Sounds like you're on the same ride I'm usually on (and yes, I'd like to get off of it, too
Sounds like you're on an intensive insulin regimen (long-acting plus short acting for food). I assume you count your carbs and inject based on your insulin:carb ratio for that meal? Do you also inject extra at that time to correct highs? Do you know if your Levemir lasts 24 hours or 16-20, like most of us? Have you tested in the wee hours, between 2-3, to see if your morning highs are actually DP or maybe you're going low and your liver is dumping glucose? Have you tested after some meals at the 2-hour mark, to see just how high you go? Do you know how much sugar brings you up how many points? Sorry for the Q's but, I can't remember if you mentioned in the past.
I replied to your "considering the pump" post with a great link to a "how to" site that easily explains how to use insulin the best way possible. If your basal doses and timing are not correct, it has an impact on everything else. It may be titled for insulin pumpers but much of the info comes from John Walsh's "Using Insulin" and applies to all insulin users, not just pumpers. Here it is again:
It's been my experience that, as a Type 1, trying to mimic a natural pancreas' function is an inexact science - more of an art
For me, insulin injections and testing have to mean something and the timing is important. It's more important to assess whether I'm trending up or down rather than if the number meets some guideline. I look backwards: how long ago was my last insulin shot& units? meal and number of carbs? BGL test? activity? stress? I look forward: how long till I eat? exercise? how many hours before bed? the insulin's action profile - Rapid or Levemir? I look at where I am: the BGL reading. How I feel. Based on the time of day and the answers to the fore mentioned questions.... I arrive at the decision to (not) inject: how much, and when or fix: how much and what the follow-up is - a snack or a meal. It may sound complicated to some but, this is the process I personally go through (require) every few hours of every day in order to best manage my diabetes. A test is a snapshot in time that leads to a decision to stay the course or alter it and in which direction until the next snapshot leads you to the decision again. Stupid roller coaster, I know, but one that we're not allowed off of. I just try to make the tracks as smooth as possible.
It's in your best interest, Jim, to understand how to manage the D yourself and not rely on any medical professional do it for you. As a Type 1, you have to manage it every few hours - no doc or nurse can do that. Read, learn, log...No one will know you like yourself
Check out the site I mention. Do the basal testing and make sure that's right. Do the ratio testing afterwards. My ratios are 1:8-10, 1:12, & 1:8-10 for breakfast, lunch, & dinner for example. My correction factor is 1 unit for every mmol/L over a GBL of 7.0 (that's 126 mg/dL) and 1 unit for every mmol/L over a BGL of 10.0 after 9:00PM. I don't like to go to bed under 7.0 (126) - too much potential for overnight low and resultant high fasting. The testing and the logging are not rocket science but, do require effort. BTW, you do all this when you go on a pump anyway so, if you're still considering one, why not start now? (MDI is often called the "poor man's pump").
Lastly, I just have to comment on your food choices....we're not like a lot of Type 2s here who HAVE to watch their carb intake and severely limit them to avoid meds. We don't have functioning pancreas' and HAVE to rely on injected insulin to supply our metabolism with what's required. However... the rule of small numbers does logically apply: less carbs means less insulin, means less chance of BGL deviation, up or down. I do eat some of the no-no carb items/products that many Type 2s have to avoid (I find for me I NEED a certain amount of carbs to function optimally), but I still eat them in moderation and balance. For me, eating a pasta with bread meal would see me spiking, testing and adjusting for many hours afterwards. Because pasta, pizza, Chinese buffet for example are such spiky, long-digesting meals, many Type 1's will inject a % of the full carb count before eating and the rest 1.5-3 hours later, just to cover the digestion process.
I'll stop now
Hang in there and let us know how you make out.
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"
"It is impossible for a man to learn what he thinks he already knows"-Epictetus