Jump to content
Diabetes forums
  • Welcome To Diabetes Forums!

    Registration is fast, simple and absolutely free so please, join our community today to contribute and support the site.

Archived

This topic is now archived and is closed to further replies.

matingara

Can I use Long acting Insulin only? (Zillion ???s)

Recommended Posts

alicat61

Hi Joel,

Hope all goes well with the Lantus. The injections become 2nd nature . I can understand the thought of them is off putting. I hate other people giving me needles now:D

It's the thoughtmore than anything else.

Share this post


Link to post
Share on other sites
matingara
Just out of sheer curiosity, were you ever tested for Islet Cell Antibodies or GAD65? I'd be curious to know.

 

Also many doctors feel or believe that sulfonylureas cause beta cell burnout since they make the pancreas start cranking out more insulin.

 

Talk this over with your doctor.

 

BTW, my GAD antibody tests were negative.

Share this post


Link to post
Share on other sites
matingara
And no other meds Joel? and what's the BG?

 

Peter, i am staying on the diamicron for now. as i said i am experimenting.

 

Here are my readings:

 

Fasting: 8.8 mmol/l (158 mg/dl)

no breakfast (dr. visit, getting insulin, needles etc)

Just before injecting 4 units: 10.4 (187)

1 hour: 10.2 (184)

2 hour: 9.2 (168)

3 hour: 8.6 (154)

4 hour: 7.8 (140) (30 mins before lunch)

Lunch of egg salad (eggs, mayo, salami, lettuce, broccoli etc)

5 hour: 8.9 (162) (90 mins after lunch)

 

will track every hour for rest of day. depending on results i will up my dose to 6 units tomorrow morning.

 

:)

 

-- Joel.

Share this post


Link to post
Share on other sites
ant hill
will track every hour for rest of day. depending on results i will up my dose to 6 units tomorrow morning

The BG looks good already and what pen did the doc give you? If it's the blue autopen24 which gives you in 2U steps then I would try and get the 1U steps because in your case having such small doses like 4 to 6U it's a massive 20% more insulin!!

I would look at 1U increase and also just the one injection each day.

So your very first injection, Geez I have had fun with an orange and those giant hypodermic needles. :D Today's systems are a boon. ;)

Share this post


Link to post
Share on other sites
Lizzie G
Just out of sheer curiosity, were you ever tested for Islet Cell Antibodies or GAD65? I'd be curious to know.

 

QUOTE]

 

i was thinking the same thing - you dont sound like you are overweight and you are struggling with a low carb diets plus meds, does kind of sound like you could be dealing with a slow onset type 1, check out the results of your tests to rule that out

Share this post


Link to post
Share on other sites
jillrapp

Hey Joel,

Sounds like you have a good plan. Please do keep us informed. :) I usually went 2-3 days before changing my dosage as daily metabolism can vary quite a lot. Be careful and good luck! :)

Share this post


Link to post
Share on other sites
Real4

so my question. can i go on to a long lasting insulin (say levemir) only provided that i stay on a low carb diet?

 

also, what is the dosage i should use? i am reading that for my weight (165 lbs) that 2 units of levemir should lower my BGL by about 2-3 mmol/l (36-54 mg/dl). is that right?

 

i am also reading that each millilitre of levemir contains 100 units of insulin - is that right? therefore, injecting 2 units of levemir would be 0.02 mls - yes?

 

i would try metformin first, since most of your problem appears to involve your basal gucose production (the liver supplies some glucose to the blood around the clock). Metformin will reduce that.

 

You can go on insulin certainly. A long acting insulin may help you greatly.

 

I would not worry too much about the dose. Usually you get started a very low dose then gradully increase it until you get the results you want.

 

You are way off on the 100 - it means that the insulin is in a solution a a one hundreth concentration (0.01) - 1%.

Share this post


Link to post
Share on other sites
lorilei

This will go down as one of my favorite threads...it is really hitting the mark for me right now. Joel, thank you for sharing your plan and decision making process and thank the rest of you for adding very valuable input.

Share this post


Link to post
Share on other sites
matingara
This will go down as one of my favorite threads...it is really hitting the mark for me right now. Joel, thank you for sharing your plan and decision making process and thank the rest of you for adding very valuable input.

