Reply #13: My mom

[gvstn]

Has been diabetic for 48 years. She is now 73. She insists on taking only 2 shots per day. So a few units of Regular in the morning with 20 or so units of NPH and then some units of NPH in the evening.

The doctors would all like to get some tighter control. But they are not there when she is unconscious in the middle of the night and there are no nurses to clean things up. I worked for 2 years to try to bring her AC1 numbers down but there were always dangerous lows. No rhyme or reason--same activities same food intake just stress or weather changes--totally unpredictable.

If I had a ten year old that was diagnosed Type I diabetes then I would probably put him/her on the pump to get the best control and hopefully avoid long term complications like neuropathy. But in the real world you have to take care of yourself. I'd suggest talking to a few endocrinologists to try to find one that is realistic. Not an easy task but worth it in the long run. Lows like 41 are not good. My mom loses her ability to think clearly at 67 or so.

I'm sorry to say that I only met one endocrinologist that seemed to make sense in the hospital but he was just a weekend guy that disappeared in the shuffle of more serious medical problems that had to be addressed.

You seem to be taking your diabetes seriously which is excellent. My only problem with the various doctors I've met is that they seem to care more about getting the AC1 levels perfect than the health of their patients. From my own experience completely eliminating fast-acting insulin worked fine to avoid lows but it increases AC1 level. I put 2 units of Regular back into my mom's routine to counteract this. I wouldn't completely eliminate fast-acting insulin without talking to my doctor. It is the long term consequences that you want to understand. I don't know your age but if you are going to be on insulin for another 25 years or so you want as tight control as possible without any scary lows.

This is not the chart I am looking for but it gives you a rough look at how different kinds of insulin react. http://www.k9diabetes.com/forum/showthread.php?t=1482 You can see the ***log insulin is very fast acting and may be part of your problem if your lows come soon after a meal or injection. Maybe talking to your doctor about using Regular might avoid lows that happen soon after using Humalog or Novalog.

The one thing my mom does is eat at the same time every day. No excuses. It keeps one factor constant. You can't control stress or the weather but you can control what times you eat. And make sure you include protein with every meal.

OK, enough preaching from me. :)