[udlaurak]

How much does your BG spike after meals? I know a little bit of a spike is normal, but frequently my BG will go up 100 (example - I was 141 at lunch and just tested and was 254) or more within 2 hours of eating. However, if I do not give myself insulin, it typically comes back down to normal levels by my next meal time. (I will usually test it 45 minutes later to see if it's come down and if not, will give myself a unit or two, but usually it has come down).

I am on Lantus (32 units in the am, 12 at dinner) and Apidra (Correct 1 unit every 50 over 100, carbs as follows: B - 1:12, L & D 1:10).

I am thinking maybe I should increase my Lantus? Or should I take more Apidra at meals? I really want my numbers to be as steady as possible (Want to have a baby w/in a year) and the in between meal numbers are concerning me. However, my fear with increasing the Apidra with meals is that I'll drop in between.

I have an endo appointment next month, just wondering what you all think and what your normal spikes are.

Last A1c was 7.8, down from 8.9, 9 months ago. Really trying for below 7.0

[dano]

Welcome to the Forum!

Congrats on getting your A1c down!

Are you doing the sliding scale or a bolus injection for the carbs after meals? It would appear to be the later, since you made reference to the (B - 1:12, L & D 1:10). I am assuming that your breakfast ICR is 12 and your lunch and dinner ICR is 10. Did your Endocrinologist happen to supply you with your ISF as well? Are you using a pump or MDI's? Do you have an exercise routine, before or after any of the meals?

I'm sorry for all the questions, but these are some things that we will need to know. I am not really familiar with Apidra, other than knowing that it is a fast acting insulin. It appears that if you are calculating your bolus injections, (based on your ICR, ISF, blood glucose readings and carbs consumed), that you may need to increase one or the other insulin's, but this is also dependent on your exercise routine and activities before and after your meals. I personally find it odd that you are taking a long lasting insulin (Lantus) injection at dinner and not after dinner or before bedtime. However, this would depend on your fasting level or out of bed blood glucose readings. If you are holding them from 70 mg/dl to 99 mg/dl then you are doing great and it is working for you.

[udlaurak]

Hi Dano,

Thanks for the warm welcome!

I do a sliding scale (1 unit if BG is 100-150, 2 if 150-200, 3 if 200-250, etc.). I count carbs, my ratios are 1 unit / 12 g carbs at breakfast and 1 for 10 g carbs at lunch and dinner.

So for example, my BG was 141 at lunch. So I took 1 unit for my sliding scale, plus 6 for my carbs (Stupid lean cuisine egg roll - 59g carbs, bad choice!). So, 7 units total. This was 3 hours ago. I just tested and am at 224, was 254 about an hour ago.

I used to be on the insulin pump but went off it about 9 months ago. I needed a mental break, plus I was getting married and didn't want to be "hooked up" on my wedding day/honeymoon. So far it's been good for me, as you read, my a1c has come down. But I get concerned with these in between highs.

[udlaurak]

Thanks again, Danny! I'm going to bring up all of your points at my next endo visit. I definitely want to discuss my ISF as well.

However, to address your one question regarding the Lantus. I was taking all of it in the morning (around 7 am). However, I work out after work and usually finish up around 7pm and would frequently drop low during or post workout. My endo suggested that I split my dose because even though Lantus is a 24 hour insulin, it does peak at 12 hours. So I take it in the morning and about 12 hours later at dinner (Just easier to take at dinner when I'm already taking Apidra).

I have a feeling that my endo is going to encourage me to go back on the pump and get a CGM. I want to try a CGM (The Dexcom makes me drool) however I'm a little apprehensive about having 2 sites. I've enjoyed the freedom of being pump free the past few months. However, the husband and I would like to start trying for a little one by the end of the year, so I guess I need to do whatever it takes to ensure a healthy pregnancy and that I'm healthy at conception.

It's such a juggle and puzzle, all the time!

[dano]

I was hoping that Rachelle would be on here to answer your question. Her user name is type1rachelle, she wears a pump and a CGM. I am sure that she will be glad to give you her opinion.

