Insulin regimen

[Zoelula]

I'm not sure how many insulin users there are onboard as I didn't get an answer to a previous question, but I'll try anyway. I started on insulin recently (Type II) and began with just one dose of Lantus first thing in the morning. My doctor is not yet sure if that will be sufficient (it would be nice!). But he mentioned if not then I will take a short acting type two hours AFTER my meals only if my blood sugar is high. I'm confused because everyone I talk to and everything I read refers to taking short acting BEFORE meals (t hold the blood sugar in control as food is absorbed). Has anyone heard of taking it AFTER meals?
Thanks,
Zoe

[WaveRider]

You're welcome.

[Zoelula]

Ah, now I understand. Yes, it is my postprandial peaks my doctor has been concerned about, the rest is good. Actually he had to lower my Lantus dose because I was dropping way too low at least twice a day, and feeling like a slave to a clock. I forgot too  that the short acting means just that...it kicks in before the food does. Now his plan makes perfect sense.
I have been testing a LOT, but I think once I get on my right regimen of insulin then I can work on learning more about ways to fine tune the food and exercise. I'm not there yet.

Thanks you've been very helpful, my doctor's English isn't great and my Spanish is worse so I needed an explanation I could understand.

[WaveRider]

The danger of before is simple; If in a normal prandial range your glucose may drop to a dangerous level. I'm ALWAYS within normal range prandial so its postprandial for me.  Since you're new to diabetes, I suggest that you test, test, test, test prandial and postprandial to see what suits you best.
This is what I did to understand what foods I could eat and which ones I couldn't to limit/reduce/eliminate my injections.

[Zoelula]

Thanks, I appreciate your explanation, Waverider; I'm the kind of person who likes to understand things, not just "follow doctor's orders." Yes, what you said definitely makes sense. I want to control my blood sugar as much as possible with diet and exercise. I was lucky because when I was diagnosed I already had good dietary habits and haven't had to make too many changes. I'm also at my perfect weight and now I'm working to make sure insulin doesn't change that!.

My post-prandial peaks are sometimes within range and when they are high they are in the high 100s or low 200s.  I know that sometimes diet isn't enough, because like you say, you eat the same thing that was good yesterday and you are too high. But I'm afraid I still don't get the philsophy of taking the insulin AFTER I eat, rather than before because it sounds like that would do exactly what you said, cause you to drop way down from a high, and you would still have experienced the highs that could have longterm diabetic side effects. The only positive I can see is then you wouldn't be taking extra insulin if you didn't need it. But wouldn't it still work better in the long run to take the short-acting, as most people seem to, before meals, eat your healthy meal and then keep your blood sugar nice and low on a consistent basis. Am I missing something?

[WaveRider]

"..isn't the idea to prevent highs before they happen, rather than compensate after?"

With proper nutrition, one can "try" to control their glucose levels. I say this because foods will trigger a rise in me even though the day before, or two days before they didn't. I try to maintain what I call my normal ranges in both prandial and postprandial with proper nutrition.

"I thought once you have highs then they already can be doing longterm damage?"

Yes, but what is "high"? I've been instructed to avoid glucose spikes, where it rises to a high level then drops suddenly. Spikes put a lot of stress on the cardio system and your internal organs. For example; if I had consumed foods that shot the levels up to 350 mg/dl, 2-3 hours postprandial, injecting insulin would cause a sudden drop and one would feel better.  This extreme up/down sudden increase and decrease does the body no good. In essence the long term effects of the extreme highs to lows will cause some sort of internal damage. So again, its back to proper nutrition to keep these extreme highs from happening. Make sense?

[Zoelula]

Thanks, WaveRider, I was starting wonder about my doctor! I can't say as I understand it, though; isn't the idea to prevent highs before they happen, rather than compensate after? I thought once you have highs then they already can be doing longterm damage?

[WaveRider]

I use Novolin R, fast acting, 2-3 hours after dinner but only when my glucose levels is above 150 mg/dl.