Logbook about switch to Humalog, 1st week.

>>>> Logbook about switch to Humalog insulin, 1st week. Last update: April 4, 1999 <<<<

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October 21, Monday

Time:	BG's (mmol/l):	Additional comments:
Before breakfast:	2.0
2 hours after breakfast	14.0
half an hour before lunch	10.0
2 hours after lunch	7.3
half an hour before dinner	12.0	half an hour after injection: 5.3 mmol/l.
2 hours after dinner	17.3	I injected 3 units additional!
2.5 hours after dinner	3.8	I eat some carbon-hydrate rich stuff
before sleeping	7.8

This was the first day for me, using Humalog. Tomorrow I'll discuss the results with the diabetes nurse. Of course I've got some questions, and some results are frightening me a little bit. In the former regimen I used to inject the Actrapid and wait for a while before starting to eat, so the BG could drop to normal level. Humalog acts in a very different way! Even when having a high BG, it seems I can eat instantly after injection!

The evening was strange to me, because the very high BG dropped so quickly after injecting 3 additional units of Humalog!! Because I was in time to react properly, there were no side effects (i.e. hypoglycemic symptoms).

After discussion with the diabetic nurse (Tuesday afternoon), the following things were made clear to me:

The very fast drop of the BG after injecting 3 additional units Humalog could be caused by a simultaneous reaction of this insulin in combination with the insulin injected before dinner.

Conclusion: I've to wait 3 hours before thinking about adding some extra insulin when the BG is to high.

Getting a higher BG in the evening (or late afternoon) hours could be caused by the insulatard. Maybe this insulin is not active anymore.

When the Humalog insulin regime is under control, I will try to split the insulatard injections (4U before sleeping and 4U before breakfast).

October 22, Tuesday

Because of the high BG's after breakfast, I decided to inject 8 units Humalog before breakfast. Because of the high BG after dinner I've injected 13 units before dinner (instead of 12). Additional injections are listed where it was needed.....

Time:	BG's (mmol/l):	Additional comments:
Before breakfast	4.8
2 hours after breakfast	6.3
half an hour before lunch	2.8
2 hours after lunch	5.0
half an hour before dinner	13.3
2 hours after dinner	12.1	I injected 1 unit additional
4.5 hours after dinner	18.6	I injected 3 units additional
before sleeping	16.3

When looking at these results, there are some remarkable changes compared to the BG's of Monday. Of course, this is logical because of the defensive start. During daytime there was only one small problem before lunch. I took an additional slice of bread and that's all.

The problem of high BG's still exists in the evening. Tomorrow I will discuss this with the diabetic nurse.

Because of this new regime, I've decided not to do things in a different way (I missed the nice dinner party with my colleagues this evening - okay, that's a part of the game ;-) ).

October 23, Wednesday

I discussed the high BG problem in the evening with the diabetic nurse. She told me there were more people having a similar problem with the switch to Humalog. She had to ask the Doc for information how to handle in this situation. Because the doc was busy with other patients, she will call me again Thursday morning. I've decided to have an alternative injection scheme for the evening. This time, I hope there will be enough basal insulin during the evening:

Time:	BG's (mmol/l):	Insulin:	Additional comments:
Before breakfast:	4.0	8H
2 hours after breakfast	6.8
half an hour before lunch	3.2	6H (injected just before lunch)
2 hours after lunch	5.7
half an hour before dinner	5.5	6H + 6 Actrapid
2 hours after dinner	11.3
before sleeping	17.3	8I	3 Humalog additional
In the middle of the night	6.6

BG's during the daytime are similar to yesterday, except the BG before dinner. I did not have to work in the afternoon; maybe this has caused the difference? Tomorrow I will try 7H in the morning trying to avoid the low BG before lunch. In the evening I had my stage-actors training. This went alright, but I took a snack there. Maybe this has caused the high BG before sleeping. Additional Humalog (3 units) corrected this properly.

October 24, Thursday

As mentioned yesterday, I will start with 7U Humalog in the morning, later this morning the diabetic nurse called me and asked me for the results of yesterday. When I told her my decision to combine Actrapid and Humalog insulin in the evening, she could understand it, but this will not give additional info about the switch, of course. She had discussed my problems with the Doc, and to avoid the aforementioned problems in the evening, he proposed the following:

My Doc doesn't seem to be in the mood for splitting the Insulatard injections right now.

