When is the right time for insulin

[becca59]

@Millie74 Yes I have a Libre. As long as my basal insulin is spot on, not eating doesn’t have an affect. On days I do not eat, If the Libra shows I am going down a bit I tend to have a dextrose/Jelly baby. I have had some stomach issues which are under a long winded investigation. I find having a fasting day helps to alleviate.

 

[Millie74]

@Millie74 Yes I have a Libre. As long as my basal insulin is spot on, not eating doesn’t have an affect. On days I do not eat, If the Libra shows I am going down a bit I tend to have a dextrose/Jelly baby. I have had some stomach issues which are under a long winded investigation. I find having a fasting day helps to alleviate.

Oh I see. With Basal insulin ok not to eat! The libres do sound good! Just wish they weren’t so expensive. I’ll let you all know how it goes Friday.

 

[Millie74]

Hi. Just an update for all. They started me on long acting insulin. One injection before bed. They started with 4 units of insulin, but didn’t seem to do anything. Still waking up around 7.8, so have moved it up to 6 units now. It still hasn’t done much. So I was 6.7 before bed and 6.9 this morning. Am I insulin resistant or is it just not a high enough dose. Worried I am resistant to the insulin.

 

[Millie74]

Hi Milly,

One very strong positive is that your exercise routine is predictable, ie. you know the timing (and presumably also the intensity?) of each class/block of classes in advance. Whatever insulin regime you start with, this is something you can plan around.

I was on basal insulin (the long-acting one) only for the first 18months and have now been on bolus as well for the past four months. There is so much to take in when you first start out on insulin....you just about get your head round the fact that there are two types (oh and mixed for some people!) and then someone kindly points out that different insulins have different timing profiles ie they take effect over differing lengths of time (lots of graphs on the Web). For example I am on Humulin basal; as I understand it this is one of the older (cheaper) shorter-lived 'long-acting' insulins, and tends to peter out after c.16hrs, whereas others will give a full 24 hour coverage. I split my dose and take 8units at 8.30pm and 6units at 8.30am, logic being that I am much more active in the day than at night. I found David Cavan's book, 'Take control of Type 1 Diabetes' really helpful on this subject. I don't want to burden you with yet another thing to worry about, rather suggest that the timing and possibly splitting of basal doses might be a helpful tool in your armoury.

A basal-only routine will be time-limited, but does have the benefit of simplicity and low likelihood of hypos. In those 18 months I only had one proper hypo, and really that was my own stupidity..... Your needs will be quite different because you do so much intense exercise. I would like to try a Libre sometime but can't justify the expense at the moment. In addition to my NHS strips, I do, however self-fund an Accu-chek cassette, which I find really helpful for testing when I am out walking, or (distant memory!!) out in town shopping/wining and dining. Lot less fiddly than strips, discrete and for some reason seems to need less blood - probably not an issue for you, but I often struggle to get a big enough blob for my test strips, and especially if I am feeling stressed about a potential hypo.

Fingers crossed for you, it really is a marathon not a sprint!

Susan x

Just reading about your split dose. I am now on 6 units of Lantus before bed. I started on 4 units. Hasn’t done a lot. Last night went to bed at 6.7. Woke up at 6.9. I keep hoping I’ll wake up with a magic 5 but it’s not happening. Any thoughts?

 

[Hertfordshiremum]

Just reading about your split dose. I am now on 6 units of Lantus before bed. I started on 4 units. Hasn’t done a lot. Last night went to bed at 6.7. Woke up at 6.9. I keep hoping I’ll wake up with a magic 5 but it’s not happening. Any thoughts?

Hi Millie
My nurse always tells me that the long acting is to keep you steady, so if you go to bed with BG at 6.7 and wake up at 6.9 that’s fairly spot on. It should be near enough the same reading. It’s the fast acting that lowers high blood glucose, remember 6.7 is normal, I would be very pleased with that reading when waking up. Have you been told about dawn phenomenon yet? You may well have been at 5 in the middle of the night and then with the dawn phenomenon gone up to 6.9. My nurse also tells me not to go to sleep with a reading of less than 6.5 to avoid nighttime hypos, so I would say you are doing great.
Do you have any fast acting insulin? You probably don’t need it for food unless you wanted a treat. However do you know if you get ill your blood glucose can go very high, nothing to do with food, it will be because your body is fighting an infection. Good to have a prescription in the house, just in case. Maybe mention this to your nurse?

