Premixed insulin

[alphabeta]

Hello everyone
I have noticed that the vast majority of diabetics (at least type 1 like me) use basal bolus regime but rarely if at all I've seen someone using premixed insulin. What is the advantage of basal bolus over premixed insulin?

 

[kaylz91]

Basal bolus is more flexible, you adjust it to suit you, mixed you have to stick to the same amount of carbs at round about the exact same time each day

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[**shell**]

Morning.
I suppose it is a case of basal (background)/bolus - it works around you and premixed - you work around it.

I was changed to basal/bolus when I went to uni so that I could have the 'student' life. Now (ten years later) I couldn't imagine going back.

I suppose the main advantage is it works in a not too dissimilar way to the pancrease where in you give yourself the dose for the food you are about to eat so in reality you can eat what you like when you like.

xoxox

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[Fearless36]

I hate basal bolus insulin. I really do detest it. I was put on it last October 2016, and as soon as I can I am changing back. I have an appointment on 30th and am really demanding to be put back on the mixed insulin. Whilst it was some 30 years I was on it, for me the control is much more easier. You do have to eat at fixed times but that wasn't a problem for me. Although you can vary the amounts of insulin you inject in a similar fashion to basal bolus. For me the control of it was much easier on mixed, and also the fact was I had to only do 2 injections a day, versus 4-5 of basal bolus. I complained at my former surgery about this and was told that Theresa May has spoken publicly about injecting 5x a day. That was little to no comfort at all. I used to have really good control on mixed insulin - never had any hypos yet since being on basal I hypo at least once a week. I know its hit me hard and I am majorily depressed over it as a result. I hated the fact that I was changed from something that worked and have been left to try to figure it out on my own with little to no support from hospital or doctor. Thankfully I've changed hospital and am writing to them ahead of my appointment asking them to consider what mixed insulin I can go back on, because if I get there and they won't - I'm not doing it any longer. I really have had enough of it. I know my body really well and the change was never explained to me properly and none of my telephone calls are returned or dealt with.

 

[azure]

@Fearless36 You shouldn't have been changed over against your will. Different regimes suit different people - as do different insulins

 

[Fearless36]

Absolutely I agree with you. The particular mixed brand I was on was being discontinued I was told, and the diabetic nurses/doctor both discussed my case. How they thought going from 2x a day to 5x a day was a good idea I will never know - because it wasn't and my control has been up and down consistently. I've even telephoned chasing them both. When I saw the doctor I told him how unhappy I was, and he told me at the time that I could easily change back (back in May). Despite chasing several times I never got to speak with him (although mind you he did say he would see me more regularly in his clinic which never happened either). Even chasing his secretary - I got no where. When I finally tracked down one of the nurses she informed me that he had changed his mind and wouldn't be switching insulin. That was the final step for me and I requested a new hospital to be allocated to.

@Fearless36 You shouldn't have been changed over against your will. Different regimes suit different people - as do different insulins

 

[azure]

That shocks me @Fearless36 You'd given basal bolus a go, hadnt liked it, so should have been allowed to change back in my opinion.

 

[azure]

Hello everyone
I have noticed that the vast majority of diabetics (at least type 1 like me) use basal bolus regime but rarely if at all I've seen someone using premixed insulin. What is the advantage of basal bolus over premixed insulin?

The advantages are flexibility regarding meals - carb amounts and times - and it being easier to adjust your insulins separately.

 

[alphabeta]

Sorry to hear that but the major thing that I hated about basal bolus is the hypos tho never tried it... i like my sugar to spike a bit then go down slowly which is something the Mixtard 30 does

 

[Daibell]

With Basal/Bolus you effectively have total control over the amount of carbs in a meal and when you eat. With mixed you need to stay within a much tighter range of carbs and timing and it may not be so easy to keep your HBa1C down low enough without hypos. Mixed may be adequate if your have some beta cells left.

 

[alphabeta]

With Basal/Bolus you effectively have total control over the amount of carbs in a meal and when you eat. With mixed you need to stay within a much tighter range of carbs and timing and it may not be so easy to keep your HBa1C down low enough without hypos. Mixed may be adequate if your have some beta cells left.

That actually fits me, my breakfast and dinner are always the same..

