Help mystious BG drops? (Long)



D

Dennis

Guest
I have a question with BG drops maybe someone has experienced or has answers for. I have been a T1
for 28 yrs with no complications. Prior to this year I have never had so much trouble managing my BG
levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now Lantus/Novalog. So far
it has been unsuccessful trying to get multiple endos to give me an explanation for my BG levels.
Right now I have been keeping my BGs a little high (200's) for fever of going hypo and fainting. My
current insulin dosage is 18 units of lantus at 8:00am and novolog with a carb raito of 1 to 10
carbs. Here are my numbers with my concerns. Keep in mind that I am currently not exercising and my
meals are pretty much the same each day.

Normal Day: (usually looks like this 90% of the time)
7:43am 228 18u lantus
8:46am 217 4.5u Novolog 48 carbs (Breakfast is always the same meal)
9:36am 277 1u Novolog correction
10:42am 252
11:48pm 183 4.5u Novolog 45 carbs (Lunch)
12:40pm 240
13:07pm 272 1u Novolog correction
14:46pm 203
15:40pm 182
16:08pm 206
17:00pm 191 4.5u Novolog 50 carbs (Dinner)
18:30pm 217
19:00pm 266
20:00pm 257 1u Novolog correction
21:45pm 176
22:30am 140
23:30am 211

Mysterious BG drops:(happens randomly 10% of the time just recently)
24:00am 174 18u lantus
25:30am 200 4.5u Novolog 48 carbs (Breakfast)
26:13am 280
27:50am 1u novolog correction
28:34pm 148 3u Novolog 58 carbs(Lunch) <-----------130BG drop in 40 mins
29:00pm 128
30:40pm 103 45 fast acting carbs + 22 carb protein bar
31:20pm 97
32:40pm 121
33:10pm 170

The dip usually happens, but not restricted between 12:00am - 3:30pm and sometimes between 6:00pm
- 9:00pm. I have been tested for Gastroparesis and two doctors have said they don't think that I
have it. What scares me is that if I try to keep my BG levels in the 130's or lower then I might
drop down to 0. Please help with any advice. I am currently going to get hooked up to a pump in
about 2 weeks.

My thoughts: Gastroparesis or Lantus peaking

Dennis T1 28 yrs diabetes sucks!
 
There is always the remote possibility you have celiac disease(CD) more than 6% of we T-1 diabetics
do. It is not a disease the doctors look for. 97% of the general population has CD and is
undiagnosed
1 : 133 according to an article in Parents Magazine. You can look at this link and see if you have
any of the symptoms then you would to see a GI doctor.
http://www.niddk.nih.gov/health/digest/pubs/celiac/index.htm This link doesn't mention the
fact that CD is a serious disease if you have diabetes because you food goes through you
undigested causing numerous Hypos. An article in Diabetes Forecast magazine saved my life in
1996. *Wheat is Your Problem* is the name of the article. I take Lantus at 8:00 PM and Humalog
before each meal.

Charlie T-1 since 1971, CD 1996

"Dennis" <[email protected]> wrote in message
news:[email protected]...
> I have a question with BG drops maybe someone has experienced or has answers for. I have been a T1
> for 28 yrs with no complications. Prior to this year I have never had so much trouble managing my
> BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now Lantus/Novalog. So
> far it has been unsuccessful trying to get multiple endos to give me an explanation for my BG
> levels. Right now I have been keeping my BGs a little high (200's) for fever of going hypo and
> fainting. My current insulin dosage is 18 units of lantus at 8:00am and novolog with a carb raito
> of 1 to 10 carbs. Here are my numbers with my concerns. Keep in mind that I am currently not
> exercising and my meals are pretty much the same each day.
>
> Normal Day: (usually looks like this 90% of the time)
> 7:43am 228 18u lantus
> 8:46am 217 4.5u Novolog 48 carbs (Breakfast is always the same meal)
> 10:36am 277 1u Novolog correction
> 11:42am 252
> 12:48pm 183 4.5u Novolog 45 carbs (Lunch)
> 1:40pm 240
> 3:07pm 272 1u Novolog correction
> 3:46pm 203
> 4:40pm 182
> 5:08pm 206
> 8:00pm 191 4.5u Novolog 50 carbs (Dinner)
> 8:30pm 217
> 9:00pm 266
> 10:00pm 257 1u Novolog correction
> 11:45pm 176
> 12:30am 140
> 1:30am 211
>
> Mysterious BG drops:(happens randomly 10% of the time just recently)
> 8:00am 174 18u lantus
> 9:30am 200 4.5u Novolog 48 carbs (Breakfast)
> 10:13am 280
> 11:50am 1u novolog correction
> 12:34pm 148 3u Novolog 58 carbs(Lunch) <-----------130BG drop in 40 mins
> 1:00pm 128
> 1:40pm 103 45 fast acting carbs + 22 carb protein bar
> 2:20pm 97
> 2:40pm 121
> 3:10pm 170
>
> The dip usually happens, but not restricted between 12:00am - 3:30pm and sometimes between 6:00pm
> - 9:00pm. I have been tested for Gastroparesis and two doctors have said they don't think that I
> have it. What scares me is that if I try to keep my BG levels in the 130's or lower then I might
> drop down to 0. Please help with any advice. I am currently going to get hooked up to a pump in
> about 2 weeks.
>
> My thoughts: Gastroparesis or Lantus peaking
>
> Dennis T1 28 yrs diabetes sucks!
 
