Long acting insulin - question

[JimBear]

I have finally(!) got my prescription through for my basal bolus insulins. I have been put on the Novorapid for the fast acting and the Insulatard for the the long acting. I have been told to inject this twice a day at 30 units a time. This, along with the the other insulin is now taking me up to 5 injections a day. Currently, on the mixed insulin I am taking 72 units in the morning and 80 in the evening and as the pen only goes to a maximum of 60, means I have to take two doses. I was hoping not to have to inject even more times a day, so can anyone explain to me please why I have been put on a long acting I need to inject twice a day? Is it better/more even to do it that way? Are there benefits which outweigh the single-dose insulin?

(I can't ask my GP because he had to refer me to an endocrinologist for approval of basal bolus on a Type 2 and he confesses he's not a specialist in the diabetes world. The diabetes nurses in my area already dislike me and the GP was met with a frosty response when he discussed with them about me going on basal bolus. He's done so much to help me I don't want to pester him with pointless questions if this Insulatard is the better option).

Many thanks for your time and all the help you've given me so far.
Jim 🙂

 

[stephknits]

Not sure about type 2s, presume the principle is the same, and I am on far smaller doses, and a different basal. That's being said, for me the benefits are being able to adjust the amount I have at night compared to that I need the day (I have less at night). Also, by splitting I have greatly lessened the occurrence of night time hypos. For me these benefits far out weigh the bother of another injection. Not sure that is much help!

 

[trophywench]

Jim - will you need so much either in the morning or at night, once you are getting fast acting with your meals?

I think you need to be very very careful and test test test!

 

[Ljc]

Hi Jim. I know for you it's 5 injections a day, but the basal bolus ( MDI) is really more flexible than mixed insulin. In time you'll learn how to carb count and adjust your bolus accordingly. You don't have to eat to the insulin or at the same time every day like you would on mixed insulin.
Honestly you will get more used to injecting
I agree with @trophywench , I'm guessing your very insulin resistant, that may well improve as your weight goes down.

 

[Robin]

The thing about Insulatard, I think, is that it doesn't have as even a profile as other basals, it can have a bit of a peak, and tail off before the full 24 hours is up, so splitting it will iron that out.

 

[trophywench]

Yeah but because it isn't flat, and now Jim will be adding Novorapid - this is why I say test test test. If an Insulaturd peak happens to coincide with a Novorapid most active period, and Jim hasn't just eaten a big, quickly absorbed carb meal - then he could be hypo-ing all over the place.

(I didn't spell that I insulin wrong, it was deliberate cos that's what I think of it, basically!)

 

[JimBear]

Thanks for your replies - most helpful 🙂 So, the twice-daily dose is better because it's more even? But I may hypo if the peak coincides with my short acting insulin?

Sorry for so many questions, but here's the next: When is it best to inject the Insulatard? I am due to pick these insulins up from the surgery tomorrow after work and would like to start using them Friday evening/weekend so I have had some practice before going to work on Monday. I confess I am a little worried about injecting at work, not least of all because I don't want my colleagues to see/know I am diabetic.

 

[VicMar]

>>> I don't want my colleagues to see/know I am diabetic. <<<
Hi Jim,
Having had type 1 for 61 years, mu experience is that it's better for your workmates to know you are diabetic.
If you have a hypo episode in the presence of a workmate they might think you are drunk, or having a stroke etc. Hypos affect different people in different ways. Some get aggressive and some like me become soppy and helpless. It's far better if your workmates know you need help and how to help you,

The same applies if you happen to go hyper. Grumpy, bad tempered, feeling or actually being sick, falling asleep can easily be misinterpreted by workmates - especially by supervisors/bosses.

Don't be ashamed of being Diabetic. Try to adopt my lifetime mantra- "I'm not a Diabetic, I'm a man who has Diabetes". That will make you feel more positive.

Best wishes
Vic

 

[Jade]

I wonder why you weren't prescribed Lantus instead of insulatard as it is a long acting and once daily injection. I was on twice daily insulatard when first took insulin about 19 years ago for a while then took once at night time when took actrapid before meals. But fortunately was switched to lantus and novorapid after a few years. As actrapid definitely wasn't fast acting and needed to be taken an hour before eating and I used to forget taken it and go do something else and go low. Altho I still do that now occasionally!
I would start on small doses and expect blood sugar levels to be unsettled for a while,
Could you phone diabetes nurse at local hospital for advice if can't speak to local Gp practice.

