I’ve been struggling for 2+ years with my blood sugars. I take Lantus, metformin, glipizide. I have hadreactions to many medication’s. We doubled my glipizide, in December I return if my A1c is not down below seven I will go on meal time insulin. My A1c was 7.4 and this is not acceptable to me. I’m a good eater. I walk 2 to 4 miles a day. My main issue is I’m terrified , I know how to count carbs. Any suggestions would be helpful. I know I have no other options left just because of complications from other medication. Thanks for any information Nancy 50
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@Nancy50 are you terrified due to visual impairment or for another reason?
Welcome to the group. There are many wonderful people who share helpful education or strategies here. I haven’t any knowledge to help you but I’m sure many others will.
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I have a fear of lows I already take Lantus, have taken basal insulin for many years. So no major issues there. I do wear a CGM. This could be a major change. Anyone have trouble advancing to this level of insulin care.Nancy50
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Freckles thank you. Have a good day! Nancy 50
I think activity is one of the best things for blood sugar control. It doesn’t matter what it is, anything like walking or gardening or even housework can help a lot.
It can make your insulin work more efficiently.
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I love to walk I do about 7,000 steps or more a day . I do housework and garden,! am active.
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Not to make you more scared, @Nancy50, but if you start mealtime insulin (bolus) talk to your doctor about starting out on the lower end until you figure out how your body reacts to it and exercise. I know that I was not prepared, and it was not properly explained to me when I first started bolusing. It doesn’t have to be difficult, or scary, as long as you ease into it. Don’t let them just tell you a formula that is iron-clad, you can always adjust to YOUR body’s needs. Hope that helps some. Good luck!
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That is an excellent suggestion. Thank you very much for your advice Nancie 50.
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@Nancy50, sorry to hear that you may progress to mealtime insulin:(
We have been dealing with mealtime insulin for 10 years now with my son K. You have a CGM, which is really great—is anyone else than you following it?
Here are my three suggestions:
- do get your partner, if you have one, or, if possible, someone else, to follow your CGM so that someone else can be your backup if anything bad occurs—serious night-time low, or signal loss that you don’t see etc.
- There are many methods used to determine dosage for meal-time insulin. There are some antediluvian ones (sliding scales…) as well as more modern ones. Do make sure that the method your endo will propose is a modern one that does not bring you back to the stone age with D-tech.
- It is a bit more involved, although by no means very difficult, to deal with fast-acting insulin. I would suggest that you take some D-classes at the hospital, unless you feel that you really understand all of this in-depth.
As a quick warning, you may find that sometimes dosing is more an art than a science… There are some high-carb-high fat meals that are difficult to dose for, and that almost always seem to result in a high. The danger is not so much the high, but the temptation to dose too much after having dosed 3-4 times already (“rage bolus”) which often leads to long and difficult lows (my son ha nights when he’ll need to take up to 80 carbs to climb back up).
Because insulin does not act right away, many people find it necessary to do some pre-dosing before the meal rather than waiting for the meal. My son injects 40 minutes before his meal, typically.
The good news is that, for the next few years, your body will definitely make it easier on you because you still make some insulin so you will not face the same level of peaks or valleys,
FUD is a great place—you can always ask here as you face new issues you are not familiar with. I understand that you are worried about the perspective of taking fast-acting insulin: normal, when facing something new that may have some dangerous consequences. But these consequences are quite unlikely and it is possible to act very conservatively, and your pancreas will be on your side for the first few years to dampen the impact. Good luck!
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One last thought about being afraid of lows: in the past 10 years, my son has been many, many times (too many to count) under 40, and has never had a problem. A couple of times, he has felt very, very low (a blood drop test got a 17 once, although who knows what it really was) and somewhat impaired so he took a lot of sugar to be sure. He has never had to call 911 or be brought to a hospital.
That said, it is good to be afraid of lows because they are definitely to be avoided:-)
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Nancy, 6-7 years ago I was no longer able to control my blood glucose levels with diet, exercise, Metformin and Lantus. That’s when I started multiple daily injections adding Novolog. I am currently using a Tandem T:Slim pump.
One of the things is to come up with a way to seperate the long insulin from the rapid so you don’t inject a long dose of rapid. That can lead to a pretty bad hypo.