Dennis wrote:

> I have a question with BG drops maybe someone has experienced or has answers for. I have been a
> T1 for 28 yrs with no complications. Prior to this year I have never had so much trouble managing
> my BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now
> Lantus/Novalog. So far it has been unsuccessful trying to get multiple endos to give me an
> explanation for my BG levels.

Hi Dennis,

My hypothesis is Novolog is the problem. I've found that Novolog has peak insulin action (maximum
glucose uptake) between 3-4.5 hours post dose for my metabolism. Humalog averages about 1-1.5 hour
peak glucose uptake for my body. My explanation is antibody binding to Novolog from previous Humulin
R use. So the Humulin R antibodies cross-react with Novolog. The net effect is slower peak action.
18U Humulin R has a peak action of 5.7 hours post dose for my body, for comparison. The most notable
problem with Novolog, is the longer tail. This gets worse with antibody binding delays. This alone
would cause unusual hypoglycemia.

My recommendation is go back to Humalog and see if you stabilize.

HTH,
--
Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily,
moderate exercise, typically <6% HbA1c
 
7 Feb 2004 15:26:07 -0800, dennis wrote:

> I usually averages around 7.5 A1c with MDI using NPH/Humalog and now Lantus/Novalog. So far it has
> been unsuccessful trying to get multiple endos to give me an explanation for my BG levels.

why not go back to NPH/Humalog?

bill t1 since '57
 
Jim Dumas <[email protected]!mindspring.com> wrote in message news:<[email protected]>...
> Dennis wrote:
>
> > I have a question with BG drops maybe someone has experienced or has answers for. I have been a
> > T1 for 28 yrs with no complications. Prior to this year I have never had so much trouble
> > managing my BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now
> > Lantus/Novalog. So far it has been unsuccessful trying to get multiple endos to give me an
> > explanation for my BG levels.
>
> Hi Dennis,
>
> My hypothesis is Novolog is the problem. I've found that Novolog has peak insulin action (maximum
> glucose uptake) between 3-4.5 hours post dose for my metabolism. Humalog averages about 1-1.5 hour
> peak glucose uptake for my body. My explanation is antibody binding to Novolog from previous
> Humulin R use. So the Humulin R antibodies cross-react with Novolog. The net effect is slower peak
> action. 18U Humulin R has a peak action of 5.7 hours post dose for my body, for comparison. The
> most notable problem with Novolog, is the longer tail. This gets worse with antibody binding
> delays. This alone would cause unusual hypoglycemia.
>
> My recommendation is go back to Humalog and see if you stabilize.
>
> HTH,

Is there some sort blood test that can be done to see if I have antibodies? How did you find out you
have antibodies?
 
