Consultant wanting to change my regime

[trophywench]

For info the first time I'd not 'primed' the tubing properly at all and there was a considerable amount of air still in there . The second time I'd got in a right tangle in bed and bent the tube at a complete right angle - so both entirely down to me!

 

[everydayupsanddowns]

I think, at the end of the day, it's YOUR diabetes, and you should be able to manage it in a way that suits you.

I'm not sure what you mean by 'bring my A1c down a couple of points', so it's hard to gauge what your overall blood glucose management is currently like, except that your clinic seem to want to improve it a little, presumably to reduce the risk of long-term complications - though having lived with T1D for as long as you have, I do wonder whether the potential upheaval of changing to a new system (and possibility of hypoglycaemia during the inevitable 'settling in' period) might actually give your clinic pause for thought. Unless of course, you are beginning to see some complications develop and/or worsen and your clinic are wanting to slow the progress.

Your current system is an odd one that's for sure - you seem to be using ActRapid almost like an old bimodal/mixed insulin, but alongside Tresiba as basal support. Actrapid as approximately a 45 minute onset, followed by peak action between 45mins and approx 3 hours, then quite a long tail with overall activity of around 8ish hours.

I suspect this means you need to snack mid-morning (depending on the size of your breakfast) to keep the 3hr peak action busy, but you are likely to have less insulin active than you need for lunch, by which time the peak action has passed and the pre-breakfast dose is probably fading - not sure if you keep your carb content at lunch low as a result?

It doesn't sound like you find it easy to do 'diabetes stuff' in public places, or around your office, so I am guessing you don't regularly check BG before/after lunch to see what your levels are doing there. I'm not sure if your weekend system is the same, and whether you've done much checking around lunch to see what's happening in an environment where you feel more able to check.

Having said all that, this is your diabetes - and you have many years of management experience under your belt. It's not a style that would suit me (I switched from 2 injections a day as soon as I possibly could for the added flexibility of MDI). What matters most of course, is the results you are getting and whether your current management system is working for YOU, which with 50+ years under your belt would seem to be the case!

Incidentally, have you seen this thread about DUK's 50 year medallists?
https://forum.diabetes.org.uk/boards/threads/new-facebook-medalists-group.70900/

 

[Radders]

When I used a pen, I was taught that it was fine to inject through clothing, so I always did - for the 17 years before I switched to a pump. I’ve never used my arms as I bruise easily and my arms were too thin. Would you consider this as it would mean you wouldn’t need to undress before injecting?

 

[C&E Guy]

Thanks for al these brilliant replies.

Oops - I meant Hb1C has to come down. It was just above the target zone (less than 1% above) but the consultant wants it down to within the zone.

I do always seem to get an astonished, funny look when I say that I am still on Actrapid - by syringe too. I much prefer the 45 minutes "leeway" in the morning and in the evening. I've worked with that for years. A rapid 5 minute insulin would be far too quick for me. It just would not fit in with my personal routine/habits. I used to mix the Actrapid with Insulatard until I got switched to Tresiba last year.

I do feel very awkward doing stuff in public although some acquaintances cope easily with that. I don't.

Injecting through clothing? About once a month on average, I get a "bleeder", which I can easily wipe from a bare arm. If that got on my shirt, I'm sure that my wife would not be too pleased. And colleagues would be looking at it and wondering what was going on.

Touch wood - I don't have any complications after 54 years. A former consultant used to comment that I must have good genes. As the nurse I saw on Tuesday told me "If it ain't broke .....

So I can stick with my Actrapid .... until they stop making it, I guess. A 2 unit increase in the Tresiba seems to be doing the trick so far.