Change of Insulin.

[Slack]

Hi, currently on 2x40 (am/pm) of Humulin 100 IU/ml.
Levels still a bit high (9-10) so have been put on Toujeo Solostar 300 units/ml.
Have been told to take at 2x30 which just does not seem right in my head.
1. Is Toujeo 3x stronger than Humulin?
2. Should i be taking Toujeo once or twice a day?
I hate to question what Nurse has told me but need some peace of mind.

 

[Robin]

A unit of Toujeo is the same as a unit of any other insulin, it’s just dissolved in less liquid, so you have to inject a smaller volume of liquid. So taking 2x30 Toujeo will be less insulin than taking 2x40 Humulin, but it may have a different effect in how it behaves in your body, with different peaks and troughs, therefore when changing insulins, it’s usual to start off at a smaller dose, and then increase gradually with the help of your diabetes nurse, until you find the right level for you.

 

[Slack]

Still confused, you stated that you have to inject a smaller volume which makes sense then say 2x30 T is less than 2x40 H.
Are the readings on the Pens Insulin volume or Total volume (ins + Suspension fluid)?

 

[Robin]

A unit of insulin is the same across all insulins. What you dial up on a pen is the number of units of actual insulin, irrespective of the amount of suspension liquid it’s dissolved in.
Sorry, my wording was unclear.

 

[Bruce Stephens]

Are the readings on the Pens Insulin volume or Total volume (ins + Suspension fluid)?

As I understand it, the pens are designed so they show units rather than volume. So the pens for Toujeo 300 inject 1/3 as much volume for 30 units as one for a U100 insulin would. But they're both giving you 30 units.

(Long ago, before U100, we all had to be careful about this kind of thing because insulin came in different strengths and we used the same syringes regardless. Indeed, there are a few murder mysteries relying on substituting different strength insulins. Technically still possible, I guess, but such stories don't seem to get written nowadays. I'm guessing at least partly because of this uniformity: it's (almost) all U100, and when you use something else you use a different device to inject it.)

 

[Slack]

NOW it makes sense. So that should help the bulging issue i have pumping 40 U100 into me twice daily.
Am I correct in assuming that Toujeo will be less total volume of fluid for the same amount of Insulin?

 

[Robin]

NOW it makes sense. So that should help the bulging issue i have pumping 40 U100 into me twice daily.
Am I correct in assuming that Toujeo will be less total volume of fluid for the same amount of Insulin?

Yes!

 

[gail2]

it makes sense questing your nurse Always do this if you are not sure hunnie

 

[everydayupsanddowns]

I’m rather surprised you nurse has suggested taking Toujeo 2x daily.

Toujeo is designed to act steadily over 24 hours and then gradually tail off over a further 12 hours or so. I believe it was designed to be taken once a day, with today’s dose slightly overlapping tomorrow’s to make up for onset/fade and to provide a steady availability of insulin.


https://www.medicines.org.uk/emc/product/6938/smpc#gref

I can’t see that taking it 2x a day would be of any benefit? It works gradually and consistently in the background - it’s not really directly acting on a meal you have near the dose/injection - it’s just constantly trickling out support for your remaining home-grown insulin.

Was it Humulin I you were taking? That’s an intermediate-duration insulin that does benefit from being taken twice a day, as the duration of action is much shorter.

Hope the Toujeo suits you well 🙂

 

[Slack]

After questioning the amount & frequency, Nurse changed to 60 once a day.
Started Toujeo Wed AM, lets see if it helps.
Last Blood test 84 mmol/mol down from 178 so getting there but still double ideal.

 

[trophywench]

@Slack - patients should still all be told that diabetes is a marathon, not a sprint! 🙂

I also believe that the new info that Mike (@everydayupsanddowns ) gave you above, demonstrates quite clearly that any number of nurses who deal with the diabetes patients within GP surgeries, are not always truly expert - they vary quite a lot depending on this, that and the other - can be the equivalent of a postcode lottery sometimes, I'm afraid. Hence, just be aware of that and should you be a bit unsure about anything else - query it as soon as possible, with whoever you can get hold of - and during weekday working hours Diabetes UK have a telephone hotline you can ask who'll give you sensible advice.