Bolus quantities? - hecsmith

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hecsmith

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Hi, I was interested to read about splitting large doses of bolus i.e. 20 units split to 10 and 10.

My partner is currently on 96 pm, 96 am (both bolus) then 16 fast acting with every meal including snacks.

The bolus may be elevated to 126 pm and am... just how many injections would this be?!

Would be interested to know who 'they' that say this about splitting doses are and and the reasoning behind this.

Is anyone else on such huge doses?
 
Hi hecsmith

Maybe this is worth putting on the main board as a separate question? is your partner type 1 or type 2?

Take care.
 
Hi Hecsmith, welcome to the forum🙂 I moved your question to its own thread. Do you mean 'basal' rather than 'bolus'? Basal is the slow-acting insulin,bolus the fast (took me ages to get used to distinguishing them, I think they should be called Slowcoach and Speedy or something!).

Large doses of insulin are normally required when a person has insulin resistance. I know we have at least one person here who is on over 180 units of insulin, as it is not used very effectively by the body. With quantities like that, I think you'd have to split, but whether you could inject slow-acting 3 times a day I'm not sure. Maybe a shorter-acting insulin would be OK if it had, say a 6-8 hour profile? Do you know which insulins he takes?
 
Hi Northerner....yes sorry I did mean basal.... doses are now 100 pm, 100 am and 20 units 'bolus' everytime he has a meal or snacks. I like the suggestion of slowcoach and speedy lol My question still sort of applies as he is now on 20 units of 'speedy' with food but if he has to split that could be a minimum of 12 + injections a day at present levels!

At the moment the insulin is humulog I and S, however have just learned he is to have an insulin pump so not sure what it will be when that happens.

Hi Patricia - He is type 2 and clearly very resistant!

Northerner...How do I make contact with the person you mention who is on 180?

You mention you have moved my question to its own thread -how do I find it?

Forgive me but I am completely new to this forum and not awfully computer literate!

Thanks for your replies.
 
hecsmith said:
Hi Northerner....yes sorry I did mean basal.... doses are now 100 pm, 100 am and 20 units 'bolus' everytime he has a meal or snacks. I like the suggestion of slowcoach and speedy lol My question still sort of applies as he is now on 20 units of 'speedy' with food but if he has to split that could be a minimum of 12 + injections a day at present levels!

At the moment the insulin is humulog I and S, however have just learned he is to have an insulin pump so not sure what it will be when that happens.

Hi Patricia - He is type 2 and clearly very resistant!

Northerner...How do I make contact with the person you mention who is on 180?

You mention you have moved my question to its own thread -how do I find it?

Forgive me but I am completely new to this forum and not awfully computer literate!

Thanks for your replies.
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Hi Hecsmith.

I don't think a dose of 20 units has to be split. Has your partner's diabetes team suggested this? Personally I take doses of 16 and 20 units all the time.

I'm assuming the Basal doses would need to be split because the pen may not be able to dispense that many units at one time? but also, you may not feel comfortable giving that much in one go.

You have found the right thread, but if you want to read the old one it's here: http://www.diabetessupport.co.uk/boards/showthread.php?t=2084

I will ask the person who takes 180 units if he would mind sending you a message 🙂 I'm sure he will post next time he is on.

Katie.
 
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Hi Katie

Thanks for your speedy reply, I didn't expect to get a reply at this hour of the morning... so there are others out there who cannot sleep!

Thank you for offering to enquire if the person who takes 180 units would perhaps contact me... I look forward to hearing from him/her.

Yes, the basal doses do need to be split - the pen only dispenses 60 units a time. This causes great problems as my partner suffers severe neuropathy and also is registered fully blind so would love to hear from anyone else to learn about how they cope with everything, especially if they use a pump.
 
Hehe yep, been having some sleep problems recently!

Sorry to hear about your partner's complications. I'm sure there will be a few people here who will be able to share their own experiences with you and offer some support. There is a whole thread devoted to pumping, so if you want to learn about those it's the best place to go: http://www.diabetessupport.co.uk/boards/showthread.php?t=3554&page=90

Right, better try to sleep now :D

Katie.
 
Hi hecsmith.

Got a message from Katie about this thread. Haven't been on for a little while so would have missed it otherwise 🙂

Although I'm on high doses, it's a little different to your partner. I take 64U of lantus (basal) split 32/32 morning and night. I take much higher boluses though, of 56,56 & 58, although thses will vary a little depending on bgs and food. I was also recently (re)started on Metformin. This helps with the insulin resistance.

I'm surprised they are talking about pumps though as acording to the NICE guidelines, they are normally only given to type 1s. The problem they would have with a pump is that the inuslin would be used up very quickly with those sort of doses. From what little I know of the pumps, they are designed to stay in place for around three days. If they take the standard size cartriges, they can hold up to 300U. This would last only a day with the amounts your partner was taking.

As for splitting doses, I split my basal because I found it gives me etter control. You can get insulin pens that will deliver higher doses than 60. Ask the doctor to look for another pen that may be more suitable. Having said that though, I find injecting high doses in one go can be more painful than a smaller dose, so it may be better staying with that.

Feel free to PM me with any questions you may have.
 
Hi Hecsmith.

I have been Type2 for almost 4 years and I take large doses of insulin but not quite as large as you are refering to.My doses are:-

Levemir (long acting) Total 150 units per day

Novorapid. Breakfast 25/35 units per day..depending on exercise etc
Lunch 25 units.
Teatime 35 units
The novorapid can vary depending on BG readings at the time and of course exercising paterns

As regards to my Long acting Levemir...I take 50 units at breakfast 8am and then at 8pm I take 100 units this of course means 2 injections because the maximum dial up on the pen is only 60 units.

These are the way my doses work best for me after a lot of trial and error, it is in no way a suggestion for anyone else to try as the one thing you quickly learn about diabetes is. There is NO ONE QUICK FIX SUITS ALL.

Best wishes and welcome to a great group.
John.
 
I've been advised to split larger doses over a few injections as potentially injecting a lot in one go could affect the absorption of the insulin making things less predictable. I've only been told that in relation to bolus insulin though.
 
Dose that can be given in one injection also depends on the pen being used - various pens have different maximum doses eg 100 units, and also vary in the increments they can give - generally, smaller total doses (up to about 40 units) can be given in single or even half unit increments, while pens that can dispense larger doses can only vary doses in 2 unit increments. So, definitely worth talking wth the specialist who suggested increasing your husband's basal dose - they will know far more about your situation than those of us on this (or any) discussion board. Please let us know how you get on.
 
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