Insulin switched today!

[Janeliz66]

Hi my DN has switched me from Humulin m3 today to Lantas and novorapid as Hba1c is 92! Sooo I'm going to begin tonight with 24 units of Lantas and tomorrow 8 units before each meal and to titrate up 2 units of novorapid until post meal is between 6 and 9 any tips or advice gratefully recieved

 

[donnellysdogs]

Do you carb count?

Will you be going on a DAFNE course?

You need to test a few nights at 3 or 4am.

Do test before each meal, and 2 hours after a meal.
If you can try to keep 5 hours between meals. Do not do this if you are liable to go hypo.

Have you got follow up callls from your DSN?

Make sure you lig everyything down... ie food, exercise, levels etc..

 

[Janeliz66]

Hi and thanks For your reply I don't count carbs and when I asked her about them she said it would be trial and error and that I'd soon learn I'd soon learn to recognise how many to Have by judging on the results....i am worried about taking it for first time as it is overnight so I'm taking your advice and Have set my alarm for 4am I took it at 10pm I'm rather anxious about Any side effects too but really need this to be a success.....

 

[ickihun]

Those units should have been calculated on your insulin need on m3. They give you a percentage to play with.
I'd be surprised if your first undertaking gave you a hypo but there's always a first.
How long were you on m3 and how many units were you taking?

 

[Janeliz66]

Those units should have been calculated on your insulin need on m3. They give you a percentage to play with.
I'd be surprised if your first undertaking gave you a hypo but there's always a first.
How long were you on m3 and how many units were you taking?

I was taking 24 at breakfast and same at evening meal been on it 2 years I also take 1000mg metformin with it.....

 

[ringi]

How long have you had Type2?

 

[Janeliz66]

How long have you had Type2?

Hi I was diagnosed with gestational diabetes 25 years ago and it never went!

 

[Janeliz66]

Fasting glucose this morning 11.7 which id's better Than the usual 14

 

[DCUKMod]

Fasting glucose this morning 11.7 which id's better Than the usual 14

Hi Janeliz - Switching medication is naturally a bit of a stressful time, as you work out what's best for you.

Right now, I would say it is really important that you are testing lots, and that you should try to only change one things at a time. If you change more than one thing at any given time, it can be impossible to work out exactly what caused any change you made (first thing, second thing, or a combination of both things).

Having read of several members switching from pre-mixed insulins to what can be more the flexible long acting + short acting insulin, often referred to as MDI (Multiple Daily Injections), it is quite a learning curve.

Most who make the change see it as a positive move, once their initial steep learning curve has passed, as it can, over time, allow you to more closely match your medication to your body's needs.

Most T1s on MDI are offered a carb counting course to help with that matching, but that appears less usual for T2s.

There is at least one online carb counting course, called, BERTIE, which others have found useful, even if it designed for T1s.

I would suggest taking things steadily, as sometimes these things can be a bit like the tortoise catching the hare, with a sure and steady approach achieving more than rushing to make so many changes you end up bewildered.

I seem to recall @Cumberland making a change to MDI along the way, although if I recall properly, that was also around the time his diagnosis changed from T2 to T1.

Hopefully there'll be other dropping by today who can give you some more specific information.

 

[Janeliz66]

Thanks you have been so helpful

 

[ickihun]

I was taking 24 at breakfast and same at evening meal been on it 2 years I also take 1000mg metformin with it.....

Wow. Just 48units of mixed insulin even with metformin is very good for an insulin resistant diabetic.
I'm guessing you were having hypos for your m3 to be changed to mdi (multiple dose insulin-injections)?
You maybe able to drop your insulin one day. Is your diabetic team asking you to carb count with your insulin? Mine doesn't as I eat as low carb as I can without feeling ill (palpatations) due to other health problems.
I was taking just under 300units of m3 at xmas 2016. I'm now on 66units of basal and 20, 20, 20 units of novarapid or 30, 20/30 if I'm fasting. Fasting doesn't benefit me, I've found. Although taking the pressure off my swollen water balloon tummy feels less uncomfortable with less food.
Do you think if you seriously reduced potato, pasta, rice and bread if you could maybe eventually reduce your bolus injections, like me?
Settle into your new routine of what insulin you will currently need first. Then you'll know your starting point.
Stick to your dn advice for increasing or decreasing your novarapid and lantus. They are invaluable when insulin needs changing. Mine has decades of experience. Of which I'd never ignore.
I bet you feel excited about the prospect of reducing your insulin units more?
How much carb and protein do you currently eat daily?

