A thankyou :)

[Doddy]

I just wanted to say thankyou to the wonderful people of this forum.

With your advice, I asked my GP today about changing from a mixed insulin to a basal/bolus insulin, and she agreed! It's the first time I have had the confidence to approach a GP with information so i am pretty pleased with myself!
It was the lovely people on this forum that gave me the knowledge and courage to ask...

SO THANKYOU 🙂

I am now on Lantus and Novorapid. Just trying to figure out the best time to take the Lantus. GP told me it must be strictly taken at the same time everyday, with a 15 minute window.
Im thinking 9am...not too early for a weekend day, and I am home again by 9 from the school run. However, would the evening be better? Anyone on lantus...what time do you do yours!?

I am right in thinking I should expect higher readings for a little while as we are titrating to a dose to suit. The GP worked out the lantus, so I am thinking by basal (?) should be ok...it's just the bolus (?) that will need titrating. More new stuff to learn eh!

 

[robofski]

Excellent news 🙂. Glad you had the confidence to talk about YOUR treatment, it is after all you that has to manage this condition so well done you, hopefully you will soon start seeing some better numbers!

I can't help with the Lantus questions, I'm a Levimer guy! It will all take some getting used to, I've been injecting now for 3 months and am at last getting consistent readings in the good range 🙂. Everyone is different of course and you'll soon find out what works best for you.

Good luck with the MDI regime, hope it improves things for you soon.

 

[trophywench]

My goodness !

Firstly - good for you Doddy ! Well done.

I venture to suggest that your GP doesn't know all that many diabetics if she thinks Lantus must be taken within a strict 15minute window. Most people take their basal insulin at bedtime (when it's one jab a day and that includes Lantus) (you can split it but let's not worry about that right now)

Thing is - when did you last meet anyone (D or not) over about 4 years old - who actually went to bed at the same time every night? LOL

Lantus lasts longer than 24 hours for most of us. See here

http://www.diabetes-support.org.uk/info/?page_id=408

You will see the graph stops at 24hrs with the Lantus in mid -air. Not possible, is it? It stands to reason that it must tail off nd not stop suddenly.

Soooo - how long it takes to tail off, is between each person and their Lantus and if it lasted 36hrs for me, it will last 27hrs for someone else and so forth. Nobody can predict that. In any event it does need topping up at regular intervals and unless you are the only person in the world who sees it out of their system by 24hrs + 15 minutes - your window will be commensurately longer than that!

So lob it in and test test test!

Good luck!

What has GP told you to do about getting the premixed out of your system before you put Lantus on top of it?

 

[Doddy]

My goodness !

Firstly - good for you Doddy ! Well done.

I venture to suggest that your GP doesn't know all that many diabetics if she thinks Lantus must be taken within a strict 15minute window. Most people take their basal insulin at bedtime (when it's one jab a day and that includes Lantus) (you can split it but let's not worry about that right now)

Thing is - when did you last meet anyone (D or not) over about 4 years old - who actually went to bed at the same time every night? LOL

Lantus lasts longer than 24 hours for most of us. See here

http://www.diabetes-support.org.uk/info/?page_id=408

You will see the graph stops at 24hrs with the Lantus in mid -air. Not possible, is it? It stands to reason that it must tail off nd not stop suddenly.

Soooo - how long it takes to tail off, is between each person and their Lantus and if it lasted 36hrs for me, it will last 27hrs for someone else and so forth. Nobody can predict that. In any event it does need topping up at regular intervals and unless you are the only person in the world who sees it out of their system by 24hrs + 15 minutes - your window will be commensurately longer than that!

So lob it in and test test test!

Good luck!

What has GP told you to do about getting the premixed out of your system before you put Lantus on top of it?

I know what you mean about this 24hr thing! It's not suddenly going to stop working at that point, and in actual fact might go on a lot longer!
I was going to take the Lantus this morning...I don't know why but I thought I might be better with it in the morning...would it be better in the evening? Again the GP said it didn't matter am or pm but to keep it at the same time within 15 minutes!