 

[Swillbos]

I think Lantus covers 24hrs better than the Humulin I am on, so you may not get any gains from splitting, but others can advise on that. It actually sounds like six units is pretty much spot-on. The purpose of basal is to maintain a steady background level of blood sugar, and the optimal level is the one which enables you to wake up at the same level as the one you went to bed with not to drop it overnight. Personally I would be happy with your numbers, and focus effort on seeing whether your diet/exercise regime is enough to control fluctuation throughout the day with the assistance of this small amount of basal.

Hope this helps, best of luck!

 

[Swillbos]

Hertfordshire Mum and I posted at almost exactly the same time, and I completely agree with what she has posted!

 

[Millie74]

Hi Millie
My nurse always tells me that the long acting is to keep you steady, so if you go to bed with BG at 6.7 and wake up at 6.9 that’s fairly spot on. It should be near enough the same reading. It’s the fast acting that lowers high blood glucose, remember 6.7 is normal, I would be very pleased with that reading when waking up. Have you been told about dawn phenomenon yet? You may well have been at 5 in the middle of the night and then with the dawn phenomenon gone up to 6.9. My nurse also tells me not to go to sleep with a reading of less than 6.5 to avoid nighttime hypos, so I would say you are doing great.
Do you have any fast acting insulin? You probably don’t need it for food unless you wanted a treat. However do you know if you get ill your blood glucose can go very high, nothing to do with food, it will be because your body is fighting an infection. Good to have a prescription in the house, just in case. Maybe mention this to your nurse?

Thank you for this advice. Yes. It’s keeping me steady. There is an improvement to before insulin. I didn’t realise I may be 5 in the night and rise to 6 by the morning. I have been 5 or 6 in the morning this last week. I am glad you think in the 6s was good. I hadn’t asked what the target was. I thought I was always aiming for 5.

I will ask about fast acting incase ill. Thank you.

 

[Millie74]

I think Lantus covers 24hrs better than the Humulin I am on, so you may not get any gains from splitting, but others can advise on that. It actually sounds like six units is pretty much spot-on. The purpose of basal is to maintain a steady background level of blood sugar, and the optimal level is the one which enables you to wake up at the same level as the one you went to bed with not to drop it overnight. Personally I would be happy with your numbers, and focus effort on seeing whether your diet/exercise regime is enough to control fluctuation throughout the day with the assistance of this small amount of basal.

Hope this helps, best of luck!

Thanks. It makes absolute sense what both you and Hertfordshire Mum are saying.

I have thought about asking for fast acting for when I want a treat. But not sure if that is sensible or not? I manage to stick to low carb 95% of the time. Probably 98%. But if I have a treat meal on a rare ocassion I get 12-14 type numbers.

 

[EllieM]

Thanks. It makes absolute sense what both you and Hertfordshire Mum are saying.

I have thought about asking for fast acting for when I want a treat. But not sure if that is sensible or not? I manage to stick to low carb 95% of the time. Probably 98%. But if I have a treat meal on a rare ocassion I get 12-14 type numbers.

I'm assuming you've got an official T1/LADA diagnosis?

Low carbs works for T2s because they are insulin resistant and can't deal with the carbs - they usually produce too much insulin rather than too little, at least at the start. But as a T1 you've got the opposite problem, not enough insulin. Though going low carb can keep you medication free for quite a while, eventually you'll need the insulin. The issue with eating more carbs is just that you are going to need to take more insulin to do it, so you may find it harder to balance. But once you are taking bolus doses there's no reason why you shouldn't take the extra for a treat. Though plenty of T1s eat low carb, plenty of them don't. You just have to learn how to manage your insulin.

