Calling any diabetologists?

[bonnie690]

Are they any diabetologists registered in this forum, preferably from the UK! :nurse:

[JediSkipdogg]

Just a question? Do you mean Endocrinologist? And Endo is one that specializes in diabetes.

[bonnie690]

Basically in a nut shell, someone who is qaulified to talk about diabetes and knows the ins and outs of insulins, i know this forum is for people who suffer with diabetes to get together and discuss it, i was just wondering if there was an professionals on here.

[JasonSmithMT]

Just a question? Do you mean Endocrinologist? And Endo is one that specializes in diabetes.

There is such a sub specialization of endocrinology called diabetology. A diabetologist is a endocrinologist who specialized in diabetes. The hierarchy goes like this: Diabetology is a subset of Endocrinology which is a subset of Internal Medicine.

Bonnie - I don't believe we have any physicians who contribute on this forum but there is a fair amount of people on this forum who know the "ins and outs" of diabetes and who more than deserve honorary diabetologist classification in my opinion. Feel free to ask your questions.

Jason

[duck]

There is such a sub specialization of endocrinology called diabetology. A diabetologist is a endocrinologist who specialized in diabetes. The hierarchy goes like this: Diabetology is a subset of Endocrinology which is a subset of Internal Medicine.

Bonnie - I don't believe we have any physicians who contribute on this forum but there is a fair amount of people on this forum who know the "ins and outs" of diabetes and who more than deserve honorary diabetologist classification in my opinion. Feel free to ask your questions.

Jason

...and I would qualify JasonSmithMT as one of the members here who deserve "honorary diabetologist" status...so yes, please ask away!

[bonnie690]

Dear Duck,

Question: what re you views on mixtard 30 insulin?

Question: do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?

Question: when using the pump, do you at anytime take it off (like when you shower or sleep) or is it worn at all times?

Thanks! :dancing2: :dancing: :ridinghor :thumbsup:

[JediSkipdogg]

I know you asked for Duck but I'll give you my opinion on them.

Question: what re you views on mixtard 30 insulin?

It's stupid, because you have to give a set amount based on the long acting part. Therefore you can't change the fast acting part and that means you must eat enough carbs to cover and no more, no less.

Question: do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?

Your control will greatly improve on 2+ a day shots instead of a mixed insulin.

Question: when using the pump, do you at anytime take it off (like when you shower or sleep) or is it worn at all times?

I take mine off for showers only. You cannot take it off while sleeping as the max recommended time off is 1 hour.

[seacomp]

Bonnie - I don't believe we have any physicians who contribute on this forum
Certainly not openly. It would be a shame if there were not a few doctors who lurked here. They could learn alot.

[jeggeman31]

Dear Duck,
Well I am not the Duck, nor do I play a duck on T.V.

what re you views on mixtard 30 insulin?
Myself I feel that mix Insulin is ****. I was on it at one time and had very poor control over my diabetes. I wish they would stop making that stuff as I don't think it works. Mixing Long and Fast acting insulin in the same shot just does not work anymore.

do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?
Your control does improve on 2 plus shots a day. Getting rid of that mix insulin was the best thing (pre pump) that I ever did.
when using the pump, do you at anytime take it off (like when you shower or sleep) or is it worn at all times?
I take mine off when I shower and get lucky with the wife. Those are the only 2 times my pump is off. My control has in-proved 110% over the last 7 1/2 months being on the pump. The pump has let me take back my diabetes and it no longer controls me, I control It.

[jeggeman31]

Certainly not openly. It would be a shame if there were not a few doctors who lurked here. They could learn alot.


:dito: Amen to that :congrats:

[duck]

Dear Duck,


That's me! As you can see, we have a lively crowd here. :king:


Question: what re you views on mixtard 30 insulin?


In theory, it may work for some. In reality, I cannot think of a single person I know in person or on the WWW who seems to even have a little bit of success with the "mix" insulins. At best, they lock you into a pattern of "feeding your insulin". At worst, they leave you without control. Going on Multiple Daily Injections (MDI) of lantus or levemir for basal (long-lasting) insulin along with Novolog/Humalog for meals will yield more flexibility for your lifestyle and more flexibility on when and how much you can eat.


