Quote:
Originally Posted by BlueSky  Lizzie,
Because I have this crazy DP, and because I am not able to get a pump, I have come up with an interesting insulin coktail to keep my blood glucose on an even keel. I use a combination of Lantus, NPH, Regular and Novorapid. I will describe my insulin regimen, just so you can see how I went about customising it. Maybe you can use a similar approach.
I inject 8 units of Lantus in the morning. It gives me a flat basal action over the 24 hours (or most of it). I inject 9 units of Protophane (NPH) at night. It is getting up to speed by the time the DP kicks in at around 3am. The NPH ensures that my FBG is in the target range, but it it is not sufficient to cover basal insulin needs later in the morning. I can't increase the NPH because it would make me go hypo at night. So I cover a low-carb breakfast with 8 units Actrapid (Regular insulin), which I inject as soon as I wake up. I usually cover lunch and supper with Novorapid.
It works quite well. My last HBA1c was 6.0%. But a pump would do a much better job. It sounds like your basal profile is a bit different. But mixing and matching the insulins should enable you to achieve the result you are looking for. Good luck with it  . |
Thanks BlueSky. I just had a chat with the diabetic nurse. Im not sure what to think really so I will try to summarise (not my strongest point so bare with me!!!). ok, the past couple of months I have felt my control hasnt been very good for a number of reasons. in part because i have been building up to about 12 (216) pre exercise each day and had been doing so maybe 1.5 hours prior to exercise (i have now worked with a dietician to get a better routine going which involves going to about 8 or 9 and only about 30 minutes prior). i also had flu and a holiday in florida where my eating habits were a little on the unhealthy side. my HbA1c came out at 6.6.
So, when I spoke to the nurse I described my basal issues and said that I would like to take NPH at night to cover the period of higher insulin need. She said that I should consider taking more lantus, i said no, daytimes would be problematic and id lose my ability to know what my blood sugar is and testing would produce more surprises etc. anyhow, when i told her what my increase is over night, from 5 to 7, she said i need to give myself a break, that my HbA1c is great (i disagree) and that waking up at 7 (126) isnt terrible and I should relax. she also said she wouldnt like me to go on NPH and run the risk of nasty hypos.
anyhow, i had a think about this. and i came to the conclusion that whilst i disagree about my A1c being excellent, i realised that i do have pretty decent control (which will be improved by the little changes im making to exercise etc) and i dont live in fear of hypos. so im thinking perhaps if i continue to take care on the little things within my control maybe i dont NEED to take on the more agressive approach to managing it and messing around with different insulins, accept i wake up a bit higher than id like but not think its too much of a problem?
im not sure whether i should keep pushing on the issue of mega mixing (!) or accept what im being told that im doing well and i dont need to change. incidentally, the nurse told me that target HbA1c for diabetics at our hospital is 7.5. i thought that was rather high???? id like my personal target to be to achieve an HbA1c that is close to normal but that doesnt involve constant worry and obsessing...so i figure 6 would be a nice goal??
