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Overwhelmed !
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tledfh posted:
Hello, new to the community, and hoping to find some answers to the hundreds of questions on my mind. My husband has type 2 diabetes, that has been uncontrolled with oral meds for several years. We finally talked our primary care into an appt with a endocrinologist, which took nearly 3 months. We had our appt. last Thurs. he just said " you need insulin" and handed us a bag with Levimer quick pins and Humalog quick pens and sent us on our way! He is to take 50 U of Levimer at bedtime....and 10u of homolog with a scale of +2 per 50 > 100 before breakfast and 30 U at supper. His last AC 1 was over 10.... This was 3 months ago. Saturday evening he took his supper dose iof Humalog against my advice, as to the timing, we were camping and having a community supper, and I wasn't sure we would be eating, within the 30 min timeframe, he injected 30 U of the Humalog, then preceded to help someone with some rather strenuous work, needless to say..his blood sugar dropped to 42! And he almost went out! So lesson learned there...1. Don't take your insulin if you're not going to eat within 30 mins...2. Exercise and physical activity lowers your blood sugar and 3. Listen to your wife, who had told you both these things. Anyway, as you all can imagine, the very low level wiped him out! Our problem is that we had no education on any of this, so we are at a loss on so much...we have been walking 2 miles the past 2 nights, to increase his activity, are eating right, he's loaded with snacks , both low carb, and rescue type high carb.. And feeling a little more confident...then this A.M. He gets up, gets his shower, and starts feeling the familiar shaking, etc..his blood sugar was 61.. So he ate Bran Flakes, a banana , and a fig newton...and didn't take his insulin, left for work, checked it at work..15 mins later..it was 168, so he then took his 12 U of Humalog . We don't even know if he should take is Humalog before he eats if his reading is 61. Any help will be so appreciated..thanks...we're kinda out here hanging on our own, and it is so overwhelming!
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tledfh responded:
Forgot to add that he also still takes metformin twice daily.
 
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mrscora01 responded:
Yes, starting insulin can be scary. If you don't mind my asking, how long has he had diabetes? It is possible, if he is only a few years in, that he is actually a type 1. Sometimes it can take 5 or 6 years before insulin is required in adult onset type 1. Since you are seeing an endo, you might want to ask about antibody testing to check this.

As for taking insulin, first off, you don't say how often he tests his glucose. It should be quite often, especially since you should be carb counting and dosing accordingly instead of just taking a set dose. Sorry, but that's a pretty old fashioned approach (IMHO).

To learn more about this, I will suggest 2 books. Available on Amazon (new and used) as well as at many local public libraries. The books are "Think Like a Pancreas" and "Using Insulin" Don't worry, it's not rocket science. Just observation and elementary school math. Take the time and you will be able to get good control.

Cora
T1 1966, Dialysis 2001, kidney transplant and pump 2002, pancreas transplant 2008
 
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tledfh replied to mrscora01's response:
mrscora101, thanks for your response. He is 53, and was first diagnosed about 5 years ago. I thought Diabetes type 1 was juvenile diabetes. His mother is also diabetic and currently in stage 4 renal failure. He was told by the Endo to test only before meals...but he has been testing several times a day, because of the lows he has been experiencing....not too happy with this Endo or his approach, we have no idea and are on system overload trying to self educate. I have no idea how many carbs he should be eatin at a meal...I have provided him with lower carb snacks for his snack times and higher carb snacks for when he feels the lows coming and checks his level.
 
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mrscora01 replied to tledfh's response:
The reason they don't call it "juvenile onset" diabetes any more is due to the fact that you can get it at any age. What would you call it if your great grandpa got it at age 95? "Senility onset" diabetes? lol Of course not.

I can't stress enough that you get your hands on the books I suggested. It may take you a bit to slog through them, but they will help. There are basically 3 things you need to learn to figure out.

1. Basal rate - how much background insulin (lantus or levemir) needed to keep your blood sugar stable when you are not eating.