"Charlie Owens" <[email protected]> wrote in message news:<[email protected]>...
> There is always the remote possibility you have celiac disease(CD) more than 6% of we T-1
> diabetics do. It is not a disease the doctors look for. 97% of the general population has CD and
> is undiagnosed
> 1 : 133 according to an article in Parents Magazine. You can look at this link and see if you have
> any of the symptoms then you would to see a GI doctor.
> http://www.niddk.nih.gov/health/digest/pubs/celiac/index.htm This link doesn't mention the
> fact that CD is a serious disease if you have diabetes because you food goes through you
> undigested causing numerous Hypos. An article in Diabetes Forecast magazine saved my life in
> 1996. *Wheat is Your Problem* is the name of the article. I take Lantus at 8:00 PM and Humalog
> before each meal.
>
> Charlie T-1 since 1971, CD 1996

Did you have unexplainable BG drops caused by your CD? WHat where your symptoms of CD?
 
Dennis wrote in message <[email protected]>...
>Jim Dumas <[email protected]!mindspring.com> wrote in message
news:<[email protected]>...
>> Dennis wrote:
>>
>> > I have a question with BG drops maybe someone has experienced or has answers for. I have been a
>> > T1 for 28 yrs with no complications. Prior to this year I have never had so much trouble
>> > managing my BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now
>> > Lantus/Novalog. So far it has been unsuccessful trying to get multiple endos to give me an
>> > explanation for my BG levels.
>>
>> Hi Dennis,
>>
>> My hypothesis is Novolog is the problem. I've found that Novolog has
peak
>> insulin action (maximum glucose uptake) between 3-4.5 hours post dose for my metabolism. Humalog
>> averages about 1-1.5 hour peak glucose uptake for my body. My explanation is antibody binding to
>> Novolog from previous Humulin R use. So the Humulin R antibodies cross-react with Novolog.
The
>> net effect is slower peak action. 18U Humulin R has a peak action of 5.7 hours post dose for my
>> body, for comparison. The most notable problem
with
>> Novolog, is the longer tail. This gets worse with antibody binding
delays.
>> This alone would cause unusual hypoglycemia.
>>
>> My recommendation is go back to Humalog and see if you stabilize.
>>
>> HTH,
>
>Is there some sort blood test that can be done to see if I have antibodies? How did you find out
>you have antibodies?

I think Jim's post is excellent.

To generalize Jim's post: I have read of "mystery" lows and "mystery" highs associated with a
given insulin and the answer given by the medical community is "variable action", and one of
the reasons given for the "variable action" was antibodies.

NPH is notorious for this behavior. I know a fellow with a similar problem with Lente.

The Lente fellow actually follows your technique, he runs very high at bedtime to avoid night time
lows. We (T1 diabetic support group) are nagging him to split his daily Lente into more and smaller
doses as a way to minimize this problem until Levemir comes out. He could not make Lantus work but I
don't know why.

Everything I have read (very little, by the way, I'm just a T1 engineer fascinated with diabetes
topics) suggests that the medical community usually does not go "looking" for the antibodies in
situations like this. AFAIK, such a search represents a big investment in research dollars and
research talent. They must restrict their use of limited resources to more universal medical
problems..

Again, AFAIK, the convenient way out of the problem is to change insulins.

Switching to a pump seems to be the most common successful technique of fighting mystery highs and
mystery lows. However, Novolog is considered the most favorable insulin to use in a pump and Jim's
experience suggests that you should try Humalog instead.

If your pump experiment must be abandoned, you might experiment with your basal insulins.

a. Rule-of-thumb: One general attack on mystery highs and mystery lows is to experiment with
splitting your daily basal into more and smaller doses. In effect, that halves, or quarters
any possible problem with variable basal insulin activity. In your case that would be
splitting your daily Lantus into two equal doses, taken 12 hours apart but always at the same
time from day to day.

b. Levemir basal insulin is advertised to exhibit superior reproducible activity when compared
to every non-beef basal on the market. Trying Levemir as a basal when it comes to the market
represents another experimental approach to your problem.

c. Beef Lente represents a whole different way of handling basal insulins. Importing it from the
U.K. is very difficult and complex. However, it also represents an experimental approach to
dealing with your problem.

I assume that since you state that you run high sugars "for fear of going hypo and fainting", you
have actually gone low and passed out or had seizures. If not, your "run high bG" technique makes me
really fearful for your long-term health. I hope you are not confusing the very unpleasant false-
hypo symptoms associated with rapid drops or dropping into normal ranges when accustomed to high bG
ranges with a real hypo.

You might read up on the Somoygi effect when thinking about the complexities of dealing with low
blood sugars.

Your bG log suggests that you feel it necessary to take 45 gram of fast carb when you drop to 103
mg/dL. That's a bit of a shocker! I take 15 gram of fast carb when I drop below 50 mg/dL.

