Hello friends :)

[Susie-Q]

Exactly the same ones I used until about 1999 ish - was OK for a couple of years until I had some terrible hypos driving home from work on the motorway despite having tested before getting in the car and being 6.0 to 7.0 ish. Yes I adjusted for meals too - but all guesswork and never very precise. Trouble is, the Humulin I is not a true 'background only' insulin and the S is not a true faster acting one either. I've done a lot better since they swapped me to more modern insulins.

You do sometimes need to 'kiss a few frogs' before you eventually find your 'prince' with insulins as well as your choice of long term life partner and bedfellow!

Shedloads of stuff about diabetes I never knew before I joined a diabetes internet forum and I'd have been 50+ by then myself. Sometimes I know I've thought 'that doesn't quite make sense to me' so thought I'll come back to that later and by the time I have someone else has thought the same and replied 'I think you are trying to say (whatever)' - and then it does make sense. Before the weekend I asked someone what tests they'd have and the person replied and sounded a bit shirty with me, as if I was suggesting they did not really have diabetes. Barbara responded for me and said she didn't think I was suggesting anything of the kind, but rather attempting to find out if they'd had the proper blood tests to establish without shadow of a doubt that they did really have Type 2 diabetes at all, or one of the other variations of diabetes and their doctor had just assumed because they were middle aged, it had to be Type 2. Barbara was correct, that is what/why I was asking.

Years ago when both Colin and myself were diagnosed (I was 22) it didn't happen quite as much as it does in more recent years, but shedloads are misdiagnosed and given the wrong label. Type 1 can happen at any age - 7 years old or 70 years old. Still no cure - so we all need to help ourselves when we can!

Aaww, hello lovely ~ thank you for your wonderful message, its incredible to hear that you used that insulin and your story is so similar to my husband (also Colin) !!
It's clear he's holding on tightly to what he knows cos he hates change ~ and for good reason sometimes, cos changes in his dosage recommended by specialists have caused him massive problems over the years
I'm sorry you had a small misunderstanding with your messages, things can sometimes come across in the wrong way with txt, especially if it's someone you don't know personally...I can see you ment well and glad it was all sorted nicely 🙂
He is considering the pump, but ideally need to sort his needle phobia first, cos even the thought of it is too much at the mo!!. I've mentioned on here before that he reported this phobia to his GP 2 years ago and despite prompts its still not been followed up.
Thanks again for your lovely message ~ take care always

 

[Bruce Stephens]

It's clear he's holding on tightly to what he knows cos he hates change ~ and for good reason sometimes, cos changes in his dosage recommended by specialists have caused him massive problems over the years

I can relate to that. I can only say that the newer insulins really are much better: the long acting ones have flatter activity curves, and the fast acting ones act much faster (and don't last as long). Overall they make management much easier than the older ones.

 

[Susie-Q]

I can relate to that. I can only say that the newer insulins really are much better: the long acting ones have flatter activity curves, and the fast acting ones act much faster (and don't last as long). Overall they make management much easier than the older ones.

Wow, that's really good to know, thank you. You'd think his GP or diabetic nurse would have talked through the options with him, especially as it seems the older ones are showing to be less reliable ... ......thank you so much for this important information 🙂

 

[Bruce Stephens]

Wow, that's really good to know, thank you. You'd think his GP or diabetic nurse would have talked through the options with him, especially as it seems the older ones are showing to be less reliable ... ......thank you so much for this important information 🙂

Concretely, I was looking at the graphs.

You can see Humulin I (Isophane)'s here (scroll down to the graph in 5.1): https://www.medicines.org.uk/emc/product/8196/smpc

Compared to Levemir (one of a few long acting insulins): https://www.medicines.org.uk/emc/product/7889/smpc

Levemir looks much flatter to me. (Though a lot depends on dose.)

And Humulin S looks quite horrible (to me, compared to Novorapid): https://www.medicines.org.uk/emc/product/8197
It looks like it has its maximum activity at around 4 hours, and lasts for 8-12 hours.

Annoyingly that web site doesn't show Novorapid's activation graph in the same way, but it acts faster and lasts maybe 5 hours. (As always, dose matters.)

Actually here's a PDF that gives those (and others): https://www.diabetes.org.uk/resourc...20of%20Leicester%20-%20Insulin%20Profiles.pdf

 

[trophywench]

Yeah but no but - needle phobia is absolutely not a reason to not consider a pump. Currently he takes 4 jabs a day - assuming he eats 3 meals.

Pump cannulas - ie the bit with the needle to get the cannula part (which is a hollow, short bit of very fine, Teflon tubing) into your body, need to be inserted (usually) once every 3 days. Hence much less contact with sharp pointy things than at the moment! What on earth is there not to like, about that? Some (but not all) even come with an inserter nothing at all like, but 'similar' to Libre sensors. I've never ever heard of Humulin S being used in any pump - they all work using fast acting insulin only cos the background insulin is dripped in constantly roughly every 3 minutes or so, instead of 'in a lump' once (or twice) a day.

