When will this go away???
I posted this to misc.health.diabetes before I found this group. I’d
like to post it here too to see if I could possibly get more help….
I’m a type 1 diabetic — have been for over 27 years now. Brittle
diabetic. A1c’s of 11 or 12. For less than a week now, I’ve been on
a pump, and I feel _horrible_. When will this go away??
Prior to getting on the pump, I was using 63 units of NPH as my
basal. To be conservative, my doctor set me up with a 43.2 unit
basal at first (she also has me shooting for 150 so that I could
gradually bring my levels down to near normal). On the second day of
the pump, my bgs took a nose dive, and haven’t come up. I’m eating
like a horse to try and get over 100 (and having to turn the pump off
before going to bed so that I can get some sleep and not find myself
waking up with my face in the glucose tabs and a bg of 50). My
doctor has me down to about 29 units basal but I’m still having
problems with feeling weak, foggy-headed, numb around the mouth, and
having dimmed vision.
A couple of hours ago, I got to the point where I couldn’t take it
any more — just sod it — so I ate a couple of hundred grams of
carbs with no bolus. Right now I’m up to 384, but I still haven’t
gotten my strength back. After 5 days of low-grade reaction, I’m
about ready to rip this fucking thing out and throw it in the garbage
can. I’m thinking about turning the thing off until my mind clears
up (I guess my body needs to restore its counter regulatory hormones,
or something), and then start off with an even lower basal. Anybody
have any ideas???
Does anybody have any ideas if, or when, the "feeling good" is
supposed to kick in?? The problem isn’t with the Humalog — I was
using it before I got on the pump…..
Thanks,
Vicki
March 24th, 2007 at 1:58 am
Vicki,
The best advice that I can give to you is talk to your pump trainer, it
sounds like they might have you on way too much insulin to start out on.
When I started the pump my basal rates were only .8 at 12am and .8 at 12pm,
then a bolus of 1unit of insulin per 15grams of carbohyrdates, I went
through many cahnges with basal rates and boluses until my pump trainer and
I found what worked best for me. What works for me might nit work for you,
it is best to talk to your pump trainer. Hang in there, the first few weeks
are the worst as you determine basal rates and proper boluses and carb
counting etc. Talk with them about changing and decreasing the basal rates,
did your dr or pump trainer talk to you about testing before meals and 2
hours after etc to see where your numbers are, or did they mention the basal
rate testings where you skip a meal and monitor your bs to see where they
are at to determine appropriate basal rates. Before starting the pump I was
taking NPH and Humalog, after getting all of my rates established etc my
insulin rate decreased by 1/2 and my bs is in better control than it ever
has been. I would call your dr or pump trainer asap and discuss your
concerns with them, because like I said before what has worked for me might
not work for you. I wish you the best of luck and try to hang in there, it
does get better, honestly it does! There will be ups and downs but is does
get better, just give it some time, but I would make that phone call asap!
Chera ( pumping in Pa for 4 months)
March 24th, 2007 at 3:21 am
Vicki,
I’m sorry you are having such a hard start up. Could it be possible that a
little bit of NPH was still circulating? I know "officially" it shouldn’t be
(and my UL was supposed to be gone in a day too — NOT). Once my UL was
completely gone, my BGs went up and basals/boluses were doing all the work.
Then it was easier to see cause & effect. After 5 days though, NPH should be
completely out of the picture. Check with your doctor and then cut your
basals back. Getting rid of those horrible hypos would be goal #1 and then
increase basals slowly until you have control.
Be careful about getting too high and watch out for ketones.
Connie & Dot….pumping almost 4 months
March 24th, 2007 at 5:43 pm
My endo described as someone living in Alaska (sorry, Jeana <vbg>) and loving
it. They get transferred to Florida and HATE it. Ask that person 2 yrs. later
how Fla. is and they love. Why? Because they acclimated to it. Your body
isn’t acclimated to this new way yet. Your HbA1c’s have been way too high
(Alaska) and if you are coming down you’re not ready for Florida - yet.
I agree with Connie - could be leftover long-acting insulin still in your
system.
Instead of discontinuing any insulin delivery - remember, Humalog lasts about
4 hours and you can go into DKA rapidly - unlike NPH lingering - could really
play havoc with your BGs. I hope you have some Ketostix to test for ketones
when you are running over 240 (unexplained) two consecutive tests.
Are you testing at those periods? See what your BG actually is at those
times - and record the results and feelings. Some people test as many as 12x a
day to get this set right. I do 6-10 and have been pumping 18 years. I want to
know if I’m too high that I can take a bit of insulin to get me in a proper
range - but slowly.
If you could step back and see this from a distance you will see your body is
on a major rollercoaster. It can’t get back to *normal* doing that. Most of us
here at one time or another tried to eat the fridge. With pumping, restraining
and eating just the recommended amounts of carbs (quick acting) will help you
level out.
Don’t do an *and then* - go to a lower basal now but *I* wouldn’t recommend
more than 0.2u adjustment at a time.
March 24th, 2007 at 11:07 pm
Hello All.
My name is Kelli and although I have been on this mailing list for about a
year, I have merely read the posts and found the information quite helpful,
but when I saw this from Vicki, I had to speak up and add my little thoughts
too.
