Blood Glucose

I'm 67 years old, had my pnacreas, gall bladder, spleen, over 1/2 my stomach, and part of my upper intenstine removed in July 2007.  I was placed on a diet of 60 carbs 3 times a day and 30 carbs twice a day, with a goal of 2200 calories a day.  With very little stomach and only 60 carbs (e.g., 8 oz of milk, bowl of quaker oats, and a piece of sugar free toast is 60 carbs) at each meal there is no chance of maintaining my weight (178) on hospital release.  Additionally, I have to take enzymes (5 before every meal, 3 before the two snacks) 30 minutes before meals and insulin (novolog) before each meal/snack based on a sliding scale of blood glucose and carb totals to be eaten.  My problems at weight lose (I now weigh 154 and falling) and very erractic blood glucose.  For no apparent reason my glucose level can change as much as 200 to 250 points up or down in an hour.  The worse case is when it went from 118 at 7 p.m. to 396 at 9 p.m. to 37 at 6 a.m.  While these are the extremes, the least bit of exercise will drive my blood glucose below 70 and I have to take tablets and sugar liquids to keep from getting confused and passing out.  I also take Lantus at night for long-term (12 hours) glucose maintenance levels based on the blood glucose reading at bedtime.

If anyone has found a solution to either or both issues please let me know.  I am active outdoors, but not to the point of being fanatical. 

Thanks

Rick

Rick,

So sorry to hear of your problems post surgery.

Insulin,an important hormone,  is manufactured in the pancreas. Insulin is secreted by the Islet cells in the pancreas once food hits the stomach. Insulin allows all carbohydrates, (which are found in EVERY food group), which are turned into blood sugars, to pass into every living cell for energy. These include lungs, heart, major organs, muslces etc. Without insulin, your body cannot make use, or use, these energy supplies. IF you don't have a pancreas, you will not be able to make insulin, so would be like me, a Type 1 Diabetic. I have a pancreas, just I don;t make insulin.

 Type 1 diabetics do not make any insulin so take 2 types of insulin. (unless they are on a pump). A long acting insulin like Lantus and short acting insulin with food.

The amount of carbs you have been given is Ok.  I noticed you are taking Lantus. this is a long acting insulin and is important at keeping the insulin level more even throughout the day and night. However I think you should be taking some Rapid insulin with each meal.

The fluctuations in your levels can be as a result of:

1. Not enough insulin with your meals. You need insulin with your meals in order that your body can use and or store the fuel without getting raised sugar levels. Or, when they go low, not enough carbohydrates for the amount of circulating insulin, or as a result of exercise.

2. When do you take Lantus? For most users, it lasts about 21 hours so depending on time will cause some fluctation in levels.

3. Do you do any exercise during the day? Sustained aerobic exercise will use your fuel, and therefore drop your levels.

4. Do you use a Glucometer? It sounds like you do and that is excellent. test before you go for exercise. test 2 hours after a meal and test before you go to bed at night.

Get a referral to an endocrinologist to help with this. As a type 1 diabetic (with cancer too) I can help a little but a specialist will be the best for you.

Diabetes, has many variables. It can be tricky at first, but once you get the hang of testing, counting carbohydrates and giving insulin, you will be back to good health in no time.

Kiwi

"Fear is a Reaction, Courage is a Decision"

On 1/20/2008 Kiwi H wrote:

Rick,

So sorry to hear of your problems post surgery.

Insulin,an important hormone,  is manufactured in the pancreas. Insulin is secreted by the Islet cells in the pancreas once food hits the stomach. Insulin allows all carbohydrates, (which are found in EVERY food group), which are turned into blood sugars, to pass into every living cell for energy. These include lungs, heart, major organs, muslces etc. Without insulin, your body cannot make use, or use, these energy supplies. IF you don't have a pancreas, you will not be able to make insulin, so would be like me, a Type 1 Diabetic. I have a pancreas, just I don;t make insulin.

 Type 1 diabetics do not make any insulin so take 2 types of insulin. (unless they are on a pump). A long acting insulin like Lantus and short acting insulin with food.