We'll get him and his brain, into the 21st century as quick as he likes, and he'll discover it's nowhere near as scary as he fears! Does he use a mobile phone?

 

[Bruce Stephens]

Currently he takes 4 jabs a day - assuming he eats 3 meals.

While we're at it, it may be worth checking he's using suitable needles. Nowadays the recommendation is 4mm, 32G (I've also heard of 33G being available though all of mine so far have been 32G). 8mm used to be common (and I imagine they have to be a little thicker, too).

 

[rebrascora]

Wow, that's really good to know, thank you. You'd think his GP or diabetic nurse would have talked through the options with him, especially as it seems the older ones are showing to be less reliable ... ......thank you so much for this important information 🙂

Unfortunately GPs know very little about diabetes (they are general practitioners, not specialists) and whilst the practice nurse may be a little more knowledgeable if s/he has had some training from a specialist nurse, their role is mostly to supervise the Type 2 diabetics at the practice. As a Type 1, Colin has the right to ask to be referred to and treated by a specialist run diabetes clinic at a hospital under a consultant. There they will have up to date knowledge of all the latest insulins and tech and how best to use them for each individual. Managing diabetes with insulin is a very complicated process but with the right support, knowledge, treatment and technology you can eventually become the specialist in your own diabetes management.
I would no more ask my GP for advice on my diabetes management than ask the postman and that is no reflection on my GP who is brilliant, but he simply doesn't have the indepth knowledge required to support me.

 

[Susie-Q]

Concretely, I was looking at the graphs.

You can see Humulin I (Isophane)'s here (scroll down to the graph in 5.1): https://www.medicines.org.uk/emc/product/8196/smpc

Compared to Levemir (one of a few long acting insulins): https://www.medicines.org.uk/emc/product/7889/smpc

Levemir looks much flatter to me. (Though a lot depends on dose.)

And Humulin S looks quite horrible (to me, compared to Novorapid): https://www.medicines.org.uk/emc/product/8197
It looks like it has its maximum activity at around 4 hours, and lasts for 8-12 hours.

Annoyingly that web site doesn't show Novorapid's activation graph in the same way, but it acts faster and lasts maybe 5 hours. (As always, dose matters.)

Actually here's a PDF that gives those (and others): https://www.diabetes.org.uk/resources-s3/2017-10/University%20Hospitals%20of%20Leicester%20-%20Insulin%20Profiles.pdf

Thank you for taking the time to compile this information ~ I will show him all the links and graphs... thank you

 

[Bruce Stephens]

Thank you for taking the time to compile this information ~ I will show him all the links and graphs... thank you

Actually the last one has more or less everything. (I found it last, unfortunately)

 

[Susie-Q]

Unfortunately GPs know very little about diabetes (they are general practitioners, not specialists) and whilst the practice nurse may be a little more knowledgeable if s/he has had some training from a specialist nurse, their role is mostly to supervise the Type 2 diabetics at the practice. As a Type 1, Colin has the right to ask to be referred to and treated by a specialist run diabetes clinic at a hospital under a consultant. There they will have up to date knowledge of all the latest insulins and tech and how best to use them for each individual. Managing diabetes with insulin is a very complicated process but with the right support, knowledge, treatment and technology you can eventually become the specialist in your own diabetes management.
I would no more ask my GP for advice on my diabetes management than ask the postman and that is no reflection on my GP who is brilliant, but he simply doesn't have the indepth knowledge required to support me.

I appreciate how you've explained the role of the GP ...Colin would really thrive given the correct attention. He is dedicated to managing his diabetes but without the basic understanding he soon gets depressed with the situation.
I will pass on your valuable advice, thank you

 

[Susie-Q]

Actually the last one has more or less everything. (I found it last, unfortunately)

Thats perfect, thank you

 

[Susie-Q]

Yeah but no but - needle phobia is absolutely not a reason to not consider a pump. Currently he takes 4 jabs a day - assuming he eats 3 meals.

Pump cannulas - ie the bit with the needle to get the cannula part (which is a hollow, short bit of very fine, Teflon tubing) into your body, need to be inserted (usually) once every 3 days. Hence much less contact with sharp pointy things than at the moment! What on earth is there not to like, about that? Some (but not all) even come with an inserter nothing at all like, but 'similar' to Libre sensors. I've never ever heard of Humulin S being used in any pump - they all work using fast acting insulin only cos the background insulin is dripped in constantly roughly every 3 minutes or so, instead of 'in a lump' once (or twice) a day.

We'll get him and his brain, into the 21st century as quick as he likes, and he'll discover it's nowhere near as scary as he fears! Does he use a mobile phone?

