Honeymoon stage

Coping & Support
21

Munirnara

You can have MUCH better control using both a very fast acting analog insulin, which in the USA would be Humalog, Novolog or Apidra (names may vary in your country) with a long acting insulin such as Basaglar, Lantus, Toujeo, Levemir, or Tresiba will definitely help. If analog insulins aren’t available in your area it gets harder, since human insulin, known here as Humulin or Novolin (R or N of either) takes longer to be effective and lasts longer than the last meal, so you would tend to go high soon after eating, then go low shortly before the next meal. Those insulins need to be taken 30 to 45 minutes before the meal, and may require a snack in between meals.

The other thing I notice is that you are eating very high carbs. For instance 50 grams of carb for breakfast is a large problem, since it requires so much insulin to balance it… and ANY irregularity in exactly how much you’ve eaten, since many times food will be as much as 10% more or less grams of carb believed to be in it will change your results tremendously. Eating lower carbs makes control so much simpler.

Also taking pre-mixed insulins such as 70/30 is always risky, since the shot you take for breakfast is affecting you into the afternoon. It sounds like you go somewhat lower in the afternoon as a result. Taking a larger dose of JUST rapid acting insulin, with a lower amount of long acting insulin before breakfast should improve your results, as well as lower carbs reducing ALL insulin levels, as above.70/30 locks you into a system of frustration, rather than good treatment of this affliction we share here.

Ted Quick
61 years of Type 1 and doing well

22

Hey tedquick & Friends!!
Good evening from Lahore, Pakistan.
Yes, u r perfectly correct about the limitations of premixed insulin & advantage of rapid & long action combination.
For the last 6 weeks or so, I have been gathering all the possible info about the diabetes & insulin.
I will make an appointment with diabetilogist in the coming week & will share the results here.
I am also convinced to move on to fast + long action combination but just need to validate it from a diabetelogist please.

your finding about carbs consumption is also correct. But in our region things are quite different & may be strange for you guys there.
ACtually cultural foods are very high in carbs content. Like our one bread (we call it NAAN or Paratha here) contain around /about 100gm or even more of flour. It is a tradition here to eat atleast one of them during BF, at least 2 each of them during lunch & dinner along with some side dishes which may also contain Carbs, starch & neat sugar. So, psychlogically what will be outcome? I mean, if someone develop DM & cutdown at least 50% of the above stated food then he/she is considered to be too much cautious in eating, while in real he/she like me still consuming relatively high carbs. Sometime family members or love ones even encourages to eat more in a fear of get weaker.

In my case, I m still struggling despite some awareness is due to the above eating habits in the past. I had been a pre-diabetic from 1996 to 2002. But didn’t care & bother too much and keep on eating like before. Then at 40, during 2002, finally diagnosed as T2D. Fear enforced to take some care. Survived 3 years (till 2005) on metformin, diet control, Then next 7 years on sulphonyl urea. Sometime cared too much & sometime not. Now on insulin since 2012. Recently (6-7 week back), I developed an urge to fight it seriously as my inner is telling me that u r almost 55 now so become serious now. So, I m trying and taking help from friends here as to understand the facts more clearly & boost up the fighting spirit.

I wish to thank all the friends here who have responded to my querries with their own experiences and shared some highly informative content.

Good Luck To all of you guys there!!!
Have a nice Sunday there!!

KInd regards,
Munir Nara.
(Lahore 30C, 2007 Hours)

23

OK, glad you already understood so much. As a matter of fact it ISN’T that much different here. High carb has been the forced rule in the USA for the last 50 years or so, since the myth that cholesterol is bad for our hearts was “established” by Dr. Ansel Keyes in 1956, and it became “official” with the government if the 70s. To avoid higher cholesterol we were always told to avoid red meat, pork, eggs and full fat foods of any variety, which left carbs as the simplest solution. Problem is that cholesterol is the feedstock for roughly half of the 200+ hormones that are needed to control our bodies. His “theory” was based on wishful thinking, and was “proven” by carefully selecting where he gathered his information. He traveled the world to “prove” it, while going right past areas, such as France, that didn’t fit his model. Besides which most cholesterol is created by the body, and eating any cholesterol doesn’t matter much at all. That’s why here, your country is likely based on different assumptions.

