Tuesday, March 21, 2006

Levemir and Humalog, Day 1

I've been pump free for close to 24 hours!
Doesn't that sound weird? It sounds like I'm at an AA meeting or something. Anyway. First, for some good news. My A1c was 7.0%!!!! I was SO happy to hear this. It's WAY down. It's the lowest its been in a while.
I talked to my endo about going back on shots and he didn't even blink. He just asked me if I wanted to use pens or syringes. Have I mentioned I LOVE my endo? He trusts me to know what is best for me. He is there to help me accomplish the best care possible. I dread the day when I have to grow up and use and an adult endo. I think he will let me stay during college though. He was going to put he on Lantus, but the pen with that, as he put it, is "an absolute failure." He said he didn't have many patients on Levemir, but if I was willing, he wanted to try it. It doesn't sting like Lantus can, because it works differently. He explained it, but I couldn't repeat it. Last night at 10.30pm, I gave me first dose. 32 units. It sure looked like a LOT of insulin to give at once. So far, it's going OK. I'm trying to stay positive. I have been higher than I would like, but I don't think the levemir has had a chance to build up in my system. I also don't know how to correct if its been less than 3hours, because I don't know how to calculate insulin on board. Does anyone know how to do this? The injections haven't bothered me so far. What has bothered me is my mother. She was the only one who hasn't been completely supportive of this. She doesn't seem to understand it. But I know she is trying. We talked about it, and she still vividly remembers trying to still a toddler with needles and forcing me to eat meals I didn't really want to. We talked about how the new insulins are different, and how I can still eat what I want whenever I want. I think she'll come around, but for now, she is driving me CRAZY!! She is looking over my shoulder to see what my blood sugar is, she's making sure I prime the needle, that I am injecting before I eat, etc. I know she wants me to keep control, but she hasn't treated me like this for years. I've been in complete control of my D care for years, and I've done very well with it. She seems to think that because I'm not using the pump, I won't take care of myself. *sigh* We'll get there. So other than the highs, and my mother, Levemir is going great! I got out of bed this morning and I didn't have to look for my pump and make sure it didn't fall, I took a shower and I didn't have to make sure my loofa (sp??) didn't get caught in my site. I chose an outfit that I only wear once in a while because the pump makes it bulge funny. It's great!


Shannon said...

Oh boy...I picture myself being like your mom when Brendon gets to your age.

I've never heard of Levemir. Does it work like Lantus? (not that I know much about that either)

Rebecca said...

My understanding...
With the 'insulin on board' thing...don't factor in the Levemir aka your basal insulin. This should pretty much just be matching what your body does regardless of food. So correct like normal.
After 3 hours the Humalog should be gone and therefor you can pretty much consider none on board.
Rereading that I'm not sure exactly which was your question but hope that helps somewhat.

julia said...

Ok, here's what I do (or try - Olivia can get food into so fast it'll make your head spin). I give a bolus about 15 minutes before she eats. I guess at the # of carbs she's going to eat and bolus for half (plus her bg reading) up front. Then I bolus for the other half at the end of the meal.

I got this from here:

"Claudia Shwide-Slavin, a dietitian and certified diabetes educator in private practice in New York City, advises the following: "If your blood glucose level is between 140 mg/dl and 180 mg/dl, take the rapid-acting insulin and wait half an hour before eating. If it’s between 180 mg/dl and 200 mg/dl, wait 45 minutes. If it’s higher than 200 mg/dl, wait at least an hour." She also notes, however, "I have seen it take two hours after an injection for blood glucose levels to budge." If a person is hungry or must eat at a specific time, Shwide-Slavin recommends limiting the amount of carbohydrate at the meal by eating mainly protein and nonstarchy vegetables.

Another suggestion from Shwide-Slavin if you can’t delay a meal is to "check your blood glucose an hour before you think you will eat. If it is high, take a correction dose so that your blood glucose will be on the downswing by the time you eat."

While the duration of action of rapid-acting insulin is usually given as 3–4 hours, some diabetes experts believe it may continue to lower blood glucose level for as long as 5 hours. Walsh believes that a good rule of thumb is to assume that about 20% of a dose of rapid-acting insulin is used each hour after it is given. In his book Using Insulin and on his Web site http://diabetesnet.com/diabetes_control_tips/bolus_on_board.php, he provides a table that shows insulin activity at 1, 2, 3, 4, and 5 hours after bolus doses of insulin from 1 to 10 units."

There's tons more on that website.

Hope that helps. I'm glad you're liking being pump-free so much. I'd bet if you had all this info to show your mother, she'd back off a little bit. Speaking as the mother of a kid with d, though, be prepared for her to be on your case about it for a while.

caro said...

I'm glad the change is going well for you. Are you taking the Levemir once or twice a day?

I think it is hard for parents who at some point have had sole, or at least majority, responsibility for their child's diabetes. Your Mom obviously wants the best for you, but all she has to draw on is her experiences from that time.

My own parents weren't entirely convinced when I wanted to start pumping. They had struggled to make injections work for me as a kid, so they knew how difficult it was, but when they passed over control to me, they had sort of made it work. As I grew up and left home, it really wasn't working, but my parents were worried about the change, because they had seen, the last time they were involved, that injections could sort-of work. Perhaps even more than that, they didn't really understand the pump. When I explained it to them, as you explained new insulins to your mom, they started to come round.

As to thinking you won't take take care of yourself now you're not pumping: Maybe you need to point out that you're not motivated to pump right now, you've chosen this regime and so you're actually likely to do better on it?

Good luck, hope it continues well.

Erica said...

Glad it's going well! I'm new to the pump but I can certainly sympathize with the clothes issue. I always keep my pump in my bra and am trying to invent ways not to be obviously feeling myself up to bolus or to turn off a reminder! Some days I also miss shots (did I just say that?)! I also found that with shots I ate healthier since it wasn't so easy/convenient to bolus :-(

Good luck with everything else :-)

Penny said...

Congrats on being pump free and on the A1C.

Don't be too hard on your mother. She loves you and she worries about you. She used to take care of you with syringes and she knows what a struggle it was for her. She's probably just afraid that you'll have the same experience. She'll come around once she sees that you're doing OK with syringes.

Felix Kasza said...

IOB for Humalog is usually calculated as follows:

30% gone after the first hour
another 30% gone after the second hour
another 30% gone after the third hour
and the remaining 10% are the tail end in the fourth hour.