Carbs and strange bg behaviour

Discussion in 'Health and medical' started by Michael WäSch, Feb 13, 2004.

  1. Hi there,

    I am type 2. Cirrently no meds, diet and excercise only.

    When I eat 20g of carbon hydrates my bg level would rise from 110 mg/dl to 200 mg/dl and stay there
    for 4 hours, me spitting ketones (up to ++ positive). After 4 hours I would have 250 mg/dl (and no
    more ketones) and one hour later I would be at 130 mg/dl.

    But: If I ate 50g of carbon hydrates, my bg levels would only rise up to 170-190 mg/dl and after 4
    hours I would be at 120-130 mg/dl.

    How comes? Any ideas?

    More strange values:

    If I eat 50g carbon hydrates starting with 120 mg/dl I'd get, as said before, 180 after meal. Now in
    several cases I had to start eating with 170 mg/dl and thought I would get really high values, may
    be even forcing me to apply insulin, but nothing happend. 1,5 hrs after meal I had 185 mg/dl.

    Weird?

    Michael
     
    Tags:


  2. Michael, I am T1 and don't really understand much of anything when it comes to T2. The only thing
    that makes sense to me is that the 50g carbs you referenced are possibly slower acting carbs, such
    as whole grains. Or, possibly slow acting carbs with fats. The fats will delay the carbs absorption.

    Watch out for those ketones! I've dealt with DKA, and it is no fun. (Ketones scare the dickens
    out of me.)

    I will be watching this thread with interest. I hope someone has some good ideas about this mystery.

    Steph

    "Michael Wäsch" <[email protected]> wrote in message news:[email protected]...
    > Hi there,
    >
    > I am type 2. Cirrently no meds, diet and excercise only.
    >
    > When I eat 20g of carbon hydrates my bg level would rise from 110 mg/dl to 200 mg/dl and stay
    > there for 4 hours, me spitting ketones (up to ++ positive). After 4 hours I would have 250 mg/dl
    > (and no more ketones) and one hour later I would be at 130 mg/dl.
    >
    > But: If I ate 50g of carbon hydrates, my bg levels would only rise up to 170-190 mg/dl and after 4
    > hours I would be at 120-130 mg/dl.
    >
    > How comes? Any ideas?
    >
    > More strange values:
    >
    > If I eat 50g carbon hydrates starting with 120 mg/dl I'd get, as said before, 180 after meal. Now
    > in several cases I had to start eating with 170 mg/dl and thought I would get really high values,
    > may be even forcing me to apply insulin, but nothing happend. 1,5 hrs after meal I had 185 mg/dl.
    >
    > Weird?
    >
    > Michael
     
  3. Beav

    Beav Guest

    "Michael Wäsch" <[email protected]> wrote in message
    news:[email protected]...
    > Hi there,
    >
    > I am type 2. Cirrently no meds, diet and excercise only.
    >
    > When I eat 20g of carbon hydrates my bg level would rise from 110 mg/dl to 200 mg/dl and stay
    > there for 4 hours, me spitting ketones (up to ++ positive). After 4 hours I would have 250 mg/dl
    > (and no more ketones) and one hour later I would be at 130 mg/dl.

    The ketones thing bothers me Mike. As a T2, you shouldn't be spilling them at those levels. I'd
    suggest (as an option) another trip to your doc for a more "in depth" look at your diabetes. Ketones
    are usually associated with a LACK of insulin, not an excess which is common among T2's.

    Also, at four hours after eating such a miniscule amount of carbs, you shouldn't be anywhere NEAR
    250. You may hit a 250 some time between eating and TWO hours, but definitely not four hours. This
    is sounding more and more like an early start to adult onset T1 to me.

    >
    > But: If I ate 50g of carbon hydrates, my bg levels would only rise up to 170-190 mg/dl and after 4
    > hours I would be at 120-130 mg/dl.
    >
    > How comes? Any ideas?

    Unfortunately, it's a strange disease and one day I can eat a meal containing 50 - 60 grams of carbs
    and not go above 100, and on another day I'll DROP to almost hypo levels for the same meal and the
    same amount of insulin/exercise. No two days are alike.

    >
    > More strange values:
    >
    > If I eat 50g carbon hydrates starting with 120 mg/dl I'd get, as said before, 180 after meal. Now
    > in several cases I had to start eating with 170 mg/dl and thought I would get really high values,
    > may be even forcing me to apply insulin, but nothing happend. 1,5 hrs after meal I had 185 mg/dl.
    >
    > Weird?

    Not really, just the nature of the beast., but Istill thik another trip to your doc is in order.
    Please go there:)

    Beav
     
  4. Alan

    Alan Guest

    On Fri, 13 Feb 2004 16:56:54 -0000, "Beav"
    <[email protected]> wrote:

