A Diabetic Riddle - at least to me anyway...

[Korban]

I take Lantus 20u per day - now 11pm/9am – took about 3 days to stabilize the splitting dosage. Also dropped from 10mg Glipizide x 2 to 5mg x 2 due to re-occurring hypoglycemic episodes (50 – 54 mg/dl). [I always re-check a 50 reading]



Seemed to be getting better control then whammo in 95 mins went from 110 to 50mg/dl. Drop was 4 hours after lunch and glipizide (5mg). I then take 12g glucose and bg (+1 hour) goes up by the textbook considering my weight. Previous days showed no such reduction.



So today, I drop glipizide – bg is normal upon waking - eat breakfast (4.5g carb) and two hours later it goes up almost 60 points. I only ate 4.5 grams CHO – I swear it.



Does anyone know if this means I have gastroparesis*? Could something else be at work here? …and what about Naomi? These seem to be big increases / decreases over short times in spite of diet. I have religiously kept carbs to 20 – 30 grams per day. As I take beta blocker (Coreg) for a heart condition - I don't get the adrenaline or epinephrine release at low bg's - I just get hungry.



Comments are appreciated as I am still a newb. I did finally find a diabetes Doc but no appointment just yet.



Thanks,

/smile



*fancy word and phenomenon I learned from Bernstein’s book.

[RobLL]

My! those are interesting numbers. Wish I knew something to be helpful, just posted to let you know that I and others have looked and don't know what to say. Have you checked with your doctor yet?

[v-effect]

It is possible that you are getting a protein spike. How many grams of protein are you eating?
V.

[Korban]

I am eating about 95-115 g protein per day (I weigh 95 kg [209 lbs] - but am slowly working toward 70 kg [155 lbs]). This is just driving me nuts trying to figure out what is going on. I was real pleased with numbers for 2 and a half days until I got the hypo spike. There has to be something I am missing because I have been diligent re: diet and exercise... I am a big believer in cause and effect - just have no clue what the cause may be.

I have finally gotten, just today, a referral (sp?) to an endo who specializes in diabetes... but still no appointment. I hope it is soon.

Thanks for your replies,
/smile

I had 44 g protein and 9.3 g CHO for lunch prior to hypo; next morning I had 16.3 grams Protein and 4.4 grams CHO prior to hyper spike... it must have something to do with the glipizide - hopefully this will all resolve in a day or two.

[eddiemcm]

10 mg of glipizide ER,for me,works a lot better than regular instantaneous release glipizide.I have never had a hypo episode with glipizide ER-
had several with regular glipizide and glyburide before that.
Eddie

[bb00p04]

Not sure if this comes into play for you.
What I notice about myself is that it is what I had the night before that affects the baseline of how I do that next day.
I am also affected by adrenaline, stress, menses and some vitamins.

I've sat down and taken blood sugars with all of the above to get an idea of what insulin to take with that and then build off what I need to add. That part I still get wrong when I try to eat wasa crackers.

I'm still learning with Humalog and Humulin N since starting on it in January this year.

Good luck. :)

[Korban]

Thank you Eddie and bb00p04.

I am thinking it must be the glipizide. I have also noticed the "night before" effect so I usually wait a couple days on a regime before I react too much... am still learning here a lot and reading a ton.

Have a nice day,
/smile

[dancinbr]

I take Lantus 20u per day - now 11pm/9am – took about 3 days to stabilize the splitting dosage. Also dropped from 10mg Glipizide x 2 to 5mg x 2 due to re-occurring hypoglycemic episodes (50 – 54 mg/dl). [I always re-check a 50 reading]



Seemed to be getting better control then whammo in 95 mins went from 110 to 50mg/dl. Drop was 4 hours after lunch and glipizide (5mg). I then take 12g glucose and bg (+1 hour) goes up by the textbook considering my weight. Previous days showed no such reduction.



So today, I drop glipizide – bg is normal upon waking - eat breakfast (4.5g carb) and two hours later it goes up almost 60 points. I only ate 4.5 grams CHO – I swear it.



Does anyone know if this means I have gastroparesis*? Could something else be at work here? …and what about Naomi? These seem to be big increases / decreases over short times in spite of diet. I have religiously kept carbs to 20 – 30 grams per day. As I take beta blocker (Coreg) for a heart condition - I don't get the adrenaline or epinephrine release at low bg's - I just get hungry.



Comments are appreciated as I am still a newb. I did finally find a diabetes Doc but no appointment just yet.



