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anprdp 04-07-2009 07:14 PM

Okay I am confused....
 
I have had diabetes of some form from 2001. Starting with Gestational Diabetes that progressed and I was officially diagnosed in 2006. I was on actos/met, but when that wasn't working anymore I was put on Lantus about a month and half ago. At 20 units at night, I was running 150 fasting and 200 to 250 2 hrs. after eating. I was upped to 40 units, which started running me low (would wake up after 6 hrs. of sleep with 80 or less blood sugar) and my after eating sugars were in good range, but I would bottom out kinda quick. I scaled back to 38 units and now my sugars are all over the board. After eating is 170 to 210 and fasting is 90 to 110. What is going on? I have my next appt. the 17th, but I am tempted to see if I can get in the 10th. Any ideas? I don't understand how I can go from one extreme to the other like this over a course of weeks.

On another note, now that I am on insulin I am testing more often than with the pills (more than 4 times a day). How often do most insulin users test? Will insurance give more strips for a higher testing volume per day? Because right now I am getting 100 strips every 19 days and it isn't lasting so therefore I am having to pay full price for a 50 ct. box so I am paying about 130 dollars a month for strips at this rate.

Thanks

catheryn 04-08-2009 06:57 PM

Re: Okay I am confused....
 
When you're on insulin you do have to test more. I test upwards of 8 times a day depending. My insurance covers about a box a month, but I supplement that with my dad's because he doesn't have to test as much (twice a day max) so he'll loan me some strips when I'm short. It's ridiculous, but insurance companies will usually only pay for 100 strips a month....which doesn't even work out to 4 tests a day! Perhaps you could call your company and ask them if you could up the allowance if you got documentation from your doctor that it's necessary for you to test more often?

I'm wondering if you shouldn't be on a rapid insulin with the lantus. Obviously the lantus if running you low at such high units, so maybe if you did a lower dosage of lantus and started taking a novolog or humalog based on what you eat then you'd be in better control and not have so many lows? Lantus is a "background" insulin and will keep your overall numbers low, but if you're going too low that's a problem and obviously you're taking too much of it. Rapid insulins like novolog and humalog work to digest the food you eat immediately. Kind of how when someone non diabetic gets a jolt of insulin from their pancreas when they eat.

I don't think I know very many insulin diabetics who aren't on both a rapid and a long lasting. Maybe you could bring this up to your doctor/endocrinologist next time you see him/her :)

Hope this helps!

SamQKitty 04-08-2009 08:15 PM

Re: Okay I am confused....
 
ANPRDP,
Are you very much overweight? If not, make sure your doctor did a C-peptide and GAD antibody test on you...and if those were done back in 2001, make them do it again. There's a type of diabetes called LADA or T1.5 which is like T1, but with a much slower onset. If that's what you have, you are definitely going to need both a basal insulin (Lantus) and a rapid-acting insulin to cover your food. And, as Catherine pointed out, you probably need that anyway. The problem with trying to cover everything with just a basal insulin is that you will definitely have lows at certain times...and probably be too high at others. Lantus is supposed to cover just your basic metabolic needs...in other words, the amount of insulin you need if you don't eat anything! It was not made to cover carb ingestion. Adding a rapid-acting insulin, while it means learning how to count carbs and figuring out your ideal insulin to carb ratio, will control your blood sugars much better with fewer highs and lows.

As for testing...I test a minimum of six times a day, and often 8-10 times. My insurance will cover as many strips as I need as long as my doctor writes a scrip for whatever amount I need. Ask your doctor to write a new scrip for the amount you're now using.

Ruth

anprdp 04-09-2009 05:55 PM

Re: Okay I am confused....
 
Thanks for the information. I went back to my doctor today and demanded some humalog so now I have a carb ratio count of 1 to 20 and a sliding scale for corrections when needed. We will see how that goes. As far as the c-peptide as far as I know no one has ever run that, but I think I will ask. Because of the early onset as far as type 2 goes and I am over weight but only by about 20 lbs.

I will have to contact BCBS and see what their policy is for testing strips. Maybe if she changes the order to a montly supply at 6 times a day that might make a difference because as of now (especially getting adjusted to the humalog) I am going to use much more.

Again thanks for the replies and information. I am always learning something new.

Angelia

catheryn 04-09-2009 08:54 PM

Re: Okay I am confused....
 
Good for you for demanding the humalog. It's nice to see patients being their own advocates. Far to many times this isn't the case for whatever reason and they suffer as a result!! Let us know how your numbers are with the humalog!

SamQKitty 04-10-2009 07:31 PM

Re: Okay I am confused....
 
Ditto what Catheryn said! And now that you have a 1:20 ratio with a sliding scale for corrections...if you end up constantly doing corrections, you'll know you need to change the sliding scale.

My doctor pretty much trusts me (after many years) to make my own adjustments, but the advice he gave me was twofold: a) never adjust more than one thing at a time...in other words, if you adjust your breakfast insulin, don't adjust any other time for several days until you know for sure that the breakfast change is good. And b) don't adjust up or down by more than 1 or 2 units at a time (or, insulin to carb, by 1-2 G at a time), and again wait to a few days to see how it's working before making further adjustments.

I think you're going to see much better results with the humalog; you may, in fact, even have to lower your lantus dose!

Ruth


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