Good morning, thought it was about time to discuss my Diabetes.

[Builderboy]

At the tender age of 78 and having been diabetic for 24 years I have been blessed with good control until recently, about two years ago
things started to go pear shape. My numbers were all over the place with poor control, I am still in reasonable heath and still work as a surveyor, however having had the good fortune to have a regular diet for many years, that has all changed. My insulin has increase to
100 units of Humulin per day with average glucose level of 9.5 which for no apparent reason can dive to 4 early morning, I have avoided
hypos to date, my nurse does not seemed phased and get the impression that I should expect the above at my age.
Any one who has experienced the above I would be grateful to hear from.
Many thanks any help is appreciated.

 

[rebrascora]

Hi and welcome.

Sorry to hear you are experiencing problems with erratic BG levels.

Roughly how long have you been on insulin and when did your dose increase up to 100u?
Has your diet changed or have you put on weight or become less active to cause an increase in needs? There are lots of things which can mean you need more insulin but these are some of the most common factors.

Which Humulin insulin do you use (there should be a letter or perhaps a number after it) and when do you take it? ie. morning or evening or both?

Are you using a Libre sensor or other Constant Glucose Monitor (CGM) or just finger pricking to get those results?

The more information you can give us the better advice we can offer you.

 

[Inka]

How long have you been using insulin @Builderboy ? Sometimes our injection sites get ‘thickened’ over time and the insulin is absorbed less well, meaning we need higher doses than usual.

 

[Builderboy]

At the tender age of 78 and having been diabetic for 24 years I have been blessed with good control until recently, about two years ago
things started to go pear shape. My numbers were all over the place with poor control, I am still in reasonable heath and still work as a surveyor, however having had the good fortune to have a regular diet for many years, that has all changed. My insulin has increase to
100 units of Humulin per day with average glucose level of 9.5 which for no apparent reason can dive to 4 early morning, I have avoided
hypos to date, my nurse does not seemed phased and get the impression that I should expect the above at my age.
Any one who has experienced the above I would be grateful to hear from.
Many thanks any help is appreciated.

Hi and welcome.

Sorry to hear you are experiencing problems with erratic BG levels.

Roughly how long have you been on insulin and when did your dose increase up to 100u?
Has your diet changed or have you put on weight or become less active to cause an increase in needs? There are lots of things which can mean you need more insulin but these are some of the most common factors.

Which Humulin insulin do you use (there should be a letter or perhaps a number after it) and when do you take it? ie. morning or evening or both?

Are you using a Libre sensor or other Constant Glucose Monitor (CGM) or just finger pricking to get those results?

The more information you can give us the better advice we can offer you.

 

[Builderboy]

Hi there,
And thank you for your response, I have been on insulin for four years until 9 months ago I was on Lantus 15 units twice a day with rapid nova 5u after breakfast. My levels become erratic which is why i was switched to Humulin M3 and dose increased to give me better control.
I have not put any weight but my diet has changed to help keep my numbers down. As stated I work every day but that is
becoming difficult due to increased tiredness.
Thank you for your interest.
Graham.

 

[Builderboy]

Hi there,
And thank you for your response, I have been on insulin for four years until 9 months ago I was on Lantus 15 units twice a day with rapid nova 5u after breakfast. My levels become erratic which is why i was switched to Humulin M3 and dose increased to give me better control.
I have not put any weight but my diet has changed to help keep my numbers down. As stated I work every day but that is
becoming difficult due to increased tiredness.
Thank you for your interest.
Graham.

 

[rebrascora]

When do you take the Humulin M3?

Mixed insulins are generally injected twice a day, before breakfast and before evening meal and the split is not always 50/50.
When you say you have changed your diet.... in what way? ie Have you reduced your carbohydrate intake significantly?

The Lantus/NovoRapid combination is what we call a basal/bolus insulin regime which allows you to be more flexible in what and when you eat.
Mixed insulin which is what the Humulin M3 is, needs quite a regimented way of eating with fairly uniform carb intake at each meal and doesn't generally allow for snacks.

I wonder if the Lantus/NR combo would have worked better for you if you had had some education on it's use from a specialist nurse or dietician or even support from this forum.

If you are just taking the mixed insulin once a day or the split of a twice daily dose is not suiting your body, then that may be part of your problem. Insulin therapy is quite complicated and needs understanding and sometimes regular adjustment by "patient" to get the best from it. Those of us who are Type 1 have access to an intensive education course to help us understand how it all works and when to adjust it but sadly Type 2s on insulin are very unfairly not entitled to this.

