Readings Query

[Duane Charles]

Well I was in Hospital, had surgery and left the op theatre for ICU, for 2 days I think. I woke up to find myself connected to a multitude of tubes (15 altogether - some draining various cavities some providing sustaining fluids), including an insulin drip that was regulated through a machine. Several days later most of the tubes had been reduced in quantity and the insulin drip was discontinued to allow me to be started on Multiple Daily Insulin (MDI) - which is a combination of a long acting background (or basal) insulin and a quicker acting (bolus) insulin that covered any food eaten and whenever corrections to my BG were needed. Injections were done by the nurses and I had to politely insist that I took over my injecting responsibility.

But in your case a GP who might be starting a T2 on insulin after oral meds have proved insufficient has a spectrum of insulins that could be prescribed. There will be a NICE Guidance Note (try a Google search) that gives a GP parameters for insulin selection and the options can include basal (background) insulin once daily, to a mixed basal/bolus insulin once or more daily. If your question here in this thread doesn't trigger others to offer their experiences then try asking in a new thread, as a "T2 when oral meds needed insulin".

It's a complicated matter, since people like me who start insulin after major surgery are one way in; several forum members have arrived at an exceptionally high BG and experienced something called Diabetic Ketoacidosis (DKA), ended up in hospital, possibly unconscious, then started on insulin and woken to a drip; others following your route - progressive inadequacy of oral meds and had insulin prescribed that they collected from a pharmacy possibly several days later.

That last group seem to have very mixed experiences of subsequent explanation and training: some excellent, some seem totally inadequate. When/if you reach that point you are already in a great position since you aren't at "death's door" so you have some leeway to take stock AND you now know there is masses of help on this forum both from threads like this PLUS the Learning zone. So no need to be anxious about moving from oral meds to insulin.

Momentarily I can't recall a frequent corresponding member who has gone your possible route but I'm tagging @rebrascora who probably has a much better memory of how different forum members got onto insulin.

Thank you for sharing

 

[Duane Charles]

There are different types of insulin.

Basal/Long acting insulin which is designed to deal with the glucose your liver releases throughout the day and night. Your liver is like a back up battery for when there is no food digesting like when fasting to keep your vital organs supplied with fuel (glucose).

Bolus/Fast acting insulin which is injected usually before each meal and is used to deal with the glucose released from the food you eat. Usually they will start you on fixed doses, but gradually you learn to carb count and adjust your doses to match what you eat.

Mixed Insulin This is a bit old fashioned now but it is still used. It is a mix of the above fast and slow insulins at a set ratio and is usually injected twice a day before breakfast and evening meal. If you follow a very routine lifestyle with set mealtimes this can work quite well for some people, but I would suggest that with your lifestyle of varied shifts you need a more flexible insulin regime so having separate basal and bolus insulin would probably be best. This is referred to as MDI or Multiple Daily Injections.

Sometimes they just start you off on basal/long acting insulin first and then add in the meal time insulin later, I assume to make it less complicated but those of us who started on both straight away, managed fine and I think this is the best approach.

The insulin comes in pens and you just screw on a new needle (which is tiny, 4-6mm long and not much wider than a human hair) and then you dial up the dose and find a place to inject it, usually the tummy, thighs, buttocks or outer upper arms. Basically somewhere where there is a decent covering of fat and few blood vessels. You are injecting into the fat. Mostly it is painless. Sometimes you hit a tiny capillary and it causes a spot of blood and a bruise. Sometimes you hit a sensitive spot and it is really quite painful in which case you find a less sensitive spot and sometimes the insulin stings a bit. The pens are a doddle to use. You then dispose of the needle in a Sharpsafe box.

Thank you for this information, I’m sure it’s not that daunting and if put on Insulin won’t take long to get used to. Plus my work will have to be a bit more accepting of the change in my health.

 

[rebrascora]

Thank you for this information, I’m sure it’s not that daunting and if put on Insulin won’t take long to get used to. Plus my work will have to be a bit more accepting of the change in my health.

It does take time to get used to I am afraid. Whilst the injecting itself is relatively simple, it is all the thoughts around keeping yourself safe with insulin which can be quite daunting and overwhelming. The thing with insulin is that it is an extremely powerful medication and it is very easy to give yourself a bit too much and end up hypo. This is because your body uses glucose and releases glucose in varying and largely invisible amounts and your own pancreas produces some insulin itself again in unquantifiable amounts, so figuring out how much you need to inject isn't just about food, but how much exercise activity you have done in the last 24-48hrs and how stressed you are and how fast or slow release the food is that you have eaten and if you have had any alcohol or if you are ill or if it is a hot day or a cold one and if you are a woman, the time of the month! Lots and lots of things impact BG levels so getting the insulin doses right is a bit of a dark art. Of course the medical professionals will support you, but they are not there with you day and night to help you decide how much you need because you ran for the bus this morning or you didn't sleep well last night or you are stressed at work. You also have to ensure you have hypo treatments with you are all times and testing kit. It's a lot to think about., so not like being prescribed tablets and being told to take 1 3x a day or whatever. You start off carefully and conservatively and test lots to see how your body responds and gradually bring your levels down into range.

 

[Duane Charles]

It does take time to get used to I am afraid. Whilst the injecting itself is relatively simple, it is all the thoughts around keeping yourself safe with insulin which can be quite daunting and overwhelming. The thing with insulin is that it is an extremely powerful medication and it is very easy to give yourself a bit too much and end up hypo. This is because your body uses glucose and releases glucose in varying and largely invisible amounts and your own pancreas produces some insulin itself again in unquantifiable amounts, so figuring out how much you need to inject isn't just about food, but how much exercise activity you have done in the last 24-48hrs and how stressed you are and how fast or slow release the food is that you have eaten and if you have had any alcohol or if you are ill or if it is a hot day or a cold one and if you are a woman, the time of the month! Lots and lots of things impact BG levels so getting the insulin doses right is a bit of a dark art. Of course the medical professionals will support you, but they are not there with you day and night to help you decide how much you need because you ran for the bus this morning or you didn't sleep well last night or you are stressed at work. You also have to ensure you have hypo treatments with you are all times and testing kit. It's a lot to think about., so not like being prescribed tablets and being told to take 1 3x a day or whatever. You start off carefully and conservatively and test lots to see how your body responds and gradually bring your levels down into range.

For the reasons stated above, that could be a reason my GP doesn’t want to go down the route of checking pancreas damage despite my asking and prescribing Insulin. Am I right in thinking it needs to be kept cold or chilled?

 

[rebrascora]

Your in use insulin is kept at room temperature, usually for 30 days but the remaining ones (they usually come in a pack of 5) need to to be kept in the fridge but not any chance of being frozen so the fridge door is generally the safest place.