Time:	BG's (mmol/l):	Insulin:	Additional comments:
Before breakfast	7.5	7H
2 hours after breakfast	9.7
half an hour before lunch	8.6	6H (injected just before lunch)
2 hours after lunch	14.3
half an hour before dinner	12.8	16H
2 hours after dinner	12.7	2H additional
4 hours after dinner	12.7		3 Humalog additional, 4.5 hrs after dinner: 11.0 mmol/l, I took a shower.
before sleeping		8I

In the morning I ate a (delicious!) pastry (birthday of a pathologist at my work). This was in addition to my "normal" breakfast. Although this was a sugar-free pastry, it contained carbohydrates of course!

Also the BG's in the afternoon were still higher, but I decided not to react to this (I still had to do some work!). The BG before dinner was around 13 so I decided to inject 16U before dinner. After dinner it was made clear to me 18 U would have been more realistic!

Why my BG doesn't drop when injecting 2 additional units Humalog in the evening is unclear to me. After the shower (half an hour later) the BG dropped a little bit. This was also the time to inject my daily portion of Insulatard and go to sleep. (after updating this logbook, of course).

October 25, Friday

This day will be different, because I don't have to work in the lab. Okay, I've to do some housekeeping, which is work for me as well of course! :-) Most of my day is more relaxed; for example I woke up about 10 AM (I like that!!). I will closely look at the results in this case, because there is less time space between the meals today.

Time:	BG's (mmol/l):	Insulin:	Additional comments:
Before breakfast	5.7	7H
2 hours after breakfast	8.7
half an hour before lunch	LOW!	6H	Oeps, took another slice of bread
2 hours after lunch	13.9
half an hour before dinner	11.1	16H
2 hours after dinner	4.6
4 hours after dinner	10.0
6 hours after dinner	6.8	4I
Before sleeping	4.1	4I

This afternoon I spoke my doc and he asked me how it went.. I told him Humalog is working a quarter of an hour BEFORE injection!! :-).

Compared to the days before Thursday, the BG's during the evening are significant lower (although the "normal" level isn't reached yet).

Of course I've informed my colleagues about the insulin switch. Normally I'm a busy person, but this week this seemed to be more pronounced! They were thinking I was using other hormones too! :-).

How a human being reacts depends on different aspects of course.I want to mention the following specific aspects:

October 26, Saturday

Weekend for me means, wake up late, drink coffee and have a delicious brunch!! :-). In the afternoon I've to do some shopping. This evening I've planned to join a birthday party. Tomorrow afternoon I'll visit my sister to help her with some database problems. This information is only mentioned to show you there are some factors which may cause
other results than predicted.

Because I will return home late tonight, I will split the Insulatard injections again.

Time:	BG's (mmol/l):	Insulin:	Additional comments:
Before brunch	5.3	6H
2 hours after brunch	5.8
half an hour before dinner	5.3	12H
1 hour after dinner	3.1		took additional carbon-hydrates
2 hours after dinner	6.6
5 hours after dinner	9.5	4I
Before sleeping	13.1	4I	I ate a delicious "broodje Shoarma", therefore injected 6H additional.

It is difficult for me to calculate how many units Humalog are needed for meals I've made myself. Before measuring the low BG (3.1) I felt some hypoglycemic symptoms. My reaction was in time, so nothing serious happened. I decided not to join the birthday party, because the low BG after dinner. I went downtown later this evening to meet some people. I've had a lot of fun and there were no problems about my BG control.

October 27, Sunday

This afternoon I will visit my sister, to help her with setting up a database. As a reward I will get a delicious dinner! :-) Because of the BG drop after dinner yesterday I will inject 8 units Humalog before dinner and see what will happen.

Time:	BG's (mmol/l):	Insulin:	Additional comments:
Before brunch	2.3	6H
2 hours after brunch	10.5
half an hour before dinner	9.3	8H
2 hours after dinner	8.7
4 hours after dinner	15.9		3H additional
Before sleeping	14.8	8I

The low BG when I awoke, was expected (felt symptoms). When using Actrapid, I was used to inject 6 to 8 units to keep track of my BG's, when eating a snack before sleeping. Next time I will inject 4 units Humalog when eating a "broodje Shoarma".

As I told before, my sister can cook very well, so I eat a lot of this delicious dinner. I think this caused the high BG later in the evening. Additional Humalog was needed. As you can see the BG dropped a little bit, but I think it will be alright tomorrow morning again.