 

[Robin]

I wonder why you weren't prescribed Lantus instead of insulatard as it is a long acting and once daily injection

Cynically, I wonder it it is cost related, Insulatard is about half the price of Lantus, and if you need large amounts, the difference is significant.

 

[trophywench]

Sadly - I agree with Robin. And it has to be said - although it's useless if you are T1 - quite a lot of T2s actually do rather well on it. However, some don't - so see how you get along with it and don't be afraid to request a change if you do identify problems with your BG and your lifestyle.

 

[Copepod]

I do fine on Humalin I twice a day. Usually about 20 units when I get up about 07:00 and 16 units around bedtime, usually between 22:00 and 23:00. I find that 2 injections per 24 hrs makes it easier for me to adjust to shifts, varying levels of physical activity, with no set pattern etc. Thanks to undoing zip on zip off trousers an inch or so, I was able to inject my thigh without anyone noticing. I sat on a low stone wall, as walkers streamed past, having completed about 2 hrs / 7 miles of Keswick to Barrow walk. We started at 05:30, having got up at 02:45 for breakfast, then quick walk to bus stop to drive Barrow to near Keswick.
I know the recommendation is to tell people around you about having diabetes, but I find that I can deal better with my diabetes than anyone else, and other people can be a far bigger nuisance. Although I don't mind letting people know, after I have proved myself able in other ways. You can't untell someone, so it's best to pick the moment that's right for you.

 

[JimBear]

Thanks for all your comments and support folks! Much appreciated!

So far, I am not doing too bad on the basal/bolus. I was nervous at first because it was a bit of a move, and I have only had one hypo (so far!) and my numbers have been pretty stable and favourable, certainly more stable than I have ever seen on the mixed. Even though it's early days and I am still suffering from this other condition that the doctors are struggling to identify, I do feel slightly better. I have been checking my numbers frequently, and in the middle of the night. The night numbers have been truly remarkable - they have given me identical readings the following morning!

I am also finding it fascinating to work out the carbs I am eating and adjusting accordingly. I seem to be using less insulin now than I was when on the mixed, with better results too which I find a little surprising. The other thing I have to say I am impressed with, is the improvement on the new pens over the Humulin pen - the novorapid pen is so smooth and has a feeling of quality engineering over the 'sticky' plastic of the Humulin one, which needed quite a push sometimes to get it to inject. I also like the idea of the cartridge refills over the whole pen being disposed of, though even the new disposable pen feels better. If I get on well with this I will ask the doc if I can have cartridges of the bolus one too and use a refillable pen.

The only people at work who know I am diabetic are my partner (who happens to work in the same office) and my line manager. I only told him in the hope they would lower the ridiculous amount of heat they use in the winter just so the women can wear the most flimsiest of clothes and then bitch about it being 'absolutely freezing' when it's well over 25 degrees. I am sorry Vic, but my tolerance towards my co-workers is only matched by their total indifference to me. I don't feel they much like or care for me and whilst I understand it can be useful to let people know in case of any kind of emergency, I keep myself at a distance so I can switch off when I leave work and keep my private life private. Having heard some of the things they say about others in the place, makes me question what they say about me behind my back. I can honestly say I have never worked in a place quite like this one 😉

My main concern about the basal/bolus is trying to figure out how much to use if/when eating out. Just very occasionally, I may have a Chinese meal and I have absolutely no idea where to start with estimating that. I've my brother's wedding to attend in September and there are canapes etc after the morning ceremony and I don't know how to work that out. I have declined the evening reception invitation for several reasons, but one because it's a buffet and I've no idea what I will eat or how much. (But I have offered to puppy-sit my parents' new friend which I will much prefer lol).

Anyway, thanks again for all your help and for holding my hand whilst I made the transition - it's been pretty good so far and seems a far more logical way of doing things 🙂

 

[trophywench]

Jim - canapés - of course - it depends entirely what they're made of and as you say, you'll be clueless beforehand really.