Didn't say anythiing about the mixed getting out of my system, although I haven't taken it since yesterday morning. I did take the Novorapid last night, and i went to bed high! I am taking a lower dose to start off with so I am expecting higher numbers for a while.
Maybe I should take the lantus later...say maybe 6pm???

 

[everydayupsanddowns]

Hi Doddy

Hope you find MDI suits you really well, and that you adjust easily to it.

I found it made little difference to me as long as I took my Lantus within an hour or two of my 'usual' time. What did make a difference though was *when* I took it - morning or evening, and I can't predict which will be 'right' for you by have a suspicion that one, other (or as TW suggests possibly 2 doses around 12 hours apart) will work better for you.

Would just try one to start with, and try to do some overnight tests (every few hours) to see what happens to your BG between bedtime an waking. If Lantus is doing its job right you should stay within 1-2mmol/L of your bedtime reading all night.

 

[trophywench]

Err - give it at least 3 days before you start relying on any testing ... just keep testing and firefight whilst that's going on because it will take time to settle down.

Eg when you come off MDI and start on a pump, you have to wait 3 days or a bit longer before you start testing for the pupose of tweaking all your doses, because initial doses are guesswork! and it's the same for you.

 

[Tina63]

My son was told to take his Lantus in the evening just before bed as it was that which would keep him stable overnight. Because of erratic bedtimes they suggested 9pm but he bit by bit moved it back to around 10pm. He does take it later sometimes though if busy. We were told though that it HAD to be taken strictly at the same time each night......

Different teams, different advice!

 

[margie]

When I started to take Lantus I was told the same time every day but if it was more than 1/2 after that there would be none left in my system. This seemed highly unlikely to me given that you are also told that it takes a few days to see if a dose change has any effect. I discovered that Lantus does not last 24 hours for me - more like 16 hours, therefore I break the dose into two to get better coverage.

I discovered that the Lantus was not lasting when I realised that if I ate at time a I would be in range but eating a couple of hours later and I was way out of range.

Everyone is different when it comes to how long it will last.

Although the GP will have come up for a figure for your basal it may well not be right - its like with the bolus ratios - they normally start you off with a ratio and then change it when they find how sensitive you are.

Do you have a DSN who could help you in these initial stages to tailor the dose? I think that would be beneficial for you.

Good luck with it all and congratulations on being so pro-active.

 

[Doddy]

Thankyou all for your postive replies 😉

I decided to take the lantus at 9am. My thinking behind this is that i read it works best at 12-16 hrs even tho it is peakless. I fuigured because my readings are highest in the evenings, this is when I want it working at it's best.
all day, I was 6.9 - 7.6 but then in the evening, shot up to 16! I did have potato, so this probably explains this jump. but a rise of 10 mmols did shock me! I know you all say give it 3 days, which is what i am doing...I won't start titrating the rapid up yet...the GP expects me to be on 20u and I am only taking 10 so it stands to reason it isn't going to work just yet.

Am I ok to inject Lantus into my tum...??

 

[everydayupsanddowns]

I've heard different people say different things about injection sites. Some of this may count as 'old' advice now, but I was always told to keep rapid and basal injections apart (Lantus forms a depot of precipitate as its acidity is neutralised after injection - the precipitate then gets absorbed over time). You dont want to accidentally hit that same place again with a later meal bolus.

I found it worked fine to inject rapid in abdomen and lantus in thighs, and a little later to use buttocks for Lantus and thighs for rapid.

I was also suggested to me that speed of absorption varied, with abdomen/arms being faster, thighs next fastest and buttocks slower - which made sense to put the long acting in a slow spot.

 

[trophywench]

If you look at the Lantus graph Doddy, the peak is approx 5 hours (maybe 6) after injection.

http://www.diabetes-support.org.uk/info/?page_id=408

But as I mentioned, just 'firefight' for a few days.

