Transition from tablets to insulin

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KJP1

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Type 3c
Hello,

I am a Type 3c diabetic. I was diagnosed with diabetes when I was 16 years old (due to chronic pancreatitis) and have been taking tablets to control this. However, my HB1AC has been a lot higher in recent months and I have been advised to transition onto insulin. Basal - Bolus has been something that has been recommended.

This is going to be a lifestyle change for me but once I get myself into a routine I’m confident it will be fine.

I would like some information on what types of insulin people are taking and whether weight gain is a common side effect?

Thank you.
 
Welcome @KJP1 🙂 I’ll tag some Type 3c members for you as I’m Type 1 - @Proud to be erratic @eggyg @soupdragon

As a Type 1, I found the insulin just helped me put back on all the weight I’d lost prior to diagnosis. I’ve been on insulin almost 30 years and have remained slim and at a stable weight.

I’ve been on a pump for years now, but there are a variety of basal and bolus insulins used here. The right ones are the ones that suit you best as an individual. Newer isn’t always better for everyone, and also we all have different lifestyles, needs and preferences.

One thing I would say is that personally I prefer a twice daily basal insulin as that gives you the ability to adjust the morning/day and evening/night doses separately. This is very useful for many people. I’d also say to ask for reuseable insulin pens (where you keep the same pen and just replace the insulin cartridge each time) not disposable ones, and to ask for half unit pens too. That makes control and fine adjustments easier.
 
Hi Type 3c here , I went from Metformin to mixed insulin but it wasn’t flexible enough. I would definitely go for a basal/bolus regime. As for putting weight on that’s a myth, you put weight on from eating too many calories! I think initially lots of Type 1s have lost a lot of weight before diagnosis and once their BGs are stable they’ll put that weight back on which is normal. If you “eat to the needle” ie deliberately take too much insulin so you’ll be low later so you can eat a snack that’ll make you gain weight possibly. If you just eat normally and take the correct dose of insulin ( which is a skill you will learn, ask to go on a carb counting course such as DAFNE) there’s absolutely no reason you should gain weight. Hope that helps and good luck.
 
Welcome to the forum @KJP1
As someone with Type 1, I had no choice about insulin. I have been taking it for nearly 20 years and not gained any weight in that time. To me, that is not surprising as I am just injecting the same amount of insulin my body would create if it could.
My understanding is that excess insulin causing weight gain if you experience insulin resistance.

Basal bolus is definitely the way to go as it gives us much more freedom to eat what and when we want.
Like @Inka I now use a pump. When starting on insulin, there seems to be two types of injectable slow acting insulin: very long acting like Tresiba and shorter long acting lunk Levemir.
If your basal requirements are very stable, Tresiba is a good option. However, if you need to frequently adjust your basal insulin dose such as for exercise or monthly cycles, Tresiba is inflexible.
Levemir allows more frequent adjustments including different doses morning and night. You have less variation around when to take it need two doses a day but, like Inka, I would favour the chance to adjust.

There are a number of different fast acting insulins available including "very fast" ones like Fiasp. In my experience, these can appear less predictable so I would not like to start my insulin journey with them. I would prefer to learn the ropes on something like NovoRapid. It is not as fast acting but seems more stable.
(I now use Fiasp and prefer it but I had to learn how to temper it for my body. The main Challenge is that the speed at which it works is very variable.)

My last suggestion is to request reusable insulin pens. For some reason, it is common to start with single use ones. Reusable pens are more robust, the cartridges take up less space in the fridge (and luggage when traveling), the NovoNordisk ones include a "reminder" of your last dose and, some manufacturers do a half unit reusable pen. Plus, they produce less waste.
 
Hi, another T3c here. Weight gain is not an issue for me, indeed after my surgery to remove my panc'y I had to drink nutrition supplements, just to get back to my optimum weight before surgery.

