mark winlund

Hi all...

I posted some of this in a reply to Loretta, but I thought I would throw
myself upon the tender mercies of the group with a question.

I am male, 58 yrs old, diagnosed T2 about ten years ago, controlled (badly)
with diet and Avandia and Rezulin (for a while), among other meds. Recently,
the Dr. convinced me to go on insulin because of heart irregularities. I
have been using insulin since about April 15th of this year.


Complications.... some neuropathy in feet, heart bypass, heart rate
irregularities... plus a severe case of arthritus that went away after
about 6 months (this was five years ago). Feeling better lately, though.

My principal problem with insulin is confusion due to not knowing cause and
effect. For instance, the other day I had a meal in a restaurant that I
had eaten previously and worked out the correct novolog dosage for. This
time, my BG went up to 200 and stayed there all night. Today, I got weak
and had a cherry turnover at lunch... right after, I added 6 units of
humalog to try to compensate, but no go... up it went over 200. An hour
later, I shot another 6 units.... no effect... the bg stayed high (250+)
for almost 10 hours. I tried 30 minutes of hard (for me) exercise at about
6 pm, and the bg went down to 158, then back up over 200 an hour later! It
stayed high until after midnight.... was down to 115 by 2 am. This is a
total mystery to me. I had nothing to eat for dinner... in fact, nothing to
eat since the "baddie" after lunch. Why would it last so long? I was told
by the Dr. that most food peaks in a couple of hours... some last longer,
some less... but 10 hours? I have read about the glycemic index a bit, and
know that meals with a lot of fat extend the effects....

This group is very helpful to me, as I don't get a lot of information from
the Dr. He has told me that "he is sure I will work it out and to keep
trying", but that doesn't help much in the above situation. There is a
diabetic adviser at the local hospital, but this person seems to know less
than I do, which isn't very much! I have been searching out posts from
"oldal" and Jennifer" and saving them as they seem to be pretty
knowledgeable and level headed. Perhaps there are others?

For meals, I wind up having exactly the same thing every day because that's
the only way I can predict what will happen with a given dose of insulin.
Typically, 1 slice of bread w/ margarine in the morning, a ceasar salad at
lunch (almost no effect on BG), and a sandwich at night for dinner.

I am on 15 units of Lantus in the morning, and 6 to9 units of Humalog before
each meal, or, if the meal is a sizeable one, up to 12 units of Novolog (I
was told that Novolog lasts 2 to 4 hours vs. 1 to 2 hours for Humalog).

Thank you for any advice you might care to give.

Regards,

Mark

oldal4865

I don't see any unambiguous answers to your questions other than that
you are not shooting very much insulin.

Some points to ponder about your insulin doses:

1. A non-Insulin Resistant person, in good shape, well-exercised,
would be need a total of about 0.5 units per day per kg of body weight.

2. A Type 2 diabetic is Insulin Resistant. By rule-of-thumb, he would
be expected to need somewhere between "twice and four times" as much as a
non-Insulin Resistant person. That means you could need anywhere from 1.1
to 2.2 units per day per kg of body weight, depending on your muscle mass,
body fat level and exercise level.

3. I assume that you are still taking the anti-Insulin Resistance med
(Avandia). However, who knows what it is doing to your Insulin Resistance.
Perhaps it dropped your needs from "four times as much" to "three times as
much", or whatever.

4. The rule-of-thumb for an insulin shooter is that his basal insulin
(Lantus) should represent about half of his total daily insulin. Thus, a
well-exercised, non-obese, non-Insulin Resistant T1 would shoot somewhere
around 0.25 units Lantus per day per kg of body weight.

You are shooting a well-exercised, low body fat, T1 dose, but you are T2.
Since you are close to my age, I assume you have some of my problems which
means low body fat and well-exercised are very difficult goals. Therefore,
IMO you need more basal.