However - you'll presumably be able to recognise what each arty farty (LOL) spoonful of topping, is sat on. A tiny bit of toast, a cracker the size of a Ritz cracker, or cream cheese piped into a bit of celery, etc. They aren't intended for people to stuff their faces with - or enough to soak up a lot of booze. Soooo - put 3 you think you quite like the look of on your plate - and just pick at them. Daintily - like eating canapes is a daily occurrence in your life! whilst waving your glass in your hand and making conversation LOL If you find you quite like one or another - well, enjoy a couple. Test your BG in a hour/90 mins - and jab according to what your BG did, or what you actually know that you've eaten. When on insulin - if in doubt - UNDER estimate the carbs - cos we can always add more insulin later if it wasn't enough - but can't remove it again if we jabbed too much.

This is a one-off occasion, you won't do it every day - so if you are a bit high that day it ain't going to send you blind or make your kidneys fail - unless you keep doing it! So - relax !

PS your workplace sounds like a bundle of fun ..... {{Hugs}}

 

[Mini-Vicki]

Jim, it would be worth while downloading the Carbs and Cals app if you have a smartphone. It's about £3.99 I think. But it gives you the carbs in almost every food, and has recently been updated to include a lot of restaurant meals too. If I know where I'm going to be eating out, I often look the restaurant up online, and often the nutritional values can be found 🙂 but I've found the app invaluable in helping me calculate insulin.
There is also a carbs and cals book, but it's bulky and the app is regularly updated 🙂

 

[Copepod]

It sounds like you are using plastic disposable pens for Humalin I? You can get metal Luxura pens and disposable cartridges. Sadly, disposable pens and cartridges cost the same in money, but environmental costs, including disposal are lower, especially as glass cartridges can be recycled.

 

[JimBear]

Eat canapés daintily - lol - that made me chuckle! Well at least I will have had a bit more experience by the time September rolls around 🙂

I have the Carbs and Cals app and I have to say it is very useful, and I can see it being invaluable when dining out. I have noticed some quite large differences in some foods and I wish there was a way to mark the ones you've checked and trusted. But, the photos help judge portion sizes and I am very grateful for living in an age where it is conveniently possible to take that amount of data around. I can't imagine how difficult it must have been to try and work out carbs even ten years ago!

 

[Bill Stewart]

have you been told about the effects of fat in a meal and absorbtion rates... when I go for an indian there is no point injecting 15mins before the meal or even when I start as the fats hold back the carbs for about 2 hours for me so no mater what I injected I was way high 4hours after the meal, If I had injected more to compensate at the start of the meal I would have hypoed before the meal ended. Pumpers have a setting that puts a little insulin often when in that situation (so I am told) so I put in my normal dose and a correction later, like wise with buffets and parties I deal with the spike rather than try and predict anything - not the best strategy, but it works for me as I am not at such things too often. And where you inject also affects how quickly its absorbed so a sugary event in in my arm and a fatty meal is in the nether regions. From top to bottom fast to slow.

 

[JimBear]

Hi Bill, Yes I know about fat slowing down the absorption rates. On my old insulin I have hypoed before the end of a meal, which is really upsetting. I imagine that eating anywhere where you are not sure of the portion sizes etc until the plate arrives you can only keep a note of the food and inject immediately afterwards. It's rare I eat out so not likely to be a problem I have to deal with too frequently!

 

[trophywench]

The pump does help - however some things what I actually need is a bit now, then a gap of an hour or so and another bit, some foods I need to repeat that for 5+ hours to get it smack on - so as not even a pump can do that - these meals are ones I try to avoid. As the main culprit is pizza this is no hardship for me actually - though I did have a fantastic one in France last year where the base was sooo thin it had bubbled and burst where it wasn't covered in the tomato base layer - and the whole of the base was crunchy crispy. Fantastic, beautiful dinner!

And I can't direct anyone to the pizza place, since it was a mobile van visiting a campsite. Lady taking orders and dealing with the bases - hand thrown - chap adding the ingredients and loading/unloading the oven which only took 2 at a time - hence why I reckon, the thinness of the bases. Fab. A campsite with a restaurant that was full every night - but closed completely on the pizza van night every week - and the queue was a good 40 minutes, plus another 5-10 after the order was taken. I wonder why? LOL