Humalog experience?

[LucyM88]

Been on Humulin for a while now and still struggling. Anyone on this type of insulin?

*edit! I'm on Humulin M3 insulin.

 

[urbanracer]

Been on Humalog for a while now and still struggling. Anyone on this type of insulin?

Humalog comes in different forms - I use Humalog Mix25 - can you elaborate a little on the specific type of insulin you're using?

 

[LucyM88]

Sorry to confuse, think my auto correct got there! Lol. I'm on Humulin M3 insulin and just wondering what people's experiences are with it.

 

[urbanracer]

Hi @LucyM88 ,

I think that maybe it's a bit too general a question, is there something specific that you need to know or something troubling you about M3 ?

 

[LucyM88]

Well just wanted to know how good control people have on it. I struggle on what to do when my blood sugars go high because it's the type of insulin that you cannot just inject or adjust. Also I'm experiencing hypo almost every night.

 

[urbanracer]

So I assume that you've been told to inject the same dose twice a day? That's how I started out and I had a few problems myself initially.

Are you counting carbs and matching your insulin to your carb intake?

 

[LucyM88]

I have 40 units in the morning and 22 units at night. Have only just adjusted to 22 at night to see if this stops the hypo at night. I don't do carb counting.

 

[urbanracer]

@LucyM88

I am reproducing the message I posted to someone else earlier today. You will experience problems if you don't count carbohydrates and match your insulin accordingly. Your insulin is 30%RA so you need to take this into account when reading the following text:-

Using an insulin to carb ratio of 1:10, if I intend to eat 30g of carbs, I need 3 units of RA (rapid acting) insulin to keep my blood sugars under control. But only 25% of this insulin is RA so I need a total of 12 units with this meal - which gives me 3 units of RA and 9 units of LA (long acting). I need to to tweak this depending on my planned activity level and whether there is alcohol with the meal.

I find that if I try to eat roughly the same amount of carbs each day and inject the same amounts of insulin at the same times, I can keep fairly good control of my BG numbers. It does restrict spontaniety a little, but it's a small price to pay.

I inject 12units every morning and don't go over 30g of carbs for breakfast. Depending on my activity levels I might need a biscuit mid morning to suppress a hypo. Lunch is a problem, because the RA insulin is spent after 4 hrs so I often take a couple of units of RA insulin for this (or have an ultra low carb lunch). My evening meal is variable so I adjust the insulin accordingly based on my experience so far.

Your insulin to carb ratio will also be unique to you but 1:10 is a good a place as any to start at and is usually recommended by the NHS. Don't be surprised if you work out to be 1:7 etc. Are you good at arithmetic?

It is always advisable to discuss any proposed changes in your insulin regime with your support team, unless you are supremely confident that you know what you're doing.

 

[sean1964]

Hi Lucy,

Is this 30% short acting, 70% slow acting insulin in a mix?
I have this as Novomix 30 brand.

I don't see how it is even possible for me to get control using only this.
If I even try to match carbs at the short end I'm stuck with 70% (!!) at the long end + hypo's around 6 hrs by experience.

It seems just mathematically wrong to me to replicate a pancreas using a strict 30/70 ratio. I'd go on lower carbs to attempt to make up for this (not that i should have to) but my pancreas / digestion can't do fats / protein at the mm. Anyway it's their choice of diet (hi-carb) so it stands - how can it be done mathematically? Cos of my knackered pancreas I put myself on daily sick day rules. But it still impossible. Why on earth 70% at the long end!!! What am i missing. Been trying 24 hrs / day for better control 8 months now.
Surely I need adjusted shortend to counter meal carbs (++variables with malabsorption, creon dose? etc)
For long end - should match what the body (pancreas / liver?) produces. My severely damaged panc a possible variable.

I've had trouble getting it looked at and changed. Specialist diabetes Dr. said she'd let the DN team know about maybe moving to 50/50. Lol and lol. Am going to see if my GP will bypass the diabetic team to get something done.

I hope someone replies, Lucy!

Good luck to us both!
Sean

 

[sean1964]

Urbanracer,

Sorry - just read your reply.
I'm also 70/30 twice a day.

Thanks. This is the kind of thing I tried, but I still have a problem that it is a work-around.
In your e.g. you take 12 for the 30g breakfast. The 9 long acting you have no choice over. Should the LA depend on what you eat for breakfast?

You mention:
"Lunch is a problem, because the RA insulin is spent after 4 hrs so I often take a couple of units of RA insulin for this "

Does this mean you also have a separate RA as well as the 30/70?

Cheers, Sean

 

[urbanracer]

Hi Lucy,

Is this 30% short acting, 70% slow acting insulin in a mix?
I have this as Novomix 30 brand.

I don't see how it is even possible for me to get control using only this.
If I even try to match carbs at the short end I'm stuck with 70% (!!) at the long end + hypo's around 6 hrs by experience.

It seems just mathematically wrong to me to replicate a pancreas using a strict 30/70 ratio. I'd go on lower carbs to attempt to make up for this (not that i should have to) but my pancreas / digestion can't do fats / protein at the mm. Anyway it's their choice of diet (hi-carb) so it stands - how can it be done mathematically? Cos of my knackered pancreas I put myself on daily sick day rules. But it still impossible. Why on earth 70% at the long end!!! What am i missing. Been trying 24 hrs / day for better control 8 months now.
Surely I need adjusted shortend to counter meal carbs (++variables with malabsorption, creon dose? etc)
For long end - should match what the body (pancreas / liver?) produces. My severely damaged panc a possible variable.

I've had trouble getting it looked at and changed. Specialist diabetes Dr. said she'd let the DN team know about maybe moving to 50/50. Lol and lol. Am going to see if my GP will bypass the diabetic team to get something done.

