Search
Search titles only
By:
Search titles only
By:
Home
Forums
New posts
Search forums
What's new
New posts
New profile posts
Latest activity
Members
Current visitors
New profile posts
Search profile posts
Log in
Register
Search
Search titles only
By:
Search titles only
By:
New posts
Search forums
Menu
Install the app
Install
Reply to Thread
Guest, we'd love to know what you think about the forum! Take the
Diabetes Forum Survey 2024 »
Home
Forums
Diabetes Discussion
Ask A Question
First appointment with community diabetic team – moving on to insulin - any advice please
JavaScript is disabled. For a better experience, please enable JavaScript in your browser before proceeding.
You are using an out of date browser. It may not display this or other websites correctly.
You should upgrade or use an
alternative browser
.
Message
<blockquote data-quote="phoenix" data-source="post: 753446" data-attributes="member: 12578"><p>...</p><p>It comes from liver . In the body there are two hormones which act to keep glucose level; insulin and glucagon. Glucagon is the hormone that tells the liver to release glucose. (this either comes from stores or is made from protein in the liver). All the fasting high blood glucose in diabetes is caused by this. In type two. in particular, the pancreas may produce very much more glucagon than it should do. (some researchers in fact think that this is the main problem)</p><p></p><p><strong>(NICE says" Begin with human NPH insulin injected at bed-time or twice daily according to need" </strong>but to consider using once a day lantus or levmir in certain cases)</p><p></p><p>NPH is a medium term insulin, lantus and levemir are long term insulins.They are used as basal insulins .</p><p>A basal insulin is an insulin used to counter the release from the liver that I mentioned. Some people with T2 just use a basal insulin, leaving their own insulin to deal with meal time glucose.</p><p>, NPH which is what seems to be the favourite with the NHS at the moment (it's cheaper for a start) lasts for about 16 hours and has a peak (ie it rises to become more active and then falls off ) Taking it twice a day results in some overlap which could be timed so that the peaks occur at times when insulin needs are highest.</p><p>Lantus and Levimir are flatter.</p><p>Graph comes from Lantus so may be a bit exaggerated but it shows the difference</p><p>[ATTACH=full]11450[/ATTACH]</p><p></p><p>There are other types of insulins that are either short acting or rapid acting. These are used in addition to a basal to cope with glucose from food sources</p><p></p><p>Many type 2s are put on an insulin regime where the basal (to take care of the glucose from the liver) and some short or rapid action for when needs are greater (mealtimes) are <strong>pre mixed</strong> together by the manufacturer</p><p>(<strong>NICE says Consider twice-daily pre-mixed (biphasic) human insulin (particularly if HbA1c ≥ 9.0%). A once-daily regimen may be an option.</strong></p><p><strong>Consider pre-mixed preparations that include short-acting insulin analogues, rather than pre-mixed preparations that include short-acting human insulin preparations, if:</strong></p><p><strong>a person prefers injecting insulin immediately before a meal,</strong></p><p><strong>or hypoglycaemia is a problem,</strong></p><p><strong>or blood glucose levels rise markedly after meals)</strong></p><p></p><p>.This article explains about pre mixed insulin used twice a day.</p><p><a href="http://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/types-of-insulin/pre-mixed-insulin/" target="_blank">http://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/types-of-insulin/pre-mixed-insulin/</a></p><p>Most people I have seen on here use a twice daily regime as shown but the NICE document does mention using mixed insulin just once a day)</p><p>(and some people on here have mentioned using it three times a day)</p><p></p><p>The big problem for your husband is that it needs to be used with a consistent meal pattern. You can't just take it and not eat when the level of insulin is high as you will have a hypo. It also requires a consistent amount of carbohydrates, too many and levels will rise, but too few can also result in a hypos.</p><p>You can't decide on one day to eat a lot more and another less because it isn't that easy to adjust the dose. This is because the insulin is already mixed (take more and you will be taking more of the long term as well as the mealtime insulin.Take less and there will be less basal insulin so levels may rise higher in between meals.</p><p>At the end of the day, for these insulins to work well he is going to have to become more willing to test and to adopt a more consistent lifestyle</p><p></p><p>From what I have read, the least likely possibility is to use two separate insulins (this comes last in the NICE options)</p><p>"Mon<strong>itor a person on a basal insulin regimen (NPH insulin or a long-acting insulin analogue [insulin detemir, insulin glargine]) for the need for short-acting insulin before meals (or a pre-mixed insulin preparation). [new 2009]</strong></p><p><strong>Monitor a person who is using pre-mixed insulin once or twice daily for the need for a further injection of short-acting insulin before meals or for a change to a regimen of mealtime plus basal insulin, based on NPH insulin or long-acting insulin analogues (insulin detemir, insulin glargine), if blood glucose control remains inadequate. [new 2009]"</strong></p></blockquote><p></p>
