Concerned about High Readings

[Michael52]

Hi everyone, when I was on protophane and Novarapid my readings were fine but ever since I changed over to Humalog and humulin my readings haven't been as good as before. I get a lot of highs but my pattern of eating has been the same. I'm worried, is it because of this new insulin that I'm using at the moment, what could be the problem? Please inform me. What should I do about this. Thanks in advance.

 

[TheBigNewt]

I never heard of protophane can't help you there. But HumuLIN is a short acting insulin that as I recall was developed by Lilly by cleaving a couple of molecules off of animal insulin to make it identical to human insulin. I used it when it came out. I think it has a similar onset/duration of action as the old insulin R (regular). HumuLOG is also a Lilly product with a shorter onset/duration of action, and is meant to compete with what we call NovoLOG or Novorapid in the UK. I use Novolog now but I used Humulog since it came out and notice no difference at all. It would be unusual to combine the use of 2 different short acting insulins in a Type 1 diabetic. Humulin and Humulog. To me that's weird. If you were good before why don't you go back to that?

 

[Kristin251]

I find I have to prebolus 20-25 min with humalog for a higher fat and protein meal with essentially no carbs I don't eat carbs per se so can't advice prebolus timing on that but it does help emmensly

Novolog was not as smooth as humalog for me. Novolog had a sharp peak at about an hour then dropped off fast. So wherever I was at 1.5 hours I only went up from there. Humalog seems to take a bit longer to work but the peaks and valleys are gentler and it seems to last a bit longer. FOR ME

 

[Jaylee]

Hi @Michael52 ,

It does look like you have been prescribed two types of short acting insulin.. (Which would explain a poorer recent BS control.)
Which are you using for meals time injections?
You realy require a basal (long acting) insulin in conjunction with just one of the shorter acting bolus on your current prescription list...

This is standard MDI protocol for diabetes control..

 

[Diabeticliberty]

There are two Humulin insulin types. Humulin-S which is soluble and fast acting. There is also Humulin-I which was developed to be slow acting. I still use them both to very good effect. I would add that the slower acting is not as slow acting as some of the more modern slow acting insulin products since Humulin is now very old technology. Is the Humulin that you are taking Soluble or Isophane? This will be marked on the bottle or vial

 

[Michael52]

Isophane !!!!

 

[azure]

Isophane !!!!

How often a day are you taking the Humulin? Is there a particular time of the day that you're going high?

 

[Diabeticliberty]

Isophane !!!!

It might be worthwhile discussing with your doctor or DSN the possibility of taking a morning and evening dose of Isophane and then taking your Humalog through the course of a day as and when you need it. This is of course if you are not already doing this. If you are then possibly have a look at your doses and maybe make upward adjustments to them. as required. You suggest that you are running 'high'. Could I ask how high you are running? One thing I cannot understand is if you had good control on your previous regime using your previous medication and it sounds like you did why was this changed? Were you given a reason? If you are unable to get the desired results from your change of medication then perhaps respectfully but firmly tell them that what they have done is unacceptable to you and you require your previous medication like erm..............TODAY!!!!!

 

[TheBigNewt]

In the US we have Humulin-R (short acting, the original product), and Humulin-N (maybe isophane there) which is probably similar to the old long acting staple "NPH". That's twice a day with 2 peaks and it overlaps partly to use as a poor man's basal, which is probably what protophane was for you. What I wonder is why they switched you from one old basal to another old basal? Cost? Just something to try? Doesn't sound like whomever thought this up got it worked out too good. At least not yet.

 

[SweetSophia]

You probably have problems because of humulin. Diabetes is different for everyone, but generally speaking: humulin (slower one) is a bad basal insulin and I honestly have no idea why anyone would give you that kind of therapy (unless it's about money). I'm not a fan of faster humulin either, but if you wanted to mix human insulin and analogue, I'd recommend the faster kind of humulin+levemir.

