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Old 08-24-2008, 04:56 PM   #1
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Is it posible to go back to taking oral meds instead of insulin....

Has anybody been able to do this.

 
Old 08-26-2008, 06:59 AM   #2
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Re: Is it posible to go back to taking oral meds instead of insulin....

I don't know the answer to that question. It has so many factors....

But, for me, I don't want to go back to oral meds. The insulin is GREAT. I have far better control and better results than I ever had with oral meds.

 
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Old 08-26-2008, 12:41 PM   #3
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Re: Is it posible to go back to taking oral meds instead of insulin....

I think you are very knowledgible about diabetes. I would like to ask you another question....I am taking levemir 54 units --10pm...my sugar is still high in the morn. My endo has cut me back to 42 but with no luck getting my numbers down. I have gone low in the middle of the night with the 54 units...

My A1c 6.7% Dr has said I might have to "trade off" my high morning for the good A1c...huh??? and not going low....

Here is my question----I take rapid ---sliding scale---before meals. Usually 8 -10-18. My PP readings are sometimes high. Like today after my lunch it was 14.3 mmol---1 1/2 hour after....Very high. Should i inject more rapid to make this number go down or just leave it and inject at next meal time according to my reading using sliding scale of 2 units for every 2 mmol it is over 10 mmol...

Hope I am getting my question across to you....

I have heard of some people making "an adjustment to the insulin" to accomodate those high numbers.

Thank you in advance for any input on this subject.

 
Old 08-26-2008, 03:51 PM   #4
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Re: Is it posible to go back to taking oral meds instead of insulin....

ok - I think I understand your question. and I think I also understand what your doctor is saying about the "trade-off".... your doctor is saying that it's the time-product of the sugar level that's important, and if you keep your numbers low during the day, it is going to be relatively unimportant if you have a high morning.

For your morning high, try a small snack right before you go to bed. Not a large deal, maybe a small fruit or couple of crackers or cookies. My hope is that this will "smooth" the action of your Levimir during the night and your liver won't get "spooked" and dump a load of glucose.

My recommendation is that yes, you can be more aggressive with your rapid. During the day only, though, until you see where this is going to lead.

I am assuming you use one of the analogs like Novolog or Humalog for this purpose which has a very quick release.

As a first "shot".... I would just try beginning your sliding scale at 8 instead of 10. Subtract 8 from the reading instead of 10. You can make that 7, too
if you find you need to.

Don't "chase" your postprandial sugar reading with the rapid, especially if you are going to use the aggressive scale we are discussing. Stay on the program of measuring before you eat and shoot according to that reading.

If you take the 1-1/2 hour reading after eating, it will likely be in the sky but it won't remain there. So the time-product of that reading doesn't affect the long-term processes very much. And, you don't want to create a low-sugar crisis for yourself.

You can shoot first thing in the morning, too. I am usually a little less agressive with that one because I sometimes don't eat much at breakfast.

Oh, and BTW ...congratulations on the 6.7 !!!!

Last edited by tfkeel; 08-26-2008 at 03:57 PM.

 
Old 08-26-2008, 04:06 PM   #5
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Re: Is it posible to go back to taking oral meds instead of insulin....

The other thing to remember about the postprandial high, is that insulin peaks twice (usually), so you will be high after eating sometimes, but the second peak of the insulin should ideally bring your numbers down, as stated previously, taking more insulin for the PP high will make you really low a few hours down the line since you will be peaking multiple times that way.

 
Old 08-26-2008, 04:25 PM   #6
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Re: Is it posible to go back to taking oral meds instead of insulin....

Quote:
Originally Posted by tfkeel View Post
ok - I think I understand your question. and I think I also understand what your doctor is saying about the "trade-off".... your doctor is saying that it's the time-product of the sugar level that's important, and if you keep your numbers low during the day, it is going to be relatively unimportant if you have a high morning.

For your morning high, try a small snack right before you go to bed. Not a large deal, maybe a small fruit or couple of crackers or cookies. My hope is that this will "smooth" the action of your Levimir during the night and your liver won't get "spooked" and dump a load of glucose.

My recommendation is that yes, you can be more aggressive with your rapid. During the day only, though, until you see where this is going to lead.

I am assuming you use one of the analogs like Novolog or Humalog for this purpose which has a very quick release.

As a first "shot".... I would just try beginning your sliding scale at 8 instead of 10. Subtract 8 from the reading instead of 10. You can make that 7, too
if you find you need to.

Don't "chase" your postprandial sugar reading with the rapid, especially if you are going to use the aggressive scale we are discussing. Stay on the program of measuring before you eat and shoot according to that reading.

If you take the 1-1/2 hour reading after eating, it will likely be in the sky but it won't remain there. So the time-product of that reading doesn't affect the long-term processes very much. And, you don't want to create a low-sugar crisis for yourself.

You can shoot first thing in the morning, too. I am usually a little less agressive with that one because I sometimes don't eat much at breakfast.

Oh, and BTW ...congratulations on the 6.7 !!!!

I think I get what you are saying. Just a bit confused with the first shot thing (morning)? 8 instead of 10? I inject 8 units in the morning, 10 at lunch, 18 at supper...I do not quite know what you mean by subtract 8 (7) from the reading. Say my reading is 13 FBS do I subtract 8----that would be 5 units I inject???? If my FBS is 13 I would inject 2 units for every 2 mmol I am over 10. That would be 3 units more, so 11 units .....Am I confused or what. That is what I am doing now....