When I started on my pump, it was something I wanted to do real bad! I walked
in my doctor’s office and told him exactly what I wanted and promised I would
do it and stick with it. I hated the nutritionist he had me start with and I
basically cursed her out and told her to find another profession because she
was useless to me. She was mean and just a piece of work. I had enough of a
medical background, I didn’t need to pay her $85 an hour to upset me.
Anyhow, I have been pumping since Oct 2000 and I think it is the greatest
thing in this world. I have had a few highs in the beginning and just one
extreme low (41) in the past 10 months and that was my fault for the carb
miscalculation. A person can walk up to me at pretty much any time of the
day and I can tell you what my blood sugar reading will be within 7 points
and I keep it down around 110. I think it is great. In my round about way,
Vicki, I am begging you to make some calls to your pump trainer, your doctor,
another doctor if you have to—-this should be making you happy. I feel bad
that you are so frustrated.
Maybe being in your brittle state for so long has made your body comfortable
with being out of control and being in the low 100s doesn’t feel right to
your body. But it will come. This pump group has the best advice and
pointers. It will take some time for you to adjust, but the "good feeling"
is going to come.
Kelli (pumping in DC since 10/2000)
DISCLAIMER: This information is not intended to substitute for informed
medical advice. You should not use this information to diagnose or treat a
health problem or disease without consulting with a qualified health care
provider.
March 25th, 2007 at 9:00 am
On Tue, 31 Jul 2001 22:47:21 -0500, you wrote:
I think I was hoping to slowly migrate south…state by state!! ;->
Just out of curiosity, how long would the NPH stay in my system?? My
last shot of N was in the morning on the 24th. It’s been around a
week….. I was wondering about absorption since I’m using areas that
have never seen a needle before (just under my rib cage, whereas my
shots had always been under the level of my navel).
Argh! I threw my hands up in despair a couple of hours ago. Shut
everything off except the appetite. Right now the bg is over 600
("Hi"), but I’m starting to bolus to get it back down…. However, my
head feels clearer than its felt all week!! ;->
> I hope you have some Ketostix to test for ketones
>when you are running over 240 (unexplained) two consecutive tests.
Yeah, negative ketones so far.
Between 50 and 90. I’ve been shooting for 150 - 200 2hrs after
eating. The straw that started my little tantrum today was when I hit
96 2hrs after eating and knew it was going to be dropping even
further.
Yeah, this past week I’ve gone through about 100 test strips. When I
was in the hospital getting started on the pump, and felt the blood
sugars dropping too far too fast, I was testing every half-hour to
every hour. The doctor didn’t seem to be too interested in that many
data points though ( ;->), so I’ve dropped back to her recommended
before meals/two hours after meals/bedtime routine. However, I will
be testing more over the next couple of days.
If I have to eat another glucose tab!!! ;-> I’ve gone through two
jars of them this past week — more than I ever want to see again!!!
;->
Thanks. I’ll get the book and start working on getting the basals
right. My endo is going on vacation, so my next appointment isn’t for
another 6 weeks, and if I call in (assuming I’ll get a call back),
I’ll be getting the on-call doctor — which would be no better than
using a random number generator…..
Thanks again,
Vicki
March 25th, 2007 at 5:07 pm
While looking through the archives of this list, I found a post from
Mike listing two formulas for figuring out a basal rate:
Looking at the first formula, I’d get a basal rate of about 2.1 u/h.
My endo started me at 1.8 since I’m so terrified of hypos. However,
with the regimen I was on before the pump, I was never in any great
control, and was gaining about 10 lbs a month chasing lows.
Looking at the 2nd formula comes up with a basal of 0.9 u/h! So,
apparently, my basal rate should be somewhere between 0.8 u/h and 1.2.
When my bg gets back down to the human range, I’m going to set up a
basal rate of 0.8 u/h, then go _up_ as I need it…..
Thanks guys,
Vicki
March 25th, 2007 at 11:49 pm
Hang in there, Vicki. We’re pulling for you. From your description of your
constant lows, it sounds like the basal is too high. It will take a bit of
work, but you can do it and you’ll be grateful you stuck with it. I still
have a lot of bumps in the road (highs and lows) in the last four years, but
overall I feel much better than the previous 29 years! Keep coming to us
and we’ll try to help. Btw, I like the "Alaska" vs "Florida" story. I can
so relate but instead of Florida, I think California. I was raised in
California and still have a hard time with Alaska even after 11 years! Oh
well. Take care, Jeana in Anchorage Ü
March 27th, 2007 at 2:37 am
Vicki wrote:
But, Vicki, dear, when you shut everything off you have shut off your insulin
supply. Remember, you have ONLY Humalog running into you - no background
long-acting insulin. Your head probably feels clearer because you’re going
back to Alaska.
Are you sure???? That might happen in Alaska, but not on the way to Florida
(or California). *Knowing* you would drop further (and probably assuming
rapidly) *I* think you overreacted. That would be the time to test - say -
every half hour and watch it carefully and perhaps be pleasantly surprised
that you weren’t dropping further. If you were, take the appropriate amount of
quick-acting carbs to keep you level - not overdo. That NPH that you used all
those years made you cater to *it* - you are to be in control now and your
insulin respond to YOUR whims.
