Quote:
|
Question: what re you views on mixtard 30 insulin?
|
Good for the newly dxed, since it introduces them to the general idea of injecting. However, it's certainly not an insulin you'd want to stay on if you want to have any semblence of a normal life.
Quote:
|
Question: do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?
|
No, it's physically impossible. Firstly, Mixtard 30 is 30% Actrapid, 70% Insulatard. Actrapid simply doesn't work fast enough to match the rate of digestion. If you eat any food after you've injected Mixtard, your BG will rocket up to around 10-11, before coming down to around 8, and then very gradually returning to around 5ish (in an ideal world) after about 5 hours. This isn't good control. You might be returning to a safe BG level eventually but diabetes damages you whenever your BG is high.
Compare this with the MDI system. You take Humalog or Novorapid, and a basal insulin (preferably Lantus or Levemir). When you eat, you inject your bolus insulin and eat, your BG will probably go up to around 8ish, then return back to 4-5 within two hours. And then it'll stay there and won't move, ideally. This is precisely how someone without diabetes has their blood sugar work. The difference is that your periods of elevated blood sugar work out to be about 2 hours in 24, compared to probably nearer 8 or 9 hours on a two-jab system. With MDI you can get an A1C of between 5 and 6. With Mixtard you'll be lucky to get below 9. And remember, above 7 is guaranteed leg-loss and blindness territory.
In addition to this greatly improved control, you also get your life back. When you take Mixtard, you HAVE to eat at the same time each day and you HAVE to eat pretty much the same amount every day. In a lot of cases this means you'll probably put on weight since you'll be eating much more in order to prevent hypos later on. It also means that you can't do anything spontaneous or eat anything different - not unless you fancy going blind or losing a leg in 10 years time. With MDI, you can eat what you want, when you want. You also don't have to eat if you don't want to. Instead of insulin ruling you, you rule the insulin. Plus, if you make a mistake, it's much easier to correct. Running slightly high? Fine, take a couple of u's of your bolus insulin and forget about it.
With multiple jabs you'll be able to live a normal life as if you weren't diabetic and you'll get much better blood sugar control. Insulin pumps are really just an extension of the theory behind MDI. The problem with MDI is that your average rate of glucose release varies slightly throughout the day - for instance, your liver probably releases more glucose in the morning than it does in the afternoon. With MDI you have a basal amount that nearly corresponds with the level of glucose release but won't match it exactly, so your control will not be perfect. A pump lets you specify at exact times how much insulin is going into your system so that users can match their insulin requirements exactly to their glucose release.
However, with new insulins like Lantus and Levemir the difference in control between MDI and pumps is decreasing. Pumps will get you a better A1C but we're talking about getting an A1C of 5.5 instead of an A1C of 6. The real advantage of pumps now is more to do with convenience (although those with very pronounced variations in glucose release will certainly get better control).
