I'VE WON - start basal/bolus regime Monday with Levemir

[pippaandben]

First thanks to everyone for all the info and support so I had facts and figures at my finger tips. Saw nurse yesterday - practice had still had no official response from PCT despite them sending two chase ups and so decided to work with me, give me what I want and hang the consequences.

Asked for the Novopen junior as it gives half unit doses - no problem with that til tried to get the script at pharmacy and found this pen ceased in December and has been replaced by the Novopen Echo which apparently also does half unit doses. So tx surgery for new script for that to pick up later today. Touted round all small pharmacies and actually found one that had one in stock still. This means I can start new regime on Monday even if the Echo is out of stock and they have to get one in. So at least I will have a spare for holiday at the end of the month.

Have also been put on list for specialist diabetic dietician for one to one carb counting info. Because of this my nurse does not want me to carb count straight away although says I can tweak basal in half units (precisely why I wanted this pen!!) but only on Wednesday onwards.

Proposed doses are basal (Levemmir)split 10am and 10pm 8 units and 6 units
Bolus (Humalog) for 2 meals only (can stop midday meal at last - thank goodness as I am sure that explains some of my weight gain of 7lbs since starting injecting) at 6 units for breakfast and 10 units for dinner. I asked for Humalog as I already have 2 Humpapens which deliver half unit doses for my Humalog mix.

I have a standard breakfast of 2 slices Burgen and either 2 slices bacon or one slice and an egg done in the microwave. So think I will add a small banana to make sure no hypo. Will need to set alarm to test hourly as I am useless at post meal checks.

Any thoughts about the doses as I know previously Abi and Patti queried what seemed to be high recommendations. At the moment on Humalog Mix 25 with 8 units am and 13 units dinner

I mentioned LADA and the nurse had at least heard of this and said I would have to see Dr over that as I would have to be referred to specialist centre at Ashford - 30 miles away. I asked why not Maidstone Hospital Diabetes Centre and she was not sure if the one in charge had the expertise for that!

I am due to see her Friday next week with loads of readings. I am not starting til Monday so that I am not without support over the weekend if doses have to be changed immediately and also, as it turns out, to make sure I have all the equipment I need.

 

[AlisonM]

Congratulations. I'm so glad you got the result you wanted. Persistence pays, eh?

 

[Northerner]

Great news! 🙂 Well done for persisting and not giving up on the treatment you thought would be most suitable for you, in the face of bureaucratic opposition (good to hear your surgery have backed you up too)

I've been using the Echo for a few months now, it's a great little pen - very easy to change cartridges and with a rudimentary memory, plus you can wind back if you wind past your desired dose - I do that a lot! 🙂

The doses do seem high to me, as you are going from 21 unit mixed to 30 units basal/bolus, so not sure how they have calculated these unless they have totally ignored how you react to your mixed doses and are using some formula based on a new insulin user. Time will tell I suppose, but it shouldn't take long to find out if the doses are set too high.

Good luck! I hope everything goes smoothly for you! 🙂

Oh, and WELL DONE!!!

 

[pippaandben]

Congratulations. I'm so glad you got the result you wanted. Persistence pays, eh?

Thanks Alison. I was determined to make them see it was my health, my body and my life and asked at each meeting for the proper procedure to appeal against any PCT decision and I think they got the message.

I see you are LADA. If I am as well is there anything I should be specifically aware of regarding BG levels/ carb counting - or anything else for that matter?

 

[AlisonM]

I think it's a very individual thing as we all seem to progress at different speeds and react differently certain foods. As a rule, I try to keep to a low GI diet but don't yet count carbs as I'm not on the kind of insulin regime that requires it... yet! It will come to that in time though.

The doctor who diagnosed me was the one who suggested I might be LADA purely because of the speed of onset which was much faster than classic T2, combined with several other medical issues which made T2 less likely and the fact that I had been tested less than six months before and wasn't even in the "at risk" group. Plus no family history of Diabetes in spite of many rellies being seriously overweight.

