Help me understand

[peej07]

I'd like to tap into the vast knowledge of our members with this one. I know a 20yr type 1 vet that is having a nasty time with things as of late. Years ago they had great control, they were into body building, exercise, and general good health habits. A few years ago they were put on a new humalog regiment and thrown into a bad insulin shock. Since that time they have been put on a 70/30 nova regiment. Now for the screwy part and I would have never believed this unless I had seen it. This person is on 2 injections per day and can cruise around 200 - 500bs and function fine and with in 15 min with no rhyme or reason crash down to a 48, eat 100g of fast acting carbs and barely budge. I guess being a pumper and former MDI I can't grasp how this can be. I want to help this person get thier life back, because living in constant fear of falling out is no way to live. Plus not being able to leave the house without a 2liter of coke is inconvienent. Thanks guys I really need you on this one.

[BlueSky]

... A few years ago they were put on a new humalog regiment and thrown into a bad insulin shock. Since that time they have been put on a 70/30 nova regiment. ....
That seems like a step backwards to me. It certainly wouldn't improve control. Surely going on a proper basal/bolus regimen would have made more sense. I find accounts of mysterious swings in blood glucose hard to believe. There must surely be a cause for them. Has a pump been considered? Maybe he/she has whacky basal rate requirements.

[TenderVittleS]

If they still exercise frequently and really into the body building then that right there messes with your insulin sensitivity. I'm assuming they probably were on a Humalog and NPH setup and most diabetics here have found that regiment terrible with lows coming out of nowhere.
If they are still exercising frequently than I would decrease the long acting insulin. I don't know much about the regimen they are on now, but from my experiences with Humalog and NPH a few years back (I was body building as well) it really is a bad combination and very unpredictable.

[peej07]

Unfortunately due to the incredible unpredictability of the BS swings they have stopped almost all activity.

[TenderVittleS]

Sounds like he should be on MDI and test more, see what kind of foods affect him the most. In order to find the best way they need to test, test, test, test, all the time to find out exactly what's going on. Once they figure out most of the stuff its pretty easy to manage. 2 injections seems kinda light.

[NoraWI]

Mixed insulins (70/30) do NOT work. If the basal part is adjusted correctly, then the bolus is not. Eating to the insulin is one of the problems of such a regimen. This person needs to go on MDI with either Lantus or Levemir (NPH is an extremely peaky insulin that is hard to control) and bolus with Humalog, NovoLog or Apidra according to the number of carbs he consumes. Matching insulin to carbohydrates is the only way to go whether it's MDI or a pump. And testing frequently is paramount! After he has achieved good control, then he should add exercise back into his life. Fear of bottoming out is no excuse for giving up on life.

[xMenace]

Mixed insulins (70/30) do NOT work. If the basal part is adjusted correctly, then the bolus is not. Eating to the insulin is one of the problems of such a regimen. This person needs to go on MDI with either Lantus or Levemir (NPH is an extremely peaky insulin that is hard to control) and bolus with Humalog, NovoLog or Apidra according to the number of carbs he consumes. Matching insulin to carbohydrates is the only way to go whether it's MDI or a pump. And testing frequently is paramount! After he has achieved good control, then he should add exercise back into his life. Fear of bottoming out is no excuse for giving up on life.

Ditto .

[lilituc]

I just don't understand putting a Type 1 on a mix. Even R and NPH separately is better than that - at least you could adjust it.

[LancetChick]

Also consider this: there is a whole range of rebound responses to low blood sugar, with people like me at one end of the spectrum (no response whatsoever), all the way to people who rebound from a 70 (and maybe even higher).

What happens to "easy rebounders" when too much basal insulin is given is that they hit a low (which may not be all that low), rebound to extraordinary heights (BG 300+ for example), eventually crashing again in a hypoglycemic episode which looks as if it came out of the blue, with no rhyme nor reason.

This guy needs to get off of the mixed insulin and do some serious basal testing, if only to rule out insulin overdose.

[-sammy-]

im a type 1 and have been on novomix 30, humalog mix25, and humalog mix50. it makes my sugars go way out all ove trhe place.
i say try the lantus or something like that. ive not long been on it and i have better readings allready.

[peej07]

I appreciate the responses and please keep them coming. :) I'm really hoping I can use this info to help this person get their life back.