If my lunch reading is 6mmol, I inject 10 units, but, if it was higher than 10mmol I add 2 units for every 2 mmol.....above 10 mmol.....Am I thinking along the right track?????
Same goes for supper--I inject 18 units and 2 more for every 2 mmol over a 10 reading....
Am I on the correct thinking?????

Yes, I take levemir at night and novo rapid during the day....

Thankyou for any help.....

I am just concerned my numbers are increasing during the day and should I be increasing my units too.....instead of what the endo set me up with...

 
Old 08-26-2008, 08:32 PM   #7
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Re: Is it posible to go back to taking oral meds instead of insulin....

Hi Twokatss,
I think we've discussed this before...at least we've discussed the morning highs, which I believe are definitely rebounds from going low at night. If you keep going low at night, you will keep being high in the morning.

One of the things that might help prevent the morning highs while still keeping your daytime numbers reasonable would be to split the levemir dose and take half at bedtime and half in the morning. Not sure if this would work, but it might give you more even coverage.

The other problem I see with your regimen is that your dose of rapid is fixed and appears to be based on time of day rather than the number of carbohydrates ingested. I know it's yet another thing to learn (and heaven knows, it certainly can be overwhelming), but I really think you would do much, much better if you were counting carbs and injecting rapid according to an insulin to carb ratio. If so, you could probably reduce the levemir even a bit more, but you might increase or decrease your rapid dose depending on what you were planning to eat.

Certainly your A1c is really good, but that may be being influenced more by the lows you're experiencing at night than by overall good control. And it's no fun physically to be bouncing from low to high and back again. Counting carbs and tailoring your insulin more closely to your meal requirements, while reducing the levemir, could help you avoid the yo-yo effect.

Ruth

 
Old 08-27-2008, 04:11 AM   #8
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Re: Is it posible to go back to taking oral meds instead of insulin....

Quote:
Am I on the correct thinking?????
I don't think so. And, I agree with SamQKitty about using a units-to-carbs ratio. That will give you the smoothest control of any methods being discussed. But it is another thing to learn, as Sam said. And, I agree with Sam that you are "bouncing" and those fixed doses of 8 - 10 - 18 that you are using are the cause. If we can get your control smoother you will feel better and you will probably lower your fasting reading, too.

What I suggested was this....although Sam's suggestion is better...and I will be happy to help you do it her way, too....it is more complex...

Let's take a few examples....

First, do not take the 8 - 10 - 18 doses of rapid. Take only doses that are based upon reading data at your mealtime. And don't use postprandial readings to shoot by. Use only the pre-meal reading.

Say your lunch reading (before you eat) is 12 - first, subtract 8 = 4, then multiply by 2 = 8 units. Take this shot before you eat.

Ok, dinner time. Your reading is 11 - subtract 8 = 3, then multiply by 2 =
6 units.

Bedtime. If you want, eat a small snack. Not a lot. Couple of crackers or a small fruit. Shoot your 42 units of Levemir. Don't even bother to finger-stick now, because I am asking you to NOT COVER at bedtime until we see where the program takes you in a week or two.

Awake. Take your fasting reading.... 14 - subtract 8 = 6, multply by 2 = 12 units.

Breakfast.... don't cover again, you already did it when you awoke.

 
Old 08-27-2008, 07:30 AM   #9
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Re: Is it posible to go back to taking oral meds instead of insulin....

OK --gotcha now.....My mind registers in the morning better than at night...!!!

It seems my injections will be less than I am taking now......


I will try this and see where it takes me.

Thanks everybody.....

 
Old 08-27-2008, 07:34 AM   #10
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Re: Is it posible to go back to taking oral meds instead of insulin....

My Family DR told me split the levemir also. And watch carefully my readings after my main meal at supper. I could have a low at that time he thought.....??

Will keep you posted....

 
Old 08-27-2008, 10:41 AM   #11
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Re: Is it posible to go back to taking oral meds instead of insulin....

Yes, the game is to reduce your injections to where we get a "smooth" action over days and then adjust based on results. Be sure to keep your readings recorded if your meter doesn't automatically do it so we can get an average.

 
Old 08-28-2008, 04:30 PM   #12
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Re: Is it posible to go back to taking oral meds instead of insulin....

So if I have a reading of 6mmol before a meal...I do not take an injection at all then....

eg: 6 mmol -8= 0 x 2 =0

 
Old 08-28-2008, 05:58 PM   #13
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Re: Is it posible to go back to taking oral meds instead of insulin....

Yes. 6 is perfectly ok with no coverage. Don't take any rapid unless you are above 8.

Last edited by tfkeel; 08-28-2008 at 06:00 PM.

 
Old 08-29-2008, 12:16 AM   #14
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Re: Is it posible to go back to taking oral meds instead of insulin....

I don't get that, tf. If twokatss doesn't take any rapid before her meal, then her blood sugar is going to go up dramatically in response to any carbohydrates ingested. That just doesn't make any sense to me. Am I missing something here?

Ruth

 
Old 08-29-2008, 04:41 AM   #15
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Re: Is it posible to go back to taking oral meds instead of insulin....

No. You aren't missing anything. And the program you are suggesting is a better method, where she would estimate the carbs about to be eaten and cover accordingly right at mealtime. This gives the best control of the instantaneous sugar, but has the disadvantages of being more complex to calculate, and it's easy to overshoot.

The method being employed here just places the insulin level adjustment on the "back end" instead of the "front end" of the intake event. Taking the sugar level integrated over time, which is the goal of the treatment, the net results are the same, if the sliding-scale "aggressiveness factor" is adjusted properly. Because the sliding-scale used dictates a dose which is, after a period of monitoring and "tweaking", commensurate with the time-sugar product of the preceding event.

 
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