    >
    >"Michael Wäsch" <[email protected]> wrote in message news:[email protected]...
    >> Hi there,
    >>
    >> I am type 2. Cirrently no meds, diet and excercise only.
    >>
    >> When I eat 20g of carbon hydrates my bg level would rise from 110 mg/dl to 200 mg/dl and stay
    >> there for 4 hours, me spitting ketones (up to ++ positive). After 4 hours I would have 250 mg/dl
    >> (and no more ketones) and one hour later I would be at 130 mg/dl.
    >
    >The ketones thing bothers me Mike. As a T2, you shouldn't be spilling them at those levels. I'd
    >suggest (as an option) another trip to your doc for a more "in depth" look at your diabetes.
    >Ketones are usually associated with a LACK of insulin, not an excess which is common among T2's.
    >
    >Also, at four hours after eating such a miniscule amount of carbs, you shouldn't be anywhere NEAR
    >250. You may hit a 250 some time between eating and TWO hours, but definitely not four hours. This
    >is sounding more and more like an early start to adult onset T1 to me.
    >
    >>
    >> But: If I ate 50g of carbon hydrates, my bg levels would only rise up to 170-190 mg/dl and after
    >> 4 hours I would be at 120-130 mg/dl.
    >>
    >> How comes? Any ideas?
    >
    >Unfortunately, it's a strange disease and one day I can eat a meal containing 50 - 60 grams of
    >carbs and not go above 100, and on another day I'll DROP to almost hypo levels for the same meal
    >and the same amount of insulin/exercise. No two days are alike.
    >
    >>
    >> More strange values:
    >>
    >> If I eat 50g carbon hydrates starting with 120 mg/dl I'd get, as said before, 180 after meal. Now
    >> in several cases I had to start eating with 170 mg/dl and thought I would get really high values,
    >> may be even forcing me to apply insulin, but nothing happend. 1,5 hrs after meal I had 185 mg/dl.
    >>
    >> Weird?
    >
    >Not really, just the nature of the beast., but Istill thik another trip to your doc is in order.
    >Please go there:)
    >
    >Beav
    >
    Hi Michael

    First, I agree with Beav. It's time to see your doctor to explain this properly.

    Just a couple of thoughts. You don't mention some other factors - the type of carbs because their GI
    may significantly affect the timing and length of a spike; the time of day because dawn effect or a
    liver dump may be involved; or even the time since the last meal if a short fast was involved.

    But even if all those factors were involved, the ketones would send me straight to the doc.

    Let us know what he says please; it may help one of us as well.

    Cheers Alan, T2, Oz. dx May 2002 , A1C 8.2=>5.8, wt 117kg=>90kg, no meds, diet and not enough
    exercise. I have no medical qualifications beyond my own experience. Choose your advisers carefully,
    because experience can be an expensive teacher.
    --
    Everything in Moderation - Except Laughter.
     
  5. Hi,

    > are possibly slower acting carbs, such as whole grains. Or, possibly slow acting carbs with fats.
    > The fats will delay the carbs absorption.

    I am always slowing down carbs with fats. Bread with lots of butter, chesse
    e.g. and meals with salads (olive oil). I have also experienced that if I eat some "fast" carbs with
    my meals (ketchup containing glucose) my bg levels are even better. In some cases they stay
    below 160 mg/dl all the time.

    > Watch out for those ketones! I've dealt with DKA, and it is no fun. (Ketones scare the dickens
    > out of me.)

    Out of me too, but they laughed at me twice in hospital, complaining that ketones can't be harmful
    if I had bg around 130 mg/dl. In my bad times I had bg levels >>330 mg/dl an guess what, no ketones.
    I only have ketones with low values.

    > I will be watching this thread with interest. I hope someone has some
    good
    > ideas about this mystery.

    I have my ideas as well, but do not want to share them right now in order not to get
    influenced answers.

    Michael
     
  6. Hi,

    > The ketones thing bothers me Mike. As a T2, you shouldn't be spilling them at those levels. I'd
    > suggest (as an option) another trip to your doc for a more "in depth" look at your diabetes.
    > Ketones are usually associated with
    a
    > LACK of insulin, not an excess which is common among T2's.

    As I just told Stephanie: They just would laugh at me at hospital. I was told (over and over again)
    that I am only in danger when my bg levels are higher than 300 mg/dl and ketones are +++ positive.
    Then there is a chance of a developing ketoacidosis. Ketosis with 100-200 mg/dl doesn't eben my
    specialist doc.

    And then I was told (over and over again) that ketones ++ positive could also arise from not
    having eaten.

    > Also, at four hours after eating such a miniscule amount of carbs, you shouldn't be anywhere NEAR
    > 250. You may hit a 250 some time between eating and TWO hours, but definitely not four hours. This
    > is sounding more and
    more
    > like an early start to adult onset T1 to me.

    I was recently tested an diagnosed: HBA1c = 6,4 C-Peptid = 2,5, antibodies = normal. Doc: "Nothing
    indicates some sort of Type-1-diabetes, but everything points towards Type-2-Resistency-Diabetes.
    Its ok for me If you cease applying insuline, but don't throw it away, it could be, that you will
    need it again."
    MW: "When?" Doc: "That can't be said. Next year, next decade or even never.".

    > I'll DROP to almost hypo levels for the same meal and the same amount of insulin/exercise. No two
    > days are alike.

    I can't drop to hypo levels.

    > Not really, just the nature of the beast., but Istill thik another trip to your doc is in order.
    > Please go there:)

    To get another portion of laughter?

    Michael
     
  7. Alan

    Alan Guest

    On Fri, 13 Feb 2004 22:48:25 +0100, "Michael Wäsch" <[email protected]>
    wrote:

    >Hi,
    >
    >> The ketones thing bothers me Mike. As a T2, you shouldn't be spilling them at those levels. I'd
    >> suggest (as an option) another trip to your doc for a more "in depth" look at your diabetes.
    >> Ketones are usually associated with
    >a
    >> LACK of insulin, not an excess which is common among T2's.
    >
    >As I just told Stephanie: They just would laugh at me at hospital. I was told (over and over again)
    >that I am only in danger when my bg levels are higher than 300 mg/dl and ketones are +++ positive.
    >Then there is a chance of a developing ketoacidosis. Ketosis with 100-200 mg/dl doesn't eben my
    >specialist doc.
    >
    >And then I was told (over and over again) that ketones ++ positive could also arise from not
    >having eaten.
    >
    >> Also, at four hours after eating such a miniscule amount of carbs, you shouldn't be anywhere NEAR
    >> 250. You may hit a 250 some time between eating and TWO hours, but definitely not four hours.
    >> This is sounding more and
    >more
    >> like an early start to adult onset T1 to me.
    >
    >I was recently tested an diagnosed: HBA1c = 6,4 C-Peptid = 2,5, antibodies = normal. Doc: "Nothing
    >indicates some sort of Type-1-diabetes, but everything points towards Type-2-Resistency-Diabetes.
    >Its ok for me If you cease applying insuline, but don't throw it away, it could be, that you will
    >need it again."
    >MW: "When?" Doc: "That can't be said. Next year, next decade or even never.".
    >
    >> I'll DROP to almost hypo levels for the same meal and the same amount of insulin/exercise. No two
    >> days are alike.
    >
    >I can't drop to hypo levels.
    >
    >> Not really, just the nature of the beast., but Istill thik another trip to your doc is in order.
    >> Please go there:)
    >
    >To get another portion of laughter?
    >
    >Michael
    >