 

[azure]

Sorry to hear that but the major thing that I hated about basal bolus is the hypos tho never tried it... i like my sugar to spike a bit then go down slowly which is something the Mixtard 30 does

I'm confused - are you saying you already tried basal bolus but had hypos? Or that you're worried about hypos?

 

[alphabeta]

I'm confused - are you saying you already tried basal bolus but had hypos? Or that you're worried about hypos?

Worried about hypos because my doctor told me that I have low rate of absorption of food at night so I want to avoid fast acting insulin... but still I take 4 to 5 units Actrapid alongside with my NPH

 

[azure]

Worried about hypos because my doctor told me that I have low rate of absorption of food at night so I want to avoid fast acting insulin... but still I take 4 to 5 units Actrapid alongside with my NPH

Ok

When I first changed to a basal bolus regime, I used Actrapid as the bolus insulin, if that helps.

 

[donnellysdogs]

For people like me that are small, one or max two teaplates of food a day it gives me total flexibility.
If I cant face breakfast or lunch I'm not having to eat.

Its also enabled me to live flexibly with my activities. I can be active without too much planning/eating.

 

[Fearless36]

I agree, and think the same. The fact the doctor told me I could in May and then did nothing was shocking. Moreso I spoke 6 times with his secretary re making an appointment to see him, and never got anywhere so in the end I went through the nurses. That was another 6 weeks before I go anywhere and they then revealed they spoke to the doctor and he didn't want to switch my insulin. I knew then it was not the right place for me. Whats worse is St Mary's in London is supposed to be a good hospital - but in my opinion on this instance it is far from it.

That shocks me @Fearless36 You'd given basal bolus a go, hadnt liked it, so should have been allowed to change back in my opinion.

 

[Fearless36]

But actually you can do the same with mixed insulin, in fact when I was on mixed insulin sometime I'd be very active and sporty and other times not hungry so I'd adjust my insulin dosage to match this. Other times if I was at a party and wanted to pig out I could again adjust the insulin dosage. It is possible with mixed insulin although it took some time to learn how to adjust it but that was prior to basal bolus. Going from 2x a day to 5x a day (and I don't care that the prime minister does it) is just too much of a change for my liking and its more restrictive in that you have to always have your insulin with you.

With Basal/Bolus you effectively have total control over the amount of carbs in a meal and when you eat. With mixed you need to stay within a much tighter range of carbs and timing and it may not be so easy to keep your HBa1C down low enough without hypos. Mixed may be adequate if your have some beta cells left.

 

[alphabeta]

But actually you can do the same with mixed insulin, in fact when I was on mixed insulin sometime I'd be very active and sporty and other times not hungry so I'd adjust my insulin dosage to match this. Other times if I was at a party and wanted to pig out I could again adjust the insulin dosage. It is possible with mixed insulin although it took some time to learn how to adjust it but that was prior to basal bolus. Going from 2x a day to 5x a day (and I don't care that the prime minister does it) is just too much of a change for my liking and its more restrictive in that you have to always have your insulin with you.

Actually I use NPH plus Actrapid at night only and yeah I can adjust my dose I'm still learning it to see what fits me the best. Sure I get more flexibility with this..

 

[novorapidboi26]

But actually you can do the same with mixed insulin, in fact when I was on mixed insulin sometime I'd be very active and sporty and other times not hungry so I'd adjust my insulin dosage to match this

Reducing or increasing it for activity would then either give you more or less of the slower acting portion and vice versa, so although it can be managed well after years of using it and noting patterns for your own personal needs, on paper at least, it wouldn't normally be recommended for any newly diagnosed diabetics....

if you like it, you should be on it though...

curiously, where you given any dose adjustment training?

 

[Fearless36]

With mixed insulin yes I was, but none whatsoever with this basal bolus stuff. What works for the mixed insulin definitely doesn't work for the newer stuff. I had been adjusting the mixed insulin for several years prior which is what is so frustrating.

Reducing or increasing it for activity would then either give you more or less of the slower acting portion and vice versa, so although it can be managed well after years of using it and noting patterns for your own personal needs, on paper at least, it wouldn't normally be recommended for any newly diagnosed diabetics....

if you like it, you should be on it though...

curiously, where you given any dose adjustment training?