Conversely, I often shoot 6-8 units of Humalog when I see any sugar above 250 mg/dL. I am willing to
take the risk of going too low and needing glucose candy to rebound in order to reap the benefit of
the fast drop.

Regards
Old Al
 
its a simple blood test you take, they check for a few types of antibodies, I had it done. takes a
few days longer to get back the results.

--
RK - t1 *Disclaimer: i'm not a doctor. I only share personal experience of being a diabetic. I have
no textbook learning, only life itself.
----------------------
In tribute to the United States of America and the State of Israel, two bastions of strength in a
world filled with strife and terrorism.

"Dennis" <[email protected]> wrote in message
news:[email protected]...
> Jim Dumas <[email protected]!mindspring.com> wrote in message
news:<[email protected]>...
> > Dennis wrote:
> >
> > > I have a question with BG drops maybe someone has experienced or has answers for. I have been
> > > a T1 for 28 yrs with no complications. Prior to this year I have never had so much trouble
> > > managing my BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now
> > > Lantus/Novalog. So far it has been unsuccessful trying to get multiple endos to give me an
> > > explanation for my BG levels.
> >
> > Hi Dennis,
> >
> > My hypothesis is Novolog is the problem. I've found that Novolog has
peak
> > insulin action (maximum glucose uptake) between 3-4.5 hours post dose
for
> > my metabolism. Humalog averages about 1-1.5 hour peak glucose uptake
for
> > my body. My explanation is antibody binding to Novolog from previous Humulin R use. So the
> > Humulin R antibodies cross-react with Novolog.
The
> > net effect is slower peak action. 18U Humulin R has a peak action of
5.7
> > hours post dose for my body, for comparison. The most notable problem
with
> > Novolog, is the longer tail. This gets worse with antibody binding
delays.
> > This alone would cause unusual hypoglycemia.
> >
> > My recommendation is go back to Humalog and see if you stabilize.
> >
> > HTH,
>
> Is there some sort blood test that can be done to see if I have antibodies? How did you find out
> you have antibodies?
 
Sun, 08 Feb 2004 00:53:57 GMT, Jim Dumas wrote:

> My recommendation is go back to Humalog and see if you stabilize.

given that he was ok on NPH/Humalog, why not go back to NPH/Humalog?

bill t1 since '57
 
willbill wrote:

> Sun, 08 Feb 2004 00:53:57 GMT, Jim Dumas wrote:
>
>> My recommendation is go back to Humalog and see if you stabilize.
>
> given that he was ok on NPH/Humalog, why not go back to NPH/Humalog?

I don't consider NPH a good basal insulin. It fails me in the waking hours when I'm most active. But
I need it for my dawn phenomenon so I tolerate it. I also like it because I can mix R+NPH at
bedtime. (So don't bug me about lente!)

So I never recommend NPH to anyone.
--
Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily,
moderate exercise, typically <6% HbA1c
 
willbill <[email protected]> wrote in message news:<[email protected]>...
> 7 Feb 2004 15:26:07 -0800, dennis wrote:
>
> > I usually averages around 7.5 A1c with MDI using NPH/Humalog and now Lantus/Novalog. So far it
> > has been unsuccessful trying to get multiple endos to give me an explanation for my BG levels.
>
>
> why not go back to NPH/Humalog?
>
> bill t1 since '57

Lantus was like the forbidden fruit to me. Before lantus I ate on a strict schedule due to the peak
in nph. I did this for 28 yrs and was ok with it because I didn't know any better. After being on
lantus I never wanted to go back to the strict schedule of NPH. I wish I never tried lantus to tell
you the truth because I would have never known any better.