    Michael

    I have no idea how difficult it may be in your situation, but I know I'd be changing doctors.
    Yesterday.

    Laughter is great therapy - when you are the one laughing. I have grave doubts about it's
    therapeutic value when the doc is laughing at you.

    Cheers Alan, T2, Oz. dx May 2002 , A1C 8.2=>5.8, wt 117kg=>90kg, no meds, diet and not enough
    exercise. I have no medical qualifications beyond my own experience. Choose your advisers carefully,
    because experience can be an expensive teacher.
    --
    Everything in Moderation - Except Laughter.
     
  8. Hi,

    > But even if all those factors were involved, the ketones would send me straight to the doc.
    >
    > Let us know what he says please; it may help one of us as well.

    See above. You just would get laughed at. Please remember. I live in Germany, that means that I live
    in a third world country concerning medical assistance. Keep that in mind.

    The last time I was in hospital when I was high in ketones they refused to treat me, arguing that I
    was not in immediate danger, since my bg levels were quite low. They told me that they had to treat
    other people first and so I saw an aold woman who had real pain in her stomach and was near complete
    breakdown. Her daughter was with her and since I was following their discussion I learned, that this
    poor lady had to wait 5 hours in the emergency room in order to get treatment. Then, finally, the
    doc arrived and told that poor lady: "Ma'am, you are full of shit! We can't do anything for you. Go
    home, drink a lot and have a huge dump!".

    Wow, that did it for me. I had to leave the room, because I had to laugh so loud, although it wasn't
    funny at all. I went straight home, refusing to let me treat by those bastards, had two Big Macs and
    my 3 IE Human-R did fine in handling it.

    BTW. I have diabetes since 1995, treated with oral antidiabetica. Then it became insuline dependent
    in 2003 due to liver problems and Eppstein-Barr-Virus. Then the virus (ugly thing, hold you down
    for more than 6 months) expired, my liver recovered and my insuline dependency was gone with the
    wind so to speak.

    My doc (regular doc) wanted to give me some sort of glitazone (as stand alone) to lessen my insuline
    resistance but my other doc (specialist dor diabetes) did not agree. He said: "I'm not here to
    execute your liver! Make excercises instead!".

    Michael
     
  9. Hi,

    > I have no idea how difficult it may be in your situation, but I know I'd be changing doctors.
    > Yesterday.

    I can't change. After a year full of change and search, these are the best. All other are much less.
    Please keep in mind that Germany now is a third world country!

    > Laughter is great therapy - when you are the one laughing. I have grave doubts about it's
    > therapeutic value when the doc is laughing at you.

    They didn't want to treat me. I was really close in just getting away with my complaints and not
    landing in the psychiatry. That's just to show you how bad medical care is in Germany.

    I can tell you stories, you would not believe (me either, but I experienced it). There's no chance,
    no help, no escape.

    BTW: I have those ketones for years. Nothing ever happend, and I am fully aware that I have to call
    the emergency immediately if I start to drink huge amounts of liquid, have to stay on the toilet
    just for peeing, have to vomit and bg levels are out of control.

    Well, as said, I have my own conclusions about this strange behaviour of my bg levels and
    ketones some times, but please allow me to wait until more answer come in, then I will share my
    thoughts with you.

    Michael
     
  10. Ozgirl

    Ozgirl Guest

    Michael Wäsch wrote:

    > Out of me too, but they laughed at me twice in
    hospital, complaining
    > that ketones can't be harmful if I had bg around 130
    mg/dl. In my bad
    > times I had bg levels >>330 mg/dl an guess what, no
    ketones. I only
    > have ketones with low values.

    You can show ketones if you are eating very low carb.
     
  11. Beav

    Beav Guest

    "Michael Wäsch" <[email protected]> wrote in message
    news:[email protected]...
    > Hi,
    >
    > > The ketones thing bothers me Mike. As a T2, you shouldn't be spilling
    them
    > > at those levels. I'd suggest (as an option) another trip to your doc for
    a
    > > more "in depth" look at your diabetes. Ketones are usually associated
    with
    > a
    > > LACK of insulin, not an excess which is common among T2's.
    >
    > As I just told Stephanie: They just would laugh at me at hospital. I was told (over and over
    > again) that I am only in danger when my bg levels are higher than 300 mg/dl and ketones are +++
    > positive. Then there is a chance of a developing ketoacidosis. Ketosis with 100-200 mg/dl doesn't
    > eben my specialist doc.

    Only in danger of ketoacidosis, but that doesn't mean you're doing yourself any good by spilling
    ketones. It wasn't really the concern about reaching DKA that prompted me to mention it Mike, is was
    purely the fact that as a T1 I've NEVER spilled ketones since dx, and as a (supposed) T2, they're
    not something you shuld EVER see unless you're eating a no or ultra low carb diet. I didn't get the
    impression you were doing either.
    >
    > And then I was told (over and over again) that ketones ++ positive could also arise from not
    > having eaten.

