[bonnie690]

I've been round the block on insulins, i was orginally on pork mixtard30 back in the 1980s then pork mixtard30 with lenatard, then with isophane, then got moved to novomix30, then novomix30 with insulatard, then novorapid and lantus and now practically full circle now on human mixtard30. My question was has anyone else feel man-handled, the reason to go to a specialist (whether they are young or old) is that they are a specialist and if you speacialise in anything you should know the background of it, mixtard30 may be viewed as old school insulin but it is still a main stream insulin, i was on 4 a day injections for a year and it turned into a pain, the fact that everytime you wanna eat something you have to injection is not my idea of fun, i am probably old school style because i prefer the 2 a day injection routine, and i know i'm not the only one. i would rather take a gamble with 2 a day injections than go back on 4.
<<---- me and the doctor!! lol

[JediSkipdogg]

Have you ever thought of a pump? Using any kind of mixed insulin in my opinion is mistreatment. Because you are allowing the treatment method to control your lifestyle. You can't give something like mixtard30 to cover your daily body produced glucose without having to eat something to cover the fast acting part of the mix. And even then, you have to eat a certain amount to cover the insulin. You can't go above or below that or you're run high or low.

That's why myself, and many others, think mixed insulins are bad. You are stuck in a schedule of this is what you give and this is how much you must eat to cover the fast acting insulin. Personally, I'd rather do 4 shots a day than be forced on what to eat and when.

[DeusXM]

The reason you've probably had problems with the specialist after going back to Mixtard is because basic science says it's a phenomenally bad idea.

Look, I get that you find it a pain to have to inject every time you eat but you're not gambling by going onto Mixtard - the end result is guaranteed. Mixtard is a mainstream insulin in the same way that L-plates and stabalisers are mainstream. It's a good insulin for people who are getting used to the idea of injections but for long-term treatment it's not a good option. If you get an A1C under 9 with Mixtard then you're doing extremely well, all things considered. Although in terms of your health, you're still doing badly.

Having said that...

...your specialists have to juggle very carefully what's best for your health and what's best for your lifestyle. Like yourself I've regressed back with insulins - I went back from Lantus to Insulatard. However my specialist recognised that this was in my best interests because of the bad side-effects Lantus was having on my psychological health. They were also perfectly willing for me to try Levemir when it first came out, and when it turned out I was one of the few people it doesn't work for, I was straight back on Insulatard.

Now I'm back on Lantus because Insulatard was starting to destroy my life by making me have up to 9 hypos a day. In fact my specialist didn't really want me going back on Lantus (because of my history on it) but in the end we both agreed that in terms of my health and my lifestyle, Lantus was the lesser of the two evils.

The problem is that your specialist is tied down by their job. Their job isn't to give you what you want; their job is to keep your healthy. Doubtless your specialist cannot see any practical health benefits from you going back to Mixtard. That's why they're being difficult - you're asking them to violate the 4th item of the Declaration of Geneva, 'The health of my patient will be my first consideration'.

The GMC also have similar rules - 'make the care of your patient your first concern' and also 'respect the rights of patients to be fully involved in decisions about their care', which is the reason why you've been allowed back on Mixtard.

[bonnie690]

Thats you! This is me! as boring as it seems i'm a pretty scheduled person and its easier for me to be slightly time tabled than not!

[DeusXM]

Yes but Mixtard still doesn't give you good control. You can also have a timetabled routine with MDI too - you just don't have to if you don't want one. However, you cannot have good diabetes control with just two injections a day. Seriously, what was your last A1C on Mixtard? If it was over 7 then you need to change to MDI.

[Erin]

Originally Posted by DeusXM

Yes but Mixtard still doesn't give you good control. You can also have a timetabled routine with MDI too - you just don't have to if you don't want one. However, you cannot have good diabetes control with just two injections a day. Seriously, what was your last A1C on Mixtard? If it was over 7 then you need to change to MDI.

Deus... I feel your comments are slightly unwarranted. Since when does messing up an a1c mean you need to overhaul your whole life? I was at 7.something last time... does that mean I need to go onto a pump? Something that I am fundamentally opposed to? No, it means I need to change a few things, and above all else, keep better records!

But, Bonnie, I am unsure what you want from us. We are a primarily MDI and Pump using group. That doesn't mean you can't get good advice from us about the other aspects of living with diabetes (exercise, food, the general suck-ness of it all) and a sense of community. But it seems like you are looking for someone on here to validate your choice. Only you can do that for yourself. It seems like you know a 2 shot a day plan works for you... good! Now ask us how you can make it work *better*

[Erin]

Thought of something to add, but the time limit on editing posts has expired...

