Hi all. I'm insulin dependent diabetic who injects humalog mix 25 twice daily. I'm ok during the day until evening when I go for a walk and don't know how much insulin to inject as my levels can reduce very fast . So I inject half what I inject in the morning. When I return from walk levels could be 8 or 9. I'd be afraid to inject then. I may have a sandwich before bed. Sometimes I check sugar levels every 2 or 3 mins and they go up and down so I eat more again thinking there may be a hypo coming. This has only been happening since I made a mistake last week and injected 24 units on a 12.3 level.did I pay for that action.sure I did. Ive been worrying about evening hypos since. As I say ok during the day. Love to know why this is. Admittedly I dont eat an evening meal just bread and Philadelphia cheese and butter.which raises blood sugar quickly. Thats it. Sorry for long post
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Hi @fantastic9888, do you count the carbohydrate in your meals? I used to take 2 injections a day and a dietician helped to work out the insulin profile so I could eat the right number of carbs to suit the dose/profile. For exercise you could take fast acting carbs, so for example when I used to hike I would eat boiled sweets throughout the walk.
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I was on Mix25 for over 3 years - it's not that easy to get along with and takes some practice.
Working on a insulin to carb ratio of 1:10 (your ratio may be different) and assuming that you get precisely 25% fast acting and 75% long acting with an injection :- taking 12 units before breakfast gives you 3 units of fast acting and 9 units of long acting.
Your 3 units of fast acting requires some carbohydrates to mop it up so at 1:10 you'd need around 30g of carbohydrate. Come lunchtime you have a problem because your fast acting insulin has gone which makes it difficult to eat unless you have very low carb lunches.
When you inject again in the evening, the same rules apply. So purely for example, 16 units would give you 4 units of rapid acting and 12 units of long acting. And with your 1:10 ratio you'd need 40g of carbs for your evening meal and maybe a bit more if you're going for a walk afterwards etc. But this dose could be too high if it gives you overnight lows and if you need to reduce the dose then you may need to eat less or different foods.
You need to find out your own insulin to carb ratio and match your food intake to your insulin dose. Hope the above makes sense but please ask if you're not happy.
Hi. Thanks for informative post.I injected the mix of 6 units after tea ad my sugars were 5.8 before tea and I'm wary of injecting at 5.8. I could be wrong about that. I ate 4 slices of toast with soft cheese and butter and went walking. A few minutes ago I returned from walk to find my levels were at 12! So now ive injected another 6 units. My goal is to get it to 7 or thereabouts so a drop of only 5 points. I'm only guessing each time I inject insulin but during the day I find it works perfectly with 5.8 this evening. Its after the tea when it all changes. If only I could get it right at that time. That said my levels are usually around 8 in the morning and sometimes 7. I'm 15 years diabetic and just had an eye test which was all clear. I have some nerve pain below right knee cap but only if I accidentally hit it off something. My feet are good. Sorry about long post. But its nice to be able to post the problem.
Hiking uses energy so I ate quick acting carbs when walking to stop me from going hypo. It was easier than altering the insulin doses.
I couldn't advise you more specifically im afraid, I will defer to @urbanracer, it was a long time ago when I was on 2 injections a day. I imagine that mix refers to a mix of long and short acting so there will be an overlap. It does sound complicated. Do you see a dietitian? x
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Have you not been given any guidance on counting carbohydrates?
Do you know how many grams of carbohydrate you eat with each meal and per day?
