Changing insulin

[Tracy38]

Hi all, I'm new here. I've been using Novolin R and NPH for about the last 35 years. Just saw a new endo who suggested I change to Novolog and Lantus and use carb counting to determine how much I take. Now, I'm running high all the time. They said that Novolog is supposed to be fast acting and take it right before you eat. Well, I'm hovering in the 170 to 200 range, even an hour after I inject. Is it possible that either one of these just doesn't work for me? It's only been 2 days, do I need to wait a little longer? Anybody else have a problem with high blood sugar on Novolog?

[JediSkipdogg]

Sounds like you need to up something. What are you running before you eat? There's a HUGE difference between NPH/R and Lantus/Novolog. A few things could be happening...

1) Your Lantus dose might not be high enough. To figure this out you will need to test when you have no food in your system and see how high you are running then. The ultimate easy way would be to fast for a full day test at what would be a meal and see what is going on, but most can't do that.

2) You may need to lower your carb counting. If you give say 1 unit for 10 carbs, you might have to try 1 unit for 9 carbs. It could also be you aren't accurately carb counting yet.

3) Ultimately the insulin may not work for you. There are 3 kinds of modern fast actings out there (Humalog, Novolog, and Apidra.) I know a person that the ONLY one that worked for them was Apidra and they took 5 times less insulin by just being put on that.

And welcome to the forum.

[WhyNotSmile?]

feeling the same. Lantus for three days. It does not work..

[Subby]

Sorry this is a little off topic, or at least it's about certain insulins just not working for certain people.

Jediskipdogg.. your comment about only Apidra working for someone you know, fascinates me. I am trying to work out reasons why I have a high insulin usage/sluggish response to insulin, here sounds like another possibility to explore. I've been on novorapid for 7 years so no idea about my response to other insulins. If possible can you elaborate a little? Was the change immediate? Were there other side effects of the "non working" insulins?

[ant hill]

First of all, Welcome to DF as you will find good helpful people. :D
Hi all, I'm new here. I've been using Novolin R and NPH for about the last 35 years. Just saw a new endo who suggested I change to Novolog and Lantus and use carb counting to determine how much I take.
It's a good thing that you are using the good insulins now. Are you getting the lower doses with Lantus?
Now, I'm running high all the time.
Up your Basel or up the Lantus a unit at a time and of course test and see that you can get a test at night if you can. :)
They said that Novolog is supposed to be fast acting and take it right before you eat.
Yes, Do that Tracy and count your carbs. :D
Well, I'm hovering in the 170 to 200 range, even an hour after I inject. Is it possible that either one of these just doesn't work for me? It's only been 2 days, do I need to wait a little longer?
Yes Tracy, Give this some time as this is a little high so up the Basel.
Anybody else have a problem with high blood sugar on Novolog?
I would take a little more or get to know your Insulin to Carb ratio in witch I should know about too. :confused:

[JJM335]

Sorry this is a little off topic, or at least it's about certain insulins just not working for certain people.

Jediskipdogg.. your comment about only Apidra working for someone you know, fascinates me. I am trying to work out reasons why I have a high insulin usage/sluggish response to insulin, here sounds like another possibility to explore. ?

Subby:

Have you got a family history of T2?

With an I:C of only 1:8/9 I am also relatively insensitive to bolus insulin. My BMI is in the normal range and I am fit and exercise almost every day so I might expect a ratio closer to 1:15. My daily Lantus dose works out at about 0.27U/Kg (also not great) but unlike my Apidra, is VERY sensitive to exercise - exactly what you expect from a T2.

Although I know of no-one else in my family with T1, both my grandfathers were thin diet-controlled adult-onset T2's. I suspect that in addition to a blown pancreas, I may also be carrying some genes that result in impaired insulin signaling. Perhaps you may be the same (T1 with T2 tendencies)

Joel

[Subby]

Joel, I have been trying to get my endos to take my insulin resistance seriously for years, with little success. I have been blocked countless times and told to just lift my game. Bollocks to that attitude.

Finally, I actually have blood tests to take tomorrow that hopefully may help indicate insulin resistant properties as may be seen in an insulin resistant person - if indeed these are a factor. I haven't specifically thought of it in the context of type 2: I will follow that up with my endo at the next step.

