I was diagnosed with diabetes about three years ago. I was experiencing weight loss and blurred vision. My doctor first tried oral medications and played with the dosage for the past few years. I was taking 1000mg of metformin twice a day, actos 30mg once a day and glyburide 5mg twice a day. With these medications I am also riding a bicycle about 20 miles once to twice a week. I should also add that I am a chef, work long hours and eat small meals all day long while avoiding simple sugars and processed flours. With these actions my BGL were always over 200 while eating and never below 160 while fasting. Now the doctor has put me on a insulin regimen. Lantus 10 units at bedtime and humulin r using a sliding scale. The sliding scale is 200-250 2 units, 250-300 4 units, 300-350 6 units.......
He also told me to discontinue taking the glyburide but continue taking the actos and metformin. I've been on this regimen for about five days now and my BGL is through the roof. I've been checking my BGL in the morning and injecting the humulin r using the sliding scale. My morning BGL has averaged around 260 so I take four units. (Before today without realizing it I was doubling my dose due to my ignorance on the syringe having two units per line scale :dizzy: but only with the humulin r and not the lantus)

A few questions:
Can I mix the lantus and humulin r in one syringe?

Can too much insulin raise my BGL?

I just caught a bad cold. Does this raise my blood sugar?

When should I check my BGL with this sliding scale and do I check and adjust it before eating or after?

After eating dinner last night consisting of shrimp and brown rice my BGL hit 304. How do I avoid this?

I know this is experimental with the meds with my DR looking for the right combo but shouldn't some of these questions have already been answered by him and I shouldn't feel so "in the dark" regarding all of this.

Thanks in advance for any advice and shared knowledge.

yes, you should have been better educated by your doctor. Demand better care or find a better one. Here are some answers, all only to my knowledge of course:

No, you should not mix Lantus with any other insulin. In fact, be careful not to inject in the same area or site as your humulin. It can negate the effect of your Lantus.

Insulin does not raise your blood sugar levels. Your dose is simply not effectual yet. The dosage and the sliding scale may be completely wrong. This is not a suggestion for you to change it. This is a suggestion to get onto your doctor or another one to work steadily and effectively towards an appropriate dose regimen.

Colds and other illness will often raise blood sugar. You need to keep well hydrated and test regularly through the day. You will want to devise a strategy (hopefully with a useful endo) of increasing your insulin in these times, but this needs wise, knowledgable decisions and is in the future (or at doctor's orders). For now, expect to run a little high until the cold runs it's course. 250 doesn't seem like a huge cause for worry. Much above 300 for more than a few hours and you should get yourself some medical attention. Fast.

I can't comment much about the sliding scale, but before meals is the time to be making dosage decisions. Afterwards is likely too late.

Dinner last night: it may be the food, the cold, stress, lack of insulin, mis-dose, a combination.... this is what your doctor will probably tell you too, which seems not very useful. The thing is you can't really work out how individual meals affect etc until you get a better dosage of insulin so you know it's enough to be broadly covering your meals, then you can better compare different meals. For the record brown rice should be ok but some can be quite hi GI. it is also high in carbs so you could inadvertantly have had a higher carb meal than normal.

Have you seens a dietician and been taught about carbs and exchanges? Absolutely necessary if you want to make insulin work for you.

Good luck, seek out better support and help.

Thanks for your response.
Since I started this thread I have talked to my doctor's RN. She said that it takes up to a month for some patients to react to lantas but she did bump me up to 15 units. She told me to stick with the same sliding scale as mentioned above. This to me is not enough so I've bumped up the humulin r to six units from 200-250 and eight units from 250-300. This seems to keep me under 300 after meals. (I still have this darn cold)
Thanks for the advice on the lantas and humulin r shots in the same area. I did not know that.

I recently switched to insulin from pills because pills were NOT doing the job and were making me nauseus.

My doc originally put me on Lantus and my sugars went CRAZY. She fiddled with my dose a bit and the more she gave me, the higher they went. Finally, she told me that they have no idea, but sometimes people just react that way. They shouldn't, but sometimes they DO.

She switched me to Humulin 70/30 and my A1c dropped to 6.2

When do you use your sliding scale? If you're eating frequently, are you using the sliding scale each time you eat?

Also, do you know how to count carbohydrate grams? If you do, you might be better off on Lantus with humalog or novolog (rapid-acting insulins) each time you eat. Regular takes longer to work and is a bit more erratic in terms of peak action, length of activity, etc.

Also, you should be testing and injecting before meals, as well as two hours after starting your meal. The two-hour post-prandial will tell you if you're using the right dose of insulin for the amount you're eating.

You also might want to ask him to refer you to a diabetes education course. Many local hospitals have them; even better would be if there's a diabetes center near you (the Joslin has branches all over the country).

Also, Subbster said "Insulin does not raise your blood sugar levels" and that's correct - most of the time. It's probably correct in your case, since your numbers seem to be running constantly high. But too much insulin/too much exercise/too little food can cause low blood sugar. When that happens, your body responds by releasing stored glycogen, a form of glucose, from the liver. Unfortunately, there's no regulatory mechanism to tell the liver how much to release...it just dumps all it's store glycogen at once, and that can cause what's called a "rebound high." That's why it's important, as your numbers start coming down (hopefully soon!) to keep testing. If your blood sugar level goes below 70, you need to treat it with 15 grams of quick-acting carbohydrate...glucose tablets, 4 ounces of juice, 3-4 hard candies, or something like that.

Also...were you/are you overweight? If you weren't, you should ask for a C-peptide and GAD antibody test to be done, because it's possible to develop Type 1 at any age. If you were overweight at diagnosis, then it is more likely to be Type 2, but many Type 2's also become insulin dependent.

At any rate...there's a lot to learn, but you don't have to learn everything at once. Keep coming back, keep asking questions, and you should be able to get this under control in another month or two. I am truly glad that your doctor isn't screwing around with oral meds anymore, though, as you definitely need to get these numbers down.

Ruth

.... When should I check my BGL with this sliding scale and do I check and adjust it before eating or after?....
The normal practice is to test before a meal, inject insulin based on the blood glucose reading and the amount of carb in the meal, and test again after 2 hours. The idea os that your blood sugar should be back in the target range within 2 hours of eating, provided that adequate insuloin was injected. But that only really works with rapid acting insulin - Humalog, Novolog or Apidra. These insulin start working after 15 minutes, they peak at about an 1 hour,and they are mostly finished after 3 hours. Regular insulin (Humulin R) is mich slower. It only starts working after about 45 minutes and and peaks at about 90 minutes. So you need to inject it 45 minutes before you eat. And if you have carbohydrate in your meal your blood sugar will go very high before it Regular starts bringing it down. And for doing corrections (bringing down high blood sugars) Regular insulin is is pretty much useless. IMO, Humulin R is only suitable if your are on a low-carb diet.

The sliding scale that you have been put on does not seem to take into account the food that you will be eating, so it is not surprising that your blood sugar is going very high. I also agree with Ruth that it sounds like you could be T1 or LADA, in which case you need to be on a proper basal/bolus insulin regimen.