[type1rachelle]

Hi Hi :-)

I've read somewhere that your postprandial BGs should never really go up over 80mg/dL even if you're on insulin (assuming you give yourself the correct dose at the correct time). So you might need to play around with your ICR (insulin:carb ratio) and ISF (insulin sensitivity factor) or the timing. I truly think sliding scales are very old school. You should have an exact ISF and be able to do the math - so for example, if you are 220mg/dL and your ISF is 1u:40mg/dL, then you'd give yourself 3.5u to bring yourself down to 80mg/dL.

Honestly, if your goal is to get pregnant, you really should consider going on the pump again since it will help you gain tighter control with the hour to hour basal patterns. As you know, you can also change your ISF and ICR based on time of day, and give yourself fractions of units. It will also calculate how much insulin you have "on board" so that you don't "stack" insulin and wind up going low later on.

I'm not saying your current method doesn't work, but you might want to reconsider the pump to gain even tighter control. You will also benefit from a CGM since you seem to be afraid to go low with higher rapid acting doses. A CGM will also show you rising rapidly after meals so you can give yourself a little extra insulin if you feel maybe you bolused wrong (happens to me all the time).

As you know, your A1c needs to be below 7% several months BEFORE you get pregnant, and especially during your first trimester, otherwise the risk for birth defects are 4x. I don't mean to scare you with this, but I think it's important to consider that you might find it is necessary if you want to get pregnant. Also, you need to consider the effect of your raging hormones!

Have you tried Humalog or Novolog instead of Apidra? They're all rapid acting, but one might work better than the other for you.

Have you ever heard of a drug called Symlin? I was on it for a while and it REALLY helped with postprandial spikes - it's a synthetic form of Amylin, another hormone produced by the beta cells, and it slows gastric emptying and the absorption of carbs. You might want to ask your Endo about it and see if you can experiment. A CGM would be really helpful with this though since a major adverse effect is extreme lows.

Also, you might get a lot out of sticking to a lower glycemic index diet. So you wouldn't necessarily go low carb, but you'd avoid things that make you spike quickly.

Lastly, I suggest getting your exercise in first thing in the morning. I'm a very active endurance athlete and work out 6 days a week, and find that the less insulin I have on board from a day of managing diabetes, the less risk I have going low. Try getting up earlier and getting your workouts in before breakfast and before work... I find it really helps me. I have way more lows if I workout during lunch or in the evenings.

Just a few thoughts... good luck!

[udlaurak]

Hi Rachelle,

Thank you for the thoughtful response. Can I bring you to my next Endo appointment? hehe.

I was previously on symlin but hated the side effects. I started out at 2 units and gradually (over the course of a 5 weeks) worked up to 10 units. It made me very nauseous though. However, i'd be willing to try it again.

How do you feel having 2 sites with the insulin pump and CGM?

My husband and I are hoping that everything will be "good to go" to start trying to conceive by the end of the year, however if we have to wait a bit in order to have the healthiest pregnancy possible, that's OK too.

I used to be on Humalog, recently switched to Apidra. I like it so far.

My only issue with exercise first thing in the AM is that I LOVE kickboxing and unfortunately the schedule at my gym is not conducive for me to go first thing. Dang job, getting in the way of my workouts!

[type1rachelle]

ha! I used to do Muay Thai as well - lots of fun! well, then you might find some helpful insight in this book: http://www.shericolberg.com/diabetic...s-handbook.asp She talks about carbs and stress hormones during exercise a lot, and it's an oldie but a goodie.

did you titrate up on the Symlin gradually? I think you're supposed to start with 2u for 3 days, then 5u for 3 days, etc. I didn't have any issues with nausea, but I know that's a common side effect. might be worth trying again? maybe you can titrate up even slower? I also read somewhere that T1s who don't need to lose weight don't really need to be on anything above 5u (30mcg) - the higher doses might make you nauseous and have this constant "full" feeling... the manufacturer is actually trying to market it as a weight loss drug now.