I recently found my original pump instructions (8/83) and was told to test 4x
a day then after being *stabilized* to test 12x a week!! Your endo sounds
like she’s still in the guinea pig stage, too. I test every a.m., noon,
supper, bed, anytime I feel *different* (and am often surprised at the
results - hi/lo) and we should test within a half hour before driving and be
sure it is over 100 to be safe and avoid a low. Others may recommend diff.
times, like especially right now at 3:00 a.m. (yeah, I know - but…). Does
your endo have access to a CGMS (Continuous Glucose Monitoring System) that
you wear for 3 days and it tells your BG about every 5 min. (?). You take
tests also and correlate it in the endo’s office and adjustments can be made
with that data.
I’ve had DM over 50 years and I think I’ve had only one glucose tab. Maybe
two. There is such a thing as honey, cake icing (from tubes), I carry those
orange slices (gum droppy-type candy) which are 9g carb each. I put them in a
doubled snack-size zipper baggy. But if you can’t stand glucotabs, find an
alternative.
Do you have a CDE (Certified Diabetes Educator) who is working with you? I
know of some people who have bought used pumps and began using them on their
own following the PI book and help from the ‘net. We can help you through
this - and hope your endo has a lovely vacation while you head for the looney
bin. <VBG> (~_^)
March 27th, 2007 at 11:21 pm
Vicki, you may have overdone it a bit with that many grams
of carb and no bolus at all. When the NPH is all out of
yuour system, you will see the BGs start to rise. I would
think that it is gone by now after 5 days, but I have no
idea of what your former injection sites lookk like. Also,
some people build up a resistance to the NPH when taking it
for so long, so that you need more and more to get results.
This might be what happened to you, and as it leaves your
system, you could be more sensitive to the Humalog, thus
having more low BGs. When does your MD want you to start
overnight basal testing? What was your BG in the AM when you
woke up after having no insulin all night? What is your
insulin to carb ratio? Are you having low BG after eating?
If so, then the bolus ration might be too high also.
Keep us posted. Stay in contact with your MD (daily, if you
have to do that).
March 28th, 2007 at 10:09 am
On Wed, 1 Aug 2001 08:59:15 -0500, you wrote:
I was wanting to get my blood sugars up. I reconnected after a couple
of hours and started bolusing. Didn’t go to sleep until I was in the
400’s. I also changed my basal rate to 1.0 u/h (I started out at 0.8,
then, during the night, raised it to 0.9 and then 1.0). Right now my
bg is 179. Not great numbers for anybody else, but great for me. I
also lowered my carb ratio from 1:8 to 1:10 (after having read through
"Pumping Insulin"). I’ll be finding out how that ratio does in a
couple of hours….
> Your head probably feels clearer because you’re going
>back to Alaska.
Just to find the turn I missed a couple of miles back!! I’m not in
Florida any more, but I’m at the Canadian border with my car pointed
southward…. ;->. I think I’m going to shoot for 200 for a couple of
days, and then move down to Tenn (150 - 180) for a short visit.
Yeah. 4 hours after eating, lately I had been 30 points lower than 2
hours after eating. So, I was looking at a 66. The first night in
the hospital on the pump, I was dropping 30 points every half hour, so
it was getting better.
>*Knowing* you would drop further (and probably assuming
>rapidly) *I* think you overreacted.
So do I. I snapped — big time.
Looking at my logs over the past couple of days (so that I could give
you at least somewhat intelligent replies), I think I’ve found the
problem.
During the night of the 29th/30th, I was awaken with a reaction. My
bg was 54. I treated it with the 15/15 rule (well, since I have 3g
glucose tabs, it’s more like the 16/15 rule). An hour after I was
awaken, while still treating, my blood sugar was 67. So, 4 glucose
tabs and 15 more minutes. 20 minutes later, my bg was 86, so I fell
back to sleep. 2 1/2 hours later, I woke up for the day, and my blood
sugar was 210. I took a 2 unit High BS bolus. About an hour later I
ate a breakfast of 57g of CHO, and took a 7.1 unit meal bolus. 2
hours after breakfast, I was at 242, so I took a 3.1 unit High BS
bolus. Now comes the fun part.
Two hours later, my bg had plummeted to 71. Because of that
precipitous drop, I spent the rest of the day eating 16 - 30g of carbs
every two hours trying to get rid of the "reaction feeling," until I
went to bed with a bg of 81. My bgs were running from 81 - 124, so
whenever I would eat, I would give myself a reduced meal bolus (over
150, add 1 unit/30 points; under 150 subtract 1 unit/30 points). With
an 81 at bedtime (goal = 100) I ate a 30g english muffin without
bolusing.
The next morning, I woke up with a bg of 284, and took a 4.5 High BS
bolus. 3 hours later, I had a bg of 176; ate a breakfast of 65g CHO;
took an 8.1 unit meal bolus along with a 0.9 unit High BS bolus. Over
the next 2 hours I dropped 114 points to 62. I ate 16g CHO which got
me up to 75. An hour later, I was still feeling shaky, so I ate 66g
CHO (no bolus), which brought my blood sugar up to 94. Then I
snapped, and spent the rest of the night eating 300g of carb with a
total bolus of 1.8 units :-/, and posting here.
So, I’m thinking that the problem is that the meal boluses have been
too high. Maybe I should be doing 1:10 instead of 1:8, because — now
that I look back, the problems have mainly come after eating. What do
you think??
I’m also wondering if I might have a touch of undiagnosed
gastroparesis….
Thanks,
Vicki
March 29th, 2007 at 10:32 am
On Wed, 1 Aug 2001 19:07:34 -0400, you wrote:
>Vicki, you may have overdone it a bit with that many grams
>of carb and no bolus at all.
