[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!