Insulin timing

Are you taking injections or do you have an insulin pump? Grazing over the course of the evening can be challenging. With practice you’ll get better at it though. Each person handles it in their own way.

I’ll just share my approach. I try to arrive with my BG steady around 120. I try to stick with low carb dishes, like turkey slices, veggies, cheese, shrimp, nuts, etc. That way I might not need to bolus immediately. I take a couple of things like that to share if I’m not sure about what will be available.

If mid evening I’m going to have a slice of pizza, I wait until then and eat 1 piece or less, as that is high in carb and fat and I’ll spike later on for sure. I try to eat only 1 bite of a dessert to keep spiking down. I usually wait to see how I’m trending before taking correction boluses. ALSO, if you intend to have alcohol, keep in mind that it can cause blood sugar to drop considerably. If I am having wine….I carefully monitor my CGM and eat carbs…..at least 30 to keep me from dropping. I am extremely careful of bolusing then.

Do you have an insulin/carb ratio to calculate your dosage?

@celia16 I take multiple injections. My sugars are not yet regulated and my endochronogist wants me to cover all carbs I eat but should only take insulin up to 4 times per day. My insulin/carb ratio is different for different times of the day. Confusing and frustrating. I've had recent treatments for breast cancer so meds and treatments affect blood glucose dramatically eg. radiation, lots of steroids, meds for colitis etc. It's been a roller coaster! Thanks for your tips.

@karenps , oh I see. Steroids can cause blood sugars to go very high and it’s extremely difficult to get it down. I recall getting a shot to combat 10 yellow jacket stings I got couple of years ago and it was quite an ordeal! Even with an insulin pump….it was so distressing.

You are also taking a slow acting insulin at least once or twice a day too, right? That insulin is also very important. Getting that dose right helps the fast acting work better.

If you’re going to continue on steroids, I would have a very candid discussion with your endocrinologist. Do they focus primarily on patients with diabetes? I think that’s important. I don’t know how I would be able to manage my BG with a limited number of fast acting injections. So that is difficult for me to understand. Please reach out and ask your doctor for an explanation. I’d make sure the doctor knows what your numbers are. Does he understand how difficult this is? Mine do and they arrange appointments with a Certified Diabetes Educator.

Also, I would discuss the possibility of an insulin pump. I’m not one to promote a pump for everyone, but if you’re taking steroids, it really should help. It gives automated micro boluses to keep the numbers down around the clock. It does much of the calculations for you.

If not a pump, could you explore a smart insulin pen? I’ve never used them, but I might explore them.
https://consumerguide.diabetes.org/products/smart-insulin-pens
I would strongly suggest a CGM. Do you have one?

Your diabetes care team should be able to provide you some other options. What they are asking you to do is very challenging and you’ll need support. Here’s a link for a site that provides all kinds of diabetes information and support. It has many videos and online conferences. It’s run by 2 endocrinologists who have type 1 diabetes. I highly recommend it.
https://tcoyd.org/
With practice, things will improve. I know how stressful it can be. Good luck and please post your progress!

@celia16 Thanks so much for all this info! I will start looking through the links. I think the most important takeaway is that I need to find an endochronogist the specializes in diabetes in my area. The meds and treatments I have for my cancer and colitis ( and other meds) interact w/ glucose levels making things complicated. I take long lasting insulin in am, then up to 4 times/day my fast acting. Not working as I have no baseline that's stable at this point. I have much research to do!
Karen

@karenps , do you have a teaching hospital nearby? Based on my experience, the endocrinologists at teaching hospitals have more providers who focus on diabetes. I have been under the care of Duke or UNC endocrinology for many years. My endo at UNC is highly focused and teaches diabetes. I know some people who just use their primary, but it’s difficult for me to imagine. The CDE is familiar with all the latest treatments and technology. They can teach you. They also have nutritionists on staff.

Good luck with everything. You’ll feel so much better when your numbers come down. This chronic condition can bring you down. I have had talk therapy before and found it very helpful.

@celia16 thanks for your encouragement and wisdom! You've been at this a long time and have learned a lot. Thanks for sharing your knowledge with me