Adrienne
Well-Known Member
- Relationship to Diabetes
- Parent of person with diabetes
Hiya
Just popping in and out again I'm afraid but I think that I helped contribute to your original post above about mixed insulins being rubbish. I would like to say that I don't think I would have said rubbish and I hope my previous emails have not upset you, I only try and explain and help. Out of approximately 300 children that I am aware of on an email group, only one child is still on mixed insulins because it works for him, which is highly unusual.
I'm not sure anyone has said about the different insulins so I'll explain it quickly, as easily to understand as I can which is what I needed to hear when my daughter was little.
The Mixtard insulins and Novomix insulins are a mixture of long acting insulin and shorter acting insulin. There are different degrees (some have now been stopped) but for example Mixtard 20, 30, 40 and 50 (they are not all available anymore). I can never remember which way around it is but your Mixtard 30 contains 30 % of either long or short and 70 % of the other all mixed together.
The long acting in theory will last in the body for approx 12 hours ish and the quick acting is approx 6 to 8 hours maximum which is not that quick. The quick acting part of it is supposed to cover what is eaten at breakfast and lunchtime and tea time especially if the injections are say at 7 am and 7 pm, for a child 7 pm is normally way to late for tea on mixed injections.
This is a hit and miss regime as the insulins work at differents speeds, there are definite peaks and troughs in both the insulins and you find you are doing what is called 'chasing the insulin' or 'feeding the insulin' because you HAVE to eat at a certain time to avoid hypos, which happen on a frequent basis on mixes.
MDI (basal/bolus or multiple daily injections) is the same sort of idea but the two insulins are not mixed and are better insulins, they are newer. The long acting insulin will either be Lantus Glargene or Levemir (same sort of thing, different companies). They are supposed to last in you for 24 hours. In reality they last less but only a few hours less and there are ways around that. So the long acting insulin is called the basal insulin (or you may hear people call it the background insulin as it is always there in the background). It is injected and it sits beneath the skin and releases itself slowly throughout the 24 hour period (or slightly less). There are still peaks and troughs but small ones, nothing like the mixed insulin peaks and troughs. This is one injection daily at the same time or in some people if it really only lasts 14 to 18 hours then it is split to two smaller injections 12 hours apart (generally Levemir - most people don't have to split the Lantus).
The other insulin in MDI is a very quick one, normally Novorapid but in some instances Humalog (different company). They peak quickly ie between 2 to 3 hours and by about 4 to 6 hours are out of the body. This insulin is given purely when you eat carbohydrates. This is why it is so important to learn carb counting on MDI and really really helps to get some sort of control of blood sugar levels. For example if for breakfast you have two weetabix and a measured amount of semi skimmed milk I know from experience that that is 32 carbs. You will be given a ratio of insulin units to carbs so you can work out how much quick acting insulin you need to cover those 32 carbs. To make it easy lets say your ratio is 1 : 16 which means for every 16 carbs you eat you need 1 unit of novorapid. So if you eat the 32 carbs you will need 2 units of novorapid to cover that food, so that is what you inject.
If on the other hand you have just bacon and eggs ie no carbs then in theory you will not need insulin. Some people get to know that they need some carbs so would add a piece of toast to the bacon and eggs and you would then need to bolus for the bread which the carbs are generally on the packet.
I hope that is all ok and that I have made it easy to take it. I know how much information thrown at you in the early days makes it so hard to get to grips with everything. I am 10 years down the line and I still learn new things all the time. So ask any question and it will be answered for you.
Take care and good luck on Thursday.
Just popping in and out again I'm afraid but I think that I helped contribute to your original post above about mixed insulins being rubbish. I would like to say that I don't think I would have said rubbish and I hope my previous emails have not upset you, I only try and explain and help. Out of approximately 300 children that I am aware of on an email group, only one child is still on mixed insulins because it works for him, which is highly unusual.
I'm not sure anyone has said about the different insulins so I'll explain it quickly, as easily to understand as I can which is what I needed to hear when my daughter was little.
The Mixtard insulins and Novomix insulins are a mixture of long acting insulin and shorter acting insulin. There are different degrees (some have now been stopped) but for example Mixtard 20, 30, 40 and 50 (they are not all available anymore). I can never remember which way around it is but your Mixtard 30 contains 30 % of either long or short and 70 % of the other all mixed together.
The long acting in theory will last in the body for approx 12 hours ish and the quick acting is approx 6 to 8 hours maximum which is not that quick. The quick acting part of it is supposed to cover what is eaten at breakfast and lunchtime and tea time especially if the injections are say at 7 am and 7 pm, for a child 7 pm is normally way to late for tea on mixed injections.
This is a hit and miss regime as the insulins work at differents speeds, there are definite peaks and troughs in both the insulins and you find you are doing what is called 'chasing the insulin' or 'feeding the insulin' because you HAVE to eat at a certain time to avoid hypos, which happen on a frequent basis on mixes.
MDI (basal/bolus or multiple daily injections) is the same sort of idea but the two insulins are not mixed and are better insulins, they are newer. The long acting insulin will either be Lantus Glargene or Levemir (same sort of thing, different companies). They are supposed to last in you for 24 hours. In reality they last less but only a few hours less and there are ways around that. So the long acting insulin is called the basal insulin (or you may hear people call it the background insulin as it is always there in the background). It is injected and it sits beneath the skin and releases itself slowly throughout the 24 hour period (or slightly less). There are still peaks and troughs but small ones, nothing like the mixed insulin peaks and troughs. This is one injection daily at the same time or in some people if it really only lasts 14 to 18 hours then it is split to two smaller injections 12 hours apart (generally Levemir - most people don't have to split the Lantus).
The other insulin in MDI is a very quick one, normally Novorapid but in some instances Humalog (different company). They peak quickly ie between 2 to 3 hours and by about 4 to 6 hours are out of the body. This insulin is given purely when you eat carbohydrates. This is why it is so important to learn carb counting on MDI and really really helps to get some sort of control of blood sugar levels. For example if for breakfast you have two weetabix and a measured amount of semi skimmed milk I know from experience that that is 32 carbs. You will be given a ratio of insulin units to carbs so you can work out how much quick acting insulin you need to cover those 32 carbs. To make it easy lets say your ratio is 1 : 16 which means for every 16 carbs you eat you need 1 unit of novorapid. So if you eat the 32 carbs you will need 2 units of novorapid to cover that food, so that is what you inject.
If on the other hand you have just bacon and eggs ie no carbs then in theory you will not need insulin. Some people get to know that they need some carbs so would add a piece of toast to the bacon and eggs and you would then need to bolus for the bread which the carbs are generally on the packet.
I hope that is all ok and that I have made it easy to take it. I know how much information thrown at you in the early days makes it so hard to get to grips with everything. I am 10 years down the line and I still learn new things all the time. So ask any question and it will be answered for you.
Take care and good luck on Thursday.
I think a good discussion with the consultant is in order. Most meters only show HI over 33, and to go from that to 1.7 is a heck of a change. I do hope that something can be sorted out, it must be awful for you all