Your Doc may have you use “sliding scale dosing. In my opinion that is not very good. At a guess most here who do MDI or by pump have a basal dose or ratte, units of insulin per grams of carbohydrates (ICR) and correction factor.
These are unique to the individual.
As to your current oral medications, I still take Metformin. It is moderately helpful. I reduces liver dump of glucose, slows digestion a bit and increases insulin sensitivity some what.
Glipizide is an insulin secretagogue. It stimulates your pancreatic Beta cells to secrete more insulin. If the doubling of the dose does not make much difference, then your Beta cells like mine are dead. It does have one other effect that may be helpful. It increases cell insulin sensitivity. This would reduce your total daily dose of insulin.
On Saturday mornings I do a bicycle ride of about 2 hours with aa group. I carry glucose tablets and peanut butter crackers. I didn’t need any of that during the ride. I went to a couple of big box stores and on the way home my blood glucose started dropping. When it hit 70mg/dl I sucked on 2 lifesavers because they were handy.
I’ve had my worst hypos when I was only on Lantus and Metformin, but then I didn’t have a continuous glucose monitor.
I wish you the very best.
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Thank you for the information . I will keep you posted.
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@Nancy50 Welcome! You’ve already received great advice from others! My suggestion is solely to accept the probability you’ll may roller coaster some and and you need not be too hard on yourself (easy to say, harder to do). It will likely take some time to learn how you react to different foods and dosing and understand you can eat the same thing, treat for it the same way, and still have a different result, there are many factors involved; and what works for one person may not work the same for yourself by! Ask any questions you have, chances are someone here has had it, done it, or has a recommendation you may benefit from!
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Gary Scheiner’s Think Like a Pancreas is a great source of information for learning to use mealtime insulin, tweaking basal insulin dosing, diabetes medications, and more. You may find that your entire regimen may need adjusting, too. Keep us all posted on your progress!
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Great book suggestion,once things slow down this winter I think I will read that . Thanks!
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So many great suggestions here from everyone. Carlos’ comment really struck me - if you start taking mealtime bolus, you might want to decrease your Lantus. Eventually, you might think about getting on a pump - somewhere down the road. When I got on the pump, I stopped taking Lantus, and that gave me a lot better control.
Good luck and keep us posted.
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Nancy, you’re already working so hard with your diet and walking. Please don’t be too hard on yourself 7.4 doesn’t erase your progress. Take it one day at a time. You’ve got this!
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I am a life-long T2D. After many years of using many types of meds and plans, and experiencing many problems, I discovered and determined an effective & simplest treatment program. The objective was A1c of 5.4 and the use of minimal meds. Key was finding the correct balance of long-term (basal) and short-term (bolus/mealtime) levels. I use 80 units of Awiqli and 10 mg of GLP-1 Mounjaro (once-weekly shots), and 1,000 mg Metformin (500 mg morning and evening) for basal control. Works great. Between meals, I stay in the 75 to 110 mg/dl range. For meal spikes, by far the best fast-acting and short life (its over in 2 hours) is Afrezza (inhaled insulin). I found this program had the fewest adverse side effects and the best results. These treatments are covered by most insurance plans (including Medicare) and made me appear as a non-diabetic.
For control and monitoring, the best (simple, accurate and reliable) CGM is the annual Eversense 365. Talk with your team to see if they agree that these may work for you.
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You are the 1st to tell of their success with weekly Awqigli insulin. As that’s a basal insulin it may not work well for someone who is on Lantus and experiencing meal time spikes.
The use of Afezza is good for meal time but may be needed to use twice if one experiences postprandial spikes 2-3 hours later. That’s me.
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I have used Awiqli for more than a year and switched from 24 hr and other long-acting (Tresiba). Switching to Awiqli will result in not continuing or need for Lantus or needing other long-acting insulins. That is one of the benefits: no daily shots. Another is how flat (little peak) the impact is compared to the other long-acting.
Yes, we need to match the dosage of Afezza and the number to the type of food. Pasta and certain other high or slow carbs will need a 2nd inhale after a few hours. What is nice is the fast-in and quick-out actions, completely unlike other insulins and no needles or shots are needed. I started using it 3 years ago, and I really like the many benefits over insulins.
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