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Question:

From Westwood, Massachussetts, USA:

I've had type 1 diabetes since 1960, nearly 53 years. Since 1979, I've been a vegetarian, first ovo-lacto, but now I prefer to eat more raw/organic foods, only gluten-free bread if I eat any bread at all, only grains like quinoa, sprouted grains, if I eat any grains at all. I try to have a green smoothie almost every day (almond milk, vegetarian protein powder, fish oil, chia seeds, fruit, lots of kale and other greens) and have it late morning to early afternoon. I occasionally have nut butters and nuts but not very much at all. I don't do dairy/eggs. Occasionally, I'll have clarified butter on gluten-free toast. I'll use olive oil, coconut oil, pumpkin seed oil, etc. on my steamed vegetables, and or salads. I dilute my fruit juices most of the time.

At my current workplace, I am very active, being a cashier. On my days off, I am much more sedentary except for one-half hour treadmill walks two times a week.

I am trying to work with Humulin N/Humulin R, (4 units of Regular in the morning combined with 18 units of NPH), and 5 units of Humulin NPH in the evening. Occasionally, I'll add one-half a unit of Humulin Regular at dinnertime depending upon what I eat.

But I also have long-term gastroparesis, which throws a monkey wrench into dosing, and my blood sugars are not even/steady. Since I'm also a Type A personality, I am adding in massage and acupuncture to help. What else can I do to improve my control?

Here's some specific data:

Date Time Blood Sugar Action
September 29 8:30 a.m. 133 mg/dl [7.4 mmol/L] 4 R, 18 N, toast, tahini and juice all day
6:30 p.m. 175 mg/dl [9.8 mmol/L] 1 R, 5 N
11:30 p.m. unknown 0.5 R
September 30 8:03 a.m. 98 mg/dl [5.4 mmol/L] 4 R, 18 N
unknown unknown salmon, rice and broccoli for lunch (had two chia bars, acai juice and two maple candies when felt low
6:30 p.m. 59 mg/dl [3.3 mmol/L] none
7:20 p.m. unknown 5 N
October 1 12:20 a.m. 188 mg/dl [10.4 mmol/] None
8:05 a.m. 164 mg/dl [9.1 mmol/L 4 R, 18 N
6:56 p.m. 221 mg/dl [12.3 mmol/L] 1 R, 5 N
October 2 1:30 a.m. 134 mg/dl [7.4 mmol/L] None
8:30 a.m. 331 mg/dl [18.4 mmol/L] 4 R, 18 N
10:00 p.m. unknown hamburger, sweet potato fries, juice, spinach
October 3 6:30 a.m. 389 mg/dl [21.6 mmol/L] None
8:30 a.m. unknown 4 R, 18 N
10:30 a.m. 310 mg/dl [17.2 mmol/L] 2 H
1:10 p.m. 66 mg/dl [3.7 mmol/L] Smoothie and piece of fruit
5:20 p.m. 166 mg/dl [9.2 mmol/L] 1 R, 5 N
October 4 12:40 a.m. unknown half piece of bread and butter with jam
2:30 a.m. unknown felt shaky-juice, half piece of bread and butter with jam
8:30 a.m. 374 mg/dl [20.8 mmo/L] 4 R, 18 N
1:10 p.m. 149 mg/dl [8.3 mmol/L] Had just completed a long walk
4:59 p.m. 320 mg/dl [17.8 mmol/L] 2 R, 5 N--salad, salmon, zucchini pancake
10:36 p.m. 189 mg/dl [10.5 mmol/L] None
11:10 p.m. 211 mg/dl [11.7 mmol/L] 1 R
October 5 8:06 a.m. 215 mg/dl [11.9 mmol/L] 5 R, 18 N
1:28 p.m. 430 mg/dl [23.4 mmol/L] 2 R
5:15 285 mg/dl [15.8 mmol/L] unknown
10:54 p.m. 205 mg/dl [11.3 mmol/L] 1 R
October 6 8:37 a.m. 179 mg/dl [9.9 mmol/L 5 R, 19 N
12:36 p.m. 213 mg/dl [11.8 mmol/L] unknown
1:50 p.m. 143 mg/dl [7.9 mmol/L] unknown
5:22 p.m. 95 mg/dl [5.3 mmol/L] unknown
10:43p.m. 447 mg/dl [24.8 mmol/L] 3 R, 1 H

Answer:

The NPH is harder to use with its peak at 8 to 10 hours. Regular insulin is even more difficult to use. Regular insulin has to be given 30 to 45 minutes before meals and it lasts much longer than the other short-acting insulin analogs. This means that a dose of Regular insulin given at a late night supper can still hang around into the night while the person is sleeping and potentiate low blood sugars.

JTL

[Editor's comment: Please be sure to continue to work with your endocrinologist about your regimen. He/she knows your medical history in more detail, what other medications you may be taking, etc. BH]

DTQ-20130930203218
Original posting 23 Oct 2013
Posted to Daily Care and Complications

  
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Last Updated: Wednesday October 23, 2013 21:15:27
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