Help me understand

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Type2insulin

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Have been type 2 diabetic for 12 years have changed medication a few times and I changed doctors once and diabetic nurses seem to come and go . So differing opinions is not helpful.

I have been taking insulin for two years in conjunction with four Metformin from four a day .
slow release insulin twice a day
And nova rapid before every meal .

Three months ago new nurse dropped me down to two Metformin a day . Which helps with number 2 issues And added one 10mg of empagliflozen. Which removes sugar in urine ( diabetic staff swear by this one .)

Moving on nurse leaves surgery step in new nurse

Review today nurse ups my empagliflozen to 25mgs
And tells me to carry on with same insulin BUT INJECT AFTER MEALS she said always after never before so have I been given wrong info for two years

All opinions thoughts welcomed
 
So first question do you take insulin before or after a meal ?

Please
 
I take it at least 15 minutes before as fast acting insulin is not that fast and takes anywhere from 10-30 minutes ish to start working
 
Mmm - what @Lucyr said - but having increased the Empagliflozin which causes your pancreas to chuck out more of your own insulin though you can't control when or how much it will do that, perhaps she's merely wanting you to be careful ? I'm not an expert though! So - why not ask her to explain why?
 
Last nurse said take before I eat new nurse said take after meal so much confusion I think I'll call the specialist diabetic team .
 
trophywench said:
Mmm - what @Lucyr said - but having increased the Empagliflozin which causes your pancreas to chuck out more of your own insulin though you can't control when or how much it will do that, perhaps she's merely wanting you to be careful ? I'm not an expert though! So - why not ask her to explain why?
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I asked nurse she said I get all my patients to take after meal .
So confusing the specialist team will look into my medication after all they are the specialists . I just find it unhelpfull that so many diabetic nurses do things so differently
 
My first question would be, why is the new nurse making any changes at all?
Secondly, what is happening with your glucose levels? HbA1c?
 
trophywench said:
Mmm - what @Lucyr said - but having increased the Empagliflozin which causes your pancreas to chuck out more of your own insulin though you can't control when or how much it will do that, perhaps she's merely wanting you to be careful ? I'm not an expert though! So - why not ask her to explain why?
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Empagliflozin doesn’t cause your pancreas to produce more insulin it works by making you pee out extra sugar
 
I think it always helps to know why someone is advising something different to the norm and it is normal to take NovoRapid before meals because that way the insulin has time to hit your blood stream as the glucose from your food is getting there. Otherwise the glucose from the food hits your blood stream and spikes your levels high and then the insulin goes in and drops them and you end up with large peaks and troughs which makes you feel rough. The more you can iron out the bumps and keep things more level the better. I have to pre bolus by as much as 45 mins at breakfast time with Fiasp which is quicker than NovoRapid.... I needed over an hour for NR at breakfast otherwise I would shoot up to 15 and then plummet back down to 5, but I only need 20 mins before lunch or dinner. Finding that balance point with your insulin and blood glucose timing wise is the fine art of good diabetes management. If your nurse has a good reason for suggesting you take it afterwards then fair enough but I would want to know the reason and agree with it.
 
Last blood test was 80

My thoughts why is she changing because she's the latest in many nurses that don't stay at surgery .

I asked the question answer I get she's not interested in what previous nurse did as she's no longer there.

This is why I will be contacting the specialist team and let them take over
 
Oh gosh! 80 is a bit high, especially if you have been diagnosed a long time, so it makes a bit of sense that she has increased your Empagliflozin dose. What sort of insulin doses are you using and which long acting insulin have you got?
How frequently do you test your BG levels and what sort of pre meal readings do you get? Just wondering if they have your long acting insulin dose high enough. Taking a bit of regular exercise if you are able will help reduce the amount you need. Doesn't have to be anything strenuous, just a brisk daily walk if you can manage it.

Have you modified your diet to help control your diabetes? Ie Cut down on not just the sweet stuff but also the starchy carbs like bread, pasta, rice potatoes etc.... Not saying you can't eat these things but portion control is a big factor in diabetes management. Do you carb count or are you on fixed doses of NovoRapid.... Sorry so many questions it's like the Spanish Inquisition but just trying to understand your current circumstances.

I hope you get more sense out of the specialist team, but it sounds like you need more support in understanding and managing your diabetes and I am not sure the advice you have been given by this nurse is helpful..... unless she had some good underlying logic behind it or you have a history of hypoing during or just after a meal and therefore need to take insulin later.
 
Apologies about wrong info for Empagliflozin. That's even more concerning though @Lucyr - because glucose doesn't even spill out into urine until your BG is around 11.0 ! (if you have a normal renal threshold) - I mean that's one of the classic undiagnosed diabetes symptoms mums are told to watch out for - Thirst, Toilet, Tired, Thinner !
 
trophywench said:
Apologies about wrong info for Empagliflozin. That's even more concerning though @Lucyr - because glucose doesn't even spill out into urine until your BG is around 11.0 ! (if you have a normal renal threshold) - I mean that's one of the classic undiagnosed diabetes symptoms mums are told to watch out for - Thirst, Toilet, Tired, Thinner !
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Im not sure I follow what you mean here. 11 ish would be a level that you would normally spill glucose into urine yes, but the purpose of empagliflozin is to make you spill more glucose into your urine to lower blood sugars. It doesn’t make you bg above 11 to do this. It blocks the reabsorption of glucose by the kidneys so that you pee more glucose out to lower the glucose levels in your blood.
 
Thought that potentially caused kidney damage though (when it does it at 11+) hence when boiling pee up in test tubes - way back when - it was a no-no ...... anyway, that was what used to be drummed into us!
 
I always find it frustrating when members on the forum are advised to change something about their diabetes management, but that the thinking and logic behind the change of strategy isn’t shared or explained very well, if at all?!

Hope you can get some extra clarity on this, or access some support from a more communicative team @Type2insulin 🙂
 
So was 80 H1 now I am 60H1 I never took nurses advice to take insulin after meal . Really weird less excercise and same diet a drop of 20. No one knows why even diabetic consultant is lost for words .
 
Maybe the 80 HbA1c result was an inflated reading due to an infection or anaemia or stress or possibly even the Covid vaccine or one of the many other things that can impact BG levels and perhaps that issues has resolved in the interim period.
Pleased for you that it has reduced substantially.
 
I have always been around 80. As the consultant said he has no idea what's going on
 
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