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Ginny's Insulin Posting?

Question:


I think Ginny makes some very important points. If your pancaneas can't produce enough insulin even if your insulin resistance goes very low, then you need insulin!! I know some wait too long before going onto insulin and I don't want to discourage anyone from taking insulin, but they need to understand the dangers of this important drug.

I don't consider talking about lows in reference to insulin as giving it a bad rap, no more than talking about digestion problems with Metformin or water retention problems with TZDs. Lows can happen when on insulin and it is important for the patient to understand what a low is, how to recognize it, how to treat it and how to prevent it. Maybe some that are trying diet and exercise will try a little harder if they understand there are down sides to insulin.

You mentioned that sometimes lows sneak up on us. As you pointed out, I have not experienced lows so I am guessing but I have a theory. Low level aerobic exercise has given me my lowest readings; so, if someone went shopping at a Mall, say for several hours, they could have a low or maybe have one on the way home that was not expected. Several hours after doing weights one could also experienced an unexpected low. Exercise makes a little insulin very powerful, so athletes turn of their pumps before they compete and some have higher target glucose levels prior to competing. These actions are taken to prevent lows during the event. You have probably explained your unexpected lows before, but sharing these experience may help others to avoid a low.

I enjoy reading your comments, Ginny, and respect your opinions.

Chuck
Answers:
This subject began in the Prediabetes Forum.

I can only relate MY experience with insulin and lows. First of all, I am not sure of my type. No one has ever said to me that I am a certain type. I have had extensive testing done and we do know that I do not produce enough insulin however I did not test postive to the pancreatic antibodies. I do have autoimmune condtions and was on massive doses of cortisone at one time that may have led to me having to go on insulin so soon into my diagnoses of diabetes. That all said........

Insulin has been the best thing to happen to my diabetes. I am also on metformin and I am sure it does something for me but I can't tell you what but I don't want to go off it to find out!

The lows that I have from insulin that are the most puzzling to me are the ones that come on close to 4 hours after a meal or right before it is time for another meal. They don't happen often but when they do they are pronounced. These are the ones that are not insulin injected related.

I most of the time have hypounawarness and that is not good. The worst was when we were sitting in a resturant and had just ordered. I had just treated a low 1 hour prior, checked my sugar again and this time my meter registered LOW. The waitress just came back to the table and I asked her for a small glass of regular pepsi, she responded immediately with it and within 10 minutes my sugar was on the rise and my food came and I ate and that was the end of it.

What I described to you was not insulin injected related. I have had only one injected low and that was shortly after going on insulin. It scared the bejeebers out of me! I had injected right before eating, counted my carbs to my insulin, ate and 15 minutes later I was at 54 and reacting. A few glucose tabs brought me out of it but unfortunately later I went into the 200's.

Trial and error. Lows are scarey and yes, dangerous. I have had a couple a month, some are worse than others but it is no reason to stay away from insulin if your body does not produce enough of it's own.

Testing is very important when you are on insulin. If I am experiencing a low it is not unusual for me to test every 15 minutes to start with and then every 30 minutes the rest of the day. I test 6 times a day everyday. Two hours after every meal. I always carry my meter and glucose tabs with me and my diabetic bracelet doesn't come off. I have two very good books, Think Like a Pancreas and Using Insulin, I recommend them highly.

There a plently of folks on here that are on insulin that can probably explain lows to you better than me. We all are a little different though however rather than explain a low it is better to prevent them but then again like I told Chuck, they sometimes sneak up on you. Just be prepared with some quick acting sugar and once you are on good ground again add in some protein, keeps you from going high.

Chuck, thank you for asking me about lows, I hope I've helped in some little way.

Ginny
Answers:
Ginny,

I think that you may want to do some logging to see if you can find the cause of your lows. Since they seem to occur when you have not eatten for a while, it maybe what you eat. A low fiber, low fat meal will digest faster than one with fiber and fat so your insulin may last longer than you food does. The other thing is to log activity, because that could be part of the problem. Standing rather than sitting burns more glucose so it may be rather minor activity. When I worked I often took walk breaks and when I got home prior to dinner my glucose was lower.

Thanks for sharing because what you experience happening may help other understand their situation.

Chuck
Answers:
For some of us its not a simple trial and error or test to find out. I must have tested a bizillion times to figure it out. I cant put my finger on it only that my body changes often. For me it takes a higher dose to move me. My mom on the other hand would exercise several times a day on a stair stepper being blind she could hold on to the rails and exercise. It would take all of 12 units for her per meal. Thing is one day same exercise or same food and one day a 70 the next day a 250 it would drive her nuts. For some of us it isnt simple, I know for others that is hard to understand.
Answers:
Fur, that is why I said those that are not on insulin can only guess, you can't know until you experience it.

Chuck, as for logging, I log everything. Some times there is just no rhyme or reason. A couple of times a month now out of 30 is not near as bad as it was for awhile. Sometimes things work and some times they don't.
Answers:
Fur,

It is not simple for me either, everyone gets some shocks, and occasionally they are good.

