Anyone with experience of NovoMix 30?

[CCS]

I'm a newbie, diagnosed Type 1, on NovoMix 30 delivered in a flexpen. I note with other insulins you are encouraged to alter your dose to cope with size of a meal for example. In the literature with this insulin it says "Any dose change alters not only the injected fast-acting part but also the long-acting part of the insulin. So a change in dose to cope with variable meal size is generally not recommended"
Have any users with experience of this insulin any thoughts on management when facing an extra big meal, or during illness etc?

 

[rebrascora]

Hi.
The insulin you have been given is the older system which was created to cover a set meal routine where people were encouraged to eat regular meals to a somewhat regimented timescale. Modern day lifestyles with some people working shifts etc or grabbing food on the go where and when they can or fasting or snackingm makes the new system of basal and bolus insulins more flexible. It is also more complicated to calculate bolus insulin which is based on carbohydrate content rather than the size of the meal, so for someone like me who eats a low carb diet I may still have a huge plate of food but require very little insulin for it. Learning to carb count is an important part of the basal/bolus system. It can make insulin delivery more accurate as individuals can tailor it to their lifestyle. It also involves more injections per day as the basal (long acting) insulin is given once or more often twice a day and then the bolus insulin before each meal or snack (depending on the snack carb content) So usually 5 or maybe even 6 injections a day instead of the 2 or perhaps 3 you currently use. I think it depends on your lifestyle as to which system suits you best.
I can see how you might be concerned about the mixed insulin for when you are feeling unwell as basal insulin is important but you might not feel up to eating much, however when you are ill your BG usually rises so the extra insulin in the mix which would normally work on what you eat may work on lowering your BG instead if you are not eating much during your illness.
As regards having larger meals occasionally, especially at this time of year, either don't worry too much about it as a "one off" large meal will not do much damage or just moderate the carb content of that meal, so have one or two less spuds or Yorkshire puds but fill up on plenty of lovely veg and meat and moderate your dessert portion size. You will probably feel tired after the meal if your BG goes high but then who doesn't feel soporific after a Christmas "pig out". The damage to nerves and blood vessels due to high BG levels tends to happen over months and years, so a one off spike after a once a year big meal is not worth worrying about.
Go ahead and enjoy your Christmas meal and try not to worry about it. Better to be a bit high for a day than mess with your insulin and risk ending up having a nasty hypo and causing everyone a lot of worry.

 

[CCS]

Hello Barbara, I appreciate your detailed reply. However I am not so much concerned about Christmas, but, as a newbie, about planning ahead and working out what life is likely to be like and what difficulties I can anticipate and be prepared for. I realise that there are different insulins and strategies, but I am stuck, for the time being anyway, with the one prescribed for me by my diabetic unit. I was therefore hoping for someone who had experience of this particular dual-insulin and its virtues and difficulties, to perhaps offer some tips.
It was kind of you to take the trouble to write.Thank you very much. Best wishes, Chris.

 

[Ljc]

Hi we do have some people on mixed insulins on the forum , hopefully they will be along soon. I can’t remember who else I would tag them.

 

[trophywench]

When newly diagnosed - it is generally acknowledged that it is better to reduce the blood glucose level gently, not abruptly - which can cause as many problems as BG being too high and that might be why medics have prescribed a less aggressive insulin regime OR they might have thought because of your age - you wouldn't welcome or cope with having to administer 4 or 5 jabs a day with the accompanying mental arithmetic - who knows?

None of us know you - so we can't judge properly what's what and it's far better not to just guess about such things.

I've had Type 1 for a long time - and being honest - I think what Barbara has suggested is spot on right now for you. After Christmas - if you want to pursue a more modern approach, then you will have plenty of time to do that.

Have you been referred to a hospital diabetes clinic or only your GP surgery? - they aren't experts regarding Type 1 diabetes.

 

[grovesy]

@CCS profile says they are 80 so this might have some bearing on the prescribing of this Insulin initially.

 

[CCS]

When newly diagnosed - it is generally acknowledged that it is better to reduce the blood glucose level gently, not abruptly - which can cause as many problems as BG being too high and that might be why medics have prescribed a less aggressive insulin regime OR they might have thought because of your age - you wouldn't welcome or cope with having to administer 4 or 5 jabs a day with the accompanying mental arithmetic - who knows?

None of us know you - so we can't judge properly what's what and it's far better not to just guess about such things.

I've had Type 1 for a long time - and being honest - I think what Barbara has suggested is spot on right now for you. After Christmas - if you want to pursue a more modern approach, then you will have plenty of time to do that.

Have you been referred to a hospital diabetes clinic or only your GP surgery? - they aren't experts regarding Type 1 diabetes.

I haven't seen a doctor yet, neither my GP nor at the hospital. I initially saw the Diabetes specialist nurse at my GP's surgery, then susequently was taxied to the Renal Unit at the hospital (they were worried about my keytone levels). At the hospital I was dealt with by a diabetic specialist nurse who taught me the basics of Glucose and keytone testing and injecting the insulin. I never saw the doctor who prescribed the insulin. I was then left to get on with it (I was given a mass of literature!). I was telephoned once a week by the hospital nurse to report my levels, and how I was coping, and how much to increase the insulin units.. Then after 3 weeks, and my levels down to almost single figures and more or less 0 ketones, she told me the dose to stay on, and said that she wouldn't be ringing me again. So presumably I now go back to my GP practice.
It may well be my age which dictated my being prescribed this insulin. I am 80, but I am still working run my own business, live alone, and have a very irregular lifestyle.

Are you suggesting ("- if you want to pursue a more modern approach, then you will have plenty of time to do that.") that I wiil have the choice to change mode of treatment in the future? My experience of doctors is extremely limited - I thought it was they who decided and I who trusted in their expertise. Can I expect a degree of choice?
Thanks for your interest, Chris.