In any case carbs are always cheaper to produce, easier to store and process than most proteins, so people everywhere that grow or process foods like to keep things simple. It’s also more profitable, so business prefers carbs too. Hard to beat, except for the fact that we, in particular, need to. I’ve been thought strange for my eating habits since 1962 when my endocrinologist put me on a relatively high protein reduced carb diet, but that’s why I’m still alive and well 55 years later. I always need to remember that MY health doesn’t rely on anyone’s opinion of my eating habits, and most people accept that I’m doing what’s necessary. That’s what you need to learn to do, too.

American health has been poorer ever since, and hopefully will be corrected by real medicine based on facts, rather than myths.There is a growing movement aimed at treating the WHOLE person, rather than just a single system or component as done today. It’s called wholistic, eastern, Ayurvedic and/or natural medicine, and likely was normal in most parts of the world outside of the USA until recently.

Of course you DO need to discuss this with your doctor, and if he’ll let you you can both learn, but his opinion IS legally defined in most countries, so don’t try any major changes without him at least knowing what you are doing and generally agreeing with it.

24

Hello Tedquick & friends here!!

Good afternoon from Lahore, Pakistan!!!

I forgot to congratulate you on your wonderful control & struggle on DM. It’s really nice to know that you have so far gone exceptionally well in your all efforts. It may possibly be a dream only here for a majority (probably more than 90%) of DM persons. I really appreciated your highly informative response which have increased my knowledge too. I have been trying to gather more & more information & knowledge as to go well onward seriously. I have been providing awareness to many in my social circle since long, though before 6-7 weeks, I myself was unaware of the several facts relating to insulin, previously my awareness was all about T2d without insulin. I have a colleague here which is also my close friend, who sadly developed T2D about couple of years back, but on various events he thanked me a lot every time that due to awareness given, he was lucky enough to be diagnosed at very early stage. Now he is doing very well at 41, & well controlled on exercise, reduced diet & only metformin. His numbers are almost as good as a normal person (mostly ranging between 100 - 150, maximum known peak 180, HbA1C just under 6%). The best part of it, is that, in turn he too started giving awareness in his family & social circle (he has inheritance DM in family circle) & luckily one of his relative just diagnosed at the border line of DM (GTT test , 2 hours reading was 208).

I mean to say that I am gathering all the info & knowledge to pass on to others as to be benefited as much as possible besides keeping my own numbers well, because here is almost no concept of awareness & visiting to the Doctors. If somebody have a headache then generally people take a pill or 2 of panadol to go well. Therefore, I have a objective in my mind to give awareness to others as much as possible, that’s why I am keep asking to you guys & friends there as to be more knowledgeable. I hope, friends there will be keep helping me.

From the efforts made during last 6-7 weeks, I realized that despite taking insulin regularly & reduced diet, BG still remain high for sometime after each meal which may make at least 8 - 9 hours daily out of 24 (means a full year in every 3 years), which need to be addressed & need correction.

In this context, I have a question for you & friends there:

  1. Could it be possible to reduce the spike after meals ( due to carb intake) by adding some other thing rather taking the neat carbs directly?

Specifically when it is hard to reduce carbs in take too quickly. By adding some other thing rather taking the neat carb, means, to do some trick to reduce the tendency of carb to spike quickly. For example, rice do that, but if boil them & then remove water from it, then we may expect less spike for the same amount of consumption.

I will appreciate if you & friend could help please.

Kind Regards,
Munir Nara.
(Lahore 34C 1241 Hours)

25

Munir,

To some extent you can slow down carb absorption by eating it with good fats (highest effect) and protein (second best effect). High fiber especially when it’s part of the carb (not likely an option) will also slow it down. That is to say high fiber vegetables will keep the sugar in them bound up longer in digestion so it won’t increase bg as fast, and be more moderate for a longer time. Adding fats will slow down absorption of sugar a reasonable amount and extend the higher level over a longer time. Things DO average somewhat. For instance, if you were going to eat a slice of bread or toast be SURE to put a lot of butter (not margerine) on it to slow it down.
Not that this exactly relates to your question, but I and SOME other Type 1s have found that carrots are different depending on how they are prepared. A raw carrot has quite a bit of carb in it, but it is rather heavy bound to the fiber in it, and much of it will not be released during digestion, so bg rise is minor. But when I eat a COOKED carrot the carbs have separated from the fiber to a great extent, so my bg spikes fast. This seems to vary widely, some find it affects them, some don’t. The more processed the food the more likely it is to create bg spikes.
Another separate thought for you, exercisng to lower bg ONLY works if you are below 250 mg/dl when you start the exercise: if above that it will keep on rising.

