Type 2 diabetic starting treatment

Gingersnappy

I'm on insulin (Levemir 10 units 2x/day), Metformin ER (1,000 mg 2x/day), and Januvia (50 mg 1x/day). With these meds, diet, and exercise, my diabetes is pretty well-controlled. My oncologist has said that with the targeted therapy and chemo, along with the steroids, I'll need to be put on a sliding scale fast-acting insulin. Is there a diabetic on here that can pre-educate me about this sliding scale?

SDCA76

Hi Gingersnappy, I posted in the August chemo board about my diabetes experience on my first chemo day today. I see you on there, too. DIabetes (41 years with type I with kidney disease, on insulin pump) was my biggest challenge today with the steroids. To be safe, the oncologist reduced my steroid dose from 2 tabs twice a day for 3 days (12 tabs total) to 3 tabs total--one last night, one this morning, one tonight. They also gave me some IV steroid during chemo today. My BGS were absolutely resistant to more than doubling my insulin. I tested every hour and gave more insulin every hour and my BGs have been in the mid-400s all day in spite of this. The doctor can use an algorithm to figure out how much insulin it normally takes to lower the BG a certain amount. This is the sliding scale. My formula is 1 unit of regular with reduce BG by 40. So if BG target is 110, and my BG is 150, I normally take 1 more unit than I would normally take to get it to 110. Many things affect it, but it is a good rule of thumb NORMALLY. Yours may be very different,but it is the same principle. I know nothing about oral meds but they may increase those drugs accordingly. HOWEVER, this does not work well with steroids. My endo significantly increased my pump basal rate temporarily. I have to be careful, because in a few days the steroid will be out of my system (no exact way to know when!) and I will be chasing severe hypoglycemia. It is one of the hardest things I ever had to manage when I took some steroids for a should problem years ago. Good luck. I hope you manage better than I do and come back to normal soon. I am triple positive, too.Because of the diabetes and kidney issues, they only started me on Taxotere and Herceptin today. We'll see if they can add the Perjeta and Cytoxan next time, but too risky today. The actual chemo drugs were tolerated well and other than the high BG, I feel great so far. Time for more drugs right now==another steroid (ugh!) and anti-nausea medication coming up!

Spookiesmom

I'm T2 on a pump also. You really need to see an endo for help with this. Sliding scale means for X. amount of carbs you plan to eat, you inject. X. amount of insulin. Usually Humalog. Everybody's insulin to carb ratio is different, and can vary as to time of day. Fixed scale is when you inject a fixed amount, then forced to eat up that many carbs so you don't crash. That's how you gain weight too. Neither a good idea.

If you have time and feel like it, suggest you read Think like a Pancreas by John Walsh.

Gingersnappy

Thanks for the responses! I figured a sliding scale was something like you described. I had to take steroids for a bronchial infection that refused to leave earlier this year and I know even those made my blood sugars in the 300s. I normally run 80-120 for fasting and 100-160 two hours after eating. Just another thing to factor in to treatment! My oncologist seems confident she can introduce the sliding scale to me since I don't have an endocrinologist (I use my PCP). If I feel like she's not capable, I'll look into an endo. Thanks again!