Hoppin' on the b/b train?

[lilibet]

Hi all

Had first clinic appt, first A1c 7.9 , though only dx recently and obv hoping to improve this)
Consultant v pleased re general bs readings over past weeks and happy to consider b/b regimen but on consulting with high honcho DSN she has asked I hold on for couple more weeks and then see. They would like me to try and be more flexible on current regime - mix 2x daily- as they think am too controlled (how do they think I get my good pre meal readings :!
DSN also asking why I want to change when results are so 'good'. I have lots of reasons re flexibility in general, freedom to look at better exercise, they are going to change me anyway so why not now and I do feel that current insulin making me feel ill so want to change to something else anyway (can imagine their reaction at my suggestion that insulin is making me feel ill)

However, they are now beginning to make me doubt a wee bit, not least with implication that things may go to hell when I change.

I know they will change for worse likely whilst titrating doses etc and no one can make decision for me but any advice on those who have changed over would be much appreciated.
Did folk have a ball park figure for time it takes to settle?

Thanks in advance, am bit feart now.

L x

 

[hanadr]

How on earth can anyone be too controlled? Those people that don't have diabetes have INSTANT feed back control systems. I would definitely be there asking them to explain what too controlled means. Does it mean you aren't listening enough to them?

 

[lilibet]

Hi Hana

By controlled I dont think they mean bg in particular, just routine. Nurse said i was almost ''clinical' in my approach. Did remind her that I was told by her colleague to try and inject at same time every day, take snacks in between meals, eat half hour after injecting and there aint much flexibility in that!

I am not averse to whipping out an oatcake in the supermarket but had to disavow them of notion that it was not my routine per se which inhibited my life(though it is a pain in the ***) - but the fact that I still feel RUBBISH. If I felt well, then I would just get on with it until such times i changed over.
Hoping bb will stop peaks and troughs as la pre mix and also be able to prevent any pp readings, if it is this which is making me feel off colour still.

We'll see...................

 

[Dennis]

Hi Lilibet,
I just love the too well controlled comment. If you went to your doctor and he said that you are too well, so lets see what we can do to change that - you would think he was insane - or from the Dr Harold Shipman school of medicine! And yet we regularly see that comment made to people who have striven to control their diabetes.

 

[Trinkwasser]

Hi Lilibet,
I just love the too well controlled comment. If you went to your doctor and he said that you are too well, so lets see what we can do to change that - you would think he was insane - or from the Dr Harold Shipman school of medicine! And yet we regularly see that comment made to people who have striven to control their diabetes.

Probably the best approach would be to ask them what is the cost of basal-bolus compared to the cost of mixturd

IMNSHO that's the reason some PCTs are unwilling to change patients over

 

[Stuboy]

definatly try basal bolus if you can! it does mean a few more injection but the control and freedom over mixtard is unbeleivable!

I think you pretty much HAVE to be clinical in your approach when treating with mixtard because it requires such a routine with injection times and having to snack between meals. I personally hated it and would never go back to it.

 

[LittleSue]

Probably the best approach would be to ask them what is the cost of basal-bolus compared to the cost of mixturd

IMNSHO that's the reason some PCTs are unwilling to change patients over

Could be right. More needles, insulin x2, pens x2, extra test strips... whereas inflexible regime only costs quality of life.

 

[lilibet]

Consultant was all for doing it that day but DSN kiboshed it for now, to be continued...............

Their reasons appear to be
- still new to diagnosis and need time to get used to diabetes per se
-units of insulin v small and they concerned how to titrate 10u per day across possibley 2 basal doses and 3 bolus, esp as insulin could prob cut to 8u
-my bg are very settled/acceptable( to their mind), rarely getting above 7 before meals, fasting sugars usually about 5.6

They seem to think I will be going on it eventually and have said as much but asking me to hang fire for now. Am going to start testing more after 2hr point, get an idea cause I want to be able to control any high pp and suspect premix not good for this.

Did people have any major probs changing over?
Also, Levemir v Lantus? Heard mixed reviews re Lantus and am not prepared to put any weight on!!!

 

[CLP]

Hi Lillibet

I've just started on Basal Bolus. Having been on pre-mixed beforehand and I was having issues with readings 2 hours after eating. I chose to go for levemir rather than Lantus. When I asked my DN how to decide she told me to go for the pen that I liked the best :!: Hopefully you'll get some more useful advice!

Its been 2 weeks today and I have to say its been quite tough, whereas before I could pretty well control my BG and knew what effect certain foods would have on me now that I've changed the same foods give different results. I'm having to relearn this all again. LIke you my doses are very small so it makes matching to food quite hard as there is quite a big difference between the effect of 3 units of fast acting to 4 units.

I'm hoping I can persuade the DN to let me split the levemir dose as by 5pm - 6pm I've run out and don't take my next dose till 10pm so this is causing some issues.

However I don't want to put you off as the flexibility you get is worth the hassle of changing over. So although its not easy it will be worth it in the long run. (I keep telling myself this when my readings go haywire :lol:

Claire

 

[Trinkwasser]

I'm hoping I can persuade the DN to let me split the levemir dose as by 5pm - 6pm I've run out and don't take my next dose till 10pm so this is causing some issues.

HUH???

I thought Levemir was always dosed twice a day. Lantus may or may not last 24 hours (people known to me have a spread from about 16 to 30 hours) I thought Levemir never did?

 

[Trinkwasser]

Probably the best approach would be to ask them what is the cost of basal-bolus compared to the cost of mixturd

IMNSHO that's the reason some PCTs are unwilling to change patients over

Could be right. More needles, insulin x2, pens x2, extra test strips... whereas inflexible regime only costs quality of life.

Which no doubt the actuaries have taken into account. Live longer, cost the NHS more . . .

 

[blackbird]

I was diagnosed in May this year, and went straight onto Mixtard 30. Although it did reduce my bs, I couldn't get the kind of results I wanted. I found that I would have a hypo mid morning, correct that, have lunch and a couple of hours after my bs would be between 15 and 21, eat dinner and then have a hypo mid evening. I changed to Levemir and Novorapid two weeks ago and the difference is fantastic. I have one injection of Levemir in the evening, and Novorapid before eating. I can eat what I want and still keep good control of my bs. For me it's been a really good move.

 

[lilibet]

Thanks for the responses all

My results have been ok, not had bs in double figures for many weeks (only dx 7 wks ago) and most pre meals within range. I know its hard to do on a mix but I have been 'managing' carbs so likely this is helping results
My results can be predictable at times such as- testing in the 4's pre dinner will give me a hypo if I wait half an hour and as such need to start snacking, or have dinner right away. Also need keep close eye pre lunch and do need to snack whether I like it or not.
Routine is manageable, cause it has to be, and at this early stage am just anxious to keep sugars down. My motivation is general feeling of malaise which I cant put down to anything else - though of course no proof.

Is good to hear however that two weeks has made a big difference Blackbird, cause I have reasonable control and would hate to lose it at this point, though do think if Im gonna change, I might as well get it over with cause mix is fine to settle things but not really a great plan for life.

Lilibet

 

[LittleSue]

Lilibet

Re your small doses, when you change to bb make sure the insulins you choose are suitable for pens that adjust in half units. DSNs working with adults may not be familiar with them, their names often include "Junior" suggesting they're for kids. Then again I suppose "Humapen Titchydose" isn't very catchy...