >I don't know enough about it. I only know if food remains in the stomach, >BG goes higher. Yeah. I wonder how knowledgeable that nurse is about it. : ( Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>>>That is kind of what I thought too. And perhaps one reason why when I >>>>do [quoted text clipped - 8 lines] > > Yeah. I wonder how knowledgeable that nurse is about it. : ( Even the dietary advice I've seen online recommends eating 6 small meals a day, but I just can't eat that often. Smal is a releative term...it can mean eating 8 almonds for one "meal"..it doesnt mean 6 full sized meals...or even 6 smaller serving of reg meals it means usually 3 small meals and 3 snacks..much easier to wrap ones head around. KROM > Even the dietary advice I've seen online recommends eating 6 small meals a > day, but I just can't eat that often. > Smal is a releative term...it can mean eating 8 almonds for one "meal"..it > doesnt mean 6 full sized meals...or even 6 smaller serving of reg meals it > means usually 3 small meals and 3 snacks..much easier to wrap ones head > around. I had best not be eating 8 almonds. I am allergic. And that to me is not a meal. That would be a snack. And for me, not at all easier to wrap one's head around when one has no appetite. Much easier just to skip the meal. In other words eat something small and quick you dont gotta think about as sitting down to a meal. My sugestion was somthing small LIKE the almonds that u can just pop in yer mouth and move on to other things.. i get that yer not hungry but you need to eat like u need meds..so make it as painless as possible is what im suggesting..not saying what you should eat specifically. KROM >> Smal is a releative term...it can mean eating 8 almonds for one >> "meal"..it doesnt mean 6 full sized meals...or even 6 smaller serving of [quoted text clipped - 5 lines] > one's head around when one has no appetite. Much easier just to skip the > meal. > In other words eat something small and quick you dont gotta think about as > sitting down to a meal. [quoted text clipped - 4 lines] > as painless as possible is what im suggesting..not saying what you should > eat specifically. I still can't eat that frequently no matter what it is. That's just too much for me. Well it makes sense that if her gut is on vacation lettign food amounts build up then all a sudden decides to get to work shed be hit with a mass rush of all the built up carbs and sugars anbd protiens etc at once putting her liver etc into overdrive.. KROM >>That is kind of what I thought too. And perhaps one reason why when I do >>have hypos, they can be so hard to recover from. Not always though. [quoted text clipped - 7 lines] > D&E, 100ug thyroxine > Last A1c 5.6% BMI 25 > Well it makes sense that if her gut is on vacation lettign food amounts > build up then all a sudden decides to get to work shed be hit with a mass > rush of all the built up carbs and sugars anbd protiens etc at once > putting her liver etc into overdrive.. Yep. >I called her today and told her of the odd readings I am having. The hypo, >the few normal numbers and the mostly much increased numbers since starting [quoted text clipped - 5 lines] > In the meantime, she said I should *not* cut back on eating carbs because > that will just cause liver dumps. Grrr... I can't win. Did you increase your carbs when you started the Lantus? If so, then you need short acting insulin before meals. >>I called her today and told her of the odd readings I am having. The >>hypo, the few normal numbers and the mostly much increased numbers since [quoted text clipped - 9 lines] > Did you increase your carbs when you started the Lantus? If so, then you > need short acting insulin before meals. No. Eating the same except she said I MUST add lunch. So I guess, yeah, there are more carbs overall than there have been in past months, but no more carbs than when I was eating lunch before. > I called her today and told her of the odd readings I am having. The > hypo, the few normal numbers and the mostly much increased numbers since [quoted text clipped - 6 lines] > In the meantime, she said I should *not* cut back on eating carbs because > that will just cause liver dumps. Grrr... I can't win. As you know, a 'diabetes nurse' is not an MD. Too bad you don't have a local Diabetician you can see. Grrr . . . is right! SignatureNick. Support severely wounded and disabled Veterans and their families! I've known US vets who served as far back as the Spanish American War. They are all my heroes! Thank a Veteran and Support Our Troops. You are not forgotten. Thanks ! ! ~Semper Fi~ >> I called her today and told her of the odd readings I am having. The >> hypo, the few normal numbers and the mostly much increased numbers since [quoted text clipped - 9 lines] > As you know, a 'diabetes nurse' is not an MD. Too bad you don't have a > local Diabetician you can see. Grrr . . . is right! I don't think we even have such a thing here. If we do, I've never heard of it. >> I called her today and told her of the odd readings I am having. The >> hypo, the few normal numbers and the mostly much increased numbers since [quoted text clipped - 9 lines] >As you know, a 'diabetes nurse' is not an MD. Too bad you don't have a >local Diabetician you can see. Grrr . . . is right! I just got a card in the mail, telling me an appointment had been set up for me at the Diabetes Education Centre. It's a followup to a group seminar I attended in late August. I called them and said I wouldn't be coming. They wanted to reschedule, and I said no thanks, that I am well under control, and that I didn't feel like arguing with their dietary advice. SignatureLarry, T2, Saskatchewan, Canada. DX 24 Aug 07. D&E Metformin 2000mg, Ramipril, Simvastatin Dx A1c 8.1 : Latest 5.1 (4 Mar 08) >>> I called her today and told her of the odd readings I am having. The >>> hypo, the few normal numbers and the mostly much increased numbers since [quoted text clipped - 20 lines] > well under control, and that I didn't feel like arguing with their > dietary advice. Yeah, well I didn't want to see the dietician, but they made it clear it was part of my diabetes education. *sigh* At least she didn't spend much time with me. Perhaps it helped that I told her I had already seen three of them. >I called her today and told her of the odd readings I am having. The hypo, >the few normal numbers and the mostly much increased numbers since starting [quoted text clipped - 5 lines] > In the meantime, she said I should *not* cut back on eating carbs because > that will just cause liver dumps. Grrr... I can't win. Just a couple of "pot shots" from your comments here. Sorry, I've had no time to read all posts over the week. If I take Lantus, say, 8:30pm, then I'm more likely to get a hypo at between 11pm and 2am. Likely, but not always so. I have learnt to avoid a hypo and still maintain a low fbg by judiciously taking a carb like a fruit, or a small serve of muesli before going to bed. Comment on carb reduction - if you do chose to cut your carbs, you have to cut your insulin dose. Otherwise you're increasing your chances of getting a hypo. Henry Mydlarz. >>I called her today and told her of the odd readings I am having. The >>hypo, the few normal numbers and the mostly much increased numbers since [quoted text clipped - 14 lines] > hypo and still maintain a low fbg by judiciously taking a carb like a > fruit, or a small serve of muesli before going to bed. She told me to move the dose from 11:00 p.m. to 9:30 p.m. I did that and felt unwell around 1ish, but I didn't test then because she has me using my max amount of test strips the way it is. It was still high at 2:00 a.m. In the 300's but I can't remember the exact number. Woke up to 96. So this is especially frustrating. I can not realistically inject more lantus or I will be risking a hypo in my sleep! > Comment on carb reduction - if you do chose to cut your carbs, you have to > cut your insulin dose. Otherwise you're increasing your chances of getting > a hypo. Cutting my carbs doesn't seem to lower my BG. Not that I am eating a lot of them now. A lot perhaps by some standards, but I am eating what the dietician said to eat per meal. Between 2 and 3 servings per. I generally eat 2. > I called her today and told her of the odd readings I am having. The hypo, > the few normal numbers and the mostly much increased numbers since starting [quoted text clipped - 5 lines] > In the meantime, she said I should *not* cut back on eating carbs because > that will just cause liver dumps. Grrr... I can't win Would wonder about how much you are eating, suspecting that since being started on exogeneous insulin, that you have possibly been eating considerably more than your pancreas can handle even with the Lantus. Be hungry... be healthy... be hungrier... be euglycemic: http://TheWellnessFoundation.com/BeHealthier Prayerfully in the infinite power and might of the Holy Spirit, Andrew <>< -- Andrew B. Chung, MD/PhD Lawful steward of http://EmoryCardiology.com A latter-day disciple of the KING of kings and LORD of lords. http://HeartMDPhD.com/HolySpirit/DiscipleNow |
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