Question: do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?

As stated, in theory it is possible. In real life, I have yet to read about anyone who does have good control.


Question: when using the pump, do you at anytime take it off (like when you shower or sleep) or is it worn at all times?

Thanks! :dancing2: :dancing: :ridinghor :thumbsup:

I disconnect as needed (showering, sometimes when I participate in sports, and um *intimate* activities). I sleep with it attached, the nice thing about a pump is that once you get the "basal rate" dialed-in, you can sleep in without hypos, etc. We are a very pro-pump crowd here, most of the pumpers here are in love with their pump.

BTW, with the water-proof pumps nowadays, you can shower with the pump attached, you can go swimming, etc. I am more concerned about the heat of a shower ruining insulin than I am about the water ruining my pump, so I disconnect.

[bonnie690]

whats the difference between a type 1 and a type 1.5? as far as i know there is only type 1 and 2 in England :confused:

[DeusXM]

Question: what re you views on mixtard 30 insulin?

Good for the newly dxed, since it introduces them to the general idea of injecting. However, it's certainly not an insulin you'd want to stay on if you want to have any semblence of a normal life.

Question: do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?

No, it's physically impossible. Firstly, Mixtard 30 is 30% Actrapid, 70% Insulatard. Actrapid simply doesn't work fast enough to match the rate of digestion. If you eat any food after you've injected Mixtard, your BG will rocket up to around 10-11, before coming down to around 8, and then very gradually returning to around 5ish (in an ideal world) after about 5 hours. This isn't good control. You might be returning to a safe BG level eventually but diabetes damages you whenever your BG is high.

Compare this with the MDI system. You take Humalog or Novorapid, and a basal insulin (preferably Lantus or Levemir). When you eat, you inject your bolus insulin and eat, your BG will probably go up to around 8ish, then return back to 4-5 within two hours. And then it'll stay there and won't move, ideally. This is precisely how someone without diabetes has their blood sugar work. The difference is that your periods of elevated blood sugar work out to be about 2 hours in 24, compared to probably nearer 8 or 9 hours on a two-jab system. With MDI you can get an A1C of between 5 and 6. With Mixtard you'll be lucky to get below 9. And remember, above 7 is guaranteed leg-loss and blindness territory.

In addition to this greatly improved control, you also get your life back. When you take Mixtard, you HAVE to eat at the same time each day and you HAVE to eat pretty much the same amount every day. In a lot of cases this means you'll probably put on weight since you'll be eating much more in order to prevent hypos later on. It also means that you can't do anything spontaneous or eat anything different - not unless you fancy going blind or losing a leg in 10 years time. With MDI, you can eat what you want, when you want. You also don't have to eat if you don't want to. Instead of insulin ruling you, you rule the insulin. Plus, if you make a mistake, it's much easier to correct. Running slightly high? Fine, take a couple of u's of your bolus insulin and forget about it.

With multiple jabs you'll be able to live a normal life as if you weren't diabetic and you'll get much better blood sugar control. Insulin pumps are really just an extension of the theory behind MDI. The problem with MDI is that your average rate of glucose release varies slightly throughout the day - for instance, your liver probably releases more glucose in the morning than it does in the afternoon. With MDI you have a basal amount that nearly corresponds with the level of glucose release but won't match it exactly, so your control will not be perfect. A pump lets you specify at exact times how much insulin is going into your system so that users can match their insulin requirements exactly to their glucose release.

However, with new insulins like Lantus and Levemir the difference in control between MDI and pumps is decreasing. Pumps will get you a better A1C but we're talking about getting an A1C of 5.5 instead of an A1C of 6. The real advantage of pumps now is more to do with convenience (although those with very pronounced variations in glucose release will certainly get better control).

[jeggeman31]

whats the difference between a type 1 and a type 1.5? as far as i know there is only type 1 and 2 in England :confused:


We have a 1.5 sub forum that has some good threads. You can find the threads at this link http://www.diabetesforums.com/type-1-5/


However to respond to the above, below is a quote from one of the threads from the above forum.