If you are not using a CGM like Libre and just relying on finger pricks, I wonder if a free 14 day trial of a Libre sensor may help you (and perhaps us if you can post photos of your graphs) to understand what is going on with your levels. That may highlight some issues which could be causing fatigue if it is diabetes related.... Perhaps going low regularly during the night or being high most of the day. Once my levels are above 10mmols I feel more sluggish and my legs feel heavier and if I get up to 15 I want to sleep. Alternatively, if you are having hypos those can really drain you too. Libre might enable you to iron out some of the highs and lows with dietary changes or possibly insulin adjustment.

Another question..... Are you also on Metformin and if so, have tour vitamin B12 levels been checked. Long term use of Metformin can lead to problems absorbing vitamin B12 from food (or supplements) and deficiency can cause problems with fatigue as well as nerve pain/tingling and I think it can be associated with anaemia. If you have access to your blood test results it might be worth checking those to see if your B12 and other bloods are within guidelines.
Of course lots of other stuff can cause fatigue

 

[Inka]

Lantus 15 units twice a day with rapid nova 5u after breakfast. My levels become erratic which is why i was switched to Humulin M3 and dose increased to give me better control.
I have not put any weight but my diet has changed to help keep my numbers down.

Your previous Lantus and Novorapid regime sounds a little unusual. Lantus is commonly taken once a day and Novorapid is usually taken before meals to deal with the rising blood sugar from the meal not afterwards. Perhaps if you’d taken a proper basal/bolus regime, you’d have found things better, ie Lantus once a day and Novorapid before each meal.

Humulin M3 is ok, but it’s a mixed insulin with set proportions of slow and fast insulin. Unless you’re one of the people who these proportions suits, it’s not going to work well for you as there’s no flexibility. Presumably you take it twice a day? Your early morning 4 could be because you’re having too much slow insulin in your evening dose because you needed more fast insulin to cover your evening meal - because the slow and the fast are mixed together in one insulin and you can’t increase one part without increasing the other.

How has your diet changed? Are you able to eat enough to maintain your weight and satisfy you?

 

[everydayupsanddowns]

Welcome to the forum @Builderboy

Sorry to hear your insulin doses have increased, and your levels have been a bit more chaotic over the past few years.

Your previous TDD (total daily dose) looks like it was 35 (15+15+5). So 100u of Humulin M3 is quite a dramatic increase, and your average glucose of 9.5 is a little above target. Good to hear you’ve not been troubled by hypos, but those overnight drops to 4.0 must be quite worrying as those are quite close to the edge.

Mixed insulins can work well for people with a fixed routine whi are happy to follow the insulin’s schedule and timings, but I do wonder whether your Humulin M3 is flexible enough for your lifestyle? If your metabolism is now needing a little more rapid-insulin support for meals, and a little less background coverage, unfortunately you can’t change the proportions or meal timings with M3

Less Lantus to *only* cover background needs, and a dose of NovoRapid matched to the carb content of each meal or snack you have would allow you more flexibility to adjust your doses to match your needs, and the timings of your day.

Perhaps your nurse is less used to people with T2 being on a basal:bolus regimen?

But we have several members here who have found it extremely effective for their T2 🙂

 

[Builderboy]

When do you take the Humulin M3?

Mixed insulins are generally injected twice a day, before breakfast and before evening meal and the split is not always 50/50.
When you say you have changed your diet.... in what way? ie Have you reduced your carbohydrate intake significantly?

The Lantus/NovoRapid combination is what we call a basal/bolus insulin regime which allows you to be more flexible in what and when you eat.
Mixed insulin which is what the Humulin M3 is, needs quite a regimented way of eating with fairly uniform carb intake at each meal and doesn't generally allow for snacks.

I wonder if the Lantus/NR combo would have worked better for you if you had had some education on it's use from a specialist nurse or dietician or even support from this forum.

If you are just taking the mixed insulin once a day or the split of a twice daily dose is not suiting your body, then that may be part of your problem. Insulin therapy is quite complicated and needs understanding and sometimes regular adjustment by "patient" to get the best from it. Those of us who are Type 1 have access to an intensive education course to help us understand how it all works and when to adjust it but sadly Type 2s on insulin are very unfairly not entitled to this.

If you are not using a CGM like Libre and just relying on finger pricks, I wonder if a free 14 day trial of a Libre sensor may help you (and perhaps us if you can post photos of your graphs) to understand what is going on with your levels. That may highlight some issues which could be causing fatigue if it is diabetes related.... Perhaps going low regularly during the night or being high most of the day. Once my levels are above 10mmols I feel more sluggish and my legs feel heavier and if I get up to 15 I want to sleep. Alternatively, if you are having hypos those can really drain you too. Libre might enable you to iron out some of the highs and lows with dietary changes or possibly insulin adjustment.