Yeah, I think that was just me holding my breath and stomping my feet.
Throwing a little tantrum, I guess.
No tissue break down, but lots of fat.
She hasn’t said anything about testing the basal. She just has me
testing my bg at meals, two hours after meals, and at bedtime. I was
reading Pumping Insulin last night, and when I get back to an even
keel, I’m going to be testing the basals.
> What was your BG in the AM when you
>woke up after having no insulin all night?
Actually, I didn’t go all night — just a couple of hours until my
head cleared up and I got my strength back. When I got to a bit over
600, I restarted the pump, lowered my basal, and started bolusing my
way back down. I took the bg down in three steps, and when I woke up
this morning, I was at 179.
I was at 1:8, but I noticed I noticed that during the 2 hours after
meals, I sometimes was dropping over 100 points. Just before my
melt-down, I was eating in order to bring my bgs up, but I was giving
myself a reduced bolus to keep from going too high — I was shooting
for 150, but couldn’t get over 96. When my doctor cut my basal nearly
in half, she didn’t touch my carb ratio. I think it was too high.
So, I’ve restored my basal to what the doctor had, and will be
reducing what I take for carbs.
>Keep us posted. Stay in contact with your MD (daily, if you
>have to do that).
Thanks,
Vicki
March 29th, 2007 at 3:19 pm
Is it any wonder that so many diabetics do not stick to their treatment
plan. Instead of blasting the dmers, I wish the media would check out the
professionals. Many times the treatment plan is "undoable" other times they
depress us so that "does it really matter if we try".
Vickie, listen to Kelli and others of us that have been there. Don’t give
up on yourself. We all have to work with the body we have been given and it
seems that others don’t understand "if our body doesn’t work right, it
doesn’t work right". They expect us to be perfect. Let them live one day or
week in our shoes.
The difference is, we do understand, so keep talking and we will listen and
give advice if we can help.
Gail
March 29th, 2007 at 11:27 pm
Vicki,
I may have missed, if you mentioned this, but do you have gastroparesus.
This is a complication of dm. I have this and it really plays havoc with my
numbers. I especially have a stomach shut down after a low. At bedtime I do
not correct for a 200 only if over 250, because often my days intake is
digesting and peaking then and if I bolus I will be too low during the night.
Just a thought, if you don’t know if you have this ask your Dr.
Gail
March 30th, 2007 at 12:24 pm
Vicki,
I am not sure if this might be helpful or not, but I noticed that you were
taking a high bs bolus two hours after eating. Humalog usually last about
four hours in your system. My pump trainer drilled it into my head to never
never take a correction bolus at 2 hours because a lot of the insulin you
took is still working. For instance the chart that she gave me says for
instance if you take a mael bolus of 7.0 1 hour later 5.3 units is still in
your system 1 1/2 hours later 4.4 is still working 2 hours later 3.5, 2 1/2
hours later 2.4, 3 hours later 1.8 and 3 1/2 hours later .9 is still
working. I have a formula that I was given to use I take the blood sugar
reading say for instance 252 and subtract my goal bs of 120 and then divide
by my sensativity factor to come up with the correction bolus. If that
number is great than the number that is estimated to still be working, I
subtract that number and take that amount for the correction, if the
correction is less than what is still working I take nothing and just test a
little later on. I only use this formula if my blood sugar is over 150, but
when I first started pumping I used the formula for any reading higher than
180. I think what may have caused you to drop so far is that you still had a
lot of insulin working and then took a bolus to correct the high blood sugar
which caused you to drop.
Since it seems like your health care team is not very helpful, I am not sure
if the pumping insulin book would be able to help you come up with a formula
that will work for you? I think I remember my pump trainer saying that you
can "assume" that every hour the amount of insulin that is still working
from the bolus decreases by 25%. Although the guidelines she gave me are
not exact. You can calculate by dividing the bolus/supplement in half for
the insulin still working in two hours and in half again for 3 hours. If it
has been 3 1/2 to 4 hours since your last bolus you can assume that nothing
is working.When I first started pumping it was very hard for me to refrain
from taking a correction bolus 2 hours after a meal if my numbers were high.
I am not sure if this is helpful or not, but just thought that I would pass
the information on to you. Hang in there it does get easier I promise!!
>Chera
March 30th, 2007 at 1:47 pm
Vicki,
You may be right, it probably is your carb/insulin ratio causing the problems.
Your correction bolus ratio may be a little off too. Different times of the day
seem to make a difference in some people too. I have learned that I have a dawn
phenomenon later in the morning than most people (mine kicks in real good around
8
or 9). It has taken some trial and error to learn how to deal with it (and I’m
still learning). My normal carb insulin ratio is 1u:7.5c, but at breakfast it’s
closer to 1u:5-5.5c. I have also learned NOT to do a correction for a high 2 hr
breakfast pp (this is my situation only and I’m not advocating anybody ignore a
high and skip a correction). If I try to correct in the mornings, you have
scrape
me up off the floor before lunch. If I leave it alone, it is usually back to
normal by lunch. Drives me crazy! I need to find the time to do more fasting
testing in the morning to see if I can nail it down a little better.
It sounds like you are getting a better handle on where the lows and highs are
coming from. BTW, think about the fat content of your meals. I can drop really
low after a higher fat meal and then go high because the carbs were slowed down
by
the fat and the insulin peaked before the carbs. The dual or square wave helps
a
lot in that situation.