    Indeed, because ketones usually present when there's too little insulin, not too much sugar. This is
    why I mentioned it. If you're spilling ketones, your medication isn't correct.
    >
    > > Also, at four hours after eating such a miniscule amount of carbs, you shouldn't be anywhere
    > > NEAR 250. You may hit a 250 some time between
    eating
    > > and TWO hours, but definitely not four hours. This is sounding more and
    > more
    > > like an early start to adult onset T1 to me.
    >
    > I was recently tested an diagnosed: HBA1c = 6,4 C-Peptid = 2,5, antibodies
    =
    > normal. Doc: "Nothing indicates some sort of Type-1-diabetes, but everything
    points
    > towards Type-2-Resistency-Diabetes. Its ok for me If you cease applying insuline, but don't throw
    > it away, it could be, that you will need it again."
    > MW: "When?" Doc: "That can't be said. Next year, next decade or even never.".

    Or even today? If you're running the levels you ARE running, then you either need insulin or some
    medication to address your resistance problem, but again, if you're insulin resistant, you'll more
    than likely to be producing excess amounts of the stuff and that would all but eliminate the chances
    of spilling ketones. Your A1c's aren't "whoopie" either, as you've gone beyond the point the DCCT
    use as a "trigger" for increasing your chances of possible complications down the line. They (the
    DCCT) advice we keep our A1c's below 6.2. All this points to your medication being wrong or
    insufficient (from where I'm sitting)

    >
    > > I'll DROP to almost hypo levels for the same meal and the same amount of insulin/exercise. No
    > > two days are alike.
    >
    > I can't drop to hypo levels.

    I can see why too. You mentioned in another post that your doc refused to script you for Glicazide
    and instead told you to take exercise, but there's a BIG problem here. If you're not medicated and
    exercise doesn't bring your sugar levels down, the exercise itself can cause more harm than good.
    You need to be able to burn the glucose that the muscles use for fuel and if you can't, the result
    of exercising is a HIGHER sugar level.

    >
    > > Not really, just the nature of the beast., but Istill thik another trip
    to
    > > your doc is in order. Please go there:)
    >
    > To get another portion of laughter?

    I feel for you Mike, I really do, but I can't do anything other than tell you what I'd do in your
    (then) unknown circumstances. If the docs you've seen laugh at you, isn't there an alternative
    hospital/medical centre.something you can go to? Can you not go private for a single "real"
    consultation? If MY life and health depended on doing that, then that's what I'd do.

    Are you on ANY medication for you diabetes btw, because it's screaming out for at least a script for
    one of the drugs in the Metformin group.

    Beav
     
  12. Hi,

    > something you shuld EVER see unless you're eating a no or ultra low carb diet. I didn't get the
    > impression you were doing either.

    I eat between 100 and 140 grams of carbon hydrates a day.

    > Indeed, because ketones usually present when there's too little insulin,
    not
    > too much sugar. This is why I mentioned it. If you're spilling ketones,
    your
    > medication isn't correct.

    There is nothing I can do about. In days I had to inject insulin my values were even worse and I had
    a lot more ketones.

    > > Doc: "That can't be said. Next year, next decade or even never.".
    > Or even today? If you're running the levels you ARE running, then you
    either
    > need insulin or some medication to address your resistance problem, but

    My doc says that I can not. Although my liver values are better now, he thinks that oral
    antidiabetica would harm it again.

    > spilling ketones. Your A1c's aren't "whoopie" either, as you've gone
    beyond
    > the point the DCCT use as a "trigger" for increasing your chances of possible complications down
    > the line. They (the DCCT) advice we keep our A1c's below 6.2. All this points to your medication
    > being wrong or insufficient (from where I'm sitting)

    In Germany my doctors are very happy with my values. We are supposed to keep A1c below 6,5 and bg
    levels after meals below 160 mg/dl.

    > a BIG problem here. If you're not medicated and exercise doesn't bring
    your
    > sugar levels down, the exercise itself can cause more harm than good. You need to be able to burn
    > the glucose that the muscles use for fuel and if
    you
    > can't, the result of exercising is a HIGHER sugar level.

    Excercise will bring me down, not fast, but it will. I have never seen any rising sugar levels by
    doing excercises, except if I had to work (physically) very hard.

    Some examples:

    Without medication: Let's say 240 mg/dl after meal. Then gone for a short walk outside (5 minutes)
    then resting 10 minutes. Measuring again: 190 mg/dl.

    With insulin: I would surely have more than 300 mg/dl (thats a proven fact). Same walk, same rest.
    Measure again: 170 mg/dl.

    Taking again insulin would worsen my values to the limit of my imagination:

    Example out of my insulin days:

    Same food, same time, same starting bg level, diffrent amount of insulin.

    Day 1: Before meal: 120 mg/dl, 9 IU human r, after meal (1,5 hrs) = 220 mg/dl Day 2: 10 IU, After
    meal = 220 mg/dl Day 3: 12 IU, After meal = 240 mg/dl Day 4: 15 IU !!!, After meal = 280 mg/dl !!!

    Doc says: "Thats normal! As type-2 you don't stand a chance of getting down those values with this
    small increase of insulin. You would have to increas in 10 IU-steps and then are in severe danger of
    hypoglycaemia.".

    But what for. I did exactly that for 6 months only to create some sort of receptor-down-regulation.
    I then needed more than 80 IU of insulin a day, steadily increasing. No, insulin doe not do any good
    for me. My values are now way better than before, even if they are not good enough, compared with US
    or GB standards.

    > centre.something you can go to? Can you not go private for a single "real" consultation? If MY
    > life and health depended on doing that, then that's
    what
    > I'd do.