2. Insulin to carb ratio (I:C) - this is how many carbs can be eaten per unit of insulin. Most docs will start you at a ratio of about 1:15. So 1 unit of humalog/rapid per 15g of carbohydrate (about 1 slice of bread). Read labels. And there is a site and book called Calorie king that will give you food contents and portion size

3. Insulin sensitivity factor (ISF) - how many points 1 unit of fast acting insulin will bring down your blood sugar if you are high.

So, for example, if my I:C is 1:15 and my ISF is 40, lets' look at the following scenario. Suppose I ate a meal with 30g of carb (1 slice toast, with bacon, egg, and a small piece of fruit). For that I would take 2 units of insulin. Also suppose that my blood sugar was 190 and I wanted it down to 150, I would take an extra 1 unit of insulin. So all totalled, for my meal and my bg level, I would take 3 units of insulin.

These ratios you will have to work out for yourself by testing. Again, these books will help you, together with your doc, figure out how to handle the new insulin regime.

Best of luck. And always have fast acting glucose on hand. I like to keep Starburst Fruit Chews handy. The bring me up fast, are individually wrapped, but I don't like them enough to snack on when I don't need them.
T1 1966, Dialysis 2001, kidney transplant and pump 2002, pancreas transplant 2008
 
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mrscora01 replied to tledfh's response:
One more thing. Many people have success keeping blood sugars in better control by cutting back on carbs. How much you cut back to will depend on how you want to live. Some people are ultra-low carb. Eating less than 30 g of carb per day. I personally couldn't live like that. The ADA recommends close to 200. I couldn't do that either as I'm a smallish woman and would end up as big as a house if I ate that much. And couldn't eat that volume either. So about 100 - 120g per day kept me satisfied and my weight normal. You will have to decide how you want to live and eat.
T1 1966, Dialysis 2001, kidney transplant and pump 2002, pancreas transplant 2008
 
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auriga1 replied to tledfh's response:
I so feel bad for you and your hubby. It can be so totally overwhelming. I know because I went through it myself. Don't mind me, but I could smack his doctor. That's for sure.

Tledfh, I am very, very lucky that I started with a wonderful diabetic team; an endo, diabetic educator and a dietician.

I don't want to overwhelm you with information. Your husband should be seeing a diabetic educator, at least once or twice and definitely a dietician.

Mrs.Cora gave you excellent info.

I take two insulins also. I started with Lantus as a basal and Humalog with meals. That set dose of rapid-acting insulin is very old-fashioned and dangerous in my opinion. My diabetes was so out of control, my doctor decided to give me a book to WRITE down what my blood sugar was before I ate, write down WHAT I ate and how many carbs were in that food and what my BLOOD SUGAR number was two hours after I ate. I recommend doing this for your husband so he doesn't encounter so many lows. I was testing 8 times a day, so my doctor could see what was going on. Food and drink affect the blood sugar dramatically, as does any physical activity.

This is only me and what I do because I was experiencing what your husband is also. I take my rapid-acting insulin right after I eat according to how many carbs are in that meal. This is what the directive was from my doctor and dietician. Your husband should have been give a number of carbs he can eat per meal and then dose his insulin according to those carbs he eats.

It's a process that takes time to digest. Physical activity combined with eating less carbs lowers the blood sugar dramatically when using insulin. I have been as low as 26. Scared me silly.

He does need to talk with his doctor about the lows and what is causing them. If this doctor cannot help clarify things, I would be changing physicians. That's me, though.

We cannot tell you or him what to do though. We are diabetics going through the same thing. I do want to tell you both that he should always (if possible) to have someone with him when performing strenous activities. Keep glucose tabs in his pockets. They are cheap and available everywhere. Lifesavers! I work a very physical job and have them on the counter. Even sugar packets everywhere.

See if you can get his doctor to refer him to a dietician. Taking my rapid-acting insulin right after I eat has worked for me for seven years now. Most times, I do not finish any given meal, so I do not want to OD on insulin and go low if I take it before a meal.