 

[everydayupsanddowns]

Great news Pippaandben 🙂

Proposed doses are basal (Levemmir)split 10am and 10pm 8 units and 6 units Bolus (Humalog) for 2 meals only (can stop midday meal at last - thank goodness as I am sure that explains some of my weight gain of 7lbs since starting injecting) at 6 units for breakfast and 10 units for dinner. I asked for Humalog as I already have 2 Humpapens which deliver half unit doses for my Humalog mix.

I have a standard breakfast of 2 slices Burgen and either 2 slices bacon or one slice and an egg done in the microwave. So think I will add a small banana to make sure no hypo. Will need to set alarm to test hourly as I am useless at post meal checks.

Any thoughts about the doses as I know previously Abi and Patti queried what seemed to be high recommendations. At the moment on Humalog Mix 25 with 8 units am and 13 units dinner

So your current TDD (total daily dose) is 21 units for three meals, but you are about to make that 30 units and (unless I misunderstand you) don't intend to eat lunch so you will be some carbs down on the day more than likely.

I have no idea whether this will have any relevance, but my TDD is (roughly) 30u, and there or thereabouts 1u of insulin deals with 11-12g of carbs. Your current breakfast is approximately 25g CHO, but the suggestion is that you take 6u - which for me would mean more like 60g of carbs . Even leaving aside some Dawn Phenom, that 6u recommendation is raising question marks for me.

10u for dinner also seems like a pretty hefty dose from my T1 perspective.

I suggest you get a bunch of lucozade in just in case, or perhaps (unofficially) go for doses more based on approx 1u:10g CHO and watch for highs.

 

[trophywench]

I agree wholeheartedly with Mike. And I think it would be fair to say, Abi and Patti would both agree too.

T1 wisdom re dose adjusting for carbs is always 'start off at 1u per 10g carb and see how you go'.

(Plus there can be issues with injecting anything over 7u fast-acting for carbs, but that concept is far too Advanced for Nursie Nightshade to envisage I'm sure.)

I also query the concept of less basal at night ... since most people need more at night than in the day ..... but hopefully if the total basal is roughly right it should mean you don't go hypo overnight.

It may be wise to set the alarm for 3am and test then for a little while once you start, just in case. But in any event keep meter and hypo remedy close by you at all times!

Good luck !

 

[pippaandben]

I agree wholeheartedly with Mike. And I think it would be fair to say, Abi and Patti would both agree too.

T1 wisdom re dose adjusting for carbs is always 'start off at 1u per 10g carb and see how you go'.

(Plus there can be issues with injecting anything over 7u fast-acting for carbs, but that concept is far too Advanced for Nursie Nightshade to envisage I'm sure.)

I also query the concept of less basal at night ... since most people need more at night than in the day ..... but hopefully if the total basal is roughly right it should mean you don't go hypo overnight.

It may be wise to set the alarm for 3am and test then for a little while once you start, just in case. But in any event keep meter and hypo remedy close by you at all times!

Good luck !

Re basal split - it was me that told nurse I thought usually a 60:40 split and not 50:50 so perhaps my fault - should have said 40:60. So is it ok to just change it round like that from the start? Jelly babies by bed at all times and I always eat if under 6.5 at bed time on a one rich tea for 1mmol basis. - Another tip I got from this forum some time ago.
Re bolus will make sure don't inject more than that so will be carb counting even if nurse thinks I won't understand it. I have done the online course and I did do a mock exercise of counting and correcting based on my readings and meals for one week - but she just glanced at it and didn't comment if I had got it right or not. Now I have got my hands on the goods I feel fairly confident in myself to carry on. Also just reading Thinking like a pancreas which has soooo much info. Do any of you deduct fibre from carbs to determine bolus?

Just as well I found a pharmacy with the old Junior pen as no-one had a Novopen Echo in stock either and it might be in at the end of today - or middday Monday! Yet another trip into town - thank goodness for the bus pass.

 

[trophywench]

Do any of you deduct fibre from carbs to determine bolus?


Noooo! 😱

The tins packets and Carb books in UK are nett carbs, ie completely excluding the fibre.

In USA - theirs include fibre so you have to deduct them to adjust insulin doses to suit. Gary Scheiner is a Diabetes Educator the the USA.