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Thank you for bringing your question to dLife. You have more than one thing going on that is challenging your glucose control. You are on a rapid acting insulin 3 times a day at a pretty high dose. You are on a NPH insulin that works for about 6-8 hours. Two oral meds that work very differently are also part of your treatment. Very complicated. My first thought is that timing is everything. The N insulin may be causing a rebound effect overnight better known as the Somogyi effect. The rapid acting insulin needs to be taken about 10-15 minutes before the meal so it will act as you ingest the carbs. Metformin will help with preventing the liver from producing glucose when you have lows. The glipizide, when taken for more than a few years can stop being effective.
Are you seeing a Diabetic Specialist? Your treatment is very complicated and may be causing all these unexpected highs and lows that you can not relate to what you eat. Have you had blood work testing to determine insulin resistance? Have you ever logged your fingersticks in the middle of the night? I suggest very structured meal times, very precise timing of your oral meds and insulin and doing fingersticks at fasting, 2 hours after breakfast, right before lunch, 2 hours after lunch, right before dinner, 2 hours after dinner, at bedtime and at 3AM. You do not need to do this all in one day. Just keep a log and really schedule your meals and sleep/wake times. After you gather all this info, show your provider. Maybe then a clearer picture will emerge. I think you can discuss carb counting and learn to adjust your rapid acting insulin. Ask your doctor. Read About Somogyi Effect Click here to read it.
Thank you for bringing your question to dLife. You have more than one thing going on that is challenging your glucose control. You are on a rapid acting insulin 3 times a day at a pretty high dose. You are on a NPH insulin that works for about 6-8 hours. Two oral meds that work very differently are also part of your treatment. Very complicated. My first thought is that timing is everything. The N insulin may be causing a rebound effect overnight better known as the Somogyi effect. The rapid acting insulin needs to be taken about 10-15 minutes before the meal so it will act as you ingest the carbs. Metformin will help with preventing the liver from producing glucose when you have lows. The glipizide, when taken for more than a few years can stop being effective.
Are you seeing a Diabetic Specialist? Your treatment is very complicated and may be causing all these unexpected highs and lows that you can not relate to what you eat. Have you had blood work testing to determine insulin resistance? Have you ever logged your fingersticks in the middle of the night? I suggest very structured meal times, very precise timing of your oral meds and insulin and doing fingersticks at fasting, 2 hours after breakfast, right before lunch, 2 hours after lunch, right before dinner, 2 hours after dinner, at bedtime and at 3AM. You do not need to do this all in one day. Just keep a log and really schedule your meals and sleep/wake times. After you gather all this info, show your provider. Maybe then a clearer picture will emerge. I think you can discuss carb counting and learn to adjust your rapid acting insulin. Ask your doctor. Read About Somogyi Effect Click here to read it.
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