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Please Advise

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
@Kaylz and @Inka thank you so much you guys.
Today I will get a new supply and try the way you suggested. I would also let him know about rotating the site. I am also gonna ask his doctor about the basal insulin. His morning BG reading today was 17. Any idea how much dose of basal insulin he can take? And also what is the best basal insulin?

Regards
Indrani
 
Different basal insulins suit different people, so there’s not really a best one. Maybe try Lantus or Levemir? He would start on a small dose and it would be increased every few days. It’s possible his Novorapid might need to be decreased as his basal is increased.

The normal regime is one or two injections of basal insulin each day, then an injection of Novorapid (or other ‘meal-time’ insulin) before each meal. The Novorapid takes a little time to work, so should be injected before eating. Ideally he’d count the carbohydrate amount in the meal he’s about to eat and work out the amount of Novorapid to inject.

I’m sure he can improve his blood sugar with the right regime (one with basal as well as Novorapid), keeping the insulin at the right temperature so it doesn’t degrade, and rotating his injection sites 🙂
 
Inka said:
Different basal insulins suit different people, so there’s not really a best one. He would start on a small dose and it would be increased every few days. It’s possible his Novorapid might need to be decreased as his basal is increased.

The normal regime is one or two injections of basal insulin each day, then an injection of Novorapid (or other ‘meal-time’ insulin) before each meal. The Novorapid takes a little time to work, so should be injected before eating. Ideally he’d count the carbohydrate amount in the meal he’s about to eat and work out the amount of Novorapid to inject.

I’m sure he can improve his blood sugar with the right regime (one with basal as well as Novorapid), keeping the insulin at the right temperature so it doesn’t degrade, and rotating his injection sites 🙂
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@Inka Thank you so much. Let me try this way. I am also hoping that he will get better. I will try to find out the dose for basal insulin and start ASAP.

Thank you for your help.
Have a good day.

Regards
Indrani
 
Indrani Das said:
@Kaylz and @Inka thank you so much you guys.
Today I will get a new supply and try the way you suggested. I would also let him know about rotating the site. I am also gonna ask his doctor about the basal insulin. His morning BG reading today was 17. Any idea how much dose of basal insulin he can take? And also what is the best basal insulin?

Regards
Indrani
Click to expand...

Welcome to the forum @Indrani Das

We aren’t medically qualified, so can’t suggest any doses, we can only comment based on our own experiences.

I hope you can get in touch with his Doctor and get access to a proper basal:bolus regime. What you have described so far certainly sounds unusual, and I would have expected much more activity from the sorts of doses he has been taking. Something strange is going on!

Hope you get to the bottom of it.
 
Thank you so much. I also think that this is very strange. I also feel helpless. I am trying hard to figure out whats going on.

Hoping for the best.

Regards
Indrani
 
If you read the leaflet inside a box of Novorapid, or the box of any make of insulin, it gives the temperature range it can tolerate. If it gets too hot or too cold, it kills the insulin!

They do tell you not to jab it straight from the fridge though as it can be too cold to work as quickly as it's meant to - it still works, but just slower - but you do need to know, what temperature is it inside your fridge? In the UK - it has always been advised (for at least the last 50 years) to store it towards the top of the door, not in the main body of the fridge nor at the back of the fridge body cos it's too cold at the back since the cooling element is there!
 
trophywench said:
In the UK - it has always been advised (for at least the last 50 years) to store it towards the top of the door, not in the main body of the fridge nor at the back of the fridge body cos it's too cold at the back since the cooling element is there!
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I have never been told that. Interesting.
I've never had a problem with my insulin suffering from being on the top shelf in the main fridge compartment.

I wonder if fridge technology has moved on in 50 years and the cold is now spread throughout the fridge more evenly?
 
Could you have misunderstood the pharmacist. "In use" insulin does not need to be refrigerated but should be kept away from direct heat or high temperatures... Ie not left in a hot car or in full sun on a window sill etc and should be OK for 30 days. Other unopened vials/pens should be stored in the refrigerator until they are needed.
I wonder if the pharmacy are storing their stock of insulin correctly, in a refrigerator. I do feel that injecting 40u NR at one go and not seeing a significant drop in levels particularly in someone with such a low body weight suggests it is ineffective. I am 64kg and 4 units would be enough to drop my levels by about 10mmols. I don't even want to think about what 40 would do to me but it would be a race against time to eat my weight in jelly babies before I lost consciousness. We are all different of course and some people need more than others but that seems like a huge anomaly. If he was 200kg then it would be more understandable as he would likely be insulin resistant.
Would it be possible to source some insulin from another pharmacy, just to rule out any storage issues with the one you have been using?
 
You might be more likely to be able to obtain Levemir, because it's made by the same people as Novorapid - Novo Nordisk who are a Danish company!
 
rebrascora said:
"In use" insulin does not need to be refrigerated but should be kept away from direct heat or high temperatures... Ie not left in a hot car or in full sun on a window sill etc and should be OK for 30 days
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I’m not sure what the ambient temperature is in Botswana at this time of year though, and whether Indrani has aircon or similar?

Worth checking the suggested temperature range in the Patient Info Leaflet if unsure.
 
Indrani Das said:
Here the normal temperature is around 30 degreeC. I did not think that temperture could actually cause any degradation
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@everydayupsanddowns The OP gave the above info on that in response to my query, but no insulin was being stored in the fridge... not even unused pens/cartridges so I suspect some degradation may be occurring.
 
Yes, I think the packaging says under 30 degrees but I was told that the insulin would degrade at higher temperature and that under 25 was preferable for room temperature.
 
rebrascora said:
@everydayupsanddowns The OP gave the above info on that in response to my query, but no insulin was being stored in the fridge... not even unused pens/cartridges so I suspect some degradation may be occurring.
Click to expand...

Ah thanks Barbara, I’d forgotten that snippet from earlier in the thread. As you say, it certainly seems the sort of environment where spare vials/cartridges need to be refrigerated, I just wasn't sure whether it would be wise to even refrigerate the in use insulin - I think Pumper Sue used to do that, and just warmed it up a little before use.
 
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