The two starting points for fast acting are 1u per 10g CHO and for correction of too high BG - 1u to counteract 3.0 mmol/L on your meter.

Early days, so collective wisdom says - don't try to correct down to less than about 7.5 on your meter - leave yourself plenty of room for manoeuvre !

So 10.5, take 1u and see what happens. If it's bedtime I'd do NOWT. At this stage of the game.

Once you know what you're doing and have tweaked, that's the time to think about when you might start correcting lower etc.

 

[Doddy]

TW...where you say 1u-10g does this apply if I am not carb counting..or should I use the adjustment figures if my readings are high (ish).
I will ride out this weekend and just put up higher readings while it's all getting into my system. Gonna have what i know is a good dinner today, and see what happens. I went up to 14.6 this morning which totally shocked me..I did eat 2 crumpets tho..they are obviously a huge no no! Ooops!

Is it normal to feel out of control again with all this?

 

[melissaf]

Hi Doddy.

Looks like we are are new MDI buddies. (Did you see my post MDI- the story so far)? My BGL since I started on MDI on Monday have been great. I cant believe how the change has me in consistant single figures already. I feel better generally - I was suffering from real hot flushes throughout the day most days and feeling nauseus in the mornings and I think this was to do with me having levels of between 10 and 15 all day. But the past 5 days have been totally different. Long may it continue - feels a bit like beginners luck - but I hope I can keep it going. Good luck with your new regime and let me know (if you want what sort of levels you are getting) Im on 5u of Levemir (am & pm) and then Novorapid (1u for every 1cp (10g of carbs). Im aiming for readings of 8.0 (before meals) and they have varied between 7.0 and 9.0 - so I am pleased (feel like Im showing off - sorry dont mean to). But we can do this - finally feel like back in control of my body - hope you feel the same way too soon. Melissa xx

 

[Doddy]

Hi Melissa 🙂

I have been reading your MDI story...we do seem very close together 😉 I am pretty much like you..have been getting "normal" figures yesterday and today. Was still getting spikes 2 hrs after eating, but I know I am not yet up to full dose...GP reckons I will go up to 20. i am not dosing according to carbs..not sure if this will change??
When I go high (13-16) I start to feel nauseous and hot, although I used to feel this when I was at 19-24 regularly. I hope you continue to do so well...it is satisfying seeing the numbers come down isn't it! And for me it's only day 2!!!

 

[trophywench]

I should b-well hope it will change Doddy otherwise you are missing approx 90% of the whole ruddy point of being on MDI

 

[Doddy]

I should b-well hope it will change Doddy otherwise you are missing approx 90% of the whole ruddy point of being on MDI

Even though I am not a "type 1"? I wonder if being LADA, it might have worked differently?

 

[trophywench]

Well yes and no I suppose, but at the end of the day once your GAD65 antibodies have finally killed off all your Beta cells, you are in much the same boat as a T1.

They could actually tell when that happens as they could do a C-peptide test to see how much 'natural' insulin you are still producing. If any.* But it takes ages and it's very expensive so in some ways, they judge by how much you need to rely on the injected insulin and how much of it you appear to need of it on a regular basis. And I know it's jolly awkward before they do snuff it, as you can get unpredictable spurts of 'own' insulin to throw spanners in the works. So you can't be quite as precise whilst that's going on. It's kinda somewhat the same as a new T1 being in their 'honeymoon' period - once it's gone, it's gone.

* some very long-standing T1s still produce some insulin, the tests Joslin have done on the oldies have proved this, it seems to be protective against complications. I'd absolutely LOVE to know whether I've got that protection or if I'm on borrowed time and they are all going to hit me 'soon' like a ton of bricks!

 

[Mark T]

Did you ever find out what your GAD antibody score was Doddy?