Most days are an experiment in education relating to carbs, physical activity and insulin. My insulin needs change daily according to what I eat and how active I am. My doctor gave me the go ahead to dose according to how I feel throughout the day and what my blood sugar numbers are.

Wishing you both the best on this journey.
 
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glucerna replied to auriga1's response:
You're learning a lot already on your own, and with the excellent information suggested here. Most hospitals offer diabetes education classes, and encourage spouses to attend along with the person with diabetes. Since there isn't one set way to manage diabetes that works for everyone, the more knowledge you have about diabetes overall and your husband's diabetes in particular, the better you'll be able to manage it. ~Lynn @Glucerna
 
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nutrijoy responded:
The two books that Cora recommended are superb and I'll second her recommendations. To be successful, insulin dosages should always be dynamic, not static, with the possible exception of the basal insulins after you have found your individual "sweet spot." That means meal time insulins should be adjusted to the food (both amounts and types) that your husband will be eating. Meal time insulin dosages should almost never be at a rigid, set amount that remains unchanged from one meal to the next. Activity/exercise levels both before and after the meal will also have a significant impact on blood sugar levels (and thus insulin dosages) and it is extremely important to dose properly if he is to avoid highs and lows. Of course, the most dominant factor in good diabetes control will be the diet itself: the types and portion sizes of the food that he consumes.

In addition to the two books that Cora recommended, I would also recommend Dr. Bernstein's Diabetes Solution (Complete Guide to Achieving Normal Blood Sugars ) and Jenny Ruhl's Blood Sugar 101 (What They Don't Tell You About Diabetes ). Both of these two books are essential references for any diabetic but may be especially valuable for people using insulin. There are lots of myths and half-truths regarding diabetes and as a PWD myself, I think we are one of the most stereotyped groups on earth. We are often subject to incredibly bad advice and poor treatment protocols due to this stereotyping. For that reason, the only real salvation lies in two sets of key words: The first is "Know Thyself" (because we're "all different") and the other is "Self-Management" (it could be argued that the latter is really one word and not two but it is the patient that has the primary responsibility for proper management of the disease).

Self-education is vital and you don't have to wait for a book to arrive in the mail. Most are available as eBooks that can be downloaded in a minute or less if you own an eReader (e.g., Kindle or Nook). You can also go online and read portions of these books for free. Some chapters of Dr, Bernstein's book (2007-2009 edition) can be found here and even entire chapters in PDF format can be downloaded to your computer. I especially recommend that you and your husband read Chapters 7 , 9 and 10 , in particular. Jenny Ruhl's book is actually a compilation of her website's online content that is available at Blood Sugar 101 . The book merely organizes the information in easier to find/read format. I would highly recommend that you start with What is a Normal Blood Sugar? , Why Lowering A1c Below 6.0% Is Not Dangerous , Research Connecting Organ Damage with Blood Sugar Level , and Do People with Type 2 Always Deteriorate? After reading this information, you might question why your husband's mother is suffering from Stage 4 renal failure when normalizing blood sugars has been shown to not only prevent organ damage but usually keeps diabetes from progressing.

The biggest trouble with half-truths when it comes to diabetes is that many people get hold of the wrong half. This post is my personal opinion and reflects my own personal experiences. Please read the WebMD disclaimers at the bottom of the page to obtain a more balanced view of this and all other postings. I am open to discussing/debating/evaluating dissenting or different opinions. After all, isn't that what discussion forums are for?

BTW, the action of Humulog is extremely rapid. Injecting it 30 minutes before eating may be too early in many instances. Many patients that I know prefer to inject it just 15 minutes before a meal; others inject it at the very start or during the meal itself.
 
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auriga1 replied to nutrijoy's response:
Excellent advice, Nutrijoy, regarding the injecting of Humalog. Speaking from experience only. I do usually inject while taking the last bite of food.

I really don't undersand why doctors still stick to the static dosaging of meal-time insulin. Just plain crazy. Basal, yes. Rapid-acting, no.


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