    I could do and I tried it twice, but the only thing they do for you there is to rigidly shoot your
    values down by using fast working insulin types like lispro or aspart. They won't even accept, that
    I might get into hypos very fast. They never believed any of my argumentation.

    One night I was so hungry (while at home), so I wanted to eat anothe 25g of carbon hydrates at 2 am,
    but I still had 220 mg/dl. But I couldn't resist, so I ate and applied 1 single IU of human R for 25
    carbs plus 220 mg/dl, then the hell broke loose. Within 15 minutes my bg levels dropped below 150
    mg/dl so fast falling I had never experienced before. In shere panic I woke my girlfried in order to
    get a doctor if I fall unconsciousness. To that point my bg levels were already down below 120
    mg/dl. I felt that I had to die and drank Cola in order to stop my bg levels from falling any
    further, but it was of no use. In the end I had to drink the equivalent of 70 grams of carbon
    hydrates in order to stabilize bg levels at 120 mg/dl.

    Let's summarize: 220 mg/dl starting value, 25 carbs eaten, then 1 IU human r, then another 70 carbs
    in order to survive.

    Well, the doctors don't care. They don't get hypos and they don't get blind. Oh yes blind. More than
    a couple of people were now blind, because they got too much insulin and got too often too fast down
    while being used to have higher values. The doctors don't care. They just walk away without any word
    of excuse and they even get rewarded for their good work!

    > Are you on ANY medication for you diabetes btw, because it's screaming out for at least a script
    > for one of the drugs in the Metformin group.

    I can't take metformin. I just get diarrea from it.

    Michael
     
  13. "Michael Wäsch" <[email protected]> wrote on Fri, 13 Feb 2004 15:42:48 +0100:
    > Hi there,

    Hi, Michael!

    > I am type 2. Cirrently no meds, diet and excercise only.

    > When I eat 20g of carbon hydrates ...........

    Just a linuistic point. The word in English is "carbohydrate(s)".

    > Michael

    Grüß aus München!

    --
    Alan Mackenzie (Munich, Germany) Email: [email protected]; to decode, wherever there is a repeated
    letter (like "aa"), remove half of them (leaving, say, "a").
     
  14. "Michael Wäsch" <[email protected]> wrote on Fri, 13 Feb 2004 22:48:25
    +0100:
    > Hi,

    >> Not really, just the nature of the beast., but I still think another trip to your doc is in
    >> order. Please go there:)

    > To get another portion of laughter?

    Persevere with the docs, Michael. I've been in Munich for not quite 6 years, and I'm already on my
    third specialist.

    The first one couldn't write couldn't write prescriptions. He was using some computer program for
    printing them out, and it was the program's fault that they weren't always right, or sometimes it
    was my fault for not having a "normal" requirement. Like, I'd ask for five boxes of testing strips,
    and only one would be prescribed. Several times I made the mistake of asking for "5 x (5 x 1.5ml)
    Actrapid Penfill cartridges", and this was slovenlily [D: "schlampig"] transferred as "5" to the
    prescription and I'd just get one box of 5. Of course, the prescription was printed in such a
    strange symbolic language that even the pharmacist often had to 'phone the doc's practice to ask
    what it meant. Somebody persuaded me to get out of that one. Phew!

    The second one was fine, as long as you were a meak worried person who just wanted to be told
    exactly what to do. Actually, I think he'd be superb for such a patient. Not for me. Tried to use
    Human NPH as a basal for some time (not to be recommended). Was waking up with BS typically over
    200. "We'll put you on Lantus, just what you need!" "Oh no you won't! I'm not touching that fragile
    garbage! I'll have beef or pork Lente, please!". And the conversation deteriorated from then on,
    till he told me I'd be better finding a different doctor. He was right, there!

    The third one seems just right for me, even though his surgery is a bit out of town. He got me onto
    pig Semilente, a true wonder drug.

    The way I found #3 was, I 'phoned up my Krankenkasse (health insurance fund) and asked them for some
    addresses. I spammed four doctors with a letter explaining my current difficulties, what I wanted,
    what I _didn't_ want, asking them if they felt they'd be the right doc for me. Two of them replied,
    one by email. His email read thus:

    :Sehr geehrter Herr Mackenzie,

    :eine Ihnen angenehme Lösung wird sich mit Sicherheit finden. Ich :akzeptiere Ihre Bedenken gegen
    Lantus, mit denen Sie in der Fachwelt ja :nicht ganz alleine dastehen. Man könnte Ihnen vielleicht
    Semilente :vorschlagen, das Sie allerdings selbst aus der Stechflasche aufziehen :müssten - aber mit
    Ihrer Diabeteserfahrung müßte das ja zu :bewerkstelligen sein.

    [Dear Mr. Mackenzie,

    A solution which is acceptable to you can certainly be found. I accept your concerns about Lantus,
    and you've certainly got good company amongst experts here. We could suggest Semilente, perhaps, but
    you'd have to draw this out of a vial yourself - but with your experience of diabetes, I'm sure
    you'd manage this.]

    So, _write_ to as many internists as you can. Describe exactly the problems you've had with the
    previous ones. One of them, at least, will reply positively. Failing that, I could give you the
    telephone number of my specialist, if you don't mind a 4 hour train journey to get to him.
    :)

    > Michael

    --
    Alan Mackenzie (Munich, Germany) Email: [email protected]; to decode, wherever there is a repeated
    letter (like "aa"), remove half of them (leaving, say, "a").
     
  15. Hi,

    > Just a linuistic point. The word in English is "carbohydrate(s)".

    No "n"? I see. Thanks for the hint.

    Michael
     
  16. Hi,

    > Persevere with the docs, Michael. I've been in Munich for not quite 6 years, and I'm already on my
    > third specialist.

    I have tried more doctors than that. All garbage, less than garbage to the point that I felt it
    would be better some authority sjould take away their academic degrees.

