Shift worker change of medication.

[Karen_Cusack]

My partner who works 12 hour shifts has had his injection regime changed and also told to use a different sort of testing meter. I am concerned as for the last 8 years he has had NO PROBLEMS with his readings and is happy with his Contour USB as it is so easy to carry and use. He has now been told to use a Gluco RX Nexus which doesn't fit in his pocket and is not so discreet to use.
His old injections were Novomix 30 which was idea for Both his Day and Night shifts. He has now been told that he must use Humalog and Lantus. As he eats EITHER on day or Night depending on his shifts I am concerned that the way he has been told to use his injections may cause him to lose the control he had. If he uses the Lantus at night how can he use the Humalog during the day when he is sleeping and not eating?
If anybody has any advise I would like to hear.
Many Thanks.

 

[Mrsass]

He will have more freedom with his eating as humalog is just injected when you eat, so if he's not eating he will be ok as long as his basal dose is correct

 

[donnellysdogs]

Under correct patient care they should listen to the patient and only change insulin so with their agreement or for better control. Is your partner having pretty good control within 4.5's to 7's the majority of the time, without assistance for hypo's and maintaining full hypo awareness?

As for meters, GPs can change them unless there is a specific requirement for one that calculates bolus's, stress, exercise etc. they are committed to finding cheaper options of strips unless there is a specific reason why somebody needs a specific meter for their control. A consultant can normally ask for the old strips to be re instated and most GPs don't argue with patients if they have valid reasons for a specific meter. Handiness for working should be valid....I had Nurse ring me a couple years ago to change mine but let me keep it when I explained my reasons.....

 

[Karen_Cusack]

Under correct patient care they should listen to the patient and only change insulin so with their agreement or for better control. Is your partner having pretty good control within 4.5's to 7's the majority of the time, without assistance for hypo's and maintaining full hypo awareness?

As for meters, GPs can change them unless there is a specific requirement for one that calculates bolus's, stress, exercise etc. they are committed to finding cheaper options of strips unless there is a specific reason why somebody needs a specific meter for their control. A consultant can normally ask for the old strips to be re instated and most GPs don't argue with patients if they have valid reasons for a specific meter. Handiness for working should be valid....I had Nurse ring me a couple years ago to change mine but let me keep it when I explained my reasons.....

Thanks donnellysdogs,
He always had readings within the range and has full hypo awareness and has never needed assistance.
The testing strips cost approx the same, and new ones, if we were to have to buy them, are only £1 cheaper.
I have no idea if the novomix is dearer than the lantus and humalog together. I am just wondering if all of this is just based on the surgery cutting costs to the detriment of the patient, I just hope not.

 

[donnellysdogs]

Is this a GP that has changed meds etc? If so, I would be asking to see a diabetic consultant at a hospital to have a full discussion with someone that specialises. He is entitled to see a specialist for his care even with a normal hba1c.

I had similar recently when I moved house and this CCG like GPs to care for T1's..... After 30 years I knew that the best care and the only way for me to get Tresiba insulin was for me to see a consultant. I stated my case and now see a wonderful consultant and had my first ever appointment with a superb dietitian. I had to argue but I saw the consultant and within 2 minutes had the new Insulin that GPS in my CCG can't authorise.

Is he under GP care only?

 

[Karen_Cusack]

The surgery has passed the general care to a specialist diabetes nurse who works under the supervision of the GP from the surgery. The nurse just informed him that they wanted him to use the new meter, explained by drawing the new insulin regime on a piece of paper and told him it would be easier for him, but if he had a problem he could ring her at the hospital where she was normally based.
He has started today on the new regime, says he will try it. It is me that is worried as I see no point in trying to fix something that is not broken so to speak. Guess I worry unnecessarily and should just leave it to him.

 

[donnellysdogs]

That's what happened to me!! So I asked the specialist nurse to refer me to a Consultant.. ..my specialist nurse liaised from a community hospital between GP and Consultant.
Basal bolus regime is considered more flexible nowadays. It will enable less or more eating and definitely more flexibility. However, at the end of the day it is a patient's choice.
Has he got pens that give 1/2 unit doses? Depending on how much insulin he is taking, 1/2 unit pens are good. Initially they start on lower doses to try and avoid hypo's. It's important that he knows how to carb count and change his doses according to his readings. The DSN should have explained this...

It's good that he is willing to try as it is good for being able to eat when wanted. Ie I used to only eat once a day. Now I eat 6 small meals a day. If I need not to eat I don't have to.

I know of one gentleman that changed from two injections a day to a pump and totally different management after 38 years.. So a change can work out good sometimes.

It's great to see he has such a caring partner....

 

[Karen_Cusack]

Not sure what doses his pens have. He didn't mention anything about carb counting when i prepare his meals, guess i am in for some homework. Just hope she explained what doses to use as they are obviously different from his novomix ones.
Thanks for all your help. Now know i need to learn more on his behalf!!!!

 

[noblehead]

If he uses the Lantus at night how can he use the Humalog during the day when he is sleeping and not eating?

He wouldn't use the Humalog if he doesn't eat, lantus is a basal insulin which (if the dosage is correct) will keep his bg levels steady in the absence of food.

 

[donnellysdogs]

There will be a lot to take on board by both of you!!

With his old regime it wouldn't be necessary to exactly carb count as you both(!!) will need to do on the new regime....on the old regime I would have expected that he ate at regular-ish times and without too much worry.

When hoing on to basal bolus regime he should be offered a carb counting course called DAFNE which teaches how to dose adjust for eating in basic terms.

I see he is a shift worker, does this mean he rotates shifts? He will need to inject each time he eats on new regime. He will need to know what his bolus ratio is and his correction ratio.

Ideally his new meter will allow him to type in his carbs that he is eating and it will calculate his dose of bolus in seconds. Hopefully the meter will be able to advise half units if he has 1/2 unit pens.

There are some good books to read up on basal bolus regimes, and on carb counting.....

I'll tag @tim2000s for help on the books as I can't remember what they are. I know one good book is carbs n cals (n proteinn) available as an app or as a book.

There is also a course available from Bournemouth diabetes education on carb counting online.. And free. Your partner will need to learn too so would be great if you both could do together.