That is a common effect with many of us and it is due to something called the "Dawn Phenomenon" or "Dawn Effect." WebMD has an article that describes the effect in greater detail that you can read here . Discuss the matter with your doctor to explore the best option for you. Many of us use insulin to counter the effect and others can dampen the effect using other means. Discussing the matter with your doctor is your best option.View Thread
I think it's terrific that you have finally found an endocrinologist you can work well with to improve your BG control. I recently lost a friend who died from end stage renal failure. In his case, he knew what was required to stop the progression but admitted that he just didn't care. The previous year he had lost his wife of fifty plus years. Although he had children and grandchildren who adored him, the loss of his wife was more than he was willing to bear. He was actually doing quite well on dialysis but it took up a lot of time (essentially consumed three days per week). He finally tired of the ritual, refused further treatments, and was gone in less than two weeks.
You BG levels are still way too high in by all standards but since you are on insulin and now under the care of an endocrinologist, the following charts may be of value to you: Adjusting Bedtime Insulin Insulin Action Times Correction Doses The charts are in PDF format and will automatically download to your hard drive when you click on the links.
Knowing the action profiles of various insulins will help you avoid lows. Understanding and adjusting insulin doses is vital to bring your blood sugars into healthy ranges (it's the only way you're going to arrest your ongoing decline in kidney function and save them). For example, your fasting BG of 130 is my own post prandial (AFTER a meal) target. When I retire for the night, If I exceed 99 mg/dL, I will inject a correction dose to bring me back down to my target range (70-85 mg/dL). I don't use the values in the charts myself because they only provide general guidelines. However, some of my friends have found them to be useful in terms of breaking their previous mindset of adhering strictly to static, physician-prescribed insulin doses so it's my hope that you will also find them to be beneficial. For good BG control, dynamic insulin dosing is essential. Each of us should (in fact MUST) set our own individual targets for a healthy range. Do discuss these charts with your new doctor to find something that will work for you. You seem to have a loving grandson and it's my sincere hope that you will continue to enjoy his company for many years to come. Keep us posted of your progress and if you have any questions regarding dynamic insulin dosing, quite a few of us here in the forums have engaged in this organ-saving practice for many years and can answer any questions you may have.View Thread
Your post is terrific and should help inspire newbies who are often clueless as to how to begin to cope with diabetes after being diagnosed. The two books that you mentioned are also my own two "best of breed" selections and I often recommend them to acquaintances. Both are now available in eBook formats which are less expensive than their hard copy editions. If you purchased Jenny's book from Amazon.com, the vendor has a "price match" offer that enables you to purchase the digital version for only 99 cents (I did).View Thread
Didn't mean to hijack your post Neesy but hopefully the supplemental information will be pertinent if you go the insulin route yourself. There is a great deal for you to learn if you do start on insulin and much of the path will require individual trial-and-error. Its virtually impossible to get good control over your blood glucose levels using static (rigid, unchanging) doses of mealtime insulin and learning how and what works for you will gradually help you control this disease and instead of having it control you.View Thread
Hooty, the primary danger of contaminating insulin vials is not infection but degradation of the unused insulin in a vial. I only use one syringe a day but inject up to six times per day. Yes, that means I do the unthinkable (in the minds of purists) and re-USE my syringes for the day. I exercise great care not to let the needle come into contact with anything other than the rubber stopper of the vial and the skin at the injection site. I NEVER inject anything into the vial, not even air, with a used syringe. To counteract the gradual vacuum buildup, I inject air into the vial the next time that I use a virgin (unused, new) syringe. This has worked flawlessly for nearly a decade and I have never experienced loss of potency in my insulin. I have also never experienced an infection even though I do not use alcohol swabs (my opened insulin vials are all stored in non-opaque, air-tight plastic vials). I also use another trick to extend the life of insulin but that's a topic for another post.View Thread
Auriga, you should ask your doctor's office to provide you with prescriptions for both your insulin and your syringes. Although Reli-On insulin and syringes can be purchased OTC (over-the-counter without a Rx), purchasing them via a prescription may count towards satisfying insurance deductibles. However, even more important, you can purchase syringes by the carton on Rx (boxes containing ten 10-packs) and the price that I pay at my Walmart is ~$12.50 per hundred. If purchased without a Rx (i.e., OTC), the cost is $1.89 per ten pack. The OTC limit of 2 or 3 packs varies by State due to fears of illicit drug use but there is no limit when purchasing it via Rx (I can purchase 3 or more boxes every 3 months). You also don't need to have your doctor's office mail you the written Rx or drive to their office to pick it up. Walmart pharmacies have a very efficient Prescription Faxing system that allows physicians in most states to simply fax the Rx directly to the pharmacy. When it has been filled, Walmart's automated system will contact you by phone (robotic voice) to notify you that "Prescription for someone in your household" are ready for pickup. You will also be told the specific dollar amount of the transaction. I just did this myself this morning following a visit to my endo and my own A1c is continuing to hold steady in the 4.x range. The really surprising thing (to my endo) was the fact that the data dump from my BG meter showed that I did not experience any lows below the sixties and even those were limited in number/frequency (I did have lots of readings in the seventies, however, but 70's are still within the "normal." range). One another advantage to having a Rx for syringes is that there is no sales tax (at least not in my state) on Rx's.View Thread
Hooty, although animal-sourced insulins are still available, they are no longer manufactured in the States. The two brands available, Humulin (Lilly) and Novolin (Nordisk), are both human insulins manufactured using recombinant DNA technology and genetically-engineered microorganisms. An interesting history and explanation of the process can be found here (it's a worthwhile read). Although far fewer people are allergic to the human insulins compared to animal-sourced insulins, a very small minority are. Most physicians think it is due to the preservatives used rather than the actual insulin itself.