26

hello @Munirnara, sorry I have been away from my computer. I am glad you are getting feedback.

regarding fasting, you could fast if you knew your requirement and used a “basal” insulin such as glargine (basaglar or other as previously said). in my opinion, you will not be able to completely fast on 30/70. once your “basal” insulin is determined, and this can take testing over many months, your blood sugar can be reasonable without having to eat. I wouldn’t be able to guess if you could switch and be ok in a few weeks.

If you had a pure long acting, then you would simply not use any fast acting and not eat. of course, insulin is tricky I hope you will not find trouble if you need a little sugar during the day. my guess is you will feel better and you will not be required to eat as you are with 30/70.

regarding your first question and the data: please let me start by saying that diabetes care is an art, maybe 50% but not much more a science. any activity, even climbing stairs or walking within the 2nd hour of taking insulin can change meal blood sugar outcomes dramatically. given your mix of insulin, I say that in the morning, you have nothing “on board” there is no insulin available to help convert blood sugar, in the morning you may have higher insulin resistance as well. a small amount of carbohydrates could cause blood sugar levels to increase very high very fast. a modified strategy woudl be to take your 30/70 a little earlier, and give it time to start working before you eat. When I was on “Regular” (the 30 in the 30/70) I notices it didn’t start to work for 45 minutes. please be very careful if you try this. at lunch time, you still had working insulin when you injected. This insulin then “helped” the new shot as you started eating. this would tend to reduce the maximum spike of blood sugar after the lunch meal, again, so would any activity even mild walking. I often use a walk instead of additional insulin (when I know there is insulin in my blood) and my sugar is a little too high. exercise will not help if there is no insulin.

you can see the typical absorption of different insulin formulations if you look up “PHARMACODYNAMICS”

https://www.ncbi.nlm.nih.gov/books/NBK278938/

don’t forget your mix is a combination of “regular” and a formulation called “NPH” and that NPH is one of the more difficult to predict. I used to mix my own, instead of 30/70 I had a vial of regular and another of NPH. I could use the regular alone for corrections and mix them for a kind-of-a long acting effect. If you can’t get glargine, mixing your own, or just getting plain “R” (regular) might also be worth a look.

27

hello @Munirnara, one additional thought. you were asking about sugar absorption rates in your conversation with @tedquick, and I have very similar observations: example milk fat plus sugar can slow absorption for several hours, grains such as durum wheat, can also slow the absorption of the carbs for hours, when mixed with a fat such as olive oil, I have experienced up to 4 hours of delay.

the rating for carbs that absorb fast or slow is “glycemic index”. you can find a database here:
http://www.glycemicindex.com/foodSearch.php

28

Hello @Joe , @Tedquick & friends here!!!

Good evening from Lahore, Pakistan.
I want to say my special thanks to both of you guys there for helping me.
I have been started learning a lot. Whatever, I have learnt in these 6-7 weeks, I haven’t before though a confirmed diabetic since 2002.
Both of you have tremendous practical experience of handling & managing diabetes which has been a great & useful for people like me who are facing problems which you had faced in the past.

The trick stated in above response (bread slice with butter) has been coincidentally verified & tested & found valid. During extensive testing during the 6-7 weeks, once it had happened that I put some lurpak brand (lighter version) butter on the slice rather to consume it with fried eggs on that particular day, & checked BG as usual & surprised to see that BG was not so high on that particular instant but I didn’t investigate the reason, but now I got the answer correctly. Similarly from your experience of real life with diabetes, your all the answers & comments are great.
I am convinced to move on to (FAST ACTING +LONG ACTING) formula, but I couldn’t get the appointment from diabetologist in this week rather expected in week after, then I will share you my results with you.

Have a nice morning there!!!

Kind Regards,
Munir Nara.
(Lahore 40C, 1700 Hours)

29

Hi All friends There!
Good day!!

I am extremely sorry to @joe & @tedquick for not getting back since 3 weeks. The reason is the appointment with the Endocrinologist, I got it nearly 10 -12 days back, he put me on Apridra & Lantus & asked for a follow up after 2 weeks, then I decided to do some homework before getting back again here, as I have no idea how to go well with Apidra & Lantus combo, whereas, Humulin (30/70) had been quite friendly with me since 2012, & makes me tought well, how to play with it nicely? Endo just told me to follow the prescription (10+10+10)Apidra & 20 units lantus at night. I tried every day but my numbers are all over the place anywhere, with the exception of couple of good days in between. Actually, by comparing the results so obtained so far, it looks like sometime that humulin was better than this? I am too confused, stressed & worried to write here, please help!!!