I am on Multiple Daily Injections (MDI), ie basal and bolus regime. I moved after 12 months from twice daily Levermir basal to the ultra long lasting once daily Tresiba and I found this to have been an excellent decision, for me. I live a very varied lifestyle, ranging from frantically busy to sometimes pretty sedentary and knowing that my basal is relatively fixed (certainly not daily changing or even weekly changing) has meant that once I'd got that basal about right all other insulin needs and adjustments can only be managed through my bolus and since bolus is relatively short acting (c.4 hours) I know after 4 hrs if further adjustment is needed; I don't have to think through should I alter my basal or my bolus! But that said I think it comes down to having insulins that your body is happy with and develop a management process that you are content with.

I particularly agree with @Inka that reusable pens are much better than single unit disposable pens; not all insulins have half unit pens - they aren't interchangeable between different manufacturers of insulin. I also agree that you should press for a DAFNE course. Feel free to ask questions, any questions - nothing is stupid and we've all been beginners once! There is a huge wealth of knowledge within the forum.

The one noticeable difference for me as T3c rather than T1 is that my BG is very quick to drop, if I'm not alert; and I am considered as having brittle diabetes. I believe this is because I have none of the normal pancreatic functions; so not only no insulin being made, but none of the other pancreatic hormones that help do a balancing act between glucose and insulin. If you don't have CGM, eg Libre, then press for that at the same time as your MDI.

Good luck.
 
Also if you drive, don’t forget to inform the dvla of the switch to insulin by filling in the online or paper form
 
Hi and welcome @KJP1
Another Type 3c due to pancreatitis here but one severe episode of acute pancreatitis in my case.
I've recently changed from a basal bolus injection regime to my first insulin pump. I started on Lantus as the long acting (basal) insulin but then asked to move to Levemir to give more flexibility. I've only ever used Novorapid as the short acting (bolus) insulin.
Good luck with your transition to insulin and do ask us if you have any questions.
 
Inka said:
Welcome @KJP1 🙂 I’ll tag some Type 3c members for you as I’m Type 1 - @Proud to be erratic @eggyg @soupdragon

As a Type 1, I found the insulin just helped me put back on all the weight I’d lost prior to diagnosis. I’ve been on insulin almost 30 years and have remained slim and at a stable weight.

I’ve been on a pump for years now, but there are a variety of basal and bolus insulins used here. The right ones are the ones that suit you best as an individual. Newer isn’t always better for everyone, and also we all have different lifestyles, needs and preferences.

One thing I would say is that personally I prefer a twice daily basal insulin as that gives you the ability to adjust the morning/day and evening/night doses separately. This is very useful for many people. I’d also say to ask for reuseable insulin pens (where you keep the same pen and just replace the insulin cartridge each time) not disposable ones, and to ask for half unit pens too. That makes control and fine adjustments easier.
Click to expand...
Inka said:
Welcome @KJP1 🙂 I’ll tag some Type 3c members for you as I’m Type 1 - @Proud to be erratic @eggyg @soupdragon

As a Type 1, I found the insulin just helped me put back on all the weight I’d lost prior to diagnosis. I’ve been on insulin almost 30 years and have remained slim and at a stable weight.

I’ve been on a pump for years now, but there are a variety of basal and bolus insulins used here. The right ones are the ones that suit you best as an individual. Newer isn’t always better for everyone, and also we all have different lifestyles, needs and preferences.

One thing I would say is that personally I prefer a twice daily basal insulin as that gives you the ability to adjust the morning/day and evening/night doses separately. This is very useful for many people. I’d also say to ask for reuseable insulin pens (where you keep the same pen and just replace the insulin cartridge each time) not disposable ones, and to ask for half unit pens too. That makes control and fine adjustments easier.
Click to expand...
@Inka - Thank you very much for taking the time to reply and tagging other Type 3c members. I wasn't aware of the insulin pen and half unit pens so will speak to the nurse regarding this. That's it, there are so many different insulins about so I am sure I will find something that will suit my body.
 
