[Diabetes-talk] question

Fri Apr 2 03:10:11 UTC 2010

Actually, the situation is complex. Although we can offer you our 
experiences, we truly aren't in a position to "prescribe" for you and you 
should probably have at least one session with your diabetes doctor and/or a 
diabetes educator.

That said, the American Diabetes Association tends to frown on doses of 
rapid-acting insulin other than at mealtimes. Why? Because they are afraid 
that you'll give yourself too much and go low. In Gary Scheiner's "Think 
Like a Pancreas", available from NLS as a digital talking book, he describes 
in detail the calculations and techniques for giving correction insulin 
doses to compensate for higher-than-normal bg readings two hours after meals 
or at bedtime. I do it all the time. But as the ADA says, yu gotta be 
careful.

If you are on MDI theraphy (multiple daily injection), with a rapid-acting 
insulin at meals and either lantus or levemir at bedtime, my immediate 
instinct (and what Scheiner would probably recommend) is that you need to 
increase the dose of your basal insulin -- assuming you give it to yourself 
at bedtime. In fact, that's how basal doses are adjusted once one gets into 
the ballpark of correct dosages -- one aims to have the readings in the 
morning come out within target range and increases basal insulin ttill you 
come out equal to night time readings when your readings are on-target or 
perhaps just a tad below or above.

But all of this should be checked with your doctor or CDE or both.

I'll confess gladly, though, that I'm a big "Think Like a Pancreas" fan.

Mike Freeman

----- Original Message ----- 
From: "eileen scrivani" <etscrivani at verizon.net>
To: "Diabetes Talk for the Blind" <diabetes-talk at nfbnet.org>
Sent: Thursday, April 01, 2010 6:33 AM
Subject: Re: [Diabetes-talk] question

> Hi Debbie:
>
> It sounds like you are on a very similar insulin regiment to what I use. 
> I do Novolog before each meal and Lantus at bedtime.  If I recall, I think 
> there was a time when you were having very low numbers upon waking in the 
> morning.  This was a problem I was having for a while as well, but it has 
> also in the last few years gone in the opposite direction.
>
> Originally, to curb the low numbers, I was instructed to have a light 
> snack of approx 15 grams of carbs and a bit of protein or protein/fat 
> (like peanut butter) before going to bed.  This had worked, but now in the 
> last few years I more often than not do not have a snack before bedtime. 
> I know it is very confusing.  It sounds to me like you might possibly be 
> having about 30 grams of carbs as your snack before bed.  Could it be that 
> your snack is more like a little half meal and a bit too heavy on the 
> carbs?  Maybe your numbers would improve in the morning if you either just 
> had milk only, or only had the 1 graham cracker instead of both?  If I've 
> miss-understood, and you are only having one of those snack foods, 
> perhaps, like me you would be better off eliminating the bed time snack 
> and go back to checking your sugar level in the middle of the night so you 
> don't drop too low and see how that works out for you.
>
> I had switched for a very short time from my "old" diabetic doctor to a 
> different specialist in diabetes, and the new guy told me to use bedtime 
> food like medicine.  If I felt my number at bedtime was in the lower range 
> and I thought I'd have a drop during the night or early morning, then to 
> have a very small snack maybe only 7 grams of carbs.  If the number was 
> running good and my Lantus was at the correct number I should be able to 
> get through the night without incident and without food. His advice to me 
> was that if I was not taking novolog, then the food intake should be very 
> low or none.  He said if I was eating because of hunger than to have the 
> snack, but take a unit or two of the fast acting to cover it.
>
> I'm not an expert ... certainly not a doctor, but your situation sounds 
> very similar to what I have been experiencing since I've moved into the 
> well-over 40 year old range! <SMILE>
>
> Good luck.
>
> Eileen
> ----- Original Message ----- 
> From: "Debbie Fredericks" <catdancing at sbcglobal.net>
> To: "Diabetes Talk for the Blind" <diabetes-talk at nfbnet.org>
> Sent: Wednesday, March 31, 2010 7:24 PM
> Subject: Re: [Diabetes-talk] question
>
>
> she asked me to send her my blood sugars (which i did for a week) and said 
> not to worry about it a week of high blood sugars wouldn't hurt anything. 
> but i never heard from her so i am taking just enough insulin in the 
> middle of the night to lower the blood sugars. To be honest this doc 
> scares me.
> I do take lantus and novolog. At 2a.m. the blood sugar varies sometimes 
> it's over 300 other times it's 160. i happen to know one unit of insulin 
> lowers my blood sugar 40 points but because i also take 22 lantus a day i 
> calculate an approximate of how much insulin i need.i guess i could raise 
> the lantus but once again that doctor told me to lower the lantus to 16 i 
> did not do that this woman scares me.
> i usually have a glass of milk and a graham cracker for a snack at night.
> Debbie
> Debbie
>
>
>
>
> ________________________________
> From: Tamera <fidano at comcast.net>
> To: Diabetes Talk for the Blind <diabetes-talk at nfbnet.org>
> Sent: Wed, March 31, 2010 2:57:10 PM
> Subject: Re: [Diabetes-talk] question
>
> first, what did your doctor advise you do about the early morning rise?
> What is your glucose level when you take a 2AM dose?
> What long lasting insulin are you taking?
>
> My bedtime snack can have a lot to do with it as well.
> Tamera
> ----- Original Message ----- From: "Debbie Fredericks" 
> <catdancing at sbcglobal.net>
> To: <diabetes-talk at nfbnet.org>
> Sent: Wednesday, March 31, 2010 12:21 PM
> Subject: [Diabetes-talk] question
>
>
>> i have been diabetic for 43 years. i recently got a new doctor in St. 
>> Louis I tend to have very high glucose readings in the morning, they r 
>> normal all day and high in the morning. To prevent this i was getting up 
>> around 2:30 or 3:00 a.m. and taking insulin to lower the a.m. blood sugar 
>> and it worked very well.
>> When i told this new doctor i did this she told me not to, now my blood 
>> sugars are high in the morning.
>> Has anyone any idea what i should do. my choice is to keep taking the 
>> insulin at2:30 or 3:00 a.m.
>> Debbie
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>
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