Latent Autoimmune Diabetes in Adults (LADA)
Autoimmune diabetes (Type 1A diabetes) occurring in individuals who are older than the usual age of onset of type 1 diabetes (that is, over 30 years of age at diagnosis). Sometimes, patients with LADA are mistakenly thought to have Type 2 diabetes, based on their age at the time of diagnosis. However, positive antibody tests would help make the diagnosis of LADA.

[bonnie690]

I can see your all pro pump and pro MDI insulin on here. I have just spent the last year on MDI and could not for love or money get use to it, you say lyou can eat what you want when you want, but for me personally, that didn't work. if you live out of packet food which tells you the exact carbs your about to eat thats fine but if like me you like on freshly prepared food its hard, and i found it hard to look at my plate and work it all out, you say your damaging yourself when your blood level goes up. when i sometimes would get it wrong my sugar would go up to 20! or the other end of that scale it would go down to 2! and i found that the sugar wouldn't maintain itself it would always slowly drop. it just goes to show that all diabetics are different, different strokes for different folks as the old saying goes!! i've just been put back on mixtard30, so i'm gonna see how it goes its nice that you all have your opinions but i'm sticking by my guns for now!

[DeusXM]

if you live out of packet food which tells you the exact carbs your about to eat thats fine but if like me you like on freshly prepared food its hard, and i found it hard to look at my plate and work it all out

Go on a DAFNE (Dose Adjustment For Normal Eating) Course. They're free and teach you how to estimate the amount of carbs on your plate and how much insulin you need. I've yet to meet a single person who hasn't found it's totally revolutionised their control and given them more freedom than they ever thought possible.

i found that the sugar wouldn't maintain itself it would always slowly drop.

Then your basal dose was too high.

i've just been put back on mixtard30, so i'm gonna see how it goes its nice that you all have your opinions but i'm sticking by my guns for now!

Let us know what your next A1C is. If it's over 7 then you'll definitely need to change your regime.

[corwin]

Great advice so far.
I want to add that as part of my job I have buisness lunches out very often and I also like to eat out at least 3-4 times a week. Obviously I don't have the exact carb count of what I'm eating. There is a lot of trial and error but soon enough you figure out specific dose for specific food, like a medium size potato needs x units of insulin etc. Many times I'm looking at a meal and I know that it's not something I ate before and I'm really not sure how much insulin I need. What I do is make an educated guess and make sure I test a lot and correct. The next time with similar food I have a better idea how to handle it.

[Ailsa]

I have a slightly different take on this to some of the others Bonnie.
I actually do think it is possible to get reasonable results on the actrapid/protophane mix. Just that, like the others, I don't think premixed insulin is the way to do it.
I used actrapid/protophane for MANY years. But always mixed it myself in the syringe. That meant I could alter the amount of actrapid if I was exercising or sitting around & also have a different ratio of the two night & morning. I don't agree with the person who said you always go up to 10 after meals. The way the peaks of the 2 insulins overlap are designed to help prevent this. I managed to achieve near normal A!cs when I was pregnant using that system.
I do have strong anti feelings about premix though. It doesn't give the flexibility required. I believe it was invented as a marketing exercise for the sellers of the stuff, & also for people (mainly T2s) who didn't like the idea of a syringe. Maybe that's an issue for you? but in the end a syringe & a pen both have a needle on the end. It's exactly the same thing.

Obviously there is a reason I am not using actrapid/protophane any more.
When I was using that I was generally getting A!cs 7.2 - 7.8. I actually don't think that is too bad but believe it is near impossible to get under 7.0 long term.
However the dissapointment for me when I switched to Lantus, was that there was no improvement. Also I was always high or hypo with the the Novorapid. In fact it was more frustrating than its predecesor.
I now realise the reason for this was that I was not told about carb ratios at the time & was still trying to work pretty much on the set carbs per meal I had been taught at an earlier era. There are some goods books on this like "Using Insulin" by John Walsh. I am now hoping to get in the 6's for my next A1c. It could be that like me, you're not getting the best help.
Have to also say, that my change of approach has made a huge difference to how I feel about my new insulin as there is now no doubt that it's all a lot easier day to day. After all A1cs are not the only thing to consider.
Hope this is constructive.