Dennis T1 28 yrs
 
Dennis wrote:

> Jim Dumas <[email protected]!mindspring.com> wrote in message
> news:<[email protected]>...
>> Dennis wrote:
>>
>> > I have a question with BG drops maybe someone has experienced or has answers for. I have been a
>> > T1 for 28 yrs with no complications. Prior to this year I have never had so much trouble
>> > managing my BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now
>> > Lantus/Novalog. So far it has been unsuccessful trying to get multiple endos to give me an
>> > explanation for my BG levels.
>>
>> Hi Dennis,
>>
>> My hypothesis is Novolog is the problem. I've found that Novolog has peak insulin action (maximum
>> glucose uptake) between 3-4.5 hours post dose for my metabolism. Humalog averages about 1-1.5
>> hour peak glucose uptake for my body. My explanation is antibody binding to Novolog from previous
>> Humulin R use. So the Humulin R antibodies cross-react with Novolog. The net effect is slower
>> peak action. 18U Humulin R has a peak action of 5.7 hours post dose for my body, for comparison.
>> The most notable problem with Novolog, is the longer tail. This gets worse with antibody binding
>> delays. This alone would cause unusual hypoglycemia.
>>
>> My recommendation is go back to Humalog and see if you stabilize.
>>
>> HTH,
>
> Is there some sort blood test that can be done to see if I have antibodies? How did you find out
> you have antibodies?

There are antibody tests but I don't think you'll learn much from them. The final result is how
insulin action really works for your metabolism.

I don't want to get carried away in theory, but I had a problem mixing R+Humalog in the spring of
1999. This mixture gave me a strong glucose uptake peak at 6-6.5 hours (hypoglycemia) post 1U R +
26U Humalog. This anomaly drove me to develop a math technique to "see" insulin action. I call it
the Glucose Transform, as it takes a post-absorptive (no GI tract activity) glucose profile and
transforms it into an equivalent "glucose-clamp" insulin action profile (so called pharmacodynamics
where a glucose infusion profile is insulin action). This is where my peak insulin action numbers
came from in the above post. I put up a fast web page describing the method at:

http://j-dumas.home.mindspring.com

But I need to update it as the method has become more refined since. I use a computer model to dose,
and this knowledge is critical to the calculations of area under the insulin action profile to
estimate future action from a dose that may cause future hypoglycemia.

In any case, I never bothered to measure my antibodies, as it's an academic issue that would not be
useful for my computer model. But I did measure the final result of estimated peak glucose disposal.
This is not insulin in the bloodstream (plasma insulin concentration, also known as
pharmacokinetics: how fast insulin gets into the bloodstream). But the Glucose Transform is an
estimate of glucose infusion required to maintain a constant BG (usually euglycemia) as the insulin
dose works. This is the curve you see at the doctor's office. See:

http://j_dumas.home.mindspring.com/lilly_human_insulins1992.pdf

for examples of human insulin action (glucose disposal) profiles.

The conclusion I came to was Humalog is the least immunogenic insulin for my body, as it has
extremely fast action after long-term use since 1996. The Humalog insulin action I measure is what
Lilly has published for normal subjects with only 1-2 weeks of use. It usually takes 6 months of use
before the antibody concentration stabilizes. (So another reason why Novolog could be giving you
trouble: the antibody concentration is still rising if you've been using it less than 6 months.) So
these subjects have no antibodies to slow down the insulin action profile. This published insulin
action data is for "perfect conditions" of no antibody binding delays. It is the fastest we will
see. But it should slow down after 6 months of use due to antibody binding delays.

One important caution: the more switching of insulins you do, the higher the antibody concentration
will be. If you switch insulins back and forth, you provoke your immune system into "secondary
responses." Much like a flu shot sets up the immune system with initial antibodies. But when you are
exposed to the real flu virus, your body mounts a higher "secondary" attack and your anti-flu
antibody concentration sky-rockets. It eventually falls after about 6 weeks but never returns to the
lower value 6 weeks after the flu shot. So you can never go back to minimal antibody (several types)
concentrations. Each time I try a new insulin, I continue to use my old ones to keep my body
desensitized to my current insulin therapy. See:

http://j_dumas.home.mindspring.com/immunogenicity_potential_human_insulin_DC1293s3.pdf

for a discussion of human insulin allergy, the extreme case of above. This paper reports that more
than 50% of T1s, that have only used synthetic rDNA insulin, have measurable anti-human insulin
antibodies. That's quite a lot for an insulin that's human to begin with. So the probability is high
that you and I have anti-human insulin antibodies.

