Insulin Options Advice

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gll

gll

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Type 2
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Hi all 🙂

So going by the last conversation with my DSN we have added an evening dose of humulin I to "try" but we have already discussed MDI if this doesn't work. I have another appointment in 2 weeks. Not looking great so far considering I haven't properly come down from last nights dinner 24h later because I actually had breakfast and lunch today, just been topping my bg up. Libres time in target 0% with average of 15.8 🙄

She mentioned we would switch the humulin I to a longer profile basal and of course add in a fast acting.

I was looking for some real world experiences of the different insulins you all use or have used. What have you loved or hated about them?

Some things that I feel would impact my decision are:
My periods are super irregular (thanks pre menopause) and like to play havoc with my numbers (usually push them up)
I am a carer for my daughter so I am often at home and if we need to go out, it is usually planned so pre-bolus time is less of an issue for me
My schedule is super erratic and I am forever breaking my sleeping pattern by being up all night with daughter or napping with period exhaustion or bg swings sending me to napsville

I like to go into stuff armed with information so I can pre make some decisions.

I would assume I would be on fixed dose initially but I know that mydiabetesmyway (scotland nhs run) has online carb counting courses and will discuss quickly moving on to counting.
I always said I would never go mixed insulin (and have told dsn the same) and always figured id rather match insulin to food and not the other way about.

Hopefully my libre for the next fortnight will just confirm once again my need for the change and it shouldn't be a hassle. I never like to pin my hopes on things as it has been a very rough ride to get to this point with a lot of disappointment in getting what will make me feel better although DSN vs GP team seems to be a different ball game.
Type testing is another fight entirely and I simply don't have the energy for that battle right now.

Thanks in advance <3
 
I take an isophane basal when I have a pump break and it works well. Different insulins suit different people so don’t be swayed by newest/most flashy, etc. Same with the bolus insulin if you go on to MDI. Newest isn’t always better.

The best one is the one that suits you. You’ll find people enthusing about insulins I wouldn’t touch with a barge-pole and vice versa.
 
gll said:
I was looking for some real world experiences of the different insulins you all use or have used. What have you loved or hated about them?
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Someone posted this PDF which shows graphs for many of the options: https://www.diabetes.org.uk/resourc...20of%20Leicester%20-%20Insulin%20Profiles.pdf

I've used Actrapid and Insulatard, and (more recently) NovoRapid and Levemir. I much prefer the more recent ones: Levemir has a much flatter profile, and NovoRapid starts acting more quickly and the activity falls more quickly.

But I'm Type 1; if you're producing insulin yourself maybe the older classes would be just as good.
 
Love, love, love my Levemir for it's flexibility. Like you I don't have a regular sleep pattern all the time and my day can be very active sometimes or much less so other days and I find the Levemir gives me the ability to tweak it to what my body needs there and then, in real time, whereas the longer acting basal insulins need at least 3 days for each change to have it's full impact. My daytime dose is pretty stable most of the time between 22 and 24 units but my evening dose needs almost daily tweaking between 0 and 7 depending upon a number of factors. I just can't see how I would ever manage with the likes of Tresiba although it works well for many people, probably best for those with a stable routine and steady hormones.
As regards bolus insulin I am not a particular fan of NovoRapid (whoever named it that was having a laugh!) or Fiasp which I now use. I can get by with it but it is a long way off being fast acting for me and there are times I have to be a bit heavy handed with it to get the result I want, so not sure I could particularly recommend either. The NR is slower but more predictable, the Fiasp has been a bit quirky and the swap to it was very frustrating for several months, but maybe if you started on Fiasp you wouldn't find that, because it would just be all you were used to.

Anyway, those are my thoughts and experience of insulins.
 
Actrapid is still the choice with sliding scales in hospitals, but never ever used as a bolus insulin where I'm concerned. Novorapid's been doing it fine for me since 1999. But, how the hell anyone could possibly know if it suited them before they actually tried it, I haven't a clue. I'll say it again - don't knock it till you've tried it!
 
Inka makes excellent poiny above about individuals own experiences with various insulins, you might find its trial & error finding right one for you.

Pre pump was using lantus, found it give good coverage & worked mixture of shift patterns when using that basal.
 
Basals:

Tresiba - I didn’t like, it’s too flat and lasts too long

Levemir - I didn’t like as wasn’t much benefit over lantus for me, and found it a bit annoying to have to remember two jabs at set times a day

Lantus: I’ve pretty much always used this, does the job, only once a day so easy to do at the same time every morning then it’s rarely due when I’m out etc.

Toujeo: I’m going to ask to try next time. It’s more concentrated than lantus, so a smaller volume dose and I’ve found that splitting doses improves absorption and bgs.

Bolus:
Apidra: I’ve always used this and love it. But I have used it a long time now so there’s more modern faster ones spoken about. For me apidra builds up over the first hour, peaks for a bit then tails off to nothing by about 3 hours.

