Mixed (biphasic) insulin, meal patterns & low-carb - experiences and practical tips

[JITR]

[Admin note: This is a spin-off thread that originated as a discussion from this thread here. Some of the references may be in regards to a user that takes mixed insulin.]

As a checklist on the dietary side how does what you eat compare with the Freshwell Meal Plan and its Food Lists?

Are you keeping a count of your carbs and other nutrients? I rely on Cronometer for that.

 

[Leadinglights]

If people are on fixed doses of insulin then they will need to eat a certain amount of carbs at each meal and low carb may not be suitable for them.

 

[JITR]

If people are on fixed doses of insulin then they will need to eat a certain amount of carbs at each meal and low carb may not be suitable for them.

Yes, I’m aware of that. The Freshwell guide itself states:

"Before embarking on a low carb lifestyle, please speak to a doctor or nurse if you suffer with any significant health conditions, particularly diabetes or high blood pressure. This is especially important if you are on any medication because you may find very quickly that you no longer need this medication and may need to stop taking it or reduce the dose. You should not do this without medical supervision."

My intention in linking it was as a checklist for reducing carbs, not to recommend a strict low-carb lifestyle. Balancing carbs with insulin dosage is something for the individual and their diabetes nurse/GP to decide.

 

[Lucyr]

It makes no sense to me to fix a dose of insulin that requires you to consume more carbs than you otherwise would.

They’re taking a mixed insulin so aren’t going to be able to follow your low carb suggestions as they can’t change the ratio of long acting to short acting insulin

 

[Inka]

But the Freshwell thing uses a traffic light system and all the normal carbs like bread, cereal, etc, are marked as Red. That could cause someone on insulin to avoid them, leading to a nasty hypo.

 

[JITR]

But the Freshwell thing uses a traffic light system and all the normal carbs like bread, cereal, etc, are marked as Red. That could cause someone on insulin to avoid them, leading to a nasty hypo.

I understand that. The Freshwell materials don’t state exact carb quantities. My link was simply to offer a food checklist for reducing carbs, if appropriate. Whether to include bread, cereal, or other starchy carbs is for the person and their healthcare team to determine.

 

[Lucyr]

I did not suggest any quantity of carbs, nor does the Freshwell infographic. Bringing carbs and insulin dosage into balance is a matter for @Raddyroo and her DN/GP.

It literally says “avoid starchy carbohydrates as much as possible” when they must include the amount of carbs their mixed insulin dose is targeting

 

[Inka]

Apologies if I’m misremembering @JITR but I think we’ve had a similar discussion before about carbs and insulin. The OP is on mixed insulin. They can’t reduce their bolus insulin without also reducing their basal. They can’t stop their bolus insulin because they’d also be stopping their basal. The percentages and starting doses of mixed insulin allow for carbs. The Freshwell site lists all normal carbs as RED - ie avoid.

 

[JITR]

The Freshwell site lists all normal carbs as RED - ie avoid.

That makes sense. My question was whether reverting to one meal a day could work, as that was the previous pattern. I’d read (incorrectly) that Humulin M3 could sometimes be taken once per day. Google had confused it with Humulin I.

 

[silentsquirrel]

The only question in my mind is why not revert to the one meal a day that @Raddyroo had been eating for the past two years, together with a single dose of Humulin M3?

Humulin M3 is a biphasic insulin designed to be taken twice a day. If you took just a single dose a day the basal(long-acting) part would be far too high for part of the day and far too low at other times. It is not just a short-acting insulin to deal with the meal.

 

[JITR]

Thanks for clarifying — so once daily is not suitable. Given the twice-daily dosing, perhaps two meals a day could be an option, but again that’s entirely for the individual and their care team to decide. My role here is only to share resources for carb-counting and food choices, not to recommend meal patterns or specific carb amounts.

 

[Inka]

No, two meals wouldn’t work @JITR as the twice daily biphasic insulin is designed to work over four segments of the day, including the three meals spaced appropriately.

 

[Lucyr]

Without the right timing of carbs, someone could be without basal coverage for hours and risk serious illness.

 

[JITR]

Understood. To summarise: twice-daily Humulin M3 requires carbs after each dose and more carbs as meals/snacks in between. The specific amounts and timings are something the individual needs to agree and test with their diabetes nurse. My original aim in posting was to provide a food checklist for anyone trying to reduce carbs — with the clear caveat to do so only under medical supervision.

 

[Ieva DUK]

Hi everyone — I’m opening this spin-off to continue the technical discussion that grew out of @Raddyroo ’s thread. This thread is for sharing peer experiences about:

• managing mixed (biphasic) insulin (e.g. Humulin M3) and meal timing,
• experiences and practicalities of lower-carb approaches while on mixed insulin,
• practical carb-counting tools and meal patterns (apps like Cronometer, Freshwell lists, etc.) and interpreting technical graphics into carb targets.

Important: This is peer support and experience sharing only — not medical advice. Please speak with your diabetes team or GP for clinical decisions. Be respectful in all exchanges.

All relevant messages have been moved here and/or edited from the original thread to fit this topic and our User Guidelines. Some posts have been removed for clarity and compliance. If you have concerns about how your message appears here, please contact the Admin Team.

 

[JITR]

Hi everyone — I’m opening this spin-off to continue the technical discussion that grew out of @Raddyroo ’s thread. This thread is for sharing peer experiences about:

• managing mixed (biphasic) insulin (e.g. Humulin M3) and meal timing,
• experiences and practicalities of lower-carb approaches while on mixed insulin,
• practical carb-counting tools and meal patterns (apps like Cronometer, Freshwell lists, etc.) and interpreting technical graphics into carb targets.

