Insulin dosage.

[Vidusi]

Hi, I have been on Insulin now for just over 14 months. In that time I have been struggling to get the insulin : glucose balance right. My dosage is increasing and I am eating less but putting on fat around my abdomen seems wrong. Any advice?

 

[uart]

Hi Vidusi. Can you start by telling us how man units of insulin you currently take (per day), and also roughly how many grams or carbs you eat.

 

[Daibell]

Hi and welcome. If you are a T2 and have excess weight you can end up in a vicious circle with insulin as your body's insulin resistance can cause excess insulin in the blood which the body can't use properly and adding more doesn't help. If your pancreas is failing, however, then the insulin will help. I'm guessing you may be in a vicious circle at present. Having a low-carb diet to try to get weight and blood sugar down will be very important if you aren't already doing that. Once the weight is down it is easier to determine what meds are best for you. There are some alternative injectables to insulin at least for a while to help reduce weight such as Victoza and Bydureon, but may be your weight isn't that high? Let us know a bit more.

 

[Mep]

Do you have a diabetes medical team? I tend to discuss everything about my insulin usage with my endocrinologist. I follow his advice. If I don't, I get a little lecture from him. He sees me every 6 months to review whether I need any adjustments. He has me on a sliding scale though and not the insulin to carb ratio. So it depends on how you've been told to use your insulin. I'm T2 but I don't produce insulin hardly at all. I probably have some insulin resistance, but I'm not too bad. I currently have a weight problem but I'm on 4 meds that cause weight gain, plus the insulin so that makes 6 (for both types). I was pulled off baclofen and then put back on it about 6 months back and I've gained weight suddenly since then... not happy jan. But yes, insulin is a fat storing hormone and my endo has mentioned quite a few times that it can cause weight gain. I'm currently using 13 units of basal dosage and 45-50 units of bolus dosage per day. I hope you can get your adjustments right soon.

 

[tim2000s]

I believe there is some work going on into an algorithm to assist with insulin dosing for t2s. It might be worth asking after this with your diabetic team. Alternatively you could look at the uk clinical trials site to see if there are any associated with it.

 

[MellitusTrap]

I believe there is some work going on into an algorithm to assist with insulin dosing for t2s. It might be worth asking after this with your diabetic team. Alternatively you could look at the uk clinical trials site to see if there are any associated with it.

There is a rough dosing calculator on the Lantus website.
Unlikely that there will be an algorithm that takes into account your personal level of insulin resistance and how well metformin works on your liver.
I've just finished 5 weeks of Lantus (@80 units a day) that didn't bring my sugars to single digits, (along with metformin, gliclazide and sitagliptan).

In the same 5 weeks I put on 10kg, mainly around the belly and it is so taught from bloating you'd swear I was pregnant!

Just saying, the Lantus website suggested 23 units as my max dose, but even 80 units wasn't enough, and at that level of Lantus, the lbs piled on!

 

[Mep]

There is a rough dosing calculator on the Lantus website.
Unlikely that there will be an algorithm that takes into account your personal level of insulin resistance and how well metformin works on your liver.
I've just finished 5 weeks of Lantus (@80 units a day) that didn't bring my sugars to single digits, (along with metformin, gliclazide and sitagliptan).

In the same 5 weeks I put on 10kg, mainly around the belly and it is so taught from bloating you'd swear I was pregnant!

Just saying, the Lantus website suggested 23 units as my max dose, but even 80 units wasn't enough, and at that level of Lantus, the lbs piled on!

Oh dear have you had a c-peptide test done recently at all? Maybe you don't produce hardly any insulin anymore. I am in that boat. So they have me on both lantus for the basal and apidra for bolus with meals. Since I've been on insulin I've had better sugar numbers that's for sure. The oral meds were doing nothing for me, which is no surprise as they only work when you have your own insulin. I would think that if I was on only basal insulin it wouldn't help me too much either because I don't have my own insulin to tackle the peak you get with meals. Maybe you also need bolus insulin?

 

[MellitusTrap]

Oh dear have you had a c-peptide test done recently at all? Maybe you don't produce hardly any insulin anymore. I am in that boat. So they have me on both lantus for the basal and apidra for bolus with meals. Since I've been on insulin I've had better sugar numbers that's for sure. The oral meds were doing nothing for me, which is no surprise as they only work when you have your own insulin. I would think that if I was on only basal insulin it wouldn't help me too much either because I don't have my own insulin to tackle the peak you get with meals. Maybe you also need bolus insulin?

In one of the first diabetes management books I read, the first chapter explained how as diabetics, we have to become our own doctors.

Your level of knowledge, much like many other diabetics, is spot on.

Not sure if I was given a c-peptide test.
But the doc replaced all but metformin yesterday evening.

As you suggested, basal wasn't enough. My doctor either thinks it would be too hard for me to manage regular insulin or... He might think that with my depression having not been so long ago, that I might still be at risk of doing something stupid.

So he gave me a 30/70 mixed concoction of fast verses long acting in NovoMix and also Empagliflozin to help me pee out more sugar too.

Quoting from the same book I mentioned earlier;
"There's nothing like getting a chronic disease to help you live a long and healthy life."

(Because you have to actively manage so much more of yourself)