    > prescription and I'd just get one box of 5. Of course, the prescription was printed in such a
    > strange symbolic language that even the pharmacist often had to 'phone the doc's practice to ask
    > what it meant. Somebody persuaded me to get out of that one. Phew!

    I know what you mean.

    > pork Lente, please!". And the conversation deteriorated from then on, till he told me I'd be
    > better finding a different doctor. He was right, there!

    Standard german doc ...

    > The third one seems just right for me, even though his surgery is a bit out of town. He got me
    > onto pig Semilente, a true wonder drug.

    I have no basal rate, but I was happy with lantus. Lantus was the only insulin that actually did
    something for me. Of course, my pancreas counter-measured the surplus insulin by reducing its
    output, but since it could do that on a 24 hour scale it was stronger if I ate something.

    And now something for another laughter: The highest dose of lantus I could stand was 2 IU ...
    literally nothing.

    Michael
     
  17. Alan

    Alan Guest

    On Sat, 14 Feb 2004 15:45:37 +0100, "Michael Wäsch" <[email protected]>
    wrote:

    >Hi,
    >
    >> Persevere with the docs, Michael. I've been in Munich for not quite 6 years, and I'm already on
    >> my third specialist.
    >
    >I have tried more doctors than that. All garbage, less than garbage to the point that I felt it
    >would be better some authority sjould take away their academic degrees.

    <snip>

    Sounds like good advice from Alan in Gemany, Michael.

    As you say you can't find a good one locally, I'd be checking out the travel arrangements.

    Cheers, Alan, T2, Oz.
    --
    Everything in Moderation - Except Laughter.
     
  18. Beav

    Beav Guest

    "Michael Wäsch" <[email protected]> wrote in message
    news:[email protected]...
    > Hi,
    >
    > > something you shuld EVER see unless you're eating a no or ultra low carb diet. I didn't get the
    > > impression you were doing either.
    >
    > I eat between 100 and 140 grams of carbon hydrates a day.

    That amount shouldn't cause you to spill. Something else would appear to be going on here. (like a
    lack of insulin?)

    >
    > > Indeed, because ketones usually present when there's too little insulin,
    > not
    > > too much sugar. This is why I mentioned it. If you're spilling ketones,
    > your
    > > medication isn't correct.
    >
    > There is nothing I can do about. In days I had to inject insulin my values were even worse and I
    > had a lot more ketones.

    That doesn't make a lot of sense to me, in fact it makes NO sense. Maybe you've got another problem
    other than the diabetes. I "would" say go to see a doc but apparently that's not going to happen.

    >
    > > > Doc: "That can't be said. Next year, next decade or even never.".
    > > Or even today? If you're running the levels you ARE running, then you
    > either
    > > need insulin or some medication to address your resistance problem, but
    >
    > My doc says that I can not. Although my liver values are better now, he thinks that oral
    > antidiabetica would harm it again.

    So now you're not using ANY meds??

    >
    > > spilling ketones. Your A1c's aren't "whoopie" either, as you've gone
    > beyond
    > > the point the DCCT use as a "trigger" for increasing your chances of possible complications down
    > > the line. They (the DCCT) advice we keep our A1c's below 6.2. All this points to your medication
    > > being wrong or insufficient (from where I'm sitting)
    >
    > In Germany my doctors are very happy with my values.

    Well if a doctor told me that HE was happy with my A1c's f they were above
    6.2, I'd congratlate him on his care and promptly find another doctor. (and we're in the HS over
    here so you can't tell me much about health care and the people within it)

    We are supposed to keep
    > A1c below 6,5 and bg levels after meals below 160 mg/dl.

    Both figures are too high. A1c below 6.2 and post meal BG;s below 140.

    >
    > > a BIG problem here. If you're not medicated and exercise doesn't bring
    > your
    > > sugar levels down, the exercise itself can cause more harm than good.
    You
    > > need to be able to burn the glucose that the muscles use for fuel and if
    > you
    > > can't, the result of exercising is a HIGHER sugar level.
    >
    > Excercise will bring me down, not fast, but it will. I have never seen any rising sugar levels by
    > doing excercises, except if I had to work (physically) very hard.

    Isnt that what exercise is? I'm not saying a stroll in the park will raise your already high
    BG's, I'm saying that if they're high and you exercise (which means hard physical effort) they'll
    go higher.

    >
    > Some examples:
    >
    > Without medication: Let's say 240 mg/dl after meal. Then gone for a short walk outside (5 minutes)
    > then resting 10 minutes. Measuring again: 190 mg/dl.

    That's about right for mild exercise.

    >
    > With insulin: I would surely have more than 300 mg/dl (thats a proven
    fact).

    Well you SAY it's a proven fact, but like I said before, maybe something else is going on. Insulin
    is THE most effective "material" for lowering BG's, yout it causes yours to go high. that's a VERY
    strange system you're operating with there.

    > Same walk, same rest. Measure again: 170 mg/dl.
    >
    > Taking again insulin would worsen my values to the limit of my
    imagination:
    >
    > Example out of my insulin days:
    >
    > Same food, same time, same starting bg level, diffrent amount of insulin.
    >
    > Day 1: Before meal: 120 mg/dl, 9 IU human r, after meal (1,5 hrs) = 220 mg/dl

    you dont say what the meal is, and if the igestion of the meal doesn't "match" the activity crve of
    the insulin, you can go high and then drop low. get the curves of the food and the insuoin working
    together however, and the BG rise is almost zero, as is the following drop. Actrapid (Human R) is
    one of THE worst insulins to "match" food too because it's too slow to get going and it has a too
    long tail, so after the food is "gone", the R keeps on shoving your BG down. Try eating either a
    MUCH slower meal (add fibre wherever possible and LOTS of it) or change to using a faster insulin
    such as Humalog or NovoRapid. both of these are MUCH MUCH faster in their "start-up" time, and both
    "rin out of steam" a long time before R does. This could be an option.

