Re: Tight glucose control in hospitals and later outcomes

On Aug 6, 6:59 pm, Emily <emsy_s...@xxxxxxxxxxxxxxxx> wrote:
jackiepa...@xxxxxxxxx wrote:
When I was in the hospital, I had a PILE of doctors. About 6
different people from the cardiologist's group, 5 different doctors
from the internist's group, one endo and the one surgeon. They told
me afterwards I needed to make follow-up appointments with the
cardiologist, the surgeon and either the internist or the endo.

Wow, that's a lot of doctors! I don't think I even had that many when I
was septic and in the ICU.

I was in nearly two weeks, so I had different people wandering in-and-
out. I guess the physician groups take turns doing rounds.


Yeah, if the only person I had met from the endo clinic I go to was the
NP I first saw (who wanted to wait for test results before medicating me
even though my BG's were 200-400 and even going to 500+ occasionally...
I'd have not been impressed either. Perhaps you could get a referral to
a different endo.

That's just ridiculous. Doesn't matter what kind of diabetes you
have, if you have readings like that, you need insulin. Even if the
need turns out to be temporary, you need it THEN.


When my BG goes unusually high, I know I'm in for a few days of
high--unless I increase the insulin. (I also know that either a)my
menstrual cycle is about to start or b)I've got an infection
somewhere). If I go low, then I'm high the rest of the day also.
Generally. If I've just gotten over an infection though, then I may have
overdone the levemir, or am overdoing the novolog in which case I have
to adjust to get my BG back to a normal range after eating.

I'm trying NOT to increase the insulin when I'm a bit high, but let it
ride and see if it comes down in a day or two.

I was talking with a long-term T1 on a web forum and he says when he
corrects for high insulin, it seems to creep up over time, and he can
find himself taking as much as 40% more insulin than he normally
needs.

I'm kind of taking that advice to heart, so mostly ignoring it if I'm
a bit high. Not... like if I'm sick, I know I have to adjust
temporarily then. But if I'm just 10-20 points high, I wait and see
if it comes down before adjusting the insulin up.

I think our bodies can adjust to some range of insulin and I'd rather
keep mine on the low side, for a lot of reasons.


With me, if I'm below 80, I could be headed for a hypo. It
basically
means it's time to eat--either a snack or a meal, whatever is on the
schedule. I do feel it when I go below 80 as well. I think sometimes
it depends on how long I wait to test--i.e. if I get caught by customers
etc., if I test right away, I may only be in the 70's and just need
lunch or a snack, if I test later, I may be hypo.

Yeah, I can see why the rule is under 80. But for me... if I get a
postprandial in the 70s... my next preprandial is in the 70s too. I
don't have symptoms of a hypo in the 70s either, not even hunger
particularly. So it doesn't seem to mean a hypo for me.


Actually, I've had a couple of CDE's tell me that the goal for diabetics
on insulin is exactly that. To be able to adjust their insulin as needed
without having to call someone to figure out how to adjust it. With
that info, I have been adjusting my own insulin as I need to. I figure I
test often enough that if I've taken too much, I'll find out and treat
the hypo, if I've taken too little, I'll take some more and correct.

Sounds to me like you've been lucky with both your endo and CDE.

Depression though is tough, and for me, that's where my ability to
control my diabetes gets rough. It's very difficult to give a damn
about what I'm eating and how much bolus I need when depressed. I
have kinda learned how to talk to myself about it though.

Yeah, I hear you on the depression. My doc gave me permission to slack
off on testing as long as I don't slack off on insulin. Well, prior to
going into the hospital, I had kind of stopped both. Also, when
depressed I used to eat nothing but cereal. That doesn't work so well
now, especially if I'm not injecting. My depression is better though--I
even went manic, and now I think I'm in the happy middle ground. I hope
I don't crash from having gone manic, but I don't see any signs of it
right now.

for me, blowing off the diet and insulin is almost a half-hearted
suicide attempt; like I'm wanting to do something *extreme* but not
actually fatal.

But... being alive and in worse health is not gonna help anything. If
I *really* want to kill myself, I'll just freaking DO that, not mess
around with my health in this half-assed manner. So for me, I've been
reminding myself that if I'm depressed, I can bloody well be depressed
and take care of my diabetes anyways.

So... that's what I tell myself when I'm depressed. I'm gonna be
depressed whether I take care of myself or not, so might as well take
care of myself.

We've got it relatively easy in terms of the figuring it out part of
things; those folks who pump have REALLY complex stuff to figure...
different boluses at different times of day, etc.

Hmm... I guess I kind of figured once a pumper figured out what worked,
then they programmed the pump and it did all the work. They could
override it for like say the pizza effect, or if they were sick, but in
general the pump would put out the right doses at the right times after
being programmed. Of course, a pumper could program the pump to put out
insulin exactly as we do, but that would defeat the purpose of a pump. I
know most people get far tighter control with a pump, so it must have
it's advantages. My cousin's girlfriend is a pumper, has been since
they were first available, and she does quite well with it.

I absolutely think it has advantages, but it seems a LOT more
complicated than a regular basal/bolus routine in terms of how much
you need to understand.


.

Relevant Pages

  • Re: Tight glucose control in hospitals and later outcomes
    ... the surgeon and either the internist or the endo. ... When my BG goes unusually high, I know I'm in for a few days of high--unless I increase the insulin. ... If I've just gotten over an infection though, then I may have overdone the levemir, or am overdoing the novolog in which case I have to adjust to get my BG back to a normal range after eating. ... I guess I kind of figured once a pumper figured out what worked, then they programmed the pump and it did all the work. ...
    (alt.support.diabetes)
  • Re: Tight glucose control in hospitals and later outcomes
    ... the surgeon and either the internist or the endo. ... and I finally did get insulin. ... to adjust to get my BG back to a normal range after eating. ... I hear you on the depression. ...
    (alt.support.diabetes)
  • Re: Tight glucose control in hospitals and later outcomes
    ... snack that is less than 15g carbs, I don't need to inject at all. ... I know I still make insulin. ... Depression is bad enough without beating yourself up for it. ... eight years since my last p-ward hospitalization when I went in this ...
    (alt.support.diabetes)
  • Re: Tight glucose control in hospitals and later outcomes
    ... One night though, I got real jello for dessert--I didn't order it, but they added it to my tray because I wasn't ordering enough carbs. ... (if you were a t1 not making insulin, or even a t2 severely insulin deficient as well as resistant) ... Yeah, I've had a schedule like that before, and then sometimes from depression... ... eight years since my last p-ward hospitalization when I went in this ...
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  • Re: Observations From A Newbie
    ... equates carbs to insulin. ... to adjust her bg as her circumstances change throughout the day. ... diet & exercise ... As for the typical American diet, the carb intake runs between 200-300 ...
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