[CarrieB]

I've been a diabetic for over 10 years, until last year well controlled on metformin.

Control started to slip last summer, and various medication changes didn't help.

DNS has just (7 days ago) started me on twice daily insulin, but its very slow progress and I'm getting fed up with it. I guess I want fast results, every day with BS too high really worries me, and I feel totally out of control.

I decided to have a look at the forum to see what views were on insulin with meals rather than twice daily.

Cheers folks

[poodlebone]

You'll probably find that most people here are all for a basal/bolus routine. That means taking long acting insulin (like Levemir, Lantus, NPH) once or twice a day and short acting (Novolog/Novorapid, Humalog, Apidra) with each meal based on the amount of carbs in your food.

What insulin are you on now? Long acting insulins won't help with meal spikes, won't help in bringing down a high BG quickly. It just gives you some background coverage throughout the day/night.

[CarrieB]

DNS has put me on novomix 30/70.

Having found out how easy insulin injections are I'm wondering if I'm on the best regime.

DNS is nice (as in pleasant and cheerful!) , but tends to think she knows what's best, I'm just not sure what to think at the moment.

[xMenace]

Originally Posted by CarrieB

DNS has put me on novomix 30/70.

Having found out how easy insulin injections are I'm wondering if I'm on the best regime.

No, not at all. I don't know why they start you type 2's on mixes. It's a brutal regimen: you can't correct, you have to eat the same every day, and you can't get sick. Push to get yourself on MDI (multiple daily injections), a combination of a basal insulin and a rapid acting for each meal.

edit: and welcome to DF!

[RobiJo]

Welcome.

I agree with xMenace those mixes (whether 75/25 or 70/30) can be brutal and certainly don't lend themselves easy to figure out.

[Eddy]

Mixes certainly can have their place. As others have said, though, this probably isn't it.

It's best to know how you react to individual components before you go mixing cocktails. Blindly deciding "R is too fast, yet N is too slow" is a bit of a stretch. Yes, one must begin somewhere...

...but I think that "somewhere" should be:

• See how much rapid is required to correct hyperglycmia;
• Start taking glargine or detemir at night, gradually increasing the dosage until your overnight numbers hold constant;
• Note what happens during daytime fasting, and do what's needed to hold constant then, too;
• Now that you have a happy basal, determine what boluses work;
• Consider mixes for fine-tuning.

Note that your daytime and nighttime basals might be different. I require more basal by night than by day. Some people have basal requirements that drop to near-zero during the middle of the night. Others have a pronounced need for extra insulin in the morning.

[Phonelady61]

Originally Posted by xMenace

No, not at all. I don't know why they start you type 2's on mixes. It's a brutal regimen: you can't correct, you have to eat the same every day, and you can't get sick. Push to get yourself on MDI (multiple daily injections), a combination of a basal insulin and a rapid acting for each meal.

edit: and welcome to DF!

being a diabetic type1 on insulin I happen to agree with this poster and not sure why they start folks on mixes , yeah too hard to keep up and you have to keep too strict of a schedule . I dont like that and could never live like that . good luck .

[xMenace]

Originally Posted by Eddy

[*] Start taking glargine or detemir at night, gradually increasing the dosage until your overnight numbers hold constant;

For type 2's, the common starting method is to get your fasting numbers on target in the morning. For someone more dependant on insulin, Eddy's objective is correct. The most common pattern is to drop in the night. You can't safely dosage beyond that level. Trust me on that!

[*] Note what happens during daytime fasting, and do what's needed to hold constant then, too;

The best you can hope for is a baseline coverage which leaves gaps throughout the day. For me it means times I need to suppliment with other insulins. If you need most of your basal at night, it means you have too much insulin at other times of the day, and these need to be accounted for. In such cases a slower acting NPH might be best for nighttime basals.
[*] Now that you have a happy basal, determine what boluses work;[*] Consider mixes for fine-tuning.

In reality, and I've been through this, you will probably attack everything at once. Your anxious and gung-ho. You can't wait days or weeks to settle your night basals when the rest of your day is all ****ed up!

I have no issues doing all at once. Keep good records. Use something like Excel and make some graphs. I'm a visual person. They work for me.

Note that your daytime and nighttime basals might be different. I require more basal by night than by day. Some people have basal requirements that drop to near-zero during the middle of the night. Others have a pronounced need for extra insulin in the morning.

I
drop low at night
skyrocket starting at 5am
bottom out from 11am to 4pm
then take a nice high ride in the evening

Basal patterns do have similarities. We can probably come up with 6-12 standard patterns. But to me and in practice they should be treated like fingerprints. They are all unique. You have to work to find yours, but once you do, it's pretty much clear sailing to low and sub 6's.

[xMenace]

Originally Posted by Eddy

DXed 2007/04 : presented with advanced-stage DKA, A1c of 12.9%, and BMI of 21.3 kg/m^2
Post-DX A1c : 5.2% @ 2008/04; 5.3% @ 2007/12; 5.3% @ 2007/08
current BMI : 26.0 (85kg on 182cm); want to get back to 23-24
basal : 13U detemir @ 0630, 3U human N @ 1530, 18U detemir @ 2030
bolus : 1:15 I:C ratio; varying mix of aspart, human R, human N
not a low-CHO eater... not even close!
last updated 2008/06/15

Eddy,

I haven't read through all your posts, but are the R & N part of your boluses more accurately described as basal, to address gaps? Or are they intricately designed to cover complex meals? It's an intriguing way to dual wave.

[xMenace]

Getting Down to Basals :: Diabetes Self-Management

A helpful learning workbook pdf

Basal Testing Guide

[Eddy]

xMenace:

my insane bolus cocktails

[CarrieB]

Many thanks for the comments and links.

Wish my DNS read the site.

[sharon333]

Welcome to the forum. Hope to chat with you soon.