eggyg said:
Hi Type 3c here , I went from Metformin to mixed insulin but it wasn’t flexible enough. I would definitely go for a basal/bolus regime. As for putting weight on that’s a myth, you put weight on from eating too many calories! I think initially lots of Type 1s have lost a lot of weight before diagnosis and once their BGs are stable they’ll put that weight back on which is normal. If you “eat to the needle” ie deliberately take too much insulin so you’ll be low later so you can eat a snack that’ll make you gain weight possibly. If you just eat normally and take the correct dose of insulin ( which is a skill you will learn, ask to go on a carb counting course such as DAFNE) there’s absolutely no reason you should gain weight. Hope that helps and good luck.
Click to expand...
@eggyg - Thank you for responding to my post. That's it, over the years I have been quite disciplined with my diet so this won't be something new to learn. It's just getting used to injecting etc. With tablets you have a bit more flexibility and can be a little discreet. How do I get myself booked on a DAFNE course?
 
helli said:
Welcome to the forum @KJP1
As someone with Type 1, I had no choice about insulin. I have been taking it for nearly 20 years and not gained any weight in that time. To me, that is not surprising as I am just injecting the same amount of insulin my body would create if it could.
My understanding is that excess insulin causing weight gain if you experience insulin resistance.

Basal bolus is definitely the way to go as it gives us much more freedom to eat what and when we want.
Like @Inka I now use a pump. When starting on insulin, there seems to be two types of injectable slow acting insulin: very long acting like Tresiba and shorter long acting lunk Levemir.
If your basal requirements are very stable, Tresiba is a good option. However, if you need to frequently adjust your basal insulin dose such as for exercise or monthly cycles, Tresiba is inflexible.
Levemir allows more frequent adjustments including different doses morning and night. You have less variation around when to take it need two doses a day but, like Inka, I would favour the chance to adjust.

There are a number of different fast acting insulins available including "very fast" ones like Fiasp. In my experience, these can appear less predictable so I would not like to start my insulin journey with them. I would prefer to learn the ropes on something like NovoRapid. It is not as fast acting but seems more stable.
(I now use Fiasp and prefer it but I had to learn how to temper it for my body. The main Challenge is that the speed at which it works is very variable.)

My last suggestion is to request reusable insulin pens. For some reason, it is common to start with single use ones. Reusable pens are more robust, the cartridges take up less space in the fridge (and luggage when traveling), the NovoNordisk ones include a "reminder" of your last dose and, some manufacturers do a half unit reusable pen. Plus, they produce less waste.
Click to expand...
@helli - Hello and thank you for taking the time to respond. I will make a note of what you have said and discuss my options with my nurse/consultant. How do you find the pump? Do you have a continuous glucose monitor?
 
Proud to be erratic said:
Hi, another T3c here. Weight gain is not an issue for me, indeed after my surgery to remove my panc'y I had to drink nutrition supplements, just to get back to my optimum weight before surgery.

I am on Multiple Daily Injections (MDI), ie basal and bolus regime. I moved after 12 months from twice daily Levermir basal to the ultra long lasting once daily Tresiba and I found this to have been an excellent decision, for me. I live a very varied lifestyle, ranging from frantically busy to sometimes pretty sedentary and knowing that my basal is relatively fixed (certainly not daily changing or even weekly changing) has meant that once I'd got that basal about right all other insulin needs and adjustments can only be managed through my bolus and since bolus is relatively short acting (c.4 hours) I know after 4 hrs if further adjustment is needed; I don't have to think through should I alter my basal or my bolus! But that said I think it comes down to having insulins that your body is happy with and develop a management process that you are content with.

I particularly agree with @Inka that reusable pens are much better than single unit disposable pens; not all insulins have half unit pens - they aren't interchangeable between different manufacturers of insulin. I also agree that you should press for a DAFNE course. Feel free to ask questions, any questions - nothing is stupid and we've all been beginners once! There is a huge wealth of knowledge within the forum.

The one noticeable difference for me as T3c rather than T1 is that my BG is very quick to drop, if I'm not alert; and I am considered as having brittle diabetes. I believe this is because I have none of the normal pancreatic functions; so not only no insulin being made, but none of the other pancreatic hormones that help do a balancing act between glucose and insulin. If you don't have CGM, eg Libre, then press for that at the same time as your MDI.

