Morning Wake Up Times

[steveman45]

Well, i have a few questions, first off, im 16, and waking up at 7 am, isint a possibility, lol. Latly ive been up at around 10, 11, or 12. My question is If im waking up this late, and im taking my long acting inslulin(the foggy stuff) at liek 12, it peaks at aruond dinner time, so do i still need to take my short acting at dinner?

[JDRF-Team-ES]

Hi Steveman,
First of all, I can really relate.  I remember when I was a 16 year old diabetic and getting up at the same time everyday was a real drag.  Even though I am now 52, there are still days I want to sleep in.  Fortunately, there are now a lot more options for diabetics that can enable them to have a more flexible schedule all the way around.  Now remember, I'm no doctor, so whatever I might suggest, you should check out with your doctor first before trying.

I'm not sure what long acting insulin you are currently on, but I know my life changed when I got on a regimen of ultralente and regular and that was over 20 years ago.  Today, there are even better long acting insulins that stay in your system up to 36 hours and don't have the dramatic peaks that some of the older long acting insulins had, like NPH, which I hated because it had those definite peaks and I had no flexibility.

So, my first suggestion is to go see a specialist in Diabetes or Endocrinolgy, if you don't already go to one.  Doctors who specialize in Diabetes tend to keep up on the latest insulins  and may know of something that works better than your current insulin with the schedule you want to live on.

I don't know if you do any blood testing, but that's another good tool for figuring out how much insulin to take when you eat.  If your insulin is peaking at dinnertime, that means it's at it's strongest level and then it's downhill from there.  So even if it's low before you eat, there is probably not enough left in you to take care of what you are eating for dinner.  You may have to take a little less regular insulin at dinner, but you will probably have to take some.  The best way to find out if you took enough is to test your blood sugar 2 hours after you eat.  I know that doing all that testing can be a pain, but once you figure out how your body responds to certain situations and foods and actvity, you may not have to test as much as you might in the beginning when you are learning about how your body reacts.  I don't know when you got diabetes, but it can take a while to figure out how this disease looks on your body and how to live your life the way you want to and still take care of yourself.

I have had diabetes for 39 years and for me flexibility was always a big issue.  About 5 years ago, I went on the pump and that has given me the most flexibility yet.  I can sleep in when I want to and eat or not eat when I feel like it.  I'm not suggesting that the pump is the answer for you. It took me a long time to make that decision for myself and you may not be ready to take that step yet. Just know that in the future, if you want real flexibility and relatively easy diabetes maintenance, the pump is a great tool.  In the meantime, a very long acting insulin with regular insulin at meals and some blood testing to keep you on track can give you excellent control and a pretty flexible lifestyle.  For me, those were the keys to living a long healthy and happy life with diabetes.

I'd love to hear more about what insulin you are on and how long you have had diabetes and any other concerns you might have.  I know it's hard having diabetes at your age and you are not alone in the struggles you may be experiencing. I'm sure there are other teenagers with diabetes who can relate to what you are dealing with. Good luck and let me know how you do.

Esther (A grownup teenage Diabetic)

[JDRF-Team-LRS]

Hi again Steveman,
A few thoughts come to mind -- even tho' you're a teen ;-)

Often our summer schedules are different from school-year schedules and it's reasonable to expect to make changes in our diabetes management, too.  I'm not sure which long-acting insulin you're taking, but it sounds as tho' it's not Lantus -- one of the newer insulins that doesn't *have* a real peak and lasts about 24 hours.  That type of insulin seems to closely match a true basal insulin like pumpers get with their pump settings.  

My suggestion is for you to tell your doc that you want to know *how* to adjust your insulin(s) for your more usual summer schedule.  I think it's important to frame that question as a "how" question, not an "if" question.  Do you know what I mean?  

It's better to find a relatively stable "basal" insulin routine when you take shots than to "tweak it" daily.  It's reasonable to have one routine for summer and/or extended vacations and another for the rigors of the school year.

One of the features of pumps that many folks just love is the automated basal feature.  Once we program our basal "profiles," it doesn't matter if we're awake or asleep, our pumps deliver that program for us.  When pumping, we don't have to choose between sleeping late or getting our insulin on time.

Finally, there's a difference between the "role" that our long-acting or basal insulins play and the role that our short-acting insulins play.  The short-acting insulins are intended to cover the carbos in our foods.  The long-acting insulins are intended to provide our bodies the insulin we need **even if we aren't eating**  Many folks don't realize taht even if we don't eat, all people need insulin to keep their cells functioning.

Your doctor should have given you (or should give you now) a set of guidelines for when/how much short-acting insulin to take with each meal, based on (1) your BG before eating that meal, (2) the carbo content of that meal, (3) your target BG, and (4) your activity/health issues.  Armed with that knowledge, you can feel very competent to compute the insulin you need to keep your teen self healthy :-)

Test ... test ... test, so you can work *with* your medical team to adjust your insulin routine to suit your life.  IMO, it's very important to *live* life and to adjust our diabetes management to work within that context.