    > Day 2: 10 IU, After meal = 220 mg/dl Day 3: 12 IU, After meal = 240 mg/dl Day 4: 15 IU !!!, After
    > meal = 280 mg/dl !!!
    >
    > Doc says: "Thats normal! As type-2 you don't stand a chance of getting
    down
    > those values with this small increase of insulin. You would have to
    increas
    > in 10 IU-steps and then are in severe danger of hypoglycaemia.".

    He may have a point, (although I doubt it) but have you considered a faster insulin?
    >
    > But what for. I did exactly that for 6 months only to create some sort of receptor-down-
    > regulation. I then needed more than 80 IU of insulin a day, steadily increasing. No, insulin doe
    > not do any good for me. My values are now way better than before, even if they are not good
    > enough, compared
    with
    > US or GB standards.

    Please don't confuse our standards and those in the US as being "tighter" than yours in Germany. The
    same standards are worldwide. Just because you're German doesn't mean you're not at risk from
    complications at the same "point" as the rest of the world. Your doctor needs a serious slap in the
    mouth, or you NEED another doctor.

    >
    > > centre.something you can go to? Can you not go private for a single
    "real"
    > > consultation? If MY life and health depended on doing that, then that's
    > what
    > > I'd do.
    >
    > I could do and I tried it twice, but the only thing they do for you there
    is
    > to rigidly shoot your values down by using fast working insulin types like lispro or aspart.

    But do they not then tell you to continue with lispro/aspart insulins? It seems to me that doing so
    would be an EXTREMELY good idea.

    They won't even accept, that I might get into hypos very
    > fast. They never believed any of my argumentation.

    Well which medico's do? None that I've ever come across, so I don't give them reasons or arguments,
    I give them a choice. Give me what I want or I get it from someplace else.

    >
    > One night I was so hungry (while at home), so I wanted to eat anothe 25g
    of
    > carbon hydrates at 2 am, but I still had 220 mg/dl. But I couldn't resist, so I ate and applied 1
    > single IU of human R for 25 carbs plus 220 mg/dl, then the hell broke loose. Within 15 minutes my
    > bg levels dropped below
    150
    > mg/dl so fast falling I had never experienced before. In shere panic I
    woke
    > my girlfried in order to get a doctor if I fall unconsciousness. To that point my bg levels were
    > already down below 120 mg/dl. I felt that I had to die and drank Cola in order to stop my bg
    > levels from falling any further, but it was of no use. In the end I had to drink the equivalent of
    > 70 grams of carbon hydrates in order to stabilize bg levels at 120 mg/dl.

    Ok, so you had a good old hypo, and they happen frm time to time (to ALL of us), but it's entirely
    possible that your insulin injections caught a vein which DOES make for a "rapid" drop. You did what
    we all have to do on occasion though, and had a high carb drink and didn't die. A singe unit if
    insulin into fat or muscle would NOT drop you that far, that quickly, it's just physically not
    possible. It's also possible that the insulin injection was "perfectly" timed with your own pancreas
    dumping insuoin to bering down the high BG, so you gat a "double whammy". Having said that, calling
    the doctor when your BG is 150 isn't going to win you any doctor friends.

    >
    > Let's summarize: 220 mg/dl starting value, 25 carbs eaten, then 1 IU human r, then another 70
    > carbs in order to survive.
    >
    > Well, the doctors don't care. They don't get hypos and they don't get
    blind.
    > Oh yes blind. More than a couple of people were now blind, because they
    got
    > too much insulin and got too often too fast down while being used to have higher values.

    It's not the coming down that causes blindness, it's the constantly being high. (Above 120 for me is
    a definite no-no)

    The doctors don't care. They just walk away without any word
    > of excuse and they even get rewarded for their good work!

    I know that, and I feel the same as you regarding them.

    >
    > > Are you on ANY medication for you diabetes btw, because it's screaming
    out
    > > for at least a script for one of the drugs in the Metformin group.
    >
    > I can't take metformin. I just get diarrea from it.

    Most people get it when they first begin with it, but most people "work through it". If you can't do
    that, and your doc won't prescribe sulphs because of your liver, then insulin is your ONLT
    alternative.#

    Beav
     
  19. Hi,

    > That doesn't make a lot of sense to me, in fact it makes NO sense. Maybe

    It doesn't make sense to me either, but it is like it is.

    > you've got another problem other than the diabetes. I "would" say go to
    see
    > a doc but apparently that's not going to happen.

    I have drawn the same conclusion half a year ago and told my docs. They have made every test they
    knew. The results were of no avail. Now they are totally clueless and when I come again with my
    complaints and symptoms they laugh at me or they tell me that they haven't heard such weird symptoms
    in their 30 years lifespan of duty.

    In hospital they would tell me that this is normal for having diabetes and no problem for them.
    They would give me rigidly insulin, hoping everything would turn out fine. If not, the docs
    wouldn't care.

    > So now you're not using ANY meds??
    Correct.

    > Well if a doctor told me that HE was happy with my A1c's f they were above
    > 6.2, I'd congratlate him on his care and promptly find another doctor.
    (and
    > we're in the HS over here so you can't tell me much about health care and the people within it)

    Forgive me if I laugh, but these numbers are only that strict, because I live in a big city. My
    mother and my grandmother also have diabetes and they live in the country. Their docs would only
    start to worry if their A1c is above 10 ...

    > Both figures are too high. A1c below 6.2 and post meal BG;s below 140.
    Not in the banana republic of Germany.