The reason i ask is because I found an interesting paper (in Portuguese) here: http://www.ncbi.nlm.nih.gov/pubmed/18438542

It starts be suggesting that LADA can be defined as those diagnosed between the ages of 25 and 65 years without DKA, who initially are not treated with insulin (but ultimately within a year or so go on insulin) and have autoantibodies (especially GAD).

I've seen a few different age ranges and durations without insulin stated, so I'm guessing this varies.

However, it goes on to say that those with high GADA scores (>=17.2 U/ml) tend to be like classic Type 1's and very rapidly go onto insulin. They also tend to have other autoantibodies present as well.

Those with low, but not negative GADA scores (>1 and <17.2 U/ml) tend to be more similar to Type 2, having some insulin resistance present. But will slowly make there way to insulin. The lower the score, the longer it apparently will take! (but no data on durations given of course)

 

[Northerner]

Even though I am not a "type 1"? I wonder if being LADA, it might have worked differently?

Well, as you may have gathered from reading some of my posts, I'm pretty much a Type 1.5 (I believe there's actually a very broad spectrum of types, just as with most human conditions - we're all different!). I started off on lantus and novorapid, needing 20 units Lantus and around 40-45 NR a day. As the years have progressed I have reduced both insulins, even going down to zero lantus, which means that my body is most definitely producing some of its own insulin even 4 years after diagnosis. I don't regard it to be like a honeymoon situation, it's very much related to my general state of health and fitness - the better I am the less insulin I need to inject.

This can make things difficult as far as accurate carb counting goes. Although I was taught the principles, I've only ever really paid lip service to it, using the carb count of a meal as a 'ball park' figure for the amount of NR I need to cover it. Because I'm old and set in my ways I tend to stick to a lot of familiar meals and most of my meals actually have a very similar carb count when you add it up (i.e. all my breakfasts are similar, lunches similar, evening meals similar). So rather than carb counting, I take into consideration other factors rather than just the food. Chiefly, this will be based on past experience and to some extent actually based on my breakfast readings.

For example, for a long time I have eaten exactly the same breakfast. I was never a big breakfast eater, and because I now have to eat something before running in the morning I just have a slice of Burgen toast and butter - I don't like to run with too much in my stomach. So, I might be injecting 6 units for that slice, which sounds like a lot, but I also have to account for Dawn Phenomenon. If I then find myself going low before lunch I would in future have just 5 units for the toast. I would also reduce the amount of NR I had for my lunch and evening meals in proportion, and also taking into account the morning's exercise (or afternoon's activity) and the fact that there is no DP.

Sorry that is so long winded, but I hope it makes some kind of sense. In a nutshell I have similar carb counts for most meals so I do not need to carb count. I do still need to adjust my insulin for other reasons though, as outlined above (as do most people). If I have something I know to be a greater/lesser carb count than usual, I will increase or lower doses by basically the proportion of the increase/decrease in carbs.

That's how it works for me, and generally it works very well. I think my pancreas helps 'smooth' some of my miscalculations/guesses, and also means I don't have problems with getting my basal insulin correct because I don't need to inject any. Often, problems with getting bolus doses correct are actually due to the basal not being quite right, or working differently at different times of the day, so that is a significant advantage for me.

Sorry for being so verbose! It's been a useful exercise for me though, to actually sit down and think how things work for me 🙂

 

[Doddy]

Thankyou for your "explanation" Northerner x

I am wondering if I will eventually go onto Carb counting, therefore injecting for what I eat. I am the opposite to you in that my meals are fairly different...depending on how fussy the children are being! If i knew I was going to be injecting according food, I think i would find it a lot easier and know what I am doing, whereas at the moment, I am still getting higher figures if I eat the wrong things. I know I am still titrating, but the fact that different food does different things to my numbers...surely it makes sense to carb count and inject accordingly. I guess my question is, can a T1.5 do this, or is this regime only suitable for T1's. Is my GP only finding the benchmark figures and will then go on to teach me carb counting.