 

[Millie74]

I'm assuming you've got an official T1/LADA diagnosis?

Low carbs works for T2s because they are insulin resistant and can't deal with the carbs - they usually produce too much insulin rather than too little, at least at the start. But as a T1 you've got the opposite problem, not enough insulin. Though going low carb can keep you medication free for quite a while, eventually you'll need the insulin. The issue with eating more carbs is just that you are going to need to take more insulin to do it, so you may find it harder to balance. But once you are taking bolus doses there's no reason why you shouldn't take the extra for a treat. Though plenty of T1s eat low carb, plenty of them don't. You just have to learn how to manage your insulin.

Yes I have an official LADA diagnosis. I know. Was starting with long acting and continueing low carb for now. I know will eventually need fast acting. I am also still on Metformin. Wish I wasn’t as have nausea and stomach upset tonight.

 

[EllieM]

I am also still on Metformin. Wish I wasn’t as have nausea and stomach upset tonight.

Has that medication been reviewed since the LADA diagnosis? Honestly, if it makes you feel ill you should speak to your doctor. There is no reason for T1 to make you feel ill as long as your have reasonable (not perfect) control over matching your insulin to your food.

 

[KK123]

Yes I have an official LADA diagnosis. I know. Was starting with long acting and continueing low carb for now. I know will eventually need fast acting. I am also still on Metformin. Wish I wasn’t as have nausea and stomach upset tonight.

Hi Milllie, if I were you (and I sort of am),I would ask them for fast acting insulin too, I'm on novarapid. I tend to stick to lower carb, so often I don't need to use it for meals at all. However, if I have a slice of bread for example then I use 1 unit of it and that is enough to keep my levels from going higher. It gives you far more flexibility over what you choose to eat, and if you don't need it for a meal, well so be it. I end up chucking out the pens before they've finished after a month so you can use as little or as much as you need. The thing about 'teams' is that they are not that proactive for an individual as they have countless people to look after, if YOU tell them that when you eat a higher carb meal you go up to the teens they will accommodate you, then you can use it as and when and if you wish. x

 

[Millie74]

Hi Milllie, if I were you (and I sort of am),I would ask them for fast acting insulin too, I'm on novarapid. I tend to stick to lower carb, so often I don't need to use it for meals at all. However, if I have a slice of bread for example then I use 1 unit of it and that is enough to keep my levels from going higher. It gives you far more flexibility over what you choose to eat, and if you don't need it for a meal, well so be it. I end up chucking out the pens before they've finished after a month so you can use as little or as much as you need. The thing about 'teams' is that they are not that proactive for an individual as they have countless people to look after, if YOU tell them that when you eat a higher carb meal you go up to the teens they will accommodate you, then you can use it as and when and if you wish. x

Thank you. This is very good advice. So I wouldn’t have to use it all the time. Just if I have a higher carb meal? Sounds ideal.

They said I had to have Metformin with T1.5 for insulin resistance. I’ve been on it a long time top dose. I am ok most of the time, but every 2-4 weeks feel very nauseated and ill at night.

 

[Millie74]

Has that medication been reviewed since the LADA diagnosis? Honestly, if it makes you feel ill you should speak to your doctor. There is no reason for T1 to make you feel ill as long as your have reasonable (not perfect) control over matching your insulin to your food.

They said as T1.5 needed it for insulin resistance. I also used to have PCOS that makes you gain weight easily and insulin resistant. But I had an ovarian diathermy op for that before children and now have a regular cycle. So not sure where I am with that all these years on. Would be good to come off Metformin as long as I don’t gain weight. I keep fearing gaining weight on insulin, but can’t see any significant gain so far.

 

[KK123]

Thank you. This is very good advice. So I wouldn’t have to use it all the time. Just if I have a higher carb meal? Sounds ideal.

They said I had to have Metformin with T1.5 for insulin resistance. I’ve been on it a long time top dose. I am ok most of the time, but every 2-4 weeks feel very nauseated and ill at night.