One of the complex factors is that exercise done either the day before or two days before can affect today's reading. Food eaten over several days affect today's readings as well. Stress, illness, amount of sleep, combination of foods all effect glucose so I have found little benefit in trying to analysis factors on a daily basis. I do know that more exercise means lower A1cs, muscle mass is a powerful treatment for my diabetes. More carbs raise glucose levels for me. While you might consider these comments might seem simple, I have learned over the years, that formulating an action plan based on such analysis work well for me.

By the way even though I don't need insulin, I think about it because I may need it in the future and if or when that happens, I want to approach it in an intelligent mannor.

Chuck
Answers:
Let me just add my two cents here re insulin and hypoglycemia. I take 172 units of Novolog 70/30 each day (72 in am and 100 in pm). I began insulin in Feb 08 after 6 years on orals. Greatest thing to happen, considering. I rarely excercise, although I am very active, and I really watch what I eat. I occasionally get lows around midnight. I get these because I broke the rules and didn't get enough carbs in the evening meal and/or snack before going to bed. The same could be said for hyperglycemia---I broke the rules and ate too many carbs.

Having/comparing diabetes is like comparing the stars. While all may seem to look and act alike they are each unique and must be accepted as such. I guess what I am trying to say is,there is hope for each of us to live a "normal" life with diabetes. We must never give up and must always read and research the latest and ask many questions. I just want to sound upbeat and positive and let those, who are struggling, know that there are many here who care and are willing to help. Nah, were not going to sing "Coom-bah-yah", but we are going to turn a new page and get on with living pretty close to the way we want. Chuck and many other posters have the knowledge and experience to give great insight and can be of great help. Let's all use that resource. Praise God and his blessings to you.
ab1246
Answers:
Hi ab1246 your very right we are all different, sometimes it frustrates me and I think you know why. We can take hints from others, we can exercise and diet and we can still have problems with our bs. It has never been easy for me to control my bs. Its not that I cant have a great a1c but to do it I would have to take a lot of insulin and then I would get to many lows, that I will not do.
Answers:
Ginny,

I assumed you had done a lot of analysis and fewer lows indicate you have found some things that work.

I form action plans based on the type of analysis you have done. If I were in your shoes based on what you have posted, I would consider the follow ideas. You have probably tried some or all of them but I will post them anyway:

Eat more small meals a day. Divide daily carbs by six and eat that much every two to two and a half hours. I have seen that recommend for keep glucose levels more constant.

Experiement with insulin like maybe less long acting insulin and more insulin at meals. Maybe different products would met your insulin needs more effectively.

Take less insulin with higher levels of activity.

If your A1c is well below 7.0, you may want to take less insulin and have fewer lows. I know this is a contrivercial view, but I would like to explain how I came to think this way. According to the ADA studies show some but not a lot of reduction in complications occur as one's A1c drops below 7.0. The charasterictics of lows are caused by the brain not getting enough glucose and I think the brain not getting enough glucose is bad. Research has shown that seniors, when they have lows are subject to heart attacks and strokes and I am a senior. I know the AACE recomends A1cs below 6.5, but the 6.5 was originally developed for type-1s and assumed to apply as well to type-2s. That goal may not be as good for older type-2s. The drug companys do research and clinical studies that enhance the sale of their products. A clinical study that shows a medication is safe, has few side effects and is effective to treat a condition is a win for the patients that use this medication as well as the win for the drug company who profit from the drug sales. Lower goals for LDL or goals based on the high number for BP are examples of how this works. The question is that if the goals for A1c could be lower, why haven't the drug companies funded tons of research in the area; if A1c targets were lowered the drug companies stand to make a hugh profit. The ACCORD study showed why, the tighter control group suffered a higher death rate and this leg of the study was stopped. The more intense treated group targeted an A1c lower than 6.5, used more insulin, gained more weight and suffered more deaths than the group targeting an A1c lower than 7.0. Both groups suffer less deaths than would have been expected if their A1cs had remained at an average of 8.0. It will be interesting to see the final ACCORD reports when they are published.

My hope in making this post is to stimulate so ideas that might help you to reduce the number of lows that sneak up on you. I don't know the details of your situation and even if I did I would not try to give specific advice, I am NOT a doctor. I just try to stimulate people to think about their diabetes and maybe try a few things, with doctor's approval of course, if they think they apply.

Chuck
Answers:
I am not sure how to approach this because it wont be taken well. Sure lows can occur and my family always says, why not take xxx of insulin or drop back. Ok I do that and that works well for a few days or a week. Then the next week the same dose that would bring me lows will bring me extreme highs. No rhyme or reason for it, I doubt I am the only one like this but is it frustrating, oh you betcha booties it is. I go on like this month after month and it seems lately I am in that zone again. There are several weeks I can have perfect readings and then boom I go into this wild up and down zone. So I have to test often to make sure I dont go to high or to low, like I said it isnt easy controlling my bs. Mine could be related to pain that I have, since I am in pain all the time its really hard to chart that with the bs level. So I just keep plugging away trying to prevent anymore diabetic related damage from higher bs, when they spike they go into the mid or higher 200s and I dont want to see those any longer. Even something as simple as an apple can raise me into the high 100s and that is with insulin.
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