Insulin advice

[Rachie B]

Hi all
I have been put on humulin twice a day, 18 units before breakfast and 10 in the evening. I am confused by differing ways to control type 1 whilst living the most fulfilled life possible. I'm active, life is spontaneous (although I'm feeling held back now) and I have a busy job.
I would really love to know what other folk do, what would be recommended. I have always been fit and healthy. Now I'm a little scared about my health, I often don't feel 'right' and I'm grieving my carefree lifestyle. I was diagnosed on April 10th after a DKA.
Big thanks in advance

 

[Inka]

Hi @Rachie B What Humulin have you been put on? There are different ones and they do different things.

Type 1 is normally treated with MDI - that is Multiple Daily Injections. These consist of two different insulins - a basal/background/slow-acting insulin and a bolus/mealtime/fast-acting insulin. The basal insulin is usually one or two injections a day and keeps your blood sugar steady in the absence of food, then when you eat your meals you use the bolus insulin to deal with the carbs you’re about to eat. It doesn’t sound like you’ve been put on that regime, but I’m not sure exactly what you’re taking without the full name of the Humulin you’re on.

However, the MDI regime I described above is the one that gives the most flexibility. It’s understandable you’re feeling anxious. A Type 1 diagnosis is a big shock. The more you can tell us, the more tailored suggestions you’ll get here. I promise you things do gradually get easier.

 

[Rachie B]

It says Humulin M3. I believe it is a mix of long and fast acting. They spoke to me in the hospital about MDI, but I confess I was so shocked by it all and the thought of multiple injections was too much. But now I just want the best regime for me to stay the healthiest and fittest I can be

 

[Ljc]

It’s only natural to be in shock
Tbh I would find mixed insulin difficult , but their again since needing insulin I have always been on multiple daily injections (MDI)
Yes it does mean more injections but as you know they are real tiny needles .
It also give more flexibility, I don’t have to eat if I don’t want too.
We can do corrections for hypers and when ill if needed.

I believe that the NICE recommendation for T1 is MDI . In time the DSN teaches you how to adjust your insulin to the carbohydrates you are going to eat. I know it sounds complicated but it isn’t , honest and you won’t be doing it all alone , the DSN will guide you through everything till you feel ready to take the first steps in solo flying (insulin wise)
If your maths is a bit iffy you can always use your meters insulin calculator or the one on your phone iPad etc .
So when you feel able do discuss this with your DSN .

 

[Inka]

It says Humulin M3. I believe it is a mix of long and fast acting. They spoke to me in the hospital about MDI, but I confess I was so shocked by it all and the thought of multiple injections was too much. But now I just want the best regime for me to stay the healthiest and fittest I can be

You’re right - Humulin M3 is a mix of slow and fast insulin. You might think that’s ideal just taking one insulin rather than two, but the problem is that the mixed insulin contains a set percentage of each insulin. I believe Humulin M3 is 70% slow (basal) and 30% fast (bolus/meal). That proportion is unlikely to work well for a Type 1 because we tend to need more of the fast insulin - a fair bit more percentage-wise. Humulin M3 is usually given to Type 2s.

MDI gives far more flexibility because you don’t have fixed percentages of the insulin. You take your basal insulin and then take as much fast/bolus insulin as you need for each meal. Yes, it’s more injections but it’s more control and flexibility.

If you really can’t stand the idea of having more than two injections a day, you could ask for separate vials of the two insulins and some syringes, and draw up your own proportions. That’s what we used to do before MDI, but it’s fiddly (you have to draw up the insulins in the right order) compared to insulin pens. It also means you have less flexibility on meal times and need to stick to a routine.

I suspect your unstable sugars are due to using the Humulin M3. Sometimes the best way isn’t the easiest way. I suggest you contact your diabetes nurse and ask about MDI. It does take a little while to get used to, but it soon becomes routine. The payback will be better control and more flexibility in what and when you eat.

 

[trophywench]

@Rachie B - moving on from where you are right now when I'd been on MDI for years - One jab a day basal insulin and however many jabs a day of bolus insulin for food as I needed, so let's average that at 1 plus 3 - I asked to change my 1 a day basal to 2 a day of a different basal insulin. My consultant said Whyever do you want to change and have another jab? implying with his tone 'surely 4 jabs a day is enough without adding another!' to which I replied 'Because I have observed from my BG Meter and my HbA1c results over a couple of years that the 4 jabs I already have obviously do not provide brilliant control 24/7 and whilst I recognise it's probably never going to be humanly possible to have perfect control of my BG - if I can only slightly improve control by having 5 instead of 4 - that's a very small price to pay in my book.' At which point, he chuckled and agreed with me.

 

[everydayupsanddowns]

Welcome to the forum @Rachie B

It used to be common practice to start people with T1 on a mixed insulin, until they got used to the idea of injecting (as you say, it can all feel a bit overwhelming to begin with). These days though it is much more common to start people on the much more flexible MDI (basal:bolus) regime, where doses can be adjusted more easily to fit in with a busy lifestyle.

I started on mixed for my first year, and found it very restrictive and limiting (and the results weren’t all that great either!). Particularly the restrictions around the timings and sizes of regular meals/snacks which were needed to ‘feed’ the insulin.

On multiple daily injections if you want to eat earlier or later, or larger or smaller meals, or even skip meals entirely, you can simply adjust as you go along. The minor faff of a few additional jabs is more than compensated by the increased flexibility 🙂