The amount of carbs you have been given is Ok.  I noticed you are taking Lantus. this is a long acting insulin and is important at keeping the insulin level more even throughout the day and night. However I think you should be taking some Rapid insulin with each meal.

The fluctuations in your levels can be as a result of:

1. Not enough insulin with your meals. You need insulin with your meals in order that your body can use and or store the fuel without getting raised sugar levels. Or, when they go low, not enough carbohydrates for the amount of circulating insulin, or as a result of exercise.

2. When do you take Lantus? For most users, it lasts about 21 hours so depending on time will cause some fluctation in levels.

3. Do you do any exercise during the day? Sustained aerobic exercise will use your fuel, and therefore drop your levels.

4. Do you use a Glucometer? It sounds like you do and that is excellent. test before you go for exercise. test 2 hours after a meal and test before you go to bed at night.

Get a referral to an endocrinologist to help with this. As a type 1 diabetic (with cancer too) I can help a little but a specialist will be the best for you.

Diabetes, has many variables. It can be tricky at first, but once you get the hang of testing, counting carbohydrates and giving insulin, you will be back to good health in no time.

Kiwi

"Fear is a Reaction, Courage is a Decision"

Thanks so much for your reply.  The items you provided are useful reinforcement for what the Dr. and others have provided.  The Lantus I take is a 12 hour kind and taken only at bedtime on a sliding scale based on my glucose reading, the day's activity and tomorrow's planned activity.  I am a rancher and get plenty of exercise.  The issue I'm dealing with is the unexpected surges (>300) for no appearent reason and the sudden declines (<40) for no reason.  I normally take my readings 6 to 8 times a day and more often when I believe necessary.  I appreciate your response and will continue to monitor my body, insulin and activity in hopes of getting "a better handle" on things.

I wish you well and hope this year exceeds your expectations.

-Rick-

Rick,

I am not aware of a 12 hour Lantus. My understanding is that the long acting insulins like Levemir or Lantus keep your basal insulin levels even. Lwevemir is designed to be taken every 12 hours. I haven't heard of only takeing a 12 hour basal once a day. Without basal insulin, your body has a very difficult time maintaining 'normal' blood sugar levels. If you don;t have enough basal insulin on board, then no amount of rapid will move the numbers, and nor will exercise which could actually be harmful if your numbers are high.

If it is a 12 hour, then taking it at night is the best as there is usually a surge of blood sugar during the night. this is called the Dawn Phenomenon. It is also good that you take a sliding scale as you can go low at night.

HAve you had an A1C done? this is a rest that measures the average of your blood sugars over 3 months. It is an average of your 2 hour post meal numbers as well as your fasting am numbers. If it is over 7.5 then you will need to get your basal insulin tuned up as well as your post 2 hour meal numbers down. If it is under 7>5 then your 2 hour meal numbers need tuning. this is where the Endo will be able to help. Do you have a Medical team? Havard University (joslin) has an excellent Diabetic web site.

When you go low, it is important to stick to the 15/15 rule. 15 gms of carbs every 15 minutes and test. I have dextrasol tablets tucked into the pouch of my glucometer so they are handy when I need them. If you go low and you don't get glucose in quickly your liver will dump a load of glycogen (stored sugar). this will cause a rebound high numbers.

Being active is good, as you will be using up the fuel you ingest. Aerobic exercise will burn fuel, however any form of maximum effort (lifting heavy objects) or short bursts of maximum activity will actually increase your levels. Also if you are exercising/working out on your ranch and your levels are over 240, and you are making ketones, then your levels will actually rise.

Eating low glycemic index food will also help as it is slow to digest so stays as fuel longer.

Another problem is to keep well hydrated, and your electrolytes balanced. High sugar levels will cause dehydration. Once the body is stressed, it releases these hormones called 'counter regualtory hormones'. these include Adrenalin, norepherine, cortisol etc. These will also raise your sugar levels up. You can buy non carbohydrate electrolyte replacement crystals which I find to be very good.

