Concerned Newbie

[DavidA]

Hi Everyone. Your thoughts would be appreciated.
72 years of age and diagnosed Type 2 about 25 years' ago.
Medication for many years, then Levemir insulin for around one year and 6 years ago managed to return to tablets (through diet). The numbers were under control!
During the last couple of years the numbers have been creeping up and I was placed on maximum dose of Metformin (2000mg morning and 2000mg evening). In addition was taking 1 x Indapamide 2.5mg.
12 months ago my stomach reacted with Metformin and three times a week I had 'projectile diarrhoea' with maybe 5 seconds warning. This caused many embarrassing moments.
Three months ago my GP reducted the Metformin to 500mg and added Gliclazide 80mg x 4 to the mix. Cutting a long story short, Metformin is no longer taken and two days ago was prescribed Humalog 100 insulin with 2x80mg Gliclazide.
The last week my readings have been lowest 16.2 ranging to 22.5.
6 units of insulin in the morning reduced numbers to 16.8 by mid morning (from 18.1 on wakeup). 3 hours later numbers 18.6.
Breakfast low carb. Grilled bacon, 1 poached egg and baked beans. Nothing eaten since breakfast and numbers higher than on wake up.
My apologies for such a long message but I am concerned my GP and DN have not prescribed the correct insulin. Years ago I was on Levemir which was long lasting. The surgery no longer prescribe Levemir. Now I am on one dose of fast acting in the morning with 160mg of Gliclazide in the evening. Numbers are high and I am eating as low carb as possible throughout the day and walking my two dogs to get exercise. Any thoughts? Thank you

 

[stephknits]

I am not sure why they would prescribe a fast acting insulin to take just once a day. Normally you would take a fast acting before eating your meals (as long as they had carbohydrate in them). This would help control the spike you would get otherwise from the carbs in your meal. If you are high to start with, it would seem that you need a long acting to manage that. I cant imagine why the surgery don't prescribe Levemir as this is a common long acting for a Type Is. It would seem strange that they are no longer prescribing it for type IIs. I guess I would do a food diary, noting down blood sugars and insulin taken and then take it back to the surgery to show how it is not working. If they are unable to help, perhaps they could refer you to the diabetes team at the hospital.

 

[Drummer]

You must be eating a very small amount of baked beans to be having a low carb breakfast including them - but I find that carbs from legumes seem to have more clout, though I notice that you are using low fat cooking techniques, and that doesn't cut it for me. I do LCHF and hope to avoid medication.
I am only aware of the working of insulin from reading how the different types are used, and the use of Humalog seems illogical - if you are particularly insulin resistant in the mornings, as many type twos report, then Humalog and baked beans? What is their thinking.
Maybe ditch the beans for sausages?

 

[stephknits]

I don't think the beans are the problem - if you look at your levels, having taken the 6 units of insulin and eaten your breakfast - you report a drop in levels - so the insulin is more than capable of dealing with the beans - as a shot acting insulin, that is what it is supposed to be doing. If your numbers had been more in range in the first place - say 7 before you ate, then you would have probably wanted maybe one unit less to cover the breakfast. Also, shortacting insulins seem to be more effective at correcting your blood sugar when your blood sugar is in the normal range. Thus it is a lack of long acting that is the problem - as you are on to a loosing wicket starting with those high levels.

 

[trophywench]

From what you've told us, I'd suggest you absolutely need a long-acting insulin exactly the same as a Type 1 would, and on top of that a fast acting insulin to deal with the carbs in meals.

Whilst the body is still producing a decent amount of insulin then fine a lot of the time the person can get away with just a long-acting insulin and it's enough to 'paper over all the gaps'. However if your pancreas can't work that hard any more, for whatever reason, then it has to be insulin and we need it (everyone LOL) for 60 minutes every hour of the day and night. To prescribe only two jabs of something that is only active for up to 5 hours, sounds potty to me.

 

[Matt Cycle]

If they're being funny about the Levemir you could ask about a mixed insulin (often given to T2's) contains both long and short acting in varying proportions e.g. Humalog Mix or Novomix.