I hope someone replies, Lucy!

Good luck to us both!
Sean

@sean1964

It is true that this regime is less flexible than a full basal/bolus regime, but it is possible to acheive control. To some extent you have to match your food to your insulin, whereas people on basal/bolus would match insulin to food.

It will depend on how much insulin you inject of course, I take 12 in the morning and never more than 16 with my evening meal and I've modified my diet accordingly. I only eat around 120g of carbs a day.

The other thing is, not all insulins are equivalent no matter what your doctor tells you. I was put on Novomix30 at the beginning and didn't get on with it, my blood sugars were all over the place for the first few months. Once I changed over to Humalog Mix25 my glucose levels settled down within a couple of weeks. As you pointed out, you might be better off with the 50/50 mix also.

Nothing about diabetes is simple I'm afraid.

 

[urbanracer]

Urbanracer,

Sorry - just read your reply.
I'm also 70/30 twice a day.

Thanks. This is the kind of thing I tried, but I still have a problem that it is a work-around.
In your e.g. you take 12 for the 30g breakfast. The 9 long acting you have no choice over. Should the LA depend on what you eat for breakfast?

You mention:
"Lunch is a problem, because the RA insulin is spent after 4 hrs so I often take a couple of units of RA insulin for this "

Does this mean you also have a separate RA as well as the 30/70?

Cheers, Sean

Yes, depends on your doctor/hospital but it is not uncommon to be given rapid acting insulin pens for sick days. When you are ill your glucose levels rise so a couple of units of RA helps to keep it under control.

The hospital told me that I could aslo use this to bolus for meals, so I do. It's been a big help.

For myself, I don't account for the long acting with meals. After experimenting I found that I can cope with the 9 units of LA in my body after breakfast. As I said to LucyM88, depending on my activity levels I may have to eat a biscuit with my mid-morning coffee to prevent a hypo. Then I'm usually OK until lunch and on to the evening meal.

By having smaller, less carby meals at night, I don't need huge amounts of insulin so I'm usually higher than 8mmol/L at bedtime and wake up at around 6mmol/L. If you're going too low at night have you tried eating a biscuit or something immediately before bedtime?

 

[LucyM88]

To be honest, my levels are not the best but they are not dreadful. I didn't want to do the carb counting because I hated the thought of restricting myself when I've been told since I was diagnosed that I don't need a special diet, they difference between me and a person who doesn't have diabetes is that I have to inject my insulin. That's it. Eat what I want (in moderation of course) just remember to do my insulin. Also I'm **** at maths and that.

 

[sean1964]

Cheers Urbanracer,

I know it's not simple, but i think by being given 30/70 only, it is impossible + therefore the wrong prescription.

You being given RA only as well makes ALL the difference!
Actually with my panc I'm unable to know whether I would be able to keep down any food adjustments.

We'll have to agree to disagree on the 30/70 alone, I think basically it involves changing lifestyle to suit the fact that the prescription is wrong.

Lucy seems happy though.

 

[urbanracer]

To be honest, my levels are not the best but they are not dreadful. I didn't want to do the carb counting because I hated the thought of restricting myself when I've been told since I was diagnosed that I don't need a special diet, they difference between me and a person who doesn't have diabetes is that I have to inject my insulin. That's it. Eat what I want (in moderation of course) just remember to do my insulin. Also I'm **** at maths and that.

Hi @LucyM88

The thing is, carb counting isn't a special diet really. It's just making you aware of what you're eating and allowing you to calculate your insulin requirements accordingly.

In theory you can eat whatever you want, in practice however many of us have found that a moderate carb intake is beneficial unless your activity levels are high and you need the energy. If you read around the forums you will (unfortunately) discover that many people believe that the NHS dietary advice is pants. They didn't tell me anything about carbs when I was diagnosed, I only realised that they all turn into glucose in the body by interacting with forum members.

 

[LucyM88]

Well that's just me, don't like the thought of me saying no to dinner out or being the awkward person at the table calculating numbers and portions. Might be very different, you have given me something to think about. I just feel maybe my old regime was more beneficial (humalog rapid acting and lantus at night) as I could always just do a couple of units if I was running high

 

[urbanracer]

Well that's just me, don't like the thought of me saying no to dinner out or being the awkward person at the table calculating numbers and portions. Might be very different, you have given me something to think about. I just feel maybe my old regime was more beneficial (humalog rapid acting and lantus at night) as I could always just do a couple of units if I was running high

I didn't realise 'they'd' taken you off basal/bolus - why ?

 

[urbanracer]

Cheers Urbanracer,

I know it's not simple, but i think by being given 30/70 only, it is impossible + therefore the wrong prescription.

You being given RA only as well makes ALL the difference!
Actually with my panc I'm unable to know whether I would be able to keep down any food adjustments.

We'll have to agree to disagree on the 30/70 alone, I think basically it involves changing lifestyle to suit the fact that the prescription is wrong.

Lucy seems happy though.

You could also ask your doc' / endo' if you can try a full basal/bolus regime. My endo' doesn't want to put me on it as he thinks I'm managing OK as it is. I've asked twice now because I thought it would offer more flexibility.

 

[LucyM88]

Because I had a huge panic attack about injecting my lantus. Basically I thought I double-dosed and had to be taken to A&E. They found I didn't and maybe the insulin was messing with my memory. I wasn't comfortable with it anymore

 

[urbanracer]

Because I had a huge panic attack about injecting my lantus. Basically I thought I double-dosed and had to be taken to A&E. They found I didn't and maybe the insulin was messing with my memory. I wasn't comfortable with it anymore

Do you still feel the same way now, I mean if you had better control before then...............?