Unfortunately, 3 days back I got an infection on inner thigh ,too close to groin area, & since BG are going high (above 200) mostly, no matter how many units of Apidra I inject? & how many times?. I told this to my primary healthcare doc, who told me that during infections it is happens. But I am still wondering what is going on? in those couple of week, done lot of experimentation but nothing working for me!!

Could you & anyone here help please?

Kind Regards,
Munir Nara.
(Lahore 38C, 1235 Hours)

30

Munir,

It is challenging. You really need to get each kind of insulin working better, then work on the other one next, BUT you need to take both all along. That is, you should likely get the basal Lantus dose advanced first, while taking a basic amount of Apidra. Never change doses more often than 3 days, since you need to get your body working with 1 dose before changing it. That lets you get a stable bg chart on the 3rd day that shows a stable response. Then you can decide if that insulin needs to be increased to lower readings for the part of the day. This would show best for Lantus overnight. While doing that take a set dose of Apidra so that it won’t confuse the Lantus results.

Of course the infection you have now will delay this, since it DOES tend to raise bg levels all the time, and so you won’t get results useful for long term treatment until AFTER the infection is cleared. Even so if you find a fairly stable pattern during the infection treatment it will give you a basis to start from later. Get your doctor to treat the infection FIRST, in any case.

Apidra (which I’ve never used) is the fastest insulin, so you need to be very careful to keep the doses minimal until you have a solid idea of how much you need. In any case if you find you come out at a fairly equal bg 2 hours after a meal with Apidra, even if it’s higher than you need, it will give you a pattern to base further increases on later.

When you take your Apidra how soon before a meal is that? Being so fast it’s VERY important to tome it correctly or you may go low soon after eating, then high when your glycogen is automatically released to save you, and it’s too much, so you go high. Anyway you may want to try taking Apidra JUST before eating, and if you then go low take it just after the meal and see if that works better.

Let us know what’s happening.

31

hello @Munirnara, when you make a drastic change to your insulin, you have to learn it all over again. when I switched from lantus/humalog to the insulin pump, it took me 6 months to get it all right again.

@tedquick is spot on in my opinion, very good advice, but I want to add that with apidra, I find it spoils the point to take 10 units and then eat according to how much I inject. INstead, I vary the fast acting dose (in your case apidra) to the amount of carbohydrates eaten at a given meal. There is a protocol to test if you took the right amount of fast acting and it involves trial-and-error. (it is explained fully in “Think like a Pancreas”) do not proceed unless you are OK with adjusting your insulin yourself.

you calculate the amount of carbs in a meal and inject apidra after testing your blood sugar. lets say your blood sugar was 5.0 before the meal. you wait 2 hours after the start of your meal and test again. your next blood sugar at 2 hours should be 7.8 (2.8 above your first reading) if it is higher, you didn’t inject enough apidra, if it is lower - too much apidra. you wait and do the test again the next day making appropriate adjustments. this is called the Carbohydrate ratio and it is a great way to know how much apidra you need per the amount of carbohydrates.

there are similar protocols for testing if your lantus is right as well. it involves skipping meals at special times and determining if your blood sugar is rising or falling.

sorry it took so long to respond I am commuting to a project that is 4660 km from my home. thankfully, not every day.

good luck!

32

Hello @tedqucik & friends there!!!
As I am getting close to 2300 hours here so I may anticiate an early morning hours there!! (may be)!!
So, Good morning there!!!
Many thanks for your detailed & too much informative response please. Yes, I agreed that dose changes must be not too frequent, rather I was just making my way gradually towards some acceptable readings & succeeded to bring down the spikes of 300-350 to under 250, but sadly hit by that nasty SCALP infection which took away all the efforts from me inside couple of days. For example, towards yesterday late evening, I succeeded to get 101 mg/dl, offcourse feeling too much hungry for not being eating reasonable since morning, even after taking 3 x10 apidra, so, finally I consumed around 60 gram carb at dinner. Two hours later, (@11:30PM) I checked BG & got 344, too much shocked to see, as my entire day efforts has been wasted in a couple of hours run. Naturally, I went crazy & took 10units of Apidra once more, & didn’t take anything, not even 1g carb,checked at 3: 30 AM again & got 208, checked again at 8:30AM & got 191. Lantus (20 units) were taken around 11PM. I mean, I have been doing dose changes abruptly in state of too much frustration. But I respect your advice, not to do too frequent changes & I will try to follow from here onwards!!