Hi. I havent been shown how to count carbs.but im going to do it myself from now on.sugars are 8.2 this morning. Things are returning to somewhere near normality. Psychologically I feel better. So the ratio is down to the carbs I eat. I eead some info on that last night. Still not quite clear how it works. Is it trial and error at the beginning. I eat 2 shredded wheat biscuits with low fat milk in the morning with 2 slices of toast with butter and soft cheese plus half cup of black tea. I usually inject 20 units hum25mix.I eat a white roll with chicken fillet and grated cheese plus lettuce plus butter at lunch time. A lot of days I dont eat a proper dinner. The white roll is bought at a take away. I must change all that as well.I wonder how many carbs are in the roll.will have to go to work on that myself. Cheers kevin
Don't know where you get your rolls from..........but a quick Google says
Kingsmill White bread rolls Carb 26.7 which sounds about rightish?
novorapidboi26
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A twice a day, mixed regime is suited best to the same carbs each day and limited to no physical activity......its just not designed to be anymore flexible than that......
the best option would be to just intake carbs if your walk brings your levels down, as opposed to trying to pre-empt the low with dose adjustment......
if you take less of a mix, then you will be holding back both basal and bolus insulin's.....when ideally you only want to hold back one of them.....
the best option would be to just intake carbs if your walk brings your levels down, as opposed to trying to pre-empt the low with dose adjustment......
if you take less of a mix, then you will be holding back both basal and bolus insulin's.....when ideally you only want to hold back one of them.....
Thanks. Im wondering now can I inject to cover both
Me again. Can I inject to cover both breakfast and lunch with one injection. Cos you were saying I wouldnt have enough rapid acting for lunch. But I always inject enough to cover brek/lunch. And in the enening pre tea,its usually ok.
Hi. I understand the first part of your post but the end part about "holding back one of them" I dont understand. Cheers kevin.
novorapidboi26
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On a mix you have no choice but to cover breakfast/lunch and then evening meal/supper with a single injection....
its been a while for me, but if you test before your AM injection and its high, then you have to either reduce the carb intake for dinner and supper and snacks in the PM or increase the insulin dose at dinner....
for the pre dinner test/injection, if its high, then you need to adjust the carb intake for breakfast/lunch or the breakfast insulin dose...
its been a while for me, but if you test before your AM injection and its high, then you have to either reduce the carb intake for dinner and supper and snacks in the PM or increase the insulin dose at dinner....
for the pre dinner test/injection, if its high, then you need to adjust the carb intake for breakfast/lunch or the breakfast insulin dose...
novorapidboi26
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well, in order to prevent hypos when exercising or just any physical activity, a diabetic on a basal/bolus regime would reduce [hold back] one or both of their insulin's in order to prevent a hypo...
with short duration, high intensity activity [running], the quick acting bolus is usually chosen, sometimes alongside extra intake of carbs....
for long duration, low/medium intensity [long walk], the longer acting basal can be chosen....
sometimes a mixture of the two can be adjusted.....its all down to what your testing has shown.....
its getting a bit detailed now though...lol....
Thanks for that.sounds very complicated. Do you mean I inject all the insulin in one go or as I am doing twice daily.
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People need insulin to counteract the sugar in food they've eaten but also to burn sugar provided by the liver when we're fasting (eg at night your stomach is empty but your body is still using energy).
Many of us are on basal/bolus regimes. Basal insulin is long acting and carries us through the day and night when we're not eating so if you get the dose right your blood sugar is where you want it to be in the morning, Most people have one basal injection (either first thing in the morning or last thing at night) though some people have two. Bolus insulin is short acting, just a few hours, so it deals with any food you eat, and you can adjust it both to cope with different amounts of food, different times of food (eg having a midnight snack or missing out a meal) and you can add in extra if your blood sugar is too high and you want to reduce it. So this provides a lot more flexibility than your current regime but typically will have 4 injections per day (one basal and a bolus before each meal). And you'll also be MUCH better off if you learn to count carbs properly and calculate the amount of insulin you need. (The diabetic clinic should teach you this.)
You can't on your current system.
Your current system is fine if it works for you but becomes difficult if you want to change carbohydrate amounts, times of meals or correct for high sugars. Because you're injecting a mixture of long and short acting insulin, if you increase your dose to cope with high blood sugar or extra food you risk going low in 6 hours time when your your increased basal is hitting you but your food has run out.
Really you need to talk to your diabetic team about your issues and get specific advice about how to correct your doses. Good luck.