Thanks,

/smile



*fancy word and phenomenon I learned from Bernstein’s book.

It will be interesting to hear what your endo has to say.

What I don't see here is what you did during the four hours. Was there exercise?

As we fast the BG will come down during the day.

Dr. B always says on his 6-12-12 regimen, which I try to approach that you fast in between meals for up to 5 hours. During that 5 hours I notice that my BG is always on its way down; certainly not as drastic as you have experienced. I have had it drop to 72 and yes I do a recheck on a low number too.

How do you feel?

And yes good idea on the glucose tabs to get it back up to 70.

I also take Metformin ER 500mg in the AM and 1500mg in the PM.

I have a lopsided split of my Levemir 35units in am and 17units in PM that seems to be working quite well now. Don't forget I weigh 265 and I am probably very definitely insulin resistant. I am slowly getting the weight down.

I also take various supplements that are good for this and that. I have to go back and re-read on them.

Chromium, Magnesium, B complex, a multi-vitamin, niacin, two baby aspirin, blood pressure pills, etc.

This whole thing is very personal and very empirical for each of us.

I recently started insulin both basal and fast acting in the last couple of months. The basal has brought my overall range down so now I am experiencing lows in the 70s and 80s rather than 100-110. The fact acting I use on the occasion when I know I am having a bit more carbs.

This is helping me control the range. If I stay between 30-60 carbs I don't need the fast acting that much. But even with low carbs I can use a couple of units of fast acting to really reduce the swings.

I am learning.

Ralph

[bb00p04]

All of what everyone is saying is right on the money. Wish I had a checklist to tell you what I do every day.

I have the Day Planner ADA equivalent in my schedule book.
That way I know the following 3 main things:

What my bg was in AM, afternoon, PM, night ( at a glance) and units used
What I ate at each time (If anyone finds a good web page for diabetic exchanges let me know. I use it in the most generic way)
If I had exercise or not.

So this lets me quickly assess alot more than I can fill out on the Glucograf charts and there is a section to write how I am feeling that day and what I did for work.

My lows come less now that I always pretty much eat the same thing for breakfast and use less insulin when I am working out.

I had one crazy low because I was trying out a new class and the instructor wanted to do laps around the track, scissor steps, lunges in laps and I had expected to do weights. oop. I found gatorade and got through it.

I've found the structure can chafe and can help me on alternating days.
I have to admit to myself I am a walking science experiment and that I can't really have rice, bread, potatoes etc

If I do have a fraction of them I have to increase insulin by 3 and I have been working very hard to keep it from 1-6 units.

I do hope this helps.

I don't know about your endocronologist and how he/she approaches things.
I found out so much more through a naturopath and she pointed me to Bernsteins book. My endo guy is there to take my blood for numbers tell me he wants me in a certain range and then tell me to leave. I don't get much out of it.

From my naturopath we are using vitamins and education for me.
In 5 chapters I now understood why formulas and high fiber for lowering cholesterol were not working for me.

That said... Your mileage may vary.

[Korban]

Thanks to all of you for the comments.

I had exercised 4 hours prior to hypo episode btw. Without the glipizide my day numbers breakfast + 2 or +3 are running in the 150 range now. I probably need more morning basal insulin. I do okay over night and will probably slowly increase morning dose a unit at a time. I hope to hear from endo today regarding appointment time. I will call later just in case I don't.

Thanks again and have a nice day,
/smile

[dancinbr]

I use levemir, roughly equivalent to lantus from everything I can read.

I know that Dr. B goes with Lantus for adults and Levemir for children since you can dilute the Levemir apparently.

In any event when my Doctor started me on Levemir he told me to start with 5 units. Go three days up it by 3 go three days, up it by three goe three days, etc., until I got the numbers I was looking for.

I was looking for a low of 80-85 3-5 hours after meals.

I ended up with 35 units of Levemir, which gets me through the day quite well with lows in the 80s and 90s and thus I can have a small number of carbs and still not go above 120 when I eat.

I still had dawn phenomena and that is when I went back and revisited the insulin section in my Dr. B's Diabetes Solution book.

It was here that I learned that an AM shot is good for up to 18 hours. But an overnight insulin injection is generally only good for about 9 hours. So, I now take a PM basal insulin injection around 11p each night. This has eliminated my dawn phenomena. I awakened this morning with a am reading of 88.

But I had forgotten to take my AM shot for an hour or two. By the time I got around to my AM injection my BFG had gone up to 118.

So all this works. It is all empirical and it is all varied by individual but the method and approach for each of us is the same.

Ralph