New T2 here and just started on insulin

[imsweetenough]

Hi T2. I'm here to chat with other diabetics as there is no one else amongst my friends and family who has it. Was triple medicated sitaglyptin, gliclazide and dapaglyflozen but my ketones suddenly went from nothing up to 1.9. 4 weeks into onboarding M3 Humulin. I'm also on Victoza. Started using Freestyle Libre 2 at the start of insulin. What a revelation. I had no idea my BGs were so stable overnight. Now I'm even more confused about the night sweats. Was diagnosed 10 years ago but had bizzarre symptoms stretching back decades. Engaged with a private endocrinologist who advised me I'd been diabetic since early childhood despite the nhs insisting there were no type 2 kids in the 70s. He immediately took me under the care of the research team at Leeds St James. I appear to have IBD although I think it is diabetic belly and started in my late teens. Looks like I have glaucoma and my intention tremor is getting worse. I'm 51. Hello.

 

[Inka]

Welcome @imsweetenough That sounds interesting. Do they think you have some kind of genetic diabetes aka MODY?

 

[rebrascora]

Hi and welcome to the forum.

Plenty of us here to chat to. Is there anything particular that you are having problems with or would like to discuss?

How are you managing with the insulin so far?
Did they give you any options about insulin regimes? With you having a recent history of developing ketones, a basal/bolus insulin regime might have been a better option rather than a mixed insulin. The reason being that you can inject more short acting insulin to bring your levels down if they go too high, particularly in situations like if you were ill. With a mixed insulin, increasing the overall dose in order to bring levels down at short notice for a particular illness or trauma is bit less predictable and probably not recommended. I personally don't have any experience of mixed insulins though and my variable lifestyle would make it very difficult to balance things with it, so I really appreciate my basal/bolus regime. If you are comfortable with a fairly regimented lifestyle with regular meals of a similar size at a similar time of day each day ie. a creature of habit, then it could work well for you and probably takes up a lot less brain power.... counting carbs and calculating doses and taking into account exercise etc can be a bit draining at times. 🙄

 

[imsweetenough]

Welcome @imsweetenough That sounds interesting. Do they think you have some kind of genetic diabetes aka MODY?

Thanks for saying Hi. It seems to be a genetic variant of T2 as my materal grandfather and my paternal grandmother had it giving me a 50% predisposition. Both died in their early 60s. I was tested for both MODY and slow progressive type 1 but both tests came up negative. They tell me there are currently 16 different genetic variants of type 2 that are known about but the main school of thought is that everyone's experience is different. I don't seem to produce enough insulin which may be down to it not being diagnosed for around 35 years. I had unconsciously fallen into some great coping strategies during my 20s and 30s which resulted in me probably playing the hokey cokey with it in terms of normal range sugars. I was hospiitalised at 30 for a week with an intestinal bleed following some spectacular cramps (I later discovered these seemed to be middle of the night false hypos because on the one occassion I had the presence of mind to test, it was the lowest BG I seen in months) which I'd been having since early 20s. During that time my weight dropped down to 11 stone (I'm 6 foot 4) and the GP misdiagnosed me with anxious depression. It has been my experience that because I never really presented primary symptoms, the correct diagnosis was always missed. They thought I had Chron's. 🙂

 

[imsweetenough]

Hi and welcome to the forum.

Plenty of us here to chat to. Is there anything particular that you are having problems with or would like to discuss?

How are you managing with the insulin so far?
Did they give you any options about insulin regimes? With you having a recent history of developing ketones, a basal/bolus insulin regime might have been a better option rather than a mixed insulin. The reason being that you can inject more short acting insulin to bring your levels down if they go too high, particularly in situations like if you were ill. With a mixed insulin, increasing the overall dose in order to bring levels down at short notice for a particular illness or trauma is bit less predictable and probably not recommended. I personally don't have any experience of mixed insulins though and my variable lifestyle would make it very difficult to balance things with it, so I really appreciate my basal/bolus regime. If you are comfortable with a fairly regimented lifestyle with regular meals of a similar size at a similar time of day each day ie. a creature of habit, then it could work well for you and probably takes up a lot less brain power.... counting carbs and calculating doses and taking into account exercise etc can be a bit draining at times. 🙄

Hello Barbara. I'm on a 30/70 insulin. 30% rapid acting and 70% basal. The injection lasts for 8 hours with 4 hours being the life of the fast acting and the rest being basal. So far so good. I have very low insulin resistance in the evening and when I wake up I'm now under 8mmol most mornings but within about 10 minutes I've gone up to 13/14. As you suggested, the morning injection is not bringing it down fast enough (and even worse with breakfast on top of that - I've been skipping breakfast if it's about 15 which I know is naughty but I do keep a very close eye on it) and that is affecting my work with brain fog and nausea. My memory is shocking. Today's morning dose was 64 units and the evening dose 52 units. My BG is starting to noticeably drop in the afternoon and today I dropped to 4.3 just before I ate. Lowest I've been so far is 3.7 but my liver seems to kick in at that point and I'll get a sudden uplift but I'm carefully watching for hypos. So far so good. I'm getting on well with keeping to a regular portion size and I've found that the Libre sensor really helps with that as it gamifies the experience and I'm a bit of a competitive geek. That is a good thing because I have been prone to binging. When they told me to have some jelly babies in my pocket and the car I said no because I know what I'm like and I'll just do them all in. I do carry a hypo kit but glucose tablets aren't attractive so they don't get eaten on a whim. There goes my glucose alarm.... straight up to 13 from 5 in half an hour. It'll drop even faster at this time of the day which causes strange muscle spasms all over and within my abdomen. What is your status, history, experience? 🙂

 

[Lucyr]

Hi and welcome, hope you soon feel you're getting the hang of things. One point is that whilst you say you have very low insulin resistance your doses of 116 units of insulin a day, plus victoza, suggests you are very insulin resistant. Have you ever tried metformin to help with your insulin resistance or did you not get on with that?

