any preference for mixed insulin

[borderter]

My novorapid only lasts 2-3 hours and levemir is like water to me so I have the option to go onto mixed so is this a good solution please

 

[oldgreymare]

My novorapid only lasts 2-3 hours and levemir is like water to me so I have the option to go onto mixed so is this a good solution please

Short answer from me is NO. If you find Novorapid only lasts 2-3 hours, that is pretty much to be expected. But what do you mean Levemir is like water? How have you calibrated your basal (= background Levemir insulin) dose? What and why has your DSN recommended?

Mixed insulin injections may seem like a simpler solution but only if you are very disciplined re exact meals (always same carbs, proteins, fats - you need to track all) and exactly same activities at the same time every day in order to match the profile of your mixed insulin doses. Otherwise learning to carb count and bolus dose on MDI may be easier/more suitable.

 

[borderter]

Short answer from me is NO. If you find Novorapid only lasts 2-3 hours, that is pretty much to be expected. But what do you mean Levemir is like water? How have you calibrated your basal (= background Levemir insulin) dose? What and why has your DSN recommended?

Mixed insulin injections may seem like a simpler solution but only if you are very disciplined re exact meals (always same carbs, proteins, fats - you need to track all) and exactly same activities at the same time every day in order to match the profile of your mixed insulin doses. Otherwise learning to carb count and bolus dose on MDI may be easier/more suitable.

Hi thanks for your imput
Only takr rapid as levemir did absolutely nothing for my glucose levels and tried lantus but strangely my ankles seized up so gave it a while then tried again and ankles seized up again so have been managing with just novo
No one ever told me how much levemir to use so just guessed but will discus this with dns next week to decide how to go foward
My bgs reach teens between meals so obviously need something in the background
Was recently put onto canagliflozin to help but kidney function dropped like a stone very bad med that one
For curiuosity how do I calibrate basal please

 

[borderter]

Hi thanks for your imput
Only takr rapid as levemir did absolutely nothing for my glucose levels and tried lantus but strangely my ankles seized up so gave it a while then tried again and ankles seized up again so have been managing with just novo
No one ever told me how much levemir to use so just guessed but will discus this with dns next week to decide how to go foward
My bgs reach teens between meals so obviously need something in the background
Was recently put onto canagliflozin to help but kidney function dropped like a stone very bad med that one
For curiuosity how do I calibrate basal please

Also have been carb counting for 12 years so thats not the problem

 

[Jaylee]

My novorapid only lasts 2-3 hours and levemir is like water to me so I have the option to go onto mixed so is this a good solution please

Hi,

I'm sorry your insulin seems to be giving you the run-around?

I Have to admit, my basal (long acting Lantus.) Can loose its potency till i change the cartridge.
& recently i had to lower my dosage due to too many fasting hypos.

This link may help you with regards to finding out what your long acting insulin is doing.. https://www.mysugr.com/en/blog/basal-rate-testing/
Do by all means talk this through with your Doctor or Nurse..

Novorapid, for me works well (Contradictory to other reports from users.) I have found it can still have a bit of a lick in the tail at around the 4.5 hour mark?

My memories of a mixed fixed dosage back in the day.. Due to my erratic schedule & lifestyle i found BGs harder to manage being anchored to fixed mealtimes? Which was why my Doc put me on MDI back in the late 1980s.

I'll tag in @urbanracer who has a more recent experience with the mixed insulins.

 

[EllieM]

No one ever told me how much levemir to use so just guessed but will discus this with dns next week to decide how to go foward

It just amazes me that doctors prescribe insulin without specifying how much to take! That is so negligent....

My understanding is that as a T2 you may need a lot more insulin than T1s such as myself. Insulin resistance is the reason that extra strong U300 and U500 insulins were produced. So it may just be that you were taking far too little levemir to make a difference. But because you are presumably still producing some of your own insulin you may be in a slightly different position to a T1.

If you haven't been using a basal how have your levels been overnight?