Yes, with the bolus (fast acting) you use it with meals if you need to dependent on the meal, with basal (long acting, background insulin), you use it whether you eat or not. You can also use bolus to bring down stubbornly high glucose levels but you really would need to be knowledgeable and confident so please speak to your medical team about that. I don't know about the metformin, how do they know you are insulin resistant by the way? As for weight gain, I guess it depends on the individual but I don't think insulin in and of itself causes weight gain unless you are giving your body more insulin than it can cope with (like any other person), for example if you decided to overload your body with more carbs than it can cope with and then use more insulin to combat the higher glucose levels, this 'may' cause weight gain or insulin resistance. It's very complicated mind! x

 

[Millie74]

Yes, with the bolus (fast acting) you use it with meals if you need to dependent on the meal, with basal (long acting, background insulin), you use it whether you eat or not. You can also use bolus to bring down stubbornly high glucose levels but you really would need to be knowledgeable and confident so please speak to your medical team about that. I don't know about the metformin, how do they know you are insulin resistant by the way? As for weight gain, I guess it depends on the individual but I don't think insulin in and of itself causes weight gain unless you are giving your body more insulin than it can cope with (like any other person), for example if you decided to overload your body with more carbs than it can cope with and then use more insulin to combat the higher glucose levels, this 'may' cause weight gain or insulin resistance. It's very complicated mind! x

They just assume I am insulin resistant as have what they call LADA type 1.5 and I had pcos which causes insulin resistance.

I was also going to ask about injection sites. They told me to only inject in stomach. Said safest place. But feeling really bloated and looking it in stomach. Is this to do with injecting in stomach? I’ve only been doing it a few weeks. 6 units per night.

 

[KK123]

They just assume I am insulin resistant as have what they call LADA type 1.5 and I had pcos which causes insulin resistance.

I was also going to ask about injection sites. They told me to only inject in stomach. Said safest place. But feeling really bloated and looking it in stomach. Is this to do with injecting in stomach? I’ve only been doing it a few weeks. 6 units per night.

Well you 'may' be insulin resistant but being LADA doesn't automatically make it so. I imagine they are assuming that type 1.5/LADA can have traits from both type 1 and type 2 but once again it sounds like they are jumping to conclusions, not sure how your pcos comes into it though. I inject in my belly mostly but sometimes use my thighs or bum!

 

[Hertfordshiremum]

They just assume I am insulin resistant as have what they call LADA type 1.5 and I had pcos which causes insulin resistance.

I was also going to ask about injection sites. They told me to only inject in stomach. Said safest place. But feeling really bloated and looking it in stomach. Is this to do with injecting in stomach? I’ve only been doing it a few weeks. 6 units per night.

Millie

I was in the same situation as you, they put me on metformin at diagnosis and I had an upset stomach and nausea almost every day, after a year I switched to a different nurse who said try stop taking it and see what happens. She said no way was I insulin resistant, within a few days I was much better, with lower BG, she thought the physical aggravation of all the stomach upsets was actually making my blood sugar higher.
I was much better without it and I stuck it out for almost a year, wish I had questioned it earlier. Really question what they are asking you to do if it’s not agreeing with you. I think they are often so pushed for time they sometimes just try a standard procedure and see whether you object or not! It’s tough at the beginning, as certainly for me no two days are the same, the more you know the better so you can adapt to changes.

 

[Hertfordshiremum]

They just assume I am insulin resistant as have what they call LADA type 1.5 and I had pcos which causes insulin resistance.

I was also going to ask about injection sites. They told me to only inject in stomach. Said safest place. But feeling really bloated and looking it in stomach. Is this to do with injecting in stomach? I’ve only been doing it a few weeks. 6 units per night.

As I understand it, it takes effect most quickly by injecting in your stomach, the next quickest place is your arm ( the back of your upper arm, the flabby bit!), then thigh then bottom. As you are mainly just on slow acting at the moment I wouldn’t have thought it matters if you inject elsewhere. As I understand it slow acting takes about 4 hours to kick in anyway.