Good luck.
Click to expand...
Everyone has been so fabulous and I am so overwhelmed that everyone has taken time to respond to my concerns. It's nice to touch base with another Type 3c diabetic.Over the years, I haven't had chance to meet any other Type 3c diabetics. I am similar to you - I suffered from chronic pancreatitis - I had about 14 attacks and this led to some of my pancreas being removed and the rest being damaged - so my functions are not how it should be. I will be sure to keep an eye out on blood glucose dropping quickly and will push for some of the other things you have mentioned. And thank you for reminding that I am a beginner and I am learning 🙂 Sometimes I can be really hard on myself.
 
Lucyr said:
Also if you drive, don’t forget to inform the dvla of the switch to insulin by filling in the online or paper form
Click to expand...
@Lucyr - Is that process straightforward if I do it online? This is something I do need to look into so thank you for reminding me 🙂
 
soupdragon said:
Hi and welcome @KJP1
Another Type 3c due to pancreatitis here but one severe episode of acute pancreatitis in my case.
I've recently changed from a basal bolus injection regime to my first insulin pump. I started on Lantus as the long acting (basal) insulin but then asked to move to Levemir to give more flexibility. I've only ever used Novorapid as the short acting (bolus) insulin.
Good luck with your transition to insulin and do ask us if you have any questions.
Click to expand...
@soupdragon - Another Type 3c ... Hello 🙂 I had around 14 attacks on the pancreas which meant it was chronic. I have had surgery etc so I don't have the best pancreatic functions. When you say flexibility - what do you mean? I'm still learning so just need a bit more explanation. Thank you 🙂
 
KJP1 said:
@soupdragon - Another Type 3c ... Hello 🙂 I had around 14 attacks on the pancreas which meant it was chronic. I have had surgery etc so I don't have the best pancreatic functions. When you say flexibility - what do you mean? I'm still learning so just need a bit more explanation. Thank you 🙂
Click to expand...
Generally Lantus is taken once a day. Levemir is generally taken twice a day. This is very useful if you need less insulin at certain times eg during the night. I took similar amounts in the morning and the evening but some people need very different amounts for their doses.
In theory you can also adjust your doses for exercise eg take less Levemir in the morning if you know you'll be very active during the day. I had limited success with this but it works well for some people.
For me, though, Levemir gave me better results than Lantus.
 
KJP1 said:
@eggyg - Thank you for responding to my post. That's it, over the years I have been quite disciplined with my diet so this won't be something new to learn. It's just getting used to injecting etc. With tablets you have a bit more flexibility and can be a little discreet. How do I get myself booked on a DAFNE course?
Click to expand...
You will need to be referred by your DSN. There’s usually quite a long wait unfortunately. In the meantime you could try BERTIE on line, I’m assuming it’s still a thing. When you start on insulin you’ll be more likely than not be put on a fixed amount ( usually quite small) to see how things go. Do you know if you’re still producing insulin? I was initially as I still had a third of my pancreas remaining, after a distal pancreatectomy, so it can be a bit tricky at times. The third I had left is now completely atrophied ( had an MRI to confirm that) and I’m 100% certain I don’t produce any insulin now although that’s never been proven by any tests. I was always refused them, cost reasons, but I’ve managed for a long time now.
 
KJP1 said:
How do you find the pump? Do you have a continuous glucose monitor?
Click to expand...
I like the pump because it gives me even more flexibility.
However, I am glad I learnt the ropes on insulin pens. Not only can pumps fail (and never at a convenient time) but they are also much simpler to understand.
Whilst you could get a pump set up by your DSN and leave it that way, it will not be getting the true value out of.
When I first transitioned to a pump, I felt I had to learn as much again (if not more) as I did when I was first diagnosed.

I now love the ability to dose 0.05 units, adjust my basal every 30 minutes and suspend it when I exercise.

Yes, I also have a CGM. I was using Libre for about 4 years. Before the recent upgrade, I was using an unofficial app so it was real time rather than scanning for most of that time. Last year, I changed to a different CGM that works with my pump. It is not full Closed loop but useful to suspend my basal when my levels get low.

My advice to you (and anyone starting on insulin) is to get used to injecting and, unless you have major issues, don't worry about pumps for a year or so.
 
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