As regards the mixed dose/fixed dose insulin, it can work but as @oldgreymare and @Jaylee said you have to be very disciplined. It was all the rage 50 years ago when I was diagnosed as a child, but you had to have meals and snacks at fixed times with fixed amounts of carbs. And no real way to do correction doses. (Of course, back then there were no glucometers, so you didn't really know that you needed a correction dose.) The one advantage was that you only had to do one or two injections per day. It's basically a question of modifying your lifestyle to fit your insulin, whereas basal/bolus allows you to modify your insulin to suit your lifestyle.

Personally, in your position, I'd work on tweaking my levemir dose before giving up on it altogether, but you do need advice from your team, as dosage varies so much from person to person.

Good luck.

 

[Deleted member 527103]

@borderter Levemir and Lantus are not the only basal insulin’s. For example, Tresiba is a longer lasting basal insulin which may be worth discussing. But again, it is down to getting your dose right.

My other thought is around carb counting. For those with Type 1, we mean counting carbs and calculating bolus insulin dose to match the carbs. I realise for some people with Type 2, carb counting means counting carbs to keep track of daily consumption.
Apologies if I am teaching you to suck eggs but I wanted to check you understood the insulin dose calculation part. My bolus dose varies hugely dependent on what I eat. One dinner may require 8 times as much fast acting insulin than another.

 

[Daibell]

Hi. I am amazed that no one explained how to dose your Levemir and also that it apparently had no effect. Basal dosage is often started based on your weight and the simple way of adjusting your dosage is to see if your BS goes up or down after several hours fasting and adjusting to keep it level. Another check is to keep your morning fasting BS level between 5 & 7 mmol. The Bolus is designed to work up to 5 hours max for NovoRapid and should be taken shortly before each main meal. Ref carb-counting for the Bolus it means adjusting the Bolus number of shots based on the carbs in the meal. Many of us will have been started on a ratio of 1 unit of Bolus per 10gm of carbs and then the ratio is tweaked based on experience. Do you have any excess weight? if so, you may have insulin resistance and that would render the insulin less effective. I can't see how using a mixed insulin would help you. If the Basal doesn't work for you, a mixed won't either?

 

[borderter]

@borderter Levemir and Lantus are not the only basal insulin’s. For example, Tresiba is a longer lasting basal insulin which may be worth discussing. But again, it is down to getting your dose right.

My other thought is around carb counting. For those with Type 1, we mean counting carbs and calculating bolus insulin dose to match the carbs. I realise for some people with Type 2, carb counting means counting carbs to keep track of daily consumption.
Apologies if I am teaching you to suck eggs but I wanted to check you understood the insulin dose calculation part. My bolus dose varies hugely dependent on what I eat. One dinner may require 8 times as much fast acting insulin than another.

I carb count to insulin dose and have that well sorted its finding background insulin thats the problem and fiasp/tresiba etc have all been a problem for me ,my body (heart) just doesnt like these and lantus most of all sadly as lantus worked well .Levemir had no side effects so maybe with dns helping I can find a dose that works for me

 

[borderter]

Hi. I am amazed that no one explained how to dose your Levemir and also that it apparently had no effect. Basal dosage is often started based on your weight and the simple way of adjusting your dosage is to see if your BS goes up or down after several hours fasting and adjusting to keep it level. Another check is to keep your morning fasting BS level between 5 & 7 mmol. The Bolus is designed to work up to 5 hours max for NovoRapid and should be taken shortly before each main meal. Ref carb-counting for the Bolus it means adjusting the Bolus number of shots based on the carbs in the meal. Many of us will have been started on a ratio of 1 unit of Bolus per 10gm of carbs and then the ratio is tweaked based on experience. Do you have any excess weight? if so, you may have insulin resistance and that would render the insulin less effective. I can't see how using a mixed insulin would help you. If the Basal doesn't work for you, a mixed won't either?

carb countng and bolusing is second nature to me after many years and its not the problem its just not lasting long enough and need a bit of background to lower the high peaks in between meals