New Member struggling with Insulin

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Mymate

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Type 2
Hi to everyone. I am a new member and have been diagnosed as a type 2 for about ten years now. In the initial stages my bloods were controlled by taking just one 30mg gliclazide but the disease has progressed so that I have taken gliclazide, metformin, pioglitaozone, saxagliptin and eventually insulin injections. The injections are relatively new insofar as I started taken them about two months ago but I am really struggling with controlling my blood sugars. The diabetic doctor has prescribed 10 units of insulatard at bedtime time with 20 units of novo rapid before breakfast and an increasing amount, currently 12 units, at luch time. Thus far, this period has been one of the worst in controlling blood sugars and they are over 12 after each meal, two hours. I know that increasing the dosage has to be a gradual process but has anyone else had a similar experience and, if so, how long did it take to resolve?

Best regards
 
Hi MyMate, welcome to the forum 🙂 Sorry to hear you are finding things difficult at the moment - how often does your doctor suggest you increase the novorapid? The key to gaining good control is not just in increasing your fixed doses, but learning to match your doses to the carbohydrate content of your food a practice known as 'carb-counting'. Has your doctor mentioned this to you? I would suggest having a look at the free Carbs Count booklet from Diabetes UK, this will help you understand the principles. Although you are currently following the instructions of your doctor, you will eventually take control yourself in deciding your doses and be able to fine tune things by using carb counting and the experience you will build up about how you react to certain favourite meals, plus various other factors, such as whether you have been/plan to be particularly active (exercise increases insulin sensitivity).

Ask your doctor if there are any courses available to help you understand how to use your insulin. You might also find the books Using Insulin and Think Like a Pancreas useful 🙂 It may take a little time, and you are quite understandably concerned at the moment with your levels, but your doctor is probably trying to increase your doses slowly so that you avoid having low blood sugar. Have you ever experienced a low (i.e. below 4 mmol/l)? Are you having any novorapid with your evening meal, or just lunch and breakfast? What are your pre-meal levels like?

Please feel free to ask any questions you may have and we will try our best to help you out 🙂
 
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Thanks for your reply. Since my post early this morning the diabetic doctor has been on the phone and after discussing my current results has asked me to inject before every meal now, i.e. three times a day and one at night, long lasting. He wants to get one of the after meal readings to the right level and then work on the others in turn. Does this sound right?:confused:
 
My pre-meal readings are not bad at about 7.5ish although these could be better if the were at about 5.5ish instead but as I say, its early days for insulin. Doctor hasn't mentioned carb counting and adjusting quantity of insulin as yet. He is more bothered with overcoming the insulin resistance in the first stage and then refining the doses thereafter. At least I think he is. Trouble is there is not a lot of explaining going on it's just a case of increasing the dose on one injection, now the evening meal one, until it overcomes the resistance and then working the others as demanded. He did say that he has a patient taking 80 units three times a day to overcome the resistance but by my calculations if this were true in my case it would take another 114 days just to reach that point on one injection and that seems to be an inordinately long time!!
 
Well, it really does depend on what you are eating for your meals as to whether he can get a dose at the appropriate amount. If, for example, you had an omelette for lunch and your post meal level was nicely within range, you'd get a completely different result if you had (for example) potato and leek soup with crusty bread - your post-meal number would be much higher, because the latter would have considerably more carbohydrate in it (potatoes, bread). Diabetes is all about carbohydrates, and when you are on insulin then it is a case of matching the insulin doses to the carbs you consume. There are other things to take into account, but this is the most fundamental thing to bear in mind. Has your doctor told you to follow a specific diet, or to eat a specific amount of carbs per meal? What sort of things are you eating?

If you are anything like me then it may be that there are similar amounts of carbs in most of your meals e.g. a sandwich at lunchtime, whether ham, cheese or tuna, will have the same amount of carbs in the two slices of bread, so the doses of insulin will be similar. But if your doctor isn't aware of exactly what you are eating (including portion sizes) then it is a bit of a crude trial and error method of finding a dose and very prone to error.

Hope that is clear! It is still relatively early days for you on insulin, but hopefully things will begin to progress at a swifter rate now you will be injecting for all your meals. Please do let us know if you have any queries, there's always someone here to help! 🙂
 
Hope some insulin-using T2s can come along to help, but like Northerner it would make sense to me to set a specific (and moderate) carb level for each mealtime and stick to that. Often I eat similar amounts of carbs at each meal as it seems to reduce errors and make doses act more reliably for me. Something like 100-150g of carbs a day might be worth considering (eg 30g for breakfast, 45g for lunch and 50-60g for eve meal) would be moderate carb, though many T2s seem to do better on lower levels (with adjusted medication)

Good luck with it!
 
Thanks for the responses. I have made sure that I have the same thing for breakfast each day, i.e. two slices of seeded bread and marmite, so that I can gauge when, if ever, the insulin kicks in. As the number of injections has changed over the past few weeks I have tried to keep to approximately the same amount/type of food for the same reasons. However that is a little more difficult with an evening meal. I am going to have to do some serious carb counting. I have never actually calculated the quantity but have, in the past, reduced them with excellent results. Reducing them nowadays seem to have little or no effect regardless of whether I am taking tablets such as pioglitazone or injections. I think that leads me to believe that somehow my resistance to insulin has increased over the years and, therefore, I need to be able to find a level of insulin that overcomes this so that it can then be fine tuned to each meal. Does all that make sense?
 
Hi MM,
welcome to the forum.
Another factor in your after meal reading is, the time of injecting.
If you inject just as you eat perhaps try 15 mins before you eat to give the insulin a chance to work. Also perhaps look at the amount of startchy carbs consumed in one meal as well.
 
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