 

Thanks Lori! I think you like this mainly because you identify with what i am going through? I will publish some more data shortly.

 

:)

 

-- Joel.

Share this post


Link to post
Share on other sites
matingara

Well here it is Day 2 of my "Insulin Augmented Treatment Plan" (or IATP as it is known :) ).

 

Day 1 went pretty well i think. the best news for me is that the injection (as i have said) was so utterly painless that i needed to check that the lil needle had gone in. Same thing happened today.

 

The other good news is that semi-socialized medicine does have some upsides. i was able to get 25 (twenty five) x 300 unit insulin pens for $5 (yes five dollars). i also got 200 needly-pointy-screw on tips for FREE. no complaining here about $$$.

 

i am a little concerned with having so much insulin whilst using so little. apparently lantus is fragile and loses potency. i have it in the refgrigerator. anyone have any comments/thoughts on this?

 

I am using a thing called a Solostar from "sanofi aventis".

 

anyway, to some results.

 

I used 4 units in my first injection at 11.15AM. Lantus is meant to "ramp up" slowly over four (4) hours. it seemed to do just that.

 

four hours after the first injection (and fasting) my BGL dropped 2.4 mmol/l (44 mg/dl). it dropped from 10.2 (184) to 7.8 (140) after four hours. then i had something to eat. (egg salad). i exercised in the evening (walk/jog) and it was quite hot.

 

Bottom line is that 1 unit of Lantus appears to lower my BGL by 0.6 mmol/l (10.8 mg/dl) after four hours (fasting).

 

for supper i had steak, mushrooms, salad and broad beans (fava beans). my BGL hovered around 9-10 (164-180) after dinner and up until bed time.

 

i guess i need more than four units based on this initial trial. (i know it is only one day - but i always knew 4 units was too low - but had to be cautious).

 

anyway, i woke this morning at 8.8 mmol/l (158 mg/dl).

 

the various websites i have read for lantus say that if yout Fasting BG is between 8 and 10 (144 and 180) to up your Lantus by 4 units.

 

so. i decided to inject 8 units this morning. i did this at 9.15AM. (i know this is not exactly the same time as yesterday - but i think the first dose had finished - so there was no overlap).

 

i am just about to hit the 3 hour mark. will test and report.

 

:)

 

-- Joel.

Share this post


Link to post
Share on other sites
matingara

OK. it is 3 hours after injecting 8 units of Lantus.

 

Yesterday, 3 hours after injecting 4 units (and fasting) i had dropped 1.8 mmol/l (32.4 mg/dl). dropped from 10.4 to 8.6 (187 to 154).

 

so - according to scientific theory - with 8 units i might have expected a drop of 3.6 mmol/l (64 mg/dl) after 3 hours today.

 

well it is pretty close.

 

after 3 hours (fasting) i have dropped from 9.1 mmol/l to 6.1 mmol/l (166 mg/dl - 110 mg/dl). so a drop of 3.0 mmol/l (55-ish in mg/dl).

 

i am feeling quite hungry (i.e. i have hunger pangs) which in my body is a signal that my BGL is getting lower.

 

theory say that at 4 hours i should be down to about 4.5 mmol/l (80 mg/dl). but theory and reality are quite different. according to theory my three hour reading should have been down to 5.5 mmol/l (99 mg/dl).

 

now i know that the meter has a 10% variance - so my current reading of 6.1 could be 5.5. :)

 

anyway - i am going to to a reading every 15 minutes until i reach hour four.

 

:)

 

-- Joel.

Share this post


Link to post
Share on other sites
BlueSky
...the crux of my question is will basal insulin alone do ma any good at all? ....

Any insulin will bring blood glucose down if you inject enough of it. But you don't want long acting insulin doing this to you. You end up having to eat to avoid going low, especially if you become more insuluin sensitive because of exercise. "Feeding the insulin" is disruptive. It makes blood glucose fluctuate, and it makes you gain weight. Using insulin in this counterproductive way is not necessary anymore because short acting insulins are readily available. It makes much more sense to bolus with as much short acting insulin as you need to keep your blood glucose down after a meal.

