Thanks for a very informative post! As you expect, I'll be saying some things which AREN'T "congrats, you're doing great" --- because, of course, he's not. Some changes are obviously needed. I *will* say "congrats for confronting the problem, you're doing great to ask for help. I hope Cora, Blondie, and Ruth chime in with other advice.
I'm not a Dr., although I have lots of experience as a pt. I AM NOT QUALIFIED to give medical advice. As a pt., here's some of my ideas about what you just said:
Originally Posted by roadfamily6now
yes, DH tests at least 10 times a day some days more. He does Lantus daily and Humalog for meals. We do watch carbs and I think you were asking how many cabs/per unit of insulin? We talked to a T1 dietician a few years back who said it looks like he was a 4 carb/1 unit? Does that make sense?
It makes sense, but it's a really unusual number. Most T1s, IIRC, are in the range of 8-15 grams of Carb per unit of insulin, so he's shooting more than twice as much as most of us.
Originally Posted by roadfamily6now
I think now days is it more like 12 -15 units to bring the levels down 100 points.
That's also a high number, I need only 4 units per 100 points. But this ratio is very dependent on body weight, is he extremely heavy? I weigh 200 lbs.
The other thing which COULD be happening is, he might have Type-2 ("insulin resistance") as well as T1. We T1s can develop T2 as easily as anyone else, although our ongoing insulin therapy tends to mask it.
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If he's already having lows, MORE lantus doesn't seem likely to help. His idea of moving the time might help make it better, or might make it worse. He could also try splitting his Lantus into two daily doses, that would even it out a lot.
But if he NEEDS uneven doses, like I do, he'll need a pump. I need to have very low doses midnight to 4 AM but almost 3x as much per hour from 5 AM to 9 AM. Lantus can't do that, the only way to do it without a pump is to wake up every dang morning at 3 AM and do a shot in the middle of my sleeping night.
Pump is far more tunable. And with his changing schedule, you can program pumps for different "daily programs" to match Graveyard shift versus Day versus Early Night.
*HE* needs to change is regimen on walking versus non-walking days. I'd do extra Humalog shots on non-walking days, but he could handle it by eating more on walking days. With a pump, he could just dial in a long-term adjustment such as "do only 70% of my normal dose for the next 6 hours". But with shots, it's gonna take some more difficult calculating, sorry.
Glycemic index is about the "speed" of digestion, not the amount of carbs. All carbs except for fiber count the same. (Fiber doesn't count at all.)
It sounds like you both understand carb counting just fine, but are failing to count successfully. Maybe he isn't watching his portion sizes, you and he need to be VERY PRECISE in estimating food. Or, your cooking methods are inconsistent. One way or another, you need to get a handle on the carb intake quantities-- you can't measure the right amount of insulin to "cover" for the food unless you know how much food you're covering!
Fewer carbs (Atkins-like) probably *could* reduce the tight-rope balancing act between high carbs and high insulin doses which he does now. And the Cardiovascular risk of eating more fat, if done successfully, is probably much less bad than the horrible bG levels which he has now.
There are books about carb counting: Buy one, and use it.
Maybe you cook for the kids, and he fends for himself? If he comes up with a couple of quick easy meals with KNOWN carb content, he might find that living with more stable bGs is really enjoyable-- even at the cost of boring meals. Heck, anyone can throw a steak in the pan and flip it, eat EXACTLY one or EXACTLY two slices of toast with it. (Or a beer.) Just an idea. I can remember feeling really lousy when my bGs were too high, he must be having an awful time.
Since he's having lows at night on Lantus, MAYBE the problem is mostly insufficient insulin for the food he eats. Whenever he makes a bad guess, he should make a little mental note of how that guess was wrong, and try to adjust for it. I would attack the frequent and ongoing high bG *FIRST*, and go after diet changes *LATER*. But if you'd rather try low-carb, go ahead-- just remember to really do it and cut out the carbs, not use it as an excuse to eat more steaks while still filling up on beer, pretzels, and chips.
I hope this gives you both something useful to chew on. Although 10 tests is a pretty good number of tests, he's still running really high most of the time. Either he's not dealing with the 'high' results aggressively enough, or he's not testing at good times. Frankly, I'd do MORE tests until it's more under control-- 15, 20, whatever it takes.
Heck, I do almost 300 tests a day. But I cheat, nearly of of them are painless and automatic.
Now sitting at 119 and wondering whether to add 1/4 of a single unit to make it PERFECT.... Naw, 119 is really good enough for me.