    > Isnt that what exercise is? I'm not saying a stroll in the park will raise your already high
    > BG's, I'm saying that if they're high and you exercise (which means hard physical effort) they'll
    > go higher.

    Not always. Sometimes. Then I sit down and wait. Strolling in the park is enough for me to
    come down.

    > Well you SAY it's a proven fact, but like I said before, maybe something else is going on. Insulin
    > is THE most effective "material" for lowering BG's, yout it causes yours to go high. that's a VERY
    > strange system you're operating with there.

    Thats me. I can't so anything about that. Go to hospital and get a new body? Sorry the docs here are
    absolutely clueless. Thats the reason for me writing here and get some information from other
    countries. Sometimes I stumble about some interesting material giving my docs a chance to make
    another test of which they didn't think before. It's so frustrating to do the work for them, but my
    only hope.

    Half a year ago, a guy in the house where I live got some sort of face-cancer. The doctors haven't
    seen such a thing for their whole lives. They simply couldn't do anything for him, except to leave
    him to go home in order to die, which he did. It wasn't the sort of cancer you could identify, but
    simply not heal. It was something really new and the docs haven't had any idea about it.

    > of THE worst insulins to "match" food too because it's too slow to get
    going
    > and it has a too long tail, so after the food is "gone", the R keeps on

    I thought so too. That was the reason why I wanted to try lispro. But lispro expires after 40
    minutes (for me).

    > He may have a point, (although I doubt it) but have you considered a
    faster
    > insulin?

    Yes I tried with desastrous results.

    > "point" as the rest of the world. Your doctor needs a serious slap in the mouth, or you NEED
    > another doctor.

    This is the best doctor I could find. Every diabetic here goes straight to him. All others are much
    less? Slap them too? And then?

    > Ok, so you had a good old hypo, and they happen frm time to time (to ALL
    of
    > us), but it's entirely possible that your insulin injections caught a vein which DOES make for a
    > "rapid" drop. You did what we all have to do on occasion though, and had a high carb drink and
    > didn't die. A singe unit if

    No it wasn't like that. It took me 3 hours to stabilize my bg levels, drinking coke. If I had
    injected the insulin into a vein it should have been expired after 10 minutes. And besides: 1 IU
    should drop my bg levels for 60 mg/dl maximum.

    > was "perfectly" timed with your own pancreas dumping insuoin to bering
    down
    > the high BG, so you gat a "double whammy". Having said that, calling the

    Could perfectly be, but 2 IU should not get me below 130 mg/dl after eating 25 carbs starting with
    200-220 mg/dl.

    > doctor when your BG is 150 isn't going to win you any doctor friends.
    Well thats a point. I have severe fears of hypoglycaemia to the point of total panic, so I was
    advised to make psychotherapy. Well, you have to wait 2,3 or even 4 years to get a place and when
    you tell a psychiatrist about diabetes, he tells you that he has no idea how he could help.

    > It's not the coming down that causes blindness, it's the constantly being high. (Above 120 for me
    > is a definite no-no)

    I was told otherwise.

    > I know that, and I feel the same as you regarding them.
    Wow, I am no longer alone with that :)))

    > Most people get it when they first begin with it, but most people "work through it". If you can't
    > do that, and your doc won't prescribe sulphs because of your liver, then insulin is your ONLT
    > alternative.#

    I know, but I prefer life quality over quantity and when I am steadily in panic when I have to take
    insulin. What sort of life is that?

    Michael
     
  20. Alan

    Alan Guest

    On Fri, 13 Feb 2004 15:42:48 +0100, "Michael Wäsch" <[email protected]>
    wrote:

    >Hi there,
    >
    >I am type 2. Cirrently no meds, diet and excercise only.
    >
    >When I eat 20g of carbon hydrates my bg level would rise from 110 mg/dl to 200 mg/dl and stay there
    >for 4 hours, me spitting ketones (up to ++ positive). After 4 hours I would have 250 mg/dl (and no
    >more ketones) and one hour later I would be at 130 mg/dl.
    >
    >But: If I ate 50g of carbon hydrates, my bg levels would only rise up to 170-190 mg/dl and after 4
    >hours I would be at 120-130 mg/dl.
    >
    >How comes? Any ideas?
    >
    >More strange values:
    >
    >If I eat 50g carbon hydrates starting with 120 mg/dl I'd get, as said before, 180 after meal. Now
    >in several cases I had to start eating with 170 mg/dl and thought I would get really high values,
    >may be even forcing me to apply insulin, but nothing happend. 1,5 hrs after meal I had 185 mg/dl.
    >
    >Weird?
    >
    >Michael
    >

    Michael,

    I've returned to your first post to go back to basics.

    Alan from Germany, and Beav and others have given good advice. I won't buy into the discussion on
    meds and insulin, because I don't take them

    Forgive me if I am telling you something you have tried already. If you can't control properly using
    the local medics, have you tried to minimise the damage with careful diet?

    I know you are at a more complex and difficult stage than I am, but I would recommend that you
    follow the programme advocated by Jennifer and others to modify your diet to gain, or at least
    improve, control.

    I know that the diet I encountered in Germany last year is high in starches like bread, potatoes,
    pastries, beer etc. It was one of the countries where I had significant difficulty in trying to
    follow my own diet. I developed it by modifying what I ate following the advice you have seen
    Jennifer post here often. If you want to review it, go to http://www.alt-support-
    diabetes.org/Newly%20Diagnosed.htm .

    Best wishes.

    Cheers Alan, T2, Oz. dx May 2002 , A1C 8.2=>5.8, wt 117kg=>90kg, no meds, diet and not enough
    exercise. I have no medical qualifications beyond my own experience. Choose your advisers carefully,
    because experience can be an expensive teacher.
    --
    Everything in Moderation - Except Laughter.
     
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