Humalog: I hated it. Had to use it when the apidra factory had a manufacturing issue and no one could get any apidra. It really had a sting in the tail at about 5 hrs where out of nowhere it would make you plummet

Novorapid: haven’t used but sounds slower than apidr

Fiasp: sounds like too many issues with it not working when you’re high for me to want to try it

Lyumjev: I’ve heard positive things and would try it if offered, though I’m not going to ask for it yet

If I was just picking my own I would go toujeo (more concentrated is good when you’re on higher doses) and either apidra or lyumjev, would have to read more about the latter to decide first.
 
Also, I’d be asking for cartridge pens and cartridges when changing insulins. Easier to ask then than changing it later. I have disposable lantus but cartridges for apidra at the moment.
 
Lucyr said:
Also, I’d be asking for cartridge pens and cartridges when changing insulins. Easier to ask then than changing it later. I have disposable lantus but cartridges for apidra at the moment.
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Any reason why you have disposable Lantus pens?
Pre pump, I used Lantus as my basal and now have it as my pump back up. I have never used pre filled Lantus pens; always cartridges
 
helli said:
Any reason why you have disposable Lantus pens?
Pre pump, I used Lantus as my basal and now have it as my pump back up. I have never used pre filled Lantus pens; always cartridges
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ive not found any of the Sanofi reuseable pens to be any good other than the half unit one. The others the whole pen would come apart when I unscrewed the needle. The junior star pen is great and I use it for apidra, but I use more than the maximum 30u of lantus, and being half unit pen it’s a long way to dial up 30u on that pen for split dosing lantus.
 
Only ever used Novorapid and Tresiba, no longer get on with Tresiba so I will be looking to switch at some point

Do be aware you probably won't get a choice of what you get first, at least in my area there are insulins that are classed as 1st line routes and the other classed as 2nd line routes if issues occur with the 1st line insulins so in Tayside 1st line bolus insulins for Type 2 are Humulin S and Actrapid for instance, it may be worth seeing if the NHS trust you are under have an online diabetes handbook as this is where I found all that information years ago
xx
 
good point there @Kaylz upon looking on general scotland guidelines Levemir is t1 only but no notes on any of the other ones. Can't really find other info for my local area.

Thank you everyone for the input. I can totally appreciate that everyone is different and its trial and error to find the right fit.
It is good to have a rough idea what each one does and how it fits in with your life and routines and that's giving me new things to consider and think about.

This convo has also made me look more at short vs rapid acting too and I will push to go to rapid over short acting if possible. Looking at the duration (rapid - 2-5 hours vs short 5-9 hours) I feel rapid would fit me better.

Thank you again <3
 
gll said:
This convo has also made me look more at short vs rapid acting too and I will push to go to rapid over short acting if possible. Looking at the duration (rapid - 2-5 hours vs short 5-9 hours) I feel rapid would fit me better.
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This statement confuses me. What do you mean by short and rapid acting? I understand them as the same thing.

I have only used fixed mixed insulin for a few months and hated it. There was a belief that I would prefer less injections. I prefer the flexibility. But the true value only came when I understood enough to adjust my insulin dose. I found fixed bolus doses only very slightly more flexible than mixed insulin as I still needed to eat a fixed amount of carbs.
I have tried a few different fast acting insulins (NovoRapid, Humalog and Fiasp) but started on NovoRapid and only tried the others once I was confident in knowing what my body and my lifestyle needs.
 
helli said:
What do you mean by short and rapid acting?
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It's language from the PDF I linked to above: https://www.diabetes.org.uk/resourc...20of%20Leicester%20-%20Insulin%20Profiles.pdf

The rapid-acting ones are the slightly newer family (NovoRapid, Humalog, Apidra) which largely replaced the older Actrapid, Humulin S, etc. (Replaced for Type 1 and anyone with very little natural insulin, anyway, where the extra speed matters a lot. I'm sure the older ones still have value.)
 
funny you posted that link @Bruce Stephens ... its been saved to my bookmarks for a while now 😉

Gotta admit I had kinda glossed over the 2 different ones until I really looked properly and also assumed the two terms to be interchangeable @helli .

Again, all this good to know before I have a conversation to make a new plan.
 
gll said:
good point there @Kaylz upon looking on general scotland guidelines Levemir is t1 only but no notes on any of the other ones. Can't really find other info for my local area.
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I know you don't have the energy to battle over type testing, but that's one of the reasons why it is important i.e. not being fobbed off with older insulins. I know because I have fought the battle and seen the change in attitude and how doors opened when I was properly dx T1.

So far in my diabetic "career" I've used Novomix 70/30 - hated it because I do not lead a regimented life and can't be doing with having to eat to the insulin. Then I was on Lantus/Novorapid and then Levemir/Novorapid (you don't have to be that strict at having the 2 Levemir doses at exactly the same times every day - or at least I wasn't). I've also trialled Humalog for a short period as my rapid insulin (can't recall why as it was a long time ago - as @Lucyr says it had a definite "sting in the tail" causing regular hypos as the 5 hour point) and finally Levemir/Apidra, which was definitely best for me. This was before going onto a pump nearly 9 years ago and having just Apidra, which is faster than Novorapid.
 
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