Insulin basics for new injector

[greendavid]

Seeking expert advice on general functioning of insulin for type 2, 'cause I'm about to start injecting (after meeting with my educator next week).

I'm type 2, now taking metformin and glyburide. My A1c is 6.4%, but I experience high BG (>200) 2 hrs. after eating 15g carbohydrate in the morning, and I go low in the afternoon unless I eat like crazy. I want more flexibility and better control.

If I understand correctly, one possible insulin regime is to inject Lantus (which has no peak) once or twice per day to provide a basal level, and inject Novolog (rapid-acting) 5-10 minutes before a meal based on the carb count. Right?

Here's one question: Assuming my pancreas is still producing some insulin, does the Lantus replace that insulin or add to it? That is, if I add Lantus can I expect a constant basal level through the day? Do I need a c-peptide test to determine how many beta cells I have left and if they are still working?

Here's another question: My HMO covers NPH insulin but not Lantus, so if I want no-peak I have to pay out-of-pocket (which I think I can afford if necessary). How much of an advantage is the peakless action of Lantus compared to the peak of NPH 8-10 hours after injection?

Thanks for any information you can provide!

[duck]

First off, NPH sucks. If I wanted to be really rude, I would use four letter words to truly express my opinions on NPH. There are some who say Lantus can cause depression, if that is a concern, get on Levemir. If you have to pay for Lantus or Levemir, it's worth it to avoid NPH.

If you can get a C-Peptide test done, do it, it can only help plan your future course. We probably can get to the same conclucions if you do not get the C-Peptide done, but it would be helpful.

Yes, Lantus/basal insulin will add to the effect of any insulin you may still be making.

I'm torn on which, if a choice had to be made, is more important for a Type 2, basal or fast-acting insulin. I suppose it always depends on the circumstance, but I would think by default fast-acting is the better choice, taken only at meals and in conjunction with carb-counting. But there are Type 2's here who do well on only basal insulin and oral meds, and others who do well on MDI. In the end, working with your docs, we can probably figure out a good regimen for you too, LOL.

[rzrbks]

On the one hand, if your normal A1c is 6.4, then the Novolog regimen might be the correct one for now.

On the other hand, if your pancreas is still "Putting out" then maybe you only need a fast acting Bolus insulin.

On the the third hand, by going to Lantus and Novolog, you might lessen the strain on your pancreas and therefore make it last longer or it could even coume back for a while since you're putting it on vacation.


All these are things you and your Dr. must discuss and decide which is the best route for you.

[liz32]

I do lantus which in the begining all by itself was great. It allowed me to acheive almost overnight control. The oral meds weren't doing much. I'm about to start on novorapid as well. I have found that lantus doesn't allow for much flexability. My routines have to be flexable so I'm heading back for a more indepth carb class and then going on the rapid. I'm hoping it will allow for a lower A1C (my last was 6.0, the one before 5.8, so it's coming up a bit). Also I have notice that for me, my body gets used to the lantus strength and then I have to up the dose: another reason for the start of rapid insulin. Anyways, this is just my experience...take from it what you can.
Everyone is different.
Liz