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Different insulins

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JimBear

JimBear

Active Member
Relationship to Diabetes
Type 2
Hello again folks,
I'd like some advice about insulin please!
I have recently been put on insulin which has been brilliant! This was before the second lot of Metformin (see other thread). The results were noticeable with just 3 doses of 10 units. I felt a lot better and my eyesight returned to normal within a week.

The insulin I am currently on is Humulin M3 KwikPen (30% fast acting/70% slow acting) which I inject twice a day, 30 mins before breakfast and evening meal. My numbers have dropped but are still well above 'normall', typically reading between around 14-21.

I realise that it can be long process to gradually increase the dose until the numbers come down.

The reason I am posting this is because personally I don't believe this is the most suitable insulin for me to be on. For example these are some of the numbers I have recently experience (dropped a little since taking two doses of Metformin):
Before breakfast ---- Before lunch
14.8 --- 19.3
17.1 --- 19.5
15.9 --- 17.8
13.9 --- 20.1
As you can see, not ideal, but most of the pre-lunch ones are not all that far away from the pre-breakfast ones. However, at around 10.45-11.00 I was become so super-tired I could have fallen asleep at my desk, so on the same days as these readings were taken I tested my blood at 10.45. These are the respective results: 31.7, HI (the meter tops out at 33.3 so this reading was above the scale of the meter), 29.6, 29.8.

As you can see these results are highly undesirable. (Incidentally I was removing each item of my breakfast to see if any one particular item was causing these effects. It seems like breakfast in general is perhaps the culprit.)

I wouldn't be at all surprised if something similar was happening during the night as the quick insulin is used up by my evening meal.

I have discussed this with my nurse and asked her about the 50/50 insulin, as to me it appears there may not be enough of the quick acting insulin to cope. She told me they only use that as 'a last resort'.

Now I was wondering if perhaps I should be looking towards mainly using a quick-acting insulin prior to every meal and then adjust by testing two hours afterwards. There are several thoughts going through my mind about this: First, it can be tailor-made to suit every type of meal. Second, it should avoid undesirable peaks in my sugars after eating.

There are other reasons too. For example, if I dine out, I don't know how long it will be before food arrives at the table, so trying to judge a 30 minute slot beforehand could be tricky (recently I had to wait over an hour in a quiet pub before a simple lunch arrived). With the quick-acting, I could discreetly inject when it arrived at the table.
Another reason is I am concerned I could end up having a hypo on the current insulin: I have noticed if I have a bacon & egg breakfast at the weekend with practically zero carbs and then perhaps a salad at lunchtime, again with low carbs my numbers are looking quite promising. If my numbers are eventually within normal range for the general week (which doesn't vary all that much), if I have a low-carb day, am I at risk of a hypo? If so, I would rather alter a fast-acting insulin to match the type of meal I am eating.

I am sorry this is such a long post, but I am trying to get as much info as possible before making any discussion with my nurse. I have great respect for the medical staff but sometimes I get the feeling they are not too interested in making any variation between one patient and another to suit their individual lives and needs and so I like to have as many facts/experiences to hand. 🙂

Many thanks for your time!
Jim
 
I would definitely think you would benefit from using separate slow and fast acting insulins - this would give you much more flexibility. Currently you are very much at the mercy of the various peaks and troughs of the insulin you are using, with very limited ability to 'correct' those high levels without things becoming very complicated. Quality of life is very important when you have a chronic condition, so do stress that this is causing you problems and ask for the basal/bolus insulin (also known as MDI - Multiple Daily Injections). It's not what's easiest for them - ti's ALL about what is best for you! 🙂
 
Hi I started on insulin end of Jan this year and was put on humulin m3, this brought my numbers down a bit but they were still high. I did not like having to eat certain amounts at certain times, it was just not flexible enough for me. I taught myself carb counting and two weeks later I asked to go on basal bolus which my practice nurse agreed to and started me on humulin I and novorapid. My figures are at last a lot better and having seen my doses for novorapid my nurse agrees I needed the more flexible regieme. I'm not entirely happy with humulin I as a basal and I think I would prefer levermir but I can't do everything at once, I also prefer the novopen 5 over the humapen savvio to use, another reason for changing basal insulin, take care
Jo
 
When I was on mixed insulin I needed more in the morning than I did in the evening so you might just need to experiment a bit with the number of units you're taking. I think I took 14 units at breakfast and 10 units at dinner. Basal bolus is definitely more flexible than mixed but if they are reluctant to change your regime then adjusting your doses is definitely worth a try. Those numbers are far too high. Try increasing your morning dose by 1 or 2 units until the figures are more acceptable.
 
Thank you folks for your replies! That has been extremely helpful to know how you are coping with your diabetes in a flexible manner. I really appreciate your time in reading my post and for the replies you've given.
Best wishes
Jim 🙂
 
Hi. I'm on seperate long acting and rapid insulins it's is flexible , once you have learnt to carb count you can adjust your Bolus (rapid insulin before meals) rather than having to eat a certain amount of carbs , also ask to go on a course.
Yes it does mean more injections but they're only tiddley little things aren't they.

Do let us know how you get on
 
Thanks LJC - I have no objections to the injections, and the results from using insulin have been sooo much better than relying on oral meds. I really wish they hadn't *****-footed around for so long. I asked them ages ago to go on insulin but my doc refused and my original nurse described it as 'a grim route'. Even though I still feel unwell, I am a heck of a lot better than I was!
My nurse is off for a week now so I shall see if I can sort out an appointment when she returns and let you know 🙂
Jim 🙂
 
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Hi. I would ask to be changed to Basal/Bolus which gives much better control. Although many do 5 injections per day, I don't split the Basal (not essential) and don't use the Bolus for breakfast as it's low carb. Although the Basal runs down after 12-15 hours, I adjust my dinner Bolus to compensate. That means 3 injections not 5 and my HBa1C is good. Not everyone can go less than 4 or 5 but worth looking at the trade-offs and it's only one more injection than mixed.
 