Generally, I took apidra almost 15 minutes before meal. But during these stated episodes, specially when running high, I did try to get it before an hour too; but never went into HYPO zone, rather never been there since its start from couple of week back. Minimum, I got so far in 90’s.

From those crude & bad experimentation, I am wondering, How does Apidra works?. I mean, If it is “344” & 1 unit drops around 30 then 10 units should drop “300” leaving behind only “44”, which didn’t happen inside 4 hours, not even after 8 hours. But sometime, I had noticed that apidra may have a tendency to drop BG by 50/hour or even 60/hour
Further, It has been seen that apidra’s power starts wearing out after 4 hours, so @50/hr, it would be capable to dispose only “200 mg/dl”, means, if there will be “350” at the start then it may be ended up at “150” after 4 hours. Right? , If there is some correction then please let me teach please, as to learn more about fast insulin.
Secondly, how many units will be required to bring down BG by 50mg/dl in an hour?
From yesterday experiment, It appears that there was only around 35mg/dl drop per hour (140mg/dl drop in 4 hours) when apidra =10 units, which looks that 1 unit apidra drop = 14mg/dl, So, will I get “28mg/dl” drop in case apidra = 20 units?

I will appreciate your kind & valuable response please.

Kind Regards,
Munir Nara.
(Lahore 30C, 2320 Hours)

As regards SCALP infection, it is getting better & primary care doc told me that it would take 3-4 more days to get even better.

33

Hello @Joe & all friends there!!!
I think, I was replying at the same time as you were replying too, after submitting I got your above reply. Thanks a lot for taking sometime for me despite you are so away from your home, Good luck to you for your ongoing project as well. The guidelines explained above are well understood & I will try to practice it & will share the results as well, but it will take some time as I have been going through the scalp infection due to which nothing is stabilized, but I am on it. Further, I have been switched to Apidra & Lantus, combo, therapy just a couple of week back, too little time? But in the meantime, I have couple of interim questions as to see off infection phase comfortably.

1 - How apidra works?
I mean, let’s say, if pre-meal BG is 200mg/dl, & decided to consume meal (let’s say around 40g carbs), which may raises BG by another 200, bringing total possible value around “400”, but before start eating, inject " XX" units of apidra & wait for about an hour as to allow the pre-meal “200” BG value to come down a little bit as to avoid too high spike after 1 hour of eating. In that case, how can I calculate “XX” units of apidra? as to avoid to see some “300” or more after 1 hour of eating?

Kind Regards,
Munir Nara.
(Lahore 32C, 1252 Hours)

34

hello @Munirnara

thanks I am fortunate, I fly back-and-forth so I am not away from home that much but I do spend a lot of time in airplanes.

Apidra starts in 15 minutes or so, and works for 4 hours or so with a peak at 1 hour or so. it is just like Humalog or Novolog.

If you inject into pure fat, or closet to muscle, these numbers can shift.

If you are active (anything that increases blood flow) Apidra can have 2x power

If you exercise, Apidra can have 4x power

All standards are at +2 hours after eating, the +1 hour is not informative and tells more about the way your body is absorbing sugar than how insulin is working. all references are to +2 hours after eating.

sorry about the mmol/l I didn’t realize you were using mg/dl
it is very important to watch that your do not go hypo and have sugar around in cease you get into trouble. do not try this unless you are comfortable.

test Correction factor
with no eating, and no exercise above “normal” you need to find out how much insulin you need to drop your blood sugar. when you get a 200 mg/dl, you inject a “guess” and measure blood sugar at +2 hours and +4 hours. my first guess was 32 mg/dl per unit, so for me, if I get a 200 and I want my blood suagr to be 100mg/dl, I inject ((200-100))/32 = 3 units. and then test at +2 and +4 hours. adjust your “correction factor” as necessary and try again. I was pretty close my corection factor ended up at 30 mg/dl per unit insulin.

don’t try any of this with an infection as infection, steroids, stress will change everything.
again - walking you get 2x power, running 4x-10x power. it is very important to keep notes on how active you are.

Joe

35

Hello @joe & all friend there!!!
Good day to all!!!

