Type 2 and MDI

[pippaandben]

My recent holiday and now Xmas has really made me re-think how to cope.Being on a mix I have really tried to tweek it around to cope with more carbs and different mealtimes but it is just not working in anything other than "normal" conditions. Last night was 24 before tea so did extra 3 units but 30 at bed time. Back to 8 this morning. And I had one chocolate after mid pm dinner - which is what threw everything out of kilter.
Nurse is so pleased that I have come down from 100 to 61 she doesn't want to see me now til May - but she doesn't seem to know the answers I need.. Any advise welcome - but it does seem that I would have better control by MDI and then I would not be eating just to feed the insulin - which I sometimes feel at the moment. Then if I know I am having a meal at an unusual time I can delay injecting til then and adjust the dose to the carbs in the meal. I am sure the swings I get are not doing me any good even if most of the time I am under 10.
Are MDI used for type 2 or will I have a fight? What arguments can I use apart from above? Is there any sourse to advise how to tweak mixes to suit circumstances. I know about altering them to suit ongoing normal situations
as I found a chart somewhere for that.
A bit deep for the festive season but this is my New Year resolution - to take care of ME despite drs and nurses!!

 

[trophywench]

Well those ARE the arguments, frankly. If you are entirely regular in your habits then a mix is absolutely fine as long as you stick with your habits and if you only stray once or twice a year, then it's still OK

BUT if you do have a lifestyle that calls for eating at non-fixed times - ie what is an entirely NORMAL lifestyle for anyone - then it's pants.

If nursie can't or won't help, or cannot see what you are going on about, don't waste any more time talking to her. Book in to see your GP, tell him - and if he won't help tell him straight off you want to see someone higher up the food chain cos you ain't satisfied with just being fobbed off - ask for a referral to the Diabetes Clinic at the hospital.

 

[Northerner]

I agree with TW, I think you have described exactly why you would be more suited to MDI than a mix. Many T2 members here are on MDI, so there is no reason I can see why you should not be put on it if it will improve your control and remove some of the difficulties of managing your blood sugar levels. What's more, you already have a good level of understanding of how to use MDI to best advantage. I would book an appointment with the GP, as suggested - if the GP does not have sufficient knowledge about MDI to approve it, ask to be referred to someone who does.

I often think that some nurses see T2s with reasonably good figures and think they are the best achievable because they probably see so many people with much poorer fgures, so their expectations of people generally are quite low.

Go for it, I am sure it will make a big difference for you! 🙂

 

[mcdonagh47]

My recent holiday and now Xmas has really made me re-think how to cope.Being on a mix I have really tried to tweek it around to cope with more carbs and different mealtimes but it is just not working in anything other than "normal" conditions. Last night was 24 before tea so did extra 3 units but 30 at bed time. Back to 8 this morning. And I had one chocolate after mid pm dinner - which is what threw everything out of kilter.
Nurse is so pleased that I have come down from 100 to 61 she doesn't want to see me now til May - but she doesn't seem to know the answers I need.. Any advise welcome - but it does seem that I would have better control by MDI and then I would not be eating just to feed the insulin - which I sometimes feel at the moment. Then if I know I am having a meal at an unusual time I can delay injecting til then and adjust the dose to the carbs in the meal. I am sure the swings I get are not doing me any good even if most of the time I am under 10.
Are MDI used for type 2 or will I have a fight? What arguments can I use apart from above? Is there any sourse to advise how to tweak mixes to suit circumstances. I know about altering them to suit ongoing normal situations
as I found a chart somewhere for that.
A bit deep for the festive season but this is my New Year resolution - to take care of ME despite drs and nurses!!

Mixed Insulins are only ever intended to be an introductory regime for T2s, along with most regimes ( d&e etc ) they will only effectively last for a few years. So yes, when Mixes begin to fail, T2s move onto basal bolus/MDI.

But beware. Type 2 Diabetics are currently being blamed for all the ills of the NHS and there is a concerted drive to deny them the best and most effective/expensive options available.

As far as Insulin goes they are trying to deny T2s the modern insulin analogues ( Novorapid, Levemir, Lantus, Humalog etc) and put them back on the old "Human Insulins" that are out of the Ark ( e.g. Humulin I and S) that are cheap and cheerful.

Type 2s are the main market for insulin ( T2s on insulin outnumber T1s 4 to 1) and so when the NHS wants to save money on insulin it has to try to attack and restrict the main market ( Type 2s).

So don't just ask for MDI regime - ask for the modern powerful analogues ( Humalog or Novorapid rapid acting and Lantus or Levemir long acting).

 

[MeganN]

I'm T2 and moving onto MDI in the new year.

Hopefully going onto lantus and novorapid.

Atm I'm on novomix30 and novorapid so it will just be a case if splitting the mix up.

I'm quite excited about it as nothing else has worked.

I had to go back to the hospital to get insulin as the GP surgery refused it. The hospital did not look amused that I had been left to cut out unreasonable amounts of carbs instead of being offered insulin. My GP surgery got their wrists slapped over it I think coz now I'm under the hospitals care.

Good luck. Keep on demanding xx

 

[pippaandben]

Thanks everyone - now all I have to do is try to get an appturer's web sites. Having looked at the various manufacturer's web sites is there really much difference between Novorapid and Humalog and Levemir and Lantus. I think I have seen comments about the latter two with one suiting more than the other for some people.

Also as I have been on a humalog mix would it be better to stick out for the Humalog? If I have to wait for an appt what specific readings and details should I log to try to identify my best basal dosage and unit to carb ratio. Or is this jumping the gun? I know you cannot give medical advice as such but I want to get the best regime for me - which may not be the best financial one for the PCT.

 

[mcdonagh47]

Humalog, because of its Pharmocodynamic and pharmocokinetic properties ( don't ask me 🙂 )is said to be the nearest thing we have to the body's natural insulin.
Lantus is said to be better at dealing with the Dawn Phenomenon than other long lasting insulins.
As for units to ratios etc exact Carb Counting is not possible for most t2s because your pancreas is still fitfully playing out and producing dollops of insulin at irregular times and in varying amounts.
probably best to build up a general databank of the global effects of particular meals and doses and take into consideration the starting bg.
As for T2 basals the general advice seems to suggest that half your weight in kgs should be the starting point to be adjusted up and down as appropriate. Many DSNs/Docs just say to t2s start with 30 units basal and take it from there, up or down.