confused.com

[lisa pirinc]

i feel so confused with all thats avalible, an the conflicting information I have recieved from different healthcare proffesionals, I really dont know what to do.
I was 1st diagnosed with type 2 diabeties in 2006 but at the same time was told I was 6 weeks pregnante so was started on metformin 500mg along with novo rapid and levimer to keep my bms as close to perfect as expecting, that I was ok with as all I wanted was a healthy baby.

I have since had 2 more children since 2006 and followed the same routine, and also due to not, not being pregnate for any length of time have been told by one consultant im insluin dependant not type 2 and most recently told NO im type 1 either way as confusing as that is I understand unless a medical breakthrough ill be on insulin for the rest of my life, in although I have some off day with it all im ok with it in the most part.

Im currently taking metformin 2x 500mg twice a day and humalog mix 25 and I was finding the routine of the novo rapid and leveimer all a bit much.

I have been looking online which I have been told as a GP's nightmare at different kinds of treatment, and from what I can see the mertformin is to help with me being over weight ok cant complain there lol and if i am as they put ir type 1 the the basal bosul routine is best ( novo rapid and levemier) but im not sure that it is currenlty for me but if needs must ill have to just get on with it.

but ive been considering taking beytta and lantus as I have heard the beytta is better at maintaining my weight then metformin how ever to keep my bm's at there best this wouldnt be a good routine as im struggleing as it is with the humalog mix 25.

any advice would be great as neither the nurse agrees with the doc nor the doc with the consultant I give up I really am confused.

and just incase it crossed your mine no more babies anytime soon lol

 

[MaryPlain]

Hi there,

what is it that you find difficult to manage about the basal bolus regime? There are lots of people on here who use this regime, I'm sure people will be willing to help if you let us know what specifically you struggle with.

You've come to the right place for learning from other people's experiences.

 

[lisa pirinc]

Its may sound silly, but its all in my head, Im sure of that, but just in general having to inject.
when im out and about, the looks peoplegive and the jumping to conclusions, which I know aint my problem, but theres.
I know im taking the meds cause I need them, but I very much felt like a drug abuser, which sounds really silly when said out load, but just the having to plan everything, at the time I was on that routine making sure I was carb counting, to take the right dose etc...
Making sure if I was out and about I had my insulin etc.... with me having a baby at the time was hard enough let alone worrying about myself in that respect, I think I could mangage it better know as she is 2 years old and even though it would appear to be the most troublesome age I dont have to carry to much for her. I was very overwelmed with the whole routine but carb counting just tipped me over the edge i have been told its quit easy even my sister carb counts but i just cant seem to get my head around it all maths was never my strong point 🙂

 

[trophywench]

Lisa - have you been on the CARBS 4-1 course ? If not get your name down for it YESTERDAY.

Where's that nurse, UHCW Walsgrave, or where?

 

[lisa pirinc]

I havent been on any course, i have only seen the dietican. my nurse is at my surgery but i have an appt at the end of january to see a nurs at uhcw i will be asking about that thank you

 

[everydayupsanddowns]

i feel so confused with all thats avalible, an the conflicting information I have recieved from different healthcare proffesionals, I really dont know what to do.
I was 1st diagnosed with type 2 diabeties in 2006 but at the same time was told I was 6 weeks pregnante so was started on metformin 500mg along with novo rapid and levimer to keep my bms as close to perfect as expecting, that I was ok with as all I wanted was a healthy baby.

I have since had 2 more children since 2006 and followed the same routine, and also due to not, not being pregnate for any length of time have been told by one consultant im insluin dependant not type 2 and most recently told NO im type 1 either way as confusing as that is I understand unless a medical breakthrough ill be on insulin for the rest of my life, in although I have some off day with it all im ok with it in the most part.

Im currently taking metformin 2x 500mg twice a day and humalog mix 25 and I was finding the routine of the novo rapid and leveimer all a bit much.

I have been looking online which I have been told as a GP's nightmare at different kinds of treatment, and from what I can see the mertformin is to help with me being over weight ok cant complain there lol and if i am as they put ir type 1 the the basal bosul routine is best ( novo rapid and levemier) but im not sure that it is currenlty for me but if needs must ill have to just get on with it.

but ive been considering taking beytta and lantus as I have heard the beytta is better at maintaining my weight then metformin how ever to keep my bm's at there best this wouldnt be a good routine as im struggleing as it is with the humalog mix 25.

any advice would be great as neither the nurse agrees with the doc nor the doc with the consultant I give up I really am confused.

and just incase it crossed your mine no more babies anytime soon lol

Hi Lisa

Sorry to hear that you are feeling a bit confused by it all.

In my opinion the first thing to try to get clear is your diagnosis type.

If they are sure you are type 1, then (as I understand it) things like byetta and victoza will not work because your own insulin production is on its way out. You might be LADA (sometimes called type 1.5 or 'slow onset type 1') in which case your pancreas may have a bit of go in it for a few years yet, but essentially you are going to need to inject insulin.

As I'm sure you know, the purpose of injecting insulin is to try to 'match' the food that you are eating as closely as possible. To keep your blood glucose levels as near 'normal' as you can and to avoid complications and nasties further down the line.

There is always a trade-off between insulin types annd methods and you need to work out this balance for yourself.

In a 'normal' three meal day your insulin need would look a bit like this:

_ _ lots-some-little _ _ _ lots-some-little _ _ _ lots-some-little _ _ _ _ _ _ _

where the dashes are just a trickle of insulin needed to deal with glucose released form the liver and 'lots' 'some' and 'little' are the boosts of insulin you need when you eat food containing carbohydrate (bread/potatoes/pasta/rice/fruit/jam/treacle pudding/blah blah blah).

