[Eddy]

Originally Posted by Funnygrl

You can't dilute NPH because of the protamine suspension. Diluting it would dilute the suspension too, and cause it not to have the same action profile.

A quick search for "NPH diluent" leads me to believe otherwise.

Originally Posted by Funnygrl

You can dilute Lantus either, because of the acidity of it.

I'm aware that Lantus can't be diluted with a neutral solution. Insulin glargine works by precipitating upon injection, due to insolubility at the body's slightly-basic pH, then gradually releasing. However, my basal shots are large enough that I'd not want to dilute them.

Originally Posted by Funnygrl

Humalog is the only insulin that can officially be diluted, with a special dilutent.

Normal saline plus phenol/metacresol, zinc, et cetera...

FWIW, I already mix rapid, R, and N... so I tend to think that "unofficially" might work well enough.

Originally Posted by Funnygrl

But why you would bother is beyond me. You're not especially insulin sensitive. You don't need lower doses than typical MDI can provide.

Need? Perhaps not. However, I'd like the finer-grained control. Would I stick with it? Who knows.

If it helps profile me, I still use assembly language now and then for speed-critical subroutines. (If this paragraph makes no sense... just ignore it.)

Originally Posted by Funnygrl

I'll admit, your insulin plan makes no sense to me.

If you really want the level of micromanagement you're going for, a pump is your only option. But there's no evidence that this level of micromanagement is helpful.

Maybe. But I can tell a difference in how I feel, think, and operate, when I get out of range. Is there any harm in reducing the error of a dose?

Originally Posted by Funnygrl

Further, there's really no reason to shoot glucagon just because you're a certain level if you can eat.

If I'm at a level where I'm concerned about passing out, I'd much rather be proactive than to lay waiting for my liver. Luckily, I've had people (janitor, friend, family) around for my three worst (sub-30) drops where I was worried. Were I to go hypo while alone, I'd probably go for the glucagon.

Originally Posted by Funnygrl

Also, why does your Lantus dose vary (sig)?

Dunno. I needed a couple units less during the winter. Once I complete the Levemir transition, I'll update my sig again.

[Eddy]

Originally Posted by RobiJo

As much as you are micromanaging you would be a prime candidate for a pump. If your insurance situation changes---get one. You are taking sooo many shots a day, mixing insulins, adjusting doses etc. A pump could take care of all of that and more.

A couple basals, [usually] one bolus per time eating, and correctional boluses... that's an average of about six per day. I'll gladly take that over a canula, tube sticking out, and depending on a mechanical device.

I appreciate everyone's advice. However, as I've stated, I'm [presently] not interested in pumping -- even if a pump were free. Yes, I'm aware of the data logging, bolus shaping, reminders, and other functions pumps offer. Maybe I'll change my mind one day. For now, though, I'm interested in exploring what I can do with MDI.

Put differently: If I could obtain my choice of U-40, U-100, or U-500, what would people recommend, and why? What is the "ideal" insulin concentration, anyhow? There's nothing magical about U-100... except that the number looks prettier to decimal-using beings.

A gasoline engine will run with 13.0:1 air:fuel, but that doesn't mean said mixture is ideal.

[shiftzor]

I think the problem is that unlike writing assembler code you can't attach a debugger to your body with a few breakpoints (to find out what’s going on). It sounds like you want pumping without the pump; you will never be able to beat the inaccuracy of the tools you use without finding a better tool to do the job i.e a pump.

[Eddy]

Originally Posted by shiftzor

I think the problem is that unlike writing assembler code you can't attach a debugger to your body with a few breakpoints (to find out what’s going on).

When writing parsers, I usually fight the temptation to drop into assembler... it's time-consuming and non-portable, so I typically stick with C, C++, or Lex/Yacc. However, it's easier to debug self-rolled assembler code than it is to look at often-messy compiled output.

Originally Posted by shiftzor

It sounds like you want pumping without the pump;

Basically.

Originally Posted by shiftzor

you will never be able to beat the inaccuracy of the tools you use without finding a better tool to do the job i.e a pump.

I'm aware that a pump provides more tools, and can deliver basal patterns that even a couple of well-crafted mixed shots cannot. And, one day, I may decide that route makes more sense.

For now, though, I wish to explore all MDI options. At DX, I knew nothing about diabetes. I've managed to drop my A1c without ever having seen a specialist or endo, or having to resort to low-CHO diets. The numbers are encouraging, but I definitely have room for improvement...

My current goals are to exercise more (which necessitates short-term basal reduction), and to reduce variation. I'm trying Levemir to address both these. To reduce errors, I also started this thread, fully aware that sane people will question what I wish to try.

[Funnygrl]

As far as diluting is concerned, it will add another variable in your regimen. You'd have to make sure it was well mixed to get even amounts of dilutant and insulin. I still maintain that it makes no sense for you and I'd be amazed if your doctor played along.

