We do not manage to lower hyperglycemia

Hello,

I am new in this forum and in the world of diabetes.My father has been in insulin for a month to start taking corticosteroids (I already had blood glucose a little before) and we could not lower hyperglycemia.

It started with fast insulin Actrapid before the 3 meals and was between 180-200 and peak, and the one before dinner 300 and much and more than 400 one day.

A week ago, Insulatard prolonged insulin has added in the morning, 12 IU, but follow 170-190 early in the morning, at noon between 130-220 and at night before dinner at more than 300 every day.

You have to take half proteins/kcal at noon because you need to recover weight and that I suppose you get more sugar.

On the pattern it gives us that if it is less than 150 we must not put insulin, and from 150 to 200 only 4UI.He has climbed 2ui more and still remains high at night ...

I understand that it is to regulate the fast insulin according to what it eats and leave the prolonged way how it is?If you are less than 150 at noon, you can put 4 or 6ui taking into account that you will drink the milkshake?

The effect of insulin before eating is immediate and if it passes, could you have hypoglycemia or the UI before eating are taken into account that it will eat and tell what makes effect during digestion?

If you put little insulin and past 2h of the food is high, can you put 2ui more for example and at night before dinner again?

We have many doubts and little info by doctors!

Thanks in advance and strength to all@s

Good afternoon, let's see, the level of glucose when you get up and before meals the slow insulin marks.If you are high, you must raise the slow units.
Rapid insulin is to compensate for ups to meals: according to what you eat and how much you will, you will get more or less fast insulin.It is what is called counting rations.
Ideally, Cojas cites with an educator@ and that I explain how to tell rations of hydrates, etc ...

Corticosteroids destabilize a lot.
It takes much more than the scheduled.
Try to climb 1 more, that is, if it is between 150-200, instead of 4, put 5.
Look to see how many carbohydrates the shake has to calculate the insulin

Hello, thanks for the answers.How do you have carbohydrates?The shake has 18.4g.You calculate them according to what you are going to eat?That is, if it is at 130 before eating and knows that it will eat normal + the shake ... could it take 4-6ui in forecast of what will upload later?

The "bowling" are the rations of carbohydrates that we eat.Every 10gde HC is 1 ration or bolus.
That is, you calculate how much you are going to eat and 15 min before you insulin for that meal, in this way the effect of insulin with food absorption coincides.

It is proof and error, if it is in Normaglycemia, 80-150, for 18.4 perhaps with 1ud of insulin you have plenty, but if it is in 180, you have to put the insulin sum of the food plus the rectification (which is the patternThey have given you), about 5 maybe.
To learn from the starting insulin, what is eaten and the insulin that is injected one, at 2 hours the blood glucose is measured.If it's okay, I got it right, if you give it a low one you have to put less and if you stay high, it was insulin.

When they take off the corticosteroids you will surely need exogenous insulin.

Thanks for the Ruthbia explanation, very clear.So if it is in less than 150, even if it is 130, you have to put the insulin for food (1 or 2UD), and if it is at 90-100 too, or is it low?And another doubt ... If after 2h leaves high, can you put insulin or do you have to wait for the next meal?I will ask for time to review the slow insulin too

Yes, that's.Because insulin metabolizes carbohydrates.If you do not put it, what I had, more what the food generates.That is why he is high in the afternoon.
With the basal it seems that it is not enough for the corticosteroids.

Meal insulin lasts about 2.5-3 hours.After this time, if it is above 180, I should use insulin, perhaps 1ud of fast to go down, if it does not go down much, next time 2 units.
Consult with your doctor, he can guide you that is better.

When you do not take corticosteroids, you will have to leave the insulin of meals and possibly lower the basal units.The doctor will tell you.

I understand ... how much practice we have left!Yesterday he was 175 before eating and put 6ud, he went down to 260 before dinner.Today I was 166 before eating and 7ud has been thinking about carbohydrates, to dinner was at 316!We have fallen short.
To look at 2h after meals he does not want for now, and the corticosteroids go for a long ... to see if maybe uploading a slow one also helps him not to upload so much.Tomorrow I talk to the doctor.Thank you very much for the help !!