The tricky thing with 2 doses of mixed insulins like Humalog Mix 25 is that they tend to have this sort of pattern:

_ _ some-some-some-some-little-little _ _ some-some-some-some-little-little _ _

So there are times when you will have too much insulin active and need to snack to avoid hypos (whether you are hungry or not). And you will need to eat your meals at sizes/times to fit with the schedule of the insulin in order to get your BGs to behave.

I was only on mixed insulins for a year or two, and I would not suggest that they just don't work full stop - but I do think they take quite a lot of work, organisation and discipline to get them to work well.

The other thing is - and I'm sorry if I'm the first person to tell you this - that if you are aiming for good control then carb counting is not just optional. One way or another you HAVE to match your doses of insulin to the carbs you are eating or your BGs will be all over the place.

It's a nuisance, but there you go.

All is not doom and gloom though, if you found the constant maths a struggle. Not so many years ago it was not unusual for a T1 to be on fixed doses of insulin and to match the food with that. Many members here, myself included, worked basal:bolus like that with pretty good levels of succcess for many years.

So rather than having to work out every meal from scratch every time, you just know that at breakfast you 'need' 50g of carbs, then 50g at lunch and then 60g of carbs as an evening meal. The exact numbers will, of course, be something for you to work out with the help of your team. But you will quickly get a feel for what 60g in carbs of rice (or whatever) looks like on a plate. You'll know that your lunch is a sandwich and fruit or crisps, but not both... and so on. It's not the full flexibility of full-on carb counting, but can take some of the mental acrobatics out of the equation.

One way or another, if you want to guard against complications, you need the insulin you are injecting to match the carbs you are eating. Some people seem to be able to get away with a bit more vagueness, other people need to be very accurate with their carb amounts. But by keeping to regular doses and regular meal sizes you can make it a bit easier 🙂

 

[trophywench]

UHCW are pretty good Lisa, whereas GPs and surgery nurses are not I'm afraid, cutting edge on ANY diabetes type. Some are better/worse than others.

Surgery Nurses in Coventry usually attend a one day-ish course at Warwick Uni Medical School, which is much more time than they've ever spent before in their career, learing about D !

I know they also do a T2 course, as well as DESMOND or possibly instead of, cos there are always posters up in the waiting room at the Rugby clinic advertising refresher courses.

 

[lisa pirinc]

thanks - you

Thank - you for the advice I have my appt with the hostpital at the end of january, but in the mean time I have an appt with my gp's diabetic nurse to express my concern and see what happens will keep you posted 😛

 

[lisa pirinc]

thank you

i think the diabetic healthcare providers need to come and have a look on here most information i have been given THANK YOU

Hi Lisa

Sorry to hear that you are feeling a bit confused by it all.

In my opinion the first thing to try to get clear is your diagnosis type.

If they are sure you are type 1, then (as I understand it) things like byetta and victoza will not work because your own insulin production is on its way out. You might be LADA (sometimes called type 1.5 or 'slow onset type 1') in which case your pancreas may have a bit of go in it for a few years yet, but essentially you are going to need to inject insulin.

As I'm sure you know, the purpose of injecting insulin is to try to 'match' the food that you are eating as closely as possible. To keep your blood glucose levels as near 'normal' as you can and to avoid complications and nasties further down the line.

There is always a trade-off between insulin types annd methods and you need to work out this balance for yourself.

In a 'normal' three meal day your insulin need would look a bit like this:

_ _ lots-some-little _ _ lots-some-little _ _ lots-some-little _ _ _ _ _ _ _

where the dashes are just a trickle of insulin needed to deal with glucose released form the liver and 'lots' 'some' and 'little' are the boosts of insulin you need when you eat food containing carbohydrate (bread/potatoes/pasta/rice/fruit/jam/treacle pudding/blah blah blah).

The tricky thing with 2 doses of mixed insulins like Humalog Mix 25 is that they tend to have this sort of pattern:

_ _ some-some-some-some-little-little _ _ some-some-some-some-little-little _ _

So there are times when you will have too much insulin active and need to snack to avoid hypos (whether you are hungry or not). And you will need to eat your meals at sizes/times to fit with the schedule of the insulin in order to get your BGs to behave.

I was only on mixed insulins for a year or two, and I would not suggest that they just don't work full stop - but I do think they take quite a lot of work, organisation and discipline to get them to work well.

The other thing is - and I'm sorry if I'm the first person to tell you this - that if you are aiming for good control then carb counting is just not an option. One way or another you HAVE to match your doses of insulin to the carbs you are eating or your BGs will be all over the place.

It's a nuisance, but there you go.

All is not doom and gloom though, if you found the constant maths a struggle. Not so many years ago it was not unusual for a T1 to be on fixed doses of insulin and to match the food with that. Many members here, myself included, worked basal:bolus like that with pretty good levels of succcess for many years.

So rather than having to work out every meal from scratch every time, you just know that at breakfast you 'need' 50g of carbs, then 50g at lunch and then 60g of carbs as an evening meal. The exact numbers will, of course, be something for you to work out with the help of your team. But you will quickly get a feel for what 60g in carbs of rice (or whatever) looks like on a plate. You'll know that your lunch is a sandwich and fruit or crisps, but not both... and so on. It's not the full flexibility of full-on carb counting, but can take some of the mental acrobatics out of the question.

One way or another, if you want to guard against complications, you need the insulin you are injecting to match the carbs you are eating. Some people seem to be able to get away with a bit more vagueness, other people need to be very accurate with their carb amounts. But by keeping to regular doses and regular meal sizes you can make it a bit easier 🙂