Another good book that can help is The MiniMed Insulin Pump Workbook. It has
pages that show you step by step how to test your basals, carb/insulin ratios
and
correction ratios. Included in each section are pages to record the results and
how to calculate any changes if needed. Use it along with Pumping Insulin when
you are ready to start your testing. Check with your CDE (if you have one) or
call MiniMed to get a copy.
Good luck!
Connie
Paul & Victoria Heisner wrote:
March 31st, 2007 at 12:30 am
In addition to overbolusing, even between meals, and geting
an overlapping effect of the insulin boluses, if you think
you have some gastroparesis, then the MD needs to order some
tests. You are rebounding from lows, overtreating, not
waiting long enough for the glucose treatment to work, on
and on. This doesn’t work the same "old way" as having NPH
in your system. Some old NPH habits need to go.
March 31st, 2007 at 10:52 am
Yes Chera what you say makes all the sense in the world, most educators tell
you to only do high blood sugar boluses prior to meals, also high bedtime
boluses I was told by my educator should be cut in half. Especially when you
first start pumping you need to have some time to become comfortable with
how your body reacts. It is worse to ride the roller coaster it is better to
ride a little high.
March 31st, 2007 at 7:25 pm
On Wed, 01 Aug 2001 22:21:51 -0400, you wrote:
I’ve just looked again at my discharge papers to make sure that I
wasn’t misunderstanding. I was told to give meal boluses at every
meal, and then give correction boluses at least 2 hours after a
previous _correction_ bolus. No correction for any remaining insulin.
The only correction I was taught was to the meal bolus if my blood
sugar was below my target. So, for example, if I’m at 120, and my
target is 150, and my sensitivity is 1u/30 points, then I would
subtract 1 unit from whatever my meal bolus would be.
I actually did this a little earlier today. Figured out how much of
an earlier correction bolus was left (after about 2 hours), and
subtracted that from the bolus I was taking right then. Made a lot
more sense…
>I am not sure if this is helpful or not,
More than I can tell you.
> but just thought that I would pass
>the information on to you. Hang in there it does get easier I promise!!
Thanks!!!
Vicki
April 1st, 2007 at 3:33 am
On Wed, 1 Aug 2001 23:26:31 -0400, you wrote:
Prior to pump training, I would treat a reaction with handfuls of
spice drops (or jelly beans) until I felt better. Not a good way, I
know, but it served my purpose (staying conscious). In the carb
counting training, I was given a handout that said for bgs below 70,
eat 15 (16) grams CHO; wait 10 minutes, then test again. If still
below 70, repeat as needed. In the hospital, I was given another
handout that said the same thing, except that it said to wait 15
minutes instead of 10. Since then, whenever I’ve had a reaction, I’ve
worked my tail off to restrain my natural survival instinct — to just
sit there for 10 or 15 minutes trusting that I won’t pass out.
Looking at the last hypo I treated, I’ve got:
8:10, bs=54, ate 4 tabs (16g)
8:30, bs=55, ate 4 tabs
8:55, bs=60, ate 4 tabs
9:09, bs=67, ate 4 tabs
9:26, bs=86
So, could you please point out where I’m "overtreating, not
waiting long enough for the glucose treatment to work, on and on? I
would appreciate learning the details of the things I’m doing wrong.
Thanks,
Vicki
April 1st, 2007 at 5:08 pm
What was the next BG after you got up to 86?
April 2nd, 2007 at 3:56 am
On Wed, 1 Aug 2001 23:08:31 -0800, you wrote:
Hi Jeana;
You’re absolutely right! I’ve got some new, current, numbers:
Target: 150
Basal: 1.2 u/h (down from the previous 1.4)
CHO ratio: 1:8
Dinner:
1:00 am, bs=155, ate 61g CHO, 7.6 unit meal bolus.
3:00 am, bs=151!!!
I know I have an hour and a half to go before the bolus is gone, but
things are looking good so far!! I lowered the basal, and am being
more careful about the timing and amounts of corrective boluses –
making sure they’re not stacking up……
Thanks,
Vicki
April 2nd, 2007 at 11:38 am
You probably should take a little bit more then what the chart says, first
of all you have to remember that you have been high for so long that your
body is probably giving you a false reaction. A false reaction is when your
blood sugar is 120 and you feel low, this happens in very poor controlled
diabetics. Your brain and your body need time to adjust to feeling close to
normal that is why the doctor targeted you much higher then most patients..
Give it time but take it slowly, your body will slowly catch up with what is
normal and you will start feeling a lot better.
April 2nd, 2007 at 5:24 pm
Since Barb (CDE/RN/MS) put here 20c worth in here
I’m not going to
respond since I’m sitting at the Library using their PC for an hour
total at a time and used 15 min. figuring out how to get to my ISPs
home page to get my mail!! arrrggghhhh My hard drive has to be
replaced and it got sent to Chicago this A.M. Supposed to get it back
b4 8/29. I’m hoping for Tuesday then will have to reprogram
everything. DOUBJ\LE ARRRGGGHHHH!!!
Jan °Ü°
April 3rd, 2007 at 4:19 am
On Thu, 2 Aug 2001 06:36:41 -0400, you wrote:
>What was the next BG after you got up to 86?
That’s cheating. A couple of hours after the hypo, my bg was 210.