[QUOTE="phoenix, post: 753446, member: 12578"] ... It comes from liver . In the body there are two hormones which act to keep glucose level; insulin and glucagon. Glucagon is the hormone that tells the liver to release glucose. (this either comes from stores or is made from protein in the liver). All the fasting high blood glucose in diabetes is caused by this. In type two. in particular, the pancreas may produce very much more glucagon than it should do. (some researchers in fact think that this is the main problem) [B](NICE says" Begin with human NPH insulin injected at bed-time or twice daily according to need" [/B]but to consider using once a day lantus or levmir in certain cases) NPH is a medium term insulin, lantus and levemir are long term insulins.They are used as basal insulins . A basal insulin is an insulin used to counter the release from the liver that I mentioned. Some people with T2 just use a basal insulin, leaving their own insulin to deal with meal time glucose. , NPH which is what seems to be the favourite with the NHS at the moment (it's cheaper for a start) lasts for about 16 hours and has a peak (ie it rises to become more active and then falls off ) Taking it twice a day results in some overlap which could be timed so that the peaks occur at times when insulin needs are highest. Lantus and Levimir are flatter. Graph comes from Lantus so may be a bit exaggerated but it shows the difference [ATTACH=full]11450[/ATTACH] There are other types of insulins that are either short acting or rapid acting. These are used in addition to a basal to cope with glucose from food sources Many type 2s are put on an insulin regime where the basal (to take care of the glucose from the liver) and some short or rapid action for when needs are greater (mealtimes) are [B]pre mixed[/B] together by the manufacturer ([B]NICE says Consider twice-daily pre-mixed (biphasic) human insulin (particularly if HbA1c ≥ 9.0%). A once-daily regimen may be an option. Consider pre-mixed preparations that include short-acting insulin analogues, rather than pre-mixed preparations that include short-acting human insulin preparations, if: a person prefers injecting insulin immediately before a meal, or hypoglycaemia is a problem, or blood glucose levels rise markedly after meals)[/B] .This article explains about pre mixed insulin used twice a day. [URL]http://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/types-of-insulin/pre-mixed-insulin/[/URL] Most people I have seen on here use a twice daily regime as shown but the NICE document does mention using mixed insulin just once a day) (and some people on here have mentioned using it three times a day) The big problem for your husband is that it needs to be used with a consistent meal pattern. You can't just take it and not eat when the level of insulin is high as you will have a hypo. It also requires a consistent amount of carbohydrates, too many and levels will rise, but too few can also result in a hypos. You can't decide on one day to eat a lot more and another less because it isn't that easy to adjust the dose. This is because the insulin is already mixed (take more and you will be taking more of the long term as well as the mealtime insulin.Take less and there will be less basal insulin so levels may rise higher in between meals. At the end of the day, for these insulins to work well he is going to have to become more willing to test and to adopt a more consistent lifestyle From what I have read, the least likely possibility is to use two separate insulins (this comes last in the NICE options) "Mon[B]itor a person on a basal insulin regimen (NPH insulin or a long-acting insulin analogue [insulin detemir, insulin glargine]) for the need for short-acting insulin before meals (or a pre-mixed insulin preparation). [new 2009] Monitor a person who is using pre-mixed insulin once or twice daily for the need for a further injection of short-acting insulin before meals or for a change to a regimen of mealtime plus basal insulin, based on NPH insulin or long-acting insulin analogues (insulin detemir, insulin glargine), if blood glucose control remains inadequate. [new 2009]"[/B] [/QUOTE]
Verification
Post Reply
Home
Forums
Diabetes Discussion
Ask A Question
First appointment with community diabetic team – moving on to insulin - any advice please
Top
Bottom
Find support, ask questions and share your experiences. Ad free.
Join the community »
This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies.
Accept
Learn More.…