5. A non-Insulin Resistant T1 shoots a bolus of about 1 unit of insulin
for each 15 gram of carb in the meal or snack.

6. An Insulin Resistant T2 would be expected to need somewhere in the
range of 2-4 units per 15 gram of meal or snack.

7. Speaking only hypothetically, if a T1 ate a cherry turnover from the
Vienna Bakery in Bay City, Michigan, he would require an 8 unit injection
of humalog to control, but that would be predicated on some exercise at the
same time, e.g. mowing the lawn, or a 2-mile walk.
He would also shoot the Humalog at least 30 minutes before eating the
turnover.

I don't think a 6 unit injection would do the job for a T2 though your 12
units sounded close. Of course you were shooting a low basal so who knows
what you needed that day. BTW, there's a heck of a summer cold going
through Michigan right now. If you are sharing one with us, that could
kick your bG up quite a bit.

8. The insulin needs for a T2 are wildly variable from person to person.
You measure yours by trial and error, and it's not easy. The docs publish
the rules-of-thumb, and we have to go from there.

9. Novolog is so similar to Humalog that most folks can't tell the
difference. For most folks, Novolog is a bit slower, and has a longer
tail.

Bill Coughlan posted some data on comparative absorbence scavenged from
Hedman et al, DiabetesCare June 2001, p. 1120.

In arbitrary units, taken by measuring a graph in magazine with a ruler,

Minutes Humalog Novolog
0 40 40 (baseline)
30 180 120
60 310 290
90 210 220
120 155 190
180 100 120
240 60 80

I think this measurement reflects "insulin-in-the-blood". There is an
added delay before the insulin-in-the-blood can knock bG down. I have
heard that some computer models suggest the delay is close to an hour.

Good Luck

Old Al
(Who believes that the Vienna Bakery is best visited only by skinny
normies, and young grandchildren)

julie bove

I don't use insulin, so I can't really tell you anything there. But you did
say that you are type 2. The worst thing a type 2 can do is to skip a meal.
Why? Because your body is expecting the food. If you don't eat it, your
liver dumps glucose and your BG goes higher. Remember it is carbs that
raise BG. If your BG is higher than it should be, then eat a meal with
less carbs. Have you seen a dietician since you started the insulin? If
not, you should.

--
Type 2
http://users.bestweb.net/~jbove/

ronetta

Mark I am sorry I cant help you knowing nothing about insulin, I can
understand the emotional rollercoaster this is causing you, Have you
talked to your doctor about changing the insulin or increasing, Again
this is only conjecture. Someone will have the answer for you.

Loretta

--
In tribute to the United States of America and the State
of Israel, two bastions of strength in a world filled with strife and
terrorism.

mark winlund

(detailed post snipped)

A lot to think about here. Let me try to understand everything you wrote and
I will get back to you. Thank you very much for the detailed reply..... I
wish I could get this type of response from my Dr..... I suppose he doesn't
have the time for it. This group has been very valuable to me.

Best,

Mark

mark winlund

I wish the Dr. could spend more than 5 minutes with me every 90 days. I am
getting more out of this group than any medical source.

I used to enjoy eating.... now, every bite is a battle, loaded with
consequences if I make the wrong move! Oh well, at least the pharmaceutical
companies must be happy... I'm going through 80 to 100 strips a week....
been getting them from Hocks.com.

Mark

memory

I am sorry to hear that you are struggling so right now. I know it must be
extremely frustrating. Old Al is a gem and I know he can be very helpful.
I know very little regarding the insulin end but just wanted you to know
people here hear you and want to give you support. You are in the right
place here and I feel you will get this under control. It just will take
some time and knowledge. Good luck to you. Many of us will be looking for
your continuing posts and progress in your journey. Memory

hi_therre

You may want to try EBay.com if you don't have insurance. A couple
weeks ago I bought 100 sticks of Accu-Chek Comfort Curve sticks for
$35 s/h included. Last Monday I purchased another 50 sticks for $20
s/h included. The first purchase arrived w/o incident. Hopefully the
last purchase should be here by Wednesday. Typically One Touch Ultra
sticks are more expensive than Accu-Chek on EBay, not sure why. Be
aware of scams on Auction sites.

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