Basal is Fine!

Maybe I'll post my doctor's comments on here at some point... maybe right now actually. Early this January I was concerned about my lack of control and wrote to my doc, Dr Saudek. During the winter months I tend to have difficulty keeping my sugars in control. Usually I had many others problems, including Holiday parties, depression, apathy, or poor medication. But this year, most all of that was eliminated and I STILL had great problems keeping my sugar levels controlled.

"Hello, I'm becoming more and more concerned about my insulin usage.
Briefly, my HA1C is ~8.9 and I have been having problems keeping my BG under control during winter months. When I met with Dr. Saudek onJan11th, he made a couple suggestions. First, I increased the correction ratio from 1:50 to 1:30. Second, I increased my carb ratio from 1:15 to 1:10.
Since then, I still see high BG levels, even when I have increased my carb ration to 1:8. For several mornings, I started at ~180 and without correcting; I am at ~160-170 by lunch time. This lets me know that my basal of 1U/hr is about right. After lunch of a very specific carb amt and a correction I still end the day at 5-6pm with a BG of180-190. This tells me that the correction or carb ratio is off. Other nights I start high at about 190 and take the correction at 1:30.After 2.5h without eating I am at 120. This tells me that my carb ratio is probably wrong. So I increased it to 1:8. I STILL have a BGof ~180 before dinner when I had a lunch BG of 100 at lunch.
Before I increase it further to 1:5.... I worry that this is getting crazy with the insulin dose. Is this normal? According to other people, this is the dose for a 250lbs inactive man. I am a 170lbs fit man. I don't exercise a lot, but I'm far from a vegetable. Aside from Max Bolusing when I eat more than 100g of carb at a meal, what should I be worrying about? Is this normal? I really need some help figuring this out.
Thank you for your time and help. If needed I can send a spreadsheet of BG readings on Monday from my work PC."


He actually got back to me quite fast and said that my spreadsheet would be quite helpful.
"Dennis I don't have chart but Sounds like basal is too low esp over night you should not have fbs [fasting blood sugar] over 120-130 Do send your spread sheet"


OK... so I send him the sheet with a message and he responds, again very quickly, with his response within the message to each question I pose.
"Dr Saudek, I attached the graph of the past couple weeks. NO PATTERNS EVIDENT IN THE GRAPH. MAINLY A LOT OF VARIABILITY. I wanted to assure you that the mornings I woke at 180 were due to me not checking before bed and waking high. THIS IS TOO HIGH A WAKE-UP FBS... SUGGESTS THAT YOU DO NEED A SIGNIFICANT "DAWN RATE" TO BEGIN WITH. NANCY CAN WORK ON THIS WITH YOU, AS MUCH AS 50% INCREASE IN BASAL RATE FROM 4 A.M. TO 8 A.M. Typically my post dinner readings are high, and if I correct, I wake at either normal (~100) or low BG (at ~4am). SO THE GOAL IS TO GIVE THE RIGHT AMOUNT BEFORE DINNER, SO YOU ARE NOT HIGH AT BEDTIME. Thank you for taking the time to look at my records. Several of my lows aren't recorded and I will try to take those measurements before eating.
PLEASE DO BE IN TOUCH WITH NANCYELLEN. CDS”





So its like he's not listening. Its like he doesn't understand what I'm saying. My basal is fine. Again, I went to bed at 166 and woke at 105! If I increased my basal by 50% in the 4-8am, that would be 60mg/dL drop. I'd be at 35mg/dL this morning. Greeeeaaaatttt advice doc. Hypoglycemic coma is a great way to stop BG irregularity.

Look, I'm a scientist with a PhD in biochemistry. I know what’s going on metabolically and I know how to set up an expt. But sometimes I need help with approaching the question or deciphering the data. And sometimes I'm just tired and frustrated and I've been a poor diabetic, so I don’t like the data, but at least I understand it. But in this case, I had been a very very good diabetic and I was suffering. I've had inconsistent results and repeatedly told Dr Saudek that my correction and basal seem just fine. But instead of offering help on how to adjust the basal or answer my primary question... IS THIS OK FOR MY HEALTH TO HAVE SO MUCH INSULIN?... he parroted back "To much variability and increase the basal."

Ridiculous. The man might as well read from a cereal box because his advise is not sound or insightful. I'm at Johns Hopkins where they apparently keep the tenured doctors in clinics no matter how bad their advice can be. In a very roundabout way, Dr Saudek basically said the dreaded, "You need to check your blood sugar and take your insulin," which is insanely irritating, pointless, and futile. That statement never helps.

In short, my basal is fine. I have a BG and 5hours later, without food or a lot of exercise, it’s the same or close to it. If I go to bed at 120mg/dL and haven’t taken insulin within the past 4-5hrs, I wake up at ~120mg/dL. To me, that shows a good basal.

Always question your doctors suggestions. ALWAYS! You have the right to ask and remember, they are human and tend to make mistakes. Asking questions forces them to defend their response and possibly correct themselves before you leave the office. At worst, you leave with a better understanding of your problem and the purposed treatment.