Hello I have been diagnosed now for 4 yrs yet I have been diabetic since a child (or so my doctors think) because I have gone undetected for so many years I am now very insulin resistance. I am on Humulin R 500 and Lantus for insulin and take numerous different pills- too many to list My sugars normally run any where from 270-450 on a daily basis.I was about 75 lbs overweight when I was first diagnosed and was able to lose 48 lbs by diet and excercise as well as watching my calorie intake I am still doing the same thing but am unable to lose my last 30 lbs or so which I can't understand. The last few nights I have been waking up around 3 in the morning having the shakes from low sugars, but my sugars are only 130-150 which is somewhat good but the doctors tell me because my sugars run so high that this is really low but i do grab something to eat during this time and they eventually get back up to the 300's which I dont want.Those numbers are good and here I am eating sugar to up it? Also I have been told to eat something high calorie before bed so my sugars dont run low but after dinner and before bed is where I am at my highest 400 or so and if I do that my sugars go extremely high and I get sick as well and then in the mornings I get the "pukey" feeling and light headed- A lose lose situation- I have been seeing a specialist in Pittsburgh Pa and she wants me to go on the pump she thinks it will help yet my family doc says no so I guess my question is What do you think about the pump? I am a little scared because I thought it dosed the insulin itself according to your sugar levels but later found out that you have to count carbs and calculate it all by yourself and I am just afraid I will mess up and give to much. I would just like to know of anyone out there that may use one and what they think Did it help? Is it really that hard? I just know that something has to give I am at the drs every week and they cant get it to come down but say I am doing everything I can right I have been told twice that if they don't get lowered I could have 6 yrs at most and my kids are 5 & 7 and that scares me. Thanks to anyone that may be able to set my mind at ease:)
Your doctors are right that a drop of blood sugar from somewhere around 270-450 down to 130 or so would produce symptoms of low blood sugar. The problem here is that if you treat it as a low and eat to raise your sugar level, you will never adjust to the lower levels. At 130 (heck, even at 70), your blood sugar is not so low that you have to fear going into insulin shock, passing out, etc. Your body can function perfectly well at that level. Unfortunately, it will take several days to a week for you to get used to it, though. But it is imperative that you get those numbers down!
For now, I'd suggest treating "the shakes" with no more than 5 grams of carbs (into the 155 range, approximately), where you probably won't have the shakes, but you won't be up around 300 either. Don't just "grab" something...have a plan! There are some mints on the market that are 5 grams each, I usually take one or two if I'm low. I use the hard candy type mints that are round and white with pink or red striping around the edge. I don't like them enough to snack on them, but I can get one down if I need to...thus, the perfect thing to have around ;)
As for the pump, they are great, but they require a huge commitment of time and learning. You do have to learn to count carbs, and you have to test very frequently. On the plus side...you can easily correct highs without overdoing and going too low.
But before you go on the pump (which is very expensive and a waste of money if you're not going to make the commitment), you can use a regimen frequently referred to as "the poor man's pump"...this is Lantus plus either humalog or novolog. The lantus is your basal insulin (what you need even if you don't eat); the humalog/novolog is your bolus insulin (what you take based on the number of carb grams you're planning to eat.) It means you take at least 4 shots a day, but it's a really good way to see if you're cut out for the pump, as you learn how to count carbs, how to bolus for carbs, test more frequently, etc. You could try it out for a few months and, if you can do it, then the pump will be easy for you after that (and involve fewer shots, give you more flexibility, etc.), but you will still have to test a lot.
Before you commit to the pump, I would try what one of the other posters suggested. Use Lantus or Levemir to give you your background insulin (usually 1 shot per day) then use a fast acting insulin such as Humalog or Novolog to provide you a fast acting insulin when you eat (usually 3 shots per day). These insulins come in a convenient pen applicator so there is no need to worry about a syringe or vial. All you have to do is dial the dose and inject. The amount of fast acting insulin must correspond with the amount of carbohydrates injected so I would suggest you also see a dietician in this initial stage. If you learn to count carbohydrates, it will only help you in the management of this disease. Once you see how this works and have that learning, then you may want to try the pump. Yes, you will have fluctuations....highs and lows....but that is the nature of the disease, beacuse there is more to the body and glucose metabolism than insulin, but for the most part the above regimen will give you consistency and control and make you more confident. I use the Levemir / Humalog regimen ("poor man's pump"), and it is what works for me. Personally, I don't think I'd like having something attached to my body that is why I stayed with the shots. For the lows, I keep sugared hard candies in my pockets. 2-4 seem to do the trick. When you are low, your body craves the sugar so it is hard to avoid a big snack, but that big snack then will swing you completely in the other direction. We've all been there. Just develop a plan that works for you, and keep at it. Good luck!