Re: Glucagon
Glucagon isn't the best method to treat lows. It's a convenient method if you're unconscious. It can cause vomiting, which can make the low harder to treat, and it depletes your liver's glycogen supply making future lows more likely to become severe and harder to treat. It also messes with your basal needs for a few days. Therefore, it's a bad idea to use it if eating is an option, and eating IS being "proactive" as you say.

[Eddy]

Originally Posted by Funnygrl

As far as diluting is concerned, it will add another variable in your regimen. You'd have to make sure it was well mixed to get even amounts of dilutant and insulin. I still maintain that it makes no sense for you and I'd be amazed if your doctor played along.

Mixtures are more likely to be homogeneous over larger volumes than they are over smaller ones. I maintain that mixing would introduce negligible error, which would be more than offset by the greater granularity during administration.

I'll just have to agree to disagree.

Originally Posted by Funnygrl

Re: Glucagon
Glucagon isn't the best method to treat lows. It's a convenient method if you're unconscious. It can cause vomiting, which can make the low harder to treat, and it depletes your liver's glycogen supply making future lows more likely to become severe and harder to treat.

This I've heard. I've never had glucagon injected, so I can't comment how I react.

I _have_ experienced nausea after going too long without eating, which I attributed to natural glucagon secretions. Later hypos _were_ more demanding of CHO, which I presumed was my liver "wanting to be paid back".

Originally Posted by Funnygrl

It also messes with your basal needs for a few days.

This I did not know. Thanks!!! Any particular trends, or does it just generally destabilize one's requirements? I'll have to research this more...

Originally Posted by Funnygrl

Therefore, it's a bad idea to use it if eating is an option, and eating IS being "proactive" as you say.

No complaints from me if I needn't use the glucagon. If simply eating is sufficiently proactive, great.

[Funnygrl]

Basal insulin is basically insulin needed to cover your liver's constant release of glycogen. So if your glycogen stores are depleted, you need less basal.

[solox316]

I have to say... your technical thinking intrigues me. It seems though you have a method to your madness. As long as you are not fighting hypos all the time, more power to ya.

[Eddy]

Originally Posted by Funnygrl

Basal insulin is basically insulin needed to cover your liver's constant release of glycogen. So if your glycogen stores are depleted, you need less basal.

Like a double-conversion uninterruptable power supply.

Makes sense. No excess sugar floating around, lower insulin need; "regular" insulin presence triggers hypo. A normal person's insulin secretion shuts off when their BG is low enough... a diabetic must do so manually.

This also dovetails with my observation about "liver wanting to be paid back" causing otherwise-idiopathic hypos several hours after eating (after having gone too long without).

I'll buy that.

[Funnygrl]

Originally Posted by Eddy

This also dovetails with my observation about "liver wanting to be paid back" causing otherwise-idiopathic hypos several hours after eating (after having gone too long without).

Well, sort of. Because insulin is needed to move glucose into the liver to "pay it back" so to speak. However, it does work if you consider that the liver isn't pushing out glycogen during this time.

[Eddy]

Originally Posted by solox316

I have to say... your technical thinking intrigues me. It seems though you have a method to your madness.

Thanks.

Originally Posted by solox316

As long as you are not fighting hypos all the time, more power to ya.

The hospital originally thought I was 1U:20mg/dL; I've now determined the ratio is closer to 1:35. Hypers used to beget hypos due to overcorrection; dosage error probably was the limiting factor on tight control. (Lantus variability probably wasn't doing me any favors, either.)

It just bugs me that dosage error can easily be 10 mg/dL. If I can reduce that, I have more wiggle room for fewer hypos (of keen interest) or lower A1c (I'd take it, but hypos currently concern me more than A1c).

At any rate, Friday is A1c day. I've tried to reduce hypos, and suspect that my A1c will be a little higher this time. Whatever it is, it's deliberately timed to coincide with the new basal... as well as any dilution, if I go ahead with that.

Thanks for the support.

[someone]

Diluting your insulin yourself really doesn't sound like a great idea to me. There is way too much room for error. You might try just getting a different type of syringe.

[BlueSky]

Originally Posted by Eddy

.... It just bugs me that dosage error can easily be 10 mg/dL. ....

As your beta cells are most likely still producing some insulin, dosage variability and the HBa1c will probably increase somewhat. It really is no big deal, and you will quickly get used to it. I will be delighted if my next HBa1c is less than 6.5% ...

[Funnygrl]

10mg/dl is the difference between 80 and 90 or 90 and 100 or 100 and 110. Realllllllyyyyy not a big deal. I'm on a pump, can take the same bolus, know that's the amount I got, and still have that much variance and more.