Reli-On syringes are no longer individually packaged but are bundled in ten-packs like the majority of other brands/types. The only one that I have come across that still packages syringes in sterile, individually-sealed packs is the Monoject brand. To minimize the problem of potential contamination of an opened ten-pack, I always store them in zip-lock bags when traveling. At home, I store opened ten-packs in a cylindrical spice jar that's similar to a small peanut butter jar but much narrower. You can also use the plastic containers that come with other products such as some packages of Crystal Light tea.
Insulin is both thermal- and photo-sensitive. Although manufacturer's state that opened bottles do not require refrigeration for the 28/30 days period before it is discarded, the potency can be extended if the insulin is kept refrigerated. Protecting it from light is also important and I use non-opaque plastic vials that older test strips used to be packaged in. The latter are almost the perfect height and diameter and the insulin so stored retains its potency for at least 60 days. I have personally used opened vials up to 90-days old with no noticeable loss of potency in terms of its impact on my BG control. That's three times the 30-day period most manufacturers recommend for discarding vials of insulin after they have been opened. Of course, you do have to follow simple aseptic techniques to ensure that it does not get contaminated from careless handling. Hope this helps.View Thread
Thanks for the encouraging words, Auriga. Neesy, when you talk to your doctor about "Walmart insulin," its really only privately branded/labeled Novolin manufactured by Nordisk Pharmaceuticals. Your doctor will be familiar with Novolin but may not know it under Walmart's label, Reli-On/Novolin. To ensure your doctor doesn't get confused, refer to Walmart's insulin as Novolin-R (Regular) and Novolin-N (NPH) instead. My own endocrinologist was not aware of this and had always labored under the belief that Reli-On insuin was of unknown or questionable quality until I informed him to the contrary and actually showed him an empty carton (the name on the carton is Novolin-R with only a tiny secondary imprint of Reli-On). Prior to the Reli-On's switch to Novolin about 2 years ago, Walmart had previously contracted with Eli Lilly for Humulin-R and Humulin-N. Purchasing "Walmart insulin" back then would provide you with Reli-On/Humulin insulin. The current Walmart contract is for Novolin (for approximately two years now). As Auriga noted, this insulin can be purchased without a prescription. However, the price for the syringes is less expensive with a prescription than without due, I assume, to quantity price breaks. I would recommend that you obtain a prescription for both insulin and syringes anyway because your purchases may count towards satisfying your deductible.View Thread
The two books that Cora recommended are superb and I'll second her recommendations. To be successful, insulin dosages should always be dynamic, not static, with the possible exception of the basal insulins after you have found your individual "sweet spot." That means meal time insulins should be adjusted to the food (both amounts and types) that your husband will be eating. Meal time insulin dosages should almost never be at a rigid, set amount that remains unchanged from one meal to the next. Activity/exercise levels both before and after the meal will also have a significant impact on blood sugar levels (and thus insulin dosages) and it is extremely important to dose properly if he is to avoid highs and lows. Of course, the most dominant factor in good diabetes control will be the diet itself: the types and portion sizes of the food that he consumes.
In addition to the two books that Cora recommended, I would also recommend Dr. Bernstein's Diabetes Solution (Complete Guide to Achieving Normal Blood Sugars ) and Jenny Ruhl's Blood Sugar 101 (What They Don't Tell You About Diabetes ). Both of these two books are essential references for any diabetic but may be especially valuable for people using insulin. There are lots of myths and half-truths regarding diabetes and as a PWD myself, I think we are one of the most stereotyped groups on earth. We are often subject to incredibly bad advice and poor treatment protocols due to this stereotyping. For that reason, the only real salvation lies in two sets of key words: The first is "Know Thyself" (because we're "all different") and the other is "Self-Management" (it could be argued that the latter is really one word and not two but it is the patient that has the primary responsibility for proper management of the disease).