 

Before you start using extra basal insulin, you should test the adequacy of your endogenous basal insulin in the same way as T1s test their basal dosages. Skip a meal and test every hour for the next 4 hours. If your blood glucose stays in the target range, you don't need any more basal insulin. You need supplemental insulin when you eat, and you should be bolusing with fast acting insulin accordingly.

Share this post


Link to post
Share on other sites
lorilei

Alright, now i have a question...what about us "grazers?" i can and have modified my diet etc as far as carbs (and sadly salt), but as far as timing meals etc....that seems like a large feat...i have always done best on multiple small meals...waiting too long makes me go low and i have a "hangover' after that occurs...so bolusing everytime seems quite challenging. Guess this is the 24/7 of diabetes..I was hoping that the basal covered more..sorry to jump on your thread Joel, but blue sky always gets me thiking in a different direction!

Share this post


Link to post
Share on other sites
matingara
Before you start using extra basal insulin, you should test the adequacy of your endogenous basal insulin in the same way as T1s test their basal dosages. Skip a meal and test every hour for the next 4 hours. If your blood glucose stays in the target range, you don't need any more basal insulin. You need supplemental insulin when you eat, and you should be bolusing with fast acting insulin accordingly.

 

Bluesky, this is exactly what u have been doing for the last two months (pre-Lantus). Skipping meals and testing regularly. if i woke at 8.0 mmol/l i would still be at 8.0 mmol/l 4 hours later in a fasting state.

 

this says to me that my basal endogenous insulin production is too low.

 

so. job 1 is to find out how much basal i need to bring me into the "normal" range (4-6).

 

This is just the first phase. i am going to get the basal insulin correct and eat a low carb diet. it may be that my pancreas has enough phase1/phase 2 response to cover the low carb meals.

 

if not, i will talk to the Doc about adding fast acting insulin as well as the basal.

 

that makes sense doesn't it?

 

:)

 

-- Joel.

Share this post


Link to post
Share on other sites
matingara
Alright, now i have a question...what about us "grazers?" i can and have modified my diet etc as far as carbs (and sadly salt), but as far as timing meals etc....that seems like a large feat...i have always done best on multiple small meals...waiting too long makes me go low and i have a "hangover' after that occurs...so bolusing everytime seems quite challenging. Guess this is the 24/7 of diabetes..I was hoping that the basal covered more..sorry to jump on your thread Joel, but blue sky always gets me thiking in a different direction!

 

yeah. he is very good at thinking laterally and that is why we gave him a job here :D.

 

don't worry - we will all work this out together.

Share this post


Link to post
Share on other sites
matingara

anyway. on to more testing results.

 

four hours after injecting 8 units of Lantus i was at 4.7 mmol/l (85 mg/dl).

 

so, i dropped from 9.1 to 4.7. a total drop of 4.4 mmol/l. or 0.55 mmol/l per unit of Lantus. This compares well with yesterday's 0.60 mmol/l drop per unit. (This is a drop of 10-11 mg/dl per unit).

 

i have just eaten a low carb lunch. 3 hot dogs with some finely chopped red onion, grated cheddar cheese, hot english mustard and a small amount of ketchup (tablespoon or so). plus a small handful of macadamia nuts.

 

i will record how much i go up and see if my pancreas does anything about addressing this rise.

Share this post


Link to post
Share on other sites
lorilei

LOL ! sometimes i feel like i am in the remedial class and the professor is speaking to me in a whole other language...several readings later, i see the light! Just how does this become so second nature?

Share this post


Link to post
Share on other sites
BlueSky
.... job 1 is to find out how much basal i need to bring me into the "normal" range (4-6). ... it may be that my pancreas has enough phase1/phase 2 response to cover the low carb meals.

 

if not, i will talk to the Doc about adding fast acting insulin as well as the basal.

 

that makes sense doesn't it?

 

:)

 

-- Joel.

