Mervyn said:
Hi,
Hope everyone is ok...I have been type 2 for 10 years and have been on Lantus insulin...taken in the morning, for about 2 months. My units have been gradually increased and my before lunch and before dinner glucose readings are pretty good..averaging 5.9. The problem is that my bedtime reading is between 11.0 and 14.0, and my morning readings are between 7.6 and 9.0.
I do not want to "up" my units too much if it means that my pre lunch and pre evening meal readings becoming too low and get into the "hypo" range.
My diabetic nurse does not appear to be listening to me very well. Does anyone think that I would benefit from an additional type of insulin in the evening? If so, how am I going to convince the diabetic specialist nurse? Or am I over reacting?
Any advice would be appreciated as I am trying not to "stress out" over all this.
Mervyn
In my opinion, Lantus is being misused by many health professionals and diabetics. Lantus is designed to provide the low level of basal insulin that our bodies should produce. It is meant for those people whose insulin production is so impaired that their blood sugar would rise even if they didn't eat (I'm not referring to the dawn phenomenon). Bolus (fast-acting) insulin is meant to cover your post-prandial insulin needs. Indeed, most type-2 diabetics lose their ability to release the large amounts of insulin needed to cover meals, not the small amounts required to keep fasting blood-sugar levels normal. Thus, most diabetics who inject should be taking bolus insulin before eating (it takes an hour to take effect). Regular (R) insulin is, in my opinion, the best bolus insulin. The faster insulins that have been engineered to enter the body quickly are more finicky. If you cover your meals with R insulin, you will probably find that your fasting levels are good also. Here is how you do it:
You inject R insulin about an hour before you eat (it takes that long to start having an effect when injected into your fat). It will then stay in your body for about 4 hours, peaking after about 3 hours (meaning, 4 hours after you injected). Thus, you can eat two small meals on an injection, one meal 1 hour after injecting, and another meal (or a snack) 3 hours after injecting. As the insulin winds down, it will bring your blood sugar back to normal.
If you don't want to inject 3 times a day, then do this: eat a no-carb or very-low-carb breakfast (such as bacon & eggs). For a mid-morning snack, have something very low-carb, such as nuts or cheese. Then inject before lunch and dinner. For lunch, you can eat a moderate meal plus a mid-afternoon snack. For dinner, you can eat a moderate meal plus a before-bed snack. You'll need to figure out your insulin-to-carbs ratio. For me, it is 1 unit per 3 carbs to be consumed (I can sometimes get away with 4 carbs). Your ratio is likely to be similar to that.
I have achieved an A1c of 6.2 even though I am not eating low-carb these days (I'm trying to improve that), and I did it by carefully covering all my carby meals with R insulin. If I were to eat fewer carbs, I could easily achieve an A1c of 5.5 or less. As for my waking numbers, they are in the range of 6.3 to 7.5, which I consider acceptable. The only time my numbers go up is when I eat more carbs than I injected for.
The only caveat: If you eat too many carbs (175 to 200 or more, depending on your body), you can start to gain weight. This works best if you keep your carbs to 150 per day or less (but I am eating more than that).
Here in the U.S., R insulin is cheap and available without a prescription. That may not be the case in Britain. There is a great bias in the medical profession in favor of the expensive engineered insulins. R insulin is a forgotten, unsung hero that can do great things for you.
