Posts filed under ‘humalog’
Gah! Another day of slightly elevated blood sugars. In order to simplify my troubleshooting, I think I’m going to have to stop using the I-Port for a week or so. I’m not happy about it but I’m more even less happy about waking up above 100 and having problems getting under 130 all day long. Other possibilities:
- hidden infection or impending illness (I feel fine though, gums and mouth fine, etc)
- insulin gone bad (I just changed my Humapen cardridge on Saturday)
- lingering repercussions from The Pizza (could one bad day really throw me for this long?)
- my meter is off (seems unlikely but I could make my newer backup meter my primary just in case)
- my strips are bad (am almost done with this vial so will be able to check that off in about two strips)
- hormones (possibly, but that usually happens on the 4th week of my birth control pill, not the 3rd)
- I’m developing insulin resistance and need to adjust my carb/insulin ratio
That last possibility scares me the most – is it possible that after only a month and a half of injecting less than 15 units of Humalog a day, I’m becoming resistant to it? Is a carb/insulin ratio of 1 unit per 8 carbs in the A.M. and 1 unit per 10 carbs in the P.M. excessive for someone under 115 pounds? Is it normal to have to increase your carb/insulin ratio after only a month and a half of usage? I always understood that MODYs were very sensitive to insulin, so of course this makes me wonder – what if I’m not MODY after all?
The other thing that has been worrying my lately is this constant anxiety surrounding losing my basal insulin production. Every morning when I wake up and test, I pray the number is under 100, and every time it isn’t, I think “well, this is the beginning of the end”. I know that sounds terribly melodramatic, but I realize just how lucky I’ve been to still make some insulin and make it in a consistent manner, and I am determined to preserve that functionality! Then today I was doing some googling on insulin resistance and MODY and came across this terrifying statement:
Progressive beta cell failure?! My PA also seems to believe that my MODY will inevitably progress, but I still don’t want to believe it. What if the MODY patients they based that observation on destroyed their own beta cells with high blood sugars or oral medications?
All this makes me want to shell out for the genetic profile needed to determine once and for all what type of MODY I have… but what if I spend thousands of dollars just to find out I’m not even MODY? If I did turn out to be the “progressive” type, would I regret finding it out? Or would I benefit from having some time to come to grips with the fact that eventually I will have complete dependence on insulin? What if I have MODY2/glucokinase? Would I celebrate? What is it I really seek to gain from such a diagnosis? Judging by the tone of this post, the money would probably be better spent on a beach vacation or something else aimed at restoring my mental health. 😛
Maybe there is more I can figure out on my own. The diagnosis flowchart on the Athena Diagnostic MODY page shows a path for Ketotic and Non-Ketotic. MODY falls under Non-Ketotic. I picked up some Ketone testing strips at Walgreens last week, so next time I’m above 200-250 I will test and see what happens.
I messed up big, big time last night. I thought I was ready to attempt to cover pizza with insulin, but my body thought otherwise and I payed the price – mentally, physically and in cash at the rate of the eight dollars worth of Freestyle test strips I used testing and re-testing on my backup meter. I struggled the rest of the night to get back down from the high 200s. I was injecting directly (no I-Port in the equation – I’d attempted an upper-backside install but it left me in tears so I threw it away) yet it was as if the insulin couldn’t keep up with the digesting pizza (or my lack of patience). It was getting late so I set my alarm to wake me up an hour and a half after I went to sleep so I could check and make sure I wasn’t still high or going too low too fast, and it was back down to 140, so I gave up and went back to sleep because I was too tired to change my suspect Humalog cartridge and I knew my own basal insulin would eventually take care of the rest anyway.
I woke up this morning with an elevated fasting of 108, but I was ready to start clean – clean diet, exercise, new insulin cartridge, new I-Port… but I can’t get my head in the right place. I’m mad at myself and don’t feel like doing anything productive, and I am dreading the blood sugar see-saw that I’ll likely experience today. Writing about my mistakes always helps me move on, so now that I’ve confessed, I’ll make myself go lift some weights and try to make up for whatever horrible things I did to my poor body with that (to borrow a word from Monday) insidious pizza last night – which, by the way, left even my non-diabetic husband at 130 mg/dl an hour and a half after! How did I stand a chance? 😛
Nothing much to report on the insulin front. Some days I feel like a lab rat with all these charts, graphs and needles, but I do like labs and some rats are pretty cute, so that’s OK.