I have an I:C of 1:4 and yet I am only slightly over normal BMI, (I:C was very similar on normal BMI, a year ago) I have an active enough life and active enough job (light regular activity, not much sitting around). My I:C improves slightly if I do daily exercise... but not a great deal. Maybe to 1:8 after a few months of daily 2 hour walk, last time I tried. (That was a while ago, the daily exercise. Now it's a few times a week)

I'm pumping now, but when on Lantus I think I did find it very sensitive to exercise. Now that I am on Novorapid alone, I am far less prone to hypos during exercise. Can you explain to me how this suggests a type 2 link? Incidentally, not much type 2, maybe a great-aunt or something. But this may mean little, really.

Thanks so much for your ideas with this, I have had such difficulty getting people to look beyond the type 1 parameters - to just consider possibilities.

[JJM335]

I have an I:C of 1:4 and yet I am only slightly over normal BMI, (I:C was very similar on normal BMI, a year ago) I have an active enough life and active enough job (light regular activity, not much sitting around). My I:C improves slightly if I do daily exercise... but not a great deal. Maybe to 1:8 after a few months of daily 2 hour walk, last time I tried. (That was a while ago, the daily exercise. Now it's a few times a week)

I'm pumping now, but when on Lantus I think I did find it very sensitive to exercise. Now that I am on Novorapid alone, I am far less prone to hypos during exercise. Can you explain to me how this suggests a type 2 link? Incidentally, not much type 2, maybe a great-aunt or something. But this may mean little, really.

.

Subby:

The T1/T2 exercise effect? If you train/exercise on a regular basis this stimulates production of GLUT1 glucose transporters. These are capable of transporting glucose from the bloodstream into the muscles without requiring insulin. Also, in the trained individual, compared to the untrained, the muscles are more efficient at using fat for energy whilst at rest, and can switch more efficiently to using glucose during periods of high work-load.

If you are fit, you need less basal glucose to keep your muscles running, and thanks to the contribution of the extra GLUT1 transporters, you don't need to rely as much on insulin to move that glucose into your muscles. My guess is that if you are insulin-insensitive, this effect becomes even more important. I would have thought that an increase from 1:4 to 1:8 was massively significant. That should drop your insulin requirements by half!

Personally, I find that it's the frequency (regularity) of the exercise that's most important. A 25 minute swim will have nearly as much effect as a 2 h walk. Perhaps this is because the enhanced levels of GLUT1 start to drop off within a day or 2.

Good luck with the blood tests! For years it was thought that T1 and T2 were related. Now they are known to be entirely independent, but then it should be possible to be unlucky enough to have both!

Having fewer hypos during exercise should be one of the advantages of pumping. My big problems are not during exercise, but in the following few hours, when my basal requirement tends to drop like a stone (and so does my BG). It's almost impossible to get a pump in the UK if you have a decent A1c, otherwise I would go for one.

Joel

[Subby]

Thanks for that concise explanation. Hmm, my I:C must have been less of a change (wasn't thinking in those terms then), my total insulin dropped roughly one quarter over that time. Which is still significant, absolutely.

I oscillate between periods of extreme resistance/absorption probs for a few hours, then a period of it all sucking in at once. (I should work out different I:C ratios through the day but am concentrating on my pump variable basals first). The pump has allowed me to rule out all the old blamed factors - I can prove it is independent of all the usual suspects. I am also wondering if this phenomenon in me is somehow an impaired adrenal / hormonal issue. Hoping to get some kind of answer though, even if it's something I can't do anything about.

I commiserate about that A1c restriction, it is absolutely wrong. Hope it changes soon! Did you read this thread here? http://www.diabetesforums.com/forum/pumping-insulin/26304-i-did-pump-session.html Perhaps it suggests there may possibly be other ways... I'm not sure.



This used to be

[Stuboy]

maybe you jsut dont have your carb:insulin ratio right yet. keep working at it. Novorapid is good stuff (i think). Didn't like Lantus much personally, Now that i've changed to levemir im starting to feel better as well (must update my thread).

Give it time and adjust your ratio's if you need to. Use the rule of 500 as a starting point and work from there... dont forget to include your corrections for your high's in the calculation!