[JDRF Team SGG]

I happen to be a type 1 who is not a pumper, but who uses the 24-hour Lantus for my basal dose, and Humalog to cover my meals. Both of the previous writers mentioned this Lantus insulin as a possibility. I just want to alert you to the fact that, BECAUSE it is a 24-hour (on the average person) insulin, it does need to be taken at the same time each day. Most folks take it at night, and if you did this, you could of course sleep in and take the quick-acting whenever you wished to get up to eat your morning meal. So do discuss the other insulin possibilities with your doctor. They may give you more flexibility than NPH, which is the milky stuff you are probably describing.

[steveman45]

WOW! thanks alot. I had no idea this sort of insluin even existed.  Right now, i am on Humalog NPH, and rapid fast acting.

I take 1 unit on fast acting, and 20 of the NPH, in the morning(not much, still in a good honeymoon)
and at dinner, i take 3 of the Fast acting, and another 7 of the NPH before i go to bed.  So what would you all think is the advatages to this other insulin?, compared to what im taking now?'

Oh, and just a side question:, how common is it for a diabetic to pass out from a servr low?

[JDRF-Team-ES]

Hi Steveman,
Personally, getting off NPH changed my life.  The advantages are just as the others have described... a lot more flexibility.  It is like slow release medicine, so there is no major peak which means you are not tied to a 7-8 hour schedule for eating.  It sounds like you are a fairly new diabetic, so things may change for you as you live with diabetes longer.  That doesn't mean it gets worse.  It just means you may need to keep testing and seeing how your body responds to insulin, food and activity as the honeymoon period wears off.  The Lantus is a great alternative to the pump and will give you the same flexibility and good control. I'd go for it!

By the way, I don't know what the stats are, but I've had diabetes for 39 years and have never passed out from a low blood sugar.  I have the good fortune of being able to feel my blood sugar dropping and I'm able to treat it before it gets so low I pass out.  I do know that some people do not get the physical sensations that indicate a low blood sugar... sweaty, hungry, shaky, confused, to name a few.  If you can't sense the symptoms it makes it a lot harder to treat.  The solution to that is to test frequently especially after a lot of physical activity or skipping meals which could contribute to low blood sugars.  I don't really know how common it is, but I do know it happens to some people.  I always carry lifesavers or nuts and raisins or some other treat on me at all times.  This is also a good reason to not keep your diabetes a secret.  Let all your friends know that you have diabetes and what to do in case you should get in trouble.  If you do pass out they should know to call 911 and put some sugar under your tongue or between your cheeks and tongue.

It sounds like your dealing with all the adjustments in a proactive way and that's a good indication that you'll do well.  Keep up the good work and keep in touch.
Esther

[JDRF Team SGG]

I am back again... the pros of Lantus are the flexibility and the fact that you don't have to worry about strong peak times, although I notice that it seems to work a little stronger for me between 4-8 hours after injection than at other times of day. But this is not a strong peak like what NPH does that requires food or else. Because it is such a slow insulin, even when you start to feel low, you have all sorts of time to help yourself because the drop is very slow. I happen to be prone to severe lows, and this is wonderful for me.

The con is that you will have to take an injection before EVERY meal, for that peak time that NPH does its thing to cover a meal won't work. So you take a shot pf quick-acting insulin every time you choose to eat. But your meal times can be much more flexible since you aren't having to chase the peak with food. Another downside to Lantus is that you cannot mix it with any other kind of insulin, so you may have to take two separate shots rather than one when you need both the Lantus dose and the quick-acting. Many of us don't mine the extra shots and prefer this in order to have the flexibility that this type of insulin affords. It has been on the market for a few years now and is a very common insulin, used by many doctors as their preference these days for treating newly diagnosed diabetics because the routine tends to be so stable.

I personally need lots of calories, having the metabolism of a gerbil and being a tiny person who seems to need to eat a lot to stay healthy. So I choose to take a unit more than I really need for my base dose of Lantus so that I can snack during the mid-morning and mid-afternoon and not have to take more quick-acting insulin to cover those snacks. So I still need to eat fairly often, but this is my choise. If you take the proper amount of the base dose of Lantus, this should keep your glucose levels even when you are not eating.

I personally have had occasions when I would have a severe low and have had problems in the past with occasional lows while asleep that didn't wake me up. Because I am such a heavy sleeper that the low won't wake me, I opt to take my Lantus in the morning so that it actually wears off a little at night while I sleep. This way, even if I DID drop at night, which is not likely, my glucose would rise as the insulin wears off, for it does peter out some after about 20 hours in most people.

If you take it at night, this means that you might need a little more of the fast-acting insulin to cover your dinner carbs than you would at other times of day since you would be eating dinner at the tail end of the Lantus action. Unless you tend to drop low at night like I sometimes do, the night-time dose is probably OK for you... this is the most typical time for people to take it. It takes a few hours to kick in, and then starts to really work at about the same time you wake up to eat. Some people even choose to split the total amount in half and take half at night and half in the morning. This way, it NEVER peters out, but keeps working for the full 24 hours at about the same rate all the time. This means one more shot, though.

I think you would find that your numbers will stabilize a lot during the day with this type of insulin, for it is not rising and falling, but works just like  a pump during the times you are not eating to keep your glucose steady. And the quick-acting insulin works well to cover those meals. My numbers have never been better since changing from NPH to the Lantus. And I really don't have to work at it much to keep them pretty stable.