 

[Diabeticliberty]

You probably have problems because of humulin. Diabetes is different for everyone, but generally speaking: humulin (slower one) is a bad basal insulin and I honestly have no idea why anyone would give you that kind of therapy (unless it's about money). I'm not a fan of faster humulin either, but if you wanted to mix human insulin and analogue, I'd recommend the faster kind of humulin+levemir.

Could I ask please. Have you ever used Humulin- I and if so I take it you feel that Levemir is a better prospect? Could I ask how they compare? I have only ever taken Humulin and have never been able to compare it to anything else. I appreciate that it is very old technology in terms of insulin. I suspect I could get a change to something else if I pushed my doctor. I just wonder whether it would be worth it?

 

[TheBigNewt]

Could I ask please. Have you ever used Humulin- I and if so I take it you feel that Levemir is a better prospect? Could I ask how they compare? I have only ever taken Humulin and have never been able to compare it to anything else. I appreciate that it is very old technology in terms of insulin. I suspect I could get a change to something else if I pushed my doctor. I just wonder whether it would be worth it?

Do you take Humulin-I twice a day? If it's the same as our Humulin-N then it's not as long acting as Levemir most likely. Levemir is many times a twice daily injection. I tried it briefly instead of Lantus and it didn't work as well for me. I use Lantus once a day.

 

[SweetSophia]

Could I ask please. Have you ever used Humulin- I and if so I take it you feel that Levemir is a better prospect? Could I ask how they compare? I have only ever taken Humulin and have never been able to compare it to anything else. I appreciate that it is very old technology in terms of insulin. I suspect I could get a change to something else if I pushed my doctor. I just wonder whether it would be worth it?

Disclaimer: I don't think you should change your therapy immediately if you had only a couple of bad days. You should consider all of your options and see if you really have long term problems. Also, I'm not a medical expert and I don't know how well you can communicate with your endocrinologist (would they be fine with you just trying out new therapy and changing it often until you find the right one).

I've used human insulin. Where I live it's not called humulin, but as far as I understand, humulin s is the one that has onset in 30 min, peak 2-4 hours and duration 6-7 hours, the liquid is clear, humulin I is the one that has 2-4 hour onset, peak 4-12 h and duration up to 14-15 hours, the liquid is probably white solution and needs to be mixed before use.
Levemir is an insulin analogue that is supposed to work for, let's say, 20 hours and it's supposed to have NO PEAK, unlike humulin I. With humulin I've had hypos in the middle of the night and when I reduce the number of units, I get high in the morning.
You should observe at what time of the day you get highs. For example: if you take humulin I before sleep and a rapid acting insulin before meals, during the day and you get high readings during the day, that means:
1.your doses of rapid acting insulin are too small, you should try to take more and if everything returns to normal, you found the right thing, if you get lows because of that increase dosage, and then high, then it might be
2.you are not covered with basal insulin between meals and you need to either do humulin s +humulin or rapid analogue+long acting analogue.
Definitely talk to your doctor and do some research before you make a decision.
Common therapy is rapid analogue+long acting analogue or, for maybe low carb diet and a bit different regime humulin s+long acting analogue.

 

[Diabeticliberty]

Disclaimer: I don't think you should change your therapy immediately if you had only a couple of bad days. You should consider all of your options and see if you really have long term problems. Also, I'm not a medical expert and I don't know how well you can communicate with your endocrinologist (would they be fine with you just trying out new therapy and changing it often until you find the right one).

I've used human insulin. Where I live it's not called humulin, but as far as I understand, humulin s is the one that has onset in 30 min, peak 2-4 hours and duration 6-7 hours, the liquid is clear, humulin I is the one that has 2-4 hour onset, peak 4-12 h and duration up to 14-15 hours, the liquid is probably white solution and needs to be mixed before use.
Levemir is an insulin analogue that is supposed to work for, let's say, 20 hours and it's supposed to have NO PEAK, unlike humulin I. With humulin I've had hypos in the middle of the night and when I reduce the number of units, I get high in the morning.
You should observe at what time of the day you get highs. For example: if you take humulin I before sleep and a rapid acting insulin before meals, during the day and you get high readings during the day, that means:
1.your doses of rapid acting insulin are too small, you should try to take more and if everything returns to normal, you found the right thing, if you get lows because of that increase dosage, and then high, then it might be
2.you are not covered with basal insulin between meals and you need to either do humulin s +humulin or rapid analogue+long acting analogue.
Definitely talk to your doctor and do some research before you make a decision.
Common therapy is rapid analogue+long acting analogue or, for maybe low carb diet and a bit different regime humulin s+long acting analogue.