So, obviously, I either overtreated, or my liver did a dump. But I’m
working under a handicap here — I’m a mere mortal. I can’t eat 4
carb tabs, hop in my time machine to race 4 hours to the future to see
if I’ve passed out, or hit it right on the head.
I have to work with the information I have at hand — I don’t have
access to what my bgs are going to be 4 hours from now. So, why don’t
you play fair and tell me exactly at what point I should have stopped
treatment _with the information I had available to me at the time_?
Should I have stopped when my bg went from 54 to 55? How about from
55 to 60? 60 to 67? Or 67 to 80? I chose the last value. If you
say I should have chosen 60-67, then could you please tell me how 15g
of CHO could shoot my bg to 210? If you say 55-60, then could you
please tell me the reasoning behind stopping a full 10 points below
the accepted floor? It’s easy to be a Monday morning quarterback and
say "well, since something went wrong, you obviously did something
wrong." However, that doesn’t provide any help what so ever for the
future, unless, of course, you’re saying that I should get my bg
readings from the Psychic Friends Network. Or would Ms. Cleo be
better, because, obviously, if I pick the wrong psychic then it will
be my fault again when my bg zooms after a hypo.
I’ve always hated CDE’s and Endos because if you don’t listen to what
they say then you’re bad because you’re an uncooperative patient.
However, if you follow their directions religiously, and something
goes wrong, then you’re bad for "overtreating." Can’t win for losing.
It must be nice to be so perfect.
Feh,
Vicki
[snip]
April 3rd, 2007 at 12:27 pm
On Wed, 01 Aug 2001 21:05:56 -0500, you wrote:
I’m wondering. I’m going to ask the doctor about it at the next
visit. But, what are the symptoms? I know about slowed digestion
(which I’m wondering if I might have) and nausea (which I don’t have),
but what else? I know I’ve got some numbness in my feet, and
occasional numbness in my hands, so I wouldn’t be surprised if I had
that too….
Thanks,
Vicki
April 3rd, 2007 at 8:34 pm
On Wed, 01 Aug 2001 21:00:18 -0500, you wrote:
Or they blame the patient. I can’t tell you how many times "it must
have been my fault" when something went wrong. I was so glad when I
was in the hospital having every bite of food and every drop of
insulin measured and still having my blood sugars run from 60 to 300.
For the first time, the doctor couldn’t say "I must be having trouble
because of your infection, but you must be having trouble because
you’re cheating." That was a priceless moment for me.
Amen to that.
>The difference is, we do understand, so keep talking and we will listen and
>give advice if we can help.
>Gail
Thank you.
Vicki
April 4th, 2007 at 4:42 am
On Thu, 2 Aug 2001 15:01:00 -0500 (CDT), you wrote:
Ouch. Where you live are there many computer stores that actually
assemble their own computers?? If there are, you might want to
consider them for your next computer purchase. They can build a
machine exactly how you want it, and since they have in-house techs,
replacing a hard drive would only take a day or two — of course,
depending upon their work load. But you wouldn’t have to send it off
to a central repair depot and wait that long to get it back (over 3
weeks?).
Just something you might want to check in to.
Vicki
April 4th, 2007 at 12:24 pm
Victoria try to be so hard on yourself for being 210 after a reaction, it is
quite normal. Do the best you can and don’t beat up yourself. If you don’t
like your educator or doctor I would start searching for another one.
As far as computer go, I pulled the hard drive out of my computer and called
the company that made it and found out my warranty lasted until the year
2003, although the manufacture warranty for the PC expired in 2000. To bad
Jan you don’t have a friend who knows how to fix pc’s.
April 5th, 2007 at 6:40 pm
Vicki,
It was only a question. There is no cheating involved. It
was only to get a bigger picture of what might be happening.
Sorry, if it touched a nerve. Most of the people who know me
here, know that I frequently tell pumpers (especially new
ones, that it is OK not to be perfect). Some people have a
slow response to glucose treatment. I suspected the next BG
after the 86 wuld be high. I have seen that frequently with
my patients. It is usually a combined result of treating
and rebounding, not just from the treatment. With long term
DM, the ability to respond to treatment is often impaired.
If you have issues with CDEs and other medical people, I am
sorry.
I will no longer offer any suggestions or ask questions that
might lead to a suggestion for your benefit.
Happy pumping.
April 6th, 2007 at 6:28 am
<< it — so I ate a couple of hundred grams of
carbs with no bolus. Right now I’m up to 384, but I still haven’t
gotten my strength back. After 5 days of low-grade reaction, I’m
about ready to rip this fucking thing out and throw it in the garbage
can. I’m thinking about turning the thing off until my mind clears
up (I guess my body needs to restore its counter regulatory hormones,
or something), and then start off with an even lower basal. Anybody
have any ideas???
Does anybody have any ideas if, or when, the "feeling good" is
supposed to kick in?? The problem isn’t with the Humalog — I was
using it before I got on the pump…..
Thanks,
Vicki >>
Hi Vicki: First: Get John Walsh’s book: Pumping Insulin - 3rd Ed. - I
think that’s the most current one.
You have to start educating yourself….you are setting up a whole new life
style and like anything else, it takes time, patience, a bit of swearing, and
dogged persistence.
You’ve only been on the pump less than a week…you have to be realistic
about your expectations for right now.
What have your bgs been running?
What was your average total daily use of insulin combined (NPH and Humalog)?
