The morning high-low

DSC02260-1.jpgUp until about a month ago I had big problem controlling my post-breakfast and pre-lunch blood glucose. I would take 18 units of Levemir and 6 units of Novolog, wait 15 minutes, and then eat breakfast. Breakfast for me is a rotation of whole wheat toast, egg beaters, Morning Star meatless breakfast patty, steel cut oats, or Scottish oatmeal.

None of my portion sizes exceeded 60g of carbohydrate but my post-breakfast 2 hour BG would almost always be high; between 160 and 200 mg/dL. My pre-lunch BG would almost always be too low; between 60 and 70. I discussed this with my endocrinologist on my last trip ( I was being fitted with a trial Dexcom unit ) I mentioned this ti him. After "yelling" at me about the hypoglycemia, he recommended splitting my Levemir dosage into two; 8 in the morning and 10 in the evening.

I tried that for a week and my pre-lunch BG was much better ( between 80 and 90 ) but my post-break 2 hour BG was still high. I returned to the endocrinologist at the end of a week ( the length of time the Dexcom sensor was good for ) and we tweaked things further. He suggested waiting a full 30 minutes after taking the Novolog before eating. Within a few days my post-breakfast BG was within the 120-150 range and my pre-lunch BG was still within the 80-90 range. Success!! By carefully controlling the amount and timing of my insulin dosing I have achieved good BG control. My estimated A1c is 5.4 but I will wait for a doctor visit and test to confirm.

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Too much of a good thing?

Jillian's photo reminded me that I meant to post about my trip to the endo yesterday.  He downloaded the data from my glucometer, looked at the long series of low readings ( my before meal BG is somewhere before 50 and 70 ) and said, "How much insulin are you taking".<br />

Err... 18 units of Novolog daily ( 6 per meal ) and about 40 units of Levemir. He looked at me they way a parent looks at a child that is doing something dumb.

Yeah. Too much Levemir. I was advised to scale back to 20 units ( 10 in the morning and 10 in the evening ) daily. He also thinks I would benefit from using an CGMS ( Resistance is futile ). I am on the waiting list to try one of several Dexcom units he has in his office. He does not like the minimed devices. I did not have time to follow up on that ( I was late for my appointment ) but I will definitely ask next time.