Yes, you are right ~ with the correct education regarding the pump I'm sure he can overcome his fears.
He's trying the Libre 2 first, but I think the pump will be better for him, with the constant feed of insulin.
This device, to me, is real scientific progress.
He'll be fine ~ I think sometimes he forgets he's not alone with this, and to share his concerns with like minded people will be a really good thing.
Thanks again

 

[SB2015]

Wow, that's really good to know, thank you. You'd think his GP or diabetic nurse would have talked through the options with him, especially as it seems the older ones are showing to be less reliable ... ......thank you so much for this important information 🙂

If Colin is managed only by your GP Practice he is unlikely to have access to the specialist support that he needs. GPs understandably see very few people with T1 so have little knowledge about it. There is often a practice nurse who has a special interest in Diabete, but will not be a Diabetes Specialist Nurse (DSN) who would have done a lot of additional training and will be familiar with different insulins and pumps and other tech. The Practice nurse is likely to be more familiar with managing T2, although many of us see them for our annual checks (It helps them to tick some boxes) It would be worth asking for a referral to the specialist team, often at the local hospital in order to get appropriate support From a consultant and/or DSN.

There are some with T1 on here who are managed at their Practice because they have now stabilised their management. However in order to be considered for a pump they wouod need to get back to see their consultant.

The insulins Colin is using will make it difficult for him to make adjustments through the day, and makes management less flexible. Switching insulins can seem a big step, but I suspect that he would see the benefits quite quickly. If he is considering a pump there are people on here with experience of different ones, so plenty of help to tap into.

 

[Susie-Q]

While we're at it, it may be worth checking he's using suitable needles. Nowadays the recommendation is 4mm, 32G (I've also heard of 33G being available though all of mine so far have been 32G). 8mm used to be common (and I imagine they have to be a little thicker, too).

Yes it is a 4mm needle on his Kwik pen ~ research lead us to discover the depth of the needle is super important, in relation to how quickly the insulin works/ or how slowly. Thank you

 

[Susie-Q]

If Colin is managed only by your GP Practice he is unlikely to have access to the specialist support that he needs. GPs understandably see very few people with T1 so have little knowledge about it. There is often a practice nurse who has a special interest in Diabete, but will not be a Diabetes Specialist Nurse (DSN) who would have done a lot of additional training and will be familiar with different insulins and pumps and other tech. The Practice nurse is likely to be more familiar with managing T2, although many of us see them for our annual checks (It helps them to tick some boxes) It would be worth asking for a referral to the specialist team, often at the local hospital in order to get appropriate support From a consultant and/or DSN.

There are some with T1 on here who are managed at their Practice because they have now stabilised their management. However in order to be considered for a pump they wouod need to get back to see their consultant.

The insulins Colin is using will make it difficult for him to make adjustments through the day, and makes management less flexible. Switching insulins can seem a big step, but I suspect that he would see the benefits quite quickly. If he is considering a pump there are people on here with experience of different ones, so plenty of help to tap into.

Yes, I am starting to get a better understanding of GPs and specialist nurses through this forum ~ a lot is making sense, and it's clear Colin needs specialist help because there is so much we are unaware of!
Oh yes, the thought of changing his insulin will initially make him run, but once he warms to the benefits he will be OK. Thank you ~ I have a lot to report to him until he joins !

 

[Bruce Stephens]

it's clear Colin needs specialist help because there is so much we are unaware of!

It's very disappointing that his GP didn't offer a referral. Ordinarily I'd expect them to notice that he really needs help that the GP surgery can't offer. Regardless, I hope he does get a referral (and accepts it!) and that the hospital team is a good one.

 

[Susie-Q]

It's very disappointing that his GP didn't offer a referral. Ordinarily I'd expect them to notice that he really needs help that the GP surgery can't offer. Regardless, I hope he does get a referral (and accepts it!) and that the hospital team is a good one.

Yes, very disappointing ~ oh, it would make a world if difference to him if he found a good team. We will press for a referral. Thank you for your kindness

 

[Bruce Stephens]

He reported a phobia to needles 2 years ago and no one has followed this up, therefore he never had the covid vaccine due to this, and was in the at risk group.

It may be worth revisiting this vaccination. Now that a large proportion of the population has been vaccinated, we can be sure that just about everyone doing the vaccinations has had a number of people who were really uncomfortable with needles (it's apparently a rather common phobia), and I'm sure whoever's offering the vaccination will be willing to help him to be vaccinated (I've read of people (who fear feinting) who've been taken to a private room, and people who've been successfully been distracted while the injection happens). (When I last looked at a booking form there didn't seem to be a specific checkbox for needle phobia which seemed like a missed opportunity, but I'm sure they're happy to try helping people with such issues. (Even thought his GP doesn't seem inclined to.))

 

[Susie-Q]

It may be worth revisiting this vaccination. Now that a large proportion of the population has been vaccinated, we can be sure that just about everyone doing the vaccinations has had a number of people who were really uncomfortable with needles (it's apparently a rather common phobia), and I'm sure whoever's offering the vaccination will be willing to help him to be vaccinated (I've read of people (who fear feinting) who've been taken to a private room, and people who've been successfully been distracted while the injection happens). (When I last looked at a booking form there didn't seem to be a specific checkbox for needle phobia which seemed like a missed opportunity, but I'm sure they're happy to try helping people with such issues. (Even thought his GP doesn't seem inclined to.))

Yes, I believe it is a common phobia, and after injecting himself thousands of times since he was 17, its odd it has become a problem quite recently ~ we need to get to the bottom of this first, and thank you for following this matter up.