You need to be doing frequent bgs for the next couple of weeks. It’s a pain
in the butt and fingers, but necessary.
Start with your fasting in the am, 2 hrs after breakfast, lunch, dinner,
bedtime, and a 2 or 3 am.
Next, you should lower your basal rate. If you were using let’s say 100
units of insulin total in 24 hours, 50 units would be half, and half of that,
which is 25 units in 24 hours.
You need to learn your insulin sensitivity factor, and find out how much
insulin lowers your glucose level….so many units will lower your glucose by
how many milligrams (mgs).
You have to learn carbohydrate counting.
Right now, the goal is to start getting your glucose stable. Ping-ponging is
what’s making you feel lousy.
How tall are you? How much do you weigh?
What is your BMI (body mass index).
Your endo and CDE should be working with you and your nutritionist to get
some stability on board.
Now is not the time to go nuts with the carbs.
Usually, when your sugar is high, you get voracious and become an eating
machine. Check your bgs. keep a record.
you need to learn your trends….when they go up even without food, which
foods jack that sugar up, which keeps them somewhat more stable….how much
protein intake?
You have a lot of work to do, so don’t quit…..
Right now you want everything, it will come, just hang in there,
You have a lot of questions, fire away, we all went thru the same things
you’re going thru right now…..Joan:) RNC(specialist), Type2 for 28 yrs,
puming for 2 1/2 yrs, Diabetes educator, soon to be Nurse Practitioner!!!!
April 6th, 2007 at 2:36 pm
<< The next morning, I woke up with a bg of 284, and took a 4.5 High BS
bolus. 3 hours later, I had a bg of 176; ate a breakfast of 65g CHO;
took an 8.1 unit meal bolus along with a 0.9 unit High BS bolus. Over
the next 2 hours I dropped 114 points to 62. I ate 16g CHO which got
me up to 75. An hour later, I was still feeling shaky, so I ate 66g
CHO (no bolus), which brought my blood sugar up to 94. Then I
snapped, and spent the rest of the night eating 300g of carb with a
total bolus of 1.8 units :-/, and posting here.
So, I’m thinking that the problem is that the meal boluses have been
too high. Maybe I should be doing 1:10 instead of 1:8, because — now
that I look back, the problems have mainly come after eating. What do
you think??
I’m also wondering if I might have a touch of undiagnosed
gastroparesis….
Thanks,
Vicki
>>
Hi Vicki: you are over compensating, and not allowing your body time enough
to adjust.
Do 1 hr post prandials (after a meal) …if your bg is under 180, but greater
than 140, leave it alone for a while.
Bolus less, and try for about 45 gms of carb per meal…..3 main meals 3
snacks….so that’s like you’re eating about every 3 hrs while awake…..next
is portion control….start with less.
You are too used to over reacting to your old ways….time to
change…….slow down…..Joan:)
April 6th, 2007 at 10:44 pm
<<
I’ve always hated CDE’s and Endos because if you don’t listen to what
they say then you’re bad because you’re an uncooperative patient.
However, if you follow their directions religiously, and something
goes wrong, then you’re bad for "overtreating." Can’t win for losing.
It must be nice to be so perfect.
Feh,
Vicki >>
OK Kid, calm down….gotta understand that us "health care providers" are
human too, and not everyone is "educated" to teach patients (us) what we
should know. And DON’T take us religiously, cause we ain’t.!!
I keep saying that we have to know much more than our providers in order to
live with our diabetes.
You need to experiment a little with food, Vicki.
Need to know which carbs bring your sugars up just how much.
If low, I teach my patients to eat….1/2 a cheese, tuna, or meat sandwich
and 1/2 cup of milk. Recheck in 30 min. Still low, eat and drink the other
1/2s. Then recheck frequently.
The combination of complex carb (bread and cheese) and protein and fat
(cheese, or meat, or tuna, and milk) work together to help your bgs from
dropping too fast. Next, don’t overcorrect so fast. Bolus less until you
get yourself on an even keel. Joan:)
April 7th, 2007 at 6:52 am
<<
I’m wondering. I’m going to ask the doctor about it at the next
visit. But, what are the symptoms? I know about slowed digestion
(which I’m wondering if I might have) and nausea (which I don’t have),
but what else? I know I’ve got some numbness in my feet, and
occasional numbness in my hands, so I wouldn’t be surprised if I had
that too….
Thanks,
Vicki >>
Joan Again!!!
A lot of initial GI stuff is related to the high bgs. That may improve once
your bgs are regularly in the normal range.
The numbness may be the start of peripheral neuropathy (nerve damage). Some
can be abated once the glucose is down to normal range. Goal is to get that
A1c below 6.
Web site you MUST check out:
www.nih.gov click on health topics then click diabetes.
Read the DCCT study - Diabetes Complicationa and Control Trial. Lots of
other stuff all about us!!!
Next web site:
www.aace.com - Am. Assoc. of Clinical Endocrinologists
Read the new guidelines for Intensive Diabetes Self-Management. Treat it
like you bible.
Use these as a guide Vicki…..Know more than your doctor….Your frustration
level will improve once you know more…..:)
April 7th, 2007 at 10:39 am
Vicki,
There is a possibility, just a possibility, that if you do have
gastroparesis, the tabs are slow in digesting. I find I drink juice or reg.
soda and it will hit my system much faster, since I do have gastro.
