Further Advice Needed - MDI or my Novomix '30/70' .... and Cholesterol

[Sut T1]

Hi All,

I last posted on this forum in Dec 2015, having been diagnosed end of October and was put on the Novomix '30/70' insulin, having twice daily injections.

Sorry, I was not sure if I continue that same thread or start a new one??

My question is, I recently had a review yesterday and my senior diabetic nurse still did not recommend MDI ( this time round I asked him q's about it!), instead he checked my blood sugar readings and told me I was doing well ( fasting morning ranges between 4.8 - 6.3, before lunch 4.9 - 6.9 and before dinner 4.9 - 7.5 ). For some reason he had told me not to bother with the 2 hour after readings.

I have managed to get my hba1c from 103 mmol/mol to 69 in just over 3 months.

The diabetic nurse left it to me to decide if I wanted to go onto MDI. His advice seemed to suggest that what I was doing at present was working as my BS readings are in the range and I have brought my hba1c down also, so to continue as I am. I talked about hypos, which for days I can go without and then I seem to have regular over 3-4 days. I have had to decrease my dosage but I am currently 26 units am and 20 units pm. He told me with hypos to just adjust the units accordingly.

So, my question is, what do I DO? Shall I remain on Novomix 30/70 or ask for MDI? Is MDI really more flexible? Would there be 3 injections or 4 ( i was told 3? but have heard others talk about 4?) Is it difficult to carb-count on MDI? What other benefits are there? or negatives?

Also, any advice regarding cholesterol? My recent result is 6.3 and I need to bring it down to about 5, any advice on this or just diet & exercise. I am 34 years old, don't want to start medication at all with this!!!

Any advice you can give me would like before be much appreciated 😉 Thank you.

SutT1

 

[pav]

I have trying been trying to switch to insulin, I would not look at the mixed version and would go MDI every time to me it would give me the flexibility I need espec as don't always eat on a regular pattern.

 

[Robin]

Hi Sut T1. Firstly, congratulations on improving your HbA1c so far. Onwards and downwards!
The question is, will MDI suit you. I think the short answer is, you won't know til you've tried. If you give it a go, and really don't get on with it, there is absolutely nothing to stop you asking to go back to mixed insulin.(though I don't think I know anyone who has asked to go back, which may be an indicator of how people get on with it!)
MDI involves one injection of long term insulin per day, or two if you find it runs out early or has peaks and troughs, and need to split the dose.
Then you inject short acting every time you eat, so if you're a three meals a day person, three jabs. If you want to skip breakfast or lunch, that's fine, just dont inject. That's one of the benefits.
Carb counting is straightforward to learn, there are a lot of resources, and you should be offered a Dafne course.( dose adjustment for normal eating.)

When I started, I was told just to test before meals. But there are NICE guidelines as to what you should be two hours after eating, and how do you know without testing then? I suspect it's a cost cutting exercise. Again, have a look at the NICE guidelines on how many strips you should be provided with.

 

[stephknits]

As Robin says, it depends whT would suit you. If you are the sort of person who tends to eat the same type of foods at the same sort of time very day, then you may find it less hassle to stay as you are.

If however, you like a bit more variety and would like to be more in control, then I cannot recommend MDI highly enough. It gives you the flexibility to eat what you want, when you want. You can get the Carbs and Cals book and/or app to help you count your carbs and as you get more used to doing it, you get to know the carbs for many of the things you eat regularly.

 

[AlisonM]

MDI is very much more flexible IMO. I can now inject for the meal I'm about to eat instead of eating for the insulin I'm injecting. I have digestive problems which make it difficult for me to eat at certain times so being able to inject when I can eat is a huge help. Basically you have a long acting insulin once a day then inject the fast acting before you eat, whenever that is. In these early days, you may still be producing some insulin of your own, which explains the hypos, being on MDI would mean you have far more immediate control in these circumstances. If you're that low, then clearly you don't need any fast acting insulin. I reckon the fact that you are having regular hypos is proof enough that your Novomix isn't doing the job for you.

