Newbie on Novomix 30 - need advice!

[RichardH54]

HI

My Hba1c was 67 back in April so on 5th May the diabetes nurse put me on 10 units of Novomix 30 twice a day, removed my gliclazide and left me on metformin. This seemed fine to me, at the time. But two days later she upped my doses to 12 in the morning and evening and encouraged me to eat more carbs to avoid hypos. A week later, she upped me to 14 in the morning and 12 in the evening.

Since then I have been having hypos in the mid-morning before lunch. Her response was to suggest I eat more carbs at breakfast and a couple of digestives with my mid-morning coffee. I suggested reducing to 12 units in the morning and having 14 in the evening which she was happy with. But I still have fairly regular hypos.

As I've been diabetic for 16 years, I'm used to managing my diabetes by limiting my carbs and having regular exercise. My thought is that I should reduce my insulin doses back to 10 in the morning (breakfast is usually shredded wheat or corn flakes) and maybe 12 in the evening. However, I'd love some input from some of you before I next talk to my nurse.

What do other people think?

 

[Leadinglights]

I'm not sure about the insulin requirement but I just wondered how long you had been trying to reduce your HbA1C with the medications and presumably some dietary measures in reducing carbohydrates. It does seem strange to have to eat extra carbs to avoid hypos as a Type 2.

 

[RichardH54]

Well, my HBA1c increased from 48 to 67 in 12 months while I was on Metformin, Gliclazidem low carbs and exercise.

Previous to that, it had been pretty well under control. After 16 years, I wasn't surprised to go onto insulin but I expected a simple early morning injection to see how it went.

 

[trophywench]

@RichardH54

You could do worse than read the official T2 Guidelines - scroll down the page until you get to Insulin based treatment in bold, and read that. Doesn't sound to me as if nursie has followed very much of that at all. Then pick up the telephone and make an appt to see your DOCTOR - and query it with him in much the same way as you typed your opening post in this thread. Tell him nobody you've spoken to (and say, eg Diabetes UK' ) thinks you should be forced to eat more than you want to 'feed' the insulin as that went out with the ark - and that it would be better to adapt the insulin regime to suit you and your food and exercise habits, rather than you have to adapt your life to suit the insulin, and that you understand there are other insulins available that would probably match your situation better.

 

[trophywench]

When we only had animal insulins which we injected either once or twice a day, you did have to snack at certain times of day to avoid hypos, but that stopped in the 1970/80s as newer synthetic insulins came into use. Hence my comment 'went out with the ark' !

They've invented a good many more synthetic insulins since then too. More and more choice, and any alternatives to what people are using right now are supposed to be discussed and explained to us, to enable us to make an informed choice!

 

[Pumper_Sue]

HI

My Hba1c was 67 back in April so on 5th May the diabetes nurse put me on 10 units of Novomix 30 twice a day, removed my gliclazide and left me on metformin. This seemed fine to me, at the time. But two days later she upped my doses to 12 in the morning and evening and encouraged me to eat more carbs to avoid hypos. A week later, she upped me to 14 in the morning and 12 in the evening.

Since then I have been having hypos in the mid-morning before lunch. Her response was to suggest I eat more carbs at breakfast and a couple of digestives with my mid-morning coffee. I suggested reducing to 12 units in the morning and having 14 in the evening which she was happy with. But I still have fairly regular hypos.

As I've been diabetic for 16 years, I'm used to managing my diabetes by limiting my carbs and having regular exercise. My thought is that I should reduce my insulin doses back to 10 in the morning (breakfast is usually shredded wheat or corn flakes) and maybe 12 in the evening. However, I'd love some input from some of you before I next talk to my nurse.

What do other people think?

Hi Richard,
the insulin you have been put on which is a mix of long and shorter acting insulin will cause you to go low mid morning unless you have a snack.
It's a very cheap old fashioned way of treating diabetes.
Basically you need to eat exactly the same amount of carbs each day and at a set time.
Most people on that mix would have to eat breakfast, mid morning snack, lunch, afternoon snack, evening meal and then supper to mop up the peaks and troughs of the insulin.

 

[RichardH54]

@RichardH54

You could do worse than read the official T2 Guidelines - scroll down the page until you get to Insulin based treatment in bold, and read that. Doesn't sound to me as if nursie has followed very much of that at all. Then pick up the telephone and make an appt to see your DOCTOR - and query it with him in much the same way as you typed your opening post in this thread. Tell him nobody you've spoken to (and say, eg Diabetes UK' ) thinks you should be forced to eat more than you want to 'feed' the insulin as that went out with the ark - and that it would be better to adapt the insulin regime to suit you and your food and exercise habits, rather than you have to adapt your life to suit the insulin, and that you understand there are other insulins available that would probably match your situation better.

Thanks. Where do I get the T2 guidelines?

 

[trophywench]

Oh blast - forgot to add the link. Sorry!

Diabetes, Type 2 in Adults: Management

This summary (updated June 2022) provides recommendations on blood glucose management, continuous glucose monitoring, and drug treatment

www.guidelines.co.uk

 

[RichardH54]

Thanks, very interesting link. I'm going to talk to my nurse rather more forcefully (if I ring the surgery and ask for a doctor's appt to discuss diabetes, I'll be given the nurse anyway) and find ou why she put me on two injections a day from the beginning, rather than one.

 

[RichardH54]

Hi Richard,
the insulin you have been put on which is a mix of long and shorter acting insulin will cause you to go low mid morning unless you have a snack.
It's a very cheap old fashioned way of treating diabetes.
Basically you need to eat exactly the same amount of carbs each day and at a set time.
Most people on that mix would have to eat breakfast, mid morning snack, lunch, afternoon snack, evening meal and then supper to mop up the peaks and troughs of the insulin.

We share the same view! I'd prefer to cut back on carbs and food rather than have to eat merely to compensate for my insulin intake.