I think you have to climb the slow one too.Go up both slowly until you have the desired controls

Hi Rosa, there are many factors to take into account, the first thing is to count the hydrates and know the insurpose ratio at each meal.In addition, it is good to know the sensitivity factor it has, that is, how much an insulin unit lowers you.If you have RRSS you can look for me, I have very short videos where I try to explain that easy, especially for people who just started, in case you want to take a look.

The link passes, please.If I put a zero type on Google I get a pizzeria in Sicily ...

salad said:
passes the link, please.If I put a zero type on Google I get a pizzeria in sicily ...

Hello, I had not seen the messages.Caromorella yes, has uploaded the slow to 14ud, which is put in the morning.Even so, it is lebiant every day at 170-190 ...
The fast we are adjusting, what happens to us now is that before eating low to 100 or less (today to 69) and when so low is not put a unit of the fast for fear of a descent during the meal ("beforethat the sugar of the food reaches the blood ") and then at night before dinner rises to 300 and peak.Do you put insulin equally if you are low and are you going to eat?Can you put 2h after eating any unit if you are high?And if later dinner will still be low and will have to get less I understand ...?
Type I have looked at your videos, thank you!The doubt is ... we have not yet succeeded in insulin to day so that it does not have hyperglycemia, and one day it is + or -... then how is it calculated?That is, there are 14 slow + fast: 4 breakfast + between 0 and 6 food + between 4 and 6 dinner.And in your summary video of your day, very visual for those of us who have no idea, how do you know the trend of whether you get off or go up?And the same, if before eating you were 70 instead of 125, would you put insulin?

Yes, of course insulin always, even if you have hypoglycemia.What can be done is to put it later, as soon as I finished eating or 20 min later to let the food go up, giving time for insulin to begin to act.The insulin of food takes about 20 min to make elected at noon and dinner, but at breakfast it can take up to 1 hour.

To calculate the insulin, it is necessary to know what it is eaten for the dose and the basal of esteem by weight initially and then adjusts depending on the glycemia when rising.

For example, a plate of vegetables, a fillet and a medium -sized orange are approx 25 grams of HC, that is 2.5 portions.If you put 4 unions of insulin and at 2 hours you have the same blood glucose as before eating, it means that for 10g of HC needs 1.6 uds of insulin.If it is well above it is that more insulin was needed, if it enters hypoglycemia, it is left over insulin.
Test and error.

If you get up in 170-190 you will have to climb the basal.The normal thing is as much rise in 140. The basal rises from 2 in 2 units and after 3 days of observation with the same values.

Thanks again Ruthbia!I do not understand because the endocrine has told us that if it is less than 100 it did not put it ... today it has passed that it was 69 before eating and it has not been put, 2h after eating at 330, it has been put 4 (PQWe are not sure how much every you lowers), and before dinner it was at 354!He has put 4 again but I guess it's little ...
How do you know how many HC each meal has?Is there a table?He has to eat enough HC, Proteins and Kcal to recover weight and muscle.
At breakfast and dinner take 2 tablespoons of powdered proteins and at noon beaten.It could that the afternoon hyperglycemia are also from breakfast proteins?And dinner proteins ... will hyperglycemia do in the early morning?
And the calculation you do ... 25g of HC = 4ud ... 10g = 1.6ud.PQ 1.6?
Tomorrow I will upload the 2ud more basal.
Sorry for so many questions!

pink_c said:
thanks again ruthbia!I do not understand because the endocrine has told us that if it is less than 100 it did not put it ... today it has passed that it was 69 before eating and it has not been put, 2h after eating at 330, it has been put 4 (PQWe are not sure how much every you lowers), and before dinner it was at 354!He has put 4 again but I guess it's little ...
How do you know how many HC each meal has?Is there a table?He has to eat enough HC, Proteins and Kcal to recover weight and muscle.
At breakfast and dinner take 2 tablespoons of powdered proteins and at noon beaten.It could that the afternoon hyperglycemia are also from breakfast proteins?And dinner proteins ... will hyperglycemia do in the early morning?
And the calculation you do ... 25g of HC = 4ud ... 10g = 1.6ud.PQ 1.6?
Tomorrow I will upload the 2ud more basal.
Sorry for so many questions!