HTH,
--
Jim Dumas T1 4/86, background retinopathy, rarely hypoglycemic: <1/mo. lispro+R+U+NPH daily,
moderate exercise, typically <6% HbA1c
 
8 Feb 2004 10:30:21 -0800, [email protected] (Dennis) wrote:

> willbill <[email protected]> wrote in message
> news:<[email protected]>...
> > 7 Feb 2004 15:26:07 -0800, dennis wrote:
> >
> > > I usually averages around 7.5 A1c with MDI using NPH/Humalog and now Lantus/Novalog. So far it
> > > has been unsuccessful trying to get multiple endos to give me an explanation for my BG levels.
> >
> >
> > why not go back to NPH/Humalog?
> >
> > bill t1 since '57
>
> Lantus was like the forbidden fruit to me. Before lantus I ate on a strict schedule due to the
> peak in nph. I did this for 28 yrs and was ok with it because I didn't know any better. After
> being on lantus I never wanted to go back to the strict schedule of NPH. I wish I never tried
> lantus to tell you the truth because I would have never known any better.
>
> Dennis T1 28 yrs

at 28 years you're well beyond insulin 101. out of curiosity, did any of your docs suggest going
back to the insulins you were using?

afaik, for the *large* *majority* of insulin using diabetics, the only insulin on the world market
for 1x of background usage is beef-Lente. everything i know about insulin suggests that that is
unlikely to change in the next 10 years (unless, of course, the current USA mad cow scare results in
killing off beef insulin in the near future)

anyhow, if going back to NPH("human") and Humalog fixes things, then i suggest that you make insulin
changes slowly in the future. one at a time also has a lot of merit

fwiw, using a pump for a couple of years isn't a bad idea, and you'd gain some new insights,
especially on what basal insulin is (by *doing* it, as opposed to reading about it; insights that
*every* t1 needs)

if you still mentually like the idea of Lantus, imo you'd be both safer and better off using 2x of
"human"-UL coz from what i've seen, using Lantus (either 1x or 2x) is inferior to using 2x of "human"-
UL for background, and Lantus is a lot less robust too

it's worth noting that beef product is used in the manufacturing process of Lantus and "human"-NPH
and "human"-UL

the only insulin that might be free of beef product is pork insulin

bill t1 since '57, ex 8-yr pumper, pork/beef-L 2x, simple MDI/DAFNE
 
> I think Jim's post is excellent.
>
> To generalize Jim's post: I have read of "mystery" lows and "mystery" highs associated with a
> given insulin and the answer given by the medical community is "variable action", and one of
> the reasons given for the "variable action" was antibodies.
>
> Switching to a pump seems to be the most common successful technique of fighting mystery highs and
> mystery lows. However, Novolog is considered the most favorable insulin to use in a pump and Jim's
> experience suggests that you should try Humalog instead.

I had similar experiance with Humalog.

>
> If your pump experiment must be abandoned, you might experiment with your basal insulins.
>
> a. Rule-of-thumb: One general attack on mystery highs and mystery lows is to experiment with
> splitting your daily basal into more and smaller doses. In effect, that halves, or quarters
> any possible problem with variable basal insulin activity. In your case that would be
> splitting your daily Lantus into two equal doses, taken 12 hours apart but always at the
> same time from day to day.

Yes. My doctor did recommend this to me in the mean time before getting hooked up to the pump.

> I assume that since you state that you run high sugars "for fear of going hypo and fainting", you
> have actually gone low and passed out or had seizures.

No. I have never passed out or had seizures, but I have had my far share of 30's with almost passing
out. But the lows I have had in the past were always my fault and explainable (ie exercising and
forgetting to eat, etc. I stay high now because about 6 months ago when I used to run in the 120's
before eating I had a low of 40 right after eating and it took me more carbs than usual to get me
back up. For 28 yrs my insulin injections always seemed to act somewhat predictable until now. I am
only staying high in the mean time until I get some sort of answer either from the newsgroups or my
doctors. I am going to ask my doctor to run an antibodies blood test next time I see him.

If not, your "run high bG" technique makes me really fearful
> for your long-term health. I hope you are not confusing the very unpleasant false-hypo symptoms
> associated with rapid drops or dropping into normal ranges when accustomed to high bG ranges with
> a real hypo.

No I just test my blood sugar alot and get an idea of the trend. On most days after eating the smae
meal my BG climbs slowly and drops slowly. On other days after eating a either get no spike and no
drop or a small spike with a big drop. I usually test myself ever 15 mins after eating on these days
and I can see my blood sugar droping fast. I don't want to go into low and pass out so I eat to
bring it up before it goes to low.
>
>
> Your bG log suggests that you feel it necessary to take 45 gram of fast carb when you drop to 103
> mg/dL. That's a bit of a shocker! I take 15 gram of fast carb when I drop below 50 mg/dL.