 

Not really. The idea is to supplement insulin where it is needed most. And I am suggesting that this is after meals. All you have established is that you basal insulin does not bring BG down into the normal range, which is not surprising. Basal insulin is not supposed to do this anyway. The 1st and 2nd phase insulin response brings BG back to normal after a meal. And you have already established that it is not working properly. This being the case, injected insulin should ideally supplement those post prandial insulin responses. Supplementing the basal insulin is likely to make blood glucose more volatile. As a matter of interest, here is the action profile for Levemir (Detemir):

 

basalinsulincomparison.jpg

Share this post


Link to post
Share on other sites
Real4
Peter, i am staying on the diamicron for now. as i said i am experimenting.

 

Here are my readings:

 

Fasting: 8.8 mmol/l (158 mg/dl)

no breakfast (dr. visit, getting insulin, needles etc)

Just before injecting 4 units: 10.4 (187)

1 hour: 10.2 (184)

2 hour: 9.2 (168)

3 hour: 8.6 (154)

4 hour: 7.8 (140) (30 mins before lunch)

Lunch of egg salad (eggs, mayo, salami, lettuce, broccoli etc)

5 hour: 8.9 (162) (90 mins after lunch)

 

will track every hour for rest of day. depending on results i will up my dose to 6 units tomorrow morning.

 

:)

 

-- Joel.

 

You're over doing it. Lantus takes about 2 hours before it STARTs working. The result you want to look at is the next morning dasting BG. The variation you're showing during the day are 1) normal fluxuations, and 2) meter fluxuations.

Share this post


Link to post
Share on other sites
soso

I took the approach to start with bolus insulin when I could no longer stay in range after meals... this worked very well for a little over a year (after 2 yrs managing on low carb and exercise alone) when my fastings started creeping up, I took this as a sign that my endogenous insulin had deteriorated to the point that it could not even fully supply those needs and started on a dose of 1 u of lantus per day in the am.. every 3 days I raised it 1 unit until my fastings (morning and pre-lunch and late afternoon) stabilized into the 4-5 mmol/l range. I maintained this for a while on 4 units and when it started to slip used the same procedure until I am now up to 6u per day and within the next month or so I expect to be moving up again to 7..

I raise the dose very slowly, so I can be sure I need to and any stray readings do not make their way into the mix... I am happy to say I have never had a low induced by long acting and any basal testing has shown my bg to stay very steady wihout food. This makes me much more confidant about my bolus calculations as I KNOW I do not have to factor in the Basal.

 

I confess, when I started on Lantus, I sort of hoped it might free me up to have the odd bolus free Cappucino or snack...but I soon realized I was on a hiding to nothing with that idea..

 

Please go steady Joel...insulin can bite back.

Share this post


Link to post
Share on other sites
lorilei

 

I confess, when I started on Lantus, I sort of hoped it might free me up to have the odd bolus free Cappucino or snack...but I soon realized I was on a hiding to nothing with that idea..

 

QUOTE]

 

****! :confused: All or nothing??

Share this post


Link to post
Share on other sites
matingara

 

I confess, when I started on Lantus, I sort of hoped it might free me up to have the odd bolus free Cappucino or snack...but I soon realized I was on a hiding to nothing with that idea..

 

QUOTE]

 

****! :confused: All or nothing??

 

A "hiding to nothing" means a "bad bet".

Share this post


Link to post
Share on other sites
matingara
Please go steady Joel...insulin can bite back.

 

well i thought i was going pretty steady. and relatively scientifically also...

Share this post


Link to post
Share on other sites
soso

I was basically asking for a good hiding if I tried to do that.. it was not going to win me anything, except a few high readings.. or if I took more Lantus a few too low readings... a lose lose situation....

 

I read your footnote Lori.. I feel your pain.. I've been there...

Share this post


Link to post
Share on other sites
soso

Not trying to criticize you Joel, you are recording it all well, I was just a bit concerned that you seemed to have gone up to 8 u pretty quickly and my understanding was that Basals should be changed slowly (as in every 3 days) as an over enthusiastic dose of rapid can be dealt with within a 4 hr window, but with long lasting you could have a day long problem.

As you only started yesterday and doubled your dose the next day, I was a bit worried that you might take even more tomorrow...

My experience of my blood sugars is that sometimes it does things I don't expect and I didn't want you to have any nasty surprises.

Share this post


Link to post
Share on other sites

×

Important Information

By using this site, you agree to our Terms of Use.