Another factor with food is that higher fat food will cause levels to rise, usually they have a more delayed response. If I am around 120 at night I will eat a small snack of 10gms of carbs in a 0%youghurt plus a handful of nuts. (right now I can't eat nuts, but cream cheese on a rice cake works too). This keeps the night time numbers more stable.

The wild fluctuations are tiring to the body. I hope you can get to an Endocrinologist and see if they can help with keeping the numbers more stable. When you have good control, you feel really good!

Hope this helps a wee bit.

Kiwi

On 1/20/2008 Kiwi H wrote:

Rick,

I am not aware of a 12 hour Lantus. My understanding is that the long acting insulins like Levemir or Lantus keep your basal insulin levels even. Lwevemir is designed to be taken every 12 hours. I haven't heard of only takeing a 12 hour basal once a day. Without basal insulin, your body has a very difficult time maintaining 'normal' blood sugar levels. If you don;t have enough basal insulin on board, then no amount of rapid will move the numbers, and nor will exercise which could actually be harmful if your numbers are high.

If it is a 12 hour, then taking it at night is the best as there is usually a surge of blood sugar during the night. this is called the Dawn Phenomenon. It is also good that you take a sliding scale as you can go low at night.

HAve you had an A1C done? this is a rest that measures the average of your blood sugars over 3 months. It is an average of your 2 hour post meal numbers as well as your fasting am numbers. If it is over 7.5 then you will need to get your basal insulin tuned up as well as your post 2 hour meal numbers down. If it is under 7>5 then your 2 hour meal numbers need tuning. this is where the Endo will be able to help. Do you have a Medical team? Havard University (joslin) has an excellent Diabetic web site.

When you go low, it is important to stick to the 15/15 rule. 15 gms of carbs every 15 minutes and test. I have dextrasol tablets tucked into the pouch of my glucometer so they are handy when I need them. If you go low and you don't get glucose in quickly your liver will dump a load of glycogen (stored sugar). this will cause a rebound high numbers.

Being active is good, as you will be using up the fuel you ingest. Aerobic exercise will burn fuel, however any form of maximum effort (lifting heavy objects) or short bursts of maximum activity will actually increase your levels. Also if you are exercising/working out on your ranch and your levels are over 240, and you are making ketones, then your levels will actually rise.

Eating low glycemic index food will also help as it is slow to digest so stays as fuel longer.

Another problem is to keep well hydrated, and your electrolytes balanced. High sugar levels will cause dehydration. Once the body is stressed, it releases these hormones called 'counter regualtory hormones'. these include Adrenalin, norepherine, cortisol etc. These will also raise your sugar levels up. You can buy non carbohydrate electrolyte replacement crystals which I find to be very good.

Another factor with food is that higher fat food will cause levels to rise, usually they have a more delayed response. If I am around 120 at night I will eat a small snack of 10gms of carbs in a 0%youghurt plus a handful of nuts. (right now I can't eat nuts, but cream cheese on a rice cake works too). This keeps the night time numbers more stable.

The wild fluctuations are tiring to the body. I hope you can get to an Endocrinologist and see if they can help with keeping the numbers more stable. When you have good control, you feel really good!

Hope this helps a wee bit.

Kiwi

Thanks.  This is really good info.  I take Novelog before meals and cannot take the Lantus until 2 1/2 to 3 hours. after I've taken the Novelog.  That pretty much negaties night time "snacks" for low blood sugar unless I eat before 6:30-7 p.m. and catch the low before 8 p.m.  I try to get to bed by 10-10:30 p.m. and I'm up before 6 a.m. each day.  On days I go to the ranch (about 4-5 days a week depending on what has to be done at home), I get up about 4:30-5 a.m. to prepare things to take.

I've had a couple of A1C's.  One was good.  One needed some adjustments recommended by the doctor.  I have another in about 35-40 days.

Your information is good and I do appreciate you taking the time and having the interest to communicte.  I'll reapply myself based on your input and my moniotoring.

Thanks again and be happy.

-Rick-