Another question..... Are you also on Metformin and if so, have tour vitamin B12 levels been checked. Long term use of Metformin can lead to problems absorbing vitamin B12 from food (or supplements) and deficiency can cause problems with fatigue as well as nerve pain/tingling and I think it can be associated with anaemia. If you have access to your blood test results it might be worth checking those to see if your B12 and other bloods are within guidelines.
Of course lots of other stuff can cause fatigue

Thank you again for your interest and support, I apologies for the delay in replying.
I would confirm that I have Free Style Libre 2 Which regularly gives me an alarm call in the morning when my levels drop 4, I also have quarterly injections of B12. As instructed I take 50 units Of Humulin M3 before breakfast around 7.30 and 50 units before diner around 6.30. I have to remove as many carbs as I can to keep my numbers in range. with no snacks or treats.
I also take 2x 500 Metforming morning and night all of my bloods are in guidelines. You are correct in your assumption that I have no or little understanding of how the types of insulin effect me other than Insulin is the Hormone of hunger and I have an overwhelming desire to die with my feet on.
In these dire times trying to get help or information from the NHS is difficult which is why I am reaching out to others for help.
Again any help or information you can give me is appreciated.
Graham.

 

[Builderboy]

Thank you again for your interest and support, I apologies for the delay in replying.
I would confirm that I have Free Style Libre 2 Which regularly gives me an alarm call in the morning when my levels drop 4, I also have quarterly injections of B12. As instructed I take 50 units Of Humulin M3 before breakfast around 7.30 and 50 units before diner around 6.30. I have to remove as many carbs as I can to keep my numbers in range. with no snacks or treats.
I also take 2x 500 Metforming morning and night all of my bloods are in guidelines. You are correct in your assumption that I have no or little understanding of how the types of insulin effect me other than Insulin is the Hormone of hunger and I have an overwhelming desire to die with my feet on.
In these dire times trying to get help or information from the NHS is difficult which is why I am reaching out to others for help.
Again any help or information you can give me is appreciated.
Graham.

Welcome to the forum @Builderboy

Sorry to hear your insulin doses have increased, and your levels have been a bit more chaotic over the past few years.

Your previous TDD (total daily dose) looks like it was 35 (15+15+5). So 100u of Humulin M3 is quite a dramatic increase, and your average glucose of 9.5 is a little above target. Good to hear you’ve not been troubled by hypos, but those overnight drops to 4.0 must be quite worrying as those are quite close to the edge.

Mixed insulins can work well for people with a fixed routine whi are happy to follow the insulin’s schedule and timings, but I do wonder whether your Humulin M3 is flexible enough for your lifestyle? If your metabolism is now needing a little more rapid-insulin support for meals, and a little less background coverage, unfortunately you can’t change the proportions or meal timings with M3

Less Lantus to *only* cover background needs, and a dose of NovoRapid matched to the carb content of each meal or snack you have would allow you more flexibility to adjust your doses to match your needs, and the timings of your day.

Perhaps your nurse is less used to people with T2 being on a basal:bolus regimen?

But we have several members here who have found it extremely effective for their T2 🙂

Thank You for your interest, please follow my post your comments are welcome.

 

[Inka]

Could you ask about a change of insulin to a basal/bolus regime @Builderboy ? That is, separate slow and fast insulins. That would hopefully give you better control and allow you some flexibility with your food.

 

[rebrascora]

Are you double checking the Libre alarm lows through the night with finger prick checks? Apologies if I have asked this before. Libre is prone to what we call compression lows where, if you lie on the sensor for any length of time it can register a false drop in BG levels and activate the alarm so, unless you feel obviously hypo, it is wise to double check any low alarms during the night with a finger prick. If they are false lows then changing the placement of your next sensor a bit by putting it more towards the back of the arm can help. If they are genuine hypos then that suggests your evening dose of insulin is too high and needs reducing. There is no requirement for the two doses to be exactly the same and should be adjusted for what your body needs.

Can you post some photos of typical Libre graphs to see if we can spot any obvious issues.

Timing of the insulin doses can be particularly important, especially in the morning when many of us can be a bit more insulin resistant. I always inject my morning insulin before I get out of bed because as soon as I sit up and swing my feet onto the floor, my levels start rising, so I need my morning dose jabbed before I even sit up to start dealing with that glucose that my liver releases as soon as I get up. This might not be appropriate for you if you don't have your breakfast for an hour or two after you get up and perhaps walk the dog, but if you eat breakfast more or less straight away after you get washed and dressed then it is worth considering.
If we can see your graphs then it may help us to advise you, particularly if your levels spike quite high on a morning.