 

[Janeliz66]

Wow. Just 48units of mixed insulin even with metformin is very good for an insulin resistant diabetic.
I'm guessing you were having hypos for your m3 to be changed to mdi (multiple dose insulin-injections)?
You maybe able to drop your insulin one day. Is your diabetic team asking you to carb count with your insulin? Mine doesn't as I eat as low carb as I can without feeling ill (palpatations) due to other health problems.
I was taking just under 300units of m3 at xmas 2016. I'm now on 66units of basal and 20, 20, 20 units of novarapid or 30, 20/30 if I'm fasting. Fasting doesn't benefit me, I've found. Although taking the pressure off my swollen water balloon tummy feels less uncomfortable with less food.
Do you think if you seriously reduced potato, pasta, rice and bread if you could maybe eventually reduce your bolus injections, like me?
Settle into your new routine of what insulin you will currently need first. Then you'll know your starting point.
Stick to your dn advice for increasing or decreasing your novarapid and lantus. They are invaluable when insulin needs changing. Mine has decades of experience. Of which I'd never ignore.
I bet you feel excited about the prospect of reducing your insulin units more?
How much carb and protein do you currently eat daily?

Hi the reason I've been changed is because Hba1c got to 92! So m3 wasn't working for me nor did it fit into my lifestyle taking m3 as recommended 40 mins before a meal wasn't practical for me but actually taking it when I'm about to eat id's much better also post meal spikes were a real worry..... I don't count carbs as that is the basis of my diet I'm following slimming world which is carby

 

[DCUKMod]

Wow. Just 48units of mixed insulin even with metformin is very good for an insulin resistant diabetic.
I'm guessing you were having hypos for your m3 to be changed to mdi (multiple dose insulin-injections)?
You maybe able to drop your insulin one day. Is your diabetic team asking you to carb count with your insulin? Mine doesn't as I eat as low carb as I can without feeling ill (palpatations) due to other health problems.
I was taking just under 300units of m3 at xmas 2016. I'm now on 66units of basal and 20, 20, 20 units of novarapid or 30, 20/30 if I'm fasting. Fasting doesn't benefit me, I've found. Although taking the pressure off my swollen water balloon tummy feels less uncomfortable with less food.
Do you think if you seriously reduced potato, pasta, rice and bread if you could maybe eventually reduce your bolus injections, like me?
Settle into your new routine of what insulin you will currently need first. Then you'll know your starting point.
Stick to your dn advice for increasing or decreasing your novarapid and lantus. They are invaluable when insulin needs changing. Mine has decades of experience. Of which I'd never ignore.
I bet you feel excited about the prospect of reducing your insulin units more?
How much carb and protein do you currently eat daily?

Ickihun, reading @Janeliz66 's posts, it looks like the rationale for changing her insulin therapy was to trim back an HbA1c of 92, not as far as I can read, to reduce the amount of insulin being taken.

My thoughts would be that the amount of insulin needs to take to balance their requirements is very personal, with some requiring more or less than others. I can't say I have read of any insulin dependent diabetics (IDDs) experimenting by mirroring each other, over any period. My guess is that would be extremely tricky, bearing in mind that sleep, stress and so many other things can get into the mix and impact blood glucose and insulin requirements

I appreciate you have always wanted to trim back your insulin requirements, and that's admirable, bearing in mind your "bigger picture" objectives. Provided it can be done without risking one's health (which you seem to be managing to do), I salute you in your efforts.

I do however agree that it makes sense for janeliz to sort out a steady state, before experimenting too much with diet or anything, if she even wants to do that.

@janeliz - I really wish you well on your exciting, but scary journey. It sounds like you want to take a careful approach and I agree that makes sense.

 

[DCUKMod]

Oooops, looks like I was composing as you were posting @janeliz .

 

[ringi]

Most people with Type2 find that a low carb diet works a lot better for them then a low fat diet.

As you are on insulin you MUST check your BG often and make changes to your diet slowly, so don't do the induction phase (first week) of a Akins type diat without carefull consideration of the risks. But the 2nd phase of an Akins type diat may work well for you, and you can just skip the first phase.

@ickihun is a very good person for you to listen to, as she can relate to what you are facing a lot better then most of us.