Thanks @joe for supporting me when I needed it most. Glad to know that you are back home too. You have explained all about Apidra is tremendous. It really helps me a lot through these days of passing through scalp infection. Basically, I was too afraid to inject more apidra in one go, but after your great response, I injected 15 units in one go, & then wait about an hour, so that pre-meal “211mg/dl” came down, then eat about 35-40 gram carb meal, & checked BG @2 hours & found “179”, checked @4 hours & found “132mg/dl”, means, it works & showed better control than before. In state of infection, I have more tendency to eat, that’s why I inject an extra shot of apidra & checked, found within range, if not, in two hours, but for sure in 3 hours. If I tried too hard to avoid eating then I feel too much weakness, unable to walk properly, drowsiness, dizziness, fatique. These symptoms disappears when I take reasonable meal (around 60 carb meal),but got high BG in next 2 hours, which didn’t stay there too much & comes back within 210-230 in 3rd hour. I discussed all these with primary care doc, who advised me to take proper meal, because, more energy is required to heal the wound/infection. So, let’s finish this phase then I will share more results too.

Hopefully I am expecting to see assistant of Endo,on 21st June as follow up visit.
Thanks a lot again for helping.

Kind Regards,
Munir Nara.
(Lahore 37C, 1220 Hours)

36

Hello @joe,
Good day there!!!

One more result need to share please.
Today,Checked BG = 125mg/dl at 8:30AM. Inject 15 units Apidra, took breaffast around 9AM & carb was around 65grams. In between office hours & outdoors didn’t find to check BG @2 hours.Checked BG@4 hours (1:00PM) & found “27”. SUrprised me???. Didn’t feel any sign of HYPO during all these 4 hours? , yes, not feeling well since morning, rather feeling very passive & unfocused, but I supposed that it might be due to infection.How do u see it?

Kind regards,
Munir Nara.
(Lahore 37C, 1322 Hours)

37

hi @Munirnara, this is the danger of medicine. I am very glad you didn’t end up unconscious with that low. A hypo can com with warnings, or sometimes they can sneak up on you.

I suppose my best guess depends on how active were you compared to normal? Also, if I do have a meal with over 30 grams carbs, I try to be very careful for the next 4 hours. Careful meaning testing more and if I have to, adding sugar (such as juice). Everybody is different, but I find that 30 grams carbs keeps my need for insulin lower and my blood sugars a bit more predictable. I “typical” shot for me is about 6-7 units of fast insulin.

the law of small numbers is just that: big numbers (large carbs and big insulin shot) can lead to big mistakes, small numbers can lead to small mistakes. I do a lot better limiting carbs at meal time to 15-35 grams. Hope you are feeling better today.

38

Hello @joe & all friends there!!!
Good day!!

Thanks for being so nice & supporting consistently. Yes, I was feeling better in next 30 minutes then after doing correction, & checked again after 2 hours & found “125mg/dl”. Today, I was even more careful. Morning level “125”, injected 15 units of apidra, wait about 30 minutes, BF at 9AM (reduced carb intake today, took around 40 grams).Checked at 11AM, “157”. So going well so far!!!. Your saying about small numbers have been verified in a way & found OK.

Your guess regarding activeness is OK, yesterday, I needed to go out for a couple of times as compare to today, which means more active on yesterday than today.

Many thanks for your consistent help in seeing off these terrible days of scalp infection!!!

Kind Regards,
Munir Nara.
(Lahore 30C, 1208 Hours)

39

hi @Munirnara good I am glad you weren’t sick from that low. let us know how that endocrinologist visit goes. you are welcome we are here to help each other! best of luck!

40

Hello @joe & all friends there!!!
Thx a lot for your kind & consistent support as to go through the ongoing infection days comfortably, it is about to heal.Yes, visited to the Endo (assistant) yesterday. updated her all about the happenings taken place so far in last 3 week. She told me just relax & be patient & advised to do continue with Apidra /Lantus (combo) as these are far better than previous insulin (humulin30/70). Further, advised me to increase the doses from (10+10+10) to (15+15+15) & see the outcome & in case if there is any problem just try to reduce/increase few units as per the numbers seen, but make sure BG must remains within the target ranges. She went on to advise that no matter how much & how many times it requires to inject; but numbers must be in target range, otherwise it is of no use.She also validated that due to the ongoing infection, it has been difficult to figure out everything right now, so just follow the advice & prescription for the next couple of week of time; & come again; but do not play with Lantus as it has been going & doing well, just try it with Apidra as per the need. Lastly, advice me to stay or atleast try to stay with either the same or similar meal plan without changing it too often; till we get some stability in numbers, & also ongoing infection gets over & then we will move on.

So, I have been following all these & my numbers are getting better.
Thank you so much for helping me as I am feeling that some sort of unexplained
anxiety has been getting over too!!!

Kind regards,
Munir Nara.
(Lahore 32C, 1520 Hours)

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