I am very keen to learn more about this and how to do the calculations right. I have a feeling my nurse is going to resist me suggesting this, but I can clearly see how much more controllable it is.
 
I had mixed insulin for a while and it was a ruddy nightmare, the 70/30 split was not good for me at all, far too much background not enough rapid, so I was sky high after eating then plummeting just prior to the next meal. Basal bolus is much more flexible and I'd recommend it over mixed every time. I have absolutely no idea why they are so insistent on mixed insulin, I mean if it works fine, but I think most people find it doesn't provide the flexibility they need. Carb counting is actually very easy once you get your head around it and if you put the work in at the start to work out ratios. I taught myself because I was determined I wasn't staying on that mixed nonsense a moment longer (it really, really didn't work for me). Ask the nurse and then is she resists ask her for her reasons, your treatment regime should be about quality of life not just what they decide you should be happy with. Good luck, hopefully the nurse won't be difficult 🙂
 
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I think there's a number of reasons why they go for mixed. Insulin of all types is expensive stuff but it is cheaper to give a mixed than separate short and long acting. If weight is an issue (often the case in T2) then with a mixed on fixed doses it should in theory be easier for HCP's to help regulate/monitor someone's diet to help them try and lose weight. Older people (and newly diagnosed) are often put on mixed as it's considered easier - fewer injections, not as complicated as MDI.
 
Kooky Cat - that is exactly how I feel about it. I will certainly ask her when I next see her 🙂
Northerner - that booklet PDF says it's aimed at Type 1 Diabetics - I am type 2; is it still valid for this kind of treatment, and if so, why does it say it's aimed at Type 1s?
Matt Cycle, that would seem to make sense. I was wondering if perhaps it was to trial out to see if patients were OK about injecting and testing.
 
JimBear said:
Kooky Cat - that is exactly how I feel about it. I will certainly ask her when I next see her 🙂
Northerner - that booklet PDF says it's aimed at Type 1 Diabetics - I am type 2; is it still valid for this kind of treatment, and if so, why does it say it's aimed at Type 1s?
Matt Cycle, that would seem to make sense. I was wondering if perhaps it was to trial out to see if patients were OK about injecting and testing.
Click to expand...
Hi Jim, much depends on the types and doses of insulin you need whether carb counting is relevant. For Type 1 it is always relevant, since all Type 1s need to closely match their insulin doses to their food. However, many Type 2s are on basal (slow-acting) insulin only and do not take a fast acting with their meals, so carb counting doesn't apply. Other Type 2s may be on very large doses of either mixed or separate slow and fast-acting insulins (hundreds of units, in some cases), and in their case, adjusting doses to match food doesn't really have the desired effect.

If, however, you are on relatively small doses of insulin then carb counting definitely does apply (as I believe it does in your case 🙂) As an example, I was on 65 units total insulin when diagnosed - you are only on 30 currently 🙂
 
JimBear said:
Did I say that? Oops. I am currently on 50 units twice a day.
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Still relevant! 🙂 You may find you would be on a similar dosage of separate insulins - they would probably start you off on the same 30/70% split, but in time you may find that you need more slow and less fast, or vice-versa 🙂 You are, effectively, currently using 30 units of slow and 70 units of fast, but the balance isn't quite right between the two - however, if they are mixed you can't adjust that balance and you are tied to eating what and when the insulin demands of you.
 
Jim, please don't worry about the book being written for T1s, it is relevant to us too except we, due to often having more insulin resistance will probably need higher doses of insulin. It's well worth the initial effort honest 🙂
 
That is really interesting to hear your views here and makes a lot of sense. I've just skim-read the booklet which is nicely written and the exercises are a good idea (and I did a few of them). I am interested to know more about the courses the booklet mention. My main concerns with any of this (including visiting my nurse!) is how much time I have to take out of work. My new nurse is miles away and only seems to work during the middle of the day so even that's a nuisance trying to arrange to make up time etc. I just hope the courses aren't during the day too lol.
 
JimBear said:
That is really interesting to hear your views here and makes a lot of sense. I've just skim-read the booklet which is nicely written and the exercises are a good idea (and I did a few of them). I am interested to know more about the courses the booklet mention. My main concerns with any of this (including visiting my nurse!) is how much time I have to take out of work. My new nurse is miles away and only seems to work during the middle of the day so even that's a nuisance trying to arrange to make up time etc. I just hope the courses aren't during the day too lol.
Click to expand...
Diabetes UK do an online course for Type 2s - I can't comment on the content because I haven't looked through it, but you might want to look at it and see if you think it is useful for you (if not, let me know and I'll feed it back to DUK!)

https://www.type2diabetesandme.co.uk/lnt/Login.aspx?ts=635098279166186250

For a more involved look at carb counting there is the BDEC free online course:

http://www.bdec-e-learning.com/

Unfortunately, most of the face-to-face courses I'm aware of are day time courses.
 
I have been on the course for diabetes type 2 who are on insulin. It was a few hours on one day and a few hours on a day the following week. Some just do it in one whole day I was told. However, it is so informative and comprehensive and they put it over so even the dumbest of people would understand it, I would do anything you can to go on one. Even if you have to take those hours as part of your holiday entitlement. It is so worth it.
 
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