The only reason is because sometimes I drop more than 5 points a min. and since I have not ruled out
GP I am afriad of passing out.
>
> Conversely, I often shoot 6-8 units of Humalog when I see any sugar above 250 mg/dL. I am willing
> to take the risk of going too low and needing glucose candy to rebound in order to reap the
> benefit of the fast drop.
>
> Regards
> Old Al
 
8 Feb 2004 14:21:56 -0800, [email protected] (Dennis) wrote:

> oldal wrote:

> > I assume that since you state that you run high sugars "for fear of going hypo and fainting",
> > you have actually gone low and passed out or had seizures.

> No. I have never passed out or had seizures, but I have had my far share of 30's with almost
> passing out. But the lows I have had in the past were always my fault and explainable (ie
> exercising and forgetting to eat, etc.

is there any chance you are varying the amount of Lantus that you take each day? if yes, that is a
major no no coz the residual of Lantus is thought to last somewhere between 50+ hours to as long as
possibly more than 100+ hours. so taking 25 units on one day can cause hypo poblems on the next day
even though you only take 18 units of Lantus that 2nd day (assuming that 18 units is your proper
daily dosage)

or how about: is there any chance that instead of taking NovoLog you took an additional shot of
Lantus by mistake? say in the evening when you are tired? (which would most affect you the next day)
i mean, Humalog is similar to Lantus in that they are both clear insulins. we've already had one t2
post about making such a mistake (in his cas he meant to take a shot of Lantus and took a HUGE shot
of Humalog by mistake (zowie powie!))

bill t1 since '57
 
----------
In article Š (Dennis) wrote:

"Keep in mind that I am currently not exercising"

I'm surprised that noone has picked up on the above in this long thread. When you don't exercise,
your body doesn't have an efficient reaction to insulin. Exercising really evens out the response
and brings the sugar down.

I know from bitter experience that when I get couch potatoitis my numbers are impossible to control.
Just taking a brisk walk around the neighborhood makes a big difference.

Luckily mom nature has given us a chance to shovel a lot of snow these past few weeks. Made a huge
difference in my sugar control.

You HAVE TO exercize!

Robert in Montreal
 
[email protected] wrote in message news:<[email protected]>...
> ----------
> In article ? (Dennis) wrote:
>
> "Keep in mind that I am currently not exercising"
>
>
> I'm surprised that noone has picked up on the above in this long thread. When you don't exercise,
> your body doesn't have an efficient reaction to insulin. Exercising really evens out the response
> and brings the sugar down.
>
> I know from bitter experience that when I get couch potatoitis my numbers are impossible to
> control.

What do you mean by impossible to control? By not exercising do your blood sugars become more
volatile or do you just run higher than normal?

Just taking a brisk walk around the neighborhood
> makes a big difference.
>
> Luckily mom nature has given us a chance to shovel a lot of snow these past few weeks. Made a huge
> difference in my sugar control.
>
> You HAVE TO exercize!
>
> Robert in Montreal
 
[email protected] wrote in message news:<[email protected]>...
> ----------
> In article ? (Dennis) wrote:
>
> "Keep in mind that I am currently not exercising"
>
>
> I'm surprised that noone has picked up on the above in this long thread. When you don't exercise,
> your body doesn't have an efficient reaction to insulin. Exercising really evens out the response
> and brings the sugar down.
>
> I know from bitter experience that when I get couch potatoitis my numbers are impossible to
> control.

What do you mean by impossible to control? By not exercising do your blood sugars become more
volatile or do you just run higher than normal?