Proteins per do not rise glycemia.Go up with hydrates and fats.

There are hydrates tables, my educator was given to me in the hospital.

As for the doses, in reality these are test-error tests, because even when you know more or less how much you should put with meals, there are not two equal days.What works for you today, tomorrow does not have to go well.

It is a bit desperate.What are we going to do.

Yes, of course there are food tables.This is what we calculate, then you learn from use.In addition to reading labels of products used.
Look is
Link QAQ & USG = AOVVAW2CQ6WZSBLOCRJ1ZZ4CXR08

Check how many hydrates the protein has and how many eats normal food.If this at 70, it is normoglycemia but since the pancreas is blocked by the corticosteroids, it is as if it had no insulin, so it needs to put on each meal and rectify more insulin at 2 hours but is below 180.

The ratios are insulin needs due to hydrates ration, 1 ration = 10 grams.I told you 1.6 with the example that I have put you, but it is calculated testing and measuring.
You can start 1ud: 1 ration, and see what happens.

Hi Rosa, as insulin have already told you you always have to put if you are going to eat hydrates.Ruthbia has made a first calculation that is for each ration, you put 1.6 of insulin and see how that ratio works.Another thing is that if you are in 70 you can put the insulin in the middle of the food, but if you do not put anything you will create a very high peak.
Because of the insulin that he puts right now, with what you have told me, his sensitivity factor is more or less 65, but well he will be refined more.
With diabetes you have to be patient since there are many factors that affect and have to know them and know how to handle them.It takes some time but little by little.
While you ask the doubts that we will try to help

Buf, if it is desperate Sandman.My father was guided when they left an entrance, until the doctor left out, he told us that they would give him pills, it was Friday, the visit of the CAP nurse the next Thursday and follow -up with her, which tells us that it is betterthat is in hyperglycemia that in hypoglycemia and only reviews how it is click.There is no educator of the hospital, nor endocrine, nor explanations ... the endocrine I have searched for private after weeks of being 300 and 400 several hours a day, and begin to understand how everything worked.Very disoriented.
I thank you again for the answers because for me they are a guide.
I understand the calculation.Yesterday was at 90 at noon and did that, he waited to finish eating and put 8 units.I looked at the table that you spent Ruthbia and compared how much what was put back was lowered.At night I was 160. He's the day that has gone better.
The issue is that you just want to look at how much is before meals, and I understand it why it has other serious pathologies and there are many things already.Then rectify anything ... and calculate HC either (I don't live with him, his wife cooks him and I can't be there at every meal).
Today the endocrine has changed the slow 12 una of insulating to 16 ud of Abasaglar why in the morning follows more than 180 and says that it lasts 24h instead of 12h.He has also modified the pattern again: less than 100 = nothing;from 100 to 150 morning and night 2, noon 4;And climbing 2 in 2 every 50. I do not see it clear, a guideline so rigidThat has hypo and hyperglycemia between meals and at night.
I understand that without measuring between meals or counting HC, we have no choice but to apply such a pattern.How do you see it?
I would love to know about the typezer sensitivity factor!Although without counting HC, I don't know how much more to what a meal can upload ... and now that they change the pattern, you will change the num of you too.These days have taken reference 50, just under 65

The abasaglar will do better, because it usually lasts 24 hours.
Measuring before each meal you can also know if it has been quite the rapid of the previous food.
If you wake up above 180, get on one unit slowly and wait two days to see results.
The sensitivity factor is usually approaching by dividing 1800 by the total insulin dose.
You have to study it little by little.
Let's see if you get glycosilada to be 7 maximum.