[Ailsa]

if you live out of packet food which tells you the exact carbs your about to eat thats fine but if like me you like on freshly prepared food its hard,
Forgot to mention in the previous post, the main reason I bought the "Using Insulin" book, is that it has a list of carbs as percentages. ie: bread is 50% carb, so you just weight the bread & mulitply the weight by 50% to get the carb content.
Its much better for me, as like you I'm not into packet food.

[duck]

Hi Alisa, I think the "anti-mix" people actually agree with you: We don't like the pre-mixed 70/30 blends (or is it 30/70?)--They lock you into a combination that allows zero flexibility. I personally have no issue with "mixing" fast-acting insulins with basal insulins, otherwise. As a matter of fact, short of being on a pump, that's just about the only way a Type 1 and some Type 2's can gain good control.

[Funnygrl]

Dear Duck,

Question: what re you views on mixtard 30 insulin?

Question: do you think someone can have good control by being on a 2 a day insulin such as mixtard 30?

Question: when using the pump, do you at anytime take it off (like when you shower or sleep) or is it worn at all times?

Thanks! :dancing2: :dancing: :ridinghor :thumbsup:
1. Mixtard 30 is awful, and doesn't mimic the way the pancreas naturally produces insulin at all.

2. No, generally people can't have good control on 2 shots a day.

3. Pumps are usually taken off from showers, but need to be left on when sleeping.

[Erin]

My take on the whole thing:

The mixed insulins (whether you mix 'em yourself or get the pre-mixed stuff) are good if you want your food / exercise to be the primary variable you use to achieve good control. You take X units, and then you know what you can eat, and how active you have to be to keep your bg good. It is a good regime for people with very routine lives, who do and eat basically the same stuff all the time.

The MDI or pump route allows people to live the way they want to live and eat the way they want to eat, and adjust the insulin to keep the blood sugar in control. This is the way most of us lean. And it also allows really precise corrections for the perfectionists among us. On a mixed insulin there really isn't too much you can do to fix a mildly high number, other than wait it out. With a pump or MDI, you can make very minuscule corrections. It takes a bit longer to get a handle on, but once you figure out your basel rates and correction / food ratios, you are afforded a level of precision and flexibility that a 2 shot a day regime simply doesn't offer.

[Cyborg]

IMHO, the pump is a major step up from MDI. For me, I learned so much more about my insulin needs, my metabolism, carb ratios (how they change throughout the day), etc. after I made the move to the pump. The improvement in bg control has been incredible and the amount of insulin I'm taking now is less than half of that while on MDI.

[Tim_Roy]

I take mine off when I shower and get lucky with the wife.

I leave mine on for that. Since I stopped using NEEDLES, anyways. So long as we're not doing gymnastics or something, it's simply a matter of setting the pump somewhere and both parties knowing where it's at.

Anyone who has a problem with my being on the pump I tend to take as someone having a problem with me. I don't tend to keep those kinds of people around for long. Not saying anything about you and your wife, mind you.

[TAutry]

If there is a 'marvelous' part to diabetes, it is that we are all different and different management or treatment routines work for us.

I have been using Novolin 70/30 since my diagnosis in 1990. I have very good numbers. I don't starve myself, feed my insulin or exercise myself crazy. Other than my own personal peculiarities, I lead a normal life.

Many opine that the pump is the greatest device ever invented. For them, it may be. My experience has not lead me to desire a pump at this time. In the future I may consider it an option.

[Goldrun]

Once I was diagnosed I started on the 70/30 Novolog...which helped me to lower my bg levels back into the normal range...but I found I experienced lows during exercise and oftentimes at night, if I didn't compensate with enough carbs at dinner. This was frustrating, as I don't like eating right at bedtime.....or feeling like I HAVE to eat when I'm not hungry. I also travel for work and sometimes cross multiple time zones...which is NOT good when you take the pre-mixed meds...as others have said, it's not the most flexible regimen!

Since January I've been on Lantus with Novolog bolus at meals, and my only problem is underestimating my carb content at times....I'm much happier than with the pre-mixed, as I feel I have much more control rather than my meds.

good luck!