Lantus and Novolog Control question

[whiskey999]

I just switched from NPH and one shot a day--to Lantus in the morning only,
and Novolog up to 6 shots a day--and testing my blood at least 10-12 times a
day--I don't see how I can determine the amount of insulin I need for each
meal--counting carbs alone is not working--any ideas are welcome--as my
highs and lows and inconsistency are driving me nuts---

[JDRF-Team-dm]

Dear whiskey999,

Thank you for reaching out to The Juvenile Diabetes Research Foundation. While I am a volunteer and not a physician, I cannot give you medical advise, but I can give you my own personal experience.

Are you seeing anyone who deals with nutrition?  It sounds like you need a specialist that can help you with both carb counting and your insulin intake. Any changes in your insulin intake can take time to adjust. The fact that you are testing so much shows that you are trying to take care of your diabetes. Have you talked to your doctor about the highs and lows? Has your doctor talked to you about going to the pump? There are so many varibles that come into play here. I would suggest speaking to your doctor. Never give up in your questions to improve your quality of taking care of yourself with diabetes. You are on the right track.

While I have not been able to be completely specific to your answer, I expect that you will recieve comment's from our volunteers and others. I have already asked that some with more knowledge than I have on this particular issue to respond. I do know this will happen. Please keep in touch.

I do wish you the best,
dm

[JDRF Team SGG]

I use the Lantus/Quick-acting Insulin program, and the basics work beautifully if your doctor has given you the correct mathematical formulas to use to lower highs with quick-acting insulin or to cover the carbs you eat. I assume that you are counting the carbs and doing the math to figure out dosage? This only works IF:

1) Your dosage for the Lantus is correct, and this will vary for each person. If you are eating the same numbers of carbs, but having swings in glucose, the main baseline dose may still not be correct for you. Keep records of your foods and insulin and talk with your endo to get this straightened out.

2) The base dose for the quick-acting is somewhat different for individuals, too. So while you may have a formula that suggests 4 units of insulin for the first 15 carbs and 1 unit for each extra 15 carbs, this may have to be adjusted to your individual metabolism rate. Again, keep good records and discuss this with your doctor.

Also, some foods digest slower than others. If you eat foods high in fats, digestion is delayed, and so when the quick-acting peaks, you may find yourself low but then have a rise later as those foods digest. I find that french fries will do this to me. Once you KNOW about the delay that fats can cause, you can perhaps delay the injection of the quick-acting insulin long enough to make the digestion match that particular food.

I would suggest that you minimize variety in your diet some while first getting the dose right. That means only eat things that you KNOW the carb content exactly for and avoid high-fat foods which will delay digestion right now. Onece you get the dose vs. carb content working right, then you become much more flexible. For me, personally, this insulin solution offers almost perfect control, with very even-keeled numbers and no unexpected drops when things peak (an occasional low may happen if you miscalculate the carb count of a meal, but you know when to look for this to happen -- 1-2 hours after mealtime). The key is to have first of all the correct base dose for your needs, and second, the correct mathematical formula to adjust your quick-acting insulin dose when necessary.

Maybe if you keep good records of what you eat and how much insulin you take for each meal and snack during this adjustment time, your records can help your doctor adjust the dosage and teach you how to do so.  Good luck!