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high dose sliding scale?

I feel I am on a huge dose for my sliding scale, which still barely seems to keep up. I am on Lantus 40 units, twice a day. Humalog sliding scale, starting at 20 units. For every 50 mg/dl over 150, 2 more units. In a typical day, Between 20-28 units multiple times a day. A1c=7.7 currently. Is Humalog maybe not the right choice if I need such high dosing?
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Avatar universal
I can walk, but not quite the same for me. Part of my injuries included strokes which shut down the left side of my body. Walking, or worse, taking stairs, is mentally taxing. I still consciously have to deliberately think each individual command, lift hip, point toe up, swing leg, plant foot, etc.. I have been able to do more than a mile and my PT has directed me not to exceed
10 minutes at a time for now. I was completely unaware of the B vitamin thing. I take a daily supplement, but will confirm with my doctor if what I am taking is enough due to the metformin effect.
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231441 tn?1333892766
COMMUNITY LEADER
Hello,

Due to your past injury I understand you are in quite a bit of pain and also have difficulty with exercise.

2 g of Metformin in close to the maximum dose.  Do make sure you take some b vitamin supplement as metformin can decrease your body's absorption of b vitamins.

Recommend you consider and look into low carb/ higher (healthy) fat diet.  This approach is actually now being recognized as one of the better ways to deal with diabetes.

Are you able to swim / walk in water or do non-weight bearing exercise, it may help (as well as with function).
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Avatar universal
I appreciate your input. I suppose I left out some extra details though. In addition to already being diabetic, I was disabled by a car accident/surgery that left me unable to do much of any reasonable exercise. I am on 1g twice a day of Metformin, which I understand is already a pretty high dose. I try to avoid high carb/high fat foods entirely, and rarely ever snack. What I understand from my pain management doctor and confirmed by my endocrinologist, is since some of my injuries were not addressed by my surgeries, I remain with chronic pain due to 2 herniated cervical discs. Which my pain level rises due to stress or exertion, my body's natural response is to dump cortisol, which elevates my glucose level without having ANY foods.
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231441 tn?1333892766
COMMUNITY LEADER
Hello,

You don't have any choice but to use insulin.  Humalog and Lantus are quite standard choices for people requiring insulin.

With an A1c of 7.7 your average blood sugar is nearly 200, which is far too high and you are guaranteed to get diabetic complications down the road (normal blood sugars are 80- <140 at all times, even after eating).

However, a sliding scale dosing scheme may not be the best approach.  Basal-bolus, which is adjusted based on 'basal testing' and then carb:insulin ratios which are determined by trial and error and which may vary depending on the time of day.

You could get the book "Think Like a Pancreas" or "Using Insulin" by John Walsh, else google this approach and you will find plenty more information.

Are you overweight?  if so, losing weight may help in reducing your insulin resistance.  

Also, ask your Doctor about metformin / glucophaage.  This drug may also help reduce insulin resistance.

Exercise will also reduce insulin resistance and should be done at least 30 minutes each day.

Further, you may consider eating a low carb, moderate protein, high fat diet (15 - 20 g of carbs per meal, 5 g per snack (but may be better not to snack)).  In this approach you get your carbs from non-starchy veges, and avoid all or most fruits and grains.  

Please look into this. The approach described above should be very helpful in both reducing your insulin doses and in controlling your blood sugar.  one word of warning though, when you start implementing the described changes you should monitor your blood sugar closely as you may need to reduce your insulin.  In any case, if you do basal testing you are going to see much better how much insulin you really need.

Let us know how you go.  H ope you can get much better control of your diabetes, with more knowledge and learned skills.

I firmly believe that diabetes management is the responsibility of each individual patient and we have to learn to manage it ourselves.  this takes the right tools and knowledge and then commitment to doing what needs to be done.
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