2 sites for the pump and CGM is a piece of cake for me. I don't even notice them anymore, and I consider it a very small price to pay for being able to see my BGs trending - totally worth it. But again, that's just me. As for the pump, I took mine off for 2 hours at a time at my wedding as well

can I ask how long you've been T1? you might be the first person I've ever met that went back to injections after being on the pump. which pump were you on and for how long? I don't find being connected to it to be a hassle at all - I take it off whenever I want and it's very simple, the infusion set is tiny, and I enjoy having tighter control, not having to do the math in my head, and only having to inject myself once every 3-4 days for the infusion set, and once every 7 days for the CGM. but again, that's just me - everyone is different and I know plenty of people who have tight control on injections too.

can I ask why you switched from Humalog to Apidra?

end of year sounds like a reasonable goal - I'm wishing you luck on getting that A1c down! I definitely want a kid in the next 5 years and am trying to get my A1c down lower as well. It's tough but so worth it from what I hear.

[udlaurak]

yes, Muay Thai is tons of fun! Only excercise I've found that I actually enjoy!!

I did up my Symlin gradually. I tried it probably 3+ years ago, so I think i'm going to mention giving it another shot (pun intended) at my next appointment (in April). I started at 2 for a week, then 4, then 6, and so on. I do need to lose weight and I really should try it again.

Glad to hear that the 2 sites isn't an issue for me. I think my concerns may be just because it's different and unknown to me. I am sure that after a few weeks, it'll be old hat. What areas of real estate do you use?

I was diagnosed when I was 18 and I'm 32 now, so 14 1/2 years. I was on injections for the first 18-20 months, then went on the pump. I most recently was on the Minimed Paradigm. The reason why I went off of it was mainly for my wedding and honeymoon, but seeing my A1c come down has been a motivator in staying off of it. However, it's also been a very stressful year (moving, getting married, new job), so now that things are settling down, that may partially attribute to the better numbers. I don't know.

My endo suggested I switch to Apidra. Said it has a more precise peak time. so far I haven't really noticed a difference.

how long have you been on a CGM? What pump do you use?

[type1rachelle]

cool! yeah, I tore both my hip labrums practicing Muay Thai (overuse injury) and after surgery in 2008 I gained a bit of weight so started running and cycling which lead me to trying triathlon in 2009 and being bit by that bug - haven't looked back since!

funny - I was diagnosed 2 weeks before my 18th birthday, and will be 32 in June so it's been almost 14 years for me too! ha!

as far as real estate, I can rarely put the CGM in my abdomen - I have to use my backside, like the "love handle" area on the back of my hip? it's a bigger and deeper needle and I just find that the less scar tissue, the longer it lasts and the better the accuracy. I always used my belly or backs of arms to inject, but I use primarily my belly or maybe the backside area for my infusion sets. you can't stick them right next to each other since it will affect the CGM readings - should be on opposite sides.

it's funny, having more of a routine for me is the best way to keep my BGs under control... I also have a hell of a time when my schedule is crazy. right now I work full time, go to school part time (career change), was married a little over a year ago, and I train 6 days a week (swim, bike, run) so it's hard at times. my last A1c was 8.2% but that was also after sustaining a horrible injury in a bike crash and needing open reduction internal fixation surgery - got a titanium plate and 6 screws put into my shattered collarbone, not fun and my BGs were all over the place... but I'm hoping for a high 6% to low 7% in June when I get it tested again. I'm also just starting to think about having a kid, so I want to see how low I can get that number.

for me, when I began getting tighter control and exercising a lot, I started having seizures in my sleep from hypos. I'm a super deep sleeper so I don't wake up when I'm low. my poor husband has gotten very used to injecting me with glucagon or watching me seize... but they've gotten MUCH better in the nearly 6 years I've been on a CGM.

I started with Medtronic since the pump and CGM was integrated and I didn't want to carry around an extra device... that lasted a couple of years before I found out about Dexcom - less painful sensors, longer lasting sensors (7 days as opposed to 4 days, and you can usually get 9 or 10 days out of them), and better accuracy! So I switched in 2010 and have loved it. In 2011 I switched to the Animas pump because it was waterproof. I don't really swim with my pump, but it's REALLY nice to know you can run in the rain or sweat all over it, or even keep it by the pool without worrying. We honeymooned in Thailand and did a lot of snorkeling and kayaking and it was nice to have it connected the whole time. It's the only waterproof pump on the market.

So yeah, now I'm on the Animas OneTouch Ping pump, and the Dexcom Seven CGM - upgrading to the G4 Platinum (supposed to be even MORE accurate) in a couple of weeks