Bonnie, it was suggested in another one of your threads that you try switching from the pre-mix, to using two insulins that you mix yourself. (Still keeping you on a 2 shot a day plan). This has many advantages over the pre-mixes. You can have a different mix in the morning than at night (advantageous if your metabolism isn't consistent over the day) you can also add a few units of the short acting insulin if you are eating an abnormally large breakfast or dinner. And if you are running super high before bed you can take a correction shot (I know you don't want more than 2 shots a day, but this is just a worst case scenario correction shot, that you don't HAVE to do every day, just if you need it)

Think about it. It might be something worth suggesting to your doctor.

[duck]

Bonnie, I agree with Deus...The pre-mixed insulins *just* don't cut it for the VAST majority of Type 1's. Deus gets straight to the point, and he is very aggressive about treating this disease, because otherwise we lose limbs and semi-important organs like kidneys and eyes. I agree with this approach, and I would encourage you to take more than two shots a day. Yeah, it's literally a pain, but probably not as painful as say...going blind. Or being tired all the blasted time. Or feeling lethargic.

This disease is literally trying to kill you, let's not let that happen!

[seacomp]

Erin's advice above strikes me as wise.

[bonnie690]

Erin's advice to me is nice advice, deus and duck's forceful approach to me is not advice its bullying, your not giving advice through being forceful. i know what diabetes is i'm not asking for justicifaction for actions i have taken myself i'm sharing my experience and asking for views. But all i get is, you've done a bad thing you should do this! blah blah blah. Us brits obviously have a different approach to things than americans do.

[duck]

Originally Posted by bonnie690

Erin's advice to me is nice advice, deus and duck's forceful approach to me is not advice its bullying, your not giving advice through being forceful. i know what diabetes is i'm not asking for justicifaction for actions i have taken myself i'm sharing my experience and asking for views. But all i get is, you've done a bad thing you should do this! blah blah blah. Us brits obviously have a different approach to things than americans do.

Deus is British.

Bonnie, I am not being "forceful". I am just dispensing advice, I once was on the two-shot a day regimen (it was not with the pre-mix, but my doctor prescribed an exact amount that I was not allowed to tinker with, so for all intents and purposes, it was pre-mix). The two-shot doesn't work well. It WORKS, but until you've done it another way, you won't realize how poorly it worked.

I'm only trying to help. I'll back out now, because I DON'T want you thinking anyone here is bullying you, that's NOT what this place is about.

[Lynne1]

Originally Posted by duck

It WORKS, but until you've done it another way, you won't realize how poorly it worked.

I wholeheartedly agree with that statement. I was on NPH and N for a long time and thought the pump would just be a convenience. It's such an improvement- I don't know what I was waiting for. Any improvement in control is worth extra work because it makes you feel so much better.

[Erin]

Originally Posted by duck

Deus is British.

And I'm American.

[Erin]

Originally Posted by duck

Bonnie, I am not being "forceful". I am just dispensing advice, I once was on the two-shot a day regimen (it was not with the pre-mix, but my doctor prescribed an exact amount that I was not allowed to tinker with, so for all intents and purposes, it was pre-mix). The two-shot doesn't work well. It WORKS, but until you've done it another way, you won't realize how poorly it worked.

I'm only trying to help. I'll back out now, because I DON'T want you thinking anyone here is bullying you, that's NOT what this place is about.

Duck, I don't think you were bullying.

But I think you are mistaken about a 2 shot a day regimen. I did it quite successfully for a number of years back in the "bad old days" I had a sliding scale for my R (fast acting) that accounted for fasting bsl, a set amount of NPH (long acting) that I took (which the morning shot covered lunch) and I even had a system of + or - units (off of my sliding scale) worked out for the meals I usually ate. Pasta was +3, chicken with a bit of rice and veggies was -2.

Of course I had to get up at the same time every day, eat basically the same things every day, eat snacks 2 hours after each meal, and eat those meals on schedule every day... It was hard...and I hated it... but it can be done.

[duck]

Originally Posted by Erin

Duck, I don't think you were bullying.

But I think you are mistaken about a 2 shot a day regimen. I did it quite successfully for a number of years back in the "bad old days" I had a sliding scale for my R (fast acting) that accounted for fasting bsl, a set amount of NPH (long acting) that I took (which the morning shot covered lunch) and I even had a system of + or - units (off of my sliding scale) worked out for the meals I usually ate. Pasta was +3, chicken with a bit of rice and veggies was -2.

Of course I had to get up at the same time every day, eat basically the same things every day, eat snacks 2 hours after each meal, and eat those meals on schedule every day... It was hard...and I hated it... but it can be done.

Egad...the inflexibility...

I guess what I wonder is...well, maybe that's not right either. Okay, I'll just say it: WHY would anyone want to live like that?