© Coos Visser, Leeuwarden, Holland >>>> Personal logbook about switch to Humalog insulin. Last update: April 3, 1999 <<<<

Monday, November 5

The first measured BG this day was higher than expected. I eat only two slices of bread (instead of 4) and took the third one before lunch when the BG had dropped to normal level.

This afternoon I had a talk with my Doc. He pointed me on the following:

1. The high BG's I have during the evening could be caused by a hypo before. He suggested me to inject 8H before dinner and see what will happen. After dinner I saw this had to be 8H, I injected 10H this evening because that's what was in my mind...
2. When BG's are to high, I want to correct this by eating less bread. Because this way of correction is an extra variable which makes it more complicated to attain a good basal insulin regimen. From now on, I will not correct the BG's anymore by eating less food. He also advised me not to measure the BG's for one day and see what will happen.

Before the night I eat a handful of gingerbread cubes to correct the hypo and to prevent problems during the night.

Tuesday, November 5

Comments:

I didn't measure my BG's this day. During daytime I had no warning signs. It went alright. In the evening I felt more uncomfortable (some hyper warnings which are hard to explain). That's why I decided to measure my BG before bedtime. I didn't correct it with additional Humalog, just to see what would happen this night.

Wednesday, November 6

Comments:

Last night was filled with hyper symptoms; be thirsty and had to pee several times (which is not usual for me during the night). The BG must have been higher during the night and dropped afterwards, caused by the Insulatard insulin.

This morning was alright. Before lunch my BG had fallen to only 3 mmol/l. This is a more common mentioned problem in this logbook. In the past I've tried to prevent this problem by injecting less Humalog before breakfast, but this creates very high BG's after breakfast! Because I can handle this minor problem (I know it already), I can eat an additional slice of bread before lunch.

This afternoon I spoke with the diabetic nurse, especially to discuss the hyper symptoms of the last night. I will use the proposed insulin regimen, but when having high BG's I will inject additional Humalog!

Before dinner my BG was much to high again. That's why I decided to inject 10H (instead of 8H).

After my stage play practice, where I only eat a small snack, the BG was very high!!! Therefore I injected 4H additional and measured my BG 2 hours later again. It had dropped very quickly and I decided to eat some sweets to prevent a hypo later this night.

Thursday, November 7

This afternoon I spoke with the diabetic nurse and she proposed to inject 12H before dinner.

Comments:

This afternoon I discussed the BG's with the diabetic nurse. The following steps will take place:

1. From now on I will eat an extra slice of bread during the coffee break in the morning to prevent a low BG before lunch.
2. Because the high BG's in the evening I will inject 12H before dinner.

This evening I've thought about what has happened until now:

• During the first and second week, I've tried to manage my BG's with 14H before dinner. This didn't work alright.
• When seeing the results of the last days, it's clear to me the evening is still a big problem to manage my BG's.
• It's made clear these high BG's are not caused by a former hypo!

I've made the following conclusions:

1. High BG's in the evening are caused by the lack of a basal insulin level.
2. Using Humalog to keep control of a good BG level during the evening is NOT the appropriate solution.

When seeing these conclusions, in my opinion there are 2 practical solutions to correct this:

1. Splitting the Insulatard injections in two parts.
2. Using Actrapid insulin before dinner.

Of course there are some benefits and disadvantages when comparing such regimes:

First of all, the BG is already rising rapidly during the second half of the afternoon. I've already tried injecting more Humalog before lunch, but didn't work alright.

Splitting the Insulatard injections:

Benefit: - There will be a basal insulin level during the whole day.

Disadvantage: - The whole insulin regimen has to be changed, which will take some time.

Using Actrapid before dinner:

Benefit: - This will create a basal insulin level during the evening.

Disadvantage: - The high BG before dinner will drop slowly.

Tomorrow I will discuss these considerations with the diabetic nurse and next week Monday with my Doc.

Friday, November 8

Because I had a day off (yes, again ;-) ), I woke up about 10.45 AM.

Comments:

When I woke up, I eat a late, but delicious breakfast! 1 1/2 hours later I had my lunch, so I had some difficulties to plan this... I decided to inject the insulin after lunch. It became about 1 1/2 hours after lunch because I had to visit the diabetic nurse first. I know the BG's were high after lunch, but I didn't measure it. After visiting the diabetic nurse and my Doc I've injected the insulin and measured 2 hours later my BG again.

When discussing the considerations, written down yesterday, with the diabetic nurse she totally agreed with me something has to be done about this problem. Therefore she called the Doc and arranged a visit this afternoon. Margreet, thanks very much!! Also the Doc agreed with it and proposed the following insulin regimen:

Before breakfast: 7 H
Before lunch: 6 H and 4 I
Before dinner: 10 H
Before sleeping: 6 I

When BG's will drop to fast in the afternoon I will inject the 4I before breakfast. I've to find out first what will happen.

Because I weekend life is different and I felt having the BG's under control, I will use the same regimen as used the first weekend. Coming Monday I will start with this proposed regimen.

At least I'm very glad this insulin regimen change will take place now!! Of course, next week will be intensive again, but I'm much more positive about the results.... Just wait and see.

Saturday, November 9

Comments:

Because I've cleaned my house this afternoon, which is a busy activity for me! :-), that must be the reason why the BG has dropped before dinner.

I eat macaroni this evening (fast digesting carbon hydrates) to see how this can be regulated. Afterwards I can see 10 H would be more logical to inject before dinner. Because the BG was rising again 4.5 hours after dinner I've decided to inject 4I a little bit earlier.

Sunday, November 10

Comments:

A close look at the results of the BG's concludes there is to much variation! When the new regimen, which will start tomorrow does work fine, I will continue this next weekend.

When I stay tuned on this regimen I do need 10H before dinner!

Please leave a note if you have additional info!