 

[Greyhound Gal]

Hi Chris. I was prescribed NovoMix30 when I was first diagnosed. It helped to get my HbAc1 reduced by half, but then having joined this forum I learnt about MDI (Multiple Daily Injections, otherwise known as Basal/Bolus).
I found the NovoMix quite restrictive in what I could eat and when. Moving onto Basal/Bolus meant I could eat when and (within reason) what I wanted. It gives much more flexibility and freedom.
I inject my Basal insulin at night and then my Bolus when I eat carbs. I carb count to know how much insulin to take with food.
If you are happy on the Novomix30 and it is working for you then that's great. However, there is another option should you wish to speak to your GP / Diabetes Nurse about it.

 

[CCS]

Hi Chris. I was prescribed NovoMix30 when I was first diagnosed. It helped to get my HbAc1 reduced by half, but then having joined this forum I learnt about MDI (Multiple Daily Injections, otherwise known as Basal/Bolus).
I found the NovoMix quite restrictive in what I could eat and when. Moving onto Basal/Bolus meant I could eat when and (within reason) what I wanted. It gives much more flexibility and freedom.
I inject my Basal insulin at night and then my Bolus when I eat carbs. I carb count to know how much insulin to take with food.
If you are happy on the Novomix30 and it is working for you then that's great. However, there is another option should you wish to speak to your GP / Diabetes Nurse about it.

Thanks so much. Your full personal description does clearly explain the advantages of MDI and I understand better what the others have been saying.. I presume this also means multiple glucose level testing? That would deter me more than multiple injections, . But I gather that it is something that I can suggest to my diabetic nurse if I find the NovoMix 30 too restrictive. Thanks for your clarity..

 

[Greyhound Gal]

Hi Chris. Glad I could help. There is no more testing required with basal/bolus than the mixed insulin you are on, so don't let this put you off. In general. when I was finger prick testing (I now used a Libre to test) I tested when I woke, before breakfast, an hour or so after breakfast, before lunch, again an hour or so after lunch, once or twice in the afternoon, before dinner, and hour or so after dinner and again before I went to bed. However, this was my regime. As you will see, everybody is different, as long as you are checking on waking, before and an hour to two after food and before bed, you'll get a good idea of what foods affect you BG and what in general your BG is doing throughout the day.

 

[everydayupsanddowns]

The current national guidelines recommend starting newly diagnosed people with T1 on Basal:Bolus MDI. I believe in the past mixed insulins were sometimes used first as healthcare professionals believed it would be easier for people to adapt to self-administering medication, but clinical studies have shown benefits in starting people on the more flexible system.

I think you should make an appointment to ask about switching as soon as possible after the festive break. Mixed insulin is not as flexible as MDI and tends to give poorer results in a T1. Unless there’s a specific reason (or your own preference) I would recommend swapping over rather than learning one way and then having to relearn everything later 🙂

 

[everydayupsanddowns]

In answer to your practical question though... ‘how to cope in the meantime’, my experience was this: I was initially put on mixed insulin in 1991, and stayed on it for something like 6-12 months. My clinic gave me set carb values for each meal of the day and snacks in between and I had to ‘feed the insulin’ regularly with the correct amount of carbohydrate.

If your clinic have not given you amounts of carbs per meal, then my advice would be to use a BG meter to try to work these out for yourself.

Essentially, total up the carbs included in breakfast and lunch (that you would normally eat) and have a mid-morning and mid-afternoon snack of say 10g CHO. Then monitor your BG and see if by evening meal your BG is higher or lower than it was pre-breakfast (and when it began to rise or fall). Then use this information to adjust the carb values of your meals to try to get better results.

Good luck with it!

 

[CCS]

In answer to your practical question though... ‘how to cope in the meantime’, my experience was this: I was initially put on mixed insulin in 1991, and stayed on it for something like 6-12 months. My clinic gave me set carb values for each meal of the day and snacks in between and I had to ‘feed the insulin’ regularly with the correct amount of carbohydrate.

If your clinic have not given you amounts of carbs per meal, then my advice would be to use a BG meter to try to work these out for yourself.

Essentially, total up the carbs included in breakfast and lunch (that you would normally eat) and have a mid-morning and mid-afternoon snack of say 10g CHO. Then monitor your BG and see if by evening meal your BG is higher or lower than it was pre-breakfast (and when it began to rise or fall). Then use this information to adjust the carb values of your meals to try to get better results.

Good luck with it!

Thanks Mike. I am seeing my GP diabetic nurse after Christmas. so I'll discuss this with her. Up to now I've been remotely controlled by the hospital Renal unit with weekly telephone calls. But that ended with Friday's call so presumably I am now back with the local GP team.. The hospital have set up a group instruction session in late January called "Carb Awareness". But actually I've been given very little information. I get the impression that the clinic's aim wassimly to get my keytones to zero and my BG into mainly single figures. These are way above NICE rec. levels. Anyway, thanks to you and the others who have kindly chipped in to answer my query I do have a better understanding, and will be better equipped to ask the right questions.
All the replies much appreciated.

 

[DaveB]

Hi. Difficult. NICE does say T1s should now be started on MDI (Basal/Bolus) and not mixed. I wonder whether your age may have influenced the decision to prescribe mixed as it's easier to manage the fewer injections but the control isn't as good with varied meals. If you are happy to have 4 to 5 injections a day and think about the carbs at each meal then I would politely insist that your GP/nurse follows NICE guidelines and changes you to Basal/Bolus. There is nothing wrong with NovoMix which is sometimes prescribed for those who still have some insulin function left or can't cope with 4 to 5 injections per day