I think you misunderstand me a little. I don't intend changing my therapy at all. At least not without the prospect of some real advantages if there are any to be had by changing to a more modern slow acting insulin. I asked my original question because I would be interested in the opinion of someone who has direct experience of Isophane compared to something else. It would appear that @TheBigNewt has experienced just that. For the record Isophane does not have to be mixed with anything else. When it was first developed the intended use was that it would be mixed in a syringe with Solube to give the flexibility that at that time pre mixed insulins could not offer. Shortly after this I believe the medical community found the basal bolus system of insulin administration and the suggestion was a single dose of Isophane was to be delivered last thing at night and mdi of Soluble was to be delivered by pens with each meal. It was a terrible system as the Ispohane didn't last long enough which resulted in far more doses of Soluble needed applying and users reported massive food cravings. I tried this about 25 years ago and for me it failed miserably. I went back to a twice daily mix of Soluble and Ispohane and backed that up with addition Soluble as and when I needed it. Thus far this has worked and worked extremely well for me. I am just a little bit conscious of being stuck in the Dark Ages which is really why I posed my question.

 

[Diabeticliberty]

Do you take Humulin-I twice a day? If it's the same as our Humulin-N then it's not as long acting as Levemir most likely. Levemir is many times a twice daily injection. I tried it briefly instead of Lantus and it didn't work as well for me. I use Lantus once a day.

I do indeed take Humulin - I twice daily. Sorry to give you the proverbial 'third degree' but may I ask why you changed from it in the first instance and the differences you find with Lantus in practical everyday usage?

 

[SweetSophia]

I think you misunderstand me a little. I don't intend changing my therapy at all. At least not without the prospect of some real advantages if there are any to be had by changing to a more modern slow acting insulin. I asked my original question because I would be interested in the opinion of someone who has direct experience of Isophane compared to something else. It would appear that @TheBigNewt has experienced just that. For the record Isophane does not have to be mixed with anything else. When it was first developed the intended use was that it would be mixed in a syringe with Solube to give the flexibility that at that time pre mixed insulins could not offer. Shortly after this I believe the medical community found the basal bolus system of insulin administration and the suggestion was a single dose of Isophane was to be delivered last thing at night and mdi of Soluble was to be delivered by pens with each meal. It was a terrible system as the Ispohane didn't last long enough which resulted in far more doses of Soluble needed applying and users reported massive food cravings. I tried this about 25 years ago and for me it failed miserably. I went back to a twice daily mix of Soluble and Ispohane and backed that up with addition Soluble as and when I needed it. Thus far this has worked and worked extremely well for me. I am just a little bit conscious of being stuck in the Dark Ages which is really why I posed my question.

Oh ok
I meant "mixed" like you have to shake before use because the liquid separates.
Just another piece of info: I didn't use lantus but from what I've heard it can sting a bit when you inject it and people consider it more efficient than levemir because it really lasts as long as it should. Levemir is generally considered safer and that's the one that's usually given to pregnant women.

 

[TheBigNewt]

I do indeed take Humulin - I twice daily. Sorry to give you the proverbial 'third degree' but may I ask why you changed from it in the first instance and the differences you find with Lantus in practical everyday usage?

When Humulin-R came on the market in the US it replaced generic regular insulin (animal). We did not have Humulin-I as you do/did. So I never used it. Back then I used generic Ultralente (which you had to mix up before injecting and you could mix it with Humulin-R it you wanted) as basal and Humulin-R as bolus. Then Humulog came out faster onset/shorter acting bolus. Then Lantus replaced the Ultralente.