 

[trophywench]

Well - exactly Alison. It's too late with a mixed insulin so you have to ride out the hypo until the short-acting portion of the jab you had hours ago, has run it's course. 3 jabs a day - could be I hour in, so that's 11 hours plus another 4, which is how long short-acting lasts. Whereas, if you are 1 hour in from jabbing a 'normal' fast acting only insulin - the max it can last is 4 - 5 hours. If your BG is too high - you can also 'correct' that with a bit extra fast-acting 'now'.

Having been on both (there were only 'mixed' insulins available really (for anyone who had a life LOL) when I was diagnosed) I'd be sorely tempted to shoot myself if I had to go back to it, quite frankly. (and I was diagnosed aged 22 so I was already an adult and well able to make my own judgements and decisions, so it wasn't kike I was a kiddie and didn't therefore get involved in dosing etc from Day 1)

By the way Sut - insulin is most certainly NOT a 'drug' ! It's a hormone which normally of course our pancreas automatically supplies. However since the cells which produce it have popped their clogs - we need to get it from somewhere - else we'll just die. Ergo - none of us actually has a CHOICE. Not if we want to stay alive!

 

[KookyCat]

I started on novomix, and full disclosure before I start, I hated it. I couldn't get any control with it at all, but I had good waking readings and some reasonable pre meal readings, it was what was happening I between that was disturbing. Mainly huge post meal spikes, well into double figures. I was tired and generally very unhappy with having to eat to such a rigid timescale and I really didn't like the post meal spikes. My advice would be to do some testing at one hour post meal and two hour post meal and see how happy you are with it. If you're getting good control post meal and you're happy with the level of flexibility you've got then maybe it works for you and you should continue with it 🙂

I wouldn't touch novomix ever again personally, but it really didn't work for me (I'm with Trophy on this one). As soon as I started MDI I had control, the post meal spikes stopped, the hypos became less frequent and less severe, and my hba1c came down from 59 on the mixed to 44. The tiredness reduced too, the only issue I was left with was overnight hypos but they reduced when I switched one of the insulins. The main issue for me was that the mix is fixed, so in order to try and deal with post meal spikes I had to dial up the basal too and I didn't need that, I need closer to a 50/50 split between rapid and slow acting. My consultant was extremely keen to get me off premixed insulin, he referred to it as "useless" for a T1, and I was extremely keen to get off it so it was any easy decision. There's a lot of evidence to suggest MDI is much more effective than mixed insulin in protecting you against complications too, so that Is a factor to consider too.

Carb counting isn't hard, although it might seem like that at first, and for most people it's between 5 and 6 injections a day presuming you don't correct often (an extra rapid injection to correct a high when you've miscounted the carbs). You take one or two injections of long acting insulin, then adjust your short acting insulin to cover food. You develop ratios for rapid which is basically how many units of insulin you need to inject to cover a specific amount of carbohydrate. Anyway I won't overwhelm you with information. The important factor is you're happy with the decision you make, and it's not a permanent one you can change regimes if you decide to later. I'm not sure I'm impressed with your nurse mind, he should have at least given you an overview of the pros and cons of the different regimes and helped you make a decision, he sounds a bit too laid back for me! Good luck 🙂

 

[shirley]

Just to add my comments. My son started on mixed insulin and we did really well on it. I was therefore very reluctant to change but we changed to MDI last summer. What a difference, how could I have ever resisted? The problems with mixed are that if there is a high, you can't correct without messing with the longer acting insulin too. As that is the greater percentage, corrections are barely effective in the short term, but lead to lows later on. On MDI you can sort things, it is so much better during periods of illness, or just when you get your calculations wrong. You don't have to immediately commit to carb counting, you can keep to fairly fixed meals if that suits you and your lifestyle, but I love that I don't have to fret about meals at friends being produced at a precise time and it was very easy to make the change, just took us a couple of days of adjusting doseage. So, I would say, go for it!