Insulin not effective

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CELTICDUFF

CELTICDUFF

Well-Known Member
Relationship to Diabetes
Type 2
Good morning. I hope everyone had a Merry Christmas and all the best in 2033. I have been on Humulin I for a few months . It doesn’t appear to make any difference to my readings . I take 54 units a day increasingly 3 units every 3 days . The diabetic team are great . They say keep on taking and call them in 2 weeks, I am concerned. Any advice as always will be welcomed
 
I can't advise on your dose but ill tell you what went down with me:

About 2 months into humulin I, while I dropped in numbers (high 20s down to mid teens), just didn't drop enough, had an evening dose added too.
Fast forward another month (so 3 months total) and I was switched to long and short acting insulins as it still wasn't doing the job. I was offered mixed but firmly asked for them to be split so I could be more flexible for eating.

The 3 months was important as it ties in with the NHS holy grail flowchart. 😉
https://www.sign.ac.uk/assets/diabetes_algorithm.pdf
Note the 4th line treatment.
IF NOT REACHING TARGET AFTER 3−6 MONTHS, REVIEW ADHERENCE: THEN GUIDED BY PATIENT PROFILE ADD ADDITIONAL AGENT(S) FROM 3rd LINE OPTIONS (NEED SPECIALIST INPUT)
ADD PRANDIAL INSULIN OR SWITCH TO TWICE-DAILY MIXED BIPHASIC INSULIN
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A lot depends on what your body can do. Humulin I if taken in morning has the profile to provide background insulin and has more of a peak than other background insulins which tend to be more even and last longer.
It is supposed to take some of the load off and let natural home grown insulin cover more of the meals with a little help.
It wasn't enough for me alone.
https://www.diabetes.org.uk/resourc...20of%20Leicester%20-%20Insulin%20Profiles.pdf

Please don't fret, your team sounds like they are monitoring you well and at least not leaving you fumbling in the dark.
I know its frustrating and you want things under control "NOW" but I haven't experienced much of them straying off the first link's flowchart and that timeline.

You might just need to keep going with Humulin I until you find the right dose and then it clicks or you might need to move onto a different regime.
The important thing is to keep monitoring levels and keep working with your team.

My dosing adjustment advice was 2 or 3 units at a time OR 10%, whatever is greater. So for a 50u dose it would be 5u increments. Might want to ask them if you can adjust a bit more at a time to get to the end result of being on the right dose a little quicker. (!!!please do ask your team first!!!).

I do understand the frustrations (been there and got the teeshirt) <3
 
CELTICDUFF said:
Good morning. I hope everyone had a Merry Christmas and all the best in 2033. I have been on Humulin I for a few months . It doesn’t appear to make any difference to my readings . I take 54 units a day increasingly 3 units every 3 days . The diabetic team are great . They say keep on taking and call them in 2 weeks, I am concerned. Any advice as always will be welcomed
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Can I ask whether you have any excess weight hence insulin resistance? Note that if you do have excess weight (you may not) you may be adding insulin when the body already has too much? One approach in that case is to reduce the carbs in your diet
 
Hi DaveB , unfortunately, I am a very large man . I will be looking at carb intake .
Thank You
 
What times are you taking your insulin?
As your insulin is just a intermediate basal insulin (Isophane) it can not cover any carbs you are eating so do not understand why you have not been given any insulin to cover the food you eat.
 
Pumper_Sue said:
What times are you taking your insulin?
As your insulin is just a intermediate basal insulin (Isophane) it can not cover any carbs you are eating so do not understand why you have not been given any insulin to cover the food you eat.
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It’s the standard pathway for T2 not to start on fast acting insulin at first.
 
Lucyr said:
It’s the standard pathway for T2 not to start on fast acting insulin at first.
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Well it obviously isn't working is it?
 
Pumper_Sue said:
Well it obviously isn't working is it?
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Well no but you said you don’t understand why fast acting wasn’t given. As I’ve explained to you and the OP, that is the standard pathway, nothing has been done ‘wrong’ in only starting on one type of insulin.
 
Lucyr said:
Well no but you said you don’t understand why fast acting wasn’t given. As I’ve explained to you and the OP, that is the standard pathway, nothing has been done ‘wrong’ in only starting on one type of insulin.
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Excuse me it is obviously very wrong as it is not working and like the majority of type2's OP is being treated like a 2nd class citizen.
 
Pumper_Sue said:
Excuse me it is obviously very wrong as it is not working and like the majority of type2's OP is being treated like a 2nd class citizen.
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Pretty rude and unhelpful response from you. The standard process is only to add a fast acting insulin if a long acting alone isn’t working after 3-6 months. It’s only been a few months for OP so it’s normal to only be on a long acting and increasing doses at this point. It may be that a fast acting is added in time, but a new hba1c would usually be done first to decide on that.
 
Thank You everyone. Nice debate developing .
Pumper Sue I take at around 5 every morning . Ideally I would rather take my insulin once per day as a t would be difficult at breakfast it would be difficult on public transport or at work . Although dinner would be ok, it’s a journey. Which I accept I have not made the best personal choices .
Thank You
 
CELTICDUFF said:
Thank You everyone. Nice debate developing .
Pumper Sue I take at around 5 every morning . Ideally I would rather take my insulin once per day as a t would be difficult at breakfast it would be difficult on public transport or at work . Although dinner would be ok, it’s a journey. Which I accept I have not made the best personal choices .
Thank You
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Ah there's your problem.
It needs to be taken twice a day as does not give 24/7 coverage
 
Thanks Pumper Sue . I did highlight this to the diabetic service I am with . I was informed that this can be given as a once per day insulin. I also know people who are on this once per day . We will see what they say when I contact them in a few weeks.
 
CELTICDUFF said:
Thanks Pumper Sue . I did highlight this to the diabetic service I am with . I was informed that this can be given as a once per day insulin. I also know people who are on this once per day . We will see what they say when I contact them in a few weeks.
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Perhaps your medical team don't realise there's 24 hours in a day! :(
 
Hi @CELTICDUFF As others have said there are usually set stages in the offers of medication for T2. This may vary in different areas as they interpret the guideline.

I noticed that in you original post you would like to stick to one injection a day, but it would be worth you talking to your team about adding in a quick acting insulin. It would mean more injections (usually one each time you choose to eat carbs). This can certainly help to get a flatter profile of your BG.

Let us know how you get on.
 
Thank You SB2015. I think that would possibly be better . Then I could have it at my nighttime meal . Tbh in the past when I managed my readings better . First one in the morning was usually a little high .
 
CELTICDUFF said:
Thank You SB2015. I think that would possibly be better . Then I could have it at my nighttime meal . Tbh in the past when I managed my readings better . First one in the morning was usually a little high .
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If you want to keep to a minimum of injections then ask for a mixed insulin. Your life will be very regimented regarding meal times and the amount of carbs you eat will have to be the same for each meal.
Mixed insulin mean 30 mins before breakfast and 30 mins before your evening meal.

To be honest with you I do find it very odd that the amount of injections seems a priority rather than your health ie., eyesight, kidneys and limbs :(
 
Can I ask if it is just don't want to jab on the bus/train etc or full on anxiety / panic attacks scenario?

I vowed to never hide it or not jab where/when I needed to and I have never gone into a public bathroom just to do one either.
Everyone is so wrapped up in their phones, they would probs not even notice anyway 😉
You can be discreet if you need to.
 
Hi GII. It’s the difficulty in being able to administer on a train . The trains in London are busy.
Pumper Sue , I think it’s natural to want to have only one injection per day .if it doesn’t work then I will have 2 , 3 . Whatever I need
 
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