 

[ickihun]

What I've found is insulin resistant diabetics on m3 would just need to add and add their units to reduce there hba1c @DCUKMod . I admire OPs diabetic team as they have recognised early that more units would reduce her hba1c but feed the insulin resistance. Making her type2 condition more difficult to manage. Like dr beinstein wrote.... smaller changes cause smaller errors. So less likelihood of a hypo.
That is why she has been advised to just adjust in small units not like some who have to adjust in larger amounts of units due to severe insulin resistance.
Her team will always evaluate the risk of her hypo for her, first and for most. The reduction of hba1c to none diabetic range may never come for some. No matter what treatment is offered.
Insulin treatment is the best treatment for lowering hba1c. In type 2s too!
Anyone can sustain lower hba1cs on insulin treatment.
The more insulin you take, the lower the hba1c if hypos are not more frequent than ideal bgs.
Hypo treatment is essential but too many hypo treatments can interfer with your hba1c result.
The less hypos, the better, all round. Nasty side affect to too much insulin injected.

 

[ickihun]

Hi the reason I've been changed is because Hba1c got to 92! So m3 wasn't working for me nor did it fit into my lifestyle taking m3 as recommended 40 mins before a meal wasn't practical for me but actually taking it when I'm about to eat id's much better also post meal spikes were a real worry..... I don't count carbs as that is the basis of my diet I'm following slimming world which is carby

There are a large amount of posters having success on this forums Low Carb Programme to reduce their hba1cs.
Through my meter readings and experimentation of what foods do what to my bgs, especially spikes, I've reduced my hba1c from 117 to 48.
With insulin too much fat slows down digestion too much for novarapid to encapsulate. Many type1s have taught me the beauty of novarapid. M3 has no rapid insulin in at all so you will flourish on novarapid.

 

[DCUKMod]

What I've found is insulin resistant diabetics on m3 would just need to add and add their units to reduce there hba1c @DCUKMod . I admire OPs diabetic team as they have recognised early that more units would reduce her hba1c but feed the insulin resistance. Making her type2 condition more difficult to manage. Like dr beinstein wrote.... smaller changes cause smaller errors. So less likelihood of a hypo.
That is why she has been advised to just adjust in small units not like some who have to adjust in larger amounts of units due to severe insulin resistance.
Her team will always evaluate the risk of her hypo for her, first and for most. The reduction of hba1c may never come for some. No matter what treatment is offered.
Insulin treatment is the best treatment for lowering hba1c. In type 2s too!
Anyone can sustain lower hba1cs on insulin treatment.
The more insulin you take, the lower the hba1c if hypos are not more frequent than ideal bgs.
Hypo treatment is essential but too many hypo treatments can interfer with your hba1c result.
The less hypos, the better, all round. Nasty side affect to too much insulin injected.

I don't want to get into any tiff on insulin therapy, but I would take issue with this phrasing in your post, "Insulin treatment is the best treatment for lowering hba1c. In type 2s too!"

I don't for an instant argue that insulin is an inappropriate tool for blood glucose management in T2, but it isn't best for everyone, if HbA1cs can be moderated by other means, whether that be diet or oral medication. I'd guess those usual things didn't work out for @Janeliz66

Clearly insulin doses need to be set appropriately for the individual's requirements, and many find MDI offers significant flexibility, but right now, I think it's important that janeliz66 works toward finding her steady state before considering too many other changes.

Having observed others go through this, it strikes me that for the most part the medics tend to start the person in a safe place, but test, test and then test some more seems like the way to go.

I'll dip out of this thread for now, as I seem to be becoming a party to deflecting it away from janeliz66. My apologies.

 

[donnellysdogs]

Doses are individual so we should not be commenting on them anyway!!

@Janeliz66 was seeking tips and advice.

I understand OP does weightwatchers so as she says its quite carby. This is her choice and whatever fits in to her lifestyle is ok.

However, counting carbs for bolysing is hugely important. Hugely! Not to become a low carber or high carber or anything to do with chosen eating roytibes BUT to give the right amount of bolys insulin.

I'm not getting in to the rights or wrongs of mdi/insulin for T2's but it is so important that no matter what you eat that you know how many carbs you are eating so that you can adjust the bolus's for when you eat more or leas or different things...

You need to have a dafne course sooner rather than later.

 

[ickihun]

Doses are individual so we should not be commenting on them anyway!!

@Janeliz66 was seeking tips and advice.

I understand OP does weightwatchers so as she says its quite carby. This is her choice and whatever fits in to her lifestyle is ok.

However, counting carbs for bolysing is hugely important. Hugely! Not to become a low carber or high carber or anything to do with chosen eating roytibes BUT to give the right amount of bolys insulin.

I'm not getting in to the rights or wrongs of mdi/insulin for T2's but it is so important that no matter what you eat that you know how many carbs you are eating so that you can adjust the bolus's for when you eat more or leas or different things...

You need to have a dafne course sooner rather than later.

Shame type 2s don't have a insulin resistance course too. You never know what the future holds.