Important: This is peer support and experience sharing only — not medical advice. Please speak with your diabetes team or GP for clinical decisions. Be respectful in all exchanges.

PROBLEM
The original OP was recently diagnosed T2 with HbA1c at 105. She has been put on insulin (Humulin M3) to get her HbA1c down below 69 as soon as possible for surgery.

She had sepsis after surgery in September 2023. Doctors said it can take months and years to recover.

Problems with her stomach mean she is in pain after eating. For the last two years she had been eating one meal a day in the evening so she can continue to work. She was used to that.

She is now eating three meals a day to align with the Humuilin M3 profile but feels hungry all day.

It seems she used to snack on crisps during the day and has now replaced them with nuts.

The OP has asked for advice on managing her diet.

DISCUSSION
We cannot provide medical advice as we are not qualified and, in any case, we do not know everytihing about her condition.

However, Ieva has gone to some trouble to facilitate a technical discussion about managing mixed insulin, meal timing, carb counting, meal patterns, and interpreting technical graphics.

An obvious feature of the problem as stated is that the OP was used to one meal in the evening with snacks during the day and is finding three meals a day difficult to manage. This leads to the question of whether an "individualised" insulin regimen to support a single meal in the evening is possible.

Eli Lilly, the manufacturers of the Humulin family of insulin products, offer Patient Booklets for Humulin M3 and Humulin I on the UK website. Each contains a technical graphic showing a profile of its insulin effect over 24 hours.



This profile appears to be unsuitable for a single meal a day. Link.


The booklet advises, Humulin® I can be injected either once or twice daily according to your needs. The most common time to inject is before bed.

With a quick acting insulin dose at dinner, this profile as shown would support a single meal in the evening supplemented by several carb controlled snacks during the day. Link

In this recent post @Inka says, Some people with Type 2 do this [inject Humulin I] and just have Humalog before their evening meal.

PROs & CONs
From your experience of taking insulin what would be the likely pros and cons of these two approaches to reducing HbA1c?

 

[Lucyr]

From your experience of taking insulin what would be the likely pros and cons of these two approaches to reducing HbA1c from the OP's point of view?

Surely it isn’t appropriate to discuss what’s best for a specific person, when that person hasn’t asked for that discussion to take place.

This is what Ieva says this thread is for, which is different to what you’re asking people to discuss

This thread is for sharing peer experiences about:

• managing mixed (biphasic) insulin (e.g. Humulin M3) and meal timing,
• experiences and practicalities of lower-carb approaches while on mixed insulin,
• practical carb-counting tools and meal patterns (apps like Cronometer, Freshwell lists, etc.) and interpreting technical graphics into carb targets.

 

[silentsquirrel]

PROBLEM
The original OP was recently diagnosed T2 with HbA1c at 105. She has been put on insulin (Humulin M3) to get her HbA1c down below 69 as soon as possible for surgery.

She had sepsis after surgery in September 2023. Doctors said it can take months and years to recover.

Problems with her stomach mean she is in pain after eating. For the last two years she had been eating one meal a day in the evening so she can continue to work. She was used to that.

She is now eating three meals a day to align with the Humuilin M3 profile but feels hungry all day.

It seems she used to snack on crisps during the day and has now replaced them with nuts.

The OP has asked for advice on managing her diet.

DISCUSSION
We cannot provide medical advice as we are not qualified and, in any case, we do not know everytihing about her condition.

However, Ieva has gone to some trouble to facilitate a technical discussion about managing mixed insulin, meal timing, carb counting, meal patterns, and interpreting technical graphics.

An obvious feature of the problem as stated is that the OP was used to one meal in the evening with snacks during the day and is finding three meals a day difficult to manage. This leads to the question of whether an "individualised" insulin regimen to support a single meal in the evening is possible.

Eli Lilly, the manufacturers of the Humulin family of insulin products, offer Patient Booklets for Humulin M3 and Humulin I on the UK website. Each contains a technical graphic showing a profile of its insulin effect over 24 hours.

View attachment 36689

This profile appears to be unsuitable for a single meal a day. Link.

View attachment 36690
The booklet advises, Humulin® I can be injected either once or twice daily according to your needs. The most common time to inject is before bed.

With a quick acting insulin dose at dinner, this profile as shown would support a single meal in the evening supplemented by several carb controlled snacks during the day. Link

In this recent post @Inka says, Some people with Type 2 do this [inject Humulin I] and just have Humalog before their evening meal.

PROs & CONs
From your experience of taking insulin what would be the likely pros and cons of these two approaches to reducing HbA1c?

This is now supposed to be a thread about managing mixed insulin, not changing it to a different form of management.

 

[CliffH]

Surely it isn’t appropriate to discuss what’s best for a specific person, when that person hasn’t asked for that discussion to take place.

This is what Ieva says this thread is for, which is different to what you’re asking people to discuss

"Nothing about us, without us"

 

[CliffH]

Thanks for clarifying — so once daily is not suitable. Given the twice-daily dosing, perhaps two meals a day could be an option, but again that’s entirely for the individual and their care team to decide. My role here is only to share resources for carb-counting and food choices, not to recommend meal patterns or specific carb amounts.

I thought the "role" for all of us on here is purely to share personal opinions/experiences, not to hold ourselves up as having any specialist knowledge about diabetes?