Advice on Insulin Adjustments

bobwest185

I am a type II insulin dependent diabetic (2+ years on insulin). I started MFP on 6/18 and am targeting about 1500 calories a day and around 200 carbs a day. So far I have lost 10 pounds. With the lower calories I have had numerous low BG readings (normally in the 50's). Is there a formula for adjusting insulin input based upon calorie restriction? When I started MFP I was taking 50 units of Levemir twice a day and 12-14 units of Novolog 3 times a day. To control the lows, I have reduced Levemir to 40 Units in am and 20 in PM, and reduced Novolog to 8-12 units. Overnight had another low at 41.

Anyway, actually trying to get this well controlled after 12 years of playing with it (HbA1c generally 7.5 over that time but moved to low 8's on insulin, Metformin quit working and A1c had gone to 9.6 before I started insulin). BTW, I have a twin that weighs 23 pounds less than me and is only on Metformin with HbA1c of 6.2. Almost all of my weight is abdominal fat.

Thanks,

bdubya55

Hi There bobwest,

I'm and insulin dependent T2 diabetic using MDI insulin therapy too to treat my diabetes since 1982.

First and foremost, out of genuine concern, I strongly urge you to discuss the hypo issues you're experiencing with your diabetes care physician as soon as possible, like today, as the events you describe can lead to serious life threatening consequences if not addressed.

I would recommend getting some fast acting glucose tabs available at your local pharmacy. Each tab contains 4g of carbs. To be taken one tab at a time. Test after 15 minutes and repeat every 15 minutes until your blood sugars are at a safe level, considered to be above 70mg/dL . I keep a roll at my bedside, in my car or any other place for easy access should/when these situations arise.

Second, each of us using insulin therapies to treat our diabetes reacts differently to include many factors. Chief among these factors are the carbohydrates we consume and how they effect our blood sugars. What matters is not the calories in a given meal consumed, but the carbohydrates eaten, as it's the carbohydrates in the foods we eat that raise blood sugars.

As someone using mealtime insulin it's paramount to effectively learn safe dosing of your mealtime Novolog (fast acting) boluses to avoid unsafe hypo (low blood sugar) episodes.

In addition to contacting your doctor, I would encourage you to purchase the book "Think like a Pancreas", a very detailed easy read, easy to understand explanation on how to figure your mealtime insulin to carb ratios for safe dosing formulas.

http://www.amazon.com/Think-Like-Pancreas-Practical-Insulin-Completely/dp/0738215147

I have different insulin to carb (I:C) ratios depending on the time of day, how much remaining action time I have left from the previous dose of Lantus (background basal) insulin, along with the types of meals eaten, exercise and other factors.

The above book was and still is extremely helpful to me in understanding insulin dosing for many of the insulins prescribed today.

It's my hope some of what I shared here is useful and beneficial to you.

Take Care!

bobwest185

I have the glucose tablets by the bed and in the car and crackers in my briefcase, wife's purse, etc. so I am prepared when I have a low.

The "Think Like a Pancreas" is a good suggestion. I will go purchase it tonight.

I had a doc's appointment the third week of July, he was more concerned about the A1c of 8.2 than the lows I had at that time. Not sure he would be much help (maybe that is telling me something). He didn't think Levemir at night would do much to cause lows. Not sure that is correct with my experiences.

Thanks for your response bdubya55.

bdubya55

Hi

Glad to hear you're prepared. It wasn't my intent to come across as harsh or judgmental.

I've experienced the effects of a hypo in the low 40's, and it's an extremely scary situation, and one I was able to correct thankfully before an emergency situation arose which could have been life threatening for me as I live alone.

Armed with that experience, I knew I needed to educate myself on the proper use of insulin and what to do in the event it happened again and without over correcting. And it did. And over corrections happen too. Not so many now.

I can empathize with your experience of your doctor not being as concerned with the lows you had, that's been my experience too, which to me isn't really a solid approach.

Diabetes is such an individual condition and our bodies all react differently, to our diabetes meds taken, to our food choices in addition to the everyday stress levels in our lives, not to mention other illnesses which makes this condition so very frustrating.
It may very well be your body is experiencing lower blood sugars from your Levemir, although not designed to, I've heard others experience this as well.

What I learned from reading Gary's Scheiners book, is establishing my basal background (baseline) dosing first and then moving on from there to learn my (Novolog) insulin to carb ratio, which for me is 1:10 or 1:11 depending upon the time of day.

By reading his book you'll learn to effectively calculate your own insulin to carb ratios which may be very different from mine.
Using the MyFitnessPal program and losing the weight I wanted to, my insulin to carb ratio has changed dramatically as I don't require as much Novolog at mealtime.

bobwest185

My guess is your book suggestion by itself is going to make joining this group very worthwhile. The main point in my introductory note was I need a formula or model to adjust insulin as I lose weight and become less insulin resistant. I think this book, which I downloaded to my Kindle last night, will give that guidance. Thanks for that.

At night, I have tended to wake up when my sugars were high 58s/low60s. Night before last was the second time in 2 + years on insulin that I had a reading in the 40s. Not a comfotable feeling at all. I do live with a spouse so there is that.

BTW, a neice's MIL passed away a month go in a diabetic coma. It definitely happens.

Thanks again for your advice.