Self-education is vital and you don't have to wait for a book to arrive in the mail. Most are available as eBooks that can be downloaded in a minute or less if you own an eReader (e.g., Kindle or Nook). You can also go online and read portions of these books for free. Some chapters of Dr, Bernstein's book (2007-2009 edition) can be found here and even entire chapters in PDF format can be downloaded to your computer. I especially recommend that you and your husband read Chapters 7, 9 and 10, in particular. Jenny Ruhl's book is actually a compilation of her website's online content that is available at Blood Sugar 101 . The book merely organizes the information in easier to find/read format. I would highly recommend that you start with What is a Normal Blood Sugar? , Why Lowering A1c Below 6.0% Is Not Dangerous , Research Connecting Organ Damage with Blood Sugar Level , and Do People with Type 2 Always Deteriorate? After reading this information, you might question why your husband's mother is suffering from Stage 4 renal failure when normalizing blood sugars has been shown to not only prevent organ damage but usually keeps diabetes from progressing.
The biggest trouble with half-truths when it comes to diabetes is that many people get hold of the wrong half. This post is my personal opinion and reflects my own personal experiences. Please read the WebMD disclaimers at the bottom of the page to obtain a more balanced view of this and all other postings. I am open to discussing/debating/evaluating dissenting or different opinions. After all, isn't that what discussion forums are for?
BTW, the action of Humulog is extremely rapid. Injecting it 30 minutes before eating may be too early in many instances. Many patients that I know prefer to inject it just 15 minutes before a meal; others inject it at the very start or during the meal itself. View Thread
Glypizide is a sulfonylurea drug. As a retired pharmacist and many years of experience interfacing with diabetes patients on sulfonylurea medications, I have never liked drugs in this category. Before continuing, please read the WebMD disclaimers at the bottom of the page. My posts are strictly a matter of personal opinion and do not in any way constitute medical advice. However, there are a few members on these forums that tend to report posts to moderators as being "medical advice" instead of the discussion topics that they really are. With that out of the way, let's focus on just a couple of reasons why I dislike sulfonylureas.
Sulfonylurea medications work by stimulating insulin secretion from the beta cells of pancreatic islet tissue. Dr. Richard K. Bernstein believes that stimulating already-stressed beta cells will only hasten them to burnout more quickly. However, that is not my own personal objection to the drug class. I have found that too many patients experience difficulty maintaining even levels of blood glucose while on sulfonylurea medication. That's because the drugs promote insulin secretion on the medication's schedule and not based on your meal contents, timing or frequency. If the beta cells secrete too much insulin, the patient may be forced to eat -- whether s/he is hungry or not. And if they don't eat, s/he runs the risk of becoming hypoglycemic. In other words, for far too many patients, sulfonylureas is the dominant factor that exerts control over their diabetes instead of allowing the patient to be the one that's in control.
And then there are the side effects . The link that I have provided lists some of the major side effects that have been reported for glipizide and yes, rapid heart rate is one of them. Earlier sulfonylurease (1st generation) in fact were directly linked to a significantly higher risk of cardiac-related problems including fatal heart attacks. The challenge that you face is working with your doctor to find safer middle ground. If your beta cells are not producing a sufficient amount of insulin on their own to meet your metabolic needs, your options become more limited. These include: 1. Reducing your dietary intake of carbohydrates 2. Increasing your exercise/activity levels 3. Using insulin that you can control in terms of dosage, timing and need.
In your previous post, you mentioned that the high deductibles of your current insurance plan virtually eliminates consideration of using insulin on an economical, cost-justifiable basis. That may be because many doctors obtain too much of their "education" from drug sales reps after they have graduated from medical school and actually believe the hype that they are often inundated with; i.e., only the basal and analog insulins can provide the control that their patients need. That simply is not accurate nor factual. "Regular" insulin (Humulin-R, Novolin-R and their NPH equivalents) can provide comparable control. The primary difference is onset of action and the duration of that action. It takes a fair amount of trial and error initially to find out what will work for each individual patient and many patients (as well as their doctors) may not want to invest the time required even though the pay-off can be substantial in the long term.
Regular insulins (including NPH) can be purchased for less than $25 per vial at Walmart Pharmacy. Quality syringes cost about $12.50 per hundred at Walmart and physically resemble B-D's brand of insulin syringes. That's the total net cost. In contract, just the deductible portion of the cost of basal insulins (Lantus, Levimir) and analog insulins (Humulog, Novolog, Apidra) will run almost the same or higher. The newer insulins can be slightly more convenient to use (available in pens and not just vials) and because of their durations of actions, may be slightly easier to adjust to although individual trial-and-error is still an essential part of the equation.