I think I’ve posted this tip before but it’s such good information I wanted to do so again. I recently had a cortisone shot and my blood sugar started rising a few hours after. I immediately thought to dose more rapid acting insulin (I’m on MDI), but I remembered, when I’d had this situation a year ago, I reached out to diabetes educator extraordinaire, Gary Scheiner, and searched back for the email where he’d advised me. His advice was opposite what I’d thought to do.
Rather than raise your rapid-acting insulin, except of course for correcting an ordinary high blood sugar from food, raise your basal.
Gary says: Most people need to raise their basal insulin by 50% starting about 6 hrs post injection, then double their basal on days 2 and 3, then taper down. Some need to triple their basal. The Humalog doses (rapid-acting) can remain as-is (correct any highs and cover meals as usual); the extra basal takes care of the insulin resistance caused by the steroid.
I take 6 units of Tresiba in the morning and one unit before bed. The day of the shot, which I’d gotten at 2 pm, I saw my blood sugar rising around 6 pm. I took extra Humalog for the rise, but also took 3 units of Tresiba before bed. That’s the 50% extra.
The next day I took 10 units of Tresiba in the morning and nothing at night because it looks like I wasn’t rising. Stead overnight around 93 mg/dl, the second day I took 8 units of Tresiba and nothing at night. Today, the third day, I took my normal 6 unit dose.
I think because I tend to be insulin sensitive eating a low carb diet and walking every day, I didn’t have to take the higher doses Gary suggested. But you may need too. As everything diabetes, it’s trial and error – but knowing it’s the basal insulin to raise is key.
Sorry folks on pumps, I can’t tell you how to translate this.
Doing Diabetes Differently is worth a read, and I’m not saying that because its author, Chad Lewis, has become a friend, or because I’ve written several pages in it. No, I say this because from cover to cover the book offers provocative ideas and methods on how to achieve our best health.
The premise of the book is in its last paragraph, “…you don’t have to accept diabetes as a progressive condition. You don’t have to accept falling apart and dying young. It is possible to safely maintain healthy blood sugars using much less medication. It is possible to live a long and healthy life.”
The promise of the book is in the author’s contrarian thinking about what it really means to live with diabetes, and the attitude and management techniques he shares that arose from that contrarian viewpoint.
I should first confirm Chad Lewis’s street cred. He has lived with type 1 diabetes for more than 50 years and used his own protocols to dramatically turn his eating and activity habits around to support his health, and has sustained a 40 pound weight loss for years.
Having spent a career in higher education and the publishing industry, Chad also clearly sees how we’ve laid a foundation for disempowering people with diabetes – from our well-intentioned health professionals who know little about diabetes and less about human behavior, to “normalizing” diabetes, to standardizing treatments and goals, to an industrialized healthcare system more vested in its own interests than yours, to the coddling and medicating of people with diabetes so that they are less committed, and skillful, to do the rigorous work to be well.
In all honesty when Chad approached me to write one of the several commentaries in the book, after reading his rough draft, I said, “You know, I don’t agree with everything you say.” I think he liked me all the more for it. I do agree, however, with many of his ideas and see their value. For example, his macro-nutrient teeter-totter, that devices should rest on an already stable foundation, and the sense-making of ‘eating to the meter’ and ‘sugar surfing’ as key steps to dynamic management.
One of Chad’s more provocative ideas is his 12-step perspective; calling out your diabetes as a recovering alcoholic would call out his condition. The point being to acknowledge its seriousness.
“Who would you rather be?,” Chad writes, “An acknowledged person with diabetes thinking … “Hi, I’m Bill, and I’m a diabetic, and eating an abnormally restricted diet to safely maintain healthy blood sugars using the minimum amount of medication possible – an approach that leads to glycemic stability, daily peace of mind, and better health. Or…a person who, thanks to the miracle of drugs and devices, can and should eat pretty much like everyone else? Even though doing so may lead to diabetes distress, devastating complications, and possibly an early death?” Actually, this paragraph reflects Chad’s basic management philosophy.
You’ll have to read the book, and my commentary, to learn what I don’t agree with.
Throughout the book is supporting research, resources and each chapter ends with questions to ask your health professionals. Notable endocrinologists Irl Hirsch and Stephen Ponder pen the Foreword and I am joined by four other diabetes patient advocates in the commentaries who add their unique insights, knowledge and lived experiences: Ginger Vieira, Dr. Jody Stanislaw, Delaine Wright and Dr. Randy Elde.
If you’re someone who’s doing diabetes just fine, you might be curious if there’s something here that can help you do even finer. If you’re struggling with your management, or feel overwhelmed by society’s pressures and judgments, I think you’ll find much to utilize here for steady improvements that can lead to a major overhaul. For $2.99 on kindle, how can you go wrong?
All sales benefit the Diabetes Daily Grind, a nonprofit dedicated to providing resources and support for people with diabetes.
I was invited to Chuck Schumer’s grass roots-diabetes advocates rally yesterday. I was there to speak on behalf of Medicare members who gained a win with the insulin cap of $35/month (per script) going into effect January 1, 2023 under President Biden’s Inflation Reduction Act. And no deductible will apply.
Schumer was there because he fought for this. Advocates were there from JDRF, T1 International’s ‘#Insulin4all’ movement, and others, to show their appreciation, and support for Schumer’s resolve to continue to fight for a cap for those on private insurance and those not insured.
Schumer shared that Republicans voted down the cap for those on private insurance and the uninsured, and I shared that last year the husband brought me back 10 insulin pens from Toronto, where it was 1/10th the price (retail). $21/pen in Canada with no insurance needed. Similar to how insulin is priced in most developed countries. The irony of my Canadian haul is that Canadian scientist Frederick Banting, and his fellow scientists who discovered insulin, sold the patent to the University of Toronto for $1.00 so that everyone would be able to afford it.
I also shared my shock when I discovered four months after going on Medicare I would fall into what’s called the “donut hole.” Insulin would then become as costly to me as if I had no insurance. So I hoarded almost two years worth of insulin. Even past-its-date insulin will generally work.
While this win is a long-awaited victory, the reality is people with type 1, and many with type 2, must use two different insulins/day, making the cap more realistically $70/month. That said, those on Medicare will benefit sizably and those who worked hard for the Medicare cap are to be applauded.
If you want to be part of the push to help bring down the cost of insulin further, and for everyone, you can contact your local senators (including Mr. Schumer) and congress people, and join the ongoing efforts of JDRF and T1 International.
Here in New York City, diabetes educator Carolyn Robertson, seems to be known and adored by all. I never met her since she moved out West before I had the chance, but she offers informative/educational webinars every so often under her group, Strong on Insulin, and several are coming up soon on insulin pump therapy.
The zoom sessions below cover the basics of the Tandem Control IQ and Omnipod 5 pumps, as well as identifying your patterns, how to use pump reports and each includes Q&A and sharing at the end. These meetings are open to all, but geared to type 1s.
Diabetes Stories 