 

[Inka]

Thanks for saying Hi. It seems to be a genetic variant of T2 as my materal grandfather and my paternal grandmother had it giving me a 50% predisposition. Both died in their early 60s. I was tested for both MODY and slow progressive type 1 but both tests came up negative. They tell me there are currently 16 different genetic variants of type 2 that are known about but the main school of thought is that everyone's experience is different. I don't seem to produce enough insulin which may be down to it not being diagnosed for around 35 years. I had unconsciously fallen into some great coping strategies during my 20s and 30s which resulted in me probably playing the hokey cokey with it in terms of normal range sugars. I was hospiitalised at 30 for a week with an intestinal bleed following some spectacular cramps (I later discovered these seemed to be middle of the night false hypos because on the one occassion I had the presence of mind to test, it was the lowest BG I seen in months) which I'd been having since early 20s. During that time my weight dropped down to 11 stone (I'm 6 foot 4) and the GP misdiagnosed me with anxious depression. It has been my experience that because I never really presented primary symptoms, the correct diagnosis was always missed. They thought I had Chron's. 🙂

That’s both fascinating and sad - sad that it was missed. It might be that you’d find a separate basal/slow and bolus/fast/meal insulin more flexible. The mixes don’t work for everyone and aren’t flexible because you can’t just adjust one component of the mix.

 

[imsweetenough]

That’s both fascinating and sad - sad that it was missed. It might be that you’d find a separate basal/slow and bolus/fast/meal insulin more flexible. The mixes don’t work for everyone and aren’t flexible because you can’t just adjust one component of the mix.

Thank you. I'll discuss that at my review in 2 weeks. I try not to get frustrated about it being missed but it is disappointing nonetheless.

 

[rebrascora]

Not nice spiking up to mid teens and then dropping back down every day. When do you inject in relation to eating your meal? I am not sure how much you can adjust the timing with a mixed insulin, but rapid acting insulin isn't nearly as "rapid" as most of us would like and it can take. I used to need to give my "rapid" insulin an hour and a quarter head start on my breakfast to prevent spiking and about 20-30 mins in the evening. I now have a slightly quicker insulin but I still need 45 mins on a morning and 15-20 mins on an evening, depending upon what my premeal level is and what I am eating. Having separate insulins instead of mixed enables you to take the basal at regular times but adjust the meal time insulin to the best timing for your body and the food you are eating and the time of day.

 

[imsweetenough]

No it isn't nice. I'm up at 19 now and will be down to five within 2 hours. I am supposed to take the insulin 20 mins before I eat but have been experimenting a bit to no real conclusions. Yes there is the option of taking separates and counting carbs. One of the things we get wrong here in the UK is that we don't measure how much insulin a person is actually producing which makes for a finger in the air approach to getting dosage and regimes right.

 

[imsweetenough]

Hi and welcome, hope you soon feel you're getting the hang of things. One point is that whilst you say you have very low insulin resistance your doses of 116 units of insulin a day, plus victoza, suggests you are very insulin resistant. Have you ever tried metformin to help with your insulin resistance or did you not get on with that?

Hi Lucy. Ok, thank you, that's useful to know. Yes I was on metformin for about 3 years but it made me feel sick all the time.

 

[everydayupsanddowns]

Welcome to the forum @imsweetenough

Glad to hear that you are enjoying the benefits of Libre, and that you can see the positive reinforcement of the gamification devices like that can bring.

Sounds like you are getting to grips with mixed insulin. If you begin to find it a bit restrictive and inflexible it might be worth asking about Multiple Daily Injections / basal-bolus where the background and meal doses are taken separately and can be tailored more precisely to your needs.

Keep us posted with how your levels continue to respond 🙂

 

[imsweetenough]

Welcome to the forum @imsweetenough

Glad to hear that you are enjoying the benefits of Libre, and that you can see the positive reinforcement of the gamification devices like that can bring.

Sounds like you are getting to grips with mixed insulin. If you begin to find it a bit restrictive and inflexible it might be worth asking about Multiple Daily Injections / basal-bolus where the background and meal doses are taken separately and can be tailored more precisely to your needs.

Keep us posted with how your levels continue to respond 🙂

Hi there. I'm just starting to mix exercise back in carefully. Haven't exercised really for a year because whenever I did I felt awful. Even the small amount of exercise I've been taking has had a very noticeable effect on my sugars in a short space of time so my plan is to start morning exercising before my shot and breakfast. I think that will flatten my moning spike. I go from waking up around 5 - 8 mmol to around 13 in an hour even if I don't eat. If I do, it'll go over 16. But the exercise is a winner. My magic bullet is unsweetened almond milk. If I drink that with some spinach whizzed in my blood sugar will drop by about 3 points. I came close to a hypo (3.4) last night but intervened with a small carton of fresh orange. Not had that in such a long time. It was delicious. I will definitely keep you posted. Thanks for looking in on me.