Gail
April 7th, 2007 at 6:46 pm
Bloating can also be a symptom. When I first started, what I found out
later to be gastro, I had terrible sour belches. They were terrible and I
hated being around anyone. Then gradually it worsened to nausea on arising
every morning, to nausea all the time, then terrible bloating and swelling
( could not wear many of my clothes, had to have something loose) then the
vomiting.
Gail
April 8th, 2007 at 3:55 am
<< I’m wondering. I’m going to ask the doctor about it at the next
visit. But, what are the symptoms? I know about slowed digestion
(which I’m wondering if I might have) and nausea (which I don’t have),
but what else? I know I’ve got some numbness in my feet, and
occasional numbness in my hands, so I wouldn’t be surprised if I had
that too….
>>
Hi Vicki,
First let me introduce myself. My name is Chrissy, Type 1 for 33yrs on a
pump. I was considered brittle b4 on the pump so I feel your pain in all of
this. Ive been reading all your posts and I totally understand what youre
going thru. As far as the gastro I have that. The sypmtoms I had mostly was
stomache pain right under my rib cage in the middle. I hope this makes
sence. The dr thought maybe I had gall stones or ulcer so I did an upper and
lower G I test. Not fun. Anyway…..they finally figured out it was gastro.
This was a long time ago so I dont remember how they came to that
conclusion. Of course I had no gall stones. Also I totally understand how
you feel when your BGs are so low and you are fighting w/yourself to stay
concious. All you want to do is get that BG level to a point where you wont
pass out. Its such a horrible feeling of helplessness. Two days ago I was
at work (I work at Target) and my BG dropped so fast. I was on the sales
floor (not literally) I was working there anyway…..I checked my sugar and
it was 56 so I started eating candy and it felt like it wasnt helping at all.
So I went back to the breakroom (terrified) not wanting to pass out and
checked it again and it was 33!!!! I got something out of the candy machine
and just shoveled it in. Anyway basically what Im trying to tell you is I
totally understand what your saying about ALL of this. For me I just do the
best I can to stay alive and concious. Im not good at fine tuning/tweaking
etc. I start getting mad and frustrated cause there are so many things that
can change your BGs. If I think about all of the if you do this or if you do
that your BG MAY do this or that I will go crazy. So I do the best I can and
hope for the best. You sound like youre a better fine tuner than me. But I
want to give you my support and tell you Im very proud of you for hanging in
there and doing your best. Thats all we can do. Good luck. Chrissy
April 8th, 2007 at 8:10 pm
<< Bloating can also be a symptom. When I first started, what I found out
later to be gastro, I had terrible sour belches. They were terrible and I
hated being around anyone. Then gradually it worsened to nausea on arising
every morning, to nausea all the time, then terrible bloating and swelling
( could not wear many of my clothes, had to have something loose) then the
vomiting.
Gail >>
I forgot about those. I had those too. Chrissy
April 11th, 2007 at 6:58 am
<<Goal is to get that
A1c below 6.>>>>
I know you know this Joan but when a Patient has a HGA1c that is extremely
high you need to bring them down slowly because coming down from 15 to 6 can
cause a lot more problems. Especially with your eyes. The target is a good
one but may not be a realistic one for some diabetics.
Frank
April 15th, 2007 at 6:03 pm
True Frank, but, over time, we can succeed…..took me about 7-9
months……Joan:)
April 27th, 2007 at 10:44 am
What Frank is saying: Move a state at a time to Florida from Alaska.
(~_^)
Jan (who is at the liberry catching up on past posts ’til PC returns)
April 27th, 2007 at 6:52 pm
Mine’s still under service contract ’til the day after Thanksgiving. I
don’t understand when Tuesday I was told it was finished and I said,
"Good, I’ll get it on Thursday’s shipment." He said no they don’t do
it that way. :(( Better be here on Monday’s shipment!
Geekless Jan (~_^)
Sittin’ at the liberry looking for a liberry pie (sugar free) recipe.
April 28th, 2007 at 11:07 am
>I checked my sugar and
> it was 56 so I started eating candy and it felt like it wasnt
helping at all.
Sometimes it’s the TYPE of sugar injested that’s the problem.
Chocolate is full of fat and that delays the carbs. Do not eat
chocolate for lows. Since I have spent $1200.00 on three broken teeth
due to chomping hard candy, I now carry those gum-droppy type Orange
Slices in a doubled plastic snack-size zipper bag. 13 carbs each. Also
the Butter Mints have NO fat in them and melt easily. The carb count
is on the package labels.
Jan (~_^)
April 30th, 2007 at 2:36 am
I used to eat M&M’s for lows… because I liked the
chocolate taste and because they melt in your mouth
instead of everywhere else. But I now use Glucose
Tablets for lows; 4g carb/tablet, no fat, very
predictable results; orange flavored–taste good.
Available at all drug stores.
April 30th, 2007 at 2:15 pm
Yeah Jan I’m addicted to Jelly Beans, Gum Drops and spice Drops myself. Fast
acting carbs are important to treat lows. Let me know when you get your pc
back.
May 2nd, 2007 at 4:56 pm
grape taste pretty good too! Stay away from the lemon ones YUCK!
May 2nd, 2007 at 7:37 pm
who likes Jelly Beans .. they have an 80% glycemic index
which is better
than other candies and Guess what Life Savers have a 78% index.. what a
brilliant name!! and they both taste much better than chalk .. I mean glucose
tablets
Keith