The first few days of high blood sugar readings were tiring, both physically and mentally, but I think I’m starting to get a better feel for dosages and timing. It’s tempting to draw conclusions about carb intake right now based on the fact that the only good numbers I’ve seen this week have been after lower-carb meals, but I will hold my tongue and give it some time.
For my diet and blood sugar tracking, I’ve gone low-tech and started using some photocopied worksheets that the dietitian gave me. The upper third of the page is an area to plot my BG on,the middle third is a chart with a column for each hour of the day and rows for blood glucose, carbohydrates, exercise, insulin doses, stress, ketones, etc. The bottom third is for food and other notes. This format will be the easiest to fax back to my PA at the end of each week, plus I really enjoy connecting the dots on the glucose plot at the end of the day. I’m thinking of enlisting my husband to makes some improvements, notably a place to record where I injected. Right now I just randomly pick an injection site and hope I don’t hit the same place twice.
I’ve returned to FitDay for my diet tracking. Combined with the occasional quick lookup on CalorieKing.com and the handy recipe analyzer on Calorie-count.com, I have a decent system for carb counting and making sure I’m getting enough calories each day. I would still like to get some sort of pocket-sized nutrition handbook to carry with me and to keep in the kitchen so I don’t need a computer when I’m planning meals and doses – any recommendations?
These How-To articles on Dsolve.com have been quite helpful in helping me understand that only time, patience and diligent testing and documentation will lead the way to normal blood sugars with insulin. Even though I have a newfound appreciation for the ease, simplicity and efficiency of Starlix, I haven’t resorted back to it – I’m just too determined to get the insulin to work.
Friday night I injected my very first dose of insulin. Before dinner I decided to check the Lilly and Humalog sites one last time for some updated Luxura information and found a video tutorial on how to use the Luxura. Fabulous – the video was excellent – clear, easy to follow, and almost as good as having someone in the house showing me what to do.
After carefully (or so I thought) calculating the carbs in the meal, I rewound the tutorial, had my husband put the pizza in the oven, then went for it.
Closeup of the dose dial
My instructor for the evening
Spread of equipment
Priming the pen
Injecting and counting to five
Success (and a little red dot)!
Since I knew my food was cooking and the clock was ticking, I had no problems pushing the needle in. Once it was over I did have that kind of post-adrenalin rush shakey/cold-sweat feeling, but otherwise was A-OK. Simple as pie and didn’t hurt one bit.
I only wish that calculating the dose was as easy as administering it. After five pre-meal injections, I have still not been able to replicate the excellent one-hour post-prandial BGs that Starlix gave me. I just have to be patient and remind myself that it takes time to figure out insulin/carb ratios. I don’t like spending the day with post-meals in the 150s-200s and resting BGs in the 110-120s instead of my usual constant 80s and 90s though – it makes me anxious and physically tired. One thing I’m noticing is that whatever my BG is at the 1 hour mark, it will be at the 2 hour mark, which is discouraging – is the Humalog even doing anything? Edit: I’m also seeing my BG hit a good target at one hour, then rise up to 130-150 at the two-hour mark. 😦
I’m not sure if the error is in my a) timing b) carbohydrate counting or c) insulin to carb ratio. Right now I’m using 1 unit per 20 carbohydrates, which so far doesn’t seem to be enough. I’m also unclear on whether I’m supposed to cover proteins – my PA didn’t mention it, but Dr. Bernstein does.
I had one low on Saturday one hour after dinner (65), which I treated with three dex-4 glucose tablets per the dietician’s “rule of 15” instructions. I waited 15 minutes and tested again to find it had doubled my BG – yikes! Next time I try ONE tablet and wait 15 minutes.
So far I really like the pen. It has a nice weight and feels like it is built to last. The only thing I dislike about it for now is having to waste two units of insulin to prime the pen before every dose. Squirting 2 units into the air is also a bit messy – what happens if insulin gets on your furniture? Clothes? Floors?
Wish me luck (and patience) getting this whole dosing thing down straight.
Back from a morning spent at the hospital visiting the dietician and my PA. I’m having a hard time capturing my current state of annoyance, confusion and disappointment into words, but I will try.
My one-on-one carbohydrate counting and meal planning session with the dietician was quite helpful. I don’t think meeting the amount of carbs that she wants me to eat at each meal is going to be as hard as I anticipated, and I’m certainly looking forward to being able to eat things like fruit again on a regular basis. I now have an idea of how many calories, carbohydrates, proteins and fats I should be aiming for every day, and I’ll see her again in a month for a follow-up and to see how the meal plan works with my insulin. I’d say it was a productive visit, and I wish I could say the same about the visit to my endocrinologist’s office that followed.