I just got back from my doctor and I still do not have an answer...HELP!?

Question

I am a type II diabetic and at the moment I take 45 units N in the morning and evening and then am supposed to use the R insulin on a sliding scale. I asked for verification of that scale and she said it is different for everyone. SO, my question is this...Say when I wake up in the morning and I take my blood and it is 138, I take my normal 45 units N....but I know I am going to eat breakfast and my sugar is going to go up. (even if I eat "good for me" food) So, should I take some R, and if so how much. (I weigh 250 right now) I DID ask a lot of questions, but did not get real difinitive answers, and will try again, but in the mean time...maybe someone who lives with this can give advice? When I eat, my blood sugars go up, so should I test just before I plan to eat a meal, then if I am over 130, take some R insulin, and again, how much. I am really getting serious about this, and would appreciate some good advice. Thanks

Answer 1

The reason you didn't get the advice that you are seeking is because there is no rule when administering insulin on a sliding scale.
Unfortunately you have to learn what your requirements are by trial and error. While you and I are both T2 diabetics, our Insulin requirements aren't the same. I have learned over time to "guesstimate" what effect a certain food will have on my sugar level, and then to dose my medication accordingly.
You can do the same by testing pre and post meals, and recording the resulting blood sugars. Eventually you will learn that a piece of pizza will make your sugar go up by X amount and that knowledge will allow you to dose your insulin correctly.
You may consider this info to be of little help to you, but I can't really be more specific than that. I am very Insulin-resistant and sometime require huge amounts of Insulin. It happens sometimes that I need upwards of 200 units of Insulin in a day. I couldn't in good conscience advise a stranger to do likewise knowing that that amount of Insulin could be fatal to some people.
Anyway, you seem motivated to get control of your sugar and I really hope that you continue to get the info you need to keep yourself healthy. Trust me when I tell you that it's worth the effort.

Answer 2

You seriously need to get another doctor!!! First of all, the sliding scale is old medicine. On a sliding scale you're chasing your glucose levels instead of CONTROLLING them! The best control is going to come from a carb to insulin ratio and will have NOTHING to do with what your meter says. You count carbs and then give yourself the appropriate amount of insulin based on what your ratio is. Most people start out at 1unit per 15 carbs. Your background insulin, long acting or intermediate, should prevent your glucose from rising to high...and preferrably to low...between meals. BUT, as already pointed out, using the older insulins like N and R you'll have more trouble keeping your glucose from doing this. I do understand that the newer insulins are more expensive and that might a consideration. However, you're able to use them you'll get much better control. You really need to see an endocrinologist that doesn't send his or her patients out of the office with a prescription and no clue what to do with it! You can really get yourself into trouble without any direction and people here might want to help you, but really can't. Take care.

Answer 3

I suffered for a long time with that type of situation. I was switched to Lantis, which is infinitely better and I did not have to make those decisions, which inevitably was frustrating. Now, thank God, I am on Byetta, a new drug which "wakes up the system" (to simplify things) and makes it perform in a manner resembling natural. I take it twice a day AM and PM 1 hour BEFORE eating (absolutely no exceptions to that rule), and my insulin is now down to 30. I'm being switched to the stronger dose after showing good response to the initial lower dose, perhaps close to not needing insulin except in rare situations. Not a good answer to your question, but a great solution to our problem. Please check it out. There is another incredible benefits to Byetta: weight loss and some restoration of insulin production (I'm led to believe). Byetta comes from lizard saliva, so don't be surprised to hear "Lizard Spit" used a lot. Check out one of the many forums. Waste no time discussing this with your doctor. I'm happy. You should be, too!

Answer 4

Like someone said before, find a new doctor. My doctor told me (I am a very well controlled Type I and I know exactly how my body reacts to food and how to plan for it through 35+ year experience), so this may not work for you.

However, I hate to see someone who is trying to control their glucose get a bad doctor who doesn't explain to them what a sliding scale is and how it works. First - your doctor had to tell you how much R to take as a base level. I take both N and R together before breakfast, R before dinner, and N and R before bedtime. Call your Dr. and make him tell you how much R to start with. For me, I can tell you that 2 units of R will decrease my glucose by 100 points. I eat 36 carbs for breakfast and (depending on (1) my glucose fasting amount; (2) whether I am sick or stressed; (3) whether I will be exercising a lot that day; (4) or am having a "low" day) I take 4 units of R with my regular N dose. I up it by 1 or 2 units of R based on whether I plan to overeat, my fasting is higher, etc.

DON'T DO ANYTHING WITHOUT TALKING TO AN ENDOCRINOLOGIST - ONLY THEY CAN TELL YOU WHAT WILL WORK FOR YOU. I am very petite and have a lot of experience. You need to get educated first. I just provide my information so you can have an example of how a sliding scale is supposed to work.

Answer 5

time to find a new doctor- preferably someone who deals with diabetes (an endocrinologist) for #1 there are a lot better insulin choices out there for you (Humalog, Lantus) that work better with a sliding scale (than basic Regular and Nph). I would think you need to take a base rate of R no matter what you are running if you are going to be eating... talk to an endocrinologist.

Answer 6

sounds like its time to get a new doctor. You should never not be told the important info that you need, and that is important info. See an endocrinologist. I would never let my family Dr. treat my diabetes (I'm type1) he can handle everything else I trust him but he has no clue about my diabetic care. Also when I made the switch from N and R to Lantus and novolog it was the difference between day and night. Also a diabetes educator would be helpfull

Answer 7

you really need to get another dr. You should test 3-4 times a day.....of course when you eat your bs will rise.... test before you eat and take your needle at that time.... 5 units will make it go down.... there are courses at local hospitals and ADA.... go on their site... but really, you need a new diabetic doctor! Good luck

Answer 8

Hi
I have been a diabetic for 22 years and just found this website about 3months ago. This is a great website for diabetics.
http://www.diabetesforums.com/

Answer 9

You may want to talk to your doc about 'Lantus'. I've been taking it for 5 years now. 50U in the evening and Avandamet x2/day keeps me in the 110-120 range (fasting).

Answer 10

u must see an endocrinologist, they deal with diabetics all day long, no question or answer hasn't already been asked.