Just taking a brisk walk around the neighborhood
> makes a big difference.
>
> Luckily mom nature has given us a chance to shovel a lot of snow these past few weeks. Made a huge
> difference in my sugar control.
>
> You HAVE TO exercize!
>
> Robert in Montreal
 
willbill <[email protected]> wrote in message news:<[email protected]>...
> 8 Feb 2004 10:30:21 -0800, [email protected] (Dennis) wrote:
>
> > willbill <[email protected]> wrote in message
> > news:<[email protected]>...
> > > 7 Feb 2004 15:26:07 -0800, dennis wrote:
> > >
> > > > I usually averages around 7.5 A1c with MDI using NPH/Humalog and now Lantus/Novalog. So far
> > > > it has been unsuccessful trying to get multiple endos to give me an explanation for my BG
> > > > levels.
> > >
> > >
> > > why not go back to NPH/Humalog?
> > >
> > > bill t1 since '57
> >
> > Lantus was like the forbidden fruit to me. Before lantus I ate on a strict schedule due to the
> > peak in nph. I did this for 28 yrs and was ok with it because I didn't know any better. After
> > being on lantus I never wanted to go back to the strict schedule of NPH. I wish I never tried
> > lantus to tell you the truth because I would have never known any better.
> >
> > Dennis T1 28 yrs
>
>
> at 28 years you're well beyond insulin 101. out of curiosity, did any of your docs suggest going
> back to the insulins you were using?
>
> afaik, for the *large* *majority* of insulin using diabetics, the only insulin on the world market
> for 1x of background usage is beef-Lente. everything i know about insulin suggests that that is
> unlikely to change in the next 10 years (unless, of course, the current USA mad cow scare results
> in killing off beef insulin in the near future)
>
> anyhow, if going back to NPH("human") and Humalog fixes things, then i suggest that you make
> insulin changes slowly in the future. one at a time also has a lot of merit

>
> fwiw, using a pump for a couple of years isn't a bad idea, and you'd gain some new insights,
> especially on what basal insulin is (by *doing* it, as opposed to reading about it; insights that
> *every* t1 needs)
>
> if you still mentually like the idea of Lantus, imo you'd be both safer and better off using 2x of
> "human"-UL coz from what i've seen, using Lantus (either 1x or 2x) is inferior to using 2x of "human"-
> UL for background, and Lantus is a lot less robust too

One of my doctors suggested splitting lantus before I get hooked up to a pump.

>
> it's worth noting that beef product is used in the manufacturing process of Lantus and "human"-NPH
> and "human"-UL
>
> the only insulin that might be free of beef product is pork insulin
>
> bill t1 since '57, ex 8-yr pumper, pork/beef-L 2x, simple MDI/DAFNE
 
Jim Dumas <[email protected]!mindspring.com> wrote in message news:<[email protected]>...
> Dennis wrote:
>
> > Jim Dumas <[email protected]!mindspring.com> wrote in message
> > news:<[email protected]>...
> >> Dennis wrote:
> >>
> >> > I have a question with BG drops maybe someone has experienced or has answers for. I have been
> >> > a T1 for 28 yrs with no complications. Prior to this year I have never had so much trouble
> >> > managing my BG levels. I usually averages around 7.5 A1c with MDI using NPH/Humalog and now
> >> > Lantus/Novalog. So far it has been unsuccessful trying to get multiple endos to give me an
> >> > explanation for my BG levels.
> >>
> >> Hi Dennis,
> >>
> >> My hypothesis is Novolog is the problem. I've found that Novolog has peak insulin action
> >> (maximum glucose uptake) between 3-4.5 hours post dose for my metabolism. Humalog averages
> >> about 1-1.5 hour peak glucose uptake for my body. My explanation is antibody binding to Novolog
> >> from previous Humulin R use. So the Humulin R antibodies cross-react with Novolog. The net
> >> effect is slower peak action. 18U Humulin R has a peak action of 5.7 hours post dose for my
> >> body, for comparison. The most notable problem with Novolog, is the longer tail. This gets
> >> worse with antibody binding delays. This alone would cause unusual hypoglycemia.
> >>
> >> My recommendation is go back to Humalog and see if you stabilize.
> >>
> >> HTH,
> >
> > Is there some sort blood test that can be done to see if I have antibodies? How did you find out
> > you have antibodies?
>
> There are antibody tests but I don't think you'll learn much from them. The final result is how
> insulin action really works for your metabolism.

Lets assume that my problem is antibody binding. How does one find out his/her own insulin action.
Since I don't have your scientific background to formulate my own graphs, the only thing that I can
do is change to humalog and see which one is the best of the worst. Without an insulin action graph
it is hard to give correct correction and or meal doses because from what you are saying I could
still have a peak after 4 hrs. Correct me if I am wrong but wont the tests verify that I do have
abnormal antibodies opposed to just assuming I do?
 
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