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Advice for a Newbie to Insulin

Discussion in 'Adults with Type 1' started by szofa12yrold, Aug 21, 2011.

  1. szofa12yrold

    szofa12yrold Approved members

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    Hi all,

    I am just starting experiments with insulin. My first goal was to learn how much a minimum unit will affect me. I started with 1 unit in a Novolog Flexpen.

    Long story short, it seemed to do nothing. Second experiment I cut carbs from the same meal and got lower #'s but same pattern, as if the insulin did nothing. Consistant with what my pancreas alone would do.

    I might eventually like to use this to cover a very low-carb meal or a meal with mixed fast acting carbs and slow acting carbs.

    I am considering what my next experiment will be and would appreciate opinions.

    I could take the same meal and cut the carbs once more and/or inject with no meal to fully exhaust any opportunity to see if/what 1 unit will do.

    OR, I could just up the dose. If I up the dose should I just go to 2 units or 1 1/2. I guess what I'm asking is should I ask my doc to track down a Novolog Jr pen for me, that way I could up more slowly but also have more fine tuning ability from there?

    If I up the dose my plan is to use that same meal that I've been using with these experiments, the second, reduced carb version. 2 c. salad greens, canned tuna or chicken 22.5g PRO, mayo with 0 carbs per serving, 1/2 bagel 21g. CHO 2g sugar and 3 g PRO.
     
  2. obtainedmist

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    If your insulin needs are small, you might need to be just on a long acting insulin (like Lantus) first instead of dosing for meals with the short acting.

    If you think you need both, my advice is to work with your endo or a dietician associated with an endo's practice to do a three day diary with dosing information including before and after meal bgs (there is a specific routine...but I forget what we did.) What they might do is start you on a sliding scale and then see how each meal is affected by the amount of insulin you are dosing. From there, they can give you an insulin to carbs ratio to use for each different meal. During certain parts of the day, your body is more insulin resistant and so your needs vary during the day regarding insulin amounts.
     
  3. szofa12yrold

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    Insulin Dosing

    Hi,

    Thank you for your reply.

    Mp pp's jump up quickly but my basal is fine. I can go a little low on my own without meds or insulin, under certain conditions and it's not reactive hypoglycemia, so my Doc doesn't feel I need basal so we are trying bolus to knock some points off my pp's. My Ogtt 2 yrs ago was 175 at 30 min. and I was shaking uncontrollably the first 30 min, teeth chattering etc. and couldn't do a thing to control it but my fasting was 87. I went up way higher than that 175 ;) and didn't start to come down very soon. I realized just recently that I was regulary going low in the early a.m.

    I am working with my primary on this, not an endo. I sought out and consulted an endo for the tests that led to my DX change but I will not be working with her on this for some reasons other than personal preference. My primary is aware of that situation. She didn't seem to really know what to do with me either. Every other sentence and visit was a compete contradiction. I'd love to find an endo that I could work with but it took me a year to find and get into the one I did and I just don't want to keep devoting that kind of effort towards that. I have too many health management tasks, between my son and I. I have to pick and choose my battles.

    My primary(internal medicine) leaves alot up to me, which has it's pluses and minuses. He's a good experienced doc. and very supportive but has his limitations and I am a very unusual patient. He's been honest and said he doesn't have any answers either, but he offered insulin and implied that I go do some experiments and I would like to give it a go and hopefully preserve beta cells so here I am.

    My experiments are conducted the same time of day-lunch only until I get a better sense of this. Once I establish a minimum dose, I will stick with L for a good long while and with various meals of similar composition until I establish some stable routine and get used to things then I will branch out to other meal times as I see fit. That's my plan at this point. A very slow process, perhaps painfully so but hopefully a good way to learn in the absence of various things at this point.

    My diet is very routine and predictable, because of numerous food allergies and because I've been low-carb for a long time due to the lack of meds and insulin. So I eat very simple, fresh ingredients, not complex dishes and know exactly every ingredient in everything I put in my mouth. I have very consistant portions.
     
  4. TheFormerLantusFiend

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    If one unit does nothing, then adding a second unit shouldn't do much, so I'd go ahead with two units. It's when one unit does a lot but not quite enough that you should think about one and a half units.
     
  5. Amy C.

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    Syringes come with half unit markings.

    I agree with PP. If one unit made no difference, then 1.5 won't either. I would go up in whole units and then adjust the food to balance it out.
     
  6. szofa12yrold

    szofa12yrold Approved members

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    2 Units

    Thanks you all for your advice and input. With my doc's permission, I upped the dose to 2 units for the same meal, with a piece of bread that had fewer carbs and was very pleased with the results! No I know that my insulin was not spoiled, it is still viable! I was beginning to wonder. And my injection technique is ok and timing fine. I didn't go too low and was happy with how this dose covered this meal. It did enough but not too much. Yay! A good step forward!

    I must have dipped just a bit low between 4 1/2 hrs and 5 because at 4.5 I was at 82 and by 5 I'd gone up to 90 something so I think I dipped a bit and my body corrected up. I felt just a bit low. But no worries.
     
  7. szofa12yrold

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    Injection Timing

    Hi all,

    I am back with a few more ?'s. All is going well so far. I started breakfast insulin and asked for the Novopen Jr. to try 1/2 units. Because of food allergies and digestive issues and different foods in the a.m. I am still wanting to try adjusting in 1/2 unit increments. I'd rather add or subtract a 1/2 unit than split my toast in half;) I was finding no matter what the insulin and carb combo, with the same foods, I was ending up cutting it close with the low end of BG or over target. There is too much of a gap for my liking. We'll see how that goes.

    My ?'s are:

    if I find my BG is a bit over target before a meal, I am playing with the idea of injecting and waiting 15 min. to eat to correct a bit. I tried it once and it knocked me down 20 points putting me at my usual starting point. I am wondering if there is a down-side to that? later on...Right now, I can't add in an extra bit to my dose. Of course, I could just live with it.

    The other ? involves the opposite side of this issue, when I find myself at 84 pre-meal does it make any sense to just eat and inject after I get started, maybe 15 min.? I could skip the shot but would rather get something on board, so sometimes I just do 1 unit when I would normally do 2, although that doesn't help much.
     
  8. Amy C.

    Amy C. Approved members

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    Both these practices of timing with the insulin are effective and commonly used. Go ahead and try to see if your sugar is in better control.
     
  9. obtainedmist

    obtainedmist Approved members

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    When my daughter is at the low end of her range, she'll just inject and then eat right away. Otherwise, she kind of uses this approach...she takes the first two digits off her bg # and uses that as the minutes she'll wait after dosing to eat. Her pump always adds in the correction dose if she's over 100, or a subtraction amount from the carb dose if she's under.
     
  10. TheFormerLantusFiend

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    The first- injecting, waiting for a drop, and then eating, is something I often do without a problem, although I also increase the dose for a correction because otherwise I'd just come right back up.
    The second- eating and then injecting- tends to make my blood sugar spike. For an 84 I'd inject and eat right away. If it's low enough that I'm not comfortable injecting with that low- say, 44, I prefer to treat the low, wait for the rise, inject and eat a meal, if I have time. Otherwise I will eat and then inject, but if I do that I really see a big meal spike, which is not something I usually see.
     
  11. pancake111

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    I would just give more units. If what you're giving isn't enough, then you're either eating more carbs than you thought, or you're simply not giving enough.
     

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