[QUOTE=blondy2061h;2892210]I agree whole heartedly with everything the other posters said, but I also feel that your insulin resistance needs to be addressed. There gets to be a point when adding more insulin just isn't the answer. The fact that you use Humulin 500 suggests that Novolog or Humalog probably isn't a good plan for you- Novolog and Humalog don't come in U-500 concentrations. You can use the Humulin in the poor man's pump technique SamQ described though. How much insulin are you using? How many grams of carbs are you eating a day? Do you exercise regularly?
hello I use 50 units of Lantus twice a day and 20 units of Humalin 500 with every meal plus a sliding scale the doctors have me on a 1500 calorie diet as well as only 200 grams of carbs a day. I am new to all of that i have tried to do research on all of that but haven't found much so I am not sure if what I do and take is right or not I just go with what the doctors say I am only 24 but diabetes runs on both sides of the family so i guess i was doomed from the beginning I do moderate excercise I walk and do 25 sit ups per day thats all i find all of these replies very helpful and am going to take all to heart and really talk to my doctor on my next visit Thank you!1
[QUOTE=blondy2061h;2893045]When you say Humulin 500, 20 units, do you mean you are actually taking 100 units with each meal? I assume by Humulin 500 you mean the U-500 strength of Humulin. If you are actually using 20 units (ie, pulling back to the 4 unit mark) there is no reason to use the U-500 concentration.
hello I am not quite sure what you mean by pulling back to the 4 unit mark ? It is Humalin R U-500 concentrate but when I give the Humalin I go the the 20 unit mark I use Bd Ultra fine 2 1cc 5/16 31 gauge needles and pull insulin down to the 20 unit mark do you think thats to much because I know at night when I give that much I get low sugars besides taking the lantus twice a day and the Humalin r u 500 with each meal I also do a sliding scale which is 4 units for every 50 over 150 which most of the time i am taking 16 extra units on top of the twenty units with meals.I thought I had it understood somewhat but the more I research the dumber I feel :) I thnk sometimes the doctors don't listen to what I say whenever I tell them that something is going on they just seem to prescribed some new meds and I walk around like a zombie for weeks till I adjust I would like to walk in there and speak like I am very well knowldged on this so maybe they won't look to give me more meds everytime I get a new one I come home and research it but still end up taking it because I think maybe it will help but still the same.Any extra info would be greatly appreciated THANK YOU
Ok, if you are drawing to the 20 unit mark on a U-100 syringe with U-500 insulin, you are taking 100 units of Humulin, as U-500 is 5x as strong.
That means you are using 200 units of Humulin a day, and only 50 of Lantus. This may indicate a problem with dosing in and of itself because Basal (lantus)/Bolus (Humulin) insulin is usually a 50/50 split. Yours is 20/80. Some of this may be skewed though as you are taking the Humulin only twice a day, but I would expect that to skew it in the opposite direction.
Long story short, you would probably do better on more Lantus and less Humulin.
[QUOTE=froggypond;2892875]..... the doctors have me on .... 200 grams of carbs a day..... The easiest way to reduce your insulin requirements is to reduce those carbs - I would suggest to about 50 grams a day. Your blood sugars will come right down.
As blondy mentioned, the basal/bolus mix seems wrong. You are taking 100 units of Lantus (2x50) and 348 units of Humulin R with meals (20x5x3+48), which is total of 448 units a day (including the sliding-scale corrections). And I agree that the proportions are way out. It should probably be more like a 50:50 split - 224 units of both Lantus and HumulinR a day. Doing this would mean that your blood sugar wouldn't go so high between meals.
I am very aware that my insulin resistance increases exponentially as my blood glucose goes up. And if it goes over, say, 250 large amounts of insulin are needed to bring it down again. It seems you are fighting this battle all the time. Increasing your basal insulin could give you a breakthrough. But you would need to do it gradually and in a controlled fashion.
The fact that you are dropping so much at night is probably mainly the result of the the 100 units of HumulinR you are taking before supper. Regular insulin acts over about 8 hours, so the pre-supper dose would still be busy in the early hours of the morning. I would suggest minimising carbs at the evening meal and reducing the HumlinR at the same time. You will also find that minimising carbs at breakfast will get your day off to a much better start. I find that my blood glucose is far more tolerant to carbs in the middle of the day, which is when I normally eat fruit.
What oral meds are you taking? an insulin sensitizer or Januvia, Byetta or Symlin might help reduce your insulin requirements too. I also agree that, while the pump is the most sensitive delivery mechanism, using one would be would be an uneccessary complication at this stage.
Sounds like a really difficult situation. Hope this helps,
I have always thought that I take too much medication between the insulin and the oral pills. But because I am new to this learning system I never argue with my doctors(that is what they studied for) As for oral meds I take a mix besides just for my diabetes, they are Gabapentin, Cymbalta, Citalopram, Avandia, Metformin, Lorazapram, Abilify, Buderprion SR, Etodolac, Naproxen Sodium, and then my Lantus and Humalin R 500.I will ask my doctor about the Symlin although I was on Byetta before and it didn't seem to work. I just think the pump would be too much for me being as I do take a large amount of carbs in and seem to go into "shock" at even 180 I would definately like to lower my sugars slowly before trying the pump:) Thank you all for you opinions:wave:
